I try to visit the Drudge Report once a day because he has a knack for finding quirky stories. One of his recent gems is a report from the UK-based Sun about an obese man who is suing the government’s healthcare system because he got close to 1200 pounds (assuming I’m right about a “stone” being 17 lbs) before getting weight-loss surgery. [CORRECTION: A “stone” is 14 lbs, so he was close to 1000 lbs]
Man mountain Paul Mason plans to sue the NHS – claiming they ignored his plight as he rocketed towards 70 stone. …Paul said: “I want to set a precedent so no one else has to get to the same size….” At his heaviest Paul was eating 20,000 calories a day – ten times what a normal, healthy man should consume – and the cost of caring for him is thought to have hit £1million in 15 years. …He finally had the £30,000 operation last spring but before it could take place floors at St Richard’s Hospital in Chichester, West Sussex, had to be reinforced at a cost of £5,000 to take his weight.
I’m not a fan of Britain’s wretched health system, but my immediate instinct is to take the side of the NHS and make some snarky comment about personal responsibility. Perhaps, for instance, we should ask Mr. Mason whether a government official was holding a gun to his head and forcing him to eat an average of 20,000 calories every day?
But that’s too easy. So I got to thinking about the public policy issues involved, particularly in the context of second-best solutions. In other words, if I’m not allowed to assume an ideal policy such as the dismantling of the National Health Service and restoration of a genuine free market, how would I deal with the issues raised in this story? There are two difficult questions we have to decide.
The first quiz deals with how to spend taxpayer money, combined with a bit of moral hazard analysis. Which option would you pick?
A. The NHS should have given him the operation right away to save money for the taxpayers in the long run. The operation cost nearly $50,000, but he was already costing taxpayers (I assume) $100,000 every year. Sounds like a smart investment that will pay for itself in just a few years.
B. The NHS should not have given him the operation at all because that is akin to forcing taxpayers to subsidize personal irresponsibility.Moreover, it sends a signal to others that it will be marginally less costly to engage in similar self-destructive behavior. Last but not least, taxpayers probably will still pay through the nose to subsidize Mr. Mason’s annual expenses.
Our other quiz is about Mr. Mason’s lawsuit. As noted above, part of me thinks this case has no merit, but the article notes that it took five years before the NHS got him in the operating room after an initial surgery was canceled. In other words, it appears the lawsuit is happening because of the incompetence and waiting lines of a government healthcare system, so the real issue is the remedy. Which option would you pick?
A. Mr. Mason should win the lawsuit, both to compensate him for the government’s presumed incompetence and to punish the NHS for being so inefficient.
B. Mr. Mason ate his way into trouble, so doesn’t deserve to win his lawsuit. Regarding the NHS, it is horribly inefficient, but any court-imposed damages would just get passed on to taxpayers, so there’s no possible upside.
So how do I answer these questions, assuming the Sun reported all the relevant facts and did so correctly?
For the first question, I reluctantly pick A. I’m guessing that the surgery will somewhat reduce the long-run burden that Mr. Mason is imposing on taxpayers. I realize there’s a genuine moral hazard issue, and that decisions like this make is marginally easier for other people to become morbidly obese (and thus impose costs on taxpayers), but my gut instinct is that surgery is still the best choice from a cost-benefit perspective. Finally, even though I’m not overflowing with sympathy for Mr. Mason, I’m a sucker for happy endings and maybe this will turn his life around.
For the second question, I do realize that governments should not be immune from lawsuits. And I say that even though it galls me that taxpayers pay for any damages awarded, either directly or because tax dollars are used to purchase insurance policies (it would be much better if successful lawsuits meant that damage awards were financed by cuts to agency budgets and/or reduction in bureaucrat pay, but I’m only allowed second-best solutions here). Nonetheless, I still pick B, and I make that choice with a decent degree of confidence. My decision is based two factors. First, I don’t want taxpayers to pay even more just because the government is incompetent. In many cases, that might not matter, but now we come to the second key factor, which is that Mr. Mason’s problems are self-inflicted.
To be sure, a court might be bound by the law rather than what’s right and therefore rule differently, but we already know from a previous blog post that I’m not similarly constrained.