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Should smokers, drinkers, drug users and obese people be charged to see the doctor?

It seems reasonable to me, after all, they consume a very large chunk of the NHS budget, so I think it's entirely appropriate that they stump up for their treatment. What do you think?

Created By on 27/06/2016

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27th Feb 2019 09:00:30 (Last activity: 27th Feb 2019 23:02:47)
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Sounds as if you are not in the UK . Despite criticism and underfunding the Health Service here is quite superb and free . Sounds as if you need medical help badly am sure there must be some proviso for people in your circumstances .
Response from CaroleAH made on 27th Feb 2019 23:02:47
It's great to see someone praising our NHS. As someone who has worked for nearly 40 years in the NHS I know it has it's faults but I have no complaints at all about the treatment I have received, as a patient, both from my GP and various hospitals I have had to attend over the years.
12th Feb 2019 17:54:05 (Last activity: 27th Feb 2019 15:09:10)
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Yes I do.People do have choices.I smoked,and gave up a few years ago.You are in charge of your body and what you put into it.
Response from jeanmark made on 26th Feb 2019 14:08:35
So easy to judge people when you have no idea of what they are going though.
Response from CaroleAH made on 26th Feb 2019 14:18:12
I totally agree, Jeanmark. We all deal with our problems in different ways, whether by smoking, binge (comfort) eating or drug abuse. I have to admit to having less sympathy with the latter possibly because I only see or read about the effects on innocent people who have been robbed, assaulted or abused by drug addicts and I don't know what led to the addiction in the first place.
Response from Tr1sh made on 26th Feb 2019 19:26:41
I agree Jeanmark. I also think that people who do have problems would be more inclined to seek help if they felt they would not be judged or dismissed.
Response from jeanmark made on 27th Feb 2019 14:47:05
Well CaroleAH, I worked with drug addicts for 13 years, most as a result of infection and never once met one, who decided at school, that is what they wanted out of life. I accept some turn to crime to feed their habit but I also recognise that desperation is a terrible thing to witness. That in no way implies I support what they do as most have a degree of understanding of their actions, but they do not necessarily get the support they need.
Response from CaroleAH made on 27th Feb 2019 15:09:10
I agree Jeanmark and the tragedy is that younger and younger children are getting involved when they are used as "runners" for the big dealers. They are so young and impressionable and no doubt think that it's "cool" (or whatever the modern day terminology is) and don't realise that they are being exploited. When I worked in A&E many years ago it was the drunks who caused havoc; nowadays it seems to be a free for all with drug addicts, drunks and people carrying weapons and the staff have to cope with it all.
26th Feb 2019 20:56:17 (Last activity: 26th Feb 2019 22:53:23)
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I smoked and gave up over 10 years ago now, but I am classed as morbidly obese.
Due to more than one chronic illness which has at times made me immobile unable to wash and dress and feed myself at times.
Although regularly poorly, I rarely visit a doctor dentist or optician.
Mostly when the appointment date/day arrives I’m too tired sore or ill
to go, I do of course cancel my appointment so no ones time is wasted.
On my reduced income, being unable to work I would struggle to pay for the doctors appointment.
I explain from an immobile situation only, as that’s all I personally know about and understand.
Response from Tr1sh made on 26th Feb 2019 22:53:23
I think your post is very relevant Meljoseph,

I know several housebound people who get home visits from their GP surgeries and also opticians but I am not sure if you are in the UK or not but, if you are, it might be worth speaking to your doctor.
15th Oct 2018 01:06:30 (Last activity: 25th Feb 2019 20:59:32)
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How easy it is to list the categories of people you have decided to write off.

Fortunately, I nor anyone close to me has suffered from the addictions you mention but if they had, I would hope we live in a society which would offer help and support rather than judgment and alienation.

I am guessing that you made this post in order to provoke conversation but, if you are serious, you might want to study the statistics as I am pretty sure that I have read that the tax revenue on alcohol and tobacco far outweigh the cost to the NHS of treating the health issues which arise from both smoking and drinking. It would seem unfair to charge people for their healthcare when the Government is already making a profit from their addictions.

Drugs of course is a difficult one to define as illegal drugs avoid taxation due to the fact they are illegal but not all drug addicts are addicted to heroin, cocaine etc, many people become addicted to prescribed drugs. Would seem wrong to penalise someone who might have become addicted to the drugs prescribed to them to treat an illness or, say, depression.

The obese? Well, there are of course all sorts of reasons why someone might be overweight and that can range from over eating, poor diet but also it can be genetics or a medical condition. Would be harsh I think to punish someone if their genetic make up was the cause of their weight problems.

Seems to me it would not be a simple matter of just excluding those we feel might be the author of their own misfortunes, perhaps we would need to screen people to decide who we should offer help and who we should only help if they can pay?

But wait, surely such a system would cost a lot of money? Likely a whole lot more money than if we were just compassionate and helped everyone who wanted and needed help? After all, it does all come down to cost, doesn't it?
Response from Lionel made on 15th Oct 2018 16:31:50
Good points, all the way through.
Response from Tr1sh made on 15th Oct 2018 17:53:20
That you Lionel. I have a tendency to get my soap box out occasionally!
Response from Lionel made on 15th Oct 2018 20:36:25
Nothing wrong with that Tr1sh. Keep it coming.
Response from Tr1sh made on 15th Oct 2018 22:26:59
Thanks Lionel. 🙂
Response from JF made on 25th Feb 2019 19:03:04
Hi Trish, thank you for the well balanced soap box opinion! Sometimes people just forget that everyone is different, their body make up is different, their personal and health issues can all create problems they may not wish to have.
I live with being overweight and have been so since a child due to suffering Hasimotos Thyroiditis which affects every part of my body mechanics and slows the metabolism down.
All my life has been a constant diet and exercise regime.
At my age now my metabolism is non existent. This has been exasperated due to yo yo dieting and I've recently found out that exercising too hard can cause additional problems with health and make you more fatigued!
Recently I needed a new hip due to Osteo Arthritis, I need my other hip replacing soon, would people be so quick to deny me surgery and remove the constant pain I live with I wonder? Unable to walk and move means I cannot exercise hence weight gain even though I eat minimum calories per day.
Sometimes I believe like you, that people should be a little more forgiving, I too pay my taxes.
Please people think first,
I thank you Trish.
Response from Tr1sh made on 25th Feb 2019 20:59:32

I had to Google your thyroid condition - your immune system attacks your thyroid? I hope you get the hip operation soon which will hopefully help your mobility and, in turn, allow you to start exercising again.

When I Googled I noticed the paleo diet is recommended. Sounds interesting as it is based on low sugar and a life diet rather than a fad. I will have to read more about it. Have you heard of it?

I think people are a lot nicer and more sympathetic in the real world - the internet can be a harsh place.

Best wishes to you JF.
25th Feb 2019 19:32:11
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No, I personally do not believe that is the correct approach.
18th Jan 2019 09:05:52 (Last activity: 18th Jan 2019 09:09:25)
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No they shouldn’t automatically BUT in my opinion if someone turns up for treatment and continues to abuse their body in way that is detrimental to that treatment then yes but only if they l ignoring all offer of support to do something about it.

Eg my wife had a friend who was admitted to hospital with a VERY serious condition. Despite the doctor telling her that her smoking was both exacerbating the condition and reducing the effectiveness if not negating the treatment she was being given, she carried on smoking and her partner carried on providing her with cigarettes. Now you can argue addiction but she ‘gave up’ for over 12 months just the previous year and started smoking again due to a messy divorce ie she could give up again. It’s also worth noting that she also refused to try nicotine patches or gum. So she understands the risks fully, knows that she could do something about it but simply refuses to do so.

In that example why should tax payers money be spent on that treatment when she is deliberately worsening her condition in a place she’s gone to improve it. In such a situation I believe that harsh love is needed by saying that treatment will not be provided on the NHS unless she starts to help that healing process by quitting smoking or at least taking steps to do so..

In other words people have to play their part.

On balance though. It could be argued that the high tax on cigarettes pays for that treatment but we all know that the NHS doesn’t get it.

The harsh reality is that given a choice between your child receiving effective treatment of the highest standard with the prospects of a full recovery or my friend receiving that money for essentially wasted treatment and so preventing your child having the best treatment, which would you choose? That IS the choice we are sadly talking about with the NHS as the Liverpool hospital fiasco demonstrates.

Therefore in summary, if someone can’t be bothered to help themselves, then they shouldn’t expect others to help them for free.
Response from ScottishIain made on 18th Jan 2019 09:09:25
I can’t edit that last statement and accidentky deleted part of the final sentence which was ‘ bothered to help themselves and refuses offer or help...’
14th Aug 2018 11:54:43 (Last activity: 15th Oct 2018 01:12:59)
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I was born back in the early 1950's we grew up with second hand smoke. Smoking was cool and an accepted grownup thing to do. You weren't a grown up unless you smoked, And, if you didn't smoke you were a wimp. During the 50's and 60's it was the smokers that kept the NHS running due to the tax paid to the government. And, if you managed to save up enough Embassy or No6 coupons you could send away for an iron lung.

I went on to develop a problem with alcohol. This is seen as being a disease. I don't drink at all now. But should I have been punished.

I hate the fact that we are often looked upon as being a burden upon the NHS as we are living longer. We are the ones who have spent our lives paying into the system, and still remain to do so and everything is still taxed.

What we should maybe ask is, Can we get a rebate if we don't need to use the NHS?
Response from Tr1sh made on 15th Oct 2018 01:12:59
Good post and well done for overcoming your alcohol problem. I imagine it takes a massive amount of willpower to conquer an addiction.
16th Aug 2018 13:17:02
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Perhaps not initially, but may be if they don’t-accept help try to cut down or work towards giving up. But in reality I can’t see it working .
Funny honey
2nd Jun 2018 12:48:54
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If that should be the case I also think athletes, walkers that have to call out the air ambulance and any careless drivers who cause injury should all be accountable for their treatment. All are self inflicted and avoidable?
13th Aug 2017 17:16:11 (Last activity: 16th Aug 2017 13:56:00)
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People already pay into the NHS via National Insurance contributions.

If some of these people don't want to take advice from doctors/specialists then maybe they should be asked to pay extra because otherwise doctors/specialists are just wasting their time trying to change patients lifestyles for the better and won't use NHS resources unnecessarily.

If say, after 3 attempts to encourage patients to change their lifestyle for the better and they still continue to smoke, eat unhealthy or take drugs etc then charge them for the doctors/specialist's time. If people genuinely want to give up their vices they might take notice earlier so then that way they won't incur extra payments.
Response from jeanmark made on 13th Aug 2017 18:39:51
I can assure you piggy50, drug addictions is not a vice but an illness and it is taxes that pays for the NHS not National insurance.

I am all for encouraging people to adopt a healthy lifestyle but it isn't always a simple matter of choice. Those who believe it is simply a matter of 'pulling yourself together' may not have witnessed the misery some people have to endure because of a path they took when younger thinking it was the right way, only to find later in life it was not.

The principle of the NHS is 'free at there point of delivery' and this was based on the premise that no one should be denied health care based on their ability to pay and/or their life style. Being poor is not necessarily a choice and sometimes the only way they can cope is to do those things we are advised not to.
Response from piggy50 made on 13th Aug 2017 21:59:54

Correction, drug abuse is not a illness if it was was it would be treatable quite easily. It is an addiction - a person has to want to come of drugs to be treated and it can take a while for someone to give up their addiction. The same with smoking and alcoholism.

There are other ways to cope if there wasn't we would all be addicts!!
Response from jeanmark made on 14th Aug 2017 15:40:09
Piggy50, I think it depends on how you define 'illness' and there are many diseases that are difficult to treat but nevertheless we attempt to treat them, or at least to try and control them.

Addiction is an illness if not a physical one, surely mental illness shouldn't be ignored because it is difficult to treat? I agree that an addict has to have the will to try and 'kick' their habit, but that shouldn't exclude them from being treated and treated with compassion. Many try for years before they succeed, I accept that some never succeed but they still need support to keep trying. Their illness may have stemmed from their addiction but many diseases stem from lifestyle choices and yet we do not question those?
Response from MrsH. made on 16th Aug 2017 01:25:27
I am amazed that Addiction is considered not to be a health problem in the 21st century. Addiction is most definitely an illness, and though many people manage to cope with life, without requiring a crutch, there are also many people who do require it. Addiction is not something that happens overnight, and it is not chosen. Addiction does not affect everyone, for some there is an internal 'switch' that pings off when they've had enough, but for other's that switch cannot be turned off. Science has proved this as a fact.
In my career, I met with people who had IQ's well above the Normal range, yet they had required help for Addiction. Intelligence would normally show a substance of whatever kind should not be taken, yet they do it. On the other hand, I met with people who had lost everything, through no fault of their own, like a car crash that kills a whole family, leaving no-one behind except for this one person. They endure pain beyond belief, but don't feel it necessary to have some sedation to help them sleep. Their level of resistance is entirely different, not stronger or more sensible, just different. The person who goes to the Pub each night, because their home is empty of company, has a greater chance of becoming addicted to alcohol, but it does not happen to all of them.
We cannot generalise about a person who is right or wrong, or what they begin with will shorten their life-span, because there are people who live to be very old indeed, who have smoked all of their adult lives, while another person dies prematurely, for having made the same choice.
Compassion is something we all need at some point in our lives as human beings. Better to give it, too. As who knows when we may need it for ourselves. Kindness doesn't cost anything, neither does love and support. If we all offered it to someone, there might never be a need for some people to need the crutch they find themselves taking and relying on. Just holding the hand of someone in emotional or physical pain can make It easier to bare. Like-wise, it could help us too, one day.
Response from jeanmark made on 16th Aug 2017 13:56:00
Thank you MrsH for also recognising addiction as an illness that should be treated with the same level as any other illness, rather than thrown on the scrap heap as being unworthy of care and compassion.
14th Aug 2017 20:10:24 (Last activity: 16th Aug 2017 07:03:27)
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Jeanmark as usual on health related matters speaks from vast experience being non- judgemental and treating all with compassion.
As an obese person I would like to know where the weight limit would be set, I may be a few pounds over but then manage to lose them to qualify for free treatment a couple of months later.
Unless you have personal experience or have worked in the health/social care sector it is all too easy to generalize regarding substance abuse and come up with solutions but unfortunately it is not a one size fits all solution that is required but an individual approach . Yes some people seem beyond help but that doesn't mean they should be written off for ever.
Response from Lionel made on 14th Aug 2017 21:39:54
Ecarg, the is certainly the most reasonable comment made in this thread. Thank you.

I was a farm worker for many years. Being only 5'3" the muscle tissue I put on gives me massive legs, arms and chest, quite out of proportion with what would have been my normal body size. So many times a Practice Nurse has reviewed me and said I need to lose weight. I don't have any excess fat. So many times I've rowed with them and asked, how do I lose muscle tissue?

No, the one size fits all doesn't work. It never did and never will.

I heartily agree with your point about substance abuse. Many years ago my work mate and I were spraying cereals. It was a dark green fluid diluted with water. In those days there were no hazmat outfits as there are now. We both saw our flesh turn green and hastened to our GP, the same doctor. Both of us were put on some sort of drug list because our skin was tainted with opiates. I can tell you, I have never knowingly been near opiates. A couple of years ago I saw my medical records on screen. That opiate incident is still flagged up. I guess this innocent man is recorded as a junkie.

No one size fits all, not in any sphere. And I find it doubtful such standards as the BMI reveal any underlying truth. Well, certainly not with me.
Response from MrsH. made on 16th Aug 2017 01:00:34
As someone who does have years of experience in the Healthcare Sector, I can confirm there is Never a One Size Fits All.
Person Centred Care is what it is all about, and as such, each Person is an Individual who is treated as such.
The idea of this is quite obvious, because of each Person being Different from the next.
The NHS does accept Everyone for Who they are, and not which box they fit into.
I had the misfortune of needing emergency care in the early part of this year. There was Never a point where I was put into a box, to be treated the same as the Person in the next bed, or even across the ward. I was treated as Me. The NHS is a huge Back-Bone to health & well-being, and each of the Staff who appears in front of you will never consider you the same as the next person they see. I can vouch for the fact, by explaining how I had very similar 'symptoms' to the person next to me, but at every point we were treated completely differently. The same age, the same colour, the same back-grounds, the same amount of children and grandchildren. It would appear we'd come out of the same box, but we hadn't. I have numerous health issues, and so did the person to who I am referring in the next bed. However, that is where the differences lay - We did Not have the same health issues, just similar symptoms on the day of admission to hospital. That Person was treated with one set of treatments, and I was treated with another. I left hospital still requiring lots of care at home, while I said Good-bye to my new friend who would be staying in for longer than I had to.
It makes sense in the long term, for everyone to be managed in a different way, so the speed of recovery if possible, is met in the fastest way.
We ARE all different.
Response from ecarg made on 16th Aug 2017 07:03:27
Mrs H
You have taken my point and explained it fully, but you have healthcare experience understand as I do person centered planning .However it was not until I started training in social care in my forties that my attitudes and understanding of peoples needs changed.Therefore I understand that those who are less understanding are those that don't fully understand the reasons and causes of addiction abuse and judge from a position of the outside looking in rather than inside looking out.
There are many things in life I don't properly understand politics,finance sport to name a few I have opinions based on what I see ,read and hear but I always try not to judge unfairly,Surely in matters of health and well being being non judgemental and kind is of the greatest importance. I am not trying to imply you need to have professional experience in health care to care just show empathy as Mrs H says it could you that needs help next.
28th Jun 2017 13:29:02
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No I don't!! I think it is an exceptionally mean spirited idea!!
24th Jun 2017 06:06:21
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hello honey i will like to get in touch with you and see if we could be useful to each other . am tracy kindly reach me on my private email . [email protected] .
23rd Jun 2017 21:20:04 (Last activity: 23rd Jun 2017 22:49:55)
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Agree. But I also think that people should be means tested for all medical services including the pills we take. Anyone who has not paid NI contributions for a minimum time should pay the going rate.
Response from jeanmark made on 23rd Jun 2017 22:49:55
Why means tested, how do you identify a minimum time for NI contributions (I assume you exclude children) and what do you perceive to be the going rate?
23rd Jun 2017 21:09:29
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Some might consider it rather hypercritical if the politicians came up with such rules! It's pretty obvious that things are going to change drastically soon or will they just let it all go bust?
11th Jan 2017 14:40:11
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Like many others here I have paid my taxes and N.I. contributions through working full-time for over 40 years. I have never smoked, am teetotal but I do fall into the category as overweight/obese. I have not seen my GP for over two years and then it was for antibiotics for an inner ear infection that affected my balance. I do not think that I should pay extra for treatment. However, I do think that those who have NOT contributed to the NHS should pay.
Georgie Girl
22nd Dec 2016 16:21:24
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p.s. harmful only if taken in excess of course, meant to add that on the end.
Georgie Girl
22nd Dec 2016 16:19:53
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You are so right Helena.

I also think we need to get in to the 21st Century and look at the benefits of cannabis, and stop making people into criminals wanting to use it for medicinal purposes. I personally cannot drink and I don't care to smoke thank you very much but I would certainly find having a cannabis muffin now and again very relaxing. Research was carried out and out of the three: smoking, drinking or cannabis, cannabis came out as actually having benefits whilst the other two are just harmful.
22nd Dec 2016 07:42:06 (Last activity: 22nd Dec 2016 16:18:25)
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When I was overweight I joined a weight watching club and the CHEMIST supplied me with healthy slimming foods and drinks. I joined a gym and an exercise class and brought the problem under control. Next I tackled my smoking habit. I went to the CHEMIST and joined a scheme whereby I was supplied with anti nicotine patches/sprays etc. Every two weeks I returned and had a consultation untill my addiction was cured. I never involved my doctor, there is nothing on my medical record to show that I asked for help.
My husband died a year ago and I now have a drink problem! A bottle of wine a day! I do not want to involve my doctor at this stage as I live in a small village and I am afraid my medical records will be accessed by the receptionists who know me and would spread gossip. Drinking is a widespread problem. Self help should be available in the early stages as it is for weight problems and smoking, without the shame of being viewed as an alcoholic or involving my doctor.
Response from Lionel made on 22nd Dec 2016 15:12:50
Helena, that second paragraph was a courageous post. Thank you for your candour.

In considering how invasive are some Personnel practices there days - social media pages, exposure of medical records etc., I couldn't agree more some assisted self help could be made available, through pharmacies as with your no smoking experience and no trace on a medical record.

I feel there is far too much retention of personal details for anyone's good and too many people having legal access to them. The fact that for a while one has emptied a bottle of wine of an evening to relieve stress or heart ache brought on by life's ever changing circumstances should not be made a stumbling block for the rest of one's life. Surely that is far better than eating anti-depressants!
Response from Georgie Girl made on 22nd Dec 2016 16:18:25
I also think we need to get in to the 21st Century and look at the benefits of cannabis, and stop making people into criminals wanting to use it for medicinal purposes. I personally cannot drink and I don't care to smoke thank you very much but I would certainly find having a cannabis muffin now and again very relaxing. Research was carried out and out of the three: smoking, drinking or cannabis, cannabis came out as actually having benefits whilst the other two are just harmful.
4th Dec 2016 20:37:27 (Last activity: 13th Dec 2016 19:07:49)
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Does that mean all drug induced, drunken, obese people who have paid the Government all their lives are now guilty of neglecting their own bodies and should be penalised?
Segregated as malingerers, looked down on by the perfects?

Drug pushing Tobacco giants told people smoking was "good" for them, now they are hooked on this drug, so let's classify smokers as drug users. Let's penalise the victims and leave the pushers wallowing in their drug money. Maybe you should sue to get the money to pay for your treatment.

If you have taken an aspirin, which is classified as a drug and is prescribed by your doctor, you are a drug user. Is the Doctor responsible for introducing you to drugs, is he a pusher?
Maybe you should sue to get the money to pay for your treatment.

If you are unlucky enough to be diagnosed with a hormonal problem that results in obesity and has no connection to consuming vast amounts of food. Are you then to be dismissed out of hand?
Categorised as one who has no control over their eating habits, penalised?

Drinkers seldom start out as alcoholics, incrementally it creeps up on them. Yet another form of drug to get hooked on.
In some cases, the brain is unable to tell the drinker or eater that he has had enough so they carry on unchecked. Is that then a medical condition?

I attach a small portion from the revised Hippocratic Oath taken by Doctors today.

I will make every effort to ensure that the rights of all patients are respected, including vulnerable groups who lack means of making their needs known, be it through immaturity, mental incapacity, imprisonment or detention or other circumstance.

My professional judgement will be exercised as independently as possible and not be influenced by political pressures nor by factors such as the social standing of the patient. I will not put personal profit or advancement above my duty to patients.

The problem stems from greed, criminal Big Business, silently slipping additives into drinks, foods and toiletries, life threatening products under the radar. No use indulging in hand wringing, impose stringent checks on these companies, don't make the victims pay.

It is easier to stand in judgement than to understand a population desperately in need of help and support.

Where do you draw the line, who plays God with peoples lives?
Everyone who becomes sick regardless of how they became ill, should be treated and helped.
Response from Lionel made on 5th Dec 2016 00:20:54
This is, I think, your best post to date. I stand with you on every point.

Judgement of others not in our tribal or cultural group is so easy, so possiblre these days. We align ourselves with a certain style, a certain milleu, and the others are outlanders. How very wrong this is.

We see a fat person and assign over eating - that may not be the case! We see a drunk in the streets, or a vagrant, but don't ask them, why, before passing judgement.

It is so easy to pass judgement from our ivory tower of self righeousness, our virtuous self centredness. But one day, others will pass judgement on us.

It must be fifty or more years ago now, I was walking up a river bank in West Norfolk - my home - heading for Kings Lynn. At one point there was a chap in the river taking a bath. I helped him get out and while he was discretely drying and dressing I lit my Primus stove and made sweet tea. He ate my sandwiches as he spoke. This chap had been a chaplain in the British Army at the end of the War. He had given army men the flim flam to fire them up for the next day, a day in which most were killed, He was there, he saw it. But he had done his duty as a chaplain.

Outwardly he was a smelly tramp, dishevelled and unkempt. Inwardly he was a man with a massive conscience before a holy God. He had done wrong and others paid the price. He had followed the system, said the words and many men died as a result.

How would you judge him? A smelly tramp, a war hero or just a hapless vagrant? It's your call.

The NHS is I think the best of Post War institutions. But if we are so easily to judge people and say they can't receive treatment free at the point of delivery, well, that is a net which is ever tightening and one day it will exlcude us!!
Response from Yodama made on 5th Dec 2016 11:42:43
Thank you Lionel, just basic humanity isn't it? I detested school bullies in the playground and I detest any attempt to subjugate any member of the human population.

Hitler was good at segregating people into types he found did not fit in with his plan.

I say to the perfects: Honi soit qui mal y pense.
Response from swills made on 13th Dec 2016 19:07:49
I've smoked all my life and was quite aware it wasn't great... I wouldn't be too upset if I were asked to pay.
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