Bribing patients

Yesterday, Sir Michael Rawlins, the head of NICE (what they call a death committee in America) was on the radio talking about whether to bribe people to stay healthy.

Once the public exchequer assumes responsibility for people's healthcare it has a financial interest in limiting its costs. Much healthcare expenditure is related to lifestyle choices - smoking, drinking, lack of exercise and doing drugs. True freedom would allow people do make these choices, though they can make the payment if they choose badly. But I don't want them doing it on my dollar. Even without government healthcare, I pick up some of the cost - spousal beatings, road traffic accidents, environmental health hazards, police, the courts, abandoned children etc.

There are studies that show that free gym membership, free self-help groups and the like can change bad habits and reduce later expenditure on treatment of coronary heart disease, diabetes and the like. So should government engage in a sort of libertarian paternalism to change people's habits?

There is a moral question. Should the honest, worthy poor pay for the feckless? And if we admit a carrot, when should we admit a stick?

Thaler and Sunstein would suggest a 'nudge' rather than money. One suggestion: a would-be non smoker opens a checking account. For every day the cost of her cigarettes goes in the bank. On any day there is no deposit, the bank empties the account into that of her least favorite charity - (Free Palestinians for example).