The Ranting Kraut

19.3.2006 – 27.9.2010

Simon Heffer on Drugs and the NHS

Posted by rantingkraut on January 15, 2008

In a recent telegraph column, Simon Heffer argued that heroin addicts should be made for to pay for their NHS treatment. He further argued that making users of illegal drugs pay for their treatment is justified because these drugs are illegal, even though some legal drugs may also give rise to expensive health problems. Making drug users pay for the health costs of their drug habit is not implausible in principle. The problems lie in the details of Heffer’s argument and they matter in practice.

Legal and illegal drugs

The argument that illegal drug consumption deserves a harsher treatment simply because it is illegal may have merit from a legalistic perspective. From an ideological viewpoint, it is disappointingly circular.

It is a task of political discourse to argue about what kind of action should be illegal in the first place. These arguments should have some basis in the values inherent in the meta-context of their underlying ideology.

To simply accept that a particular prohibition is appropriate because a legislator has decided to outlaw something is at best consistent with an authoritarian mindset. Not a conservative authoritarian mindset, nor a socialist one, just an authoritarian one without any specific reference values.

The classical liberal view

What then would a classical liberal argument in this case look like? Two basic principles of classical liberal ideology are important here:

1. the view that the state should not protect responsible adults from their own folly so long as they respect the rights of others, and

2. that these adults should be held responsible for their own choices.

On this basis, there is no reason why users of recreational drugs should not pay for the health costs arising from their drug habit.

Practicalities

There is no a priori reason either why this accountability should be limited to users of particular drugs. Having said this, it is also not obvious why a state health authority rather than a private insurer should be in charge of holding drug users to account.

There are reasons why a reasonably competitive insurance market may do a better job of this [1]. If consuming a drug –such as cannabis- comes with a small risk of a very costly health effect, the extra insurance cover could still be quite cheap, if paid for in advance by a large number of drug users.

If a state rationing body charges the drug user after the event, the cost for the individual user can be very high. In practice the cost may not be recovered at all if the pothead is unable to pay.

Heffer’s target group, junkies, are in fact least likely to be able to pay the cost of their treatment. The pragmatic option in this case may simply be to do what the Swiss did and give them their Heroin for free [2]. Not because they have a moral right to receiving it, but because it may well work out cheaper for the rest of us, while eroding drug dealers’ profits.

The problems with authoritarianism

One problem with Heffer’s argument, as presented in the telegraph, is the absence of an underlying value framework. Heffer’s article freely admits that over-eating, drinking and smoking are legal for the moment, thus implying that their legality may soon change.

If any legislated prohibition is self-evidently legitimate then the reasoning that applies to Heroin and Marijuana consumption today could just as legitimately apply to smoking, exceeding food rations or alcohol consumption tomorrow.

Heffer goes so far as to demand Chinese style mass executions for drug dealers. If any state legislated consumer prohibition is sufficient for such a punishment, then what applies to heroin pushers today could just as validly apply to the butcher, the brewer and the baker tomorrow.

Those who read Heffer’s column regularly will of course know that he largely holds conservative values. One can guess that he feels strongly about drugs because they combine adverse health effects, with an anti-establishment counter-culture and support for organised crime.

Moral posturing vs. pragmatism

It is therefore likely that his main reason for demanding that junkies pay for their treatment is a desire to make a visible punitive gesture rather than an attempt to internalise costs. A similar desire for political signalling may well underlie his demands for the death penalty for drug dealers.

This is where the structure of the political argument becomes important from a purely pragmatic perspective. To the best of my knowledge, there is no strong evidence that authoritarian regimes are particularly effective at suppressing the drug trade or drug consumption. There is evidence –past and present– that a combination of drug prohibition and high drug prices provides a fertile ground for the growth of organised crime: both, the Taliban and the FARC thrive on it just as Al Capone did in the past.

A liberal approach –combined with a healthy dose of pragmatism—therefore has the potential of limiting damage by eroding drug dealers’ profits, by internalising more of the costs of at least some drug consumption and by limiting the costs to third parties in other cases. Authoritarian grandstanding, on the other hand, is more likely to be useless at best, counterproductive at worst.

[1] One reason why a competitive market should lead to a better solution is because competitors have an incentive to outperform inferior service providers. We can, for example, assume a situation were Cannabis users are excluded from standard health cover for psychosis and have to buy extra insurance in the private sector (assuming that the legal framework allows this).

If private insurers then charge too high a premium, any competitor can offer a better premium and attract extra business. In theory, the insurance premium should therefore gradually reduce to reflect the expected cost of the risk. In practice, competition isn’t perfect and there is a limit to how well this mechanism works. The basic fact remains though that where there is some competition, consumers can put pressure on suppliers by voting with their feet. Where there is a legally protected monopoly supplier no such option exists.

[2] The Swiss programme of giving Heroin free of charge to existing addicts apparently was highly successful. (In the quoted case, the drug had to be consumed on the premises in a setting that was deliberately unappealing.) Similar approaches may work elsewhere, although there may be specific factors to this particular success

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