Thanks very much for a very full answer. It would obviously be a very difficult transation to make. I suppose that phasing it in a manner similar to the way that the state pension age is being moved right might just work without causing too much upheaval.

Another cynical point – public health care spending is one of those things we do because we want other people to have it and not just us. I.e. we don’t want lots of sick poor people lying about on the streets because they can’t afford health care.

On another issue, regarding the 5 million public sector jobs, I think there are less of them than there used to be due to contracting out. We should beware of hocus-pocus which makes a fairly minor difference in something look major because a token nameplate change means something that was “public” is now “private”.

In a sense, discussing libertarianism from a theoretical position is like discussing a car in a ditch; the best strategy is not to drive into the ditch, but once in there a different strategy for disenditchment is required. A century of progressivism has put the whole population in the ditch to various degrees; how we all get out of it would require considerable thought.

I also think this quote from commenter Ivan at Samizdata is so good it’s worth repeating in full, as it focuses very well on the health provision issue-

This is in fact the core of the problem. There has never been such thing as “health insurance,” and the whole concept is a giant misnomer and generator of confusion.

None of these costs are amenable to “insurance” in any meaningful sense of the word. They don’t represent an insurable risk, because they are not subject to risk, but high certainty. Any scheme devised to finance them, whether public or private, cannot be other than a savings program or a transfer in disguise. All the existing schemes, including the present American mixed corporatist/socialist model, represent a transfer from the young and healthy to the old and chronically sick (and to the medical cartel, of course). The way it’s used in practice, the phrase “having health insurance” means having the right to place oneself on the receiving end of these transfers. No honest discussion of the situation is possible until the entirely false and misleading concept of “health insurance” is dropped.

Perhaps indeed it is time we stopped referring to health “insurance”.

I understand your libertarian ideas and have a lot of sympathy with much that you say. What worries me is how one could make the transition between a state run health system and one funded as you propose. For example, I am now in my mid 60’s and as a fairly high wage earner throught my career have paid my fair share of NI. Typically I have suffered some health problems in later life. Would you propose that I should now forego any expection to free treatment and start paying private health insurance premiums, given that these would be heavily weighted and nodoubt exclude existing conditions?

In a system where individuals paid for their own health insurance then smoking would certainly cause either exemptions or significant premiums to be added. Of course, considering the amount smokers currently pay in taxes versus how much it costs to treat smoking related diseases then you can see that smokers could, theoretically, pay a lot less.

It would be like people with extremely fast cars pay more in car insurance. It’s up to them.

The difference is that smokers would be paying what it costs, and it would be an honest transaction. The Government, on the other hand, uses smokers as a source of free money and it does it through the most underhanded, dirty techniques (and with huge popular support.)

As Laurence says, free at the point of use just means people don’t have to take responsibility for their own health.

Same goes for drugs, although I would say that it would be predominantly uninsured young people that would be using drugs the most. They do have the habit of believing themselves to be indestructible. I would expect the charitable sector to pick up this sort of thing though. The point is that they’d be gambling with their health and their minds, not with a criminal conviction

As heretical as it might sound, I really have no problem at all with someone whose chain smoked their entire lives without insurance suddenly finding themselves unable to get treatment. It would be horrible and a complete tragedy, but the tragedy is not the lack of treatment – it’s the 40 years that came before it. Every smoker is gambling with their lives and they know it, and the ’sin taxes’ make them feel that they’re fully entitled to claim whatever medical treatment they can get – after all they’ve paid for it four-fold. Anyone who can currently afford to smoke could afford to insure themselves to smoke.

Those e-Cigarette things are nearly at the point where they can successfully manage a lifelong Nicotine dependence without the lethal effects of tobacco – so people do, in fact, have a choice.

What I really believe in more than anything else is that people should be free to take risks, and deal with what happens either way. That’s what being an adult is about: Calculated risks.

I want to write more about drugs at some other date btw

* Is that kind of talk considered blasphemous on here?

Then go up and read Devil’s post. People who want to smoke and drink themselves to death will find themselves paying higher medical bills or increased insurance premiums. Pretty much the worst thing about the NHS is that it is free. The irony is that most people think that is the best thing about the NHS. So we have a bit of work to do.