Having lived in many collective environments and in some collective systems – I spent six months of my misspent youth in an Israeli Kibbutz in 1968, for example – I feel half-qualified to talk about a subject which is controversial, of the moment and requiring clarity of thought. Some may wish to leave any opinions to real experts, but I believe that that is the slippery slope to academic oppression.
In my terminology, I would define modern society as a collective environment from which only the very wealthy can extract themselves. Many services are collectivised – roads and schools in most countries, for example, and many mutualised such as insurance. Health services are usually collectivised, as in the UK, and often mutualised or both as in France.
In any mutualised or collective environment or system, we cannot just rely on ever greater resources being made available for growing populations. The subscribers to these environments or systems must be prepared to adjust their behaviour to reality. In a shared space – in a collective lounge on a Kibbutz, for example – you cannot allow everyone to listen to their own radio programmes. If you don’t like what is being broadcast you can suggest a change of station or go elsewhere.
Health is relative. Some people choose an absolutist approach whereby they believe that the slightest ailment should be cured by collective resources. My view is that we cannot cater for that sort of person in a collective system – they need to be encouraged to reduce their expectations. My mother was told by her doctor to stop smoking in order to improve her health relatively, not to solve all her multiple health problems. She was a subscriber to a mutualised system whereby the majority of healthier people agreed to pool resources to cope with unusual events or help those less fortunate, not those who were addicted to a debilitating drug who refused to modify their behaviour. She eventually did give up smoking and lived well into her eighties. Would anyone suggest that that doctor was heartless or not doing his job?
Cardiovascular disease, for example, is aggravated by lifestyle. Allowing people to abuse their bodies and then socialising the consequences is unsustainable and, I would say, morally unacceptable. COVID 19 has demonstrated to what extent underlying conditions are the determinant factor in life and death for those severely infected.
So, when someone who consumes drugs, legal or illegal, refuses to exercise sufficiently, eats more than they should etcetera, and then complains of deficiencies in their mental or physical health, what should the reaction of the collective be? Should we pay more so that they can continue their lifestyles or should we use our scarce resources to help those who respect the collective system but are in greatest need?
Taxation of income is a good solution but not the only one. As an aside, someone said to me today that we should increase corporate taxation, or better collect it, to pay for healthcare. We need to be clear that corporate taxation is eventually paid for by people – it just seems as if someone else is paying. If, for example, people were obliged to pay directly for a percentage of their health costs, maybe they would think more carefully about their responsibility towards the collective good. We can increase direct taxes on harmful products as we have done with tobacco. More could be done on currently illegal drugs, alcohol, sugar and saturated fat. I would argue that meat consumption should be taxed, not just to ensure that those who abuse their bodies by overeating animal products contribute more to collective healthcare but also to defray some of the environmental costs and to highlight the moral cost of ignoring animal suffering.
The point I am trying to make is that we cannot delude ourselves, given what we have experienced from the COVID 19 crisis, into accepting that people should be free to do as they wish and that, when it all goes wrong, the majority should pay the bill. The majority should be prepared to pay the bill, whether through higher taxes, higher prices or reduced services, where those people who are able to change their lifestyles at least make an attempt to do so.