The government is addicted to persecuting fat slobs who smoke

am writing this article at my diningroom table. To my left is a bottle of cut-price Bulgarian Soave, to my right, stacked neatly in their three smart black packets, 60 cigarettes of the Raffles brand. 1 very much doubt that I will get through all the cigarettes this morning, but I'll have a bloody good try.

My predilection for alcohol and cigarettes is a pervasive and complex thing. It is part medical, part psychological. Undoubtedly, I am a slave to the narcotic properties of both substances and, being a fairly addictive personality, am therefore a hapless victim of the ruthless multinational companies that have inflicted their murderous products upon me. Giving up smoking and drinking would be painful and temporarily debilitating. Maybe I should sue.

Except, of course, that I thoroughly enjoy smoking and drinking for another combination of what I dare say are biological and psychological reasons, and I do not want to give up either vice. This, I accept, is a personal decision. 1 also accept that my chances of dying a fairly unpleasant death are increased by between 15 and 30 per cent as a result, and that 1 may become a burden on the state, racked by some chronic pulmonary condition which requires frequent medical attention.

Now. I learn that the government has plans to deprive me of primary healthcare unless I undertake to quit smoking and — who knows? — maybe drinking, too. Also, they don't want me to get fat. These plans are part of five policy documents now under discussion, 1 would be forced to enter a contract with my GP promising to behave myself, with the sanction that free healthcare would be removed if I relapsed and reached for the Raffles.

On the face of it, this is a good, old-fashioned Conservative idea, in that it imposes a degree of responsibility on me and makes me pay hard cash for acting in an irresponsible manner. It is Conservative in another sense, too — the people it will most seriously affect are yet working classes, gawd love 'em, who smoke more, drink more and pig out on lard-infested food with rather more enthusiasm than their middleor upper-class counterparts.

And it is here that we stumble across the iniquity of these proposals. If I were to break off from this article to indulge in a quick bout of unprotected, alfresco buggery. I would knowingly run the risk of contracting any manner of unpleasant diseases — not least of which is Aids, which has killed 15,000 British people. But my doctor will not sanction me against such activity and threaten to withdraw his free healthcare.

The government is not really imposing responsibility on us all in a fair and equitable manner. It is instead considering penalising people who lead lives of which it does not approve. There are countless risks still open to us which we can take without fear of censure (or a demand for payment) from our local general practitioner; but they are risks against which it would be politically incorrect, or simply impractical, to impose sanction.

According to the Cancer Research Campaign, smoking accounts for about 50,000 deaths per year. If correct, this is, without question, a lot of deaths. The government has estimated that a further 30,000 occur as a direct or indirect result of obesity, although it does not distinguish between obesity that is genetically determined and obesity caused by eating like a gannet.

But this simple prevalence can be looked at another way: it is clear that lots of people like to smoke and eat dangerous food. Why should they be penalised simply because there are a lot of them? Because the government would not dare take on those other great precursors of death and injury, that's why.

In the last year for which figures were available, some 238,923 people were injured in road-traffic accidents, 40,834 very seriously so. This is an enormous drain on the NHS, before we so much as consider the 3,421 people who died within 30 days of such accidents. Driving is a risk. It is an especial risk to drive on A-roads (as opposed to motorways) and almost suicidal to contemplate driving up to a road junction (61 per cent of all accidents). You may argue that it is an unavoidable risk, but you would be on dodgy ground, I think. It is a risk I've managed to avoid for the last 43 years. Can I have a rebate. please? If we cut our number of car journeys by one or two per week, our risk of death or injury would be significantly reduced.

Some 10,000 deaths per year are estimated to be work-related. Your occupation is, in the end, a matter of personal choice and we can easily identify those which are the most perilous. Should we tell agricultural labourers to cease work immediately or pay when they visit the doctor? Of course not.

The government's planned contracts envisage targeting people with particular risks of illness. But I bet they don't target promiscuous homosexuals, or promiscuous heterosexuals (uh-oh) or people who, as a result of racially inherited characteristics, are far more likely to die if they act in an 'irresponsible' manner. A recent study in the US showed that African-Americans were far more likely to die of heart disease than whites or Asians (possibly as a result of inherited high blood pressure). Vv'otcha gonna do about that. DoH?

And, of course, we should not forget those individuals who go in for dangerous, life-threatening sports. Will they be penalised? And what about the 5,000 people per year who die as a result of ... er . .. doctors in our hospitals? Being hospitalised is a risk which, of course, we can often avoid.

Risk is everywhere. You might even argue that it is intrinsic to the state of being human. After all, we are the only creatures capable of culpable irresponsibility. And while you can warn people about the dangers of smoking, drinking, taking class-A drugs, fornicating, driving too quickly, eating at places other than the River Cafe, sitting down (lack of exercise, don't forget, contributes to the deaths of tens of thousands every year), travelling abroad (1,400 deaths per year even without al-Qa'eda), penalising the people who do these things makes sense only if there is no such thing as a free health service, and we are all forced instead to pay for our crimes and misdemeanours. Then we might be justified in letting the market decide.

My own GP, mercifully, will have none of it. I rang him because I was worried, frankly. But Dr Vivian Stevens told me. 'I don't like it all. It smells of Big Brother and Nineteen Eighty-Four. Nor would it work. We get a lot of information from our patients through our close relationship with them; they tell us things voluntarily. That would stop.'

And then — rather surprisingly — he made the main point: 'Our patients, even the most stupid ones, are incredibly complex, subtle and multifactorial. You could not possibly legislate against all the variables of risk. It wouldn't work.'