More NHS success stories

This time, it's do-it-yourself dentistry.

Here's the primary problem, as I understand it.

In any health care coverage system, only certain things are covered since, if everyone else is being forced to pay for your medical care, there had better be a good reason why you need that care.

As an example, a necessary appendectomy, chemotherapy or other life-saving treatment would obviously be covered, whereas cosmetic surgery such as penis enlargement, breast enhancement, or other elective procedures would not. In that sense, only "necessary," and not "elective," treatments would be covered

The difficulty arises in so-called "elective" treatments. We'd all agree that penis enlargement is an elective surgery, but what about arthroscopic knee surgery, or hip replacement surgery? Clearly, one could live without having either of those, albeit at a dramatically reduced quality of life and increased levels of pain.

Who exactly decides when a knee replacement, or a rhinoplasty to correct breathing problems caused by a deviated septum, or a breast reduction to alleviate back pain, cross the border from "elective" to "necessary?" (One should also take into account the fact that the treatment's costs, while significant, may be offset by the increased future productivity of the patient if the treatment is successful in alleviating their symptoms.)

It seems to me that disagreements between the patient (and his or her doctor) and the government minder who decides what's covered and what's not, are the source of trouble here. (It certainly is with private insurance companies, so why should it be any different for a government-run system?)

What I don't know is how much of an issue this is. I hear horror stories about cases like the above, but really, how frequently does this happen? Perhaps someone from across the pond can fill me in, since all I have is media coverage, which of course tremendously skews in the man-bites-dog direction. Are these just extraordinarily rare cases that draw disproportionate attention, or a frequently encountered fact of life in a nationalized health care system?

Also, I hear horror stories of tremendously long waiting lists. Is there any particular reason why this is?

Another troubling issue is necessary treatments for conditions caused by lifestyle choices. Foremost would be life-saving treatments for lung cancer, the vast, vast majority (though not all) of cases of which are due to smoking. One could also (with a similarly strong causal chain) target treatments for cardiovascular disease and diabetes which are largely caused by obesity, poor diet and lack of exercise.

As for myself, I exercise regularly, try to maintain a reasonable weight, and while my diet is not stellar, I do what I can to eat right. I think that people who fail to do these things are stupid. Why should I be forced to pay for the stupidity and negligence of others?

Is there any way to single out these cases? A smoker's tax? And how would one enforce such a tax - cameras inside peoples' homes to make sure they're not smoking?

(Which brings up the ancillary issue... if knowledge that the things you're doing to yourself are known to cause a dramatically reduced life expectancy - you are quite literally killing yourself - is insufficient to convince you to change your ways, why are obesity taxes, or tickets for smoking in certain places, so feared? If knowingly causing your own early death isn't a sufficient demotivator, why is a $25 ticket so effective?)