Like clockwork, any opposition to the Tobacco Products and Electronic Delivery Systems Control Bill is met with the rejoinder that the Bill ought to be adopted because the Department of Health – and therefore the taxpayer – spends billions on treating smoking-related conditions annually. This was repeated at a recent roadshow engagement on the Bill.
This argument must immediately fall apart, however, because this is a burden government assumed voluntarily.
To crystalise what I mean, here is an analogy: If Person A, without any compulsion, happily and eagerly binds themselves to pay for all of Person B’s medical expenses, then it would be inappropriate – immoral, even – for Person A to start exercising coercive control over Person B’s lifestyle.
Such totalitarian control of healthcare means the state will in all likelihood double-down on other forms of lifestyle control.
This is what has happened in South Africa.
The Tobacco Bill is rife with intrusions into personal affairs. These include prohibiting people who live alone and work from home from smoking in their own homes. It also treats vaping, regarded by some as 95% less harmful than smoking, as indistinct from smoking. Finally, making all its other provisions seemingly redundant, the Bill gives the Minister of Health what is effectively a sovereign, completely discretionary power to ban smoking outright across the country.
All of this is justified, in part, on the basis that government provides free healthcare and that it must therefore protect taxpayers from spending billions on treatment for smokers.
‘Access’ to healthcare
Nowhere in the Constitution is there an obligation on government to establish a public healthcare system that provides comprehensive care for all manner of ailments and for everyone.
Section 27(1)(a) of the Constitution simply provides that there exists a right to ‘have access to health care services’. This ambiguous wording is intentional. It allows government much flexibility to determine what this ‘access’ looks like in practice.
The ‘access’ requirement would be constitutionally satisfied with healthcare vouchers, or a limited safety net that provides only for emergency treatment. It would also be satisfied if government provided subsidies to the private healthcare sector in proportion to how many indigent South Africans the latter treats, thus creating an incentive for the private sector to treat people it otherwise might not.
Crucially, the ‘access’ principle would not be harmed if the public healthcare system did some basic gatekeeping.
This means that if government introduced a rule saying that the state will not cover any treatment for the smoking-related conditions of smokers, it would be legally within its constitutional power to do so. Smokers would then need to procure treatment privately – a burden the private sector happily takes on without attempting to impose lifestyle controls.
Personal responsibility
Personal responsibility is a concept that appears to be going out of vogue. During virtually every election cycle government assumes more and more responsibility over those things that are properly personal.
It used to be an unquestioned reality that parents were responsible for the rearing and education of their children, that the individual was responsible for how he or she internalises slights and offences and, of course, that people were ultimately responsible for their own wellbeing. Some of this responsibility remains, but the state has voluntarily become liable for an unacceptably large part of it.
This has, predictably, resulted in threats to civil liberty like the Tobacco Bill.
Every individual must bear the responsibility for the choices they make in life. If someone decides to be a lifelong smoker, then this means that when the metaphorical chickens of smoking come home to roost, the individual must be responsible for dealing with it.
Personal responsibility is a crucial part of building a free and prosperous society. When responsibilities that are properly personal are delegated to the state, then all sorts of perverse consequences come about. In this case, that perverse consequence is a government that believes it has any authority to dictate to adult individuals in a free society what they may and may not consume.
National Health Insurance
This is all likely to worsen under the proposed National Health Insurance (NHI) scheme.
The NHI proposes to introduce comprehensive healthcare coverage that is ‘free’ to the end-user. Various committees will determine what kinds of ailments will be covered and to what extent, what treatments will be utilised, and what health practitioners may charge to provide these services.
Such totalitarian control of healthcare means the state will in all likelihood double-down on other forms of lifestyle control. Very little of individual lifestyle choice will remain, because the state will always be able to claim that it is totally responsible for our wellbeing, meaning it must have total say over our wellbeing.
While the Tobacco Bill represents another small step away from personal responsibility for health and medical affairs, the NHI stands to eliminate it completely.
This will eventually mean that smokers will not even have the option to argue that they will procure treatment for their smoking-related ailments privately. The door to private alternatives will be closed for most people.
‘Voluntary’ assumption
Some might argue that it is not the state that has ‘voluntarily’ assumed this responsibility for South Africans’ healthcare, but that society, through a democratic mandate, has imposed this responsibility upon the state. This is clever wordplay which, if accepted, would nullify any and every complaint about government misconduct.
Unhappy with how public procurement occurs in South Africa? Government’s approach was mandated in the last election.
Think Bheki Cele is doing a bad job as police minister? The electorate expressed its satisfaction at the last election.
Displeased at the COVID-19 lockdown? Government’s authority to deal with public health crises was ratified at every election after the Disaster Management Act was adopted.
‘It’s the people’s mandate’ is the argument of someone who cares naught for democracy-in-practice and cares significantly about democracy-in-theory.
The reality of ‘democracy’ – at least as we understand it in South Africa – is that the people get to choose the identity of the political party that will govern for the next five years. That is the extent of it. Reading anything else into that decision – like the electorate endorsing the totality of that party’s manifesto or its conduct – is intellectually dishonest.
It is government, not the electorate, that is responsible for what government does. And it is government that has voluntarily assumed the responsibility for healthcare in South Africa. The white papers that gave rise to the Tobacco Bill, the NHI scheme, and all previous government intrusions in healthcare, were all written by government officials and commissioned experts.
Furthermore, and perhaps more importantly from a classical liberal perspective, those who want the government to take responsibility for their healthcare should be free to do so, but under no circumstances must this mandate be interpreted as meaning government may dictate lifestyle choices to those who did not ask for their sovereignty over their own medical and healthcare affairs to be abrogated.
As a lifelong teetotaller who is put off by smoking, I can comfortably say that I do and any other politically sensible South African should oppose the Tobacco Bill. Not because we approve of smoking, but because we disapprove of government setting aside civil liberty after it took upon itself the responsibly for things that are properly personal.
Martin van Staden is the Head of Policy at the Free Market Foundation.
Article first appeared in Daily Friend.
Photo by Mehdi Imani via Unsplash.