What happens when a nation chooses to have government run its entire health-care market? Single-payer advocates insist it means better and more equitable care, while critics warn about the loss of personal freedom and intrusion on private choices. Try to guess which way the latest proposal from the British National Health Service goes.

Hint: It ain’t better and equitable care.

In recent years, a number of areas have introduced delays for such patients – with some told operations will be put back for months, during which time they are expected to try to lose weight or stop smoking. But the new rules, drawn up by clinical commissioning groups (CCGs) in Hertfordshire, say that obese patients “will not get non-urgent surgery until they reduce their weight” at all, unless the circumstances are exceptional. The criteria also mean smokers will only be referred for operations if they have stopped smoking for at least eight weeks, with such patients breathalysed before referral.

Why impose these conditions? Do they have any medically sound reason for withholding treatment from the obese and from smokers? Not really, no … they just want to punish them by rationing care away from them. And the need to ration is one of the main motivations for the proposal:

East and North Hertfordshire CCG and Herts Valleys said the plans aimed to encourage people “to take more responsibility for their own health and wellbeing, wherever possible, freeing up limited NHS resources for priority treatment”. Both are in financial difficulty, and between them seeking to save £68m during this financial year.

In some circumstances, the very obese might have too many complications for immediate surgery, and smoking is always a complication. However, those contraindications already get applied. This proposal is simply punitive — they want to punish people who do not make life choices approved by the government, or more accurately, the bureaucrats who operate these systems. At least in a free-market system, even if an insurer or provider took this position, a patient could opt for a different provider or insurer. In a single-payer system, they have no choice at all.

Wesley Smith warns at NRO that the social engineering won’t stop there, although it will depend in large part as to the political correctness of the behavior:

What other patients with unhealthy lifestyles will be banned next? The promiscuous? Of course, that will–and should–never happen because unlike the obese and smokers, promiscuous people are not scorned by the technocrats. But the injustice would be the same. Centralized control in health care eventually leads to bioethical authoritarianism.

Conservatives have warned of those consequences since at least Ronald Reagan’s famous 1961 speech against socialized medicine. Giving power to control health care exclusively to the state is the power to coerce the most intimate choices in a person’s life at the behest of the government. Every choice in life transforms from private business to public policy. It does not take long for bureaucrats to become impatient with their subjects and use their power punitively in order to exert their control over choices and lives.

Some will likely shrug and say, “Well, obese people and smokers live unhealthy lives and cost us money.” In a free-market system, only the former would be true, which would make their choices none of our business, nor would we have taxpayers subsidizing those choices by quasi-socialized structures like ObamaCare. Freedom only exists when people have the choice and the risk of making poor decisions as well as good choices, and then own all of the consequences of both on their own.

In the end, socialism imposes all sorts of authoritarianism on its subjects. The bioethical version is simply the most insidious.