Wrong .Professionals may purchase special PA covers but no-one else does and incidentally they do so for loss of earnings not primarily for the relatively minor cost of being patched up again. Amateur Clubs and so on may purchase Liability but negligence is not usually an issue. You do not have to work on a Demolition site which is about as high risk an occupation as I can think of and in this country we have Liability not workers Comp although it is virtually strict admittedly . It is however irrefutable that many occupations can be identified with varying degrees of poor health in which negligence does not arise.
The point is this. If the Government removes, as it does, an amount that is more than enough for the health care it provides (in the case if many) , then withholds the care purchased , as you suggest , on the basis of certain life style choices , then you have to have to show that you are acting fairly to them and not simply out of malice and general bossiness.(You have, remember, removed the means by which they might make their own arrangements ). The state show they are , as a group , not behaving in ways it merely disapproves of ,but actually presenting an unreasonable burden on everyone else .In that case it is irrelevant which category of person you call “behaviour “ and which you call , whatever you call them. BTW ,what about drinking?

If the NHS was a commercial insurer and it was not just a matter of your judgement or my objection the truth is this. Yes there would be a surcharge for smokers. BUT, many many people would not be able to obtain cover at all. We would not allow the latter so pretending there is a moral of logical case for the former is all a ‘Just so’ story. Your suggestion has been made in the real world and the dreaded BMA churn out similar stuff all the time. On £250,000 pa their own habits are unlikely to be affected .

Amway basically I smoke so get you tank of my lawn LFAT…

Being gay is not a behaviour, genetic predispositions are not behaviours, dangerous sports already have insurance to cover them and are therefore not relevant, sick postcodes are not behaviours, people working on building sites presumably are covered by insurance from their employer etc etc.

This is not social engineering – this is asking people to pay towards their treatment under some limited circumstances.

Some people are congenitally disposed to heart conditions- £20,000 excess?
Some people work on building sites ? 20% co-insurance?
Some people are Gay ? Drugs related and STD excess ?
Soempeople come from sick postcodes ( Glasgow has some shocking figures ) ? Why should those who do not pay for those who do?

Etc.

I am not averse to introducing Insurance concepts into the NHS and I am not against the NHS continuing in its illogical way, leaving it alone for bit is one good idea. I am, averse to it being used as weapon by the people I pay to take my rubbish out ( which they don`t) against any life style choice I make and employing some half baked gesture towards risk rating as a cover for social engineering .

So there

Patently, my angle has always been that for diseases that are scientifically proven to be linked to certain behaviours e.g. smoking to lung cancer, I would make people pay a percentage of their treatment rather than pay the whole amount – maybe 10-20%. That would be small enough to counter criticisms of the difficulty in proving what caused an individual to develop lung cancer but would still force people to take responsibility for their own angle. People who used to smoke years ago but gave up would still be forced to pay. Obviously the list of conditions for which this applies should be small because of the need for unequivocal scientific evidence to establish a link.

For example, some non-smokers develop lung cancer, from which we can conclude that although smoking greatly increases the risk of the condition, it is not the sole potential cause. We can surmise, therefore, that some smokers who develop lung cancer would have done so anyway, so their cancer is not caused by their smoking habit. What we can’t do is say which particular smokers this applies to.

We could of course decide to say that by smoking, you accept that the state will not pay for treatment of your lung cancer regardless of its cause. That would resolve the immediate issue, but would then create others – such as the case of a person who smoked in their 20s, stopped in their 30s, and developed lung cancer in their 50s. Should the NHS treat that?

I’m not disagreeing with you – the people who remember a time before the NHS are dying out (literally, sadly) and leaving behind generations who expect to be supported no matter what. But I’m not sure exactly how to draw the line. Where to draw the line, I’m happy with. But how … gosh that is tougher.