Smokers, virgins, equity and health care costs.

Julian Le Grand's case for saying that it would be equitable ifsmokers and smokers alone were to pay the costs ofsmoking-related health care is considered and found to be deficient. Should smokers (and smokers alone) pay the costs of smoking-related health care? No I shall suggest at least in contemporary Britain, they should not. I will consider the question with specific reference to the philosophy of public health finance of Le Grand. This philosophy of Le Grand's is based upon a very dubious notion of 'equity'. Nonetheless, what he says about smoking and health care costs is of interest in its own right and might well be attractive to some people who have no knowledge of nor interest in his views about 'equity'. According to Le Grand: 'Situations where one person is disadvantaged relative to another due to factors beyond either's control are commonly judged inequitable; situations where the disadvantage arises because of differences in individual choices freely made are not. Equity depends on the extent of individual choice' (1). I do not think that people normally conceive of equity and inequity in this way. More importantly, they should not conceive of equity and inequity after this particular fashion. I shall use the term 'equity' in what I think is the normal usage, whereby, 'equity', 'fairness' and 'justice' are identical or, at least, very, very similar. Due to factors beyond our control, at our births, Kenny Dalglish was and I was not a potentially great footballer yet, it would be bizarre ofme to claim that regarding the distribution of football-playing talents I have been treated inequitably. Perhaps I have been unlucky but that is a different matter. Suppose that a tyrant in some society economically very much less developed than our own decided independently of the choices and wishes of the people to install, in the interest of public health, a public sewerage system. The decision and its implementation need not be