This is where private health insurance would be needed. Making people responsible for their health would require some form of payable premium based on lifestyle choices and previous health histories. I f you smoke, drink to excess, do dangerous sports, expect to pay way more as your risk to the insurers will be much higher.

I'm not actually in favour of personal health insurance. It's the US model, and that's pretty broken.

Essentially, the NHS (and the "Welfare State") was created to act as a backstop when all else failed. Over the ensuing half-century, it's mutated into something else entirely. In 1948, the population of the UK was as healthy as it had ever been, and the NHS provided free-at-the-point-of-delivery dental care, spectacles and health care. The welfare state was intended to help you if you hit rock bottom - nowadays it's there if you don't want to work for a living. Free money for doing nothing - that's not what it was created for.

Now, lifestyles and work patterns have changed. We're no longer a largely active and physical workforce, instead being passive and planted in chairs in front of PCs and tellies. Our diets have changed, not necessarily for the better, so despite the fact that folk 50 years ago probably smoked more and drank harder, we're actually a lot unhealthier than we we used to be.

But that's okay, because the health service can pick up the pieces when it all goes wrong. Only, it can't cope with all the overweight alcoholic smokers any more.

What we do about it, I don't know. There's no simple answer any more. There's probably enough tax revenue made on sales of alcohol and tobacco that in theory it covers the extra costs of illness caused by their misuse. Would a system work where if you drink and/or smoke, you are made aware that beyond a certain point you may have to pay extra for your healthcare? I don't know.

+1. Smokers pay enough in taxes to pay for private healthcare.