Families are strange things.

Just say you have a wayward sister who has never quite settled down, and fritters away successive generous attempts to help.

She starts to drink herself into alcoholism, but asks you to give her several thousand pounds to help her get through a detox clinic to make yet another new start.

You, by contrast, work hard and behave responsibly. You have some spare money  which might be used to help her, but only because you have worked hard and lived modestly.

Should you give her the money?

Most of us might think something along the lines of:  "Oh heavens. Not again. But … oh well, families are families. I’ll help but do my best to set some stern conditions this time, to make sure that she really benefits from the help and does not squander it."

Along comes someone from work whom you vaguely know and quite like. He tells you a sorry story of his sister who has been drinking and smoking too much and now needs several thousand pounds to go on a detox course. He asks you to help as he is broke. Should you give him this money?

Most of us might think something along the lines of:  "Huh? Look, it’s bad enough helping my own profligate sister – why should I help her too, when I don’t even know her?"  And politely decline.

Or maybe not.

Maybe we are altruistic enough to want to give away most of what we have to help others, whether we know them or not and without conditions, precisely because they have shown themselves to be unable to cope. 

The point is that once we have a decision to make about our own money, we are capable of fine-tuning it to suit different cases.

We might decide to help those who are likely to really benefit from our help. Or we might say that those who inflict harm upon themselves need to take responsibility for their own bad behaviour, and not draw down on the good behaviour of others. Or we might give help but with robust conditions.

If these decisions are aggregated up, a general view will emerge as to how society looks at responsibility, and at cause and effect.

But look what happens when the state nationalises all those decisions.

Fecklessness, selfishness, stupid risk-taking and incompetence are then subsidised indefinitely. This may create strategically ruinous long-term disincentives, which start to skew huge resources in weird, accumulating, even system-threatening directions. (See eg the ‘European Social Model’.)

How to measure the costs and benefits of that, not only in financial terms but also in what it does to relations between people, and the deepest capacity of us all to behave responsibly and generously towards each other?

As the US political elite attempt to vote for or against radical new healthcare legislation, Zombie explains bluntly why he is not happy.

He starts with the lively case of Dr Sunderhaus who got into trouble for telling an obese person that she was likely to get diabetes.

Then he gets into his stride:

A built-in false assumption with the health-care debate is that sickness is always no-fault sickness. It’s never socially acceptable to assign blame for people’s medical problems — especially blame on the patient.

But I’m not afraid to confess that I’m a judgmental person. And I’m pretty confident that most Americans who oppose socialized medicine share this same judgment: that some people are partly or entirely to blame for their unwellness.

I’m perfectly willing to provide subsidized health care to people who are suffering due to no fault of their own. But in those cases — which, unfortunately, constitute perhaps a majority of all cases — where the unwellness is a consequence of the patient’s own misdeeds, bad habits, or stupid choices, I feel a deep-seated resentment that the rest of us should pick up the tab to fix medical problems that never should have happened in the first place.

I’m speaking specifically of medical problems caused by:

• Obesity
• Cigarette smoking
• Alcohol abuse
• Reckless behavior
• Criminal activity
• Unprotected promiscuous sex
• Use of illicit drugs
• Cultural traditions
• Bad diets

He concludes:

On one hand, we’re headed toward a totalitarian nanny state whereby your freedoms are constrained for the good of others.

But at the exact same time we’ve entered the Era of Hurt Feelings where it’s taboo to tell anyone they’re doing something wrong. The solution proferred by the universal health-care advocates is to expand the circle of responsibility to include all of us.

So, rather than insult an individual by telling him or her to get healthy, we all have to pretend we’re all equally in need of self-improvement, and we all endure the restrictions and hardships and costs which by all rights should be reserved exclusively for those who earned them…

All such arrangements built upon perverse incentives and assumptions must crash, sooner or later.

Not only because you run out of rational people to pay for them.

In the end because they are just not healthy.