LAST week a Yorkshire health authority announced, and then quickly abandoned, plans that would postpone surgery for up to a year for smokers and obese people. The suggestions understandably raised alarm, with some professionals comparing the proposals to racial or religious discrimination, prompting uncomfortable mental images of segregation. How did an English NHS board move so far from its founding principles to embrace ideas that mix rationing with lifestyle profiling to create an ideological brew that smells dangerously like eugenics?

Once again, this brings us back to our dear old friend austerity. When the Tories, Liberals and Labour argued for cuts after 2008, they promised to “protect the NHS”. But the health service has been starved of funds. The NHS still stands among the most cost-efficient and potent healthcare systems in the world, and our doctors and nurses perform miracles with far less cash than rival systems abroad. But we can’t expect world-class service with second-rate funding for ever. Britain’s austerity programme added to a long-standing problem of underfunding and creeping privatisation. Add on top a dash of demonisation of the poor under austerity, and it’s pretty obvious that “radical” proposals, like denying surgery to some groups, were bound to seep in eventually.

This funding crunch has forced hospital managers into making dystopian, emergency decisions, as if we’re living in the end of days. And, if you believe the myth that there’s simply not enough to go around, that “Britain’s full”, then you’re accepting that more of this will follow.

In genuine natural disasters or emergencies, doctors and nurses face real moral choices about who to treat and who to let die. I recently listened to an excellent podcast interview with New York Times journalist Sheri Flynn about her book on Hurricane Katrina in New Orleans. As floodwaters rose, as temperatures reached 100 degrees, as emergency power supplies failed, staff at Memorial Hospital in New Orleans had to find a system to decide who should be treated and rescued first, who would be eventually evacuated and who would be left behind to face certain death.

Such moral dilemmas can pose fascinating questions. After Katrina, researchers at Johns Hopkins University Hospital used a process called "deliberative democracy" to get public views on who deserves treatment in these scenarios. These "open conversations" allow the public input into policy proposals that deal with mainly moral questions, like delivering health treatment during a state of emergency, a flu pandemic, or a terrorist attack. Participants usually favoured saving the most lives or years of life by giving priority to people with a good chance of beating their illness and living healthily. Equally, where patients had a roughly equal chance of survival, participants proposed a lottery or first-come-first-served approach.

Although the researchers scrupulously tried to avoid the uglier side of these debates, inevitably the discussions uncovered obviously disquieting thoughts. Did undocumented immigrants deserve an equal chance of treatment as full citizens? Are criminals entitled to the same rights as the law-abiding? Should drug users and alcohol abusers be treated before health-conscious gym freaks?

These research scenarios were designed to deal with emergency situations like hurricanes or disasters like Fukushima. In these life-or-death environments, harsh and brutal decision-making comes to the fore.

However, the weird effect of our current low-tax political consensus is to artificially spread a “state of emergency” around everyday life. We’re living in societies dominated by the richest people in human history, yet sometimes it’s like living through a permanent disaster or even a zombie apocalypse. Surrounded by routinised emergency, people think in emergency terms. Other human beings become competitors for resources: if my neighbour gets that treatment then I won’t.

And a twisted morality starts to emerge: why should people who abuse their own health get treated before me and my family?

Since the 1980s, even where our public services have remained in public hands, this culture of individual competition has been gaining ground. There’s been a growing sense that we can solve public problems by blaming the private individuals who suffer from them. According to this logic, if fat people take responsibility for their flab, we’ll cut down significantly on the health bill.

It sounds convincing. Indeed, it still sounds convincing even when we know that creating stigma around weight is completely counter-productive. “There is a lot of negative stigma which is associated around weight and that sometimes isn’t helpful and can perpetuate the cycle, particularly when there is a lot of behavioural issues and psychological issues at an individual level,” notes Debbie Provan, spokeswoman for the British Dietetic Association. “We need to look at everything, from education to opportunities to be physically active to how we produce food, how we market food and how we view food.”

Let’s not deny it, we’ve got a food problem, and that problem costs the NHS millions. But our food problem starts with the food industry and the food lobby. Fast food companies, with their primary colour schemes and cartoon characters, target the most impressionable. They spend billions every year selling junk to children, which gets kids hooked on salt, fat and sugar early in life, and the problems stick into adulthood. These vampires make billions by draining society’s resources. But we’re accustomed to seeing this as normal.

In the 1960s, advertisers used cartoon characters like Fred Flintstone to sell cigarettes. In the 1990s, companies used cartoonish advertising to get teenagers drinking alcopops. Advertisers manipulate our weaknesses to get us hooked on things we don’t need so they can make huge profits.

Rising obesity poses a future challenge for the NHS. But the cost of smoking will decline, because kids are turning away from cigarettes in droves. Why? Because we’ve taken on the smoking lobby who spent billions to make smoking seem “cool”. Most smokers who need NHS treatment today started their habit before we got tough on the industry.

The truth is that obesity, like smoking-related illness, is a disease and we should target the companies that make billions from those diseases and impose huge costs on society without any sense of responsibility. That’s how we’ll save the NHS’s resources.

Ultimately, though, what emerged from the outcome of the deliberative democracy discussions was a curious consensus: when faced with trying to make these brutal decisions, people’s first instincts were "how can we stop this happening in the first place?" Like any good doctor will tell you, prevention is better than cure, so let’s take on the real corporate leeches profiting from our health crisis to stop it getting worse.

And let’s stop expecting world-class service on the cheap. The middle class gets huge benefits from the extreme efficiency of the NHS, but to stop it collapsing they need to pay in just a little bit more or the evils of rationing and profiling will only intensify. Either that or some ultra-expensive private system will take its place.

And if you want to know what a real apocalypse looks like, try an American hospital.