If the government is paying for all medical care, which it does in Medicaid and in a single-payer system, could the bureaucrats outlaw high-risk behavior? Could cigarettes be banned? Could people be forced to be height–weight proportional? Could patients be compelled to be compliant in taking their medications and following their doctors’ orders?
Rightfully, these harsh government mandates would be unacceptable to Americans. On the other hand, the financial impact of any high-risk activity should not be shifted onto taxpayers, most of whom lead responsible lives.
The logical solution is to remove the government from our health-care delivery system and allow patients, as consumers, to control their own health-care dollars and be responsible for their own lifestyle decisions. Meaningful reform would require a change in the federal tax code so individuals could take the same tax break that employers have had for 70 years. It would require provider price transparency, and it would require health insurance reform and the restructuring of the existing government health programs.
Sadly, there are no current federal or state programs in which personal responsibility plays a key role or is incentivized to play a key role.