To the Editor: I am troubled that the Physicians'
Working Group1 made no demand for individual
responsibility. If health care is a public good, as the authors implied, then
it is something that taxpayers pay for continuously, whether they use it or
not. Such common public goods include police and fire protection and public
sanitation. However, with each of these public goods, there is an explicit
understanding of individual responsibilities. For example, although the fire
department is there to put out fires in our homes, we have the responsibilty
not to purposely start a fire and to have appropriate smoke detectors in our
homes and businesses. If medical care becomes a public good, then should we
not insist that individuals have responsibilities toward their own health?
If we enforce mandates such as smoking cessation, exercise, and weight loss,
what would be the punishment for those who do not comply?
Proposals for US National Health Insurance. JAMA. 2003;290(21):2797. doi:10.1001/jama.290.21.2798-d