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December 3, 2003

Proposals for US National Health Insurance

JAMA. 2003;290(21):2797. doi:10.1001/jama.290.21.2798-d

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?