Should People Who Cause Their Own Illnesses Pay for Their Own Health Care?

David Friedman weighs in:

I recently came across a news story about a British legislator who proposed that patients suffering from life style illnesses, medical problems mainly due to behavioral choices such as being overweight, ought to have to pay for their own medicines rather than having them provided for free by the National Health Service. It is a proposal that I expect will provoke strong responses both against and for…

[I]t is not clear just how the logic of endogenous disability can be dealt with in a governmental system such as the National Health Service. There is a serious problem of lack of bright lines. Many sufferers from type 2 diabetes, an example mentioned in the news story, may have it because they choose to be greatly overweight, but presumably not all. Similarly in other cases.

Okay, commenters. What do you think?

Comments (14)

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  1. Kyle says:

    “I just think that we have got to have an affordable system that rewards individual responsibility.”

    Absolutely. There should be a system of oversight to ensure that it is actually a result of lifestyle choices.

    Refreshing to hear about individual responsibility from a politician.

  2. Bill Radiar says:

    What system can determine a proper illness from every patient that has created an illness due to a life style selection? What about the grey areas?

  3. Saul says:

    “medical problems mainly due to behavioral choices such as being overweight, ought to have to pay for their own medicines rather than having them provided for free by the National Health Service.”

    The problem for me is the phrase “mainly due to behavioral choices”. This is the dilemma when the government feels the need to regulate things like health care. Is it fair that people have to subsidize other people’s poor life choices? No. But what if obesity is due to something like a Thyroid problem, and not food and excercise choices? Do they then pay higher payments? So, then the government would have to create some kind of decisionary board that decides appeals and what not. I just dont think this is an eficient use of money.

  4. Devon Herrick says:

    Should People Who Cause Their Own Illnesses Pay for Their Own Health Care?

    The health economics literature finds that somewhere between half and two-thirds of health care expenditures are on conditions related to lifestyle behaviors. Hypertension, high cholesterol, heart disease, diabetes, gout, joint problems, and many cancers are all caused or exacerbated by lifestyle. Public health advocates are prone to argue that people should not bear the cost for conditions over which they can exercise little control. Many also believe it’s insensitive to force people to bear the costs for their own lifestyle choices. But, over the course of a lifetime, it really makes no sense to exempt people from the cost of their decisions when those choices no only worsen their health, but shorten their lifespan, and foist costs on others that must be absorbed society. I don’t have a problem with people exercising their own preferences. But there’s no reason to believe society at large should bear the costs of individual decisions.
    People should treat medical conditions like retirement. You have to save extra while young to cover the cost of living after you can no longer work. By way of comparison, people should save in an HSA while young to accumulate balances to use on health care when they get old. The medical marketplace would respond once patients illustrated they were more price sensitive. Patients themselves may respond once it becomes clear that their choices are costing them money. If consumers don’t alter their bad behaviors, society is not harmed by their decisions.

  5. Kyle says:


    Devon beat me to it. If ~50% of health care expenditures fall within the purview of this sort of regulation, I’d have to argue that this has the potential to be a VERY efficient use of tax dollars.

    Another point he alludes to is that society is not only bearing the healthcare costs of irresponsible individuals, but a shortened lifespan reduces their aggregate economic contribution.

  6. Saul says:

    Where does the rabbit hole end though? For me, the problem is that it is in a government system. If private insurance companies want to charge people higher prices for smoking, I have no problem with that. But, when (and Im not all that familar with British HC so I could be wrong)the government forces you into a program, THEN forcibly charges you higher costs for something you may or may not control, it takes in my opinion choices away from the people.

    If private insurance wants to charge higher prices for irresponsible behavior, so be it. But I dont want the Govt charging me more when it’s not my choice to be in their program in the first place.

  7. Joe Barnett says:

    I note that the WSJ recently had an article “One Shoe in the Grave” pointing out the health problems caused by running/jogging & other fanatic exercise by middle aged and senior citizens. They wear out their parts, including their hearts, and receive no net benefit from their exercise: Shouldn’t they pay for their knee & hip replacements? Their new heart valves?
    I doubt it, because the nanny state wants to punish behavior it dislikes, however harmless to society generally, and reward behavior it likes (exercise, recycling) regardless of the cost to society of that behavior.

  8. Kyle says:


    John posted an NBER paper recently that concluded ACA was actuarially unfair. So is your problem really that you could be forced to pay more for your lifestyle, or that you are being forced to pay at all?


    So what are our options? ACA is happening, and I don’t relish the chance that advisory panels would be scrutinizing my life, ensuring that I lead a Gattica style existence. But it’s a risk I’m willing to take to keep from wantonly subsidizing generations of people who are about as health conscious as Chris Christie.

    (Unless Gov. Christie has a thyroid problem.. in which case, sorry)

  9. Jennifer says:

    My answer would be absolutely yes! If those conditions are caused by the individual’s choices, then it’s nobody else’s responsibility but theirs. If we are talking about genetic conditions and other types of illnesses that the person could not prevent, then that would be another topic of discussion. But if the case is a situation that could be prevented by a better lifestyle or better choices, then the individual should take on the responsibility of paying for his/her mistakes.

  10. Timmy says:

    @ Kyle
    My problem is that you are forced to pay and be a part of something that you may not want to be. Then, your lifestyle will effectively be taxed because of the forced participation. I think it just gives too much authority to the govt.

  11. Wasif Huda says:

    I feel like this may be one way to influence behavior. Certainly, individual responsibility must be accounted for, accordingly, if people make bad decisions, like unhealthy choices, they must be willing to live with its ramifications.

  12. August says:

    How about removing community rating, and allowing insurance companies to negotiate individual contracts with consumers. If they want to be responsible for thier health they pay less, if they choose not to they pay more. This would make the system both more efficient and fairer.

  13. seyyed says:

    thanks for the link joe-that is something to consider the next time i go running!

  14. Alyn Ford says:

    While I agree, the issue becomes more complicated once we get outside the healthcare topic. Do we deny support to farmers whose families purchased unproductive land? What about the fisherman who purchased a bad boat or the home owner who purchased a house in a hurricane zone because of the prestige of living on the coast…?

    One of the bi-products of a civilized society is caring for the population. This does not have to be resolved by socialism. A free market can accomplish it as well.

    Just my two bits.