Even though we may be reluc­tant to pay a pre­mium for our insur­ance because of oth­ers who engage in irre­spon­si­ble behav­iours (for exam­ple: smok­ing, overeat­ing and health insur­ance), Sandeep Jauhar, M.D. reminds us of some per­ti­nent results from the health care field.

Jauhar pro­vides evi­dence that “puni­tive mea­sures to force healthy behav­ior” do not work; reminds us that we all undoubt­edly engage in some form of com­pa­ra­ble, irre­spon­si­ble behav­iours (e.g. using a phone while dri­ving); and that the issue of per­sonal respon­si­bil­ity in health care is a lot more com­plex that we imagine:

Per­sonal respon­si­bil­ity is a com­plex notion, espe­cially when it comes to health. Indi­vid­ual choices always take place within a broader, messy con­text. When peo­ple advo­cate the need for per­sonal account­abil­ity, they pre­sup­pose more con­trol over health and sick­ness than really exists.

Unhealthy habits are one fac­tor in dis­ease, but so are social sta­tus, income, fam­ily dynam­ics, edu­ca­tion and genet­ics. Patient non­com­pli­ance with med­ical rec­om­men­da­tions undoubt­edly con­tributes to poor health, but it is as much a func­tion of poor com­mu­ni­ca­tion, med­ica­tion costs and side effects, cul­tural bar­ri­ers and inad­e­quate resources as it is of will­ful dis­re­gard of a doctor’s advice. […]

Healthy liv­ing should be encour­aged, but pun­ish­ing patients who make poor health choices clearly over­sim­pli­fies a very com­plex issue. […]

‘It’s the con­text of people’s lives that deter­mines their health,” said a World Health Orga­ni­za­tion report on health dis­par­i­ties. “So blam­ing indi­vid­u­als for poor health or cred­it­ing them for good health is inappropriate.”

No men­tion of moral haz­ard.