Choice-sensitive health costs.

The growing incidence and expense of health care expenditures due to deliberate and avoidable risks taken by patients are causing many to question whether society should continue providing health care to risk-takers. The challenge for a just society is to avoid the pitfalls of either becoming overly choice-insensitive, and doing too little to encourage responsibility, or becoming overly choice-sensitive, and doing too little to care for its vulnerable members. Whereas liberal neutrality's overriding commitment to autonomy seemingly renders society unable to prevent an individual from taking risks or from requiring him to compensate society for the costs of his actions, the rights-based theory defines good apart from individual choice and thus allows, but does not often encourage, society to trump individual preferences. This paper outlines the consequences of cigarette consumption, as an example of a choice-sensitive health care cost, and details how a just society can require risk-takers to contribute more to the health care system, in terms of premiums and other inputs, while still allowing them to enjoy the same outputs, in terms of access to care. The legality of smoking mitigates, but does not obviate, the smoker's responsibility to compensate others for the economic consequences of his habit. Society must neither unfairly burden non-smokers with the expense of others, nor abandon its smokers to rationing. This paper offers a theoretical exploration of the relevant issues to be considered separate from the more immediate political realities.