Today's Debate: What should be required of patients?

One of the more popular recent posts here was on IBM. I questioned the marketing efficacy of blaming patients for their conditions.

But many conditions are preventable. You don't really have to be overweight. You don't have to smoke. You don't have to drink. You don't have to get high. You don't have to sit around all day like a lump, with Cheetos in one hand and a beer in the other.

These actions have consequences. Those consequences have costs. Taxpayers don't like paying those costs, unless it's their costs.

Outside the U.S., this debate is already joined. No hip replacement for you, fatso! writes the Healthcare Economist. Welcome to mandatory physical activity, complains a Canadian.

Compliance is a never-ending problem throughout health care. Patients don't take care of themselves. Sometimes they don't even take their medicines. This lack of prevention costs pounds to cure.

This problem won't be solved with carrots. It won't be solved with sticks. It can only be impacted at the margins, with a mix of both carrots and sticks.

But what mix? And who drives the cart? Doctors? Insurance adjusters? Government? Business? Few have gone as far as former Sen. John Edwards, who wants to mandate regular checkups.

But the idea doesn't sound as crazy today as it did 14 years ago, the last time the nation debated health care policy seriously. Tennessee, no hotbed of liberalism, wants to mandate physical activity for kids.

Already, we're seeing businesses choosing to drive the cart. No smoking policies, enforced through drug tests, are becoming popular, because cigarettes are so unpopular. But what about mandatory weights, or firing those who drink too much, or those who don't comply with their diabetes care?

Something has to give. We all agree on that. But what?