We thought about it, talked about it and wrote lots about it. In the end, there are only two ways to control costs overall in a system that deals with people and choice and sickness. Given a population of people, some of whom are sick, some of whom are healthy one can:

1. Limit the number of people who become sick. This is called prevention.

2. Limit the care you give sick people so as not spend infinite dollars. This is called rationing.

Option 2 is not what we are talking about here. Prevention is.

When you get a person in my office who I counsel to eat better, lose weight and exercise, two things may happen.

a) My patient ignores me.
b) My patient listens.

If they listen, they still may not stay healthy. Thats called biology and life.
If they do not. Well, then Houston, we have a problem. What to do? Do we force or compel people to listen? Not so easy. But, one way to start that ball rolling is to penalize people for behavior or conditions that will hasten their conversion to the sick pool. Tax alcohol and tobacco, limit speed in cars, add rules to workplaces for safety, tell parents to put fences around pools. And, eventually, target more specific things, like being obese.

Here we find a great debate by two leading pundits, one from each political camp.

So– it begins with debates like this on websites. Be careful of the very, very slippery slide unrolled down that steep slope.