Some medical professionals and regular citizens say that the issue of personal responsibility to lead healthy lives has been missing from the national debate over healthcare reform, MSNBC reported Aug. 10.

“I just had to go take care of man that left our hospital this morning and now has gone and got drunk and will suck up more health care dollars,” wrote emergency physician Steven Spady in a recent e-mail; Spady also detailed caring for patients with diabetes who don’t take their medication and others who overdosed on prescription drugs. “It just makes me very upset when I have to pay more and more taxes to support government healthcare programs and have to work longer and longer hours to help a lot of people that just don’t seem to care,” he wrote.

“Seldom does anyone suggest how — or if — the individual’s role should be reformed,” said former healthcare administrator and blogger Lisa Herrington. “Having health insurance coverage doesn’t make a person healthy. It’s what you do with that coverage and your personal choices that make the difference.”

Smoking costs an estimated $193 billion annually in medical expenses and lost productivity, while obesity-related costs are estimated at $147 billion per year.

The group Action on Smoking and Health (ASH) has addressed personal responsibility in its healthcare reform proposals, urging Congress to impose a $60-per-month fee on smokers to help cover the cost of their healthcare. “If you don’t have a user fee on smokers, that forces everyone else to pay those healthcare costs,” said ASH head John Banzahf. “One argument is that it’s simple fairness.”

However, a 2007 poll found that only 37 percent of Americans supported charging smokers, obese people and others who make poor health choices more for their healthcare. The Wall Street Journal/Harris Interactive poll found that 57 percent of those surveyed backed higher fees for smokers, but only 36 percent though that obese Americans should pay more.

There is little consensus on what actions and activities should be the responsibility of the individual and which should be borne by the healthcare system. “We can’t allow ’personal responsibility,’ in quotes, to become a polite way of saying, ’You’re on your own, Mac,’” said Rob Gould, president of the Partnership for Prevention. “When kids don’t have a way to safely bike or walk to school because there are no sidewalks, that’s not personal responsibility.”