I was happy that the always interesting Phillip Howard has joined me in calling for more personal responsibility in health care payments:

Universal health care coverage is supported as a moral imperative, but the current proposals undermine a more important moral imperative - to focus public resources by containing costs.

... The culture of American health care delivery can't be fixed by piling 2,000 pages of new law on top of a mountain range of current entitlements, regulations, and protocols.
What's missing in American health care is a basic principle essential to all human accomplishment: Individual responsibility... .

Up to now, we have organized health care as an entitlement - a free good, like the air we breathe. This has led to a failure of personal responsibility. Neither patients nor providers have any incentive to be prudent in their use of resources. Unreliable law further encourages irresponsible decisions, causing doctors to squander billions in defensive medicine and to make treatment decisions based on what bureaucratic guidelines will reimburse.

Without an overriding principle of individual responsibility, prudence is lost in the labyrinth of entitlements and bureaucratic mandates, and waste is inevitable.

Health care cannot be organized as a free good. Throwing money at health care is proof not of a moral society, but of a society that lacks the sense of responsibility that is the core attribute of morality - every wasted dollar is not available for some other public good ... .

I’m skeptical about some of his recommendations , but I sure agree with this:

... [R]equire patients who can afford it to pay a meaningful portion of their care ... without reorienting the delivery of care around the core principle of individual responsibility, any cost-saving proposals will ultimately die on a political vine that is nourished not by principle but by special interests.