Those who participate in current discussions of “health care policy” assume . . . that it does not matter how or why people came to be in whatever unfortunate medical condition they are in—the government has the right, and of course the duty, given that right—to impose taxes on all of us to relieve those conditions to some level or other. And then it is just a question of how much the taxpayer can be expected to be willing to part with, as measured by who will win which elections in which this has become a major issue.
Those assumptions are pretty obviously wrong in every way. First, many people care little about their health: drug users, people who eat huge amounts of foods known to be likely to shorten their life expectancy significantly, and so on. Second, and more generally, all of us have interests such that we are willing, with perfect rationality, to expend less of our time, energy, and money on trying to maintain an advanced state of physical health than we are in promoting those interests. And third, both of the first two are clearly the subject of huge variation among people. It is self-evidently absurd and, if pressed, fascist to compel them all, at some comparable level, to force higher levels of health care on all than are called for by their particular profiles of interest and resources.
(Jan Narveson, "The Medical Minimum: Zero," The Journal of Medicine and Philosophy 36 [December 2011]: 558-71, at 569 [ellipsis added])
