New York's Medicaid program is now testing, on a small and limited scale, giving people financial incentives and requiring compliance in changing their behavior. The approach has promise — if done right; it's important to keep in mind the lessons of welfare reform.
When an individual insists on eating too much of the wrong food while not exercising at all, or smoking or never getting a physical checkup, he's at serious risk of developing a chronic illness.
His choice, his problem? Yes, but when that same person is enrolled in a taxpayer-funded health-insurance program like Medicaid, he also risks becoming a very expensive problem for the rest of us.