There is some good thinking in this piece, except that the trick is to promote individual responsibility for improvements in cardiorespiratory fitness. Why? because improvements in fitness are related to decreased levels of chronic disease independent of weight, and are more readily achievable than significant weight loss, even though these are associated. That's why, in a recent piece on Radio National's Perspective,(http://www.abc.net.au/rn/perspective/stories/2007/2023406.htm) I advocated a scale of graded payments for a) having fitness assessed in conjunction with general health checks, and b) showing verifiable improvements in fitness over a six month period. Get the scheme right and you provide nothing but incentives for verifiable, individual reductions in the risk of chronic disease, and thus, on average, a reduction in the burden this places on our health system. Surely this is preferable to a) ignoring this most significant (poor) health issue, b) expensive and poorly focussed public health campaigns with uncertain outcomes, c) undue subsidies to providers with no verification of results. Most importantly, it provides support and opportunity to the highest risk individuals, without removing responsibility from them for their own health behaviour.

Charles Worringham
Independent Candidate for Ryan

The idea that doctors should be empowered to make judgements about who "deserves" treatment is absurd. They are paid - handsomely - to treat diseases, not to triage or discriminate against individuals on the basis of "lifestyle". We pay our politicians to guarantee services, not to decide whether all of us deserve them. It seems odd to me that someone from a libertarian "think-tank" would recommend that doctors, as representatives of the state, determine whether or not someone merits treatment, on the basis of the pleasures they have pursued throughout their lives. Sounds like nanny wagging her finger to me. The philosophy underpinning socialised medicine is less riven with contradiction: treat everyone, without favour, on the basis that guaranteeing medical care is a necessary element of any society that pretends to civilisation.

Perhaps if one was to look around rather than thinking in isolation, responses to this suggestion would not be so clear-cut:-

How many of the incredible people who run animal shelters, rape crisis centers, volunteer their time and services for the good of the community, work in social services etc. etc. are overweight?

Now, compare that to the numbers of self-absorbed, narcissistic people who are found in every gym, at health food stores, at de-tox centres and so on...and who have never contributed to the common good in their lives.

Yep, of course not all fat people are selfless, nor are all fit people uncaring: .....and that's exactly why medical care needs to be given objectively. How the hell does it become a doctor's, or a committee's, or even a taxpayers - responsibility to judge who is more worthy to live and who to die? Who is even capable of judging?

I hope poor life style choices includes people who hurt themselves while climbing mountains ,joggers who twist an ankle or get bitten by a dog,hikers who get lost and suffer heat or cold problems,gym junkies who
overdo it,politicians who fall off exercise bikes,reckless drivers who have accidents.The list goes on and on.Are we going to say that only healthy,fit and flu sufferers are entitled to free health care.By all means advise people to lose weight,quit smoking and live healthy lives but don't disadvantage those who don't.Living a healthy life didn't save Pritikin the diet guru.

There's another leg to this debate. As Australians get fatter and they demand their rightful access to healthcare, what they will do is put so much weight (pardon the pun) on the health system that it will no longer be able to cope. In fact, the system is well on the way now.

What happens then? Does the Government just let the system go under? If people themselves do not pull their collective fingers out, the Government is going to have to do some rationing of beds etc. The question then is: should the rationing be done on a rational basis (eg charge extra to those that are unfit) or ask the fit population to pay more to subsidise the rest? There's a limit to how far people are prepared to go either way.

It doesn't take much thought to realise that the only sustainable solution is that people pull their fingers out.

Whilst speaking with a workmate - "The Doctor put me on Crestor, thank God I can eat whatever I want from now on."
Whilst standing in a lunch line behind a generously proportioned couple - "I'm going to have a diet C**e today. (He went on to order a bucket of chips and a vanilla slice- the diet drink was his adipose offset I suppose.)
Whilst grocery shopping - a rambunctious toddler is rewarded with a M**s Bar. Later, at lunch, an even younger baby sits in a high chair fingering and slobbering over a generous serve of some kind of deep fried potato nuggety things.
These are a minute sampling of the kind of attitudes that exist and that constantly force changes to out health/health insurance system.
Also, by the way,I object to paying the Medicare levy while having private cover. This double hit is no more than a subsidy to people who make poor, stupid, avoidable life choices.
RobP, Haygirl and aqvarivs - More power to you.