Michael Lissack less than what their driving costs encourages more driving, which in tum intensifies the problems of overuse. Or take health care. Behavior and non-medical technologies have always been the keys to widespread good health. For individuals, technology can buy cures, but for a society it buys mostly cost. The society that substitutes behavioral discipline for medical technology-the opposite direction from where we’re headed right now-is ahead by a hundred to one, if not a thousand to one. The great breakthroughs in conquering infectious diseases around the turn of this century came primarily through the application of sanitation techniques. That in turn required behavioral change. It was not enough simply to install safe water systems; people had to buy and use them. The whole profession of plumbing had to be created and financed. Now we face a different set of behavioral problems - our “diseases of choice.” During the next thirty years, the great majority of diseases of people under age fifty or so will be incurred as a result of specific behavioral choices. These behavioral choices include: Smoking Diet and activity patterns Alcohol High-risk sex Violence Illicit drugs Many hundreds of thousands become victims of these behaviors without indulging in them. Drunk drivers kill others besides themselves. Secondary smoke is a killer. At least 150,000 babies per year in the United States are se- verely damaged by fetal alcohol syndrome and fetal cocaine addiction. Their lives can undoubtedly be improved to greater or lesser degree; but keeping hundreds of thousands of brain-damaged children alive from infancy will become a multi-billion-dollar problem. Prevention is clearly preferable, yet may require controversial behavioral intervention controlling what preg- nant women do. Medical costs are viewed as the responsibility of those using the system, not as society’s burden. We wouldn’t ask only those who have had fires to pay for the fire department or only those who have been crime victims to pay for the police department. But health care is different. Some states, like Minnesota, even proposed or enacted taxes on the gross receipts of health
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