The recent federal court ruling that the Obama health reform bill is unconstitutional—due to its mandate that individuals must purchase health insurance—reminds me of a seminar on personal health records I attended several years ago. The speaker, a physician who was running a PHR software company, was asked if the technology would have any impact on health outcomes. His answer: Americans are in denial about their own health. He cited the rising incidence of obesity (which has since grown even more dramatically), the corresponding spread of expensive chronic diseases, and the overall reluctance of many people to take responsibility for their own health, PHRs or no.

There’s no telling how the courts may ultimately rule on the reform law. But I have no problem with the government telling us we need an ownership stake in health insurance. We have become so disassociated from the economic reality of paying for care that we take health care services for granted. We are fast becoming a nation that wants to eat, drink, smoke, snort and inject itself into oblivion, without regard for the fiscal fall-out—let alone regard for our bodies.   To me, owning health insurance—and trying to keep my own health in good order—fall under the category of responsible civic behavior. Conservatives have argued that compelling people to buy health insurance sets the stage for compelling them to do just about anything. To them, the “nanny state” lurks ominously. But who among us can legitimately claim they will never use health care services?

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