Opponents also point out the genetic and

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by any factors aside from the natural right of everyone to receive adequate, affordable healthcare. Opponents also point out the genetic and socioeconomic factors that may prevent individuals from personally improving their health. In an article published in the Emory Law Journal, Erin Patrick argues that there are socioeconomic barriers that must be addressed in order for any penalty-based program targeted at obesity and health to have any success. Some of the barriers include access to high quality food sources and realistic avenues for pursuing a healthy lifestyle, for example, access to transportation and childcare (280). Patrick also explains that genetic factors play a significant role in health issues, particularly in obesity (282). Opponents argue that individuals should not be held accountable for factors that are out of their control. Those opposed to this idea also question the efficacy of such penalty-based healthcare programs. One such program was initiated in West Virginia in an attempt to reduce the obesity epidemic, increase overall health, and reduce costs within Medicaid. Regarding this program, Patrick puts forth that, “…there are no available studies regarding penalties, or other evidence, suggesting that penalties will work, especially when it comes to obesity” (280). There remains a
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substantial group of people who are opposed to making personal responsibility the central focus of changing healthcare because of the genetic and socioeconomic factors that contribute to health, as well as because of concerns of fairness and efficacy. While some are completely opposed to the idea of rewarding or penalizing health plan participants for their lifestyle choices, others believe that it can be cost-efficient and beneficial to personal health for individuals to be a part of a program that penalizes poor lifestyle choices through financial or health benefit cuts. In a recent article in the Journal of Law, Medicine & Ethics , Madison, Volpp, and Halpern from the University of Pennsylvania assert that penalties may be more effective in producing behavioral change because, “…there is evidence that people are loss averse, in the sense that they feel losses more acutely than equivalent gains” (459). There are many that believe that because healthcare costs continue to rise, it is only fair that those who maintain unhealthy lifestyle habits such as overeating, smoking, and remaining inactive should have to pay more for the health conditions that they bring on themselves. Dr. Robert Steinbrook, writing in
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