Much of the current debate on health-care policy centers on "mandates." Namely, should government require people to have health insurance? But this question ignores an important fact: Today, there already is a mandate on individual taxpayers.

Under federal law, hospitals must treat each and every person who comes to their emergency rooms, regardless of ability to pay. More than three-quarters of this uncompensated care, tens of billions of dollars annually, is financed, in some way, by taxpayers. So today we have, in effect, a taxpayers' mandate for health care - and no member of Congress has signaled a willingness to change that policy and enable hospitals to deny care to anyone unable to pay.

No one's arguing destitute people should be denied reasonable care. But we need to admit the status quo is financially untenable. We also need to admit that many people who can take precautions and protect themselves - and us - are failing to do so.

That's why my colleagues at the Heritage Foundation support the "personal responsibility principle." All persons have a responsibility to buy their own health insurance, pay their own health-care bills, and not shift those costs to others. Coupled with a restructuring of the health-care market so persons can own and control the health policy of their choice, there are a number of options.

First, people who can reasonably afford it have a responsibility to buy health insurance to protect themselves and their families against the financial devastation of catastrophic illness. Most Americans are able to do that.

Second, if an individual is poor and unable to afford private health insurance, then he or she should be able to get help buying that coverage, either in the form of a refundable health-care tax credit or a voucher.

Finally, if one believes insurance is a bad value for the money, or entertains some ideological hostility to even catastrophic coverage, then one can and should have the right to self-insure. This is an exercise in personal liberty. Persons who do not wish to buy health insurance should be free to do so. But they must also demonstrate in some tangible way that they are really going to pay their hospital bills, either by putting several thousand dollars into an escrow account for that purpose or making some other verifiable arrangement that they are prepared to make good on their promises.

If someone does not wish to pursue any of these options, that's fine. But they should no longer be able to claim a personal tax exemption. Whatever revenues are collected could be used to offset, to some degree at least, a portion of the rising costs of the uncompensated care.

The option not on the table is to charge the cost of one's personal irresponsibility to others (taxpayers). No one has a right to increase the existing burdens of the mandate on individual taxpayers. So, to be clear, persons should have the personal right to self-insure, but they also have the personal responsibility to pay their own medical bills. Rights and responsibility are inseparable.

Robert E. Moffit, Ph.D., is Director of the Center for Health Policy Studies at The Heritage Foundation.