A Maine Sunday Telegram editorial (“Retirement out of reach for most older workers,” Sept. 30) points out that Social Security is moderately solvent, but that Medicare will require either increased taxes, reduced benefits, and/or a reduction in health care costs.

There is a fourth approach that is seldom mentioned: Reducing benefits for those who cause their own problems.

It has been estimated that four types of disease eat up most Medicare spending: heart disease, end-stage renal disease, cancer and what is called metabolic syndrome.

According to the Mayo Clinic, heart disease is often the result of “unhealthy diet, lack of exercise, being overweight and smoking.” All four are preventable by means of changes in behavior.

The other three types of disease are more complicated with respect to causes, but there is often a behavioral component involved.

Reducing benefits for those who cause their own problems would have two effects. The immediate effect would be to reduce the cost of health care for all of us, because of reduced expenditures.

The long-term effect would be to reduce the incidence of preventable diseases, because the lifestyles leading to those diseases would no longer be subsidized.

Personal responsibility seems to have gone out of style, but requiring responsible behavior as a condition of receiving health care would serve to help bring it back.

William Vaughan Jr. is a resident of Chebeague Island.