 The final difficulties for trying to formulate policy that compensates people for bad luck but not for irresponsible decisions are epistemic and practical. Even if one grants that there are cases where individuals should be held responsible for engaging in unhealthy behaviors by holding them to book for the costs of their behavior or denying them certain interventions, the fact that many health conditions are multi-factorial in their causal origins poses significant epistemic challenges for formulating responsive public policies. Take lung cancer, for example. There are many people who smoke who do not develop lung cancer and many who have never smoked that do. It is daunting to envision determining for an individual person, let alone groups of people, what causal role risky behavior played in their becoming ill. Moreover, even if this epistemic difficulty could be resolved, it remains the case that public health policy, like all public policy, is a blunt instrument. We should worry that public health policies that try to ensure that individuals pay for their own irresponsible choices will often fail to penalize irresponsible behavior, or, more worrisomely, penalize individuals who should not be held responsible for their ill health. 