Some estimates peg about 50 percent of health care problems on bad genetics or accidents, the Director of the Connected Health Center, Dr. Joseph Kvedar noted during his closing remarks at the Connected Health Symposium in Boston on Wednesday.

"Those are the types of patients that politicians [love to point to] and ask providers: Why would you want to deny that patient care? The other 50 percent of health care problems result from patients who have been irresponsible," Kvedar said. "No one wants to talk about that. We need to find ways -- both societally and in our businesses -- to hold people accountable [for being irresponsible with their own health], but if we don't and we continue on our merry way of believing that every one is a victim, then we won't accomplish the vision discussed here today. That's hard for politicians to do and it's hard for us to do, but we have to do it."

Kvedar may have spoken softly, but his words were clear: We need to carry a big stick.

How did we, as a society, largely stamp out smoking as a socially acceptable activity? Panelists throughout the day invoked the decades long campaign toward smoking cessation and hinted that those people who make irresponsible health decisions need to be poked, prodded, nudged and shamed into making healthier decisions beyond just not smoking.

Earlier this month we wrote about Safeway's practice of giving employees discounts on their health insurance for having certain body mass indexes, quitting smoking, controlling hypertension or lowering their cholesterol. According to the original NPR report, organizations, including the American Heart Association and the American Cancer Society, argue that incentives programs like Safeway's let healthy employees pay less for health care while discriminating against those who may have pre-existing conditions or a different socioeconomic status.

While the groups make a fair criticism of Safeway's plan, they are also making Kvedar's point: Maybe 50 percent of those people who won't receive bonuses from Safeway had pre-existing conditions, but what about the other half who are make poor health decisions?

"Yes, we need to hold people accountable, but I'm not sure how that can be done. I am sure it will be done eventually, but it may be done with significant negative consequences for certain populations," Deepak Ayyagari, Director, Technology Programs, Sharp Laboratories opined during a panel session following Kvedar's remarks. You cannot penalize someone for not being able to afford a salad and choosing to buy a Big Mac instead, Ayyagari said.

"Maybe we need a Big Mac tax and a salad subsidy," Verizon's newly appointed Chief Medical Officer Dr. Peter Tibbett American Telemedicine Association CEO Jon Linkous quipped.

UPDATE: The ATA's Jon Linkous actually made the Big Mac tax/salad subsidy joke on-stage at the event yesterday. Apologies for the confusion. For the record, Verizon's newly appointed Chief Medical Officer Peter Tibbett also got a few laughs from the crowd.