Invited Commentary

The authors conclude that high-risk behaviors are associated with increased injury severity and cost and that the victims frequently depend on the public sector for their reimbursement. The corollary to this conclusion is that the hospitals in which these patients are being treated are inadequately or negligibly reimbursed for their care. The authors then recommend the institution of taxes or penalties designed to decrease these injuries and thereby reduce the disproportionate amount of public funding necessary to treat these patients.

Before adopting what could be construed by some to be substantial penalties broadly applied across an entire population, it is important to determine if these solutions are likely to be effective in decreasing the production of injuries. The best preventive strategies are passive and do not require the involvement of the potential victim to reduce the injury. Most of these strategies are in the engineering domain. Any strategy that decreases