''... you don't get health insurance unless you sign a living will or directive.''

In an AP article today, Dean expands on a new theme that he started to develop at the Iowa forum. Thoughts on this?

Dean, a doctor and former governor of Vermont, has proposed an $88 billion plan to provide health insurance coverage for all Americans under age 25 and expand coverage for uninsured adults.

In exchange, he wants Americans to take more responsibility for their health care.

Pharmaceutical companies, insurers and lawyers deserve some of the blame for rising health care costs, he said, but so do individuals who don't take care of themselves or don't make realistic decisions about their medical care.

''Most politicians treat voters as children: 'Elect me, and I'll solve all your problems,''' he said during a forum at which he explained his plan and answered questions from voters. ''When are we going to talk about our own responsibilities?''

''If we're going to have health insurance for everyone, you don't get health insurance unless you sign a living will or directive,'' he said.

Dean, an internist who left his medical practice in 1991, described how he used to sit down with relatives of seriously ill patients to discuss treatment options. But he said that connection between families and physicians has been lost due to the ''corporatization'' of medicine.