In the film “Thank You for Smoking,” a girl informs the lead character – tobacco company spokesman Nick Naylor – that her mother says smoking kills. “Is your mother a doctor?” Naylor asks. When the girl says no, he snidely replies: “Well then, she’s hardly a credible expert then, is she?”

The response, though brusque, reflects the quagmire of tobacco discussions. Many have opinions on smoking, such as who’s responsible for causing smokers to start, who should help them stop and who should pay for treatment for those suffering from its health effects.

The latest flame-up is from Maine Sen. John Martin, who wishes to create incentives, and sanctions, for Mainecare beneficiaries who smoke. His proposal is an extension of a growing national trend of using “personal responsibility” clauses to control Medicaid costs, and deserves examination by the Maine legislature.

The response, however, has been mixed. The American Lung Association of Maine said the idea deserves consideration. The Maine Civil Liberties Union derided the plan as “lifestyle discrimination.” Anti-smoking lobbyists said sanctions would further victimize tobacco’s victims, when it is cigarette companies that should pay.

“A more appropriately directed bill would be to target manufacturers, and require them to pay for treatment for all smokers who want to quit, for as many times as it takes them to attempt it,” said Carol Kelly, of the Maine Coalition on Smoking or Health.

West Virginia instituted the nation’s first incentive program for Medicaid recipients earlier this year. It includes asking patients to pledge to attend all scheduled physician’s visits, take their prescriptions, engage in smoking cessation or weight-loss programs if directed, and generally try to live a healthy life.

West Virginia Commissioner of Medical Services Nancy Atkins told the New York Times, “We always talk about Medicaid members rights, but rarely about their responsbilities,” Atkins said. She’s right.

In Maine, around 35 percent of pregnant women on Mainecare smoke, according to the lung association, a testament to the need to instill responsibility into the program for now, and for the future.

But in August, the New England Journal of Medicine blasted West Virginia, and said the plan “asks the most vulnerable populations to do more with less ability to accomplish what we ask of them.” Yet West Virginians like John Johnson, a 61-year-old diabetic on Medicaid, stoutly refuse to change when asked.

“I’ve been smoking for 50 years – why should I stop now?” Johnson told the Times. “This is supposed to be a free world.” Except Medicaid, as Maine well knows, is far from free. Some 270,000 receive Mainecare benefits, at an annual cost of $872 million to Maine taxpayers.

These costs must be controlled. “Why are we as a state…paying the health care cost of people that are smoking two and three packs a day?” Martin asked the Capital News Service.

It’s a good question. Injecting some “personal responsibility” could be the answer.