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Posts Tagged ‘Paternalism’

Last year, I showed an image of evolutionary stages that was so accurate that it would earn approval even from many strict creationists.

Here’s a new image of evolutionary stages that sets the stage for today’s discussion. Simply stated, Americans are becoming bigger. In some cases, a lot bigger.

Is this trend toward greater obesity a bad thing? As a reader asks, is it something that requires a government response?

The answer is yes…and no.

Libertarians believe people should be free to make their own decisions so long as they’re not infringing on the rights of others. And that includes the right to eat too much and exercise too little.

But the “yes” part of the answer is that we can think obesity is unfortunate and we can encourage our friends and family members to live healthier lifestyles. And if we’re willing to be pests and to run the risk of being told to mind our own business, we can even encourage strangers to shape up.

The “no” part of the answer refers to whether the government somehow should get involved. I shared a great video from Reason TV several years ago that explained why paternalistic anti-obesity programs don’t work. And just this week, one of my colleagues at the Cato Institute, Michael Tanner, addressed this issue. Here’s some of what he wrote for National Review.

Recently the American Medical Association declared that it will consider obesity a disease. …the AMA’s move is a symptom of a disease that is seriously troubling our society: the abdication of personal responsibility and an invitation to government meddling. …the AMA’s move is actually a way for its members to receive more federal dollars, by getting obesity treatments covered under government health plans. A bipartisan group of congressmen has already seized on the AMA declaration as they push for Medicare coverage of diet drugs. Observers also expect an effort to expand Medicare reimbursement for bariatric surgery, a.k.a. stomach stapling. And there will almost certainly be pressure to mandate coverage for these things by private insurance carriers, under both state laws and the Affordable Care Act. …After the AMA decision, John Morton, treasurer of the American Society for Metabolic and Bariatric Surgery, was almost giddy, calling the AMA decision a “tipping point” and adding that “now coverage policy must catch up to that consensus.” Since a typical bariatric surgery costs as much as $40,000, that could be interpreted as a warning for all of us to get out our wallets. In the end, we will be paying more, through either taxes or higher premiums.

And don’t forget that the price of treatments such as surgery almost surely will climb as there’s more “third-party payer,” so our taxes and premiums will climb by a lot more than what it cost to provide these services today.

But that’s only part of the story. Since government is picking up the tab, that gives politicians a green light (at least in their minds) to pass laws and rules designed to control and influence our behavior.

…expanded Medicare and insurance coverage socialize the cost of treating obesity, thereby inviting all manner of government mischief. After all, if being fat is not our fault, the blame must lie with food companies, advertising, or other things that need to be regulated. And if you and I have to pay for the food and exercise choices of others, we should have a say in those choices. Already, Harold Goldstein, executive director of the California Center for Public Health Advocacy, has cited the AMA declaration to boost his group’s efforts to ban junk food and tax soft drinks. …The nanny state can now claim medical backing.

Mayor Bloomberg doubtlessly thinks this is a wonderful idea. Maybe he can ban snack food as well as 17 oz. sodas.

Heck, why not have a cop in every house to make sure we consume 5 servings of fruits and vegetables every day? Actually, I shouldn’t say that too loud. Given the Supreme Court’s Obamacare decision, there’s apparently no limit to the federal government’s power to control our behavior through the tax code, so I’d hate to give politicians any more crazy ideas.

If you think I’m engaging in a bit of hyperbole, just remember that New York City already has gone after bake sales for peddling sweets.

So what’s the big picture? Mike nails it, explaining that the medicalization of obesity is symptomatic of the effort to undermine individual responsibility.

Much of public policy these days seems designed to eliminate personal responsibility. Take efforts to reduce poverty, for example. How much of poverty is due to poor lifestyle choices? We don’t want to blame the poor, nor should we forget that there are those, especially children, trapped in poverty by circumstances beyond their control. But we also know the keys to getting out of or staying out of poverty: (1) finish school; (2) do not get pregnant outside marriage; and (3) get a job, any job, and stick with it. Unfortunately, much of the welfare state we have constructed is perversely designed in ways that end up encouraging destructive behaviors.

In other words, the welfare state hurts the poor, as Thomas Sowell explained the other day. Though I suppose fairness requires me to admit that there are those who benefit from all the various income-redistribution programs. A vast army of bureaucrats get very comfortable salaries to administer these program, and these poverty pimps, as Walter Williams describes them, enjoy much higher levels of compensation than they could earn in the economy’s productive sector.

But I’m guilty, once again, of digressing. Let’s get to the rest of Mike’s final point.

Big government reduces all of us to the status of children. We have no responsibility for anything in our lives; therefore, government must take care of us. All we have to do, like children, is give up the freedom to make our own choices — good or bad.

Amen. A “good choice” isn’t good if it’s the result of coercion. Paternalists sometime have admirable goals, but they err when they want to turn big government into big daddy and big mommy.

P.S. Several readers have noticed that I’m now writing one post a day instead of two and have asked whether this is a permanent change. The answer is yes. With all the other things I’m trying to juggle – researching and writing, dealing with Capitol Hill, talking to the press, giving speeches, etc – this seems like the best way to allocate my time. Particularly now that my posts tend to be a lot longer and more substantive than when I began blogging.

P.P.S. Since we’re on the topic of obesity, it goes without saying that our real problem is bloated government, not bloated people. Which is why I always enjoy cartoons that portray DC as the true home of gluttony. For good examples, see here, here, hereherehere, here, here, here and here.

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Whether they’re banning bake sales, federalizing school lunch menus, or criminalizing Big Gulps, the nanny-staters feel they have some special wisdom that gives them the right to tell other people how to live their lives.

This irks libertarians since we value human liberty, even if it means people sometimes make foolish choices. But so long as you’re not interfering with someone else’s rights, we don’t think government should dictate your private behavior.

Parternalists obviously disagree. For a very reasonable explanation of this mindset, here’s some of Cass Sunstein’s work, as excerpted by The New Republic.

What seems to unify paternalistic approaches, however diverse, is that government does not believe that people’s choices will promote their welfare, and it is taking steps to influence or alter people’s choices for their own good.

In other words, people are sometimes dumb and the government at the very least needs to nudge them in the right direction.

Sunstein outlines the objections to this approach, largely focusing on the fact that the market process will discourage bad behaviors.

To the committed antipaternalist, government should not short-circuit the valuable process of learning by doing. If people make mistakes about diets, drinks, love, or investments, they can obtain valuable lessons, and those lessons can make their lives a lot better. …In a market economy, companies compete with one another, and people are free to choose among a wide range of options. If a car has terrible fuel economy, and if it costs a lot of money to operate, fewer people will buy it. As a result, companies will produce more fuel-efficient cars. Some consumers may be fooled or tricked, but in the long run, free competition and open markets will help. On this view, paternalism presents a major risk, because it may freeze the process of competition.

Not surprisingly, Sunstein argues that the market process is sometimes inadequate.

…even if we are inclined to think that individuals are generally the best judges of how to make their own lives go well, the word generally is important. With that qualification, we can see that the objections to paternalism depend on some empirical judgments. …The relationship between freedom of choice and welfare is being tested, with complex results. Sometimes people’s means do not promote their own ends. Behavioral economists have identified a number of reasons that people’s choices do not always promote their welfare. …sometimes we fail to take steps that really are in our interest. Human beings often procrastinate, and the long-term may not be so salient to us. We can be tempted by emotional appeals. Sometimes we do not take steps that would make our lives go a lot better. If welfare is our guide, means paternalism might be required, not forbidden.

To be fair, Sunstein recognizes that many antipaternalists are motivated by freedom, not some abstract measure of human welfare.

Suppose that we are not so focused on welfare and that we believe that freedom of choice has a special and independent status. We might think that people have a right to choose, even if their choices cause harm, and that government cannot legitimately intrude on that right, even if it does in fact know best. …Many of the most deeply felt objections to paternalism are based on an intuition or judgment of this kind. They often take the form of a question: By what right can government legitimately interfere with the choices of free adults?

This passage captures my view.

I actually agree with paternalists in that there are lots of people who make bad choices. I think a major problem is that these people over-value the positive feelings they get from “bad” behaviors today and under-value the harm  that those behaviors will cause in the future.

At the risk of making a sweeping judgement, I even think the biggest barrier to upward mobility is that some people don’t have a properly developed sense of deferred gratification.

So I think paternalists often are right, but I disagree with the notion that government should coerce people and impose “good” choices. Simply stated, freedom and liberty matter to me.

To butcher a very important quote, “I may disagree with your decision to smoke cigarettes and guzzle 32 oz. sodas, but I will defend to the death your right to do so.”

Actually, to be perfectly honest, I won’t defend to the death your right to be foolish. But I’ll surely write a snarky blog post.

Let’s close by acknowledging there are some gray areas. What about the idea that government can “nudge” us to make better choices? A classic example is a government rule to automatically sign new workers up for things such as 401(k) plans, but then give them the ability to opt out.

I don’t want government to interfere with private employment contracts, but that type of policy is obviously not nearly as objectionable as banning Big Gulps.

And you can come up with other proposals that might even pass muster with rabid libertarians. If a high school has a consumer finance class that teaches people about compounding and present value, that presumably will nudge them to be more pro-saving.

Is there anything wrong with that? Probably not, though we hard-core libertarians would argue that such lessons presumably would be part of the market-based education system.

In other words, there’s a reason why our answer to just about every question is “less government.” Not only is that a good philosophy, it’s also the way of getting the best results.

P.S. If Sunstein’s name sounds familiar, it may be because I have criticized him for endorsing more redistribution based on FDR’s awful Economic Bill of Rights.

On the other hand, I have favorably cited his research to show that too much regulation can cause needless deaths.

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