Posner’s Argument for Paternalism
I am not particularly interested in saving the obese from themselves. I am concerned about the negative externalities of obesity — the costs that the obese impose on others. Some of the others are the purchasers of health insurance and the taxpayers who pay for Medicaid and Medicare and social security disability benefits. Though the obese die on average earlier than the non-obese, which reduces their average health costs somewhat, the reduction is more than offset by the higher health costs that they incur (and by incurring impose, to a considerable extent, on others) because of the effect of obesity on chronic health conditions such as diabetes, heart disease, and joint problems, on mobility generally, and, because of these conditions, on ability to work (and hence on social security disability costs) and on employability (and hence on unemployment insurance costs). Obesity kills, but slowly, and en route to dying the obese run up heavy bills that, to a great extent, others pay.
Think of the history of cigarette regulation. That smoking is unhealthful was discovered early on. (Oddly enough, the pioneers in discovering the link between smoking and lung cancer were doctors in Nazi Germany, and the Nazi government actually campaigned to discourage smoking.) But the initial steps to discourage it in this country were tepid — polite warning labels on cigarettes. Later, warnings were required in ads as well. Then the warnings in both labels and ads became scarier. Cigarette companies were sued for concealing the dangers of smoking. Zoning ordinances imposed increasingly tight restrictions on where one could smoke. The federal government banned smoking in federal buildings. Cigarette smoking fell, from an average of 40 percent of the adult population in the 1970s to 19 percent today. There is some grumbling about this massive governmental intrusion into consumer choice, but very little. I certainly am not grumbling about it.
Looks the like obese people are getting to heavy for the system to keep holding them up, and the folks who have to do the holding are getting tired of it.
A complex issue, and, as healthcare stands now, I have agreements with both sides.
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Do you think Posner is referring to the negative externality you experience when, after boarding your (full) flight bound for Tokyo, you discover your middle seat is between two obese people — neither of which can actually fit in their assigned seat?
The key to this issue is to convince people to stop engaging in activities that lead to obesity without banning said activities. When things get banned, people get angry, and the actual outcome rarely has the desired effect. A step in the right direction might be to require fattening foods and drinks to have obvious warning labels on them, particularly if we are going to compare the obesity epidemic to smoking and follow smoking’s history. Personally I would be a lot more hesitant to pick up a bag of chips that said “These will make you fat” on them.
Alexis is right.
When I am banned from smoking my pipe in certain places I tend to get angry, smoke somwhere else, and plot ways to bring down the nanny-state. When I see the warnings on the package my tabacco comes in, I’m more likely to sit and think about what I’m doing. more than once its convinced me to put down my pipe and save it for later.
Education is more effective than blanket bans.
While I think Alexis is right (I would definitely be unlikely to eat a bag of chips that say “these will make you fat” on them), I think there are a lot of reasons why warning labels are unnecessary and potentially disruptive. For example, I am not obese and I eat healthily, but occasionally I do enjoy a bag of greasy potato chips. I really don’t want to look down at my bag and see ‘these will make you fat’ as I’m trying to enjoy my salty treat. Furthermore, do we really need a warning label to tell us that chips make us fat? I sincerely doubt that obese people are ignorant of the fact. They know it, and they decide to eat them anyway. Fundamentally, this comes down to a question of the extent of government involvement. Is it really their place to monitor not only what we eat but also its packaging? It seems to me that lifestyles must and should be changed by an individual’s intrinsic decision to eat healthier, not by more government regulation.
@Alex, clever use of the pun, but probably meaningless.
As for the externalities bit, don’t you think Posner could get farther with people if he didn’t begin the second paragraph with “I am not particularly interested in saving the obese from themselves.”? Couldn’t he have just left that out?
By the same token, @Studebaker, wouldn’t you be more effective if your complaints regarding obesity didn’t just involve how much room you have on an airplane?
@Lucius, is that really what happens!? At first I read that and thought you were being sarcastic and then I read it again… You know what happens when I go some place that doesn’t allow smoking? I get happier, patronize that place more often, then plot ways to make us all Nazi’s so we can have government propaganda against fatty foods.
That last bit, by the way, was sarcasm.
Has anyone considered the fact that obesity, like almost every other problem in this country, disproportionately affects poor people? I’m glad that one of our biggest problems is that poor people eat too much–it certainly beats the alternative–but has anyone ever stopped to consider why we have that very odd problem? After you ponder the CAUSE of obesity, I’d love to hear if you really think there is a solution that doesn’t involve government intervention.
Also, given that disproportionate effect, can we really say that education is the answer, given that low test scores are also disproportionately common among the poor?
@Alexis and @Gwenevere and @Lucius, you have all proposed we fix a problem that disproportionately affects the less-educated with…more education (but not if it means more government education, so the poor are gonna have to learn about health on the internet… oh wait, poor people have disproportionately less access to internet… well, shucks)
I don’t think, in other words, that your solution of more education is a solution at all.
If government instead spent health care dollars on building fitness centers, and then gave tax credits to obese people for losing pounds each time they checked out of the gym (which would be monitored remotely through a direct feed to the IRS), would that be a better use of public monies?
@ Brian,
My old BlueCross plan offered a fitness club deal, where enrollees could join a network of fitness clubs and workout at any of a number of participating clubs. BlueCross would track the number of times I checked in at the gym and credit fitness points to my Blue Account that could be redeemed for fitness items.
From policymaking perspective, this is truly a difficult situation. On the one hand, regulatig lifestyles–particularly those that can’t be criminalized–is not desirable. On the other hand, it is hard to ignore the social costs of personal choices.
Two things:
1. Smoking and obesity are incomparable issues in regards to public policy to fix them. This is because the relationship between smoking and adverse health outcomes is relatively transparent, whereas the causes and implications of obesity are much more difficult to understand. Just look at the number of diets out there (good carbs, bad carbs, no carbs, only carbs, only protein, no protein, no red meat, eat only cheese, etc.) and you realize that the science of avoiding obesity is far from settled. Of course, there are maxims that are relatvely free from contention (exercise is good; portion control is good), but these are few. Thus, government policy to reduce lung cancer was quite simple (get people to smoke less), whereas policy to save people from obesity would be muddled with what strategy to follow. And where there is uncertainty, the door is opened for lobbying and pressure groups (What about a corn-only diet?!)
2. I tend to agree with @Gwenevere on the whole about education: if they don’t know it by now, there’s really nothing you can do.
Also:
“I am concerned about the negative externalities of obesity — the costs that the obese impose on others.”
Numerous studies have found that the fact that obese people die at a younger age on average (as you mention) does in fact outweigh (lol) their higher health costs. Though you certainly disagree with their conclusions, I think it would be good to mention why and what scientific/statistical support there is for one side over the other.
@ david
Do we really need a solution to the obesity epidemic? Perhaps the question we should be asking ourselves is, does government really have any legitimacy at all in adwressing obesity? I think not.
Also, Where does government derive the legitimacy to control individual behavior that does not directly harm other individuals?
These are the questions that require answering for someone who wants a government-based solution that restricts liberty and choice.
I imagine you likely want smoking banned in all indoor establishments. Tell me why businesses and consumers can’t make that decision together, without government forcing them to. In the marketplace of ideas, you have to win that debate before you can propose a winning “solution”.
@Ambrose:
Good points, but keep in mind that the jury is still out on just how bad smoking is. There are those of us that will smoke every day until we are 90 and never miss a beat.
Joe Camel for the win.
@brian
“Do we really need a solution to the obesity epidemic? Perhaps the question we should be asking ourselves is, does government really have any legitimacy at all in adwressing obesity? I think not. Also, where does government derive the legitimacy to control individual behavior that does not directly harm other individuals?”
Honestly Brian, did you read the blog post? This commentary is taking place under the assumption that obesity DOES harm others in the form of a negative financial externality. While I dispute this claim, that is the framework for this discussion.
@Brian, as fate would have it, I dined at a restaurant last night that banned smoking entirely when it had previously been segregated; therefore I proceeded to “plot ways to make us all Nazi’s so we can have government propaganda against fatty foods.”
To answer your question, though, I believe I began my last post by suggesting that a solution to the obesity epidemic would be easier if we didn’t do so on the grounds of the many ways obese people harm us (such as airplane seats). In that statement, I acknowledged that perhaps there are ways in which obese people do harm the population, but if we try to solve the obesity problem only out of our self interest, then the obese will respond with their own self interest, which is apparently to be obese. If you show people that you don’t give a hoot about them, they will not give a hoot that you’re squeezed between them on an airplane–after all, you would be outnumbered.
Do you think segregation (while it was mostly mandated, you can imagine it wasn’t) would have ended in the south were it not forced upon them?
Also, the existence of “those of us” does not show there is not causation between smoking and poor health, but merely that there is variation (which would be expected among so many people).
@Ambrose
I understand the assumption – it looks like you’re trying to get me on a topicality-like argument. My comments are simply intended to question the reasoning of those who would argue that obesity harms others in the form of externalities and that such warrants paternalistic policies. I say such harm doesn’t warrant government intervention.
@david
Not to quibble, but there is no moral equivalency between segregation and the obesity epidemic.
On the smoking subject, yes it’s variation and indeed smoking does cause poor health for most people. But so do a lot of things. I’m not opposed to labeling, but excessive taxation and bans constitute oppression.
@Brian, I wasn’t suggesting a moral comparison (who do you think I am!?) but a pragmatic one, suggesting that businesses and consumers won’t always work things out the way you suggest, not in a timely fashion anyway. With the costs of obesity, I don’t think we have time to wait.