Continuing Assaults

by Don Boudreaux on December 3, 2007

in FDA, Food and Drink, Health, Nanny State

At a family gathering this weekend in New Orleans — as I enjoyed a rich, very yummy, and sodium-laden bowl of okra gumbo — I complained to a cousin about the recent calls to have the government force food-preparers to use less sodium.  Karol — sitting nearby and enjoying her own sodium-enriched Cajun dish — lamented with me the fact that our freedoms are increasingly under assault (pun intended).  But, she pointed out, the alleged justification for such intrusions isn’t so much a simple nanny-state itch to treat us as children but, rather, the need to control health-care costs.

Of course Karol is correct.  This "stop each of us from imposing costs on others" justification is typically used to support motorcycle-helmet regulations, smoking bans, and, now, eat-less-salt commands.  And as more and more of Americans’ health care is provided collectively, the ring of validity to such justifications increases in volume.  As Russ points out, if you’re paying, I’m ordering the expensive menu items.

If you are obliged to subsidize the costs of my behavior, then you clearly have an interest in restricting any of my behaviors that might potentially raise the costs you bear as my subsidizer.

But a question: if the proponents of greater collectivization of health-care provision not only recognize this fact but cite it as a justification for restricting personal freedoms that would otherwise be no one else’s business, it seems to follow that these proponents of collectivization of health-care provision would recognize also that the problem is so general that it indicts the very idea of collectivization of health-care provision.

Because such collectivization creates a giant tragedy of the commons – because such collectivization enables each of us at each moment of making health-care choices to impose most of the costs of our choices on others – such collectivization will require not only that government restrict our access to fun but unhealthy life choices (such as eating lots of Cajun food), but also restrict our access to medical-care.

So the idea that a young mother whose child has a runny nose will be able to skip off to the pediatrician pronto for a diagnosis and treatment is chimerical.  Just as collectivization of health-care provision will encourage people to eat too much sodium and too much bacon, it will also encourage people to seek medical treatment too frequently and too frivolously.  And in both cases, these attempts to free-ride on the largess of the collective will oblige the protectors of the collective to restrict personal freedoms and personal choices lest the collective be utterly ruined.

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{ 20 comments }

Randy December 3, 2007 at 11:31 am

No question about it. I can easily see tobacco products being outlawed entirely, along with high fat and high sugar foods. Obesity becoming grounds for mandatory counciling and social condemnation, if not fines and penalties. Mandatory exercise programs becoming the norm, first in the schools, then the workplace. And once on a roll, why not root out "unclean" activities of all sorts. I know, this is the worst kind of slippery slope argument – but I figure one is either for liberty or against it.

Nathan Benedict December 3, 2007 at 11:51 am

Very well put Don. This is my number one go-to answer when I need to defend my libertarian beliefs. The current most extreme example of this phenomenon is in China, where the communist government considers itself responsible for feeding and taking care of its citizens. The result of such a policy is that even the most personal decision–the size of one's own family–is dictated by the government, resulting in the horrors of forced late term abortions and female infanticide.

Interestingly enough, many of the heavily socialized economies of Western Europe are dealing with the opposite problem–not enough children to support the giant pension systems they have in place. So far, the measures they have adopted to counteract this have been non-coercive, but it will be interesting to see what happens when the problem worsens. Of course, due to immigration-phobia, the obvious fix to the problem of one country having too many people and another too few will never be implemented.

Brad December 3, 2007 at 12:24 pm

Time to perfect the sound bite then… "This universal health care thing is just your excuse for butting into our lives and taking away burgers, chocolate, beer, and cigars. Some of us enjoy those things and prefer that the state not have an interest in restricting them."

Could you imagine any politician saying that?

Chris December 3, 2007 at 12:43 pm

There's also an information issue here. I was generally aware that "too much" sodium is bad, but I had no real idea how much was "too much" or how much sodium is in most foods. Nutritional labels make it easy to find sodium levels on pre-packaged food, but restaurant food is another matter.

There are two potential regulatory ways to solve this: (1) Just say "thou shalt not …" or (2) force restaurants to include information about sodium levels in their menus.

If the only potentially unhealthy thing in foods were sodium, alternative (2) would make a lot of sense. But, if I should be worried about saturated fats, partially hydrogenated fats, high-fructose corn syrup, sodium, selenium, calories, nut protein and so on, I may rapidly get overwhelmed either by the information itself or by the difficulty in understanding what the various numbers mean. And, at that point, alternative (1) becomes more appealing.

This is one reason why many drugs are prescription-only: the information that people need to know about what's appropriate for them is so specialized that we'd rather turn over the decision-making to those specialists. (Plus, especially with antibiotics, narcotics and anti-psychotics, there are potential externalities to abuse.)

Maurice December 3, 2007 at 1:20 pm

Where does it stop? Do we restrict any potentially dangerous activity? Which foods really are bad for us? Can we go skiing anymore, since accidents clearly happen to skiiers. Ban corn dogs, all fried foods…all water sports, ice skating…and heck, even driving. All these have inherent risks, and ok, this is an ad absurdam argument…but who are the mandarins going to be that decide for us, what is healthy/unhealthy?

Don, I can tell you that the "average" citizen still does NOT understand that these nanny-state laws take away our freedom. They are sold the "we're just watching out for you" line, from the do-gooders and politicians, and do not stop to think of the consequences of these laws. When I bring up to them the loss of free choice…they stare at me, they don't initially get it. Sometimes they do figure it out, but more often than not, they've bought into the nanny-statism.

Methinks December 3, 2007 at 1:23 pm

That's all well and good, Chris, except there is no conclusive evidence that a high salt diet is dangerous to anyone who doesn't have other risk factors for high blood pressure. In fact, for endurance athletes, a higher salt diet is essential. In fact, there's no conclusive evidence that any one ingredient is responsible for obesity. However, there is conclusive evidence that too many calories cause obesity. So, perhaps we should have the government work out exactly how many calories are alloted to every individual and each individual will be prohibited from ever eating beyond that caloric limit.

the information that people need to know about what's appropriate for them is so specialized that we'd rather turn over the decision-making to those specialists. (Plus, especially with antibiotics, narcotics and anti-psychotics, there are potential externalities to abuse.)

And how are those government controls working? After minor surgery last year, I filled but did not consume a prescription for Vicadin. I could sell it right now to a drug addict (of course, I wouldn't). does it matter to an addict or to someone determined to take Vicadin instead of aspirin for a head-ache that it's not necessarily the best choice? It doesn't seem to. Even if you could prescribe food in the way that you prescribe drugs, there is nothing preventing a robust black market.

"The more you clench your fist, the more we will slip through your fingers."

Chris December 3, 2007 at 2:19 pm

Methinks -

Regarding your surgery, I don't suggest that limiting access to certain drugs perfectly accomplishes its goals. But, I don't need perfection — I just need moderate effectiveness. It seems clear that there would be more Vicadin addicts if the drug were available over-the-counter. (Some people would self-medicate with it in situations where a doctor would not prescribe it, and some percentage of those additional people will become addicted.)

Similarly, I also don't need "conclusive evidence" — i.e. 100% certainty — that's just too hard to come by. 80% may be enough for me.

Methinks December 3, 2007 at 2:52 pm

Chris, either you missed my point, or you are indeed suggesting that food should be prescribed like drugs – or both.

My point is that it's not possible to control other people's personal choices – especially what they choose to put in their mouth.

I'm troubled by your claim that if vicadin were sold over the counter that there would be far more addicts. Alcohol both widely available, tasty and consumed socially and we aren't suffering from an epidemic of alcoholism. What evidence do you have that Vicadin addiction will surge if it's not "controlled"? It doesn't seem clear to me at all.

"Conclusive evidence" is not 100% certainty. Further, you may not need conclusive evidence to exchange your liberty for more government intervention in your life, but I do. What do we do about that?

If you do go as far as prescribing rationing calories, how are you going to stop a robust black market in calorie credits? The "war on drugs", designed to squash the black market in illegal drugs has cost us trillions without success. However, drugs are not necessary for daily survival and food is. What do you suppose the cost of a calorie rationing system would be and would that cost be more or less than the current cost of obesity?

If you only want to force a limit on the amount of salt and other food products restaurants can use as ingredients, what's to prevent people from simply taking the food out of the restaurant and salting it or dipping it in grease (a.k.a, mayonnaise) at home? For that matter, how will you prevent home cooks from using all of those ingredients? Or will you really just outlaw them and force grandma to buy her Crisco in a back alley?

But let's assume that you're successful in your effort to eliminate the consumption of certain ingredients. Why wouldn't a person just over-eat other, non-contraband foods and become obese that way?

Mathieu Bédard December 3, 2007 at 3:03 pm

I'm wondering, and I don't want to sound like I'm very serious about this it is just a thought, if the huge amount of alcoholics in Soviet governed countries had anything to do with the way their health care was managed…

shawn December 3, 2007 at 3:15 pm

…or whether it had more to do with how their lives were managed in general?

Randy December 3, 2007 at 3:20 pm

From the Wik;

During 1985-1987 Mikhail Gorbachev carried out an anti-alcohol campaign with partial prohibition, [2] colloquially known as the "dry law". Prices of vodka, wine and beer were raised, and their sales were restricted in amount and time of day. People who were caught drunk at work or in public were prosecuted. Drinking on long-distance trains and in public places was banned. Many famous wineries were destroyed and plantations of grapes uprooted, often of precious cultivars. Scenes of alcohol consumption were cut out from the movies. The reform did not have any significant effect on alcoholism in the country, but economically it was a serious blow to the state budget (a loss of approximately 100 billion rubles according to Alexander Yakovlev) after alcohol production migrated to the black market economy. Coupled with inflation of the Soviet rouble, these restrictions had a curious economical side effect: a bottle of vodka had become a kind of "hard currency". For example, a handyman would replace a window for a certain, fixed, number of bottles of vodka regardless its current price in roubles.

http://en.wikipedia.org/wiki/Prohibition_in_Russian_Empire_and_Soviet_Union

Alan Gunn December 3, 2007 at 4:07 pm

I think you give the nanny staters too much credit for good intentions. Take smoking–it doesn't increase health-care costs, it lowers them, because smokers tend to die before they get debilitating but long-drawn-out conditions like Altzheimers. I've seen claims that smokers, on average, have health care costs about $10,000 less than non-smokers, per person. To be sure, the nanny staters say they want to control smoking to reduce health costs, but that's just an excuse: they want to control things, period.

I note with some dismay that the republican now leading in Iowa proposes a federal ban on smoking in public.

When's the last time you heard anyone say of the U.S. "It's a free country"?

Chris December 3, 2007 at 5:18 pm

MeThinks –

I think you're over-stating my position.

First of all, I think you've set up a straw-man on the Vicadin v. Alcohol comparison — I didn't say that you'd see a "surge" in Vicadin addiction (presuming that by "surge," you mean a large increase.) I just postulated an increase; I don't think that half the country would end up addicted. As far as the comparison with alcohol, I suspect that we have more alcoholics (per capita) now than we did during prohibition, when access was more limited.

Who talked about rationing calories or preventing people from salting their own food? The issue is that salt is often hidden in foods where it's unexpected.

Presuming that there's a decent consensus on how much salt is "too much," I think the appropriate policy would be to ban the sale of food items above a specific salt level unless the menu notifies patrons: "Warning! This food contains half the maximum amount of salt that the AMA thinks a typical person should consume in one day." If the food is targeted at children, then it should refer to the "typical child."

Frederick Davies December 3, 2007 at 5:25 pm

I have always found it very funny (or tragic) that one of the justifications Labour (notice the UK spelling here) put forward for the National Health Service was that even though it might be costly at first, as people would become more healthy due to their free access to medicine, the costs would diminish as the general health improved. For those of you who are not living in the UK or know about the NHS, let's say that the monetary benefits of free healthcare were greatly exaggerated.

Eric Crampton December 3, 2007 at 5:53 pm

Edgar Browning wrote the defining article on this issue. Public Finance Review, 1999 27:1: "The Myth of Fiscal Externalities". I've copied the abstract below, but it's massively worth reading the whole thing.

Many economists refer to phenomena whereby the behavior of people affects the cost of some subsidy or alters the revenues from some tax as externalities. The author refers to these as “fiscal externalities”; an example is smoking imposing costs on taxpayers due to the existence of subsidized medical care. This article shows that fiscal externalities do not necessarily imply any inefficiency, and when there is inefficiency, it is the result of the preexisting policy (the medical care subsidy) that creates the fiscal externality. Moreover, when there is inefficiency, the nature and magnitude of the fiscal externality is not a reliable guide to the appropriate corrective policy. For example, it will usually be best to modify the preexisting policy (the medical care subsidy) rather than tax smoking.

Methinks December 3, 2007 at 8:37 pm

Chris,

I never claimed that you said half the country would end up addicted to Vicadin if it were sold over the counter. You claimed that there would be more addicts. I assumed that you would need to see a statistically significant increase in Vicadin addiction before you called it a problem. We may have had fewer alcoholics during prohibition (I don't know), but did the benefit outweigh the cost?

The issue is that salt is often hidden in foods where it's unexpected.

Salt appears right on the label. Most restaurants salt to taste, don't measure portions exactly and don't measure exactly how much salt is in each portion. To force them to do that for salt and every other potentially harmful ingredient would be cost prohibitive.

Presuming that there's a decent consensus on how much salt is "too much," I think the appropriate policy would be to ban the sale of food items above a specific salt level unless the menu notifies patrons: "Warning! This food contains half the maximum amount of salt that the AMA thinks a typical person should consume in one day."

Given that sugar, salt, hydrogenated fat, saturated fat, and high-fructose corn syrup are just a few items on the "potential harmful to your health" list, how many warnings do you suppose a single menu could hold? But warning labels weren't your original suggestion.

Originally, you said: There are two potential regulatory ways to solve this: (1) Just say "thou shalt not …" or (2) force restaurants to include information about sodium levels in their menus.

If the only potentially unhealthy thing in foods were sodium, alternative (2) would make a lot of sense. But, if I should be worried about saturated fats, partially hydrogenated fats, high-fructose corn syrup, sodium, selenium, calories, nut protein and so on, I may rapidly get overwhelmed either by the information itself or by the difficulty in understanding what the various numbers mean. And, at that point, alternative (1) becomes more appealing.

You just wanted to ban any potentially harmful ingredient. Excess calories are also harmful – more harmful than any single ingredient. Since you propose to ban individual ingredients, how do you propose to handle calories? And would the benefits of all that banning outweigh the costs, because that's the test.

Actually, come to think of it, one of the largest factors in healthcare costs is age. What do we do about that?

Chris December 4, 2007 at 9:27 am

Methinks –

Well, so I meant my dichotomy to illustrate that, at some point, just providing information isn't particularly effective. I think my solution to the salt issue falls between the two.

Judging from what I've read in the news (and, I realize that the news tends to hysterically report any new medical finding as though the world were coming to an end), restaraunt food often has a lot more salt that a person would expect.

I make Bloody Marys and used to order them all the time at bars, until I ordered one on an airplane once, got a look at the can of Bloody Mary mix and realized that it had something like 140% of the USRDA of sodium. I knew they were salty, but until that point, I had guessed that it was 10-20%, which is about what mine are.

Now, if I'm the only person worrying about salt, it makes sense for me to just ask when I order food. But, there are a lot of people worried about it, and (if news reports are to be believed) there are a lot of people who would be worried about it if they were aware of it. If, indeed, restaurant food often contains more salt than people really expect, what is the correct public policy response?

More generically, if restaurants are hiding something bad into food to either make it taste better or to lower their own costs (at the expense of customer health), when and how does the government step in? What if it's arsenic or mercury and not salt?

Steve December 4, 2007 at 11:09 am

Chris,

How long will a restaurant stay in business that puts arsenic or mercury in its food?

At the margins, those that care the most about sodium content (such as those with high-blood pressure) will avoid eating at restaurants that do not provide information on Sodium content. Your solution would put good restaurants that do nothing more than cater to the tastes of its patrons out of business.

Steve

Chris December 5, 2007 at 11:17 am

Steve –

Who's talking about putting restaurants out of business? Under my suggestion, if they have a lot of sodium, all they have to do is mention it in their menu. If they're driven out of business by that, it will be because their customers, seeing that there's a lot of sodium, choose not to eat the food. It's almost exactly what we do with nut protein now.

In any case, my original point wasn't really about salt — I was just trying to point out that there are limit to the market-based solution of providing information and allowing consumers to make up their own minds. At some point, the amount of knowledge that you need to protect yourself becomes prohibitive.

In general, I think tort law goes a long way to solve the problem — if you put something dangerous in food and somebody gets hurt, you get sued. And, that's typically enough of a deterrent. But, that breaks down when the thing in the food doesn't immediately hurt your customer.

Methinks December 5, 2007 at 12:01 pm

You know, Chris, a very dangerous thing that restaurants put into their food EVERY day, right under our unsuspecting noses, is calories. Oh, they won't kill you right away! But, like mercury and arsenic, if you consume enough of them, they'll kill you.

Ask any expert and they'll tell you. Since the amount of knowledge you need to know to protect yourself from calories is prohibitive, we should really get government to step in and regulate those suckers.

Also, the amount you need to know about sleep is prohibitive, so we should have government controlled national "lights out".

acetaminophen kills more people annually than AIDS. We should definitely make aspirin and Tylenol prescription meds.

In fact, before we do anything or go anywhere, we should first ask permission from our government to make sure we can't possibly hurt ourselves in any way.

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