Avalanching Down the Slope

by Don Boudreaux on January 17, 2010

in Food and Drink, Health, Hubris and humility, Nanny State, Regulation, Risk and Safety

Here’s a letter that I just sent to the New York Times:

Writing in support of Mayor Michael Bloomberg’s effort to force Americans to eat less salt, Gerald Glasser asserts that “the first and most important step in addressing health care in the United States is to do whatever we can to make Americans healthier so they need less care, thereby reducing the cost of the system” (Letters, Jan. 17).

This attitude is frightening.  If America’s current quasi-socialization of health-care justifies government telling us how much salt we may eat, where does such intrusiveness end – especially if government socializes health-care even further?  What’s to stop officious politicians tomorrow from enacting other measures that would likely improve Americans’ collective health – such as forcing each American to spend a few hours every week in the gym, or outlawing sports such as hang-gliding and rock-climbing, or requiring that all aspiring parents be genetically tested before they are approved for procreating, lest genetic diseases that raise “the cost of the system” be passed on to children?

Sincerely,
Donald J. Boudreaux

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  • udctrox
    I guess there's nothing wrong in providing information about the correlation between high blood pressure and salt intake. The government has no right to encourage or discourage certain healthy/unhealthy practices using taxpayer money.
  • johndewey
    I certainly abhor government restrictions on either diet or other personal activity decisions. I am also irked by the socialization of the health care. But I'm also realistic. Given that taxpayers are on the hook for medical expenses of the elderly, does it make sense for taxpayers to fund research and education programs which might reduce such expenses? I would prefer private market solutions, but I'm not sure the incentives are there.
  • Under laissez faire each person bears the cost of his chosen lifestyle. As Ludwig von Mises never tired of pointing out, there is no logical stopping point for socialist policies. Each intervention creates unanticipated adverse consequences that require a new intervention...until the entire economy is socialized. BUT, it doesn't stop there! Since socialism doesn't work, civilization collapses! The only reason the Soviet Union lased as long as it did was due to Western aid. But when the West itself commits to socialism, there is no one left to prevent collapse.
  • MikeRulle
    I find that if we can imagine it, the Government will eventually propose it. So, yes to your "hypotheticals" on hand gliding and genetic testing. We will see taxes proposed on all kinds of behaviors.
  • ArrowSmith
    I'd love to see politicians force the inner city ghetto dwellers to eat properly. You know those people eat fast food and shop at 7-11. Why are they lecturing the rest of us who eat more responsibly?
  • Gil
  • ArrowSmith
    Talk about racial stereotypes!
  • Skipper_C
    Been a lurker for a while, but I thought this was humorous and relevant:

    http://www.youtube.com/watch?v=6AitHxiOGSs
  • deweaver
    If you get the primary journal references, you find out that radical changes in NaCl (salt) consumption makes a relatively small change in blood pressure (only about 6 mm Hg depending upon the study). As someone with hypertension, my ACE inhibitor changes by BP by over 20 mm Hg.

    The primary references in the journals also show that reduced BP by salt reduction doesn't seem to impact actual health outcomes. If you tried to get FDA approval of what the political class wants to do about salt, not having actual outcome data would force a rejection of the application.

    I could also get into the relevance of Na/K ratios and the ratio of total Na+K to water.
  • esoxlucius
    Socialized Healthcare is a trojan horse for fascist control of our lives. I have had this conversation with some of my friends that are still bullish on Obamcare. It's fun to see their heads explode when after they suggest that risky behavior needs to be regulated you suggest that the government regulates unprotected homosexual sex. After all if fat people and salt eaters can be regulated because of the risk and cost to the system then surely so should people that run a disproportionate risk of contracting AIDS.
  • geoih
    Health care reform, wellness programs, prohibition, etc., are all the new wave in totalitarianism, and soon to be the politically correct eugenics of the left. If it's OK to control what people put into their bodies as food or otherwise (e.g., tobacco smoke, transfats, salt, etc.), then why would contorlling sex be any different? It's just putting something different into your body which could result in higher health care costs.
  • esoxlucius
    Well that's kind of my point. As a libertarian, I can't stand the totalitarian bent this country is headed down. However, the best weapon to change minds is to show the totalitarian how their viewpoint could easily be used to crash into their political correctness. They love the idea when it is fat people you are lording over, but they hate the idea when it is gay people you are lording over. All you have to do is ask them how the two things are different. If they can't explain, then they lose the argument.

    Bump, set, Spike.
  • geoih
    Lording over fat people and/or gay people is just the beginning. What about people with genetic issues, or people with a family history of cancer, heart disease, arthritis, diabetes, etc.? Why stop at potential medical issues?
  • RL
    If the government has the power to force people to stop doing things that harm them, surely they should outlaw voting...
  • J Mauad
    Because of low consume of iodine, perhaps Americans should eat more salt, not less. See this article:

    http://www.lewrockwell.com/miller/miller20.html
  • martinbrock
    Iodine is an artificial additive to salt. If you need more iodine in your diet, you can take an iodine supplement.
  • Billy P
    It should be noted that Bloomberg's initiative is voluntary and involves no legislation.
  • Like the trans fat one? Oh wait...

    This won't stay voluntary for long.
  • eventually we'll have to impose death at retirement. Not contributing? Goodbye.
  • magilson
    This brings to mind a book I was fortunate enough to read for middle school. The Giver, while not exactly the same conveys the same idea.
  • mariorizzo
    An additional issue that concerns me is that economists (even Gary Becker) have used the term "externalities" to refer to the costs that people who don't take "proper" care of themselves impose on public health systems, like Medicare or Medicaid. It is undeniably true that in some cases (perhaps not cigarette smokers who simply die earlier) bad health habits increase healthcare costs and this the burden on taxpayers. But this is an artifact of legislation that mandates a certain interdependence. It creates a *pecuniary externality* along the lines of a compulsory participation in a "market." It is somewhat like my being forced to buy insurance from a provider that must cover people of all risk profiles. (Oops that is just what ObamaCare amounts to!)

    The system also creates some degree of moral hazard, at the margin, insofar as people have less incentive to take care of their health if ex post healthcare is guaranteed.
  • Does a poor life style actually increase lifetime health costs? With the big health cost hit being in the last 6 mo of life, really out of shape overweight diabetics with clogged arteries may die faster, thereby saving money. Perhaps your health directives are more relevant to lifetime medical cost than your life style.

    We will all die sometime and the shorter your lifespan from poor habits, the less time to spend medicare and collect SS. Someone who bicycles 50 to 100 miles a week, eats well, etc. may live long enough for more than one 4 X heart bypasses plus have a body in good enough shape to go on for years after his brain is lost to Alzheimer's.
  • johndewey
    "With the big health cost hit being in the last 6 mo of life, really out of shape overweight diabetics with clogged arteries may die faster, thereby saving money."

    I'm not sure that big cost hit is so great for most of the population. On average, end of life care is enormous. But I think diabetics who cannot change their lifestyle are much more likely than healthy Americans to incur such expensive care. Furthermore, it is not just at end of life that overweight people incur higher medical expenses.

    According to the medical journal Orthopedics Today:

    "Being overweight or obese has been reported to increase the risk of orthopedic complaints such as osteoarthritis, tendinosis, bursitis, overuse syndromes and surgical complications."

    The National Cancer Institute reports that:

    "obesity increases the risk of cancers of the breast (postmenopausal), endometrium (the lining of the uterus), colon, kidney, and esophagus"

    Not all treatment for orthopedic, cancer, and other obesity-related health problems occur at end of life. Obesity causes medical expenses to be higher in total, even though life may be shorter.
  • Dallas
    John,

    Yes, if you are out of shape you will have more things going wrong at a younger age, but we all will die of something. If someone was 350 lb and had a 90+% blocked arteries in his heart, their chances of a fatal outcome or complications leading to a fatal outcome are a lot higher than mine were. They wouldn't go through the post bypass exercise program and start bicycling 50 to 100 miles/week. They wouldn't continue to collect SS for another, hopefully, 20 years then die when everything falls apart anyway. The worst outcome is the brain going and the body being in good shape, being economically milked by the medical system as a cash cow, connected up to equipment keeping the body alive as long as possible.

    The real question is "what is the total cost to society (both SS, SSI and medical) for obesity and other poor behaviors"? Even with a large discount rate on the future value of money, delaying the inevitable fatal outcome for 5 or 10 years while paying SS or SSI still may be a loosing proposition for the tax payers.
  • johndewey
    "if you are out of shape you will have more things going wrong at a younger age, but we all will die of something."

    If a person is obese, he is likely to have more serious health problems over his shorter life than will the average person who maintains a healthy lifestyle. Yes, we all die of something. But that doesn't mean we all incur a million dollars and more of health care expenses.

    I object to your initial speculation:

    "really out of shape overweight diabetics with clogged arteries may die faster, thereby saving money"

    because I have known too many such diabetics. Their medical expenses were enormous, but neither they nor their heirs had to directly foot the financial bill for their lifetime of unhealty living.
  • Dallas
    if the reports of most of the lifetime medical costs being in the last 6 mo of life are true, the ability to die faster that goes along with diabetic patients multiple problems could still decrease total costs. That ability to die faster may also decrease the probability of mental failure with its associated huge costs.

    Diabetics do, statistically, die younger and obesity increases your probability of type 11 diabetes along with increased heart, liver, kidney and circulation problems. However, once you start on the slippery downhill to the grave, multiple failures combined with multi-drug interactions may make the trip much faster, thereby cheaper.

    It is not even clear that you need to include SS and SSI costs in the equation to show that being obese is irrelevant to health care costs.
  • johndewey
    Well, Ok. You've changed the question from:

    "Does a poor life style actually increase lifetime health costs?"

    to

    ""what is the total cost to society (both SS, SSI and medical) for obesity and other poor behaviors"?

    I stand by my reply to your first question. I have not researched your second question.
  • indianajim
    "even Gary Becker"?

    Yes, I agree with mario that it is unfortunate that Becker does not seem to be as sharp as HE WAS when he won the Nobel? For another example, read his theory about restaurant pricing in the JPE in 1991 with the roller coaster shaped "demand curve" center staged. The hypothesis fails Milton Friedman's test that a theory's implications should not be wildly at odds with observational reality; when demand slopes upward all standard comparative static results reverse themselves (a critique spelling this out can be found in EJW). The younger version of Becker, in the 1970s, made sensible statements about the law of demand being the bedrock of economics; the older Becker, not so much.
  • Once you win the Nobel, there is nothing to constrain you from saying what ever you want to say. If I Nobel laureate came out promoting cannibalism, there would be more than a few people jumping on all the while saying, "How can he be wrong, he has a Nobel!"
  • indianajim
    Appeals to authority ("How can he be wrong, he has a Nobel") get short shrift in venues like this one, and EJW! The extent to which these effectively constrain nonsensical Nobelists, and other elites peddling defunct ideas, will be known only over time; the precise nature of the emerging order is unknown and unknowable. Hope, as the saying goes, however "springs eternal"; so be of good cheer!
  • ArrowSmith
    That's one of the reasons I like this blog community - appeals to authority do not count here.
  • bowenj10
    Has anyone taken on the claim that the claim that x externality imposes x costs is wrong? Is anybody even aware of it? It is the only one of its kind that I know of and I haven't seen any rebuttals as of yet. Perhaps someone who is more capable than I am of understanding the concepts in this study can take a look at it.

    Assuming it is somewhat accurate, I can certainly see how this study might lead one to believe that a better public policy vis-a-vis poor dietary and exercise habits might be to encourage bad lifestyle choices rather than to discourage them (this study doesn't appear to account for increased productivity as a result of better health during the productive years, but that's the only large problem I see with it insofar as its being useful for such an argument).
  • LiamH
    Living in the UK I am well used to hearing the argument: "we must do something about health problem X because it is placing a strain on the resources of the NHS."

    Being cynical I would say that the ultimate end of health care reform is control of the population.
  • vidyohs
    Well yes, and not cynical at all, just observant.
  • Easy to see why. The current furore about minimum alcohol pricing is allegedly to protect the NHS from the danger of an alcoholic nation, but in purely financial terms drinking alcohol brings more money into the exchequer than will be spent by the NHS on alcohol-related injuries - including things like walking into a door, or falling off a bar stool. The difference being that drinking is an easy target for a dishonest political class, and the NHS is the sacred cow.

    We all know statists can't add up properly, but this really is a moral crusade. Americans beware!
  • bowenj10
    I couldn't but help remember this article in the Christian Science Monitor: http://www.csmonitor.com/Commentary/Opinion/200....
  • Economiser
    Well said. Why does the total cost of the "health care system" matter? Do we talk about reducing costs of the "food system" or the "clothing system" or the "high-tech system?"

    Total cost only matters if health care is socialized. And with that we get rationing and control and favortism and all sorts of socialist evil.
  • Janza44
    You have to remember that these politicians are much smarter than we could ever hope to be. They have infinite wisdom and we need to do what they say because we obviously cannot make decisions on our own.
  • ArrowSmith
    Of course they are.
  • brotio
    Hehe, that's a pretty good muirdiot impersonation.

    He'll be on soon to tell us that only politicians can know how much liberty a man needs in order to be free, and that we should just shut up and stop eating so much salt.
  • Yes, it is an interesting concept, isn't it? Campaign for universal healthcare, but insist that some behaviours are too expensive and need to be stopped. So it's only universal if you fit in where the government thinks you are eligible. Otherwise do as you're told and be grateful for what you have.

    If they wish for an American NHS, that is what they'll get.
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