Bob Duffy Director of Ipsos Social Research Institute, is a true believer in governmental social planning. In an opinion piece in the Wall Street Journal he opines that people are now ready for the government to help us make the “right” choices that will benefit our health. He’s particularly interested in getting people to stop smoking, drink less alcohol, and exercise more – all of which are desirable though not by government fiat.
He writes: According to the World Health Organization, obesity alone is already responsible for up to 8% of health costs and 10-13% of deaths in Europe. In the U.S., the costs are even higher and the problem is set to get worse; by 2030 the health-care costs associated with being overweight and obese could account for up to 18% of total U.S. health-care spending.
He thinks that the public here and abroad is ready for new laws and taxes which will “nudge” us in the right direction – ie, the one he thinks we should go in. Let’s forget about the assault on individual liberty he seems so comfortable with and concentrate on what he wants to achieve. He thinks exercise will reduce obesity. Of course, unless you’re a lumberjack or a marathon runner it won’t. Only eating less will. Calculating how much obesity contributes to mortality is an exercise in fantasy. Obesity is so connected with other diseases that its contribution to death rates independent of these other diseases is the kind of meaningless invention the World Health Organization loves.
Here’s an example of the processes Mr Duffy thinks might prove useful: But in parallel to these relatively subtle approaches there are also growing examples of governments using straightforward laws and taxes in areas we wouldn’t have countenanced even a few years ago. For example, the Danish government has become the first in the world to impose a tax on junk food—more of a shove than a nudge, but still raising important questions about the border between personal and government responsibility. Just think, if we eat less junk food Medicare will be on the road to solvency.
But even allowing for this type of fairy tale there’s still another problem before us. Despite getting fatter, we are still living longer. If we were a nation of svelte fashion models we’d still be spending vast hordes of our national treasure on medical bills. Ninety percent of Medicare’s expenditures are on patients in the last year of their lives. Medical care is so expensive because we spend a lot of money taking care of old people. Reducing childhood obesity may be a good thing but it’s not going to help Medicare’s budget. Neither will getting thirty year olds to exercise.
Most of our medical dollar is spent taking care of old people with cardiovascular disease, strokes, chronic pulmonary disease, cancer, renal failure, degenerative joint disease, dementia, and a host of other age related catastrophes which are the inevitable consequence of growing old. If we are to reduce medical costs the government can’t do it by encouraging or even mandating better behavior which is what Mr Duffy advocates. There are only two ways that these costs can be modified down and the both have distasteful consequences. The first would be to eliminate aging and its associated diseases. Just delaying aging only buys a little one time relief. People would still age and gradually collapse. They’d do it at an older age but we’d still have to pay for the care associated with this slow motion decline. If aging and degeneration were prevented we’d save money on medical costs, but we’d have another social and political problem just as formidable to deal with. I’ll leave it to you to work this problem out.
As defeating aging does not seem to be at hand in the foreseeable future, the only way to deal with monstrous medical bills is to change the way we deal with the diseases of aging. Doing this, of course presents problems just as intractable as the ones we are trying to solve. Mr Duffy’s proposal to have the government save us from the badder angels of our nature is naive, paternalistic, and a misdiagnosis of our malady.
There may be no workable way out of the medical mess we’re in. The only solution may be to wait for this edifice to collapse and then to rebuild it. This is a terribly pessimistic view of where liberal democracy has led us. I hope it’s wrong even as I think it’s not.