The more I think about this one the more complicated it gets. OTOH, a lot of what the government does to prevent and treat what are called non-communicable diseases (like cancer, diabetes, anorexia, Alzheimer’s, and hypertension) is widely supported by most Americans. The public loves govt funding basic research on chronic diseases, Medicare and Obamacare subsidies, and govt-enforced safe food and water.
But, when Americans perceive that other people’s illnesses are due to poor lifestyle choices things get controversial. How far should, for example, regulation and taxpayer-supported health insurance go in protecting people from their own bad choices?
It’s not just a moral judgment, either. As the first article below points out, it is hard to attribute many chronic conditions to specific behaviors. This is true even for health problems they’ve been studying for decades like cancer and diabetes and (it seems to me) is probably even more true for behaviors that public policy is newly targeting, like obesity. How can we know what interventions are cost-effective if we don’t know how a lot of the science works?
Oh, and what constitutes a bad lifestyle “choice” exactly? Not all decisions about what to eat and where to work and live are equally voluntary, especially for children but also in a sense for people too poor to afford healthy choices.
Along with these issues, here are some other basic questions we might consider on Monday. I will be back from my vacation, BTW.
DISCUSSION QUESTIONS –
- Rationale: Why should the govt try to prevent/minimize bad lifestyle choices?
— Why: General public interest? Externalities (effects on other people)? To help the economy? To prevent needless suffering? To fulfill international obligations?
— When: Scientific uncertainty.
— Who: Federal govt v. state/local concern?
- Targets: Which behaviors?
— Smoking/drinking, other drug use and vices.
— Diet: Obesity/sugar, child nutrition/school lunches, “food deserts” in poor areas.
— Violence and accidents: Guns, hazards. At work/home.
— Health care: Insurance, Obamacare carrot and sticks.
- Tools: It’s not just regulation.
— Information and advocacy.
— Market regs: Restrictions on buying/selling, food service, product safety regs, etc.
— Health care.
— People under govt control: School kids, prisoners, soldiers…
- Limits: How much govt action is too much?
— Who should decide?
— Where has govt gone too far or should do more?
SUGGESTED BACKGROUND READING –
- Problem #1: Experts don’t exactly know how lifestyles and health are related. Recommended.
- Problem #2: It’s hard to know which govt interventions change people’s lifestyle choices. Recommended
- General issue: Who should pay for individuals’ increased health risks? Recommended.
- School lunches: Michelle Obama did a lot to make them healthier and Trump is reversing it.
- Health care: Many conservatives oppose paying for health care for lifestyle-linked diseases. A rebuttal is here. Both.
NEXT WEEK: Does foreign aid work?