this is why they hate us, people (or, how NOT to sell liberalism)

Economist Noah Smith has written what must be a deliberately provocative piece for the Atlantic suggesting we use the awesome power of the federal government to make ourselves less fat:

Government paternalism is in some sense a last resort, but it has worked wonders in the realm of public health in the past. Hand-washing regulations, sewage treatment regulations, cleanliness education, and other such paternalistic initiatives brought us out of the cesspool of the Middle Ages into the clean, safe, mostly disease-free paradise in which we now reside. Fat, though not contagious, is no different in terms of its ability to cripple and kill our citizenry, and the epidemic has reached emergency proportions.

Of course, this compact history of successful public health measures demonstrates exactly what the proper reach of government is. Where an individual’s behavior would create public health externalities — usually in the form of infections, but there are other examples, like second-hand smoke — then the government should act to mitigate or eliminate the externality. So we all agree that it’s a good idea for the guy making the tacos to wash his hands after he uses the bathroom, not because we care whether he gets sick, but because we don’t want him making us sick.

It’s far less clear, however, that we should use the power of government to interfere with individual behaviors that primarily harm the individual himself. So, for example, a tax on skis to discourage skiing injuries seems rather too intrusive, even though there are real costs to society from skiing accidents (deaths, costs of medical, missed work, etc.).

A more borderline case might be one in which the proposed remedy — say, mandatory vaccines — would have health benefits for both the individual and the community. But even here, requiring individuals to be vaccinated — or, somewhat less drastically, forcing them to pay a tax if they don’t get the vaccine — still seems like a drastic and unwarranted intrusion on bodily autonomy and personal liberty, even if the social value in having 100% vaccine compliance is very high.

Smith proposes three possible government solutions to the obesity epidemic: more aggressive food labeling, heavy taxation on obesogenic foods, and public health education campaigns.

Probably only taxation really presents a personal liberty problem, but all three proposed solutions have a similar weakness: namely, we still don’t really know what has caused the obesity epidemic, what the ramifications of fat for public health might be, or how to reverse either the trend or its consequences. So, for example, various theories to explain the last three decades’ fat epidemic have included:

  • decrease in exercise
  • increase in restaurant portion sizes
  • increasing amounts of hidden sugar in food, especially “low-fat” food
  • fat acceptance leading to decreased incentive to control weight
  • obesogenic environmental pollutants
  • bad eating habits formed in childhood/more permissive parenting, especially when coupled with…
  • increasingly aggressive advertising of junk food aimed at children
  • problem of plentiful food supply — perhaps we used to live closer to starvation and so aren’t built to self-regulate calorie intake
  • food manufacturers have figured out a secret trifecta of flavors — basically, sugar, fat, and salt — that overcome our willpower

Some of these are more compelling than others. (The exercise hypothesis, in particular, is starting to look like a bust — people exercise more than ever, and they get fat anyway.) But the fact that so many theories have been floated, and none of them has really been proven with the kind of certainty that we can invest in, say, the germ theory of disease underlying many other successful public health campaigns, should give us pause. What if our well-intentioned paternalism ends up making things worse, or creating new, unforeseen public health problems? In the absence of clear evidence that a particular intervention will really improve the public health, we should be leery of diving in with government “solutions.”

(There’s also some question of whether fat, per se, is actually bad for you, or whether some other, more fundamental health condition is the real epidemic, obesity being merely one symptom of that health condition.)

Finally, Smith notes that, culturally, Americans don’t like being told what to do:

In 2008, Japan’s diet passed a law designed to combat “metabolic syndrome,” which is known to Americans as “pre-diabetes.” The so-called “Metabo Law” requires overweight individuals, or individuals who show signs of weight-related illnesses, to go to dieting classes. If they fail to attend the classes, the companies that employ them and/or the local governments of the areas in which they live must pay fines to the federal government. In addition, companies with more than a certain percentage of overweight employees are fined directly.

Americans, of course, would never submit to this sort of violation of personal liberty…. But in this case, it is clear that the two different value systems have led to radically different outcomes in terms of the health of the populace. Japan has succeeded in keeping its people largely thin. America has not.

Apart from being an unconscionable oversimplification of the incredibly difficult task of comparing health outcomes in different national populations, this points up perhaps the most important reason for liberals to stop going around proposing soda taxes: it distracts from the main game. It gives the Sarah Palins of this world ammunition, and it makes us sound like exactly what Republicans always claim we are — a bunch of fussy busybodies who want to micromanage other people’s lives. And when we have to fight that kind of bullshit characterization, we become less effective at getting our other, more important proposals a fair hearing.

And guess what? If we keep our eye on the big picture — reducing inequality and ensuring universal access to quality health care — the fat thing will largely take care of itself. Health outcomes, including obesity, are closely tied to income and social class. Fix that — fix the corrupt plutocracy, allow the middle class to expand again, facilitate a return of the living wage, and, above all, give everyone access to the preventive medical care that really maintains good health — and we won’t need to hover over people tsk-tsking their lunch choices.

Fix the problem. Fix the problem. Fix the problem. Stop dicking around, stop giving the other side ammunition, and fix the real problem.

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