Commentary

Private Matters and ‘Public Health’

This article originally appeared on TechCentralStation.com on February 6, 2005.

Obesity Policy Report has become a leading insider newsletter for lawmakers, regulators, food industry executives, and nutrition advocates. The following is a Q&A the publication recently ran with frequent TCS contributor and Cato Institute policy analyst Radley Balko.

OPR: You’re completing a white paper for Cato on obesity that will be published later this year. What’s your thesis?

Radley Balko: It’s an overview of the obesity debate, with an emphasis on personal responsibility and consumer choice. It will first make the case that obesity is fundamentally a private issue, not a legitimate “public health” issue within the purview of government. Second, it will examine whether the obesity problem is really as dire as it’s made out to be by activists and the media. Third, it will look at many anti-obesity initiatives and examine their flaws and features. Finally, it will make the case that the free market has done a more than adequate job addressing these problems, and I’ll make recommendations for how the government can help fight obesity by restricting its influence in the food marketplace.

OPR: From a libertarian standpoint, what’s at stake in the war over obesity, and the way in which government and special interest groups are trying to solve the problem?

Balko: Quite a bit, I think. The danger here comes with the one-two punch of an increasingly socialized healthcare system and an ever-expanding nanny state. More and more, we as individuals are being held financially responsible for the health and well-being of everyone else - your high cholesterol shows up on my tax bill or in my insurance premiums. When that happens, it becomes much easier for government to justify further intrusion into our choices as diners and consumers, on the premise that “we’re saving taxpayers money.” That’s pretty scary. We need to reverse both trends. We need to make healthcare more private and market-oriented. But we also need to let people make their own decisions about what they eat, and make clear that they and they alone will bear the consequences of those decisions.

OPR: You specialize in analyzing the “nanny culture.” With obesity, who are the biggest offenders, in your view — the biggest nannies? Government is often accused of being a nanny, but in the case of obesity, many special interest groups criticize it for not doing nearly enough.

Balko: I find that troubling — that there are those who think government hasn’t done enough. Many of the same groups pushing for more government action on obesity are also active on the anti-alcohol (Center for Science in the Public Interest comes to mind) and anti-tobacco (the Robert Wood Johnson Foundation comes to mind) fronts. There, we’ve seen them push some pretty severe restrictions on consumer choice, civil liberties, and due process. Given that they’re using many of the same arguments in the obesity debate that they’ve used in the tobacco and alcohol debates, it’s frightening to think what types of policies they might push down the road.

Where government has intervened in matters as private and intimate as what we put into our bodies, we’ve seen some pretty drastic and unintended consequences. The forbidden fruit effect has led to a scourge of underage binge drinking. Jurisdictions with high cigarette taxes have spawned black markets that fund crime syndicates and international terrorism organizations. And we’ve all seen the devastating effects wrought by the failed war on drugs.

OPR: In your opinion, what’s the worst thing the government could do to “fight” obesity?

Balko: The worst thing it can do is treat obesity as a “public health” problem or, for that matter, “fight” obesity at all. Government is too prone to the influence of special interest groups and congressmen out to promote the industries and agriculture of their home districts for us to trust it to dictate or influence something as important as our diet and our health. Look at the disaster that is the Food Pyramid. Look at the CDC’s infamous, bogus, “400,000 annual deaths attributable to obesity” statistic. Look at the ridiculous BMI system, where some of the world’s greatest athletes are lumped in with “obesity” figures.

We shouldn’t be restricting liberty even if science proves the most alarmist claims about obesity correct. But the science is all over the place. There’s lots of research coming out right now suggesting that all of this influence on weight may be killing people. It makes overweight people turn to dieting — which almost always fails — instead of focusing on becoming more active, which doesn’t do much for weight, but is far more beneficial for overall health than dieting.

The best way to ensure bad public policy is to pass reactionary laws at the height of a media frenzy. The president of the Robert Wood Johnson Foundation said at a conference last June that “we need to act ahead of the science.” I think that’s the single worst thing we can do. We should wait for the science to become conclusive, so we can be sure what we are doing isn’t unnecessary or, worse, counterproductive.

OPR: What’s the best thing government could do?

Balko: Get out of the way. The free market consists of hundreds of millions of people engaging in voluntary, mutually beneficial transactions every day. It’s the best way to allocate resources. It’s arrogant to think that a handful of government bureaucrats or nutrition activists know more about what foods should be available to us than the collected wisdom of millions of self-interested people. If food some consider “bad” is available on the market, it’s because there are people out there who enjoy it. It’s offensive and condescending to say the average Joe is too dumb to know that a Hardee’s Monster Thickburger slathered in cheese, bacon and mayonnaise, or a decadent, chocolaty dessert probably isn’t all that good for him. He knows it’s not the best thing for him. He chooses to accept the risk because he enjoys the indulgence. A free society doesn’t use laws, taxes, or restrictions to deny him that indulgence.

For some reason, our society has put a premium on longevity. Anything that shaves minutes off of our lives is by definition considered something that ought to be taxed or restricted. But there are plenty of people out there who have probably heard that a cigarette or a slice of cake might take a few minutes off the ends of their lives, and they’re willing to sacrifice those few minutes because, believe it or not, they want a cigarette or a slice of cake. Why is that decision any business of the government’s?

OPR: You’ve written about the push to introduce variable health insurance premiums - people who exercise and maintain a healthy weight would pay less than those who don’t. What kind of impact do you think such a system would have on obesity rates?

Balko: I hope it will put market forces to the task of finding the diet-lifestyle combination that’s most conducive to good health, but that’s not really the point. Insurance is about guarding against risk. Health insurers should be free to evaluate risk in the same manner auto and life insurers do.

But to answer your question, what I’d like to see — and what I think might happen — is that insurers would begin initiating various carrot-and-stick approaches to group health plans. People who lead healthy, active lifestyles would no longer be forced to subsidize people who don’t. We’d see lots of experiments with incentives. People would still be free to make their own decisions about diet and lifestyle, of course. But they’d make them knowing that they’ll have to bear the consequences of those decisions. This time, your high cholesterol would no longer affect my health insurance premiums. Obesity would become less a public issue and more of a private one. As it should be.

OPR: Some argue that “personal responsibility” is just another way of the food industry saying, “Leave us alone so we can make lots of money.” From a libertarian viewpoint, does the industry have a responsibility to its customers to provide them with healthier food?

Balko: No. The only responsibility any industry or corporation has is to be honest and forthright about what it’s putting on the market. If a company is making false claims about what it’s selling, it should certainly be held accountable, and we have laws against fraud and false advertising for that.

But it’s silly to expect the food industry to market products the public doesn’t want. I’m baffled by the criticism of the fast food industry in particular, which has never really claimed to be in the health food business. Should Baskin-Robbins be held liable for not putting fresh fruits and vegetables on its menu, too? If not, why should McDonalds?

If consumers truly want healthier options, they’ll indicate that preference by buying healthy. Until only recently, they hadn’t been doing that. Now that they are, we’ve seen an explosion of grocery and restaurant options for carb-, calorie- and fat-counters. That’s the market in action. When corporations make money, they don’t do so at the expense of consumers, they do so with the blessing of consumers. It takes two parties to make a sale. To the extent that there may be a problem here, it isn’t with corporations, it’s with consumer preference. If the nutrition activists want to launch privately-funded public relations campaigns aimed at changing consumer habits, I say bully to them.

But don’t blame corporations for giving the public what it wants. That’s what a market economy is all about.

Radley Balko is a policy analyst with the Cato Institute.