Not in libertarians’ name

2009 February 4

Listening to BBC Five Live just after Iain Dale’s appearance in defence of Twitter, and hearing Dr Alan Maryon-Davis, President of the UK Faculty of Public Health, defend his ridiculous article ‘Why we need more nannying‘:

Is the government ‘nannying’ us too much? Is it trying too hard to micro-manage our health? I say firmly - no. … On the contrary, there’s plenty of evidence that people want to see the government doing more to help us avoid big killers like heart disease, stroke and cancer.

Of course, if you ask people a suitable question - “Do you want to regulate smoking more heavily?” - people will say (firmly) yes!  Why?  Because most people don’t smoke.  The same applies for almost any activity one can name. Tyranny of the majority is no defence.  In totality, most people oppose the nanny state - hence it becoming a pejorative term.  I thought that was obvious.

But the doctor went on in his radio address from the People’s Broadcaster:

Don’t get me wrong: I’m a libertarian.  But we accept rules about seatbelts.  We accept rules about driving with mobile phones … Perhaps we should think about banning [smoking with kids in the car].  Some people would suggest we should ban smoking in cars altogether. … I wouldn’t want us to be overly health-and-safety and the rest of it gone mad.  I just think we should think about this, about the regulations and laws, that allow people to make the good choices, the healthy choices.

We already allow people to make the ‘good’ choices.  It’s called ‘not banning lettuce’.  People aren’t stupid enough to think that lettuce isn’t good for them.  They just decide not to eat it because the pros do not outnumber the cons.  Those pros and cons are inherent to the nature of lettuce, and nothing can change that.  Maryon-Davis’s argument thus falls apart.

The best way to create a happy, healthy society, is to incentivise good health.  That requires an end to the absurdity of ‘unlimited, unconditional healthcare, free at the point of use’.  Just as guaranteeing bank deposits incentivises risky lending, guaranteeing good health incentivises risky lifestyle choices.  Not that that’s necessarily a bad thing, but, as a doctor, I thought Maryon-Davis would recognise the words of Hippocrates: “First do no harm”.

Until he puts that principle first, and advocates truly sorting out our healthcare crisis, I’ll thank Maryon-Davis for not bad-mouthing the movement by association.

3 Comments leave one →
2009 February 4
Jonathan permalink

Oli, I was reading your compelling critique but was somewhat taken aback by ‘Just as guaranteeing bank deposits incentivises risky lending, guaranteeing good health incentivises risky lifestyle choices’. Are you seriously suggesting thousands driving up justify there reckless behaviour such as ‘screw putting on the seatbelt, a windscreen dive is nothing the good ol’ National Health can’t solve’. The crux of the argument should lie in good the provision of sound Health education – something government has consistently demonstrated it is woefully inadequate of providing.

2009 February 4

I am indeed. However, it is made to seem implausible only by the binary state that one has created: getting healthcare or not. Say, instead, that you must buy insurance: either provided through vouchers by the state (as in a number of countries, including France) or paid for by yourself.

Either way, that set amount of money that you can afford to invest in healthcare will go further if you buckle up. In a ‘normal’ insurance contract, those that did not wear seatbelts when the accident occurs don’t have their healthcare claims reimbursed by the insurer. By comparison, those that are willing to pay a bit more money to get a more comprehensive insurance policy that, in this case, covers healthcare even if one doesn’t wear one’s seatbelt, can do so.

It’s a matter of your own personal choice: and monetised such that everyone can understand the decision that he or she makes. The government, by comparison, doesn’t really understand it. Back in the early 1980s, UCL’s own John Adams published findings that showed that, around the world, seatbelts (on average) killed more people than they saved. This was borne out in the evidence in the first years of introduction in the UK.

Why? Because people that are told to wear their seatbelts feel as though they are safe, when they most certainly are not. People that wear seatbelts drive faster than people that don’t, have more car-on-car accidents, and kill and injure more pedestrians. These are things that a binary ‘make seatbelts compulsory’ or ‘don’t make seatbelts compulsory’ setting do not consider. It is a clear case of government failure.

These things can, again, all be monetised in the form of expenses on healthcare, life insurance, legal liabilities, etc. In the terminology of the economics of law, by passing those costs onto someone else, we create a moral hazard that leads to under-cautious behaviour. That greatly harms our national health.

2009 February 6
George permalink

Other than claiming to be a Libertarian, Maryon-Davis also said that playing with snow can be fun but we need to be “extremely careful”.

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