Sunday, November 27, 2005


The proper conception of "public health" is innocuous enough. There are unquestionably some threats to our health and safety for which the remedies constitute a legitimate public good. They're limited to risks to which no rational person would submit himself – examples might include communicable diseases like tuberculosis or typhoid, calamitous events like asteroid impacts or tsunamis, or biological or chemical terrorism. Under these limited circumstances, it's understandable, even advisable, for a government limited to protecting the lives and property of its citizens to take collective measures to eradicate or minimize such risks, or minimize the damage should they come to pass.

But "public health" as it's advocated today goes well beyond public goods. Over the last century, "public health" has come to mean state pressure coercing us to avoid risks, even risks we knowingly and willingly undertake. The most obvious and conspicuous example was alcohol prohibition. And though Prohibition took an untold number of lives, bred corruption, and legitimized criminal behavior, it is distinguishable from more recent expansions of public health in that lawmakers at least recognized it as a failure, and repealed it (Unfortunately, we don't seem to have learned. The last twenty years have seen increasingly aggressive restrictions on the production, sale, and consumption of alcohol by local, state, and federal government).

But the Harrison Act – which fired the first shots of the drug war – was passed even earlier, in 1914. Drug prohibition has marched onward since. Its episodic ratchetings-up and coolings-down have commenced to a particularly aggressive and militaristic incarnation over the last twenty-five years.

Once we've accepted a definition of "public health" expansive enough for government to dictate what we can and can't put into our bodies, it's a short leap to seat belt laws, motorcycle helmet laws, assisted suicide bans, and prohibitions and restrictions on all sorts of other risky behavior. More recently, we've been given "public" smoking bans that extend to private businesses such as bars and restaurants. The Supreme Court recently upheld an Alabama ban on sex toys and marital aides. And parents are all too aware of the myriad regulations on the risks to which they can legally subject their children. Over just the last several years, governments at some level have prohibited motor scooters, "pocket bikes," all-terrain vehicles, snowmobiles, alcohol vaporizers, and fireworks, to name just a few -- all designed to keep people from hurting themselves.

So it shouldn't be the least bit surprising that "public health" might now come to include the size of our pants and the content of our refrigerators.

The justification for expansions of the government's power to promote the "public health" is typically couched in "the number of lives this will save." Sometimes, we're told that a law will add x number of years to the average life. The most-used and easiest tactic is to simply state that the law's necessary to protect "the children."

The ad naseum recitation of the 400,000 figure is a good example. As is a report released in January of 2004 stating that being overweight at forty would cut several years off the typical life. The public health activists at the Center for Science in the Public Interest have long been fighting for marketing restrictions on junk food, particularly on programs directed "at our children."

Longevity seems to be an obsession among the public health crowd. There seems to be no limit to the costs they're willing to endure if some policy promises to lengthen lives. It seems improbable to them that there may be people who'd sacrifice a month or two of their senior years for the lifetime of pleasure some get from a daily cigarette, a night of hard-drinking, or a slice of cherry pie after dinner. It's as if adding more days to the end of our lives were the only reason for living.

Even then, as British doctor and author Michael Fitzpatrick explains in his book The Tyranny of Health, death can't be prevented. It can only be postponed. And "death can generally be postponed only for a relatively short time by relatively intensive preventative measures," Fitzpatrick writes. That is, high-cost measures that would typically add just a few days or months to the average life.

There's certainly nothing wrong with studies or public awareness campaigns designed to discover and inform us about how we can make healthier choices. It's that the "advice" rarely stops there. Inevitably, such studies and campaigns lead to calls for government policies aimed at increasing longevity, and in so doing, take options and choices away from people who may value pleasure, convenience, or indulgence more than perfect health or a prolonged geriatry.

In the eloquent polemic Cigarettes Are Sublime, Richard Klein writes, "Healthism in America has sought to make longevity the principle measure of a good life. To be a survivor is to acquire moral distinction. But another view, a dandy's perhaps, would say that living, as distinct from surviving, acquires its value from risks and sacrifices that tend to shorten life and hasten dying."

Classical liberals should argue against the ever-expanding "public health" initiatives not only because they're supported by junk science or manipulated data (though that's often the case), but because the freedom to risk, indulge, and "sin" are essential to preserving individual liberty and a free society. Governments of free people aren't authorized to ensure good health, they're charged with securing liberty, which most certainly includes the liberty to hold bad habits.

Excerpt from here


For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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