Consider a low-socioeconomic status individual who is smoking, drinking, gambling, eating junk, spending on frivolous retail purchases (a ‘shopping addict’) and having indiscriminate sex (‘sex addict’). Does she or he really employ sophisticated risk management equations and decide that the benefits outweigh the costs?Hear hear.
Arousing public anger at those deemed unworthy of the privilege to make choices is a dangerous tactic. However, it is probable that many of the more vocal public health academics do genuinely believe that they, the elite, have a paternalistic duty to control the incapable masses.
As every dysfunctional behaviour can, without many inferential steps, be related to health expenditure, appeals to such imperative have few logical limits. The folly of enforcing interventions against peoples’ will on the basis of economic analyses of the cost to the state is obvious, and educated health professionals should know better than to use such divisive and emotive arguments.
If the growth of the Nanny State is to be curtailed, policy makers must have the confidence to stand firm against the mutton of opinion even when it is dressed up as the lamb of science.
Even worse, most numbers cast as representing social costs, which most folks interpret as costs to them via the state, consist almost entirely of costs borne by drinkers, smokers, and gamblers themselves. The healthist beancounters don't just assume that the addicts fail to employ cost-benefit analysis; they rather assume that such consumption has no associated benefits. That's how they get to count private costs as being social. Any evidence of potential market failure through imperfect information or irrationality is taken as sufficient reason for dismissing all potential consumption benefits. The argument of course proves too much.