May 6, 2003

A tale of two diseases

By: Eric Wang

For a population still jittered by heightened security alerts, ongoing attacks overseas, and the global SARS pandemic, the recent outrage over obesity almost provides an element of comic relief. But while reasonable people snicker at the lawsuits against Big Macs and Oreos, beneath this frivolity lurks a dangerous assault on our liberty.

As disparate as these diseases are, the attempt to treat SARS and obesity equally as threats to public health betrays a society oblivious to its founding principles of limited government and self-reliance.

To illustrate the problems with treating every medical malady with the same public health mallet, a brief refresher in civics and economics is in order. As the preamble to the Constitution explains, the purpose of our government is to “establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty… .” Taken as a whole, the Constitution’s brevity and its paucity of enumerated powers suggest a government that is limited in scope to the provision of public goods. As the dismal science tells us, public goods are items like national defense, law enforcement, and critical infrastructure – things that the market has trouble providing because so few are willing to pay for these services that benefit so many.

The public health infrastructure is an example of a public good insofar as it is used to combat legitimate contagions like SARS, which, regardless of individual initiatives to prevent its spread, poses a general threat unless the government uses its every means to treat and isolate patients. But when public health is contorted to confront problems like obesity, which is by and large a function of personal preferences, we risk trampling roughshod over the capacity for individual decision-making that is so essential to our democracy.

Just last week, the Centers for Disease Control launched a massive salvo, lumping obesity with smoking in terms of its economic costs to society. In tandem, the Department of Health and Human Services issued a chilling warning to fast food purveyors to shape up, or else. As HHS Secretary Tommy Thompson told CNN, “We’re asking them to step up and see if they can do innovative things, like encouraging their customers to eat properly and to exercise.” Otherwise, The Washington Post reports, Thompson is threatening advertising campaigns and even a tax on fatty foods.

While culinary czars are recycling tobacco prohibitionists’ tired old arguments about external costs, they are no more valid for obesity than they were for smoking. As the Post reports, the bulk of obesity costs afflicts government programs like Medicaid and Medicare. The problem of external costs in these cases is that they are a function of social welfare programs; the more people become wards of the state, the more their behavior will affect society. How to trim the fat in this government spending? How about putting the nanny state on a diet?

President Bush selected Tommy Thompson for his job in no small part because of his pioneering welfare-to-work policies as governor of Wisconsin. His Wisconsin Works program set a model of self-sufficiency that inspired the landmark 1996 federal welfare reforms. That’s why it is especially disturbing now to see this erstwhile champion of individual initiative doing the bidding of public health paternalists and nanny state nags.

Implicit in the concept of self-government is the freedom to make bad choices, so long as they do not adversely affect others. When the government treats individuals as incapable of making intelligent decisions for themselves on what to eat, drink, or smoke, it creates a self-fulfilling prophecy in which an infantilized populace increasingly relies on the government because it cannot think for itself. Whether or not the government succeeds in making us slimmer, we are well on our way to becoming stupider.