Equality Is Important—But It Isn't Enough

[archerships]

Black people often make bad decisions about their health. For instance, a slightly higher percentage of black men than white men smoke, despite the fact that black men are 34 percent more likely to get lung cancer. Most black women weigh too much: According to the U.S. Department of Health and Human Services' Office of Minority Health, "African-American women have the highest rates of being overweight or obese compared to other groups in the U.S. About four out of five African-American women are overweight or obese."

Black men are 30 percent more likely to die from heart disease than non-Hispanic white men, and they contract AIDS more than seven times as often. Black women are 2.5 times as likely to start prenatal care in the third trimester, or not to start it at all. As a group, African-Americans are 50 percent less likely to exercise. The death rate for African-Americans is higher than whites for heart diseases, stroke, diabetes, and homicide.

All of this imposes immense costs on society.

By now it should be clear that simply trying to educate black people is not enough. Therefore, the United States needs a multi-pronged, coordinated effort aimed at forcing black people to make better choices. African-Americans should be required to pay higher taxes for unhealthy foods. They should be encouraged, if not required, to engage in regular exercise. Cass Sunstein, President Obama's regulatory czar, has proposed in his book Nudge a system of "libertarian paternalism" through which government incentives could encourage people to make the right choices. We should do this with black people by, for example, charging them more for snack foods, cigarettes, and other unhealthy products.

Not really, of course. No one should seriously make such a condescending and paternalistic argument. And anyone who did should be denounced as a bigot of the first order.

What's interesting, though, is that many progressives think nothing of making the very same argument about Americans generally. With more and more frequency we are told Americans' poor choices about their own health lead to higher costs for everybody -- so the government must act. Hence the campaign against obesity. Hence proliferating proposals for higher taxes on soft drinks. Hence the drive to have the FDA regulate Americans' salt intake. And so on.

via www2.timesdispatch.com

Posted via web from crasch's posterous

Comments

[ilwitchgrrl.livejournal.com]

good article. Thanks for sharing.

[pasquin.livejournal.com]

That's because statist politicians hate Americans, but love black people.

[jhogan.livejournal.com]

lawl

[nasu-dengaku.livejournal.com]

I don't buy the analogy.

I know you're not in favor of government-run healthcare, but if we're going to have it, then the govt should incentivize people to act healthy so as to save money and prevent wasteful use of government healthcare services.

When taxing an undesirable behavior, it's worth taxing it as precisely as possible to give the desired incentive structure. That's why it's silly, not just bigoted, to charge black people more for unhealthy food when simply charging everyone more for this food would be more accurate.

[denshi.livejournal.com]

Well said.

[crasch.livejournal.com]

the govt should incentivize people to act healthy so as to save money and prevent wasteful use of government healthcare services.

That's your preference, though, isn't it? Isn't it possible that those who enjoy KFC and Krispy Kremes believe that the extra healthcare spending they incur ("wasteful, in your view") is money well spent? What about those who would prefer that the government leave them alone entirely? Why does your preference deserve to be enforced by law?

Even if government run healthcare is inevitable, does it necessarily follow that the government should become even more intrusive in other parts of our lives?

For example, would you support taxing risky sports such as say, snowboarding? How about taxes on sex clubs and bathhouses? Reproductive bans/taxes for parents with a high risk of passing on genetic disorders, such as higher propensity for heart disease? What are the limits to your paternalism?

What if it turns out that black people require higher incentives than white people to change their behavior? For example, traditional "soul food" is high carb, and high fat. Blacks probably have a greater emotional attachment to fried chicken and grits than say, white liberals who grew up on fresh fruit and vegetables. What if it turns out that that in order to get the same compliance by blacks, you have to tax them 50% more? Would you support higher taxes on blacks then?

BTW, why be so indirect? Since lean, healthy bodies are what you want, why not just charge fat, physically unfit people higher taxes? For example, for every percentage point above your ideal body fat percentage, you pay an extra 1% on your income taxes.

[easwaran.livejournal.com]

Isn't it possible that those who enjoy KFC and Krispy Kremes believe that the extra healthcare spending they incur ("wasteful, in your view") is money well spent?

BTW, why be so indirect? Since lean, healthy bodies are what you want, why not just charge fat, physically unfit people higher taxes? For example, for every percentage point above your ideal body fat percentage, you pay an extra 1% on your income taxes.

These are connected to the same point. It's possible that people who enjoy KFC and Krispy Kreme believe that the extra healthcare needed is money well spent (as many athletes believe that the physical damage they cause to their body is a reasonable trade-off for excellence in their sport), but I suspect that it's far more likely that most people who enjoy KFC and Krispy Kreme don't really know what the health impact of these things is. (They probably realize that it's negative, but it's unclear that they have any idea just how negative it is.)

And the same is true for the healthiness idea - the point of the exercise is to send people signals through the marketplace that supplement the very limited information that they already have. Taxing people on their overall ill health might make sense (especially if you think of taxes as just being premiums for health insurance), but it won't have a useful effect unless people are extremely well-educated about the health impacts of every action they might take. If someone doesn't realize how quickly Krispy Kremes will increase their BMI, then a tax on BMI will just amount to a hidden tax on Krispy Kremes. Matt is proposing a visible tax on Krispy Kremes that will probably have a larger impact on people's BMI than a direct tax on BMI would.

[easwaran.livejournal.com]

For example, would you support taxing risky sports such as say, snowboarding? How about taxes on sex clubs and bathhouses? Reproductive bans/taxes for parents with a high risk of passing on genetic disorders, such as higher propensity for heart disease? What are the limits to your paternalism?

I might actually be willing to support a lot of this, though I'd have to think much more carefully about it - especially the reproductive issues that affect different people differently.

Blacks probably have a greater emotional attachment to fried chicken and grits than say, white liberals who grew up on fresh fruit and vegetables. What if it turns out that that in order to get the same compliance by blacks, you have to tax them 50% more? Would you support higher taxes on blacks then?

I don't think the libertarian paternalist should think that the extra taxes ought to give everyone exactly the right amount of incentive. If that were the case, then the taxes definitely wouldn't be percentages of the price of the good, but rather percentages of the buyer's wealth or income (or other measure of financial means).

And the point of the system is that it's libertarian paternalism. We aren't trying to ban these activities by taxing them - we're just trying to give people a visible reason not to do them, that corresponds in strength to the invisible reason not to do them. (Extremely unhealthy foods would have high taxes, moderately unhealthy foods would have lower taxes, and healthy foods would have low or maybe even negative taxes.) If someone really likes unhealthy foods or risky sports, they're allowed to engage in them. The libertarian paternalist accepts revealed preference theory to the extent that willingness to pay high prices up front reveals someone's high desire for something, but rejects the general version of revealed preference theory that says that willingness to accept all negative effects of something (visible and invisible, present and future) reveals one's high desire for something.

The point isn't to get people to make all and only the most healthy choices - it's to get people to make choices that actually reflect the value of the activity to that person, rather than choices that reflect the immediate costs and benefits of the activity to that person. So if black people still eat lots of unhealthy food despite higher prices, for cultural reasons, then the libertarian paternalist will accept that. Presumably they will still cut back slightly though, which will have good effects in any case.

[nasu-dengaku.livejournal.com]

Some points:


That's your preference, though, isn't it? Isn't it possible that those who enjoy KFC and Krispy Kremes believe that the extra healthcare spending they incur ("wasteful, in your view") is money well spent? What about those who would prefer that the government leave them alone entirely? Why does your preference deserve to be enforced by law?

The tax is being proposed as part of a healthcare system proposed by the government. I would not support such a tax in a society where healthcare is privatized. If people want to cram themselves full of donuts, that's fine by me, but they should pay more for healthcare, whether it's from the government or from private insurers.

Even if government run healthcare is inevitable, does it necessarily follow that the government should become even more intrusive in other parts of our lives?
For example, would you support taxing risky sports such as say, snowboarding? How about taxes on sex clubs and bathhouses? Reproductive bans/taxes for parents with a high risk of passing on genetic disorders, such as higher propensity for heart disease? What are the limits to your paternalism?

Some things are easier to tax than others, it's true. Some things are more intrusive and feel morally unpleasant. Being practical, I'd suggest:
- Taking sports injuries into account by either raising insurance rates after they happen (kind of like what car insurance does by raising your rates if you have an at-fault accident) or by asking for reimbursement of sports injuries by the patient. Both incentive structures would encourage people to be safer when practicing their sport of choice.
- Sex clubs can either be done safely and unsafely, and the same is true of ordinary dating. I think that whoever's paying for healthcare (whether it's govt or private insurers) should offer people rate discounts if they get certain vaccinations (eg Gardasil and Hep B) and complete an STD safety course. I have an idea for reducing the spread of STDs that involves letting people sign up for a service where they get tested regularly and then having a "credit check" you can run on potential sex partners with their consent. The credit check would be so simple that it would be the sort of thing that could be done over the cellphone in a few seconds by a drunk, high clubgoer, yet verifiable against identity fraud.
- I do have qualms about penalizing people for things they have no control over (eg genetic defects). That gets into a human rights issue for me -- someone born with muscular dystrophy or another serious disorder already has an extremely difficult life ahead of them even without raised healthcare premiums. Genetics is a significant cause of obesity, so I'd rather encourage people at all weights to eat healthier instead of just taxing by weight.

What if it turns out that black people require higher incentives than white people to change their behavior? For example, traditional "soul food" is high carb, and high fat. Blacks probably have a greater emotional attachment to fried chicken and grits than say, white liberals who grew up on fresh fruit and vegetables. What if it turns out that that in order to get the same compliance by blacks, you have to tax them 50% more? Would you support higher taxes on blacks then?

Lumping people into categories for some other metric by race just isn't that accurate. I'm guessing that the variation in quality of food consumed is much bigger within races than between races. Generally, I'm not a fan of race-based policies for that reason.

[crasch.livejournal.com]

I do have qualms about penalizing people for things they have no control over (eg genetic defects).

While they may not be able to control having the defect, they certainly have control over whether they reproduce. If it's okay to tax people to discourage them from eating unhealthy foods due to the health care costs they will impose on others, wouldn't the same logic imply that we should disincentivize people from having children who will be a burden on the rest of us?

Genetics is a significant cause of obesity, so I'd rather encourage people at all weights to eat healthier instead of just taxing by weight.

Presumably, those that have a predisposition find it more difficult than the average person to avoid eating to excess. Therefore, don't we need to charge them higher tax rates in order to provide a sufficient disincentive?

[easwaran.livejournal.com]

Oh, I should say - I'm very argumentative because that's my job, as a philosopher. But this discussion and the examples you raise have been very helpful in making me think about what the reasons really are for these sorts of policies. Judging by nasu_dengaku's responses, he seems to see them in a somewhat different way than I do.

The tax is being proposed as part of a healthcare system proposed by the government. I would not support such a tax in a society where healthcare is privatized.

Judging by this, he seems to see this tax as a way to recoup lost revenue and save the government (or health insurer) money. But I see this tax as a way to help the people who are being taxed. People are very often unaware of many of the consequences of their actions, and by putting taxes on dangerous things, you're making the immediate incentive structure better represent the long-term incentive structure.

[mercyorbemoaned.livejournal.com]

when simply charging everyone more for this food would be more accurate

This is a perfect example of how the weird conditions of modern abundance have made people forget really basic stuff.

If you hate fatties, incentivize exercise all you want, but if food gets more expensive, children will get less of it, the most vulnerable children will lose out the most, and malnutrition in growing children is so much more serious than being fat it's not even a contest. The worst thing that being fat will do is maybe kill you later. But it's very easy for a whole society to screw itself by inadequate nourishment of little kids. This is one of the big things that progressives got right, once upon a time; it's why we have WIC and food stamps and RDAs, probably explains most of the Flynn effect, and is responsible for decreased infant and maternal mortality. Making food more expensive is only a tiny bit less stupid than getting everyone to reduce their BMI by voluntary amputation.

Incentives are hard. Singapore pulls it off in this area, but it's a city of 6 million, not a country of 300 million. And Singapore subsidizes cheap cooked food, and incentivizes exercise; they don't try to keep people healthy by making food more expensive, presumably because not having enough food is more of a reality to the policy makers than it is to Americans.

[nasu-dengaku.livejournal.com]

Some quick points:
- We already massively subsidize unhealthy food via corn syrup subsidies. That's why it's so cheap. I'd rather subsidize healthier, more nutritious food with the same money.
- I don't want anyone to starve or be malnourished. I think programs like food stamps and soup kitchens are good, and support them.

[mercyorbemoaned.livejournal.com]

It's not a subsidy to corn syrup; it's a subsidy to corn. Obviously this is the real problem, and it's weird that people talk about messing around with incentives downstream from it.

Soup kitchens and food stamps aren't like each other in any way. Very little in the world of charities and nonprofits exists without some public funding, but soup kitchens are primarily funded by private donations and run by churches. Food stamps is the colloquial term for SNAP (http://en.wikipedia.org/wiki/Food_stamps), and this program is an entitlement that everyone in the US gets below a certain income level.

Nobody wants little kids to starve but making food more expensive will cause that to happen, because poor people will as a group buy cigarettes and booze first.

[easwaran.livejournal.com]

I don't quite get the connection between the first part of this and the last paragraph. In fact, as soon as the passage mentioned Cass Sunstein I was wondering where the sudden left turn had come from.

There's no connection between condescension/paternalism on the one hand and bigotry on the other - I can see why people are offended by condescension/paternalism, but it's not a moral issue the way that bigotry is.

Also, I'm not quite sure where the "All of this imposes immense costs on society" line comes from either. It's true that all of the facts mentioned in the first two paragraphs impose immense costs on society, but they also impose immense costs on black people. Obviously, we should do something about these facts, both to help black people, and to help society at large (which of course includes black people). While the "libertarian paternalism" of Sunstein et al. makes sense for problems that are clearly problems of personal choice, the first two paragraphs don't establish whether the special health problems of black people are problems of personal choice in the relevant sense. For one thing, most of the problems mentioned are problems that are common in poverty - these paragraphs say nothing about whether these effects still appear after controlling for income or wealth or other relevant economic measures.

[crasch.livejournal.com]

I can see why people are offended by condescension/paternalism, but it's not a moral issue the way that bigotry is.

Why don't you see condescension/paternalism as a moral issue the way that bigotry is? Is it that you think that being a condescending paternalist isn't as unethical as being a bigot? Or not unethical at all?

[easwaran.livejournal.com]

I guess the way I see it is this - the central moral issue is whether people are being helped or harmed. Bigotry essentially involves harming someone, while paternalism (when done properly) involves helping someone. There are of course some downsides to paternalism even on this view, because it often makes the individual involved feel bad in various ways (disrespected or helpless or whatever), but if the help to the individual is great enough then it outweighs this fact. So on my view, it seems that paternalism is only a minor moral issue that can easily be outweighed by its benefits.

However, I suppose some people think of the central moral issue as preserving the autonomy of individuals. (I think this is something that Kantians and some libertarians might agree on.) Since paternalism involves making someone else's decisions for them, you are disrespecting the autonomy of that person, and perhaps even taking away some aspect of their freedom (though the Sunstein case attempts to at least not do that - people are still free to do the bad thing, but it's slightly more expensive than it would have been otherwise). Kant also sees bigotry as bad because you are treating the individual as a member of a group, rather than as an individual; I can't quite see off the top of my head whether a pure libertarian would have a justification for seeing this as a moral issue, but I'll assume that there is some such justification.

Anyway, I think some people might find my view implausible because there's no room for fundamental rights - anything can be trumped by particular circumstances. And I find the Kantian/libertarian view that I sketched pretty implausible because it takes basically no account of what is actually helping or harming people in cases where this isn't reflected in their individual decisions.

But on a mixed view of some sort, it still seems that bigotry comes out worse than paternalism. Paternalism violates the rights of the individual for autonomy, but also gives benefits to the individual. But bigotry violates the rights of the individual to be seen as an individual, and also harms the individual. If rights and benefits are both moral issues, then bigotry has two strikes against it while paternalism only has one. I suppose you can see them as equal if you take a fundamentalism position about rights, but this doesn't strike me as the correct moral theory.

[easwaran.livejournal.com]

But also, what do you think about congestion charges on roads? Given that driving your car in Manhattan causes several person-hours of delays to others, does it make sense to charge people for that, so that they only cause problems for others to the extent that they are willing to pay for it? It disincentivizes driving in crowded areas (just as Sunstein and others want to disincentivize consumption of salt or sugary drinks or whatever), but in this case it does so in order to restore market efficiency, rather than disrupting whatever efficiency you might think was there before.

[crasch.livejournal.com]

Well, I personally would prefer congestion pricing, since I make enough money that I would be willing to trade money for less time in traffic. However, I could see how an unemployed person, who has little money and lot's of time, would prefer the reverse. Since roads are government owned, the policy depends on whoever holds political power at the moment. So far, at least, voters in most places have rejected congestion pricing in favor of free access (in terms of money) at a cost of greater time spent in traffic.

In an ideal libertarian world, the roads would be privately owned, and the owner of the road would set the policy. My guess would be that most private road owners would set up a form of congestion pricing.

[darius.livejournal.com]

_Good Calories, Bad Calories_ shows that much official diet advice was counterproductive anyway (and probably still is).