The “Public Health” Myth

A headline in the Washington Post blares:

Japan’s New Public Health Problem Is Getting Big

Obesity Has Grown, Along With Appetite For Western Foods

But no. Obesity is not a public health problem. It is apparently becoming more widespread in Japan, though still much less so than in the United States, but it remains an individual and non-contagious problem.

The meaning of “public health” has sprawled out lazily over the decades. Once, it referred to the project of securing health benefits that were public: clean water, improved sanitation, and the control of epidemics through treatment, quarantine, and immunization. Public health officials worked to drain swamps that might breed mosquitoes and thus spread malaria. They strove to ensure that water supplies were not contaminated with cholera, typhoid, or other diseases. The U.S. Public Health Service began as the Marine Hospital Service, and one of its primary functions was ensuring that sailors didn’t expose domestic populations to new and virulent illnesses from overseas.

Those were legitimate public health issues because they involved consumption of a collective good (air or water) and/or the communication of disease to parties who had not consented to put themselves at risk. It is difficult for individuals to protect themselves against illnesses found in air, water, or food. A breeding ground for disease-carrying insects poses a risk to entire communities.

The recent concern over a tuberculosis patient on an airplane raises public-health issues. You might unknowingly find yourself in an enclosed space with a TB carrier. But nobody accidentally ingests a Big Mac. And your Big Mac doesn’t make me fat. That’s why obesity is not a public health issue, even if it’s a widespread health problem. As I wrote before,

Language matters. Calling something a “public health problem” suggests that it is different from a personal health problem in ways that demand collective action. And while it doesn’t strictly follow, either in principle or historically, that “collective action” must be state action, that distinction is easily elided in the face of a “public health crisis.” If smoking and obesity are called public health problems, then it seems that we need a public health bureaucracy to solve them — and the Public Health Service and all its sister agencies don’t get to close up shop with the satisfaction of a job well done. So let’s start using honest language: Smoking and obesity are health problems. In fact, they are widespread health problems. But they are not public health problems.

Posted on June 19, 2007  Posted to Cato@Liberty,General,Health Care

The Suburban Spending Machine

A few weeks ago I noted that the $3.3 billion county budget in one of Washington’s wealthy suburbs, Fairfax County, had a bit of fat in it, such as manners classes for kids. This weekend the Washington Post reported that ”a $2 million [swimming pool] renovation [in neighboring Arlington County], dedicated yesterday, is part of the Northern Virginia Regional Park Authority’s effort to woo residents from the increasing number of pools run by homeowners associations, officials said.”

Maybe if the private sector is providing a service, taxpayers could be relieved of that burden. If the argument is that government-run pools are intended to serve poor children who don’t have access to private pools, we could debate that policy. But the Post article makes clear that Northern Virginia government officials see themselves as competing in a “market” to attract customers from the pools provided by homeowners associations. And that seems a strikingly inappropriate mission for government.

Posted on June 18, 2007  Posted to Budget & Tax Policy,Cato@Liberty,General,Government & Politics

You’re Not the Boss of Me

A headline in the Los Angeles Times reads,

GOP senators getting visit from boss on immigration

And who is the boss of 49 Republican senators Minority Leader Mitch McConnell 50 million voters No, the Times is referring to President Bush. Thankfully, the suggestion that the president is the “boss” of the Senate appears only in the headline, not in the text of the article. But even headline writers should remember that Congress is created by Article I of the Constitution, and the president by Article II.

The president is not the boss of the Congress. Nor is he the commander-in-chief of the United States, as Sen. John McCain has said. Small-r republicans need to keep reminding people that what Gene Healy calls “the bipartisan romance with the imperial presidency” is not rooted in the American system.

Posted on June 12, 2007  Posted to Cato@Liberty,Constitutional Studies,General,Government & Politics

Here’s to You, Mrs. Swedenburg

Juanita Swedenburg, the Virginia winemaker who took her battle for economic liberty to the Supreme Court and won, died June 9 at the age of 82. Clint Bolick, who argued her case as a lawyer for the Institute for Justice, discussed it in his new book David’s Hammer:

My curiosity was sparked, however, during a visit in the early 1990s to a small winery in bucolic Middleburg, Virginia. The proprietor was a striking older woman, Juanita Swedenburg, who owned and operated the winery with her husband. She produced several good wines, including a chardonnay with the toastiest nose I can remember. We got to talking and Mrs. Swedenburg asked me what I did for a living. When I told her that, among other things, I challenged regulatory barriers to entrepreneurship, she exclaimed, “Have I got a regulation for you!”

Most states, it turned out, prohibited direct interstate shipments of wine to consumers. So that if tourists from another state visited Mrs. Swedenburg’s winery and asked how they could obtain her wines back home, she would have to reply, “You can’t.” …

As a descendant of settlers who fought in the American Revolution, Mrs. Swedenburg was outraged that such a stupid law could exist in a nation with the greatest free-enterprise system in the world.

Eventually, Bolick writes, the Institute for Justice took Mrs. Swedenburg’s case to the Supreme Court. He argued against a New York law, and Stanford law school dean Kathleen Sullivan (who also spoke recently at the Cato Institute) argued against a similar Michigan law. The Court ruled 5-4 that such laws “deprive citizens of their right to have access to the markets of other States on equal terms.” When Bolick launched his new book at the Cato Institute in April, Mrs. Swedenburg was sitting in the front row.

Juanita Swedenburg was the kind of citizen a free republic needs. After a career in the foreign service, she and her husband “retired” to a Virginia farm that had been in business since 1762. They set up a winery and worked seven days a week to make it a success. As the Washington Post says, “Mrs. Swedenburg did not take the Constitution for granted.” She knew that there was something wrong with a law that prevented willing customers from buying the fruits of her labors, wherever they lived. And when she found a lawyer who shared her enthusiasm for both wine and constitutional liberty, she pressed him to take the case on behalf of her and her customers.

Like John Peter Zenger, Rosa Parks, Allan Bakke, Michael Hardwick, Bill Barlow, and many others, Mrs. Swedenburg made our constitutional rights real by using them. Raise a glass to her memory.

Posted on June 12, 2007  Posted to Cato@Liberty,Constitutional Studies,General,Law & Legal Issues,Libertarian Philosophy

What a County Government Does When It Has Too Much Money

The Fairfax County Taxpayers Alliance, here in the Washington suburbs, complains that property taxes have soared over the past seven years. The typical Fairfax homeowner is paying $4830 a year in property taxes. The FCTA points out that “if during the past seven years the Supervisors had held real estate tax increases to the rate of inflation, which averaged three percent per year, the typical homeowner would be paying $3,079.” Home values have been rising fast in the Washington area (at least until the past year), so taxes have also increased sharply.

Taxpayers urge the supervisors to cut taxes. The supervisors–in Fairfax County and everywhere else–respond, “Would you have us close fire stations or fire teachers or throw widows out in the snow ” Somehow they never discuss, as another item in the FCTA newsletter does, the fact that salaries and benefits have increased far more than population growth or any other measure over the past seven years. Just hold county employees’ salary increases to the rate of inflation, and you could save the taxpayers a lot of money.

Or maybe, just maybe, Fairfax County’s $3.3 billion annual budget contains some low-priority items, like this one that was the subject of a charming article in the Washington Post:

This group of 12 kids, ages 6 to 10, are in the otherwise empty cafeteria of Anthony T. Lane Elementary School in Alexandria for the last of their eight Saturday morning classes on manners, offered through the Fairfax County Park Authority.

Posted on June 6, 2007  Posted to Budget & Tax Policy,Cato@Liberty,General

Robert Reich, Wrong Again

President Clinton’s secretary of labor, Robert Reich, complains on Marketplace Radio that the new immigration bill may encourage immigration by high-skilled people. He argued:

A century ago, America’s immigration policy was best summarized in Emma Goldman’s famous lines on the Statue of Liberty: “Give me your tired, your poor, your huddled masses yearning to breathe free.”

It’s a lovely poem, and it’s true that America was the land of opportunity for millions of people. But as Julian Simon pointed out, on the whole immigrants in the 19th century were not tired, poor, huddled masses. He cites findings from economist P. J. Hill:

[I]mmigrants, instead of being an underpaid, exploited group, generally held an economic position that compared very favorably to that of the native born members of the society.

Reich is wrong again. But then, he’s notoriously loose with the facts.

Posted on June 6, 2007  Posted to Cato@Liberty,General,Trade,Welfare & Workforce

Good News on Income Mobility

Steven Pearlstein of the Washington Post takes a beating around here sometimes, so I want to draw attention to his dynamite column this week on the non-disappearance of the middle class. Drawing on a new book, Social Stratification in the United States by Stephen Rose, Pearlstein demonstrates that

rumors of the demise of the American middle class are greatly exaggerated. In fact, living standards for most Americans are improving. Not everyone is flipping hamburgers or working at Wal-Mart. To the degree that the middle class is shrinking, it is because more people are rising out of it than falling from it.

Pearlstein takes pains to note that Rose “is not your standard-issue conservative market apologist — far from it. He left medical school to get his PhD in economics, then alternated between teaching and community organizing. He served on the Democratic staff of the Joint Economic Committee and in the economics shop of the Clinton Labor Department.” So you can trust him — he worked for Clinton!

And Rose finds, as Pearlstein lays it out, that there’s a lot more good news than the “sky-is-falling rhetoric of the Democratic left” would lead you to believe. Pearlstein notes:

[I]t is often reported that the median household income in the United States is $44,500. Of course, that takes in households of varying size, from singles to the Brady Bunch. It also includes households headed by workers in the prime of their working years (29 to 59), as well as those just beginning or ending their careers, when earnings tend to be lower. So, to get a truer picture of economic well-being, Rose adjusts the data for household size and excludes those headed by people younger than 29 or older than 59. And when he does, it turns out that the median income for the “typical American family” jumps to $63,000, which in most parts of the country buys a pretty comfortable middle-class lifestyle.

This doesn’t mean the middle class isn’t shrinking. In fact, from 1979 to 2004, Rose calculates, the percentage of households in the “middle class” category — those with incomes of $30,000 to $90,000 — fell to 39 from 47 percent. But it would be hard to describe that as bad news when the proportion of well-off households — those with incomes of more than $90,000 — rose by nearly nine percentage points. During the same time frame, the percentage of households that were poor or near-poor remained about the same.

One of the favorite liberal story lines is that the only way middle class families have been able to maintain their standard of living is by forcing mom to work more hours. But that, too, turns out to be an exaggeration. By looking just at married couples at various points in the income ladder, Rose found that for all but the poorest households, inflation-adjusted income was higher in 2004 than in 1979 even after factoring out any increase in spousal work hours.

It is also a myth that the Great American Jobs Machine is producing mostly lousy, low-paying service jobs. Rose simplifies the government data by putting all jobs in three categories: “elite” jobs, encompassing managers and professionals; “good jobs,” such as those held by supervisors, skilled blue-collar workers, craft workers, police, firefighters and clerical workers; and “less skilled” jobs, such as those held by unskilled machine operators, laborers, sales clerks and waiters. Looking at it that way, it turns out that the number of lousy, low-skilled jobs has been on a long, steady decline since 1979, while the number of “elite” jobs has been growing steadily. The number of “good” jobs has declined marginally as skilled office work has replaced skilled factory work.

Rose is concerned, quite properly, about the condition of the poorest people in the American economy, though he and I would probably disagree on the best way to help them enter the economic mainstream. But he’s also brought a healthy dose of reality to the debate over “the declining middle class.”

For more on these topics, see the recent posts by Brink Lindsey at his personal website and the award-winning Cato Institute book Cowboy Capitalism: European Myths, American Reality by Olaf Gersemann.

Posted on June 1, 2007  Posted to Cato Publications,Cato@Liberty,Economics & Economic Philosophy,General,Welfare & Workforce

Free the Scholars

Justin Logan discussed the “Travesty in Tehran” – the arrest and incarceration of Haleh Esfandiari — astutely yesterday. As he noted, these actions are a real provocation at a time when reduced tensions between Iran and the United States are devoutly to be hoped for. But more importantly, the unjust imprisonment of a peaceful scholar is a striking affront to human rights. The people of both Iran and the United States who want to see Iran as part of a peaceful and democratic world must deplore these actions.

And of course, to make matters worse, Esfandiari is not the only scholar currently being held by the Iranian government. The regime is also holding Kian Tajbakhsh of the Open Society Institute; journalist Parnaz Azima from the U.S.-funded Radio Farda; and Ali Shakeri, a peace activist and founding board member at the University of California, Irvine’s Center for Citizen Peacebuilding. There is no evidence that any of these people are engaged in espionage or threatening Iranian national security. Indeed, most or all of them have worked to improve relations between Iran and the United States and to turn both countries away from a collision course.

Leading human rights groups and activists have spoken out against these arrests. In a joint statement, Amnesty International, Human Rights Watch, Reporters without Borders, the International Federation for Human Rights, and 2003 Nobel Peace Prize laureate Shirin Ebadi urged Iran to stop “harassment of dual nationals.”

To add insult to injury, Esfandiari’s husband was informed yesterday that Citibank had frozen his wife’s bank accounts ”in accordance with U.S. Sanctions regulations,” which stipulate that U.S. banks are prohibited from servicing accounts for residents of Iran. A resident She’s an involuntary resident of the notorious Evin Prison. Late in the evening, after many phone calls and the intercession of the State Department, Citibank relented and unfroze the accounts. As painful as that experience was, her husband no doubt wishes that a day’s worth of phone calls could persuade an Islamic government to admit its mistake.

Posted on May 31, 2007  Posted to Cato@Liberty,Civil Liberties,Foreign Policy,General

National Service Is Garbage

In Albania, anyway. NPR reports that garbage is piling up in the streets of Tirana, and “It’s something you could blame on the fall of communism.” As reporter Vicky O’Hara explained,

When communism collapsed here in the early 1900s so did the city’s system of garbage removal. Shpresa Rira, a teacher at the foreign language institute in Tirana, remembers that under communism families were ordered to spend part of their weekend picking up trash.

Ms. SHPRESA RIRA: It was called the communist Saturday because people were meant to come to come together and give their services to the community.

O’HARA: Rira says that people were not paid but they turned out anyway, because if they didn’t, the consequences could be dire.

So it was universal compulsory service, like Melvin Laird and John Edwards want for the United States. But it turns out it didn’t work so well in Albania.

The communist tactic, she says, destroyed community spirit in Albania.

Ms. RIRA: We thought that we were closely connected, but as soon as communism was over, you know, we understood that that community spirit didn’t exist at all. It was just a fake.

And like most collectivist systems, it did not “foster a culture of responsibility for our democracy.” Instead, it left people expecting that government would handle everything. So now, the government no longer threatens people with dire consequences for not picking up trash, and no one does. The city has been slow to create a normal garbage collection system. Maybe this forced community spirit stuff isn’t such a good idea after all.

Posted on May 30, 2007  Posted to Cato@Liberty,Civil Liberties,General,Int'l Economics & Development

State to Young People: You Belong to Me

Under the benign headline “Turning Apathy Into Good Deeds,” former secretary of defense Melvin Laird endorses a strikingly authoritarian proposal: “a system of compulsory universal civil service for young people.” Laird recognizes that the military doesn’t need all the recruits a draft would produce and that today’s high-tech military needs longer-term training and commitment. But the drawn-out war in Iraq threatens to discourage future enlistments. So “universal service” might pressure just enough young people to join the army, while also producing a bumper crop of slave labor for schools, Head Start, Peace Corps, hospitals, the Department of Health and Human Services, and the State Department.

Laird thinks such a program would “foster a culture of responsibility for our democracy.” Not among free and responsible people, it wouldn’t. It may be no accident that Laird repeatedly mentions democracy, but the words freedom and liberty–the fundamental values of America, which our constitutional republic was created to protect–do not appear in his piece.

Laird does not address how you square compulsory service with the Thirteenth Amendment to the Constitution: “Neither slavery nor involuntary servitude, except as a punishment for crime whereof the party shall have been duly convicted, shall exist within the United States, or any place subject to their jurisdiction.” Laird’s proposed “service” is clearly involuntary.

For generations and centuries, old people have complained that today’s young people just don’t appreciate the sacrifices of their elders. They talk too loud and they don’t care about the community. They need, in the words of William James, “to get the childishness knocked out of them, and to come back into society with healthier sympathies and soberer ideas.”

And meanwhile, they can do a lot of useful things that we older taxpayers would like to have done but don’t want to pay for. After all, in a market economy, if you want more people working in hospitals or day-care centers, you can pay them to do so. And if you don’t think $2.9 trillion is enough to pay for all the useful services of the federal government, you can propose a tax increase. But how much easier it might seem just to commandeer four million free or cheap laborers.

Of course, they’re not really so cheap. You do have to pay them something. And you’ll need massive new layers of bureaucracy to manage four million people (the approximate number of Americans who turn 18 each year).

And then there are the opportunity costs. Workers will be allocated to government make-work jobs instead of the jobs where the market demand is strongest. The economy will be less efficient and less productive. As Doug Bandow writes, “paying young people to sweep floors entails the cost of forgoing whatever else we could do with that money and the cost of forgoing whatever else those young people could do with their time. An additional dollar spent on medical research might be a better investment than one used to add an extra hospital helper; an additional young person who finished school and entered the field of biogenetics might increase social welfare more than one more kid shelving books in a library.”

What kind of message does compulsory service send to young people It tells them that they are national resources, state property, that they do not own themselves. That’s not the message the Founders thought they were sending in the Declaration of Independence and the Constitution. It’s not an attitude appropriate for citizens of a free society. It’s a collectivist, authoritarian concept. It says, with much less charm than the old song, “You belong to me.”

Melvin Laird should be ashamed. So should John Edwards.

Posted on May 28, 2007  Posted to Cato@Liberty,Civil Liberties,Defense & National Security,General,Libertarian Philosophy

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