Then, They Came For My Saltshaker...

Having already gone after trans fats and high fructose corn syrup, public health nanny staters are now agitating for banning salt in prepared foods. From a culinary point of view, this is an outrage - as celebrity chef Anthony Bourdain points out in the story, salt is an indispensable ingredient in good cooking. There are aren't many recipes that don't taste better with at least a bit of salt in them, and some dishes simply can't be prepared without it. I'm as ready as the next person to denounce T.V. dinners - they're disgusting, and there's little doubt they're unhealthy. But if you enjoy eating food that tastes good when you go to a restaurant, the possibility of a bill like this becoming law should make you shudder in your boots. This is doubly so given that the evidence that sodium is uniquely pernicious in its effects on heart health is scant. The Japanese eat a lot of salt. They also have a very low incidence of heart disease and hypertension compared to Americans. Perhaps this is because their diet is relatively low in fat, cholesterol, and other substances which raise the risk of heart disease. As far as I can see, the best we can say about consuming a lot of salt is that it's bad for you in conjunction with consuming a lot of other substances. I don't see how eating it alone is a problem.

If the government wants to encourage people to eat more healthily, there's a simple solution that doesn't entail nanny state regulations, and has the benefit of raising a bit of revenue to boot - taxes. As a libertarian-leaning free-marketer, I see no problem with the idea that the prices of unhealthy foodstuffs ought to reflect their true costs to society. I'm fine with taxing the holy hell out of soda, cookies, doughnuts, chips, and whatever else is causing Americans' waistlines to bulge and their hearts to give out, the same way we do with tobacco and alcohol. I see no reason whatsoever why soda, for example, should be cheaper than bottled water. If the price of a two liter bottle were to go up fifty cents or even a dollar, it might discourage people from guzzling it as if it were water while not impeding their ability to pay for it as an occasional treat, and force people who do want to continue to drink it regularly to pay for the negative externalities that creates. The same is true of every other unhealthy food. If we decide that salt belongs in that category, I'll be happy to pay an extra $0.30 for my real French Onion soup rather than eat an alternative prepared without salt.

Good News On Public Health!

In North Korea at least, there are plenty of health service personnel and obesity is not a problem, according to the head of the World Health Organization. Good to know that at least one country has enough doctors, even if it's an oppressive Stalinist hellhole that shoots citizens who try to leave. As for obesity, well - it's hard to see how people could get fat when they suffer from chronic food shortages. No doubt the occasional nationwide famine has also contributed to the viability of the North Korean health care sector, by killing off the weakest 10% of the population and reducing their contribution to health care costs!

Suddenly, the answers to America's health care problems are clear - all we need to do is collectivize agriculture so that people can't get fat, and institute a police state to force doctors to work for free. Why hasn't anybody been pushing these solutions?

Specific Predictions For Health Care Reform

Megan McArdle has been writing a lot recently about the effects that Obamacare will have on American medical and financial well-being, and one of the things she's been demanding is testable predictions from progressives about the positive impact of the bill. Progressives have been hammering the idea that lower U.S. life expectancies, as well as higher rates of morbidity and infant mortality, are clear indicators that we needed a universal health care system. If in fact our lagging statistics in those indicators were due largely to a lack of universal coverage, they ought to improve dramatically over the next 30 years. With few exceptions (e.g. Nicholas Kristof's absurd contention that there will be significant increases in life expectancy as a result of the passage of this bill), very few progressives seem willing to go out on a limb and actually make predictions.

I'll make a few (hey, unlike journalists and healthcare bloggers, I don't have professional credibility to worry about). In the long run confounding factors that make it hard to evaluate actual cause-and-effect on many metrics will have come into play, so I'll state them partially in the form of negations of predictions that won't happen.

1.)The bill will probably save a number of lives, but the number will not be high enough to make an appreciable difference in life expectancy. Unless, that is, it somehow has the unintended benefit of causing young people to stop dying due to accidents, substance abuse and violence in numbers that, compared to those of other developed countries, are disproportionately high. Although I don't think there's a way to measure it, I suspect that the bill may also cost us some lives due to unintended and unfortunate economic consequences.

2.)There will be no statistically significant increase in infant mortality figures. That is, unless we start writing off rather than trying to bring to term high-risk pregnancies, and deal with the disproportionately high rates of malnutrition, substance abuse among pregnant women, etc. among our economic underclass (doing so is a goal libertarians and progressives ought to be able to cooperate on in my opinion).

3.)There will be no statistically significant decrease in morbidity, or particularly in rates of chronic conditions associated with poor diet and exercise habits (i.e. heart disease, obesity, etc.) unless Americans stop washing down quadruple cheeseburgers with 32 oz. sodas and eating pop tarts for breakfast, and/or stop watching TV for three hours a day and actually start exercising.

4.)The number of bankruptcies caused by medical expenses will go down somewhat, perhaps even precipitously. This is a good thing. As McArdle points out in the linked piece, however, this could have been achieved much more easily and cheaply.

5.)The bill will not contain costs for individuals. Medical services will continue to increase rapidly in cost due to greater demand from an aging population and expensive new products hitting the market (the prices of which will be further inflated due to new taxes on medical devices and medium-sized businesses which are passed on to consumers). For people who are already insured the mandates will increase the rate of premium increases, if they have any effect at all.

6.)The true cost of the program to the U.S. government over 10 years is going to be $2 trillion or more, not the $940 billion that's being touted. When you factor in the so-called "doc fix" to Medicare reimbursement rates that was rumored to be the price of A.M.A. support for Obamacare, it's already well up over a trillion, so I have 95% confidence in this prediction. Whatever the benefits of the bill are (and you'd have to be either intellectually dishonest or obtuse to deny that there will be some, perhaps even significant ones), they are not going to be worth the price we pay for them.

7.)Liberals will engage in goalpost shifting that would make Iraq war apologists proud rather than admit they were wrong if predictions #1-#6 are born out.

Keep your hands off my friends' cigarettes

I see that New York busybody-in-chief, er, mayor, Michael Bloomberg, as is his wont, is hot on extending a smoking ban again, this time to publicly owned outdoor spaces such as parks and beaches. The logic being, of course, that everyone in a public place has a right to clean air. Guess what? If that's the case, then, as William Saletan points out in this article, we ought to ban smoking on private property as well, not to mention lighting the grill and driving cars.

I wasn't wildly enthusiastic about Bloomberg's 2002 ban on smoking in bars and restaurants, but at least in that case a sound argument could be made in favor on the grounds of public health. This is different. There is no evidence that secondhand smoke in outdoor places causes harm to other people, and even if there was, there are numerous ways to deal with the problem short of intrusive government restriction of private behavior. I hate smoking. I think it's a vile habit, I can't stand the stink of burnt tobacco, I feel an immediate and overpowering need to shower after I return home from spending time in a smoke-filled place, cigarette butts are my least favorite form of litter, I consider ashtrays fouler than toilets, and a smoking habit is one of the few things that's always been an unnegotiable and immediate deal-breaker for me with the opposite sex. And yet, people smoking on the beach or at the park has never bothered me. Truthfully, I can't even recall an incidence of it happening, but if there was one, I probably just moved to a different spot elsewhere in the park or a bit further down the beach, the same way I'd respond if I came across someone in one of those places who was talking too loudly or playing music I didn't like.

In my ideal world nobody would smoke tobacco, but I find the idea of the government attempting to enact that ideal by passing laws restricting the rights of my fellow citizens odious, no matter how widely shared by the populace or scientifically justifiable anti-smoking attitudes may be. That's doubly true when smokers are not bothering anyone else by pursuing their habit, which as far as my experience goes is the case here. Saletan quotes a NYC official who claims that smoking on the beach or at the park has "no redeeming value". Why doesn't he let the good people of New York, many of whom smoke, make that determination for themselves?

Thinner, or healthier?

This study showing a relationship between obesity and increased brain degeneration is interesting, but it more inclines me to further questioning than persuades me to adopt the new national pasttime of obsessing over weight. How could a longitudinal study such as this possibly tease apart causation and correlation between these two variables? It seems to me quite plausible that a brain in poor condition might predispose a person to become obese, since poor impulse control, planning skills, and cognitive ability would naturally make one less able to design and maintain a healthy, low-fat diet or regular exercise regimen. Furthermore, it's equally possible that both obesity and brain degeneration are products of a third, unidentified variable - high cholesterol consumption, lack of exercise, etc. Everyone knows people who eat like horses and don't get fat, as well as people who exercise regularly and eat healthy foods but remain heavyset, and it's pretty well established that metabolism rate and static body weight are strongly influenced by genetics. As such, focusing on making people thinner seems like it might be fighting the wrong battle - not to mention one that will be difficult to win. It's clear that being overweight is not a good sign in regards to health, but it's not necessarily clear that it (rather than related issues like diet or exercise regimen) is the critical risk factor it's made out to be. I wonder if public health officials ought not to focus their attention on related, more easily addressed lifestyle issues.

To Snip or Not to Snip

One of the criticisms that libertarians often make of universal health care proposals is that they put us on a slippery slope toward lifestyle paternalism. If the government's paying for your health care, the logic goes, it has legitimate reason to interest itself in what you're eating, whether you exercise or not, how much you smoke and drink, etc. I've never been entirely persuaded by this criticism, but I have to say that this controversy over CDC promotion of circumcision gives me pause.

I've always found the idea of surgically mutilating a newborn boy without his consent problematic, and I don't see why it's any less problematic just because there may be a public health rationale. It's even more troubling when it's done at the insistence of the government. It is true that we already do things to our bodies at government insistence (routine immunizations, etc.), but in those cases, there's a clearer and more compelling rationale. The misconceptions of those in the immunization-causes-autism crowd aside, preventative injections are relatively simple and do not cause lasting harm, and they address a serious health threat which cannot be easily countered in any other way. Someone who falls ill with a highly infectious disease is, no matter how careful and responsible he or she may be, a threat to the welfare of everyone around who is not already immune. As anyone who's taken a middle school health class or seen the movie Philadelphia can tell you, that's not the case with HIV, which is almost impossible to spread to those around you unless you engage in certain well understood high risk behaviors with them. While circumcision may cut the risk of HIV infection, there are other, less drastic measures that could also accomplish that goal, by reducing the incidence of these behaviors - in the case of risky sexual practices making condoms more readily available, promoting safety and non-promiscuity, etc. For almost every sexually active man who follows safe sex guidelines, they work perfectly in preventing HIV infection, and without nonconsensual mutilation of half the newly-born population.

It is not true, as Hanna Rosin contends, that circumcision is without medical downside - from what I've read, it drastically reduces sensitivity, which has, shall we say, a deleterious effect vis-a-vis enjoyment of the sexual act. The health benefits of circumcision can be duplicated with good hygiene, and as far as I'm concerned, attention to good hygiene is a small price to pay for increased sensitivity. If Rosin believes that decreased sensitivity is a worthwhile tradeoff for the health benefits, she's entitled to that opinion, but as she's not directly affected by the issue of male sexual satisfaction, I'd suggest that hers is not the opinion that ought to be weighed most heavily. And while she may dismiss other objections to the procedure as just so much useless cultural, emotional, and religious baggage, that doesn't change the fact that many people are deeply uncomfortable with it, and will become even more so if it's forced on them. "Laws must deal with people as they are, not as you'd like them to be" is a political lesson that many liberals never quite seem to learn.

In short, circumcision advocates have to come up with a better argument than "it will cut the rate of HIV infection due to sexual transmission" to convince me it ought to be mandatory, or even recommended. After all, mandating castration for every newborn baby would clearly help in the fight against AIDS - rather than slowing the rate of sexual transmission, it would stop it entirely. No sane person advocates such a policy, because almost everyone is in agreement that the downside isn't worth the benefits - but for me at least, neither is the downside of circumcision.