Bringing harm reduction to Washington

I’ve studied various public health efforts to change problem behaviors. Sometimes, the right response requires a pragmatic acceptance that such behaviors won’t change. One can hope for personal transformation. And it’s only human to wish that people would enter a treatment program and straighten themselves out. Experience teaches that we can’t count on such character transformation when facing deadly consequences of these behaviors. So we need to meet people where they are, understand their motivations and perceived incentives, and then help them reduce the risk to themselves and to others. This is the chastening harm reduction insight.

Thus, in some cases, the right policy is to give injection drug users access to sterile needles. In others, the right policy is to give grandstanding congressmen some way to pander to ignorant voters without crashing the economy. We all wish that heroin users would stop using. We all wish that Congressmen would not demagogue the debt ceiling. Neither wish will be granted soon.

Ezra Klein has imbibed this harm reduction perspective. He writes about Senator McConnell’s convoluted proposal to raise the debt ceiling:

McConnell is proposing to permanently disarm the bomb that is the debt ceiling. He’d formalize the informal arrangement the parties have had in recent years, which is that the debt ceiling is used to embarrass the party in power, but it’s not allowed to threaten the American economy. If his plan passed, it’d become easier for the minority party to embarrass the majority party, but harder for them to threaten the economy.

That’s not very satisfying, because it acknowledges and seems to legitimate pathological behavior. That’s the harm reduction dilemma.


  1. says

    American culture is atypically averse to doing nothing, often the best strategy. Not on the debt ceiling; but letting the Bush tax cuts expire as per current legislation would be better than any of the alternatives in play. Look at Indian anti-terrorism policy post Mumbai – blather and no change.

    As John Milton wrote: “They also ssrve who only stand and wait”. Or as the theatre director (who?) said to the young Method-trained actor, “Don’t just do something, stand there.”

  2. Brad says


    Thank you, Very well said – I wish that I had your skill in saying the obvious in a quiet convincing way.