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.