Thought Provoking

Benevolent paternalism has its critics.    A quote from the Sunday NY Times;

“When the biologist Daniel Lieberman suggested in a public lecture at Harvard this past February that exercise for everyone should be mandated by law, the audience applauded, the Harvard Gazette reported. A room full of thin affluent people applauding the idea of forcing fatties, many of whom are dark, poor and exhausted, to exercise appalls me. Government mandated exercise is a vicious concept. But I get where Mr. Lieberman is coming from. The cost of too many people getting too fat is too high.”

How would Sunstein and Thaler respond?

Author: Matthew E. Kahn

Professor of Economics at UCLA.

23 thoughts on “Thought Provoking”

  1. By trying to nudge people to exercise? A tax credit, perhaps? Or maybe reimbursement of some part of out-of-pocket health care spending in return for well documented exercise that meets certain minimal requirements each year? This last is what my own employer-provided health care offers.

    I know: how about something a la cap and trade?. People who exercise a lot and enjoy it can sell documentation that they have exercised to those who find it more burdensome. People in this 2nd group can, in turn, submit this documentation to their health insurance providers for reimbursement. A market will develop in exercise documentation, and pretty soon, average levels of exercise will rise to approximate more closely what the average would be if all were exercising at their optimal level.

  2. It’s not benevolent or paternalistic if their complaint is “The cost of too many people getting too fat is too high”; it’s plain old self-interest.

  3. “How would Sunstein and Thaler respond?”

    Give every citizen $100. But require a licence to be a passenger in an elevator in any public building, with an annual licence renewal cost of $100.

    That’s sort of a joke. Sort of.

    “But I get where Mr. Lieberman is coming from. The cost of too many people getting too fat is too high.”

    Its not at all clear that this is true. Yes, there are a lot of explicit cash costs of providing medical care (and other services) to people who are obese. But everybody dies, and they generally die of things that prompt medical care or other services (i.e. nursing home care) before they die. If fewer people are obese there will be fewer costly heart disease cases to manage (and fewer deaths from heart disease) at age 65. But that just means more people will live to see 85 and 95, when God knows what other chronic disease will beset them (or how many years they will require other types of costly assistance).

    This is why there hasn’t been such a massive economic benefit to society from the reduction in smoking rates. A lot of grisly lung cancer deaths have been prevented, and that’s a good thing. But not a single death has been prevented, writ large. And therein lies the rub. Lung cancer deaths, while terrible, don’t necessarily generate long drawn out streams of costs (though the costs are indeed very high for a few months or years). The smoker who would have died of lung cancer at age 62 but who instead quits at age 30 and suffers no lung cancer at all, now lives to age 90. But the last 30 of that life he battles mild heart disease (which requires expensive drugs and frequent monitoring by a specialist). And the last 20 years of that life he battles joint problems (which requires costly drugs and frequent monitoring by a specialist. And the last 10 years of that life he requires care in a residential nursing care facility. Who knows which total bill is lower?

    Now – that’s not to say that increases in health aren’t a good thing. Clearly its good for people to live longer. So advances in medicine and awareness are clearly beneficial to society. But the “public good” case for imposing restrictions on the liberty of adult citizens is that it’s “costly” for society to support them in their unhealthy habits. Well – maybe, maybe not.

  4. My insurer rebates $150/yr of my gym membership. Maybe S&T would encourage more of that sort of thing.

  5. I think you’re all missing the point of the paragraph. The same people applauding Lieberman – thin, rich (white) people — no doubt substantially overlap the sort of folk who support the “ed reformers” who push a singleminded focus on test scores and a winner-take-all society, while phys ed programs and recess get cut, children have to learn to take tests instead of how to love learning, and our adults work longer hours and lead sleepless, unhealthy lives, setting cr*p examples for their children, who then get fat.

    But by all means, let’s reduce it to a simple argument about tax incentives.

    That article is wonderful, you should all read it.

    1. Just read it. It IS wonderful- and I learned something important about Black culture.

      When an issue is cultural, change has to come from the people who live that culture. A certain type of person who, sadly, is bipartisan is unwilling to think seriously about that fact, whether it be being over weight or being a conservative Muslim or Christian.

      Setting a good example and carrots but not sticks are probably all people on the outside can do.

    2. I agree that the article is great, but consider the following paragraph:

      How many middle-aged white women fear their husbands will find them less attractive if their weight drops to less than 200 pounds? I have yet to meet one.

      And then look at these vintage ads targeted at white women for gaining weight.

      Tempora mutantur et nos mutamur in illis, in other words.

      And the bigger question is really why women are willing to do unhealthy (and sometimes downright stupid things) for the sake of attractiveness (she says, guiltily hiding her high heels in the back of the closet).

      1. To partially answer Katja’s question, I refine it further: “Why are [straight] women willing to do unhealthy (and sometimes downright stupid) things for the sake of attractiveness[, even if such things are never noticed by one straight man in a hundred]?

        1. It might be related to the phenomenon of (most often male, although see “Germany, East”) athletes doing unhealthy (and sometimes downright stupid) things for the sake of athletic success

        2. >“Why are [straight] women willing to do unhealthy (and sometimes downright stupid) things for the sake of attractiveness[, even if such things are never noticed by one straight man in a hundred]?

          Because the “audience of admiration and criticism” is not straight men, but her circle of female friends and associates.

          1. That would be a reinforcement mechanism, not the cause.

            I’m not disagreeing with the gist of your statement; already when you’re growing up as a girl, your looks are something that everyone (especially female relatives and friends) feels surprisingly free to comment on.

            But there’s also the flip side of the coin: Call a boy “pretty”? Them’s fighting words. Because pretty = effeminate.

            The underlying cause, I think, is mostly that in our society a woman’s looks factor heavily into her social status. Men, obviously, have their own (but different) traditional status symbols (mostly revolving around power, strength, and influence).

            That’s separate from using physical attractiveness to attract a mate, which obviously matters for men, too. To quote Patrick Stewart (about becoming bald as a teenager): “I believed that no woman would ever be interested in me again. I prepared myself for the reality that a large part of my life was over.” (See also: Rogaine Extra Strength.)

            Also, the reinforcement mechanisms are most definitely not limited to women, though from men a woman is more likely to experience negative reinforcement. Consider this historical example, talking about Emmy Noether [1]:

            Hence all the disparaging quips, not meant unkindly at the time, that have become part of mathematical folklore. Best known is the reply by her colleague Edmund Landau, when asked if he did not agree that Noether was an instance of a great woman mathematician: “Emmy is certainly a great mathematician; but that she is a woman, I cannot swear.” Norbert Wiener described her somewhat more generously as “an energetic and very nearsighted washerwoman whose many students flocked around her like a clutch of ducklings around a kind, motherly hen.” Hermann Weyl expressed the common opinion most gently: “The graces did not preside at her cradle.” Weyl also tried to take the edge off the appellation Der Noether (der being the masculine form of the definite article in German): “If we at Göttingen… often referred to her as Der Noether, it was… done with a respectful recognition of her power as a creative thinker who seemed to have broken through the barrier of sex… She was a great mathematician, the greatest.”

            Admittedly, those were extremely misogynist times, but you get the “lite” version today still.

            (I’m in a bit of a rush; I may write more later if I have time.)

            [1] Yes, it’s by John Derbyshire. But much as I may disagree with him on matters of policy, he’s summarizing things pretty accurately here.

        3. Well, I wish I could believe you, but I do think men notice things like shoes and short skirts too. And there isn’t anything so wrong with that in itself.

          I just get frustrated that people leave mental health out of the health equation when subjects like this come up. Also, I don’t believe that health *is* the thing most people actually care about when they talk about weight, though I’ll give Lieberman the benefit of the doubt on that, as it sounds like he actually *was* talking about health, perhaps clumsily. And thanks to Katja for pointing out that the current mania for heroin chic wasn’t always the style. If someone’s naturally thin, but they’re healthy and energetic, we shouldn’t be browbeating them either.

          The other thing I find frustrating is the way research gets reported in the press. The stories will say really insane things like, if you don’t exercise for an hour a day, you can never lose weight (so don’t bother). Well, I know for a fact that this isn’t true. I suspect it is the research scientist version of how economists work. Here, we’ll take this group of people, feed them 500 calories of goop every day (in other words, set them up to fail by treating them like animals and not people…) and see if they lose any weight. (That’s only a small exaggeration of studies I’ve seen in the press.)

          Well of course it’s not going to work! Then they can write another piece about how hard it is. And you know, it is hard, but they’re also looking at the wrong things. The question should be, does this person eat vegetables and fruit every day, and can they undertake a healthy amount of activity they enjoy? (Accent on the “enjoy” part. People work hard enough already.)

          And if the answer’s yes, why do we give a flying hooey what their weight is? It will drop if they get those other things going first.

          1. NCG: Well, I wish I could believe you, but I do think men notice things like shoes and short skirts too. And there isn’t anything so wrong with that in itself.

            Yes, that’s why I was specifically referring to unhealthy practices. A guy may or may not notice a difference in makeup or a different haircut, but those are things that don’t generally affect your health. Things that do have a noticeable effect on your health are things that men will notice, too. (There of course are also other things that both don’t affect your health and do get noticed, such as the aforementioned short skirts.)

          2. That’s a good point. Some artifice hurts and some is just time-consuming! And I for one love platform shoes and will not quit, no matter how “out” they may be. Footwear is such a problem for women, if they care at all about fashion. When I people-watch, it’s so easy to tell whose feet hurt from the way they walk. It’s probably another thing most men don’t notice, bless their hearts.

  6. How about if we just eliminate the subsidies for commodity crops and replace them with subsidies for good things like fruits, vegetables, nuts?

    Eliminate the multiple subsidies for sprawl and replace them with funding for walkable cities?

    1. How about if we just eliminate the subsidies, and replace them with… nothing at all?

  7. Forcing a woman to have a scan of her abdomen before an abortion? Good.
    Forcing fat republican men to exercise? Bad.

    My reason for calling one good and the other bad? The former is obviously good because it serves my purposes. The later is obviously bad because it serves someone else’s purposes. Q. E. D.

  8. Fat people are at least partly a victim of our lifestyle and culture. We sit way too much and eat way too much, and chronic stress is a way of life for a lot of people, whose only pleasure is often eating and watching TV. Not sure how to change that, but education is a start.
    And I agree that “the cost of getting high is too fat”.
    ‘less I read it wrong.

  9. We already have government-mandated exercise. It’s called gym class in public school. In most states, everyone is required to attend school until 16, and most schools require (or used to require) gym. Of course the governments doing the mandating are state and local, and the people being coerced are kids, but it’s still a mandate.

    Does anybody know if gym classes actually improve lifetime fitness?

    They certainly didn’t when I went to school in the 70s and early 80s in an upper-middle-class New England suburb. At that time, gym classes were 13 years of aversion therapy to exercise for people of below-average fitness. They were an opportunity for fit people to embarrass and/or bully the less fit with the tacit (or occasionally explicit) approval of the gym instructors, who were usually coaches for the bullies in after-school athletics. So, not much encouragement for lifetime exercise for them in gym class. And for people of above-average fitness, gym classes actually didn’t offer much intense exercise or training, so it didn’t seem to increase fitness for them very much either. Wonder if that’s still true?

    1. I agree that youngsters should be treated with respect, at any level of fitness or coordination.

      But by your reasoning, we would give up on all education just because children aren’t correctly socialized, or because one teacher is mean or incompetent. Or because test scores are really all that matters, so to heck with P.E. We can do better than that.

      In fact, it sounds like you have good priorities and might make a good member of a local school board. Maybe you should think about running.

  10. If people who are in danger of becoming diabetic are informed about it soon enough, they might resolve to change their eating and exercise habits enough to do their health some good. What we don’t need to do is blame them or shame them.

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