Bioethics, healthcare policy, and related issues.
Michael Bloomberg, the Republican, but reasonably decent, mayor of New York City, has been aggressive in promoting healthful lifestyles and a healthier public environment in the City, especially through the use of the law-making and regulatory powers of government to prohibit or discourage harmful practices. Recently he spoke to a national convention on public health, advocating the use of the law to its maximal extent to promote the same goals nationwide.There is no doubt some of his initiatives here in New York have been outstandingly beneficial – none more so than the smoking ban in restaurants and bars. But each such policy raises the question of the limits of and justification for government intrusion into private behavior, especially on the frankly paternalistic grounds of improving the citizen’s own health.
Bloomberg seems unembarrassed by how far he wants to go:
Mayor Michael R. Bloomberg told some of the nation’s top health officials on Wednesday that government should use laws to influence behavior to fight chronic disease.
Appearing before a public health law conference here run by the Centers for Disease Control and Prevention, Mr. Bloomberg urged other cities and the federal government to follow New York’s strategy to attack problems like tobacco use, obesity and related ills.
“New threats result from, and are aggravated by, our forbearance, and even social and economic encouragement, of such behavior as tobacco addiction, unhealthy nutrition and excessively sedentary lifestyles,” Mr. Bloomberg said, calling chronic and noncommunicable diseases like diabetes the biggest health threats facing Americans.
“An effective public health strategy must therefore alter that calculus by changing how we live,” he said.
He’s certainly correct that much unhealthy behavior is encouraged by corporate interests that profit by it. But I am concerned when he says he thinks society has been wrongly “forebearing”. I don’t think it’s the government’s place to decide what private behaviors it will encourage and which it will discourage – especially by the heavy-handed means of taxation, licensing laws, and the criminal code. I think forebearance is the defining characteristic, and default principle, of liberal democracy.
Traditionally, public-health measures aimed at suppressing unhealthy behavior have focused on the harms to others that result from that behavior: the dangers to other motorists of unbelted drivers, the costs of emergency room care for unhelmeted motorcycle riders, and the dangers to others of secondhand smoke. Arguments for curtailment of these dangerous practices faced opposition when the justification was simply improving the health or safety of the person engaging in that behavior; they succeeded only when the focus was shifted to the harms to society or third parties. I think that is appropriate (though it results in some strained claims about third-party harm – cf. the fear that equality of civil rights for gays will “destroy the institution of marriage”). For the government to simply pick some lifestyles it approves of and bring its coercive powers to bear to force people into those and out of alternatives – without even giving an argument based on social need or harm to third parties, but simply because the officials of the day think that would be better for everybody – is a gross imposition on people’s right to live by their own values. “Changing how people live” is the gravest offense a government can commit, from the classical liberal perspective; the fundamental liberty is precisely to choose how one shall live.
We may here drag in Mill’s most-famous quote, overused but nowhere more appropriate:
The object of this Essay is to assert one very simple principle, as entitled to govern absolutely the dealings of society with the individual in the way of compulsion and control, whether the means used be physical force in the form of legal penalties, or the moral coercion of public opinion. That principle is, that the sole end for which mankind are warranted, individually or collectively in interfering with the liberty of action of any of their number, is self-protection. That the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant. He cannot rightfully be compelled to do or forbear because it will be better for him to do so, because it will make him happier, because, in the opinions of others, to do so would be wise, or even right. These are good reasons for remonstrating with him, or reasoning with him, or persuading him, or entreating him, but not for compelling him, or visiting him with any evil, in case he do otherwise.
- J.S. Mill, “On Liberty”
I would argue that, with respect to government power particularly, the government may not even “remonstrate with” the public – because government’s “reasoning”, as Bloomberg happily makes explicit, takes the form of its coercive powers. I have no objection to public-health posters extolling healthy habits, but Bloomberg makes it clear that is exactly what he doesn’t want to do; he wants to force people to be healthy by using the leverage that the government’s unilateral powers grant. Mill points out that the “moral coercion of public opinion” is itself too invasive to be brought to bear against individual liberty – how much more so are the legal and regulatory powers of the government?
The problem becomes acute when you see how much coercive power government officials have taken on themselves even without Bloomberg’s encouragement. The conservative governments of many states have made it official policy not only to oppose, but to actively block, the exercise of legal righs the citizens already possess (specifically regarding abortion and birth control). When the government believes it can take away your explicitly affirmed legal rights because those who control the government simply don’t want you to exercise them, the idea that government would also encourage or discourage mere matters of personal inclination using similarly coercive powers becomes even scarier.
Though he’s far from the worst of their bunch, Bloomberg, like so many Republicans, needs a better acquaintance with, and more respect for, the “classical liberal” principles they pay lip-service to.
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