Peter, who is a physician, a libertarian, and one of my oldest friends (we met in the 6th grade) from Arlington, Massachusetts, generously responded to my request for his professional expertise and philosophical perspective regarding the New York City soda ban. Here is his thoughtful response, the Comment of the Day, on the post The Ethics of Bloomberg’s Soft Drink Ban:
“It has become a reflex response to answer adverse circumstances with more regulation. To a lawyer, there is always a law, or regulation for any and every misstep in human behavior. Of course, we forget that we cannot predict the unintended consequences, not even to mention reviewing the effects of the laws we pass to determine if they are even having the INTENDED effect. Somehow, we believe that it is appropriate to pass laws to deny other people’s freedoms due to the “discomfort” of whiny types who have the connections and persistence to keep whining until they can get someone to pass a law. The consequence of such legislation’s continued passage, at ever more confiscatory levels of our liberties, is that we are legislating our way into a police state, and the widespread acceptance of the idea that it’s OK to deny personal liberty because it makes someone else “uncomfortable.” Again, as RR so aptly pointed out, “the government that is big enough to give you everything you want, is big enough to take away everything you have.” And this goes for not just your personal assets, but your freedoms as well.
“That said, in this context, yes, drinking lots of sugary sodas will make you fat, smoking will kill you, too much alcohol will kill you, doing extreme sports can kill you, and so on. And as long as one’s decisions affect only himself, have at it. However, when you want me to pay, through my insurance premiums, and my taxes, for the consequences of your stupidity, you cede the sovereignty of your decision to others beside yourself. If you want to ride your motorcycle without a helmet, while drunk, sure, do it. Just don’t expect me to pay the costs of your head injury.
“As much as I hate the idea of the “nanny state,” and I do, I do NOT oppose the idea of a user’s “fee,” or user’s “tax” and lobbied for a bill in Colorado some years ago, that would direct that state’s tobacco tax towards the costs of indigent medical care in that state. The argument was that smoking was much more prevalent in the indigent population, and there was at least some kind of plausible connection. (Of course, you can’t trust legislators, and the possibility exists that, in the future, in the midst of some budget crunch, those funds would be confiscated for the general treasury. So far, however, they seem to have been put to good and multiple related uses in that state).
“In this context, recognizing that the potential health costs related to obesity will be huge if such predictions come true, and there is little reason to believe that they will not, one can make the argument for a “user’s fee,” here as well. It’s just that I don’t trust Bloomberg to “escrow” the proceeds from such a tax to build up the reserves to pay directly for such health consequences to the population in the future. Again, one can make the argument that the predictions about obesity are likely to affect the indigent population disproportionately, since therein lie many who make poor personal choices in a number of areas, and direct the funds toward defraying the costs of indigent care in New York (thereby freeing up other funds, or, God forbid, reducing income tax rates to stem to loss of productive people whose enterprise and job-creating abilities are treated more favorably in other states).”
Ethics Alarms 
If you apply for health care and life insurance, they ask if you smoke, drink, are overweight and/or engage in risky behavior. Your premiums are adjusted accordingly.
Yes, these are simple and easily measureable risk parameters, but they address what to do AFTER the fact. The proposed measures under discussion attempt to deal with PREVENTION.
My take on the comment was that anything good it may have contained was lost in a blink with….
“Again, one can make the argument that the predictions about obesity are likely to affect the indigent population disproportionately, since therein lie many who make poor personal choices in a number of areas,”
That is a pretty high horse. Watch out for the fall… you might want to wear a helmet in case no one wants to pay for the head injury due to riding while pompous.
And yes, I DO wear a helmet when riding (AND leather and denim to protect against road abrasion, AND proper boots to protect the lower legs AND a hard plastic spine protector under my jacket to protect against impaction against the vertebrae, even when it’s hot outside, and I DO disclose my riding to my insurance company and I do NOT engage in motorcycle racing….
Pompous or not, but is is true? The matter of personal choices and their effect on health is well-studied, and well-known, e.g.(http://www.eufic.org/article/en/health-and-lifestyle/food-choice/artid/social-economic-determinants-food-choice/)
Your point may be that it is unfair to assume that their choices are willfully self-destructive, instead of made out of economic necessity and lack of knowledge, and for that, I apologize, because to assume that is more contentious. It is appropriate to lay considerable blame on corporate marketing techniques, which have profits as their motivation and no regard for public health effects. Nevertheless, I don’t think it is an inappropriate observation that there is often a connection between poor choices and adverse outcomes, and that many people of low socioeconomic standing are more likely to make self-destructive choices (for whatever REASON), than others. One doesn’t have to have seen such a connection in health care practice for over 30 years to be able to make such a connection.
You are correct, your original comment was overly simplistic in a judgemental way. The economics of obesity is more complex than poor personal choices, more complex than the cost of healthy calories and when you add healthcare in its entirety, from accidents to smoking to obesity, it becomes even more so. I am still not sure if you are saying rich people don’t make poor choices – which a recently famous financial crisis would suggest otherwise. Or if you are saying that rich people are not obese – which a quick view of the Forbes top 400 slideshow would suggest otherwise. Or if you are saying that rich people can afford to be fat so it is OK but poor people cannot afford it so we need to monitor and restrict their choices.
“since therein lie many who make poor personal choices in a number of areas,” is offensive, pompous and totally misses the cause of the problem. It’s not an observation, it is a judgement. So my point was exactly as stated. Watch out for the fall.
And so, my original comment became simply an introduction to a very complex topic that, indeed, cannot be summarized, or presented in a few sentences.
Of course, some rich people DO make bad choices, and, perhaps worse, can do much more far-reaching damage,to far more people than themselves, and can do so with intention, rather than from simple ignorance. And yes, they can be fat, just that such is less frequent, probably due to having more money to buy better food, and more education to know the difference between good food and bad. And no, it’s not OK for rich people to be fat any more so than for poor people to be so IF they call on the public purse to pay for their health problems. If a rich person wants to become obese, develop the expected health problems, and pay their own doctors, pay full cost of the hospitalizations, medical testing and the like, I would have less of a beef with them.
Generally, I reserve judgment of those who cannot help themselves, it’s just that we may differ over what constitutes such a group, and I may believe that is smaller than you do. Perhaps I believe that, TO SOME DEGREE, other than ZERO, poor people either become, or remain poor through the choices they make, and in those cases, yes, I do believe that such judgment may be justified. It doesn’t mean that one doesn’t try to assist such people, just that to solve such a problem, you must get to the root of the problem. Not taking personal responsibility, where such is appropriate however, will NOT get at the root of the problem.
Well, that seems a lot more open minded than your first comment. Thanks! It is still unlikely we will ever be on the same page with this one because I think the difference of opinion we have is in “to some degree, other than zero, poor people either become or remain poor through the choices they make” and in “IF they call on the public purse to pay for their health problems. If a rich person wants to become obese, develop the expected health problems, and pay their own doctors, pay full cost of the hospitalizations, medical testing and the like, I would have less of a beef with them.” The first one is irrelevant because every single person on the planet makes some poor choices with consequences that others, beside themselves, have to live with. Selecting poor choices and assigning them to a group as the explanation for complex, problematic results doesn’t help to explain or solve problems. It only serves to hold members of that group down. Your opinion would have been stronger without the blame being placed on that, in my opinion. The second one we will never agree on because my position is so far from yours on the curve. I believe that heathcare for everyone should be out of the public purse and applied equally. I don’t see myself stepping off that value anytime before I’m planted in the ground and I would suspect you feel the same about your position. I am certain we both know all the arguements we could make to each other and still not change the others mind. You get to be the lucky one though as it is also unlikely health care will ever be free for all and applied equally.
Surprisingly, we may agree to a greater extent than you may think. I have worked in, and am fairly familiar with the public health system of New Zealand. I would prefer to see some kind of universal enfranchisement. However, Kiwis are, for the most part, devoid of the “entitlement” attitude that is prevalent among many of our Medicaid (i.e. indigent) population, and among our American populace in general. They understand that they cannot go running to the ED for every little thing, and they don’t even require the American “co-pay” method to dissuade them, something which does not apply to the Medicaid beneficiaries. In addition, the NZ health system provides basic care, and is rationed. For all but the utopian ideologue, it is understood that a public system will involve rationing, sooner or later, and that the rationing process will become politicized. In the case of NZ, they don’t pretend that everyone will have equal access. The basic system is pretty good, and is excellent for emergency care (within the limitations of a very sparsely populated and mountainous country), but if you want your hip replacement in 2 weeks instead of 6 months, you’ll buy private insurance, or have a friend in the system to help you. In the real world, if you care to live in it, this is about the best you can expect.
Sorry if this appears to be politically incorrect to you, but, to be quite frank, the term “politically correct” is an oxymoron. The term “correct” needs no modifier, (except “actually”, “really” and the like, which are then simply redundant). To say that something is “politically correct,” therefore, in essence, is saying that it is NOT correct.
No need for apologies. The words politically and correct, used together, are not in my vocabulary. Beyond travellers insurance, I don’t know anywhere near enough about the American healthcare system to have a specific opinion on it, and nowhere near interested enough to investigate but wait lists and rationing are not the same thing at all. I definitely live in the real world. With a young daughter-in-law that has early onset MS and an even younger grandson with hemophilia. I don’t plan on visiting south of the border with either of them – insured or not.