With responsibility comes freedom

Many scholars, such as F.A. Hayek in his book The Road to Serfdom, have explained that political and personal freedom cannot survive without economic freedom. The argument, however, is an intellectual one, typically presented in mostly abstract terms. And unfortunately, the abstract concept cannot easily compete with the raw emotional propaganda trafficked by the enemies of economic freedom. As a consequence, most people continue to believe that government can expand its control of the economy without threatening political and personal freedom. The folly of this view is best revealed through example, for as Edmund Burke observed, “Example is the school of mankind, and they will learn at no other.”

Consider, therefore, the treat to freedom posed specifically by government control over the provision of health care. In the United States, government has already taken responsibility for about half of all spending on health care, and the enactment of Obamacare is certain to increase this figure substantially. Does government control over health care pose a threat to liberty? Well, just this week come two news stories suggesting that government is preparing a crackdown on smokers and others with unhealthy habits.

First, Oregon’s state legislature is considering a bill to make cigarettes a controlled substance, requiring a physician’s prescription.

The bill would force all cigarette smokers to carry a prescription from a doctor or face jail time. Offenders of the proposed law would face maximum punishments of one year in prison, a $6,250 fine or both, Fox 12 Oregon reports.

The article includes the following quote from another sterling product of our school system.

“I hope it passes, and I hope people actually think about it,” said Rick Cannon of Salem. “You know there’s less and less smokers everyday because they know how bad it is for them, so I just hope people wake up and realize how bad it actually is for them.”

And if people don’t “wake up,” Rick Cannon of Salem is apparently perfectly happy to wake them up with fines of up to $6,250 and/or imprisonment for up to one year. Feel the love!

In addition to smokers, the following Associated Press piece extends the love to those who are overweight or obese. They too will have to get with the program.

If 1 in 5 U.S. adults smoke, and 1 in 3 are obese, why not just get off their backs and let them go on with their (probably shortened) lives? Because it’s not just about them, say some health economists, bioethicists and public health researchers. “Your freedom is likely to be someone else’s harm,” said Daniel Callahan, senior research scholar at a bioethics think-tank, the Hastings Center….

“When you ban smoking in public places, you’re protecting everyone’s health, including and especially the nonsmoker,” said S. Jay Olshansky, a professor at the University of Illinois-Chicago’s School of Public Health. It can be harder to make the same argument about soda-size restrictions or other legislative attempts to discourage excessive calorie consumption, Olshansky added. “When you eat yourself to death, you’re pretty much just harming yourself,” he said.

But that viewpoint doesn’t factor in the burden to everyone else of paying for the diabetes care, heart surgeries and other medical expenses incurred by obese people, noted John Cawley, a health economist at Cornell University. “If I’m obese, the health care costs are not totally borne by me. They’re borne by other people in my health insurance plan and – when I’m older – by Medicare,” Cawley said.

Now, in a free society, individuals would be responsible for their own medical costs. And if you are in fact paying for your health care yourself, people can generally agree that smoking a cigarette or eating a pint of ice cream in the privacy of your own home is nobody’s business but your own. “When you eat yourself to death, you’re pretty much just harming yourself.” Indeed, the article correctly points out that

there would be less reason to grouse about unhealthy behaviors by smokers, obese people, motorcycle riders who eschew helmets and other health sinners if they agreed to pay the financial price for their choices.

But the problem is that responsibility for payment has been turned over to government, and he who pays the piper calls the tune. When the public at large, through the state, assumes responsibility for medical costs, any personal behavior that impacts those costs becomes a matter of public interest. Smoking and obesity in particular are perceived to increase the government’s liability for health care costs: “Annual health care costs are roughly $96 billion for smokers and $147 billion for the obese, the government says.” With the public bearing the cost, now smoking that cigarette or eating that ice cream becomes an anti-social act. What had been “your freedom” suddenly becomes “someone else’s harm.” The state will therefore act to suppress those freedoms.

[P]ublic health officials shouldn’t shy away from tough anti-obesity efforts, said Callahan, the bioethicist. Callahan caused a public stir this week with a paper that called for a more aggressive public health campaign that tries to shame and stigmatize overeaters the way past public health campaigns have shamed and stigmatized smokers.

National obesity rates are essentially static, and public health campaigns that gently try to educate people about the benefits of exercise and healthy eating just aren’t working, Callahan argued. We need to get obese people to change their behavior. If they are angry or hurt by it, so be it, he said.

Feel the love! And ponder what is being proposed: An “aggressive public health campaign”–which sounds to us like something that would be funded and implemented by government–that would “shame and stigmatize” a subset of society. Maybe the government’s campaign can coin a convenient catch-all term for those it seeks to shame and stigmatize. “Kulaks,” perhaps. Or maybe “refuseniks.”

In any event, this assault on freedom would never arise in a world where people took responsibility for their own health care. Everyone is familiar with the old saying that “with freedom comes responsibility.” But it may equally be said that with responsibility comes freedom.