Coyote Blog

Here is the Wikipedia definition of  a Pigovian tax:

A Pigovian tax (also spelled Pigouvian tax) is a tax levied on any market activity that generates negative externalities (costs not internalized in the market price). The tax is intended to correct an inefficient market outcome, and does so by being set equal to the social cost of the negative externalities. In the presence of negative externalities, the social cost of a market activity is not covered by the private cost of the activity. In such a case, the market outcome is not efficient and may lead to over-consumption of the product.^[1] An often-cited example of such an externality is environmental pollution.

The Left often tries to justify new taxes based on their being Pigovian taxes.  The classic example is a carbon tax -- it is claimed there is a social cost to carbon-based fuel combustion (e.g. CO2 production and resulting global warming) that is not taken into account by market prices.  By adding the tax, these other costs can be taken into account, likely raising the price of these fuels and thus both reducing their use and providing a higher price umbrella for alternatives.

For years, I accepted these arguments at face value.  I might argue with them (for example, I think that the Left has tended to spot 10 of the last 2 true negative externalities), but I accepted that they really believed in the logic of the Pigovian tax.  I am now becoming convinced that I was wrong, that the Left's support of Pigovian taxes is frequently a front, a way of putting a more palatable face on what is really a naked grab for more taxpayer money by public officials.  To support this emerging hypothesis, I cite two examples.

 1.  Proposed Carbon Tax in Washington State

This last November, a carbon tax was placed on the ballot in Washington State.  In many ways, it partially mirrored my own proposal (here) by making the tax revenue neutral, ie the new carbon tax was offset by a reduction in other regressive taxes, particularly other consumption taxes.  If the Left and environmental groups truly embraced the Pigovian logic of a carbon tax, they should have jumped at supporting this initiative.  I discuss what happened in depth here but Vox has a good summary:

The measure, called Initiative 732, isn’t just any carbon tax, either. It’s a big one. It would be the first carbon tax in the US, the biggest in North America, and one of the most ambitious in the world.

And yet the left opposes it. The Democratic Party, community-of-color groups, organized labor, big liberal donors, and even most big environmental groups have come out against it.

Why on Earth would the left oppose the first and biggest carbon tax in the country? How has the climate community in Washington ended up in what one participant calls a "train wreck"? (Others have described it in more, er, colorful terms.)....

the alliance’s core objection to I-732 is that it is revenue-neutral — it surrenders all that precious revenue, which is so hard to come by in Washington. That, more than anything else, explains why alliance groups are not supporting it.

Opponents say they wanted to use the revenue for climate-related investments, but even if true there are two things wrong with this.  First, it shows ignorance of the economic theory of the Pigovian tax -- the whole point is that by raising the price of carbon-based fuels, markets will find the most efficient way to reduce this fuel use.  The whole point is that it is way more efficient to reduce CO2 production through this simple pricing mechanism than it is through government cronyist winner-picking "investments".  The second problem is that such promises of funds dedication never last.  Supposedly the tobacco settlement was all supposed to go to health care and tobacco-related education, but there is not a single state where even a double digit percentage went to these things (the American Lung Association estimates just 2% of the funds go to the original purpose).  In New York, the entire tobacco settlement stream was securitized and used to plug a single year's general budget hole.  You can be assured the same thing would happen with carbon tax revenue.

2.  Soda Tax in Philadelphia

Last year, Philadelphia passed a large soda tax.  The justification for such a tax is that such drinks cause obesity and other health issues.  Either for people's own good or to reduce the future burden on government health care programs, the whole point of such a tax is to reduce soda consumption.  Or so it was justified.

But now, once the tax took effect, the city government that passed the tax seems to be shocked and surprised that soda consumption is way down.  You would think that they would be declaring victory, ... that is, if the point was ever to reduce soda consumption and not just to raise some extra revenue.  Via Reason:

For now, Kenney and other city officials seem unfazed—dismissive, even—of the problems caused by the new tax. A city spokesman told Philly.com that no one knows whether low sales figures and predicted job losses are anything more than "fear-mongering to prevent this from happening in other cities."

Kenney put an even finer point on it.

"I didn't think it was possible for the soda industry to be any greedier," Kenney said in an emailed statement to Philly.com reporter Julia Terruso. "They are so committed to stopping this tax from spreading to other cities, that they are not only passing the tax they should be paying onto their customer, they are actually willing to threaten working men and women's jobs rather than marginally reduce their seven figure bonuses."

It's not the first time Kenney has tried to ignore basic economics when it comes to the soda tax. A few weeks ago, he blamed grocery stores and restaurants for "price gouging" when they increased prices for sugary drinks to make consumers pay for the cost of the tax (the tax is technically applied on the transaction between distributors and retailers, but, like all other taxes, it gets passed along).

Its clear that this tax justified as a pigovian tax is really no such thing.   City officials seem to be honestly surprised that consumption is down as the result of a Pigovian tax whose purpose is to... reduce consumption.  And if they really did not expect the tax to get passed on to consumers, then how does it work?   In fact, city officials are actually worried that reductions in soda consumption is going to cause the tax to yield less money than they expected, creating a hole in their budgets.

*    *    *

Going forward, I plan to apply an order of magnitude more skepticism to any future calls for Pigovian taxes.  I think the first thing I will ask of each new suggestion is "do you still support this tax if I were to make it revenue neutral, say by offsetting it with reductions in another regressive taxes?"

A reader pointed me to this letter apparently sent to the Chicago Tribune last year in response to an editorial saying the Redskins name had to go.  I can't prove it was real, but who cares at this point?  It is funny:

Dear Mr. Page...

I always love your articles. and I generally agree with them. I would suggest, as in an email I received, they change the name to the "Foreskins" to better represent their community, paying tribute to the di@k heads in Congress.

Here are some other politically correctness to consider: I agree with our Native American population. I am highly insulted by the racially charged name of the Washington Redskins. One might argue that to name a professional football team after Native Americans would exalt them as fine warriors, but nay, nay. We must be careful not to offend, and in the spirit of political correctness and courtesy, we must move forward. Let's ditch the Kansas City Chiefs, the Atlanta Braves and the Cleveland Indians. If your shorts are in a wad because of the reference the name Redskins makes to skin color, then we need to get rid of the Cleveland Browns.

The Carolina Panthers obviously were named to keep the memory of militant Blacks from the 60's alive. Gone. It's offensive to us white folk.
The New York Yankees offend the Southern population. Do you see a team named for the Confederacy? No! There is no room for any reference to that tragic war that cost this country so many young men's lives.
I am also offended by the blatant references to the Catholic religion among our sports team names. Totally inappropriate to have the New Orleans Saints, the Los Angeles Angels or the San Diego Padres.
Then there are the team names that glorify criminals who raped and pillaged. We are talking about the horrible Oakland Raiders, the Minnesota Vikings, the Tampa Bay Buccaneers and the Pittsburgh Pirates!

Now, let us address those teams that clearly send the wrong message to our children. The San Diego Chargers promote irresponsible fighting or even spending habits. Wrong message to our children.
The New York Giants and the San Francisco Giants promote obesity, a growing childhood epidemic. Wrong message to our children.
The Cincinnati Reds promote downers/barbiturates . Wrong message to our children.
The Milwaukee Brewers---well that goes without saying . . . Wrong message to our children.
So, there you go. We need to support any legislation that comes out to rectify this travesty, because the government will likely become involved with this issue, as they should. Just the kind of thing the do-nothing congress loves . . .

As a die hard Oregon State fan, my wife and I, with all of this in mind, it might also make some sense to change the name of the Oregon State women's athletic teams to something other than "the Beavers."

From Atlas Shrugged:

Dr. Ferris smiled. . . . . ."We've waited a long time to get something on you. You honest men are such a problem and such a headache. But we knew you'd slip sooner or later - and this is just what we wanted."

[Hank Reardon:]  "You seem to be pleased about it."

"Don't I have good reason to be?"

"But, after all, I did break one of your laws."

"Well, what do you think they're for?"

Dr. Ferris did not notice the sudden look on Rearden's face, the look of a man hit by the first vision of that which he had sought to see. Dr. Ferris was past the stage of seeing; he was intent upon delivering the last blows to an animal caught in a trap.

"Did you really think that we want those laws to be observed?" said Dr. Ferris. "We want them broken. You'd better get it straight that it's not a bunch of boy scouts you're up against - then you'll know that this is not the age for beautiful gestures. We're after power and we mean it. You fellows were pikers, but we know the real trick, and you'd better get wise to it. There's no way to rule innocent men. The only power any government has is the power to crack down on criminals. Well, when there aren't enough criminals, one makes them. One declares so many things to be a crime that it becomes impossible for men to live without breaking laws. Who wants a nation of law-abiding citizens? What's there in that for anyone? But just pass the kind of laws that can neither be observed nor enforced nor objectively interpreted - and you create a nation of law-breakers - and then you cash in on guilt. Now, that's the system, Mr. Rearden, that's the game, and once you understand it, you'll be much easier to deal with."

Here is the same thing, Obama Administration style

Major U.S. corporations have broadly supported President Barack Obama's healthcare reform despite concerns over several of its elements, largely because it included provisions encouraging the wellness programs.

The programs aim to control healthcare costs by reducing smoking, obesity, hypertension and other risk factors that can lead to expensive illnesses. A bipartisan provision in the 2010 healthcare reform law allows employers to reward workers who participate and penalize those who don't.

But recent lawsuits filed by the administration's Equal Employment Opportunity Commission (EEOC), challenging the programs at Honeywell International and two smaller companies, have thrown the future of that part of Obamacare into doubt.

The lawsuits infuriated some large employers so much that they are considering aligning themselves with Obama's opponents, according to people familiar with the executives' thinking.

"The fact that the EEOC sued is shocking to our members," said Maria Ghazal, vice-president and counsel at the Business Roundtable, a group of chief executives of more than 200 large U.S. corporations. "They don't understand why a plan in compliance with the ACA (Affordable Care Act) is the target of a lawsuit," she said. "This is a major issue to our members."

At the exact same moment, one branch of the Administration is encouraging an activity that another branch is working to criminalize.

The theory behind the idea that government should nudge (or coerce, as the case may be) us into "better" behavior is based on the idea that many people are bad at delay discounting.  In other words, we tend to apply huge discount rates to pain in the future, such that we will sometimes make decisions to avoid small costs today even if that causes us to incur huge costs in the future (e.g. we refuse to walk away from the McDonalds french fries today which may cause us to die of obesity later).

There are many problems with this theory, not the least of which is that many decisions that may appear to be based on bad delay discounting are actually based on logical and rational premises that outsiders are unaware of.

But the most obvious problem is that people in government, who will supposedly save us from this poor decision-making, are human beings as well and should therefore have the exact same cognitive weaknesses.  No one has ever managed to suggest a plausible theory as to how our methods of choosing politicians or staffing government jobs somehow selects for people who have better decision-making abilities.

Here is a great example.  These are the people who think YOU have a problem with delay discounting:

When all the numbers are crunched, one fact is crystal clear: Yes, a disaster was looming for Detroit. But there were ample opportunities when decisive action by city leaders might have fended off bankruptcy.

If Mayors Jerome Cavanagh and Roman Gribbs had cut the workforce in the 1960s and early 1970s as the population and property values dropped. If Mayor Dennis Archer hadn’t added more than 1,100 employees in the 1990s when the city was flush but still losing population. If Kilpatrick had shown more fiscal discipline and not launched a borrowing spree to cover operating expenses that continued into Mayor Dave Bing’s tenure. Over five decades, there were many ‘if only’ moments.

“Detroit got into a trap of doing a lot of borrowing for cash flow purposes and then trying to figure out how to push costs (out) as much as possible,” said Bettie Buss, a former city budget staffer who spent years analyzing city finances for the nonpartisan Citizens Research Council of Michigan. “That was the whole culture — how do we get what we want and not pay for it until tomorrow and tomorrow and tomorrow?”

Ultimately, Detroit ended up with $18 billion to $20 billion in debt and unfunded pension and health care liabilities. Gov. Rick Snyder appointed bankruptcy attorney Kevyn Orr as the city’s emergency manager, and Orr filed for Chapter 9 on July 18.

The first three times I read this, I was sure it was supposed to be ironic and sarcastic.  I am increasingly convinced that this was written for real

Mayor Michael Bloomberg’s ban on sugary drinks is good for you, New York, and for the rest of the country, too.

And here’s something else, a guaranteed wager: Winston Smith, the suffering protagonist in George Orwell’s “Nineteen Eight-Four,” would trade every aspect of the society dreamed up for him by the sadistic totalitarian government in place of a ban on sugary drinks in 16-ounce cups any day.

There I said it. I know the sentiment is unpopular. I know people will fear the ramifications of a ban on that black bubbling cola in their plastic Big Gulps because they believe it is the road to bigger restrictions on more of their choices. It won’t.

We are a nation of fatties. According to the Centers for Disease Control and Prevention, or CDC, more than one-third of United States adults -- 35.7 percent -- are obese. And obesity is expensive.

Medical costs associated with obesity were estimated at $147 billion in 2008, the CDCnoted. And for people who are obese were $1,429 higher than those of normal weight. While sugary drinks like soda and fruit drinks are not the only culprit here, it is a fact that people are consuming these beverages at an alarming rate. Something needs to be done.

I am sure long-time Coyote Blog readers will not the Health Care Trojan Horse (TM) -- using the socialization of health care costs to justify coercive interventions in individual choices that used to be considered personal.

I have been studying HG Wells of late.  One thing I didn't know about him before is that for all his skepticism about the future in many of his books, and all his prescience about the worst impulses of man, he believed it was possible to create an ideal government that would a dictatorship of the elite, scientific, and enlightened.  Historians called that view "naive", and at the time it may have been. But to hold this sort of view today, as this author does, given history, is simply insane.  Power begets more power.  Coercion begets more coercion.

There really is a very simple test for this - simply imagine the coercive power you advocate in the hands of your worst political enemy.  Still happy with it?  I bet not.

Don't say I have not been warning you.  For years.  Philip Klein via Peter Suderman:

...Bloomberg highlighted a comment from a supporter of the [soda] ban, who wrote, "Anyone who pays taxes and thus bears the health care costs of obesity should support this."

In a free society, individuals are able to take risks and make decisions detrimental to their own well-being -- be it smoking, drinking, excessive eating or anything else -- because they'll bear the ultimate costs of their decisions. But when government assumes a greater role in the health care system, suddenly there's a societal cost to individual risks. This provides an opening for those who believe in a paternalistic role for government to make their regulations seem pragmatic. Bloomberg used the "health care costs to taxpayers" argument during his previous drives to ban smoking in bars and restaurants and to outlaw the use of trans fats.

I have written a lot about government-provided health care as a Trojan Horse for government micro-management of individual behaviors.  The logic is that once the government is paying for your health care, your decisions that once only affected yourself now affect public costs.  Here is a great example:

Touting new recommendations from an Institute of Medicine panel on obesity on Tuesday's NBC Nightly News, science correspondent Robert Bazell proclaimed to viewers: "...a sea change in how we perceive obesity. No longer a question of individual responsibility, but a need to change what's called an 'obesity-promoting environment.' Calling on corporations, government and individuals to act."...

Bazell further pushed the findings: "With the cost of treating obesity-related illnesses approaching $200 billion a year, many on the panel say the nation is ready to act."

I wonder how many feminists who were pretended to be libertarian rather than just pro-abortion by arguing "keep government policy out of my body" are all-in on this type of food consumption regulation?  I would bet a lot.

Update:  Here is an idea -- let's deal with the perceived issue of people eating poorly by ... licensing nutritionists to make their advice scarcer and more expensive.  And here too.

Gwyneth Paltrow learns that human beings did not evolve in caves.

Gwyneth Paltrow learned that staying out of the sun could have health consequences when she was diagnosed with a severe Vitamin D deficiency.

Like many stars, the "Iron Man" actress insisted on staying out of the sun and covered up for summer trips, but then she learned her caution was costing her good health.

..."This led my western/eastern doctors in New York to test my Vitamin D levels, which turned out to be the lowest they had ever seen (not a good thing). I went on a prescription strength level of Vitamin D and was told to … spend a bit of time in the sun!

"I was curious if this was safe, having been told for years to stay away from its dangerous rays, not to mention a tad bit confused as we are all well schooled in the dangers of overexposure to the sun."

Next up -- an increase in anorexia from the obesity panic?

I have written any number of times about government health care as the excuse to regulate nearly everything, since nearly every individual decision and activity can be argued to affect one's health.  If government is paying the health care bills, it now has an interest in regulating behaviors that might raise those bills.  Given the US government has been on a 80-year mission to end the concept of individual responsibility, Obamacare is a huge milestone.

Witness, yet again:

You see, Ms. Kaplan obviously thinks it is the role of government to "help Americans eat healthier" even if it means banning things.  My guess is she'd not be quite as ready for government bans it they had to do with, oh I don't know, books or something similar.The excuse?

In Santa Clara County, one out of every four kids is either overweight or obese. Among 2- to 5-year-olds from low-income families, the rate is one in three. The county health system spends millions of dollars a year treating kids for health problems related to obesity, and the tab is growing.

If you haven't yet figured out that the passage of ObamaCare has emboldened the nannies at all levels, this ought to make the case.  Trust me, this reporter didn't dig this nugget out.  It was handed to her by those trying to justify this power grab.

Yeah, I know this is just a local action, but this is just a market test for future similar federal actions.  I can just picture John Jay and James Madison arguing in a tavern.  "Jimmy, I am just not sure what kind of Constitution we need.  Well, John, whatever we do, we absolutely must make sure the Federal government has the power to ban toys from kids meals.  Oh, and to regulate salt content too.  After all, that's what we fought a war for."

Postscript: My question is, how long are health cost advocates going to nibble at the margins?  Childhood obesity costs are probably close to zero, in the grand scheme of things, despite the BS numbers from "advocates."  Two individual decisions drive a ton of health care costs - driving (the most dangerous activity we pursue, typically) and sex (not just in disease but in pre and post natal care).  And I wonder how long it will be before government health care costs treating gunshot victims will be used to trump 2nd amendment arguments?

It's hard to imagine a more naked example of rent-seeking than this one

A group representing Arizona hospitals is pursuing a ballot initiative that would tax the state's high-income earners to help pay the health-care tab for the state's neediest kids and adults.

The Arizona Hospital and Healthcare Association expects to file paperwork for the initiative later this week, aiming for a place on the November ballot.

It asks voters to raise the state income-tax rate 1 percentage point on income exceeding $150,000 per individual and $300,000 per couple.

The association estimates the initiative would raise more than $140 million each year to pay for health insurance for low-income children and adults, graduate-school medical education and reimbursement to hospitals that care for the poor.

In other words, the government will take the money and hand it over to hospitals to do the things they are already doing.  I could put together a heartwarming story too for my industry -- we think there should be a 1% tax on all Arizona residents for kids to visit parks and campgrounds to fight childhood obesity and improve their connection with nature -- but you don't see me rent-seeking like this.

My gut feel, though I have no direct evidence, is that this is being rushed through to beat the deadline on Obamacare implentation -- my guess being that this will be somehow moot once that program is in place so the hospitals want to get their licks in before anyone really figures out the new health care law.  Once the tax and program is in place, it will be virtually impossible to kill, even if it is irrelevent post-Obamacare.  Anyone have knowlege about this one way or the other?

I have warned for quite a while that government health care is a Trojan horse for all kinds of intrusive micro-regulations of our decisions and behaviors.  Here's an update: (via Maggies Farm)

"As the government assumes a larger share of health care costs, it is increasingly able to use that as a justification to intrude into personal decisions or private enterprises, whether it's a matter of smoking policy, trans-fats, or salt," we wrote last month. Now the Wall Street Journal is out with an editorial praising Michelle Obama's campaign against childhood obesity, reasoning, "the reality is that U.S. obesity imposes huge costs on taxpayers. In 2006, the per capita increase in spending attributable to obesity was 36% for Medicare and 47% for Medicaid, according to a paper last year in Health Affairs. Many fat kids grow up to be fat adults, and you've got to start somewhere."

Almost any behavior or decisions, from eating to driving to sports participation, has implications on one's potential future health care costs.  So by this logic, almost anything can be regulated.  For example, I would argue that sex has a much higher health care cost impact than eating, not just in STD's but in the cost of pregnancies and pediatrics.   Or as another example, our family spent far more in health care costs on treating our kids' accidents while playing sports than in dealing with any obesity costs.  Should we be requiring kids to stay indoors playing on the computer where they will be safe from potentially expensive accidents?

I have written on this topic any number of times, warning that when government pays the health care bills, said payments gives it nearly infinite room to label just about any individual behavior as "costly" to the health care system and therefore fair game for micro-regulation.

Via a reader:

If you happen to be the 1-in-3 Americans who is neither obese nor overweight (and, thus, considered at risk of becoming obese), you might well conclude that the habits of the remaining two-thirds of Americans are costing you, big time. U.S. life expectancies are expected to slide backward, after years of marching upward. (But that's their statistical problem: Yours is how to make them stop costing you all that extra money because they are presumably making poor choices in their food consumption.)

"Facing the serious consequences of an uncontrolled obesity epidemic, America's state and federal  policy makers may need to consider interventions every bit as forceful as those that succeeded in cutting adult tobacco use by more than 50%," the Urban Institute report says. It took awhile -- almost 50 years from the first surgeon general's report on tobacco in 1964 -- to drive smoking down. But in many ways, the drumbeat of scientific evidence and the growing cultural stigma against obesity already are well underway -- as any parent who has tried to bring birthday cupcakes into her child's classroom certainly knows.

Key among the "interventions" the report weighs is that of imposing an excise or sales tax on fattening foods. That, says the report, could be expected to lower consumption of those foods. But it would also generate revenues that could be used to extend health insurance coverage to the uninsured and under-insured, and perhaps to fund campaigns intended to make healthy foods more widely available to, say, low-income Americans and to encourage exercise and healthy eating habits.

Please, please note the text in bold.  They have made overeating a crime with a victim - people who are thin are victims of those who are overweight, and therefore can call on the government to take swift action to protect them.  Eek!  And the LA Times is clearly in love with the idea.   Is it any wonder my chief concern about government health care is not the costs, but the threats to individual liberty?

John Stoessel has further comments.

For those of you comfortably thin who chose to ignore this as not your problem, consider this:  If an overweight person is a threat to a thin person, via the health care charges he might burden taxpayers with, what about, say, a skier?  I don't chose to participate in dangerous sports, so isn't a skier doing a crime against me by the same logic for taking a risk of a potentially expensive injury?  How about a person whose hobby involves dangerous tools.  If TJIC cuts his finger off on his band saw, isn't that costing me money in our new socialist regime?  What about bike riding, or motorcycle riding, or rock climbing, or rugby?  What about any parent that lets their kid play somewhere they could get hurt and cost us mone?

This is why government health care is so dangerous  -- it takes what should be individual decisions with individual consequences and socializes the costs of our personal choices.  Once the costs are socialized, won't control of the choices themselves follow?

Postscript: Again going into morbid mode here, obesity may increase costs for younger patients, but its higher early morbidity actually can reduce lifetime costs.  Basically, morbidly obese people tend to die more often before they grow old enough to get expensive cancers and such.  Several studies have shown lifetime costs for the obese to be lower than for other folks.

Which is not to say that obesity is good, so please do not misunderstand my point.  I would work hard to help someone I loved who was morbidly overweight to get in better health.  Obesity can be bad but its a crappy excuse to take another axe to our free society.

Via the Junkfood Science blog,

It has actually happened. Lawmakers have proposed
legislation that forbids restaurants and food establishments from
serving food to anyone who is obese (as defined by the State). Under
this bill, food establishments are to be monitored for compliance under
the State Department of Health and violators will have their business
permits revoked.

Unbelievable.  And not that this would make it right, but the ban is not even on serving certain types of fattening foods, but on serving any food.  Here is the key part of the law:

Any food establishment to which this section
applies shall not be allowed to serve food to any person who is obese,
based on criteria prescribed by the State Department of Health after
consultation with the Mississippi Council on Obesity Prevention and
Management established under Section 41-101-1 or its successor. The
State Department of Health shall prepare written materials that
describe and explain the criteria for determining whether a person is
obese, and shall provide those materials to all food establishments to
which this section applies. A food establishment shall be entitled to
rely on the criteria for obesity in those written materials when
determining whether or not it is allowed to serve food to any person.

In about the hundredth post in this series, yet another example of government health care costs being used to micro-regulate even the smallest personal lifestyle decisions:

The city that banned plastic grocery bags and styrofoam take-out
containers has found a new cause: your favorite soft drink. San
Francisco may impose a new fee on those big retail stores that sell
them. The purpose is to curb the obesity problem among kids and adults.
Such fee or tax would be the first in the nation.

 

San Francisco says the obesity problem is costing the city too
much money in health care costs. Studies have linked obesity to
diabetes and heart disease.

"One third of all of our new
on-set diabetics are type 2 because of obesity and this is in children
now," says Robert Lustig, M.D., Endocrinologist, UCSF.

It is perhaps appropriate, given the polls in Iowa, that Mike Huckabee precipitated one of the earliest posts in this series:

Mike Huckabee, the Governor of Arkansas, now
requires annual fat reports. These are sent to the parents of every
single child aged between 5 and 17; a response, he says, to "an
absolutely epidemic issue that we could not ignore" in the 1,139
schools for which he is responsible.

I
just cannot craft any reasonable theory of government where this is the
state's job.   The "obesity" crisis in this country just amazes me.
"Experts" every few years broaden the definition of who is overweight
or obese, and suddenly (surprise!) there are more people defined as
overweight.  Even presuming it is the state's job to optimize our body
weights, is it really the right approach to tell everyone they are too
fat?  Having known several people who were anorexic, including at least
one young woman who died of its complications, is it really a net
benefit to get young people more obsessed with looks and body style?
And what about the kids that are genetically programmed to be
overweight?  Does this mean that years of taunting and bullying by
their peers is not enough, that the state's governor wants to pile on
now?

It is interesting to note that governor Huckabee apparently started
this initiative after his own personal battle with weight loss:

[Huckabee] lost 110lb after being warned that his
weight, more than 280lb after a life of southern fried food, was a
death sentence. A chair even collapsed under him as he was about to
preside over a meeting of state officials in Little Rock.

We
all have friends who have lost weight or gotten into homeopathy or
became a vegan and simply cannot stop trying to convert their friends
now that they see the light.  Now we have the spectacle of elected
officials doing the same thing, but on a broader scale and with the
force of law, rather than  just mere irritation, on their side.  One
can only imagine what report cards kids would be carrying home if
Huckabee had instead had a successful experience with penis
enlargement.  What's next, negative reports for kids with bad acne?
For women whose breasts are too small?  For kids who are unattractive?

Update: I see Q&O posts on the same issue

I have argued on numerous occasions that government-funded health care is a Trojan Horse for detailed regulation of how we treat our bodies.  The Economist Blog has a great post on this topic:

Why exactly is obesity a public health issue? Well, when,
by force of law, you externalise responsibility for providing a good,
such as health care, then the effects of all individual choices that
affect the cost of providing that good for the individual are thereby
transformed from internal to external effects. If you, like
Mr Dubois, are in the grip of the blithe assumption that reducing
negative externalities by raising the cost of the behaviour that causes
them is simply what government does, then obviously my gluttony and sloth are public problems. Because public policy made them public problems! So, obviously,
it's up to the government to fiddle with prices to manipulate our
behavior in order to minimise its impact on the tax-financed national
budget.

This sort of thing drives me crazy because it's just so
thoughtlessly arbitrary -- intellectual empty calories. Why
specifically a tax on junk food? Yes, one
of the causes of obesity is "the consumption of too many calories."
Another is the failure to burn the calories one consumes. So why not
levy huge fines on people for not showing up at "voluntary"
government-funded yogalates classes? Or if people are consuming too
many calories, then just put a tax on calories. Why tax some calories
but not others? You can get fat eating steak, too. Maybe a national
"cap and trade" system of calorie credits would do the trick. Hey, do
you know who's healthy? Mormons are. Maybe the government should
provide giant tax credits for being Mormon. Or perhaps it would be
easier if the national health care system could just deny services for
ailments it judged to be obesity-related.  You could even decide not to
have a national health care system at all and allow insurance premiums to reflect the actuarial risk of individual behavior! But that would be crazy. 

Hat tip to TJIC, who has more.  I think this would be a great anti-universal-coverage T-shirt:

Ironically, this shirt is produced by the National Organization of Women, who are strong government health care supporters.  Go figure.

It is often said that capitalism won over socialism in the late 20th century, with the fall of the Berlin Wall and the rise of powerful Asia market economies.  Be that as it may, this statement certainly does not apply to American university campuses.  In the ivory tower, capitalism is still the number one whipping boy. 

An interesting illustration of this is Jacob Sullum's review of a pair of books that attempt to debunk the myth that being mildly overweight is deadly.  This is a rich topic, given some of the really bad science that has gone into trying to make being overweight the next smoking, and the review is worth a read.  However, this part caught my eye:

Both he and Campos blame the unjustified obsession with weight and the
cruel vilification of fat people on capitalism, which, they say, prizes
self-discipline and stigmatizes those seen as lacking it. To be fair,
Campos more specifically blames a pro-capitalist Protestant asceticism
that encourages the pursuit of wealth but frowns on those who enjoy it
too much. There's an element of truth to this analysis; a similar
ambivalence regarding pleasure helps explain American attitudes toward
sex, drugs, and gambling.

But wait!  Aren't most of the folks like the food nazis who are launching government obesity campaigns leftists?  They are, and Sullum makes this point:

But it does give you pause when you consider that the obesity
obsessives also blame capitalism, for precipitating the current crisis
by making food plentiful, inexpensive, appealing, and convenient. New
York University nutritionist Marion Nestle, for example, blames
America's adiposity on "an overly abundant food supply," "low food
prices," "a highly competitive market," and "abundant food choices,"
while Kelly Brownell claims restaurants exploit consumers when they
give them more for less, since "people have biological vulnerabilities
that promote overeating when large portions are available, a strong
desire for value, and the capacity to be persuaded by advertising."

Great.  So capitalism causes obesity as well as anti-obesity.  You can't win.

Every time I write that government funded health care and health nannyism are becoming a Trojan horse for fascism, I get several emails telling me I am being a paranoid flake.  So I will have to just keep posting this kind of thing (from England), via Overlawyered:

SOCIAL workers are placing obese children on the child protection
register alongside victims thought to be at risk of sexual or physical
abuse.

In extreme cases children have been placed in foster care because
their parents have contributed to the health problems of their
offspring by failing to respond to medical advice.

The
intervention of social services in what was previously regarded as a
private matter is likely to raise concerns about the emergence of the
"fat police".

Some doctors even advocate taking legal action against parents for
illtreating their children by feeding them so much that they develop
health problems.

Dr Russell Viner, a consultant paediatrician at Great Ormond Street
and University College London hospitals, said: "In my practice, I can
think of about 10 or 15 cases in which child protection action has been
taken because of obesity. We now constantly get letters from social
workers about child protection due to childhood obesity."

It seems of late that obesity is the new sky-is-falling health care issue I see in papers all the time.  One of the easiest ways to create a "trend" is to steadily change the standards**, which is in fact what has been happening with obesity in the US.  Every year or two, government officials or whoever does this stuff expand the range of weights that constitute "obese".  By doing this, even if the average weights are not changing (and I don't know if they are or are not) you can create a trend in increasing obesity just from changing the standards.  In fact, I argued here:

By the way, I am willing to make a bet with anyone that no where near
40% of our healthcare charges in Arizona are due to obesity.  I am
positive some advocate made up this number, or created it using some
ridiculously broad assumptions, and it has now been swallowed by the
credulous and scientifically-illiterate press. 

Sandy Szwarc who runs the new Junkfood Science blog, writes of a similar effect in hospital statistics.

The HCUP report
is not actually reporting hospital stays of obese people. It is a tally
of the numbers of times "obesity" was checked off on the billing codes
on the hospital records. These codes are currently known as ICD-9
codes, taken from the International Classification of Diseases, Ninth Revision.
This is an enormous, complicated and continually changing system which
gives a number to every disease and medical procedure, and currently
has about 12,000 codes. The medical literature is filled with
documentations of their inaccuracies in reflecting actual patient
disease rates. But over recent years, healthcare providers are being
increasingly educated on using these codes in order to receive
reimbursements ... including coding for obesity. The weight loss and
bariatric industry has been especially intense in marketing the usage of the obesity code, in particular.     

Not surprisingly, more providers are.    

So that 112% increase in hospitalizations for "obesity"since 1996 actually reflects increased usage of
the coding, but whether or not it means there are actually more obese
patients is arguable. But with the heightened stringency and
surveillance by third party payers in compelling providers to
accurately note ICD-9 codes in order to receive reimbursements, the
current figures are certainly more complete than in past years.

She concludes by questioning whether there really is an epidemic of hospital admissions for obesity.  Remember that this is important because it is this obesity epidemic that is used as justification for nanny-state interventions like the NY trans-fat bans as well as potential tobacco-clone litigations against fast food companies. 

This report is being
presented as proof that ""˜obesity' has become a major public health
problem." That was even its opening sentence. But the media's failure
to give us the full story is demonstrated in the most significant fact
in the report: 94.3% of all hospitalizations made no mention of obesity!    

Fat people are not flooding into hospitals with health problems more than anyone else.   

"Obesity" is the primary diagnosis in only 0.4% of all hospitalizations and
virtually all of those (95%) were for bariatric surgery! Not the result
of fat people succumbing to life-threatening health problems, but a
profit-making elective surgery targeting them.

My sense is that the obesity issue is the next phase of what I call the health care trojan horse (and here and here).  This is the practice of using government funded health care expenditures as an excuse to micro-regulate our eating and other personal practices.  As I said then:

When health care is paid for by public funds, politicians only need to
argue that some behavior affects health, and therefore increases the
state's health care costs, to justify regulating the crap out of that
behavior.  Already, states have essentially nationalized the cigarette
industry based on this argument.

** As an aside, a fantastic example of this game is in the movie "An Inconvenient Truth."  The filmmakers try to make the argument that global warming is making weather more volatile.  As "proof", they show the number of reported tornadoes in the US rising dramatically since the 1950's.  But here is the rub:  In the 1950's, we had no good way of detecting smaller class 1 and 2 tornadoes that we now detect using Doppler radar and the like.  This means that we do not necessarily experience more tornadoes, we just can detect more.  In fact, if you look only at larger class 3-5 tornadoes that we could detect through the whole period, the tornado frequency has NOT gone up.  I leave it to the reader to decide if the filmmakers are terrible at interpreting scientific data, or if they are disingenuous.  Neither reflects well on the rest of the film.

Via Overlawyered, from the nanny's at the British Medical Journal:

Clothes made in larger sizes should carry a tag with an obesity
helpline number, health specialists have suggested. Sweets and snacks
should not be permitted near checkouts, new roads should not be built
unless they include cycle lanes and food likely to make people fat
should be taxed, they say in a checklist of what we might "reasonably
do" to deal with obesity.

I know a number of larger folks who already get huge self-esteem hits everytime they shop for clothes.  I am sure they would love to see a tag that says "If you are trying this on, you are fat.  Get help" on their clothes.  Oh, and thanks for all the help with girls that have a tendency towards anorexia.  I am sure all this media and government obsession with body size and losing weight will be a big help (when I was younger, I had two acquaintances both die from complications associated with anorexia and bulimia).  What's next?  Special tags on small-size condoms saying, well, never mind.

From the NY Times:

People of Valentin Keller's era [mid 19th century], like those before and after them,
expected to develop chronic diseases by their 40's or 50's. Keller's
descendants had lung problems, they had heart problems, they had liver
problems. They died in their 50's or 60's.

Now, though, life has changed. The family's baby boomers are reaching middle age and beyond and are doing fine.

"I feel good," says Keller's great-great-great-grandson Craig Keller.
At 45, Mr. Keller says he has no health problems, nor does his
45-year-old wife, Sandy.

The Keller family illustrates what may
prove to be one of the most striking shifts in human existence "” a
change from small, relatively weak and sickly people to humans who are
so big and robust that their ancestors seem almost unrecognizable.

Scientists are looking for the explanation of a generation of humans so much stronger and healthier than those who preceded them.  Hypotheses seem to center on pre-natal maternal health and early life nutrition.  But I can give the bigger picture answer:  wealth.  Not Bill Gates wealth, but the generally enormous increase in wealth, even among the poorest Americans.  I discussed this issue along with other related ones in this article on wealth creation.  And this cartoon seems relevant.  Also makes you wonder about whether the obsession with obesity nowadays makes much sense.

The biggest surprise emerging from the new studies is that many chronic ailments like heart disease,
lung disease and arthritis are occurring an average of 10 to 25 years
later than they used to. There is also less disability among older
people today, according to a federal study that directly measures it.
And that is not just because medical treatments like cataract surgery
keep people functioning. Human bodies are simply not breaking down the
way they did before.

Even the human mind seems improved. The
average I.Q. has been increasing for decades, and at least one study
found that a person's chances of having dementia in old age appeared to
have fallen in recent years....

People
even look different today. American men, for example, are nearly three
inches taller than they were 100 years ago and about 50 pounds heavier.

A nice perspective to maintain during modern media-fed health panics.

Update:  Brian Doherty makes a similar observation.

Via Liz Lightfoot in the Telegraph:

Nearly 60 per cent of girls aged 12 to 15 described themselves as
overweight when only 15 per cent met the medical criteria for excess
body fat.

The findings prompted the Schools Health Education Unit, which carries
out the annual survey, to issue an appeal for an end to the "obsession"
with skeletal body shapes in the media and fashion industry.

Yeah, I know this is the UK, but I bet you would get similar results in the states.  While the article points the finger at the media and fashion industry, how about government and academic know-it-alls who with their recent obsession on teenage obesity are reinforcing this message?  For example, remember this previous post about the Arkansas governor's new program:

I get email and comments from time to time that my language deriding
government's intervention into every aspect of our lives is overblown
and exaggerated.  My answer:  Oh yeah, well how about this:

Mike Huckabee, the Governor of Arkansas, now
requires annual fat reports. These are sent to the parents of every
single child aged between 5 and 17; a response, he says, to "an
absolutely epidemic issue that we could not ignore" in the 1,139
schools for which he is responsible.

I
just cannot craft any reasonable theory of government where this is the
state's job.   The "obesity" crisis in this country just amazes me.
"Experts" every few years broaden the definition of who is overweight
or obese, and suddenly (surprise!) there are more people defined as
overweight.  Even presuming it is the state's job to optimize our body
weights, is it really the right approach to tell everyone they are too
fat?  Having known several people who were anorexic, including at least
one young woman who died of its complications, is it really a net
benefit to get young people more obsessed with looks and body style?
And what about the kids that are genetically programmed to be
overweight?  Does this mean that years of taunting and bullying by
their peers is not enough, that the state's governor wants to pile on
now?

It is interesting to note that governor Huckabee apparently started
this initiative after his own personal battle with weight loss:

[Huckabee] lost 110lb after being warned that his
weight, more than 280lb after a life of southern fried food, was a
death sentence. A chair even collapsed under him as he was about to
preside over a meeting of state officials in Little Rock.

We
all have friends who have lost weight or gotten into homeopathy or
became a vegan and simply cannot stop trying to convert their friends
now that they see the light.  Now we have the spectacle of elected
officials doing the same thing, but on a broader scale and with the
force of law, rather than  just mere irritation, on their side.  One
can only imagine what report cards kids would be carrying home if
Huckabee had instead had a successful experience with penis
enlargement.  What's next, negative reports for kids with bad acne?
For women whose breasts are too small?  For kids who are unattractive?

Frequent readers will now that I have long warned of government-funded health care acting as a Trojan horse for micro-management of our personal lives, the logic being that if our lifestyles or behaviors make us less healthy, then the government that funds medical care may claim an interest in regulating those behaviors.  I often post examples of this phenomena, the most recent of which is here.

This installment comes via Reason, and looks at the NYC Health Commissioner Thomas Friedan's new fascism to prevent diabetes program.  I am not sure I even need to comment on the following for you to get the picture:

New York City is at the forefront of this new public health movement. In
January, city health officials began
requiring
that medical testing labs report the results of blood sugar tests for all
the city's diabetics directly to the health department. This is first time
that any government has begun tracking people who have a chronic disease.
The New York City Department of Health will analyze the data to identify
those patients who are not adequately controlling their diabetes. They will
then receive letters or phone calls urging them to be more vigilant about
their medications, have more frequent checkups, or change their diet....

So what could be wrong with merely monitoring and reminding people to take
better care of themselves?  New York City Health Commissioner Thomas Friedan
has made it clear that it won't necessarily end there. If nagging is not
sufficient to reduce the health consequences of the disease, other steps
will be taken. Friedan
argues
that "modifications of the physical environment to promote physical
activity, or of the food environment to address obesity, are essential for
chronic disease prevention and control." Friedan envisions regulations for
chronic disease control including "local requirements on food pricing,
advertising, content, and labeling; regulations to facilitate physical
activity, including point-of-service reminders at elevators and safe,
accessible stairwells; tobacco and alcohol taxation and advertising and
sales restrictions; and regulations to ensure a minimal level of clinical
preventive services."

The NYC health department starred in a previous post for their brave attack on restaurants that give patrons too much for their money.

Again, via Reason's Hit and Run:

Yesterday an Institute of Medicine committee released a report on food marketing and children that called for
congressional action "if voluntary efforts by industry fail to successfully shift
the emphasis of television advertising during children's programming away from
high-calorie, low-nutrient products to healthier fare." According to The New York Times, the IOM report "links TV ads and
childhood obesity." According to The Washington Post, it says "TV ads entice kids to
overeat."

It is amazing that the human race has made it this far given that our children are raised by two entities, "TV" and "Congress", who are so often bickering with each other over how to best accomplish the task. 

I have a proposal.  I think we should nominate some smaller group of adults, maybe two on average, to take over the care, feeding, and education of children until they reach adulthood.  Though its probably not an absolute requirement, maybe we could have one of these adults be a female and one a male, to make sure children can draw on the experience and insights of both genders.  These individual child protective guardians could actually live with the children, helping them to avoid making bad decisions about diet, entertainment, and many other life issues.  This would drive accountability for raising children down much closer to the individual level, and relieve from "TV" and "Congress" the need to micromanage decision-making from afar.

I get email and comments from time to time that my language deriding government's intervention into every aspect of our lives is overblown and exaggerated.  My answer:  Oh yeah, well how about this:

Mike Huckabee, the Governor of Arkansas, now
requires annual fat reports. These are sent to the parents of every
single child aged between 5 and 17; a response, he says, to "an
absolutely epidemic issue that we could not ignore" in the 1,139
schools for which he is responsible.

I just cannot craft any reasonable theory of government where this is the state's job.   The "obesity" crisis in this country just amazes me.  "Experts" every few years broaden the definition of who is overweight or obese, and suddenly (surprise!) there are more people defined as overweight.  Even presuming it is the state's job to optimize our body weights, is it really the right approach to tell everyone they are too fat?  Having known several people who were anorexic, including at least one young woman who died of its complications, is it really a net benefit to get young people more obsessed with looks and body style?  And what about the kids that are genetically programmed to be overweight?  Does this mean that years of taunting and bullying by their peers is not enough, that the state's governor wants to pile on now?

It is interesting to note that governor Huckabee apparently started this initiative after his own personal battle with weight loss:

[Huckabee] lost 110lb after being warned that his
weight, more than 280lb after a life of southern fried food, was a
death sentence. A chair even collapsed under him as he was about to
preside over a meeting of state officials in Little Rock.

We all have friends who have lost weight or gotten into homeopathy or became a vegan and simply cannot stop trying to convert their friends now that they see the light.  Now we have the spectacle of elected officials doing the same thing, but on a broader scale and with the force of law, rather than  just mere irritation, on their side.  One can only imagine what report cards kids would be carrying home if Huckabee had instead had a successful experience with penis enlargement.  What's next, negative reports for kids with bad acne?  For women whose breasts are too small?  For kids who are unattractive?

As I have argued many times in the past, a large part of the blame for these initiatives is public funding of health care.  Beyond the efficiency and choice arguments, I have tried to point out that publicly funded health care is a Trojan horse for a number of truly intrusive nanny-state government controls of our lives.

It isn't such a stretch to imagine the effect
when people realise "” as residents of Arizona have been told already "”
that about 40 per cent of their healthcare charges are spent treating
the consequences of avoidable obesity.

When health care is paid for by public funds, politicians only need to argue that some behavior affects health, and therefore increases the state's health care costs, to justify regulating the crap out of that behavior.  Already, states have essentially nationalized the cigarette industry based on this argument.

By the way, I am willing to make a bet with anyone that no where near 40% of our healthcare charges in Arizona are due to obesity.  I am positive some advocate made up this number, or created it using some ridiculously broad assumptions, and it has now been swallowed by the credulous and scientifically-illiterate press.

Update: Wow, the solution to obesity!  Government funded shrubbery:

City dwellers living in areas with little greenery and high levels of
graffiti and litter are more likely to be obese than those living in
pleasant areas with lots of greenery, say researchers in a study
published on bmj.com today.

Reason number 6,345 not to ever take "facts" from a "study" reported in the media at face value.

Update #2: More about the health care as a trojan horse for statism  (emphasis added)

BangkokThe World Health
Organization (WHO) has always had a rather expansive notion of what it
means to be healthy. If one looks at the official definition it defines
health as a "state of complete physical, mental and social well-being
and not merely the absence of disease or infirmity." According to that
understanding there isn't much that is not in some way connected with
health.  And for the health promoters at WHO's recently completed Bangkok conference that means that health is the supremely important value that trumps everything else.

After
all, the health promoters argue, it is surely obvious that health is a
necessary condition for any sort of life, so it must follow that for
any truly rational person health must outweigh any other value that
might conflict with it. But the "obvious" -- especially the obvious of
the health promoter -- is often likely to be untrue. While it may be
true that being alive is in some not very interesting sense necessary
for having a life, it is not at all true that being "healthy,"
especially as defined by WHO, is a necessary condition for having a
good life.

 

All
of us make trade-offs between optimal health and other values all of
the time. We travel by car for instance, for reasons of economy or
convenience, even though we might recognize that statistically planes
are safer. We smile at Alan Dershowitz's cardiac calculus where a
patient chooses between ten years of inactive life and the risk of
sudden death:

 

"My
doctor has made a prognosis/That intercourse fosters thrombosis/But I'd
rather expire/Fulfilling desire/Then abstain, and develop neurosis."

Apparently, the mortality rates from obesity that the media has been breathlessly lecturing us with were overestimated by at least 1500%:

But in a study released this week by the CDC
and published in the Journal of the American Medical Association ("Excess Deaths
Associated with Underweight, Overweight, and Obesity"), the public health
community has finally owned up to their massive fib by acknowledging that the
number of deaths due to obesity in the US is closer to 26,000 not 400,000 as
previously reported.

The part of the earlier study that really got people's attention was the fact that even those slightly overweight but well short of obese had a significantly increased risk of death.  Now, the CDC channels Emily Littella in saying "never mind":

for the merely overweight with BMI's from 25-30 there is no excess mortality. In
fact, being overweight was "associated with a slight reduction in mortality
relative to the normal weight category." Being overweight not only does not lead
to premature death, something that dozens of other studies from around the world
have been saying for the last 30 years, but it also carries less risk from
premature death than being "normal" weight. In other words the overweight=early death "fact" proclaimed
by the public health community is simply not true.

In fact, the study argues, the risks from being underweight are greater than overweight, something that resonates with me having known two women who died due to complications from anorexia.

Other studies will have to replicate these findings, but this study does seem to have taken a more careful approach than previous approaches.  One thing you can be sure about, is that this will not stop lawsuits against fast food companies, since overwhelming medical evidence of the safety of breast implants has not stopped litigation in that arena.  Heck, the fact that most people who are suing asbestos companies admits they are not even sick has not stopped litigation in that arena.