Is the nanny state caused by socialised healthcare?

Paul Hsieh, a medical doctor, has an article up at Forbes asking whether an overbearing nanny state is an inevitable consequence of socialised healthcare. Dr Hsieh is the co-founder of a group called Freedom and Individual Rights in Medicine, whose very existence the British Medical Association must consider utterly baffling ("What are these 'individual rights' of which you speak?"). He argues that once the costs of healthcare are collectivised, the state can use efficiency savings as a justification for legislating against any personal behaviour that might be unhealthy.

One of Bloomberg’s primary justifications for his regulations is that widespread obesity drives up health costs for everyone. Nor is he alone in making this argument. USA Today and National Public Radio both recently published stories linking rising obesity rates to rising health costs. First Lady Michelle Obama has made childhood obesity her signature cause, arguing that obesity-related health costs jeopardize American economic prosperity. Former GOP Senate majority leader Bill Frist supports taxing sugar products to reduce obesity and national health spending.

The recurring theme: The government must limit our freedoms to limit overall medical costs. But this issue can only arise in “universal” health systems where taxpayers must pay for everyone else’s medical expenses.

Hsieh gives many other examples of excessive government interference being justified on the pretext of saving money, but I think he is wrong in his basic assumption. These people may use socialised healthcare as an excuse for sin taxes and prohibitions, but that does not mean that socialised healthcare is at the root of their concerns.

It is, as I explain at length in The Wages of Sin Taxes, demonstrably untrue that 'unhealthy' pastimes increase net healthcare costs. The obesity time-bomb is largely mythical, but the pensions time-bomb is not. If saving money was the real concern, we would subsidise cigarettes, remove speed limits and tax green tea (or whatever foodstuff is supposed to protect us from cancer this week). Many people are aware of this. Some are not, but I doubt that one prohibitionist in a thousand would waver in his or her support for controls on eating, drinking and smoking even if they did understand the real economics of the matter.

They might use the 'cost to the abstainer' argument to further their agenda, but that is only a rhetorical device. Removing these costs would not appease the likes of Bloomberg. People have long fought wars in the name of religion, for example, but the appearance of avowedly atheist regimes in the twentieth century did not lead to the decline of war. There is a difference between a reason and an excuse.

As smoking bans move beyond 'public places' (most of which are in fact private) and into the outdoors and people's own homes and cars, it has become clear that such bans are not about 'protecting' nonsmokers. As the years go by, it will also become clear that the crusades against food, drink and alcohol are not about protecting the public purse, nor even about 'thinking of the children'.

Prohibitionists have always found ways to bypass the obstacles presented by a liberal society, usually by appealing to some nebulous harm to others. These arguments can be shown to be fallacious, often with ease, but the fact that they do not change their minds despite their arguments being utterly refuted indicates that they are not motivated by their putative concerns, but by a deeper desire to control.

At the moment, the 'cost to healthcare' argument is popular, partly because it allows almost unlimited scope for political action, but it is a mistake to think that those who espouse it would fall silent if socialised healthcare were to disappear. Indeed, as Hsieh shows, many parts of the USA are hotbeds of nanny statism despite having a far less collectivised healthcare system than other wealthy countries.

It is tempting to believe that the arguments made by prohibitionists are sincerely held and that their prohibitionism can be cured by either refuting their arguments or removing the source of their supposed concern. In truth, their arguments exist only to decorate and obscure their true motivations. When one is destroyed, another instantly emerges to support the exact same policy. Refuting these arguments is not entirely pointless since a genuinely open-minded observer might be within earshot, but one should never confuse what a prohibitionist says with what he believes.