A feeble defence of the nanny state

I have never been a huge fan of the term 'nanny state' because it implies a degree of care and compassion that is largely absent from the spiteful 'public health' lobby. Nevertheless, it has the advantage of being readily understood by the public. It has an immediacy and efficiency that more accurate terms like 'coercive paternalistic lifestyle regulation' lack.

It also has the advantage of really annoying people in 'public health' and that alone is a good reason to use it. Every few years one of them tries to discredit or reclaim it. I wrote about one such effort in 2015. One of their journals dedicated a whole issue to it in the same year.

The problem with these critiques is that their authors are unable to pass the Ideological Turing Test. They don't seem to understand the arguments of their opponents and, as John Stuart Mill said, he who knows only his own side of the case knows little of that.

For example, the distinction between banning something that harms other people and banning people from doing things that only harm themselves is pretty fundamental. It is the difference between nanny state regulation and plain old regulation. But it is amazing how often defenders of the nanny state conflate the two. When Simon Chapman listed his 'One hundred and fifty ways the nanny state is good for us' in 2013, most of his examples were laws that protect individuals from other people, such as building regulations, speed limits and killing mosquitoes.

To be fair, Chapman is an imbecile whereas the latest contender - John Coggan, a professor of law at Bristol University - may not be. His essay was published by the Faculty of Public Health yesterday and it shares many of the shortcomings that undermined its predecessors. In particular, it prefers to attack straw man versions of the libertarian and economic arguments rather than addressing the real objections.

I don't know whether this is conscious misrepresentation or a simple failure to understand the arguments against his position, but it is a big problem for a critique. Coggan considers there to be three basic arguments against nanny statism. One of them is that 'health is an entirely subjective concept' and that the government therefore has no business getting involved. I have never met anyone who believes this so I will leave it to one side.

The other arguments seem more familiar at first glance. He describes them as 'Philosophical Libertarianism' and 'Economic Libertarianism'.

He defines Philosophical Libertarianism as follows:

... it may be claimed that to respect persons as moral agents the government must always respect their rights to make their own decisions for themselves unless their choices cause unjustified harm to other people or other people’s property. This holds where a person’s decision seems unwise to other people, or even where a person’s decision seems unwise on her own terms (for example when a person prioritises short-term interests over long-term happiness and security, such as by opting out of a pension scheme that she wants to be in).

If we accept philosophical libertarianism, we hold that the government and public health community have no right to interfere with people’s right to smoke cigarettes, to treat activities such as gambling as public health concerns, or more generally to prioritise values other than autonomy (or liberty/freedom).

On this view, the great majority of public health activities and agendas are nannying because, regardless of whether in fact they promote better health, they are unjustifiably paternalistic: people have a natural right (on some counts even a duty) to make their own choices without the influence of the state or the public health community.

This is his full description and it is quite inadequate. It suggests that Philosophical Libertarianism is little more than an assertion that the government should leave people alone. There is, of course, a lot more to it than that. John Stuart Mill wrote a whole book about it but Coggan never refers to Mill or his arguments. There is no hint here that the philosophical argument is consequentialist. It is not that libertarians think that free speech, free association and free trade are self-evidently human rights. It is that individuals and society are better off with them than without them.

I would concede to Coggan that the theory of natural rights is just a bald assertion and can be dismissed as much, but there are philosophical and practical arguments for limited government and individual liberty that go far beyond natural rights. Coggan doesn't discuss them but they are mostly covered by what he calls Economic Libertarianism, which he sees as a separate category.

I'm not sure they are separate categories. The line between philosophy and economics is blurred. Mill was both a philosopher and an economist, and economics started as a branch of philosophy. The view in economics that society is best served by free markets unless there are market failures is very similar to the philosophical view that society is best served by individuals being free unless they cause harm to others. But economics is more explicit in its focus on wellbeing (utility) and so I regard it as more useful in explaining why coercive paternalism is harmful.

Unfortunately, Coggan ignores most of the economic arguments and gets the rest of them wrong. He claims that:

Economic libertarians do not (of necessity) claim that health is unimportant; rather, they claim that health is best achieved without public health interventions. 

No they don't! They claim that wellbeing is best achieved without government interventions in self-regarding activities.

He describes his version of Economic Libertarianism at greater length on page 23. This is what he says (in full):

One category of argument against the nanny state holds that, as a matter of practical reality, health outcomes and opportunities are best realised through market freedoms and individual choice.

On this reasoning, most public health measures are economically inefficient. Furthermore, such arguments may hold that health promotion measures and campaigns (for example the provision of a publicly-funded healthcare system; anti-obesity programmes) are harmful to population health as they reduce personal responsibility for health: by providing a ‘safety net’, it is suggested, such policies encourage people to become less healthy by incentivising unhealthy behaviours and attitudes.

From the perspective of economic libertarianism, health protection and promotion are nannying because they infantilise: they leave people who would in fact be able best to take care of their health unable to do so.

This is almost entirely wrong. Very few people, if any, claim that health will be maximised by leaving people to their own devices, although it is true that some 'public health' policies have led to worse health (hello, snus ban!). The claim of economic libertarians is that wellbeing will be maximised. 

Wellbeing is the most important thing and health is only one component of it. There are trade-offs between risk and reward and between health and enjoyment. Maximising health requires sacrificing pleasure and bearing unwanted costs, such as turning away the dessert trolley and going to the gym. Different individuals place different values on the costs and benefits. Some people are more risk averse than others. Some people enjoy going to the gym and some people hate the taste of tobacco. Other people feel quite the opposite. 

It is because people value different things differently that individuals need to make their own trade offs to suit their tastes and preferences. Almost nobody values health and longevity to the exclusion of all other concerns. Maximising health would lead to sub-optimal wellbeing for almost everybody because the sacrifices would be too extreme. As such, coercive policies that are fundamentally rooted in the presumption that health is the most important concern can only do damage - not necessarily to everybody, but to a large number of people.

Why does Coggan think that economic libertarians believe that freedom maximises health? He refers to the idea that people would take better care of themselves if they had to pay for their own healthcare. I have heard people say this on occasion but the evidence for it is weak and it is a side issue at best. It is certainly not the central argument for economic libertarian, as Coggan implies. The real issue is human welfare and utility, which Coggan completely ignores.

In response to his straw man, he writes:

The arguments here rest on empirical claims; arguments (putatively) based on facts about the world. Responding to them therefore relies on evidence-based public health.

This is where members of the public health community likely feel most comfortable responding to nanny state arguments. Arguments devised in response to economic libertarian accusations of nanny statism should be guided by the best interpretation of the scientific evidence: where public health science (e.g. on commercial, political, or social determinants of health) shows that interventions would (likely) improve health or reduce health inequalities, this will rebut economic libertarian arguments.

If the libertarian objection to the nanny state was that it makes people less healthy, it would indeed be easy to rebut. But it isn't. If you want to know what the real economic/libertarian objectives to paternalistic lifestyle regulation are, read Killjoys.