A prescription for disaster

nick cowen, 24 October 2007

Professor Julian Le Grand has a radical strategy for tackling the supposed problems of ill health in the UK: smoking permits (which might require a doctor’s note), an ‘exercise hour’ for company employees, a ban on additional salt in foods, more free fruit in general and more stern notes sent to the homes of children that have been found to be obese. Le Grand calls this broad sweep of measures ‘libertarian paternalism’, claiming, perversely that none of these actually restrict individual freedom. Wouldn’t ‘libertarian paternalism’ be more normally understood as a friendly word of advice without the backing of force?

The spin is that these measures simply change an ‘opt-in’ decision to an ‘opt-out’ decision. You make the active choice to add salt to your mandatory healthy food, or to go and appropriate a smoking permit, or to refuse to take a free exercise hour.
This contention is quite simply false: I already make the passive decision not to buy cigarettes. I would have to opt myself into smoking at some cost. But many individuals choose to do so through a consensual exchange between consumer and newsagent. If the government comes between that exchange, it will likely produce a number of bad, unintended but quite foreseeable consequences. Ever stretched local government would have to spend more money on issuing permits, stretching taxpayer funds or making the permits prohibitively expensive. GP waiting rooms (if a doctor’s signature were required) would be packed with people who are not ill but want their right to buy tobacco renewed.
Of course, this might be part of Le Grand’s plan. Make the costs of obtaining tobacco more prohibitive in the hope that more people will give up. I guess under this plan that leaves people who are actually ill waiting to see a GP as collateral damage! But this is not even the end of it. Some individuals may give up. But others will seek alternative sources of cigarettes. The amount of illegal tobacco vending (already common due to high duties on legal cigarettes) will increase because people will be less willing to put up with the time and expenditure of gaining a government permit. This will criminalise a great many individuals who were previously law-abiding consumers. This in turn will necessitate a police ‘crackdown’ on these newly created criminals who lack the government permit to continue their habit, taking more resources away from tacking criminals that pose a genuine threat to the general public rather than smokers who merely pose a long-term threat to their own health.
Meanwhile, this new army of black market consumers will generate a huge new market for our fledgling gangs who will be more than happy to add tobacco to their portfolio of drugs, prostitution and people smuggling. These gangs will need to purchase protection and defend their market, thereby increasing the demand for guns and thugs in our streets. So Le Grand’s use of law to regulate people’s smoking habits will turn a public health issue into a law and order disaster.
As for requiring companies to set aside an hour a day for employees to exercise, one might suspect that Le Grand has spent rather a lot of his working life within academia and government. If an average academic took an hour off work, no one would notice (unless that was in fact the hour of the day that they did do work), and for officials in several government posts, the fewer hours worked the better! But in the more productive sectors of the economy (the parts that actually pay for academia and government to operate), an hour can represent rather a lot of work and rather a lot of wealth generated. The costs of the goods that we take for granted when we buy from this sector would have to rise to account for this lost hour. Meanwhile, people in high-pressure companies who gallantly refuse their free hour of exercise in order to remain at their desks or worktops will be much in demand. Le Grand’s suggestion would, paradoxically, lead to the stigmatisation of the healthy and the veneration of the fat: they will not live so long so as to dry up pension funds, nor will they demand a company paid subsidy for their lifestyle!