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Saturday, May 29, 2004

NHS AND OBESITY: WELFARE DEPENDENCY VS INEQUALITY? With obesity in Britain being a big topic for discussion Stephen Pollard has this posting on how the NHS and the welfare state is to blame:

The problem is that we have things the wrong way round, and that leads directly to the obesity epidemic. Although it is my responsibility what I eat (and as for the 3 year old girl who died of heart failure, whose fault is that but the parents?) the NHS system of taxpayer funding blunts the critical element of individual responsibility.
In a system where it wasn't the state which funded healthcare but individuals, whether through insurance, medical savings accounts or another method (when people have, in other words, direct control of their health care funding) then people have an incentive to look after themselves.
That's why obesity is so much less of a problem on the continent, where healthcare is insurance-based. (And as for the US, obesity is primarily a problem for the poor, and they are covered by the state funded Medicare, which has a similar impact on incentives as the NHS.)
So the solution is not to impose rules which deaden the role of individual responsibility even more by restricting our right to eat what we want, but to construct a health system where the incentives point to taking responsibility for our own health.
On a first reading this sounds quite sensible, but it has a few holes in it. The first problem I have with it that even in insurance-based health system, or whatever, the incentive can't work in the way Pollard suggests. The insurance, at least here in Germany where I am at the moment, will cover any treatment you need. If stuffing yourself is the reason for your illness you'll be treated as often as will be and however often you need treatment, the amount you pay into the insurance scheme won't change. So as a net result the financial incentive will be exactly the same as it is under the NHS. And -in light of this, unsurprisingly- Germans are the second-fattest people after Americans, which just goes to show that the insurance system doesn't impact the overall obesity rates. The only way to get the incentive structure right would be by making patients pay directly for their treatment, which at the current costs of healthcare would mean the vast majority of the population would go without healthcare; surely not what Pollard has in mind. The question whether there is a magical third way is something I've been pondering recently, but I can't quite come up with the conditions such an alternative would have to meet.
The second problem and one that Pollard doesn't explicitly address is the question of culture. I can say pretty definitely that the reason people stuff themselves has to do with personal characteristics such as self-control and discipline. Where those are present people are able to change bad dietary habits. Stephen Pollard can attest to this himself, as can I myself. For the record, from September 2002 to September 2003 I put on about 20 pounds, exclusively from eating too much (which in case you're sceptical can be unbelievably enjoyable). I then decided enough was enough and have lost 15 pounds since last September. The question therefore is why these virtues are so little to be seen in our population? (And to be honest when it comes to other things I am quite lacking in them too.) Decline of religion or common decency? Too much advertising promoting immediate and uncomplicated gratification? I don't know, but I'm pretty sure the welfare state is more the result of this cultural shift than its cause, and I can't see the NHS' abolition changing this much either. Perhaps the way in which this cultural change has affected different parts of the population might explain their relatively different percentage of obese.
Which quite neatly leads me on, because I wonder where Polly Toynbee puts the blame? Surprise, surprise: inequality. To be fair to her this piece isn't quite as risible as her usual fare, but it still fails to convince and certainly makes less sense that Pollard's piece. For example she hasn't done her homework and thus misses for example that it is Rhineland wonder model Germany that is much fatter than Britain.
Now, the actual reason why I bring her up is with her preoccupation with inequality. (I agree is a little off topic.) On that point I read an essay for class yesterday by Irving Kristol that included this aside:

Nor is equality itself any more acceptable than inequality-neither is more "natural" than the other-if equality is merely a brute fact rather than a consequence of an ideology or social philosophy. This explains what otherwise seems paradoxial: that small inequalities in capitalist countries can become the source of intense controversy while relatively larger inequalities in socialist or communist countries are blandly overlooked. Thus, those same young radicals who are infuriated by trivial inequalities in the American economic system are quite blind to grosser inequalities in the Cuban system. This is usually taken as evidence of hypocrisy or self-deception. I would say it shows, rather, that people’s notions of equality or inequality have extraordinarily little to do with arithmetic and almost everything to do with political philosophy.

-Irving Kristol: "When Virtue loses all her Loveliness", Public Interest, Fall 1970
Good point.
(And now that I've figured out how to use the text scanning equipment here I will be posting more quotes from books and printed articles in general.)

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