One way to foster experimentation in education is to break the monopoly of government-funded schools in K through 12. Instead of spending 136 billion dollars on public education, the government should allocate this money to the consumers (parents) who can choose the best educational options for their children. This would create a competitive and profitable education industry, where low-performing schools would be driven out of the market, and high-performing schools would expand and scale. Schools that developed effective teaching methods would be emulated and improved by others. Moreover, the market would offer a variety of schools that cater to different needs and interests, such as manual arts, STEM subjects, art, etc.
Your conversation with the bureaucrat whose inability to see beyond his limited notion of “controlled experiments” conjures an image of Dilbert’s pointy haired boss (whose best line was “The goal of this meeting is to figure out why nothing ever gets done around here”). In years past my employer got on the Deming bandwagon about process improvement. Even though I am a cynic about business fads, I had to agree with Deming’s basic principles and used them in our work processes for genuine positive results. I could also see application beyond manufacturing. If there were ever an industry that could stand quality improvement, it’s education – at every level.
In practice "making the improvements early in life" tends to boil down the the following:
1) Subsidizing pre-k and daycare (but not SAHM)
2) Embracing educational fads in elementary school (many of which turn out dumb like giving up on phonics)
I think your view that kids before age eight mostly need a small peer group in and informal setting that spends a lot of time outside playing with some direct instruction on the three Rs mixed in is probably correct. Learning pods were awesome. My kids kindergarten was basically a lot of outdoor playtime with some phonics and math worksheets mixed in (she did a great job learning to read and write without draining away her childhood).
Trying to improve early childhood education will tend to end in more money (more jobs) with kids sitting inside rooms away from their family being regimented more and wasting time (but not in a fun way).
While I agree with Deming over all, an ounce of prevention and all that, I am not sure how well that applies to life outcomes for people. The issue I have with it is that it presumes both that the government should attend to the production of good life outcomes for people (whatever that means), and that the government can achieve those same good life outcomes. There are many, many problems with those two notions.
First would be that the amount of process control, tracking and reporting in industrial processes applied to individuals would mean the government spying on you all day, every day, in every aspect. Car parts do not have a private life.
Secondly, it would mean that the government would have a great hand in determining what your outcomes will be. Do you want to be an artist or an accountant or a boxer? Too bad, you don't get to choose. Car parts do not get to decide they want to be in a lawnmower instead.
Thirdly, the government has very little reason to care whether or not their processes produce the stated outcomes, and indeed often want them not to. Instead, they want the processes to produce power and wealth for the government officials, regardless of what is good for the people. Car parts are not what is important to the company, profits are.
Deming did some great stuff. It works well in a setting with repetitive tasks and willing participants. In health care we mostly don't have willing subjects. The tasks don't seem repetitive. Fixing a person can difficult. Obesity and substance abuse are largely problems we don't know how to fix. Maybe some providers are more successful but it's a bit like picking stocks except that it's theoretically possible everyone can win. But that's not going to happen with today's capabilities. As for early education, good parenting, etc., we have been going in the wrong direction on what might be most important. More and more kids grow up in single parent households. Statistics suggest this has far worse outcomes. Various studies look at this or that intervention for young
kids with mixed results. Maybe some successful trial improvements can be scaled but even that is mostly doubtful.
Whether what you propose is good or not, possible or not, I'm more than a little surprised to hear it from you. I don't see a way to even attempt it other than by a big government program.
I think we do know how to fix obesity, if we stop thinking of it as a medical condition and looking for a treatment. I suspect that a tax on carbohydrates would do an admirable job, at least for lots and lots of people over generations, just like the tobacco and alcohol taxes have.
I would prefer we stop subsidizing carbohydrates and taxing/regulating into the ground meat and egg producers, personally. The amount of government intervention in the agriculture sector is insane.
Except for the grain we turn into ethanol, which drives the prices up. Or the grain we never grow because farmers are subsidized to not plant food to support prices. Or the mash from alcohol production that farmers are no longer allowed to feed to cattle.
We need to have the government stop trying to tweak market outcomes via subsidizing and regulating food, period. No amount of government intervention and good intentions are going to lead to better outcomes.
As to nuts, how subsidized do you suppose almonds are? CA's water goes overwhelmingly to those farms.
You are right, I was unclear in my writing. I meant that the water subsidies going to almonds was really high, in that 13% in one region of the state in one industry, and in a state that imports a ton of water at state expense, seems pretty overwhelming to me. I can see why the phrasing is confusing, however. I should rather have specified that the amount of water the state purchases that gets directed to the use of almonds at a very subsidized price overwhelmingly distorts the market. I rather doubt there would be much of a CA almond industry if the state government didn't spend a lot of money importing water and selling it at subsidized rates, as there wasn't much of an almond industry there until fairly recently. You don't expect water intense agriculture in a state that imports water because it is largely desert.
Sure, that should be part of the picture. But the point I was trying to make is that we put blinders on by thinking of these as medical issues. Among other things, it leads us to defer to bureaucrats who claim to be experts dictating policy on the basis of credentials issued by other bureaucrats.
That is true, but we need to also bear in mind why those bureaucrats want to make it a medical issue: it allows for infinite government regulation and market intervention. Particularly since the passing of the PPACA Trojan Horse, everything with health effects can cost or save the government money (in theory) and so is deemed a reasonable interest for the government to legislate or regulate.
Remember these are the same folks who put out a report a few months back that Luck Charms are healthier than steak. We need to get them as far from the control levers of agriculture as possible, the opposite of encouraging them to tweak relative prices through taxes.
We could just tax fat people, either directly or though allowing insurance companies to charge more like they do with smokers.
There are always two problems though:
1) It's JUDGEMENTAL! the horror...
2) How do you punish someone with nothing left to lose. Addicts in the gutter don't have any assets to seize. All you can do is let them die. I'm a heartless bastard who would be fine with that but I can't seem to get a governing majority to accept it.
This reads a lot like "we should tax people for doing things I don't like", which never ends well. Perhaps it would be better to simply stop taxing everyone to pay for people's medical problems?
Do you know a country in the first world that doesn't have something along the lines of universal healthcare? It seems like a political inevitability.
As stu notes, some health conditions aren't the fault of some people and some are. The ones that aren't peoples fault cause mass public support for universal healthcare.
Defining what conditions are or aren't peoples fault, in addition to often being a thorny and difficult problem, is also unpopular. I think the fact that my company pays a ton of money for anti-virals to keep gays from AIDSing themselves to death via their promiscuity is wrong. But there is a strong gay lobby that has made these drugs a "protected class" and forced insurers to cover them at favorable cost shares.
At the end of the day I think the most logical way to assign the cost of bad behavior to people is through surcharges for that bad behavior. Determining that a fatass can't get medical care they need is a tough sell (and would require immense resources be put into underwriting and be a hot button political topic). Charging fatasses more just as we charge smokers more would reduce the subsidy to fatasses and provide a better incentive structure.
Overall, I think libertarians need to accept that human beings are "too human to fail" in our modern democratic society. They aren't allowed to just die in a ditch, and even if they were they might leave behind family and communities that relied on them. "Let them be degenerates and if they die whatever" has been tried for awhile now and it turns out that when people self implode there tends to be negative externalities.
Do you know a first world country that isn't spiraling into government debt driven oblivion along side its ailing culture? Maybe it is something to avoid.
Your own example belies your theory. Do you think the lobby that got your company to pay "for anti-virals to keep gays from AIDSing themselves to death via their promiscuity" is going to have a problem getting AIDS deemed not the fault of those who get it? Do you really believe that there is any possibility that promiscuity will be deemed "bad behavior" that will suffer a surcharge? Especially LGBTERGAWERJ++ promiscuity?
How's that been working out for you the last few decades?
Your solution to the problem is exactly the solution that we are currently living with, you just seem to believe the system that roundly rejects your assignment of blame will suddenly start to accept it and generate the outcomes you like. That's the wrong tree to bark up.
You and Paul Ryan should team up and run for president on your plan to abolish Medicare, Medicaid, and Obamacare. Good luck.
"That's the wrong tree to bark up."
Ultimately, there is no substitute for a shared moral consensus. The Japanese have a shared moral consensus that being fat is a moral vice, so they are OK taxing it.
I'm not optimistic about any changes in the health insurance sector. I just think its easier to get a fat tax added then it is to abolish the entire health insurance sector.
"We should tax fat people"
vs
"We should have no health insurance and sick people should just die"
The former seems and easier sell, even if you are pessimistic about both.
Your first sentence is on target. I'm stunned by how much Kling's post and many comments reek of big government. I'm not saying it is wrong, just that I didn't expect it from this crowd.
As for your second sentence, what about medical conditions that are entirely genetic? What about ones that are mostly or partly genetic? Do we know how much? What about people who are physically or mentally unable to care for themselves? Ignoring all of that, do we just let people who inflict medical problems on themselves suffer and die?
As for your second paragraph: Yes? Once you have a line between "things that are voluntary we don't pay for" and "things that are involuntary we do pay for", you get an entire industry of people trying to redefine things in the first category to be in the second. It just doesn't work at a governmental level. Private charities and the like can handle those decisions, but governments cannot do it well, as sooner or later everything gets into the second category.
See, for example, education, the quintessential local and private concern, and how much of it has been vacuumed up into the federal level.
Who is fat? BMI is might work at a group level but not for an individual. Do you do a cat scan each year to measure fat? Some fat is needed. How much is too much? Who decides? Are there skinny people who are less healthy than fat ones? How do you adjust for that?
In Japan employers are required to measure their employees waistlines once a year. They are fined by the government for each overweight person (based on waistline size), with an additional fine if they can't get a certain % of overweight people to lose weight.
This results in most employers pressuring their employees to lose weight so the company can save money.
I can't tell you how excited I am to have government getting involved in my physical fitness, and even more so to have them do it through my employer. That worked SO well with COVID. I am sure the HR ladies will find wonderful ways to make sure that is well orchestrated.
Do you answer your companies question on being a smoker when you sign up for health insurance?
When you got life insurance, did you attest to what pre-existing conditions you have or undergo a medical exam?
Does your company give you an HSA contribution if you join the gym?
Understand that most underwriting in health insurance is illegal. Insurers would absolutely do more of it if the government allowed it. You are already living under government intervention. What I am asking is that the government STOP INTERFERING with insurers ability to charge appropriate premium costs to people based on their insurable risk.
Obviously if you have government insurance then you are going to be subject to government underwriting, just as you are subject to it in private insurance. Should government insurance do a shittier job of underwriting then private insurance?
That doesn’t seem like it would be effective because people don’t seem to be able to connect what makes them fat -- carbohydrates -- to being fat. If you make McDonalds fries cost twice as much, fat people will eat fewer fries. If you make fat people pay an extra $10 per pound they are over their ideal weight, the consumption of fries won’t change much.
You really think we have control of alcohol problems? I'm skeptical the tax makes more than a tiny difference in use and abuse. What is your evidence?
We've made big improvements in reducing tobacco use but I'd argue it's still pretty high. And how much of that success comes from the tobacco tax? Is the fact that society basically shuns smokers maybe a bigger factor? Wasn't the tax high long before smoking rates came down? Again, what is your evidence? How do you account for the fact that poor people are more likely to smoke than the wealthy?
Surely you don't want to tax produce even if that's what you've just indicated. What makes you think the government would tax the right things?
Sorry but you don't sound like maximum liberty even if you propose using incentives, which is less authoritarian than some methods.
The effects of alcohol and especially tobacco taxes are well documented as being quite effective. It’s been too long since I read any of it to remember how to find it, and I no longer have access to the academic research tools that I would have used then.
Their purposes are not to extirpate either product. So the fact that there is still alcohol and tobacco abuse is not a rebuttal to their efficacy.
My point here is that we do actually know ways to significantly reduce obesity, but our obsession with treating it only as a medical issue puts blinders on us. That point does not become “we should tax carbohydrates,” so it doesn’t conflict with my long-held, completely pointless position that all government should be abolished. But if I had to choose between $X of income taxes on the economy or $X of carbohydrate taxes on the economy, I’d probably pick the latter, on the ground that income is always good but carbohydrates can be excessive (and are in the typical American’s diet).
I totally agree that taxes on tobacco and alcohol made a measurable difference. We can quibble over whether it was effective or did an admirable job but that seems pointless. I'm not even sure I have an opinion on such vague metrics. Be that as it may, I don't think there is any question that those taxes have not come close to fixing anything.
Re: "In the case of health, getting treatment is the equivalent of inspecting and fixing defects in cars as they come off the assembly line. The cost is high relative to the benefits. There is more leverage to be had in people choosing behaviors that promote health. Avoiding substance abuse and obesity. Obtaining treatment for mental illness."
Wouldn't the Deming approach be to choose behaviors that promote mental health, before the onset of mental illness? (And to favor institutions that help youths cultivate behaviors that promote health.). I have in mind diet, exercise, positive social interaction, rapport with teacher/coach/mentor/chaplain, drama-avoidance, avoidance of situations fraught with unreasonable expectations (given individual ability and temperament), practical search to discover one's comparative advantage (talents) and individuality, etc.
PS: I get it, that mental illness — what Thomas Szasz called problems of living — makes everything harder. But the same is true of substance abuse and obesity. Why take an upstream, preventive approach to substance abuse and obesity, but a downstream, treatment approach to mental health/problems of living? Isn't there "more leverage to be had" in cultivating mental health upstream, than in downstream treatment?
I am deeply suspicious of getting government into the realm of upstream mental health. We have an extremely poor understanding of mental health in general, and can you imagine what monstrous policies might be enacted to keep people from doing obviously crazy things like disapproving of the government?
Agreed! I have in mind a shift in culture or norms. The mindset towards youths in civil society should be: Who are you? How might you grow to bring something to market and to community? What challenges might inspire you -- and might you meet? And so on -- how to learn from failure, listen well, seek friends who pull you up, avoid friends who pull you down, etc. Neighbors, chaplains, coaches, managers are all potential adjuncts to stable family life, and perhaps occasionally helpful remedies to dysfunctional family life.
Quality Education is good, but what does it mean for the 1/3 or more folk with below avg IQ (depending on how big the middle 'around avg' group is; technically 1/2 minus 1 are below avg.)
Everybody can improve behavior, but there is some optimal education that results in max IQ potential, and those with low potential shouldn't be expected to go to college.
The MBTI (Myers-Briggs Personality) is better than Big 5 (OCEAN) model in the N-S axis (iNtuitive-abstract vs Sensitive-concrete). College is more for NTs & NFs, the abstract Thinkers & Feelers who usually lead and are most usually the decision makers and almost exclusively theoretical experts; plus most often having higher IQs.
We need more vocational education, and probably more outdoor play & fun in pre-K day care & even Kindergarten. Also edu could probably improve with more male teachers 6-12, more so than K-5. As you noted earlier about smaller size gov't more often being better, we should be looking for what school systems are producing ... a) the best top outcomes? or b) the fewest criminals? or c) the fewest unmarried mothers?
Since it's pretty known, accepted, and data consistent that, on average, kids raised by married parents do better, maybe it's time to have more gov't support for being married with kids. Like a $10k gov't check on the first year anniversary to a married couple who have a child, or on the birth of their first child after at least one year of marriage. (Or some 1, 2, 3, or 4 month avg wage of ~$5k/month).
This kind of social support is not "need based", but would be "rewarding good social behavior" based. Our society, in reducing the real problems suffered by folks who have bad social behavior, have increased the bad social behavior. In our rich (post-) Christian Capitalist societies, such help for those needing it isn't going away -- but should be somewhat offset by significant govt reward, which equals gov't cash, for good behavior.
We need more gov't incentives for good behavior - if we want more good behavior. Incentives need to be tried.
Along those lines, some large direct cash to students for doing better homework and getting more text questions correct are likely to work better than more cash for teachers and admin. So far as I know, little has been tried at paying students to "learn" and test well. I think lots of folks, especially poor folks, would be interested in having their kids get paid to learn. I would have been motivated.
Glad that you brought Deming into the conversation. As you well discuss, his principles have wide application and could be quite helpful if applied to present problems.
In 2012 Jim Manzi wrote a book titled Uncontrolled: The Surprising Payoff of Trial-and-Error for Business, Politics, and Society that covers the same issues at greater length.
Your statement: "He asked me if as a parent I would want to see my child used in an experiment, as if this was an argument against experimentation. My jaw dropped." does say what is wrong with almost all the social science / eduction areas of academia and government. They don't understand the scientific method or scientific thinking. The damage done by this "feels correct" and "feels good" or "I believe" type belief systems is huge. Show me the data.
Being the victim of "whole word learning" displacing phonics as a reading/learning method in the 40's and 50's I ended up not being able to spell and read almost nothing. After sputnik from the USSR went into orbit, my understand of math and physical reality got me into UCLA. I am now more functional with spell-check, but that is long past my prime productivity. Without my wife as an editor, I don't think I would have been able to finished writing my thesis.
One way to foster experimentation in education is to break the monopoly of government-funded schools in K through 12. Instead of spending 136 billion dollars on public education, the government should allocate this money to the consumers (parents) who can choose the best educational options for their children. This would create a competitive and profitable education industry, where low-performing schools would be driven out of the market, and high-performing schools would expand and scale. Schools that developed effective teaching methods would be emulated and improved by others. Moreover, the market would offer a variety of schools that cater to different needs and interests, such as manual arts, STEM subjects, art, etc.
Your conversation with the bureaucrat whose inability to see beyond his limited notion of “controlled experiments” conjures an image of Dilbert’s pointy haired boss (whose best line was “The goal of this meeting is to figure out why nothing ever gets done around here”). In years past my employer got on the Deming bandwagon about process improvement. Even though I am a cynic about business fads, I had to agree with Deming’s basic principles and used them in our work processes for genuine positive results. I could also see application beyond manufacturing. If there were ever an industry that could stand quality improvement, it’s education – at every level.
In practice "making the improvements early in life" tends to boil down the the following:
1) Subsidizing pre-k and daycare (but not SAHM)
2) Embracing educational fads in elementary school (many of which turn out dumb like giving up on phonics)
I think your view that kids before age eight mostly need a small peer group in and informal setting that spends a lot of time outside playing with some direct instruction on the three Rs mixed in is probably correct. Learning pods were awesome. My kids kindergarten was basically a lot of outdoor playtime with some phonics and math worksheets mixed in (she did a great job learning to read and write without draining away her childhood).
Trying to improve early childhood education will tend to end in more money (more jobs) with kids sitting inside rooms away from their family being regimented more and wasting time (but not in a fun way).
While I agree with Deming over all, an ounce of prevention and all that, I am not sure how well that applies to life outcomes for people. The issue I have with it is that it presumes both that the government should attend to the production of good life outcomes for people (whatever that means), and that the government can achieve those same good life outcomes. There are many, many problems with those two notions.
First would be that the amount of process control, tracking and reporting in industrial processes applied to individuals would mean the government spying on you all day, every day, in every aspect. Car parts do not have a private life.
Secondly, it would mean that the government would have a great hand in determining what your outcomes will be. Do you want to be an artist or an accountant or a boxer? Too bad, you don't get to choose. Car parts do not get to decide they want to be in a lawnmower instead.
Thirdly, the government has very little reason to care whether or not their processes produce the stated outcomes, and indeed often want them not to. Instead, they want the processes to produce power and wealth for the government officials, regardless of what is good for the people. Car parts are not what is important to the company, profits are.
The list could go on...
Deming did some great stuff. It works well in a setting with repetitive tasks and willing participants. In health care we mostly don't have willing subjects. The tasks don't seem repetitive. Fixing a person can difficult. Obesity and substance abuse are largely problems we don't know how to fix. Maybe some providers are more successful but it's a bit like picking stocks except that it's theoretically possible everyone can win. But that's not going to happen with today's capabilities. As for early education, good parenting, etc., we have been going in the wrong direction on what might be most important. More and more kids grow up in single parent households. Statistics suggest this has far worse outcomes. Various studies look at this or that intervention for young
kids with mixed results. Maybe some successful trial improvements can be scaled but even that is mostly doubtful.
Whether what you propose is good or not, possible or not, I'm more than a little surprised to hear it from you. I don't see a way to even attempt it other than by a big government program.
I think we do know how to fix obesity, if we stop thinking of it as a medical condition and looking for a treatment. I suspect that a tax on carbohydrates would do an admirable job, at least for lots and lots of people over generations, just like the tobacco and alcohol taxes have.
I would prefer we stop subsidizing carbohydrates and taxing/regulating into the ground meat and egg producers, personally. The amount of government intervention in the agriculture sector is insane.
We feed most of that subsidized grain to the animals you mention.
For sure it isn't perfect but I think one could make an equally strong argument that meat is overly subsidized and lacking needed regulation.
Vegetables, fruits, beans, and nuts are far less subsidized (maybe there are some exceptions in my list) and they are generally the healthiest.
Except for the grain we turn into ethanol, which drives the prices up. Or the grain we never grow because farmers are subsidized to not plant food to support prices. Or the mash from alcohol production that farmers are no longer allowed to feed to cattle.
We need to have the government stop trying to tweak market outcomes via subsidizing and regulating food, period. No amount of government intervention and good intentions are going to lead to better outcomes.
As to nuts, how subsidized do you suppose almonds are? CA's water goes overwhelmingly to those farms.
CA's water does not go overwhelmingly to almonds. They get 13%. https://www.c-win.org/cwin-water-blog/2022/7/11/california-almond-water-usage#:~:text=Q%3A%20How%20much%20of%20California's%20developed%20water%20supply%20do%20almonds,the%20total%20developed%20water%20supply.
Be that as it may, this doesn't mean almonds are heavily subsidized compared to other agriculture and I noted there might be some exceptions.
You are right, I was unclear in my writing. I meant that the water subsidies going to almonds was really high, in that 13% in one region of the state in one industry, and in a state that imports a ton of water at state expense, seems pretty overwhelming to me. I can see why the phrasing is confusing, however. I should rather have specified that the amount of water the state purchases that gets directed to the use of almonds at a very subsidized price overwhelmingly distorts the market. I rather doubt there would be much of a CA almond industry if the state government didn't spend a lot of money importing water and selling it at subsidized rates, as there wasn't much of an almond industry there until fairly recently. You don't expect water intense agriculture in a state that imports water because it is largely desert.
Sure, that should be part of the picture. But the point I was trying to make is that we put blinders on by thinking of these as medical issues. Among other things, it leads us to defer to bureaucrats who claim to be experts dictating policy on the basis of credentials issued by other bureaucrats.
That is true, but we need to also bear in mind why those bureaucrats want to make it a medical issue: it allows for infinite government regulation and market intervention. Particularly since the passing of the PPACA Trojan Horse, everything with health effects can cost or save the government money (in theory) and so is deemed a reasonable interest for the government to legislate or regulate.
Remember these are the same folks who put out a report a few months back that Luck Charms are healthier than steak. We need to get them as far from the control levers of agriculture as possible, the opposite of encouraging them to tweak relative prices through taxes.
We could just tax fat people, either directly or though allowing insurance companies to charge more like they do with smokers.
There are always two problems though:
1) It's JUDGEMENTAL! the horror...
2) How do you punish someone with nothing left to lose. Addicts in the gutter don't have any assets to seize. All you can do is let them die. I'm a heartless bastard who would be fine with that but I can't seem to get a governing majority to accept it.
This reads a lot like "we should tax people for doing things I don't like", which never ends well. Perhaps it would be better to simply stop taxing everyone to pay for people's medical problems?
Do you know a country in the first world that doesn't have something along the lines of universal healthcare? It seems like a political inevitability.
As stu notes, some health conditions aren't the fault of some people and some are. The ones that aren't peoples fault cause mass public support for universal healthcare.
Defining what conditions are or aren't peoples fault, in addition to often being a thorny and difficult problem, is also unpopular. I think the fact that my company pays a ton of money for anti-virals to keep gays from AIDSing themselves to death via their promiscuity is wrong. But there is a strong gay lobby that has made these drugs a "protected class" and forced insurers to cover them at favorable cost shares.
At the end of the day I think the most logical way to assign the cost of bad behavior to people is through surcharges for that bad behavior. Determining that a fatass can't get medical care they need is a tough sell (and would require immense resources be put into underwriting and be a hot button political topic). Charging fatasses more just as we charge smokers more would reduce the subsidy to fatasses and provide a better incentive structure.
Overall, I think libertarians need to accept that human beings are "too human to fail" in our modern democratic society. They aren't allowed to just die in a ditch, and even if they were they might leave behind family and communities that relied on them. "Let them be degenerates and if they die whatever" has been tried for awhile now and it turns out that when people self implode there tends to be negative externalities.
Do you know a first world country that isn't spiraling into government debt driven oblivion along side its ailing culture? Maybe it is something to avoid.
Your own example belies your theory. Do you think the lobby that got your company to pay "for anti-virals to keep gays from AIDSing themselves to death via their promiscuity" is going to have a problem getting AIDS deemed not the fault of those who get it? Do you really believe that there is any possibility that promiscuity will be deemed "bad behavior" that will suffer a surcharge? Especially LGBTERGAWERJ++ promiscuity?
How's that been working out for you the last few decades?
Your solution to the problem is exactly the solution that we are currently living with, you just seem to believe the system that roundly rejects your assignment of blame will suddenly start to accept it and generate the outcomes you like. That's the wrong tree to bark up.
"Maybe it is something to avoid."
You and Paul Ryan should team up and run for president on your plan to abolish Medicare, Medicaid, and Obamacare. Good luck.
"That's the wrong tree to bark up."
Ultimately, there is no substitute for a shared moral consensus. The Japanese have a shared moral consensus that being fat is a moral vice, so they are OK taxing it.
I'm not optimistic about any changes in the health insurance sector. I just think its easier to get a fat tax added then it is to abolish the entire health insurance sector.
"We should tax fat people"
vs
"We should have no health insurance and sick people should just die"
The former seems and easier sell, even if you are pessimistic about both.
Your first sentence is on target. I'm stunned by how much Kling's post and many comments reek of big government. I'm not saying it is wrong, just that I didn't expect it from this crowd.
As for your second sentence, what about medical conditions that are entirely genetic? What about ones that are mostly or partly genetic? Do we know how much? What about people who are physically or mentally unable to care for themselves? Ignoring all of that, do we just let people who inflict medical problems on themselves suffer and die?
As for your second paragraph: Yes? Once you have a line between "things that are voluntary we don't pay for" and "things that are involuntary we do pay for", you get an entire industry of people trying to redefine things in the first category to be in the second. It just doesn't work at a governmental level. Private charities and the like can handle those decisions, but governments cannot do it well, as sooner or later everything gets into the second category.
See, for example, education, the quintessential local and private concern, and how much of it has been vacuumed up into the federal level.
All true but that doesn't make your alternative better, or even feasible. As a well-known economist has said, there are no solutions, only trade-offs.
Who is fat? BMI is might work at a group level but not for an individual. Do you do a cat scan each year to measure fat? Some fat is needed. How much is too much? Who decides? Are there skinny people who are less healthy than fat ones? How do you adjust for that?
In Japan employers are required to measure their employees waistlines once a year. They are fined by the government for each overweight person (based on waistline size), with an additional fine if they can't get a certain % of overweight people to lose weight.
This results in most employers pressuring their employees to lose weight so the company can save money.
I can't tell you how excited I am to have government getting involved in my physical fitness, and even more so to have them do it through my employer. That worked SO well with COVID. I am sure the HR ladies will find wonderful ways to make sure that is well orchestrated.
Do you answer your companies question on being a smoker when you sign up for health insurance?
When you got life insurance, did you attest to what pre-existing conditions you have or undergo a medical exam?
Does your company give you an HSA contribution if you join the gym?
Understand that most underwriting in health insurance is illegal. Insurers would absolutely do more of it if the government allowed it. You are already living under government intervention. What I am asking is that the government STOP INTERFERING with insurers ability to charge appropriate premium costs to people based on their insurable risk.
Obviously if you have government insurance then you are going to be subject to government underwriting, just as you are subject to it in private insurance. Should government insurance do a shittier job of underwriting then private insurance?
That doesn’t seem like it would be effective because people don’t seem to be able to connect what makes them fat -- carbohydrates -- to being fat. If you make McDonalds fries cost twice as much, fat people will eat fewer fries. If you make fat people pay an extra $10 per pound they are over their ideal weight, the consumption of fries won’t change much.
You really think we have control of alcohol problems? I'm skeptical the tax makes more than a tiny difference in use and abuse. What is your evidence?
We've made big improvements in reducing tobacco use but I'd argue it's still pretty high. And how much of that success comes from the tobacco tax? Is the fact that society basically shuns smokers maybe a bigger factor? Wasn't the tax high long before smoking rates came down? Again, what is your evidence? How do you account for the fact that poor people are more likely to smoke than the wealthy?
Surely you don't want to tax produce even if that's what you've just indicated. What makes you think the government would tax the right things?
Sorry but you don't sound like maximum liberty even if you propose using incentives, which is less authoritarian than some methods.
The effects of alcohol and especially tobacco taxes are well documented as being quite effective. It’s been too long since I read any of it to remember how to find it, and I no longer have access to the academic research tools that I would have used then.
Their purposes are not to extirpate either product. So the fact that there is still alcohol and tobacco abuse is not a rebuttal to their efficacy.
My point here is that we do actually know ways to significantly reduce obesity, but our obsession with treating it only as a medical issue puts blinders on us. That point does not become “we should tax carbohydrates,” so it doesn’t conflict with my long-held, completely pointless position that all government should be abolished. But if I had to choose between $X of income taxes on the economy or $X of carbohydrate taxes on the economy, I’d probably pick the latter, on the ground that income is always good but carbohydrates can be excessive (and are in the typical American’s diet).
Maximum Liberty
Jun 8 "I think we do know how to fix obesity, "
I totally agree that taxes on tobacco and alcohol made a measurable difference. We can quibble over whether it was effective or did an admirable job but that seems pointless. I'm not even sure I have an opinion on such vague metrics. Be that as it may, I don't think there is any question that those taxes have not come close to fixing anything.
Re: "In the case of health, getting treatment is the equivalent of inspecting and fixing defects in cars as they come off the assembly line. The cost is high relative to the benefits. There is more leverage to be had in people choosing behaviors that promote health. Avoiding substance abuse and obesity. Obtaining treatment for mental illness."
Wouldn't the Deming approach be to choose behaviors that promote mental health, before the onset of mental illness? (And to favor institutions that help youths cultivate behaviors that promote health.). I have in mind diet, exercise, positive social interaction, rapport with teacher/coach/mentor/chaplain, drama-avoidance, avoidance of situations fraught with unreasonable expectations (given individual ability and temperament), practical search to discover one's comparative advantage (talents) and individuality, etc.
PS: I get it, that mental illness — what Thomas Szasz called problems of living — makes everything harder. But the same is true of substance abuse and obesity. Why take an upstream, preventive approach to substance abuse and obesity, but a downstream, treatment approach to mental health/problems of living? Isn't there "more leverage to be had" in cultivating mental health upstream, than in downstream treatment?
I am deeply suspicious of getting government into the realm of upstream mental health. We have an extremely poor understanding of mental health in general, and can you imagine what monstrous policies might be enacted to keep people from doing obviously crazy things like disapproving of the government?
Agreed! I have in mind a shift in culture or norms. The mindset towards youths in civil society should be: Who are you? How might you grow to bring something to market and to community? What challenges might inspire you -- and might you meet? And so on -- how to learn from failure, listen well, seek friends who pull you up, avoid friends who pull you down, etc. Neighbors, chaplains, coaches, managers are all potential adjuncts to stable family life, and perhaps occasionally helpful remedies to dysfunctional family life.
Quality Education is good, but what does it mean for the 1/3 or more folk with below avg IQ (depending on how big the middle 'around avg' group is; technically 1/2 minus 1 are below avg.)
Everybody can improve behavior, but there is some optimal education that results in max IQ potential, and those with low potential shouldn't be expected to go to college.
The MBTI (Myers-Briggs Personality) is better than Big 5 (OCEAN) model in the N-S axis (iNtuitive-abstract vs Sensitive-concrete). College is more for NTs & NFs, the abstract Thinkers & Feelers who usually lead and are most usually the decision makers and almost exclusively theoretical experts; plus most often having higher IQs.
We need more vocational education, and probably more outdoor play & fun in pre-K day care & even Kindergarten. Also edu could probably improve with more male teachers 6-12, more so than K-5. As you noted earlier about smaller size gov't more often being better, we should be looking for what school systems are producing ... a) the best top outcomes? or b) the fewest criminals? or c) the fewest unmarried mothers?
Since it's pretty known, accepted, and data consistent that, on average, kids raised by married parents do better, maybe it's time to have more gov't support for being married with kids. Like a $10k gov't check on the first year anniversary to a married couple who have a child, or on the birth of their first child after at least one year of marriage. (Or some 1, 2, 3, or 4 month avg wage of ~$5k/month).
This kind of social support is not "need based", but would be "rewarding good social behavior" based. Our society, in reducing the real problems suffered by folks who have bad social behavior, have increased the bad social behavior. In our rich (post-) Christian Capitalist societies, such help for those needing it isn't going away -- but should be somewhat offset by significant govt reward, which equals gov't cash, for good behavior.
We need more gov't incentives for good behavior - if we want more good behavior. Incentives need to be tried.
Along those lines, some large direct cash to students for doing better homework and getting more text questions correct are likely to work better than more cash for teachers and admin. So far as I know, little has been tried at paying students to "learn" and test well. I think lots of folks, especially poor folks, would be interested in having their kids get paid to learn. I would have been motivated.
Glad that you brought Deming into the conversation. As you well discuss, his principles have wide application and could be quite helpful if applied to present problems.
In 2012 Jim Manzi wrote a book titled Uncontrolled: The Surprising Payoff of Trial-and-Error for Business, Politics, and Society that covers the same issues at greater length.
Your statement: "He asked me if as a parent I would want to see my child used in an experiment, as if this was an argument against experimentation. My jaw dropped." does say what is wrong with almost all the social science / eduction areas of academia and government. They don't understand the scientific method or scientific thinking. The damage done by this "feels correct" and "feels good" or "I believe" type belief systems is huge. Show me the data.
Being the victim of "whole word learning" displacing phonics as a reading/learning method in the 40's and 50's I ended up not being able to spell and read almost nothing. After sputnik from the USSR went into orbit, my understand of math and physical reality got me into UCLA. I am now more functional with spell-check, but that is long past my prime productivity. Without my wife as an editor, I don't think I would have been able to finished writing my thesis.
Tampering is an experiment in progress. A well designed "tamper" and well designed outcome could move the needle to better whatever.
Cheers
So let's tamper and see if the things you are investigating has a better out come. The ?? is: better for who!