This Yglesias post reflects a group of beliefs regarding public health that tend to cut across ideological lines, probably because they resonate with some deeply embedded cultural puritanism that affects both the right and the left in America.
To simplify somewhat (but not much), the argument is roughly that health care costs so much because people get sick, and people get sick because they have bad habits. So the key to cutting health care costs is to get people to behave better.
Right-wingers tend to frame this argument in terms of “individual responsibility,” while lefties are more prone to blame structural factors, but in both cases the solution to the problem is the same: get Americans to stop stuffing their fat lazy faces with “junk food,” soda, alcohol, and cigarettes, so we can get health care costs under control.
This argument is wrong-headed on a whole bunch of levels. In particular it assumes that people get sick primarily because of their lifestyle habits, when in point of fact people get sick mainly because they get old. And old peoples’ health care costs a lot. But an even bigger problem is the assumption that improving peoples’ health means their health care will end up costing less.
Indeed, consider the one item on this agenda that would actually improve public health: decreasing smoking rates. It’s far from clear that decreasing cigarette smoking would actually save health care costs. It may well be that the improved health quitting smoking produces decreases costs in the short run, but increases them in the long run, because non-smokers live so much longer.
As for the other stuff, it’s been 90 years since Prohibition and the spiritual descendants of Carrie Nation are very much with us. When a smart guy like Yglesias simply assumes that alcohol consumption is a net negative to society it’s easier to understand how this nation’s insane drug policies remain so difficult to reform. It should be unnecessary to point out that alcohol seems to have a markedly beneficial effect on the health, even narrowly defined, of moderate drinkers. This doesn’t even take into account that drinking produces enormous amounts of pleasure, which of course is why the puritans hate it so much. Surely that should count for something. Drinking also generates considerable social costs, but to assume without argument that America would be a better place if people drank less is completely unwarranted.
As for soda and “junk food,” Barry Glassner’s The Gospel of Food is a nice introduction to the moralistic hysteria surrounding these subjects. In any case the notion we can cut health care costs significantly by getting people to drink less soda and eat fewer Doritos is unsupported by any evidence.
The bottom line is that health care costs have risen so much in large part because health has improved so drastically in America. 100 years ago life expectancy was 50, most diseases were basically untreatable, and health care costs were really low. Getting everybody to stop smoking, give up the demon rum, and eat like Alice Waters isn’t going to return us to that utopia.