Matt Yglesias

America’s Employer-Friendly Labor Market Conditions Imperil Public Health

The Centers for Disease Control sensibly suggests that in these times of swine flu, if you get sick you should stay home rather than spread the disease to your coworkers:

Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people. If you get sick, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

Which is nice for those people whose employers provide them with paid sick days. But as Pat Garofalo points out not that many people have employers who provide them with paid sick days:

Currently, nearly 50 percent of private-sector workers have no paid sick days. For low-income workers, the number jumps to 76 percent, and climbs to 86 percent for food service workers. These workers have to decide between the health of themselves and their co-workers, and the wages that they lose by staying home.

In other words, on any given day a large proportion of sick food service workers are going to find themselves unable to afford to take the day off, endangering the health of everyone else. This bill from Ted Kennedy and Rosa DeLauro would “guarantee workers up to seven paid sick days a year to recover from an illness or care for a sick family member.”

The “Health Aura”

Yesterday I was cooking a lamb ragu that’s not especially healthy. It kept running through my head that maybe I should also make some brussel sprouts on the side to make it healthier. But of course it doesn’t really work that way; the quantity of fat or calories or whatever in a pasta sauce isn’t negated by adding a side dish of vegetables. Still, just about everyone falls into that kind of trap now and again and I think everyone who’s not a Chicago School economist understands how this works. But this finding (via Ezra Klein) is truly weird. It seems that the mere presence of a salad on a fast food menu makes people more likely to order french fries.

The causal mechanism that Keith Wilcox, one of the report’s authors, gave to The New York Times doesn’t strike me as super-compelling: “When you consider the healthy option, you say, well, I could have that option. That lowers your guard, leading to self-indulgent behavior.” The measured effect in their study, however, is not a small one so it would be interesting to see if this result can be replicated elsewhere. The study will be out soon in The Journal of Consumer Research.

The Food Politics blog remarks labels this phenomenon “health aura” and says it “explains a lot about current food marketing trends” such as how I “may have noticed that vitamins, antioxidants, and omega-3’s are added to everything these days.” That kind of marketing gimmick, however, seems like a much cruder thing. People have heard that omega-3s are good for you, so you take a product that’s not good for you, put some omega-3s in it, and slap a big graphic on your box, thus implying that your omega-3 enhanced Fritos are health food. If I’m reading it right, this new study is saying that you could sell more Fritos just by putting them on the shelf adjacent to something that really is healthy.

How to Think About Public Health Taxes

I don’t know anything about Will Saletan’s article “Sweet Surrender: Taxing soda to make you stop drinking it” other than the title. But I do know the title, and I don’t think that’s the right way to think about the case for taxing soda.

Think about the case for taxing income, via the income tax and FICA. Why do it? Well, to get the money. That’s how we finance Social Security, the Department of Defense, Medicare, interest payments on the national debt, Medicaid, federal aid to schools, veterans’ health care and benefits, the FBI, etc. Now what’s the case against taxing people’s income? Well, it’s that it discourages work and it discourages investment. And that’s bad for the economy. Now we go back and forth over whether any given expenditure has a value that outweighs the economic costs. Liberals, like me, tend to think that a relatively high level of expenditure is justified whereas folks on the right tend to disagree.

But what if we could raise some revenue by taxing something else? Like, say, cigarettes. Or soda. Or booze. Well, then the case for doing the taxing remains similar—you can fund useful programs with it. But the case against looks a lot weaker, since reducing consumption of cigarettes or soda is not so bad. You introducing a little bit of allocative distortion into the economy, but not a huge amount, and you’re improving public health which is going to be beneficial.

There are limits to how much you can raise through these kinds of methods before you create problematic black markets. But at the margin, it makes sense to try to raise revenue through taxing environmental and public health hazards rather than, say, FICA or the ten percent income tax bracket.

I Have Smoked Pot and Don’t Really Care for It

Will Wilkinson has a good essay on marijuana in The Week:

Marijuana is neither evil nor dangerous. Scientists have proven its medical uses. It has spared millions from anguish. But the casual pleasure marijuana has delivered is orders of magnitude greater than the pain it has assuaged, and pleasure matters too. That’s probably why Barack Obama smoked up the second and third times: because he liked it. That’s why tens of millions of Americans regularly take a puff, despite the misconceived laws meant to save us from our own wickedness.

The Atlantic Monthly’s Andrew Sullivan has been documenting on his blog the stories of typical, productive Americans—kids’ football coaches, secretaries of the PTA—who smoke marijuana because they like to smoke marijuana, but who understandably fear emerging fully from the “cannabis closet.” This is a profoundly necessary idea. If we’re to begin to roll back our stupid and deadly drug war, the stigma of responsible drug use has got to end, and marijuana is the best place to start. The super-savvy Barack Obama managed to turn a buck by coming out of the cannabis (and cocaine) closet in a bestselling memoir. That’s progress. But his admission came with the politicians’ caveat of regret. We’ll make real progress when solid, upstanding folk come out of the cannabis closet, heads held high.

So here we go. My name is Will Wilkinson. I smoke marijuana, and I like it.

For my part, I’ll say that my name is Matthew Yglesias. I have smoked marijuana in the past, and enjoyed it on occasion, but mostly I haven’t really liked it so I don’t expect I’ll smoke any more in the future. That said, there’s still no really compelling reason that people who do enjoy it should be legally prohibited from doing so.

Is it really true that marijuana isn’t dangerous? Well, yes and no. I’m not a libertarian. I believe in paternalist measures for the sake of public health. And smoking marijuana is not a healthy undertaking. But it ought to be put on a spectrum that includes other unhealthy things that many people enjoy—neither beer nor cigarettes nor M&Ms are good for you. My understanding is that pot is more dangerous than candy, but less so than tobacco (which is more addictive and involves similarly bad-for-you inhaling of smoke) or alcohol. I’m inclined to think that all such substances should be legal, and subject to taxation and restrictions on permitted forms of marketing, with the level of taxation roughly scaled to the actual scope of the public health issue.

Obama and the Marijuana Question

Andrew Sullivan deems Barack Obama’s dismissive answer to a question about marijuana legalization “pathetic”.

I think it’s worth putting this into context. The administration has set up a number of mechanisms by which the public can get questions asked by the White House. This is a good idea, and will help break the hold that Beltway trivia has on the public conversation. This question—about whether legalizing and taxing pot wouldn’t be a good way to deal with the economic crisis—arose through one such process, as a result of an organized campaign by marijuana-legalizers to push it to the top of the agenda. The easy thing to do under the circumstances would have been to just ignore the question. Nobody made the administration do it. But they’re committed to the process, so given the organizers’ success in getting a lot of people to push this, they made it part of the town hall. That’s all a very good thing in my view.

But I do think the question deserved a more serious answer. Even something as simple as “I think the public health costs of legalizing marijuana would exceed any economic benefits” would be a real answer. Marijuana prohibition is popular, and pro-pot interests are not influential. So I don’t expect the president to come out in favor of reform. But it would be nice to see him discuss the issue seriously.

Death By Collision With People Driving Their Cars Illegally

To echo Dave Alpert’s concern I think it’s deplorable that this is the standard way of describing what happens when illegal driving kills people:

Four people ranging in age from 19 to 21 were killed early yesterday in Culpeper County, Va., when their car collided with a vehicle that was going the wrong way, Virginia State Police said.

Nobody would ever write “four people ranging in age from 19 to 21 were killed early yesterday in Culpepper County, Va., when their heads collided with bullets that were flying in the wrong direction.

Cars and trucks are, obviously, useful ways of getting around and I expect that people will continue to use them regularly for a long time to come. But equally obviously, fast-moving heavy metal objects are extremely dangerous. The people piloting them have a responsible to be careful with what they’re doing. And people who aren’t careful—especially those people whose carelessly leads to deaths and serious injuries—deserve to be subjected to strong implicit and explicit moral criticism. The common rhetoric of “accidents” the use of the passive voice serve to obscure what’s happening and where the responsibility lies.

Good News at the ONDCP

Harold Pollack gives us the good news about the new team at the Office of National Drug Control Policy (”drug czar”):

Things are looking up, though. The new Drug Czar, Gil Kerlikowski combines the credibility of a big-city police chief with a solid reputation for pragmatic and decent law enforcement practices. More important are those being brought in to back him up, particularly on clinical and scientific matters beyond the Chief’s personal experience.

Sources report that Tom McClellan will be Kerlikowski’s deputy director, and second-in-command. McLellan’s appointment is part of a weird pattern of hires made by the Obama administration: Appoint people who actually know what they are talking about rather than ideologues or the President’s smiling and funny roommate from boarding school.

The more you think not just about the administration’s big policy objectives on health care and energy, but also the large number of good people already in the place throughout the administration poised to do excellent work on dozens of second- and third-tier issues, the more frustrating it becomes to realize how it could all easily be brought down by poor handling of the banking crisis.

Marijuana Legalization as a Revenue Enhancer

Jesse McKinley takes a look at states searching for unorthodox revenue sources including this one:

Nowhere is that more true than California, where Assemblyman Tom Ammiano, a freshman from San Francisco, made a proposal intended to increase revenue, and, no doubt, appetite: legalizing and taxing marijuana, a major — if technically illegal — crop in the state.

“We’re all jonesing now for money,” Mr. Ammiano said. “And there’s this enormous industry out there.”

I don’t think this is the optimal policy. I fear the creation of a legal marijuana industry with lobbyists and advertising aimed at creating as many problem pot smokers as possible. It would be better, I think, to decriminalize possession and growing for personal use but keep maintain a ban on selling and marketing marijuana. That said, the revenue possibilities of moving to full legalization are pretty tempting. And what Ammiano is proposing would be a significant improvement over the status quo. I think it’s a real sign of the poverty of our policy conversation that this idea isn’t in wider circulation.

School Lunch Or; How to Make Government Work

One of the craziest stories I heard while I was in Finland was the shocking tale of the 1999 school lunch reform. The way this worked is that in 1999, parliament passed some legislation guaranteeing a nutritionally balanced school lunch. So the National Nutrition Council wrote some guidelines dictating that a properly balanced lunch would feature fresh or cooked vegetables covering half the plate, a starch (potatoes, rice, or pasta) covering a quarter of the plate, and meat or fish or a vegetarian protein alternative covering the remaining quarter. A desert of berries or fruit is served “if the nutrient content of the main course is not adequately diverse or if it contains little energy” along with skimmed or semi-skimmed milk and bread.

It was a crazy story not because the nutritional guidelines are crazy. Nor because the nutritional guidelines are perfect. This still actually leaves a lot of variance depending on exactly what’s served. But what’s crazy about it is the way it happened. Parliament felt children should eat a well-balanced meal, and so guidelines were written by a government agency and then implemented. Like magic!

It’s very hard to imagine anything like that happening in the United States, where something as basic as the food pyramid winds up being a locus for interest-group politics. Michael Pollan talks to Mother Jones about the way of the world:

MJ: Does WIC still specify that you buy dairy?

MP: Yes. We had a huge fight to get a little more produce in the WIC basket, which is heavy on cheese and milk because the dairy lobby is very powerful. So they fought and they fought and they fought, and they got a bunch of carrots in there. [Laughs.]

MJ: Specifically? Who knew: the carrot lobby?

MP: Specifically carrots. The next big lobby. But there is also money in this farm bill for fresh produce in school lunch. The price of getting the subsidies was getting the California delegation on board, and their price was $2 billon for what are called specialty crops—fresh fruit and produce grown largely in California.

Or watch this video:

Democracy is democracy, politics is politics, and life is what it is. But still, it seems to me that Americans have a deplorable tendency to take pride in the dysfunctional nature of our political system, and actually revel in it. It makes, after all, for a fascinating game in a way that a simple outsourcing of nutritional guidelines to apolitical experts wouldn’t. But I think there’s a big challenge for progressives here. And not just with regard to school lunch, but with regard to the whole thing. There are certain ends that can only be accomplished by state action. But state action is only really tolerable if you can actually make the government work well and an awful lot of our basic institutions just don’t work very well. At the same time, the medium-term policy frontiers increasingly focus on questions of public health and environmental security that have a hefty technical element. A lot of the argument for universal health care hinges on the fact that, in principle, comprehensive reform could deliver a much more efficient system. But will it actually deliver such a system, or will it just deliver whatever happens to get lobbied for? Care that benefits patients, or care that benefits health care providers of various kinds? Those ultimately aren’t questions about the design of any particular plan; instead, they’re questions of whether or not progressive governance can manage to somehow deliver better overall governance.

UPDATE: On a related note, Ezra Klein observes:

CBO occupies a weird space in Washington. They decide what legislation costs. They may get it right or they may get it wrong, but the number they settle on is the number legislators agree to use. And so this morning’s hearings featured powerful senators begging a small, bearded budget geek for favorable judgments as if he were the Oracle at Delphi.

And the thing of it is that while the CBO’s methods aren’t perfect and its conclusions aren’t incontestable, it really does do a pretty good job—good enough that it can continue to be widely respected. And having an expert agency be widely respected and do a pretty good job, thus providing a convergence point for congressional consideration of legislation, is much better than having our legislative debates just proceed with everyone inventing their own cost estimates.

The Virtue of Quasi-Legal Status for Marijuana

Speaking of marijuana legalization polls, the question of course arises as to whether we should legalize pot. On this, I’ve come to stand with Mark Kleiman who conveniently repeated his gospel yesterday:

Substantively, I’m not a big fan of legalization on the alcohol model; a legal pot industry, like the legal booze and gambling industries, would depend for the bulk of its sales on excessive use, which would provide a strong incentive for the marketing effort to aim at creating and maintaining addiction. (Cannabis abuse is somewhat less common, and tends to be somewhat less long-lasting, than alcohol abuse, and the physiological and behavioral effects tend to be less dramatic, but about 11% of those who smoke a fifth lifetime joint go on to a period of heavy daily use measured in months.) So I’d expect outright legalization to lead to a substantial increase in the prevalence of cannabis-related drug abuse disorder: I’d regard an increase of only 50% as a pleasant surprise, and if I had to guess I’d guess at something like a doubling.

So I continue to favor a “grow your own” policy, under which it would be legal to grow, possess, and use cannabis and to give it away, but illegal to sell it. Of course there would be sales, and law enforcement agencies would properly mostly ignore those sales. But there wouldn’t be billboards.

That beautifully-crafted policy has only two major defects that I’m aware of: it wouldn’t create tax revenue, and no one but me supports it. On the drug-warrior side of the argument, even those who can read the handwriting on the wall won’t dare to deviate from the orthodoxy. As we did with alcohol, the country will lurch from one bad policy (prohibition) to another (commercial legalization). I just hope the sellers are required to measure the cannabinoid profiles of their products and put those measurements on the label.

I support it too! But if it is true that we need to choose between the current regime and an alcohol-style regime, I would certainly prefer commercial legalization. The public health harms would be real, but they’d be more than offset by the benefits—gains to non-abusive users, increased tax revenues that could fund worthwhile endeavors, resources currently devoted to a senseless criminalization scheme could be repurposed. This would also be an area in which America’s tradition of federalism and localism could be put to good use. In many parts of the country, people probably wouldn’t want to see any pot stores or “coffee shops” and they could, presumably, decline to license any even if federal law permitted such licenses in general.

The Government Makes the Stuff We Need

A commenter at the Atlantic remarks:

There’s the rub. My company’s bank loan officer has called frequently asking if we need to borrow. They are begging to lend money. For what? We could buy a nice new machine tool at a good price, but why do that when sales are falling? Put an extension on our building? Buy some failing competitor and strap oneself with debt? Unless you absolutely need a new car or a new television or a new roof, the big ticket discretionary purchases paid for by loans aren’t going to be made. The loans the banks are making now are companies rolling over existing debt, not new debt. Given the “stuff” out there that is discretionary purchases, I wouldn’t be at all surprised to see unemployment hit 20% before a bottom is reached.

I think this captures something important. And I also think it’s an important part of the case for increased public investment, somewhat apart from the specific issue of the economic stimulus package. If you try to put the contemporary United States in historical and international perspective, you’ll see that we’re doing really well in a lot of ways. As a society, we’re not suffering from an objective shortfall in the quantity or quality of automobiles we have. We’re certainly not falling short in either the number of houses around or their general size and lavishness. We have a lot of very nice televisions, a lot of computers, a lot of cell phones and DVD players, etc. It’s not just that we’re prosperous enough that people aren’t starving to death, but over and above that compared to anyplace else in the world we just have a ton of consumer goods stockpiled such that even if purchases of new goods slowed enormously for years we could keep on keeping on at a high standard of living.

But that’s not to say that things are perfect. Compared to other times and other countries, there are a lot of scores on which we’re doing extremely well. But there are other respects in which we’re falling well behind what we know is achievable by contemporary societies.

We have a smaller proportion of our population graduating from college than do some other countries, and we’re making no progress. Relatedly, our K-12 education system could perform better. Our intercity passenger rail offerings are much worse than they could be, and none of our non-NYC metro areas have really top-notch mass transit offerings. We have substantially more violent crime than do other countries or historical periods in the United States. The level of prenatal health care our pregnant women are receiving is substandard, as is the physical fitness of our children. Public libraries are generally worse than they were a generation ago. America’s streets and sidewalks are, in general, not especially clean or well-maintained. And though our highways are plentiful, they’re not well-maintained either.

This all adds up to a lot of fields in which it would be plausible to say that we could enhance human welfare by expending more funds. But these are basically all things in which the private sector could realistically only have a secondary role. There’s a lot of dogma about to the effect that jobs working for the government aren’t “real” jobs—that somehow the police and teachers and firefighters and the guys who build the bridges and drive the buses aren’t creating anything of value. But that’s preposterous. The work is real, the jobs are real, and the benefits are real. It’s true that it’s difficult to maximize the efficiency of a public sector enterprise. But it’s also true that there are categories of goods that can’t be adequately provided without a large public sector role. And given the generally high level of wealth we enjoy, compared with the past 35 years of starving the public sector, the marginal dollar invested in these kind of endeavors can do an enormous amount of good. And that’s especially true at a time when it seems that relatively few individuals seem inclined to go further into debt for the sake of acquiring a BlueRay player. There’s enormous willingness out there at the moment to lend money to the United States government, and there’s a lot of stuff the United States government could be doing to benefits its citizens.

The Low Price-Elasticity of Vegetable Consumption

Ezra Klein has an interesting post primarily focused on the disappointing results of trying to subsidize fruit and vegetable consumption:

Diansheng Dong and Biing Hwan-Lin recently conducted a study for the USDA’s economic research service modeling the likely impact of a 10 percent discount on fruits and vegetables for low-income Americans (defined here as incomes below 130 percent of the poverty line). They concluded that the policy, which would cost $580 million, would spur low-income Americans to increase their consumption of fruits by 2.1-to-5.2 percent and vegetables by 2.1-to-4.9 percent. It’s not nothing, but it’s not much. The graph below shows the effects of the policy, the effects of the policy doubled (20 percent off fruits and vegetables), and in the final column, how far even the double-subsidy world is from the USDA’s recommended consumption of fruits and vegetables (which is probably still too low!)

One cautionary note about the graphic here would be that actual behavior is so far off from USDA recommended behavior that putting the USDA goals in the chart winds up making the changes very small. If the goal is a 70 percent increase in vegetable consumption, you shouldn’t be surprised that a 20 percent discount doesn’t achieve the goal.

More broadly, though, when discussing this issue it’s important to recall that vegetables are not expensive. I went to the farmer’s market over the weekend and mixed root vegetables (sweet potatoes, carrots, turnips, various kinds of onions and potatoes, etc.) were available for $1 a pound and all these are, needless to say, for sale for less money at a regular supermarket. Indeed, it’s the relative abundance of vegetables that gets us in trouble. Having evolved in an environment where plants are plentiful but meat and sweets and refined grains are rare, we’re programmed to act as if we’ll be eating plenty of vegetables out of necessity and had better grab the other stuff while we have a chance. So any policy to turn these habits around will run into some difficulties as it’s literally going against human nature.

But the bigger issue than price for most people is almost certainly convenience. We’ve created a society where people work longer hours than they used to, where parenting expectations have gotten higher, and where fewer and fewer families have mom serving as a full-time unpaid housekeeper/cook/nanny. Ezra observes that most people “live closer to a McDonald’s than a grocery store.” And, indeed, looking back on it I’ve been struck by how rapid and dramatic the change in my eating habits has been since I moved from being near many takeout food options but far from a grocery store to living closer to a supermarket than a takeout spot.

On the other hand, Ezra says “taking 10 percent off the price of the rotted bananas at the convenience store won’t do much to encourage their consumption” since they’re still rotten. I’m actually not so sure. Sometimes a store can get into a bad fruit equilibrium, as Sonya’s Market on 11th and Harvard was circa 2003 when I lived nearby. Few people bought the bananas there, so the bananas were rarely fresh, so you didn’t think of Sonya’s as a good place to buy banana’s, so the banana turnover was low and the banana’s were rarely fresh. Conversely, you can achieve a good bodega equilibrium where expectations of high demand lead to fresh produce lead to high levels of consumption which keeps the produce fresh.

Last but by no means least, I don’t think it makes a ton of sense to talk about subsidizing fruits and vegetables without talking first about un-subsidizing corn, soy and the corn ‘n soy derivatives that artificially drive down the price of Fritos and Big Macs. The policy argument for subsidizing healthy eating is convincing enough to me, but obviously is going to fly in the face of widely held anti-paternalist sensibilities. The case against subsidizing unhealthy eating, by contrast, is totally unimpeachable.

Health Scares Reduce Smoking, But Not Obeisity

I don’t think people talk enough about public health issues in the policy realm, so I’m resolved to start following news like this even if it doesn’t have a clear policy upshot:

Smokers are three times more likely to quit if they get a wake-up call in the form of a heart attack, stroke, lung disease or cancer diagnosis, a new study has found.

But obese and overweight people lose two to three pounds at most after being diagnosed with a serious illness like heart disease or diabetes, according to the same report. The study, which looked at weight loss only in people under age 75, was published on Monday in The Archives of Internal Medicine.

Part of the issue, I assume, is that even though quitting smoking is incredibly hard in a large variety of ways, it’s not hard to monitor yourself. Nobody accidentally smokes a cigarette. And tobacco addicts can come to realize that we’re addicts and that we need to abstain from tobacco consumption.

Food isn’t like that. Healthy eating doesn’t mean you give up eating. But that means you’re subjected to all kinds of judgment calls. That leaves people subjected to misinformation about the healthiness of different foods—often deliberate misinformation—as well as a whole range of weakness of will and self-deception phenomena. Or perhaps to put it another way, if you get a health scare and resolve to stop smoking, you’ve made a first-order commitment to yourself: “I won’t smoke cigarettes anymore.” Resolving to eat healthier, by contrast, is a second-order commitment. People could probably do a pretty good job of resolving to quit one particular bad eating habit—no more Swedish Fish for me ever again—but it’s not clear how much that sort of thing would really help. Fewer Swedish Fish could just mean more delicious Sour Patch Kids.

Booze Taxes and Booze Regulations

The other day I wrote a not-very-popular post making the point that a higher tax on alcohol would be a boon to public health and crime control, a way of raising some revenue that would provide a net boost to the economy rather than a drag like an income tax. Thinking more about this, it’s worth observing that our current low-tax environment has hardly created a free market in intoxicating beverages. On the contrary, getting your drink on is—at the retail level—one of the most regulated enterprises in everyday life.

Just about everywhere, you need a special license of some kind to see booze. In many states, you can only buy liquor from state-run monopolies. In Pennsylvania, you can’t buy beer in stores. In New York, you can’t buy beer in liquor stores. Here in DC there’s a tendency for very mediocre drinking establishments to be incredibly crowded simply because there are immense regulatory hurdles to opening a new bar. And read Radley Balko on the evils of beer distributors.

All these rules and regulations add up to alcoholic beverages being more expensive and more inconvenient to obtain than they would be in a less-regulated world. But whereas with a tax on alcohol the government would get its hands on revenue that could be spent on valuable social services, the increased cost associated with these regulations is just an overall loss. As for whether or not it makes sense to try to increase the retail price of booze, that’s neither here nor there. But insofar as we’re doing something in this neighborhood I would much rather act through taxes than through scattershot and arbitrary regulatory schemes.

The Case for Booze Taxes

Harold Pollack observes that in public health terms our most serious drug problem by a wide margin is the perfectly legal drug known as alcohol. The good news about alcohol is that whereas cigarette smoking is really bad for you from puff number one, moderate alcohol consumption is genuinely fine. But problem drinking is behind a lot of social ills—not just the famous drunk driving, but developmental disabilities in children, liver damage, violence, etc. And to an enormous extent, the harms caused by excessive drinking are imposed not just on the drinker but on other people, making the case for using taxes to moderate consumption clearer than in the cigarette case.

But Pollack observes that while cigarette taxes have been going up, the reverse is the case with booze: “Over the past 50 years, Cook reports, the inflation-adjusted value of federal liquor taxes declined by a factor of six while the inflation-adjusted value of federal beer taxes declined by a factor of 3.6.” When the time comes to start paying down the massive national debt we’ll be facing, there’s a very strong case that reversing this trend should be part of the picture: “Cook argues that a 10-cent tax per ounce of ethanol (the amount contained in two drinks) would reduce ethanol sales by 12 percent and would reduce motor vehicle fatalities by about 7 percent. An estimated 80 percent of these taxes would be paid by the 13 percent of American adults who are heavy drinkers.”

As with cigarette taxes, you wouldn’t want alcohol taxes to go too high, lest it spawn serious black market issues and associated criminal activity. But a more modest, yet substantial, tax could provide us with some revenue and do an enormous amount to build a safer, healthier country.

LA Contemplates Further Smoking Restrictions

Los Angeles is considering making it even tougher to smoke legally in the city:

Lighting up on the outdoor patios of cafes and coffee shops may soon be a thing of the past in Los Angeles. The city’s arts and parks committee took a first step Wednesday toward a new ban on smoking on restaurant patios or within 10 feet of any outdoor establishment that serves food or beverages.

Bars with outdoor areas and other over-18 venues would be exempt.

I think the arguments presented on behalf of these kind of restrictions are often kind of confused and misguided. But what does make sense is the simple observation that the more you act to make smoking inconvenient and stigmatized, the more it (a) encourages smokers to quit, (b) encourages non-smokers to restrict their cigarette consumption, and (c) discourages new people from taking up smoking. I’m not sure I have a systematic theory of when paternalistic regulations to promote public health are good and when they go too far, but I think that’s a basically cogent rationale for policy.

Part (b) in particular I think tends to get underestimated. I quit smoking when DC stopped letting people smoke in bars. Many friends of mine didn’t quit. But it’s still striking that they smoke much less now that they need to step outside to light up than they used to when we would all sit around a table chain-smoking.

By Request: Smoking

Matthew Struhar asks:

As a former smoker, what steps do you think the Obama administration could take to help people trying to overcome addiction? Other than raising VATs on tobacco products, are there any interesting proposals out there to deter smoking and/or help people quit?

I don’t have many interesting ideas here. The main policy levers in use — taxes and restrictions on places wherein you can smoke — work pretty well, though it’s important not to kick the taxes up to a level that’s so high that you get tons of black market activity. One neglected aspect of this, I think, is the prospects for more rigorous enforcement of laws against giving/selling cigarettes to kids. Most smokers start earlier than 18 and the earlier you start the more deadly it is. I’m enough of a libertarian to think that what adult smokers choose to do with their money and their health should be mostly up to them, but it’s really worth squeezing the vise to try to prevent the emergence of the next generation of tobacco addicts.

Beyond that, this is a very vague policy idea, but clearly one problem with our health care system is that there’s more money to be made treating lung cancer or emphysema than there is persuading people to quit smoking even though the social value of preventing smoking-related illness is much greater than the value of treating it.

Last, since Obama himself is a smoker who’s been struggling with efforts to quit, I’ll observe that I think it would be good if more people talked seriously about tobacco addiction. There’s a lot of individual variation to this, but I’ve got it really bad and I’m sure I’m not the only one. I was out at a bar in Geneva back in November and people were allowed to smoke inside and generally being all European. I bummed a cigarette — my first one in almost two years. From that point, it took maybe 36 hours for me to return to a full-blown self-destructive pack-a-day habit. When you watch The Wire and see Bubbles quit heroin and then relapse you understand that he’s not going to shoot up just once. For me, at least, it’s just the same with cigarettes. When I got back to the states and resolved to re-quit, I found out that it’s a lot easier to stop after six days of heavy smoking than after ten years. But it’s not that easy, and didn’t spare me days of being depressed and irritable.

The effort to avoid smoking is often portrayed as a kind of quest to battle temptation — like the struggle to not eat too much chocolate cake and get fat. And for some people maybe it’s like that. But for a lot of people, it’s not like that at all. It’s a very serious addiction like hard drugs that just happens to come in a form that’s (sort of) socially acceptable and non-incapacitating.

Soda Taxes

Nick Kristof makes the case for a soda tax:

Mr. Paterson suggested the tax — an 18 percent sales tax on soft drinks and other nondiet sugary beverages — to help raise $400 million a year to plug a hole in the state budget. But it’s also a landmark effort that, if other states follow, could help make us healthier.

Let’s break for a quiz: What was the biggest health care breakthrough in the last 40 years in the United States? Heart bypasses? CAT scans and M.R.I.’s? New cancer treatments?

No, it was the cigarette tax. Every 10 percent price increase on cigarettes reduced sales by about 3 percent over all, and 7 percent among teenagers, according to the 2005 book “Prescription for a Healthy Nation.” Just the 1983 increase in the federal tax on cigarettes saved 40,000 lives per year.

I think there’s a reasonable case to be made that diet soda shouldn’t be exempt from the tax. I’m a Diet Coke man myself, but my understanding is that the research into how much healthier that really is is somewhat ambiguous, and I think enforcement of a soda tax could be made a lot easier if we didn’t add exemptions. But Kristof is on the right track here. As liberals tend to do, I would like to see the government spend more money on infrastructure and social services. I think it’s important that we pay teachers enough to recruit an adequate number of people into the profession. And beyond teaching, we probably need to spend more on a range of civil service salaries. We need to upgrade our infrastructure and we need to make sure children aren’t going hungry. We need to do a whole lot of stuff, and it would cost a whole lot of money to do everything I’d like to see us do. A lot of money can be found for that stuff, over the long run, by reducing the amount of money we spend on non-productive things like defense and medical waste. But ultimately there’s some need for taxes.

And while tax increases to fund useful services are things worth doing, it is worth considering the economic impact of taxes. Taxing the work people do can have a net beneficial impact on the economy if the tax revenue is spent on something adequately useful. But all else being equal, it does create a drag on the economy. Taxing cigarettes and soda and so forth, by contrast, mostly pushes people toward better healthy outcomes and therefore does something to boost quality of life and economic growth. And on top of that, it creates revenue that can be used for useful things. You wouldn’t want to try to fund the public sector entirely through vice taxes lest you wind up with black markets, perverse incentives, and a highly regressive code. But levied at a moderate rate, vice taxes can raise a lot of funds while having a modest-but-real positive impact on lifestyle choices and health outcomes. It’s something we ought to rely more on.

All The Best

As Ezra Klein was pointing out yesterday the idea that Americans receive the best health care in the world is hard to support with evidence. Here’s a chart:

It also bears mentioning that it’s far from obvious that maximizing quality is the right policy objective. If the wacky statists in France were to implement a “minimum price” of 2,000 euros for a high-definition television you’d rapidly see France become the country with the “best” HDTVs in the world. Everything would have full 1080p resolution or be really big or what have you. Because when you can’t compete on price, you try to compete on quality. But in the real world, when you’re thinking about what’s a “better” or “worse” television situation, the price is relevant not just the quality.

Back to the health care case, it’s far from clear that the British system’s focus on cost containment is the wrong idea. There are certainly countries with better health care than the UK, but the practical impact of the international variation seems pretty small. Meanwhile, the much lower price the UK is paying has real benefits in terms of economic growth and the ability to make public investments elsewhere. Even if all you care about is health outcomes it probably makes more sense to focus on equity, cost containment, and the basics while focusing public expenditures on ways to make healthy lifestyle choices broadly available.

The Future of American Transportation

Probably won’t look like this:

Might I suggest running or a bicycle?

Death By Trainlessness

Randal Archibald writes for The New York Times about the recent fatal rail crash in LA: “Warning System Could Prevent Train Crashes.” And of course as a rail transit booster, I certainly favor efforts to improve train safety.

Still, it’s worth noting that there won’t be any headlines tomorrow about the car crashes that could have been avoided by building more and better rail networks. We had 37,248 fatal car crashes in 2007. That’s over 100 every day. And yet you don’t see “100 Die Nationwide in Car Crashes” on a daily basis in the headlines. We just take it for granted that most Americans will make almost all of their trips via the most dangerous possible way of getting around. One person dies for about every 415,000 vehicle miles traveled.

The considerable environmental benefits of shifting our transportation infrastructure so that a minority of people would drive radically less and most people would drive somewhat less are so large that the environmental case for such shifts has tended to crowd out other arguments. But in many ways the public health benefits are even more clear cut.

STRONG: Apologies — one fatality for every 415,000 vehicle miles traveled is a ridiculously low figure and implies something like universal death by car accident. There were about three trillion vehicle miles traveled in 2007. Three trillion divided by 37,248 is, unless I’m making another mistake, about 80 million.

The Business Models We Need

Marginal Revolution reader Peter Risager says:

A Danish chain of gyms is now offering membership free of charge, with the only caveat that you have to show up, in order for the membership to be free. If you fail to show up once per week you will be billed the normal monthly membership fee for that month. This should solve the problem with incentives that gym-membership normally carries – there is suddenly a very large (membership is around 85$ per month) incentive to show up each week.

I have my doubts that they’ve nailed the structure just right here. But the general shape of the solution seems right. And we should all hope entrepreneur or other cracks the code and manages to make something like this work. In the domain of personal health habits, we have a lot of instances of akrasia and these are exacerbated by the fact that the business world has done a much better job of finding ways to make money by taking advantage of our akrasia than they have of finding ways to help us overcome it. If you could actually find a workable business model that’s built around getting people into the gym — rather than just buying a membership to the gym — you’d wind up doing a lot of good for the world.

Annals of Conservative Paranoia

I was in a cab just now and the driver was listening to some of the old-fashioned conservative talk radio. The host’s subject was a bill in (I believe) New York State that was going to have public schools tracking body mass index information for schoolchildren. This sounded like a reasonable enough idea to me, but the host kept repeating it over and over again in an outraged tone of voice as if it was an obviously absurd idea. Finally, he started to explain — correctly, I thought — that once this data started coming in, people were going to start citing it as showing that there were problematic levels of childhood obesity and arguing for some new policy initiatives to combat it. And, again, he kept repeating this like it was clear that childhood obesity prevention programs were the worst idea imaginable. The trump card to his argument, basically, was that these new programs would cost money and some of that money would go to salaries for implementation, so really the “only” reason people were agitating for this BMI tracking was to fatten up the bureaucracy. This was allegedly comparable to the greed-based reasons behind the anti-smoking campaigns of the past several decades.

Not un-comparable to some paranoid ideas you hear on the left, but interesting to hear it nonetheless. Then the driver corked off a doozy. Like cab drivers across the country, he explains that MSP area cab drivers have been hurting due to gas prices. Thus, he said, they’d been agitating for about a hear for approval of a fare hike by the relevant regulatory authority. Finally, one got approved and it took effect five days before the GOP convention. This he explained as part of a “liberal agenda” to somehow stick it to the Republicans.

Next up — ads for gun shops.