So I drove down to Fear’s Cape with my dad in a U-Haul this weekend to move a bunch of heavy furniture. I generally like to use drive time with my dad to bounce some of my political ideas and beliefs off him to a.) judge how crazy I am, and b.) try to gently nudge him leftward. The topic of the day was health policy.
Here were my proposals. First, I suggested that the government offer everyone a voucher to buy a gym membership at qualifying gyms (i.e., gyms that meet certain sensible requirements in terms of facilities and availability of a wide range of exercise programs, etc.). Regular exercise can obviously go a long way towards reducing the prevalence of very costly and highly unpleasant chronic conditions such as diabetes, heart disease, and cancer. Judging by personal experience, it has a noticeable effect on mental health as well. The government could very feasibly make the money spent on the vouchers back (especially if we had a single-payer health system where the government was on the hook for all the medical care that would later have to be provided) in reduced chronic care costs down the road. But even in the (unlikely, I think) event that it didn’t quite make its money back, it would still probably be worth it, as it would surely significantly improve the quality of life for many people. After all, one of the functions of government should be to spend money in such a way as to improve the life of its citizens. If we’re out a few bones preventing heart attacks and strokes I’m ok with that.
The question then becomes – if it’s such a good idea to make widespread exercise a policy priority, why not just make it mandatory? Even under the voucher system, you’d probably have to keep track of how often the voucher recipient actually goes to the gym and assess penalties for people who never go – otherwise the government would be just wasting its money paying gyms for nothing. So we’re already taking attendance and penalizing absenteeism. And any time you rely on subsidies to induce people to voluntarily do something that’s for their own good, you’ll still get some people who, for whatever reason, just don’t do it. It’s analogous to one of the problems with Obama’s “no mandate” health plan – under that plan we can still expect that a good number of people will simply act irrationally and not take advantage of the subsidies. Does it not make sense just to make these people do it? It will, on balance, make their own lives better and most likely reduce the costs of health care for all of us.
This may strike people as kind of authoritarian (sorta like mandatory gym class for our entire lives, with Mr. Burdsall scolding full-grown adult slackers). But if the benefits are as large as I suspect they may be, it still may make sense. And who knows, maybe by forcing the population into regular exercise we could develop USSR-style global athletic dominance. That’s gotta count for something. Winning a FIFA World Cup, a world rugby championship, and a world cricket title (on top of our dominance in traditional U.S. sports) would establish us as the Greatest Nation in History.
My second proposal was that we subsidize certain health care procedures. The idea dawned on me when I read that the French health care system (very sensibly) charges no co-pay or deductible for 30 kinds of preventative care services. But colonoscopies, prostate exams, and gynecological exams are still highly unpleasant, despite their absolute medical necessity. Some people avoid these procedures even when their insurance covers them completely. So “free” probably isn’t good enough to establish complete compliance. Maybe it would be worth it to give people a $50-$100 subsidy for such necessary exams. Once again, this is the way to go if we are committed to the idea of getting people to do things intended for their own good voluntarily through subsidies. We could always just make them do it and assess fines for failure to do so.
What do people think? I tend to lean towards the authoritarian method, but I could be convinced otherwise. And yes, I know the authoritarian method would be totally politically impossible. So would absolutely everything else I advocate on this Blague. I’m more interested in the question of what would be best in a political vacuum.
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I don't have any stats to back this up, but can we assume our country's health (obesity) problem starts with young children, and especially affects underclass kids?
ReplyDeleteIf that's the case, to take a sizeable bite out of the problem, we wouldn't really need to go as far as giving every citizen a gym membership or force them to excercise after work.
We could just prioritize public works projects to build more public gyms, tracks, pools, and parks (with accompanying sports equipment and supervision), especially in the inner cities.
Subsidies could be given to business wanting to sell healthy snacks at said locations.
Where I definitely agree is that the ventures don't necessarily have to be profitable. It is the state's raison d'être to protect and improve the quality of life of its citizens. Besides, we don't worry about getting a return on our $800,000 investment every time we fire a Tomahawk missile to kill brown people in a foreign land, so it shouldn't bother anyone that we don't make a buck off of encouraging healthy habits in our own cities.
First of all, I think the paying people for the unpleasant exams thing is a really good idea. It would be easy to administrate, hard to cheat, and compliance would probably be pretty high. I think people would take to it pretty enthusiastically, whereas if you just mandate it people will go but won't be too happy about it and you'll have to deal, with fines or whatever, with a certain number that just won't do it. Probably the same people that won't do it even if you pay them $50 or $100. So anyway, I think the subsidy approach is an effective non-confrontational way of getting people to do something they should do anyway.
ReplyDeleteIn terms of the gym thing, however, I think trying to pay for people's memberships, or even paying people to GO, would be much harder to administrate. Since its not a once a year thing or once every five years thing but a several times a week thing, there would be a lot of scope for cheating. One simplification you could make is just have good, clean, well-equiped gyms (state-run? maybe, could just be subsidized) available free-of-cost for everyone, and not MAKE anybody go. People would simply have no monetary excuse not to go. But then you wouldn't have to keep track of people's compliance.
If you really want to increase the number of people that go to the gym, in a relatively efficient manner, I think the best way then is the authoritarian path. You could assign people to a neighborhood gym, say, three days of the week, 30 minutes or 1 hour per session, and it could be a group activity led by instructors to ensure people aren't just sitting around drinking gatorade in the locker room. You could fill your quota doing different things... working out, joining a basketball or softball league, swimming, jiu-jitsu, whatever, as long as your physically active for the prescribed amount of time. If you make sure you have a lot of variety (which means fairly heavy investments in terms of sports infrastructure), I think people would probably get into it and forget relatively quickly that you're making them do it. And while big government investments in pools and indoor basketball courts etc are always welcome, you could definitely do what Finley implied originally and have people that already run gyms and other private sports facilities sign up to be contracted providers for the government program.
I think that'd be a pretty good initiative.
Let's do it!
Ryan, Permit me to Post, and I shall blog all over your delicious blog. And I willnot care who gets in the way.
ReplyDeleteCarlos, I think you may overstate the difficulties in administration throught he voucher approach, but you know I favor the authoritarian path in my heart of hearts. We should do this.
ReplyDeleteI was talking to my good friend Luis over the weekend, and he, uncomfortable with the dirigisme of universal compulsory gym, suggested the following compromise: gym should be compulsory only for recipients of government-funded health care whose health-care professionals, after mandatory yearly checkups, have deemed a certain gym regimen necessary for the maintenance of good health.
ReplyDeleteI think this is fine. People who are already physically fit wouldn't have to have their routines modified, and you serve the purpose of lowering long term health care costs by targeting those patients whose health would most benefit from compulsory gym.
Anyone else have thoughts?
If continued regular national service (not limited to but including defense service, community building and cleanup, disaster relief, public outreach, tutoring, etc.) is going to be required, which certainly many are for, I don't see too much of a problem with demanding that people fulfill a certain fitness requirement as well.
ReplyDeleteI agree with Carlos for the reasons he mentions, plus the additional fact that it will save the government money if it doesn't have to provide gym meberships (or whatever subsidy is enacted) for those who would maintain a certain level of physical fitness on their own.
ReplyDelete