Public Health Is Not What Many Think It Is

Many people seem to think that that “public health” is a scientific white knight. For sure, many medical experts in the public health movement do have real scientific knowledge, but the science stops there. The rest is essentially a political movement.

The Reason Foundation just published my primer on public health: “Public Health Models and Related Government Interventions: A Primer.” A few excerpts:

“In many respects,” says a major textbook of public health, “it is more reasonable to view public health as a movement than as a profession.”

With its wide definition, ideology, and scope, public health is as much as, or more of, a political movement than a field of scientific inquiry. Elizabeth Fee agrees with “the idea that public health is not just a set of disciplines, information, and techniques but is, above all, a shared social vision.” This  hared social vision is not founded on the respect of the preferences of all individuals and an attempt to find social institutions that can best reconcile them, but on the idea that some experts, or perhaps a democratic majority that agrees with them, should impose their values and trade-offs on other individuals in society. The progress of public health appears closely tied to the collectivist ideologies that developed in the 19th century. At the beginning of the 20th century, medical educator Harvey Jordan of the University of Virginia predicted that in light of eugenics and “the general change from individualism to collectivism,” medicine would be transformed into public health, and that physicians would upgrade from “doctors of private diseases” to “guardian of the public health.”

One factor in the drift of public health toward total government care has been a non-scientific conception of society.

The ideological content of the public health movement is visible there: a priori, they believe the issue is a matter of collective choice, that is, of imposing a politically determined opinion and behavior on those who don’t agree, instead of leaving it to individual choices. There is no recognition of the existence of two distinct facets of human activity: it is one thing for science to determine (at least provisionally) what are the health consequences of different actions; it is another thing to impose one course of action on those individuals who would make different trade-offs. In the perspective of this paper, truth is a matter of scientific inquiry; choice is a matter of individual preferences (with some exceptions).

Few economists should fail to see how anti-scientific this ideological movement is in matters relating to society, politics, and economics.

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A Hole in the Market

“When markets fail, use markets.”

The above is a quote from Arnold Kling, the person who started this blog. I thought of that when reading Sally Satel, “Rethink Crisis Response,” Reason, October 2020. The whole October issue, by the way, is focused on fixing the police, and it’s excellent.

Here are the first 3 paragraphs from Satel’s article.

“Please just send one police car, please don’t have your weapons drawn, please take him to the hospital.” These are the words that many families with a mentally ill loved one have learned to say when crisis strikes. Sabah Muhammad and her siblings have spoken them several times since 2007, the year her brother was diagnosed with paranoid schizophrenia. He had been a standout student and star running back at his high school near Atlanta, but everything changed around his 18th birthday. “He would become catatonic, barely moving, just staring into space,” Sabah explains. “Sometimes he locked himself in his room for weeks, refusing food, except to come out of his room at 3 a.m. to make toast that he blackened to carbon ‘to get the poison out.’”

Mute and malnourished, he would not allow family to take him to a psychiatrist—but he desperately needed help. The only option in the Muhammads’ Atlanta jurisdiction was a 911 call to report a psychiatric emergency, which tended to bring the police, multiple squad cars with lights flashing, and the ominous specter of armed agents encountering a young black man in a delusional state. So Sabah and her family would call the police, and pray.

The data justify their dread. Between 25 and 50 percent of all people killed annually by police are in the midst of a mental health crisis when they’re slain, according to a report by the Treatment Advocacy Center (TAC), a Virginia-based nonprofit dedicated to improving treatment for people with serious mental illnesses.

Satel goes on to discuss why there should be other models: why it would make sense to call emergency responders who are skilled at dealing with people who have mental health problems.

I agree. Implicit, though, in her article seems to be the idea that the emergency responder should be a government official. But why? Even economists with more trust in government than I have tend to think that governments should provide public goods. But when someone has mental health problems, treating that person is a private good. The treatment is rival in consumption (the resources to treat one person can’t be used to treat another person at the exact same time) and excludable (it’s easy to withhold the service from someone who doesn’t pay.

It’s true that such private provision does not seem to exist now. My guess is that that’s due in large part to the fact that we are so used to calling 911 in an emergency and to the fact that the government doesn’t charge for the service. But if people, as Satel writes, “dread” having the government come with guns, people might not think that service that they pay zero on the margin for is so great.

That’s where Arnold Kling’s line comes in. Private provision doesn’t exist; start providing privately.

 

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More men on the moon?

The federal government seems to have an almost inexhaustible willingness to waste money. At the same time we are experiencing a pandemic with a completely inadequate testing system, the government is contemplating spending many billions to send men back to the moon in 2024—55 years after the first moon landing. That would be about as exciting as flying a crude airplane a few hundred yards along a North Carolina beach in 1958.

Boeing Co.’s Space Launch System, the largest rocket in NASA’s history, will carry a price tag of at least $9.1 billion — or 30% more than the previous estimate for a key element in the agency’s plan to return to the moon.

Additionally, the costs for new ground infrastructure at Florida’s Kennedy Space Center to support the deep-space exploration program has jumped to $2.4 billion, Kathy Lueders, NASA’s associate administrator for human spaceflight, said in a blog post Wednesday. That’s also a 30% increase, the National Aeronautics and Space Administration said in an email Thursday.

America has a far more dysfunctional society than in 1969, so I predict more delays and cost overruns.

I’m actually a big fan of having a space program, just not a manned space program.  Manned space exploration is several orders of magnitude more expensive than unmanned probes, which means that spending money on manned space exploration is actually negative value added in terms of science.  Congress is willing to spend only so much on NASA, and if we do more manned exploration then there’s much less money for the truly exciting stuff, such as searching for life on Saturn’s moons with an unmanned probe.  (I’m not saying that all the money is being diverted from other space activities, but surely some of it is.)

There was a psychological benefit from the 1969 moon landing that went well beyond the scientific payoff.  I was only 13 at the time, but I still found the moon landing to be quite inspiring.  On the other hand, I can hardly think of anything less inspiring than a moon landing attempt in 2024, which would demonstrate that NASA has made almost zero progress on manned space exploration in 55 years.  Are there any other high tech industries where there has been virtually no progress in 55 years?

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Have a Non-Rivalrous and Non-Excludable 4th!

Sarah Skwire and Steve Horwitz

Here’s what we do every July 4th. First we grill some kind of meat, and then we eat pie. Then we sit on the back porch, and we wait for it to get dark. When we have decided that it’s dark enough, we gather up the kids, the bug spray, and a big beach blanket, and we drive a few subdivisions over to a spot just across from the summer home of the Indianapolis Symphony Orchestra. There, we join a small group of neighbors and plant ourselves outside the gates of the concert shell, where we can listen to Sousa marches and the 1812 Overture and wait for the fireworks to begin.

 

And some people say there’s no such thing as a true public good.

 

The classic economic definition of a public good is a good that is non-rivalrous and non-excludable. This means that no matter how many fireworks and Sousa marches we enjoy, our neighbors can still enjoy just as many along with us. And even though we didn’t buy the tickets the symphony would like us to buy, they can’t keep us from enjoying the show. Compare this to most goods. If I eat an apple it’s unavailable to anyone else, and apple sellers can ensure that people who want to eat apples have to pay for them. True public goods are rare, but fireworks are a great example. That’s why so many economists use them to teach the concept.

 

However, even fireworks have their limits as a public good, especially if we put stress on the word “good.” On July 4th, people want to see and hear fireworks and some are even willing to pay to do so. That they do so tells us that on July 4th, fireworks are an economic good. That’s not always the case. In Indiana, July 4th seems to extend from sometime in late June until sometime around mid-July. Fireworks are a constant sight, and especially sound, for weeks and weeks in the summer.

 

For many people, and even more dogs, this turns the public good of fireworks into a negative externality, or a kind of “public bad”. Kids are trying to sleep, adults want some peace and quiet, and dogs are just trying to stay sane. The same elements that make fireworks a public good on the 4th make them a real problem on other nights. The enjoyment of those who set them off does not make them invisible or inaudible to the rest of us. And no one can restrict the sights and sounds to those who are setting them off. The “publicness” of fireworks becomes a challenge when neighbors don’t want to experience them.

 

One of the central messages of economics is that actions and choices are always contextual. Fireworks serve nicely as an example of a public good, but only on the assumption that the context is one in which people wish to consume them. That won’t likely be true of fireworks every day of the year. 

 

The fireworks are quiet this year, and the symphony won’t be playing. As with a lot of public goods–like Joni Mitchell’s paved over paradise–we don’t know what we’ve got til it’s gone. This year, we’ll sit on the porch until it gets dark, and let the lightning bugs be our fireworks. But next year? We’ll be right back where we were, just outside the gates non-rivalrously enjoying our favorite public good. 

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