Who Owns You?

The issue comes down to whether the individual is viewed as a private person or as public property: the former has no obligation to the community to be or stay healthy; the latter does.

Virtually everything the Founding Fathers sought to achieve by separating church and state has been undone by the apostles of modern medicine, whose zeal for creating a therapeutic state has remained unopposed by politicians, priests, professionals, journalists, civil libertarians, and the public.

–Thomas Szasz

Many people have legitimate complaints against the Food and Drug Administration. For example, during its long history, the FDA has delayed the marketing of badly needed drugs and medical devices, leading to unnecessary pain and death. Excessive bureaucratic requirements for testing have made drugs more expensive than they would have been otherwise. And, as I’ve detailed elsewhere, its regulation of tobacco and nicotine interferes with people’s enjoyment of those products.

I want to suggest, however, such isolated complaints fail to go to the heart of the matter. The problem is not this or that regulation. Nor is the problem even the FDA itself. The root problem is the government’s claim to jurisdiction over so-called “public health.” In the United States, once Congress assumed this power and created myriad regulatory agencies to exercise it, the door was opened to the kinds of mischief that Thomas Szasz (1920-2012) placed under the label “the Therapeutic State.” All manner of interference with individual freedom can be and has been presented in the name of safeguarding public health. It’s a Pandora’s box.

The ultimate question is: who owns you? The answer will determine who is to be in charge of health.

The courts have routinely affirmed that the government has a “substantial interest” in the “health, safety, and welfare of its citizens.” In other words, citizens are public property. It’s time that this currently uncontroversial premise was questioned.

The modern state’s “substantial interest” in the physical and mental welfare of its citizens is an echo of the pre-liberal era, when the sovereign was seen in part as the father and custodian of the physical and spiritual welfare of his subjects. Paternalism served the interests of the sovereign, of course: he needed healthy taxpayers and soldiers. But the relationship was bigger than that.

The liberal revolutions of the 18th century did not fully push aside that model of governance, and many vestiges of the old regime have remained. Whatever the rationalization, whatever the ostensible basis of authority, the state was (and is) about taboos and social control. Of course, the form changed — church and state have been more or less separated — but in many ways the substance has been unchanged. The power of state-related clergymen was succeeded by the power of state-related medical men (including psychiatrists) and putative scientists. As the theological state receded, the therapeutic state advanced. Illness (including so-called mental illness) came to play the role in public policy that sin once played. Health stands in public life where salvation once stood. Treatment is the modern way of redemption. The burning of witches was succeeded by, for example, the confinement in madhouses of people who had committed no crimes. Electroshock and lobotomy replaced the rack and thumbscrew. The pattern repeated itself in the United States; state governments involved themselves in public health from an early date, followed by the federal government. Drug dealers and users became the modern scapegoats who had to be cast out (imprisoned) to protect the public’s health, although drugs entered people’s bodies by volitional acts. (On the resemblance between the theological and therapeutic states, see the works of Thomas Szasz, a psychiatrist who made a career demonstrating the unappreciated parallels. Links to many articles are here.)

In the modern age, Szasz wrote, “To resolve human problems [e.g., “bad habits”], all we need to do is define them as the symptoms of diseases and, presto, they become maladies remediable by medical measures” — more precisely, political-medical measures. Doctors, having been deputized by the state, wield power they could have not obtained otherwise. (The head of the FDA, Scott Gottlieb, is a physician.) Thus we have (to use another phrase from Szasz, “the medicalization of everyday life.” For example, any disapproved behavior that anyone engages in repeatedly is branded an “addiction,” which is in turn defined as a disease, as though calling behavior, which has reasons not causes, a disease were not a category mistake. Never mind that metaphorical, or mythical, diseases are not real diseases. (Are substances or people habit-forming?) To say that an ascribed disease is a myth is not to deny the behavior or even to deny that the behavior may a problem for either the actor or the people around him. As the philosopher Gilbert Ryle wrote, “A myth is, of course, not a fairy story. It is the presentation of facts belonging to one category in the idioms belonging to another. To explode a myth is accordingly not to deny the facts but to re-allocate them.”)

It is in this light that we should view the FDA and other government medical and scientific entities. They are part of a massive apparatus of social control, making their personnel agents of social control, not truth-seeking. Whether the FDA, for example, is a friend of industry or an adversary (at different times it’s been both), the public is ill-served precisely because the right of individual self-determination in a free market, including tort- and fraud-redress procedures, is undermined by prohibitions and restrictions. It is also ill-served by the monopolistic effects of centralized political authority over science and medicine. (On the FDA’s growth, see this.) Free competition is the universal solvent because facts emerge through rivalrous activity, both economic and intellectual.

Many people don’t see things that way, of course, and so government has increasingly controlled people’s choices with respect to health and science. On the basis of the fiction that the free market has failed in these realms — when has it actually been tried? — politicians, bureaucrats, and deputized practitioners have gained power. A gain in political power, Albert Jay Nock taught us, necessarily means a loss in “social power,” that is, self-control by individuals and their voluntary associations (including families). If self-control is denied in one area of life, we should not be surprised to see it fade from other areas of life. Today, the battle cry is “Medicare for all!” But if “the public” (the state) is to pay for everyone’s medical care collectively, won’t the public’s putative representatives want to impose restrictions on individuals’ risky behavior if for no other reason than to minimize the hit to the government’s budget? What then becomes of what’s left of individual freedom?

The coercion exercised by the government-medical complex is routinely defended as being for people’s own good: in this view, they are compelled to do only what they really wish to do but cannot because of addiction, mental illness, etc. To Szasz, this is “the authoritarian, religious-paternalistic outlook on life,” to which he responded: “I maintain that the only means we possess for ascertaining that a man wants to [for example] stop smoking more than he wants to enjoy smoking is by observing whether he stops or continues to smoke. Moreover, it is irresponsible for moral theorists to ignore that coercive sanctions aimed at protecting people from themselves are not only unenforceable but create black markets and horrifying legal abuse.”

Szasz added: “The issue comes down to whether the individual is viewed as a private person or as public property: the former has no obligation to the community to be or stay healthy; the latter does.”

We know how the “public health” lobby views the matter. When it panics over how much smokers “cost the economy” in lost productivity (through sick days and shorter lives), the lobby is proclaiming that Americans are indeed public property. How dare they enjoy themselves and risk their health at the expense of the economy, the people, the nation? (The Nazis and Bolsheviks followed this idea all the way.) In contrast, quaint classical liberals believe “the economy” — that is, the institutional framework for free exchange — exists to serve people. When the “public health” lobby advocates coercion for a person’s own good, in reality it does not speak of treatment and cure but of assault and battery — and perhaps torture. A medical relationship without consent is like a sexual relationship without consent. But few people understand that.

Perhaps sensing the flaw in the case for coercion based on preventing harm to self, much medical coercion is offered in the name of protecting others. There is a grain of truth here, of course. People can carry deadly communicable diseases. (Whether the state’s centralized bureaucracy is needed or competent to deal with this is another question.) But as the public-choice thinkers point out, state officials won’t be satisfied with such a narrow mission as protecting people from such diseases. Public-health jobs will tend to attract people dedicated to reforming other people’s “vices.” Inevitably, they will push the boundaries to acquire more power, money, staff, and prestige — all dedicated to breaking our “bad habits.” The alleged threat from second-hand smoke is in no way analogous to the immediate threat from a communicable disease. The former can easily be dealt with through contract and other voluntary arrangements but that doesn’t stop the public-health zealots from working to outlaw smoking in bars, restaurants, and even tobacco shops.

But what about the children? In a free society, families are responsible for raising children to be autonomous adults. Of course, this does not always happen, part of the reason being the government’s own obstacles, such as rotten schools for low-income kids. At any rate, history makes clear that government crusades, say to keep adolescents from doing “adult” things — such as drinking, smoking, and now vaping — only adds to their allure and has horrendous unintended consequences. Fruit is harder to resist when it is forbidden. Meanwhile, adults find themselves harassed — in the name of protecting the children — as they go about enjoying themselves.

Would life be perfect if “public health” were left to free and consenting adults in the free market? No, of course not. But a real-world free society should not be compared to an unreal and unrealizable utopia of all-wise, all-knowing, and all-good “public servants” who have only your health and welfare in mind. Rather, it should be compared to the real world of fallible, morally flawed, egotistical, self-serving, and centralized politicians and bureaucrats whose worldview is one where they give orders and you obey. Markets — which is to say, people in both profit-seeking and non-profit capacities — are capable of producing reliable consumer information and guidance, not to mention certifying the quality of products. They do it every day. Governments, after all, are comprised of nothing but human beings.

“Those who would give up essential liberty,” Benjamin Franklin might have said, “to purchase a little temporary health, deserve neither liberty nor health.”

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Technological Unemployment: A Self-Test

Normal people worry about technological unemployment.  Economists keep telling them to relax, but to little avail.  You can’t trust a coven of eggheads, can you?

Rather than rehash the textbook arguments, let me propose an easy way for the public to test its own understanding.

Step 1: Create a graph where the x-axis runs from 1948 to the present, and the y-axis shows the overall level of technology.

Step 2: Sketch whatever you personally believe about the evolution of the overall level of technology during this period.  Do NOT proceed to Step 3 until you have finished Step 2.

Step 3: Compare your graph to the actual history of U.S. unemployment from 1948-present.  I repeat: Do not peek until you’ve completed Step 2.

Step 4: If technology were an important cause of unemployment, the two graphs should look a lot alike: more tech, more unemployment.  (If you favor the more sophisticated theory that it’s tech growth, not tech level, that raises unemployment, eyeball that instead).

Step 5: So what do your own eyes tell you?

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We Wanted Tech

“We wanted workers, but we got people instead.”  This line from Max Frisch didn’t just give George Borjas the title of his most recent book.  At last Friday’s immigration conference in St. Cloud, Borjas declared it his all-time favorite immigration epiphany.  The point, he explained, is that immigrants aren’t just machines that produce stuff; they have broad social effects on our culture, politics, budget, and beyond.

Borjas is right, of course.  In fact, he doesn’t go far enough.  After all, even machines aren’t just machines that produce stuff.  They too have broad social effects on our culture, politics, budget, and beyond.  If you look closely at any major technological development, you can justly say, “We wanted tech, but we changed society instead.”

Consider cellphones.  When they were first introduced, you might picture them as more convenient phonebooths.  But they’ve revolutionized not only our society, but our psychology.  Many human beings now interact with their phones more than they interact with fellow human beings; go to any public place and you will see this to be true.  Even when we are talking to fellow human beings, cellphones have changed the tone and tenor of our conversations.  When I casually chat with my friends, for example, we often fact check each others’ assertions.  And cellphones are crucial for social media, which has dramatically swayed not only public discourse, but elections and policy.  Without Twitter, would Donald Trump’s candidacy even have been able to get off the ground?

When driverless cars come, they’ll disrupt our whole society again.  Commuting time will plausibly skyrocket, especially in high-rent areas.  If you can relax – or even sleep – in your car, why pay $1M for a tiny apartment downtown?  Indeed, once you get rid of the driver’s seat, we’ll probably turn cars into small motorhomes, so “living out of your car” could become an alternative lifestyle rather than a tale of woe.  And what will happen to all the truck drivers, taxi drivers, Uber drivers, and delivery drivers?

Still not convinced?  I trust you’ll admit that nuclear technology did more to the world than slash electric bills.

Verily, we wanted tech, but we changed society instead.

How should you react to this truism?  You could say, “Duh, everybody knows this already.”  That’s my knee-jerk reaction to Frisch’s quote, too.  But both “duhs” are too dismissive.  “Obvious once you think about it”≠”Obvious.”

What else is there to say?

1. You could retreat to agnosticism.  “Well, there are direct economic benefits, plus an array of intangible social effects.  We don’t know how to measure these intangibles; we don’t even know if they’re good or bad.”  This is basically what Borjas said about immigration in his Friday talk.  There’s no reason we couldn’t generalize it.

Reaction: Philosophically, agnosticism of any kind is incoherent sophistry.  We always have some information.  We can and should combine this information with common sense to form reasonable guesses about whatever question is on our minds.  Crucially, “information” includes psychological evidence about the errors to which the human mind is prone.  And one of the best ways to keep your guesses reasonable is openness to bets.

2. You could start by measuring the direct benefits, then see if any of the broader social negatives are plausibly in the same ballpark.  If not, the standard conclusion still goes through despite the complexity of the world.

Reaction: Once you factor in the value of time, this is typically the best approach for laymen.  It’s a quick way to resolve a wide range of policy disputes, especially if you embrace some version of weak deontology rather than consequentialism.

3. You could try a lot harder to study the measurement of so-called “intangibles.”  This might require a massive research program to fill in the enormous gaps in our knowledge.  Or perhaps if you play around on Google Scholar, you’ll discover that many researchers have already measured the stuff you imagine “no one knows.”

Reaction: This is the best approach for experts.  If you do good work and/or publicize it, you also help laymen reach the truth with modest mental effort.  So earn your paycheck!

Whatever you conclude, know that immigration is nothing special.  Everything has broader social effects.  These complexities are no reason to defer to popular prejudice, which is what I suspect Borjas hopes we’ll do.  Instead, these complexities are a reason to think broader and work harder to get the best answers we can.

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A One-Page Hop from Bleeding Heart to Mailed Fist

Sometimes the hop from bleeding heart to mailed fist is only one page wide.  From Oscar Lewis, Ruth Lewis, and Susan Rigdon’s ethnography Four Men: Living the Revolution: An Oral History of Contemporary Cuba.

p.105:

Illiteracy is at the bottom of juvenile delinquency because illiterate parents don’t understand the development of the Cuban Revolution.  I’ve always been an enemy of slavery and illiteracy… My dearest wish is that every person, not only in Cuba but in the whole world, should know how to write his own name.

p.106:

Drastic measures are needed to fight delinquency.  First, I’d give a juvenile delinquent good advice.  Second, if that didn’t help, I’d suggest going to the work farms, along with study.  That way I’d gradually try to perfect the individual’s feelings and conscience.  And finally, if the first two measures brought no improvement, I’d send him before the firing squad.  Or maybe I’d advise Fidel to have an incinerator dug about 40 or 50 meters deep, and every time one of those obstinate cases came up, to drop the culprit in the incinerator, douse him with gasoline, and set him on fire.  The incorrigible delinquent is a blot that can’t be washed out.  If he’s allowed to go on living in our society, his influence will carry into the future.  So it’s best to make an example of him for future generations.

(interview with Lazaro Benedi Rodriguez, 70-year-old Defense Committee President for his housing project)

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Why I’m Optimistic About Venezuela

If there were mass protests against the government of Saudi Arabia, and the U.S. decided to recognize the opposition as the legitimate government of Saudi, I would expect disaster.  Why?  Because…

1. Supporters of the Saudi monarchy remain powerful and confident enough to aggressively fight back, plunging the country into hellish civil war.

2. If the monarchy loses, it’s most likely replacement will be a revolutionary Islamist dictatorship.

3. Even if the new Saudi government sticks to democracy, the median Saudi voter probably favors even worse policies than the Saudi monarchy now imposes.  In particular, government enforcement of Islamic fundamentalism would tighten, and economic policies would move even further toward socialism and populism.

And now you know why I am optimistic about the constitutional crisis in Venezuela.

1. Supporters of Maduro are too weak and demoralized to aggressively fight back, so I put the risk of hellish civil war below 10%.  (Indeed, since there’s a high base rate for civil wars in situations this dire, it’s quite possible that the risk of civil war has actually fallen due to the crisis).

2. If the Maduro regime loses, its most likely replacement will be a moderate pro-Western democracy.

3. If the new Venezuelan government sticks to democracy, the median Venezuelan almost certainly favors better policies than Maduro now imposes.  In particular, government enforcement of socialist ideology will crumble, and economic policies will move sharply away from socialism and populism.

If you’re too young to remember the collapse of Communism, this is a tiny taste of the sweetness of 1988-1991.  When’s the last time you had reasonable hope of dramatic peaceful pro-freedom change in the world?

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Are Your Dreams Keeping up with You?

Whenever you follow a dream, it leads to new observations, discoveries, and relationships.

These experiences will modify your sense of what is possible and what is preferable.

To chase after a dream is to undertake a surprising and challenging process of personal transformation.

It’s impossible to act on your dreams while remaining identical to the person you were when you took the first step.

For this reason, dreams need to be upgraded in order to account for the evolution we undergo when dreams are pursued.

Who we are is always changing. Why should our dreams remain the same?

Follow your dreams, but don’t forget to let your dreams follow you.

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