Obesity, Wireheads, and the case for and Against Paternalism
Suppose we come up with really good pleasure drugs, drugs that give us lots of pleasure without negative side effects such as hangovers or cirhosis of the liver. If we accept the economist's model of the rational actor, their invention is clearly a good thing. It expands our choice set, provides us one more and possibly better way of getting what we want.
To people sceptical of the rational model, that conclusion is less clear. To see the problem, consider an extreme version. Larry Niven, in some of his stories, describes wireheads, people who have had a wire inserted into the pleasure center of their brain and stimulate it with a mild electric current. The intense pleasure that results dominates all other concern, making it possible for a wirehead to die of hunger and thirst because getting food or drink is simply more trouble than it is worth.
For a more homely example, consider a pleasure drug that many of us overdosed on a couple of days ago: Chocolate bars. If you have more elevated tastes, substitute dinner at a four star restaurant in Paris. While it is true that food is useful to keep us alive, sufficient food for that purpose--lentils, powdered milk, vitamin pills, rice or potatoes--does not cost very much or taste very good. Most of what we spend on food buys pleasure. In modern societies, calories, even moderately tasty calories, are cheap. People like to eat. Voila: An obesity "epidemic."
I would like to be thinner, but am not very good at getting that way. Considering the situation as an economist, I conclude that the benefit of lost weight must be less than the cost. Introspection provides a less complimentary picture of my role in the situation. It looks rather as though I am, like Niven's wireheads, irrationally willing to sacrifice my own long term welfare to my own short term pleasures.
For a different angle on the situation, consider a question I raised in another recent post: Does consumer sovereignty, the principle of accepting individual actions as proof of what we value, apply if we have good reason to regard the actions as due to evolutionary mistakes, adaptations to a past environment very different from the one we now live in? In most past environments, after all, eating when you had the chance, eating enough to get fat, was a sensible strategy, since next month might be famine. From an evolutionary standpoint, current obesity is simply one more case of humans being poorly adapted to their current environment.
Following out the logic of that argument, one would conclude that greater choice sometimes makes us worse off. If so, is that an adequate reason to abandon libertarian conclusions—to, for example, support government restrictions on fat in food, cheap junk food in restaurants and grocery stores, and the like. Is it a good argument, following out the line other economists have taken with regard to gasoline, to support high taxes on food, designed to force consumers to compensate for their irrational tastes?
If we had a government run by benevolent philosopher kings, that might make sense. The problem with it in the world we live in is that although I may sometimes be a bad judge of my own welfare, sometimes even a bad judge in predictable ways--arguably the central point of behavioral economics--I have one enormous advantage over any one else when it comes to making decisions about my own welfare. Unlike almost everyone else in the world, I can be trusted to put my own welfare very high in my priorities. Once we shift the decision to someone else, however rational, we can expect him to make decisions for me in his interest rather than mine.
Which brings us back to an old libertarian argument—for certifying doctors instead of licensing them. Patients, however rational, are imperfectly informed about the competence of doctors. Why not solve that problem by having some competent authority decide which physicians are allowed to practice? That is the theory of medical licensing as it now exists. The practice, as shown long ago, is that the medical profession uses licensing to hold down the number of physicians, sometimes in ways unrelated to their professional competence. That is why it would be better to allow the competent authority to certify doctors, telling patients whether that authority considers them competent, and then let the patients decide for themselves whether to accept the authority's judgement.
If you do not find that claim convincing, you might consider the wide range of other professions that also require licensing—yacht salesmen, egg graders, barbers and the like. It would be a curious coincidence if it turned out that medical licensing existed, and functioned, for wholly benevolent purposes—unlike every other example of professional licensing.