“You invent for public health a role and a power that it’s never historically had and never ought to have. That’s social engineering. Eliminating choice and coercing behavior is not the American way.”
Now, we could discuss long and hard the just how un-American it is to eliminate choice or coerce behavior. However, I was most struck by her suggestion that this is “a role and a power that [public health] has never historically had.”
First and foremost, how food is cooked in restaurants has long been a public health issue. Inspecting restaurants and overseeing the safe handling of ingredients is nothing new to public health. Neither is deciding that some ingredients simply aren’t safe. That’s why classic absinthe, made with wormwood, is illegal. It’s why cattle “found down,” collapsed alone in the pasture, no longer make it into butcher counters in the United States.
Secondly, there’s hardly any question that trans-fats are as harmful for us as are saturated fats. Adding hydrogen (“hydrogenating”) oils to make them solid and stable at room temperature makes for great ease of use. It also makes for great biscuits and pie crusts (there is no substitute in the Southern kitchen for Crisco!) It just happens to make for blocked arteries for young and old alike.
So, we have a known disease (coronary artery disease) and a significant contributor (trans-fatty acids). How is this not a public health issue? How is this significantly different that cleaning up standing water to reduce mosquitoes?
I have a more basic disagreement with Ms. Silk. She speaks as if these were necessarily matters of private choice, and not of public health. However, private choice or no, all our health is “public.” That’s true because very few of us pay the full cost of our own health care. Most of us have our health care supported by one third party payer or another, whether insurance from government (Medicare, Medicaid, TriCare) or from a private commercial insurer. Yes, we make contributions toward that in the form of co-pays and premiums and salary deductions; but put one of us in the hospital and all of that is covered and exceeded in a matter of hours. We participate in risk pools of various sizes, and so may be able somewhat to adjust our contributions; but few of us pay all of the expenses ourselves.
Indeed, even those who try that, who choose not to participate in insurance plans, end up dragging us into participation. Cost-shifting by providers and insurance requirements by government bodies (for example, to drive a car) are different ways of including the rest of us in the risk pool, and in paying the costs. And that doesn’t even get into support for public educational institutions for physicians, nurses, and other health care professionals – all supported by tax dollars.
That, you know, is the most ironic thing about opposing a single-payer national health plan. We’re already sharing those costs, whether through higher premiums or higher bills due to cost shifting or higher taxes to cover the gaps for a few. A national health insurance plan would spread the risk over the greatest possible number of people, and so offer each of us the lowest relative risk; and at the same time would offer the possibility of efficiencies of scale and of uniformity of forms and charges (check it out: Medicare actually has some of the lowest administrative expenses out there, far lower than most commercial insurers).
In any case, we’re all participating already in health care that is publicly supported, whether we’re honest about it or not. If reducing your trans-fats in restaurants reduces your risk of heart disease, and so your medical expenses, it also reduces my expenses (much less my risk of heart disease). Is that coercive? Perhaps a little. On the other hand, we have an alternative: expect those who choose not to make these decisions and not to carry insurance to actually pay the expenses of their actions. I live in a state that requires motorcyclists to wear helmets, but work in a state that does not. I’ve heard the suggestion that we allow motorcyclists to ride without; and if they crack their heads open, to let them do without – without, that is, expecting the public or an insurer to pick up their Emergency Room bills.
All our health is “public:” publicly supported and publicly funded. So, maybe restricting trans-fats in restaurants isn’t coercive behavior after all. Perhaps it’s as American as a barn-raising or a neighborhood watch. Perhaps it’s just a decision based on a realization of common interest.