julian le grand #pp40 slides
TRANSCRIPT
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Government Paternalism: Nanny
State or Helpful Friend?
Julian Le Grand
London School of Economics
Policy and Politics 40th Anniversary Conference
Bristol, 18 September 2012
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Questions
• Should the state save people from themselves?
If so, how? Ban, regulate - or nudge?
• More specifically, if individuals engage in
behaviour that harms no-one but themselves
, does the state the right to intervene? If so, are
libertarian paternalistic policy interventions
appropriate?
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The problem of health damaging behaviour
• Smoking
– heart disease, cancer, cerebrovascular diseases
• Alcohol
– chronic liver disease and cirrhosis, nephritis and other kidney diseases, accidents, violence
• Obesity
– diabetes, heart disease
• Type of diet (excess fat, salt)
– heart disease, cancer, cerebrovascular diseases
• Illegal drugs
– accidents, suicide, pneumonia
Source: Oxford Textbook of Public Health, p.115
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Proportions(Premature Mortality)
Genetic
30%
Health care
10%
Determinants
of Health
Behaviour
40%
• Genetic predisposition
• Behavioral patterns
• Environmental exposures
• Social circumstances
• Health care
Social15%
Environment5%
Source: McGinnis JM, Russo PG, Knickman, JR. Health Affairs, April 2002.
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Paternalist policies (1)
Legal restrictions on risky behaviour
Policies that:
• ban smoking in public places
• requiring the wearing of motor cycle helmets
• requiring the wearing of seat belts
• regulate hours worked and other health and safety requirements at work
• restrict dangerous recreational activities
• prohibit the sale of various drugs
• incarcerate or ‘section’ the mentally ill
• set a maximum interest rate on loans
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Paternalist policies (2)
Legal restrictions on intentional behaviour
Policies that:
• make suicide or assisted suicide illegal
• make certain sexual acts between consenting
adults illegal
• invalidate certain contracts, including
voluntary self-enslavement, sale of body
parts, prostitution
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Paternalist policies (3)
Tax/subsidy of intentional behaviour
• ‘Sin’ taxes (tobacco, alcohol, gambling)
• Taxes on fat content of foods/subsidies to
healthy foods
• Pension subsidies
• Arts subsidies
• Public service broadcasting
• In kind rather than cash provision of welfare
(food stamps)
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Definitions
• Mill’s harm principle:
The only purpose for which power may be rightfully exercised over any member of a civilised community , against his will, is to prevent harm to others. His own good, either physical or moral, is not sufficient warrant.
• A paternalistic policy is one that interferes in a person’s freedom for their own good
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Gerald Dworkin Definition
[Paternalism is the] interference with a person’s liberty of action justified by reasons referring exclusively to the welfare, good, happiness, needs, interests or values of the person being coerced.
But:
• Mill: forcible restraint when no time to inform
• Subsidies
• Nudge
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Thaler and Sunstein
A policy is paternalistic if it tries to influence
choices in a way that will make choosers better
off, as judged by themselves.
But:
• Includes simple provision of information
• How do we find out what would make people
better off ‘as judged by themselves’?
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Le Grand and New
A state intervention is paternalistic with respect
to an individual if its rationale involves:
• addressing a failure of judgment by that
individual
• in order to further the individual’s own good.
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Possible Justifications for Paternalistic
Policies
• Hurts third parties (not really paternalism)
– Passive smoking
– Costs to state
• Autonomy failure.
• Ends failure.
• Reasoning failure.
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Autonomy Failure
• Children
• Mental handicap (learning difficulties)
• Mental illness
• Addiction
Not really paternalism
But how much autonomy failure justifies intervention?
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Ends Failure
State disapproves of the ends that individuals
themselves have voluntarily chosen.
Examples: Outlawing suicide, certain sexual
practices between consenting adults, religious
observances, wearing burkhas.
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Reasoning Failure
• Limited technical ability
– Failure to process information properly. Decision
overload: too many choices.
• Limited imagination/experience. Status quo
bias, endowment effect, myopia
• Limited willpower. Procrastination. Addiction.
Akrasia.
• Limited objectivity. Confirmatory bias
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‘There is no quality in human nature which
causes more fatal errors in our conduct than
that which leads us to prefer whatever is
present to the distant and remote’
David Hume, Treatise on Human Nature
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Justification
A paternalistic state intervention is justifiable if :
• There is a demonstrable failure of reasoning by the majority of individuals affected by the intervention, leading to a significant welfare loss for those individuals.
• The state can do better for those individuals
• There are relatively few individuals without reasoning failure and the loss in welfare to each of them from the intervention is relatively small.
• The impact on autonomy of the intervention on both groups is small.
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Types of Intervention
• Provision of information/education
• Regulation
• Subsidy
• Tax
• Libertarian paternalism (nudge)
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Libertarian paternalism
Basic idea:
• Private and public institutions might ‘nudge’ people in directions that will make their lives go better, without eliminating freedom of choice
• Framing. Different default positions. Opt in/opt out
Examples: pensions, organ donation
Source: C. Sunstein and R.Thaler ‘Libertarian paternalism is not an oxymoron’University of Chicago Law Review, 70, 1159-1202
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Permit to smoke
• Have to buy a permit every year. Have to supply
ID, fill out form and pay charge. Doctors’ signature?
Advantages
• Have to ‘opt in’ every year
• Stop people starting. More effective than price rises
Issues
• Enforcement
• Regressive? But marginal increases in tobacco tax
rate progressive.
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Other LP ideas
• Fat tax
• Exercise hour
• Salt packs in processed foods
• Separate alcohol outlets
• Marriage default
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And the feedback…
I think it's a great idea. I would love to do sports and get healthy, but I never have time, I'm stuck at my desk all day. An hour of sports a day? Count me in! Ali, London
These people are leftovers from the regimes of Mao, Stalin, Mussolini and Hitler. Is there any aspect of people's lives that they don't want control over? We should all be frightened, very frightened. R M, London, UK
Simply a wonderful, community focused, idea. We all must work together, but someone must lead us and this wonderful fellow is doing his part. Trunk, US
I think this is a fantastic idea. It is a real struggle to get to the gym when you are working early, and then late and through your lunch hour. If it was built into the working day it would ease stress, make workers happier and increase productivity. And great for mental health, as then as soon as you are home you are free to enjoy your evening. Rachel, London
It'll be just like communist China, that should please the government no end. Of course, there will be one key difference, unlike in China, you can be fairly certain that no senior management - definitely including cabinet ministers - would ever have to take part in something so demeaning. Long live the revolution, power to the people! Andrew, Cambridge
Source: This Is London Website (2007)