One of the principle ideological arguments against health reform is that government involvement in medicine is unwarranted. I wrote the following piece in 2007, and while it focuses more specifically on public health measures, I think that health care–delivered privately to the individual–is nonetheless a public good insofar as it has implications for the health of others, the productivity of businesses, and so forth. The essay references Malcolm Gladwell’s book The Tipping Point. If you are not familiar with it, you can read an informative Q&A with the author here.
In public health, the power of government to regulate individual behaviors must be carefully balanced against the ultimate goal of promoting the common good, namely the health and wellbeing of the population so governed. If government becomes too intrusive and overly restrictive of individuals’ freedom, critics assert that the system has become paternalistic. That is, government claims to know what is better for the individual than the individual him or herself, and passes laws with the intended effect of modifying individual behaviors, such that they align with this “right” view. Conversely, a government that refrains entirely from intervening, in the name of protecting the liberty of the individual, neglects the common good, and may actually permit harm to befall the population. Negotiating this balance remains a critical aspect of public health policy.
Where should the line be drawn that delineates an appropriate public health intervention from an inappropriate one? The amount of paternalism deemed acceptable varies contingent on the argument put forward. The most anti-paternalistic stance holds that government should only limit an individual’s actions if those actions have the potential to harm another. A more relaxed variation on this position allows for some paternalism if the benefits to society far outweigh the costs to the individual. An even more accepting view of paternalism considers any risk to the individual to pose a risk to another (i.e., society), and therefore has redefined the anti-paternalism stance to include a wide variety of government interventions to promote the common good.
Should government be permitted to pass laws requiring the wearing of seatbelts, the fluoridation of water, and the vaccination of school-aged children? Should government be permitted to pass laws that tax unhealthy foods to combat obesity, offer a tax credit to individuals who can document an annual screening for sexually transmitted diseases, or require private employers to provide a minimum level of insurance coverage to their employees? All of these laws would potentially serve the common good and improve the public’s health. The first set of laws, however, are more easily identified as providing great benefit to society while infringing little upon individual rights. By contrast, the second set of laws would likely provide great benefit to society, but at great costs to individual liberty.
Malcolm Gladwell’s best-selling book The Tipping Point seems to suggest, albeit indirectly, that the dividing line between the individual and society is nearly imperceptible. The small actions of a small group of people can set off a large-scale chain reaction. In fact, one individual’s actions can push a situation past the tipping point, as is suggested by the case of an individual with over 2,500 sex partners in a short period of time who is considered a major player in the widespread emergence of the HIV/AIDS epidemic. The Tipping Point makes clear that there is another kind of balance, not a balance between the individual’s freedom and society’s common good, but a balance that means the difference between a state of equilibrium and one of exponential growth. This balance does not exist solely in the biological world leading to epidemics, but exists in the socio-political world as well, and it can yield an abundance of good outcomes just as well as it can bad outcomes, depending on how it is controlled and applied or allowed to run free.
Accepting the logic of The Tipping Point, any public health intervention which will benefit society as a whole is worthy of implementation, regardless of the costs to any particular individual living within that society. Said another way, refraining from implementing an intervention for the sake of preserving an individual’s freedom may permit that individual to act as the tipping point in a chain of events that works against the common good.