Friday, January 9, 2009

Rhoads: On Preventative Medicine

Jared Rhoads, director of the Lucidus Project, has written another OpEd on the government's flawed push to promote preventative medicine. It is reposted here with his kind permission:
On preventive medicine
by Jared M. Rhoads (December 16, 2008)

With expectations for major healthcare reform on the rise, members of Congress are pushing for comprehensive measures for increasing the use and funding of preventive medicine. Senators Tom Harkin (D-Iowa) and Chris Dodd (D-Conn), for example, want to put more prevention programs in place because prevention is "smart economics in addition to good public policy."[1]

Actually, this type of prevention has nothing to do with economics, and it has no place in any proper discussion of public policy.

Practicing good prevention is a thoroughly personal responsibility. Signing up for a mammogram, having a colonoscopy, or keeping on schedule with dental exams are all part of what it means to be a rational, self-interested adult. The same is true of exercising, eating well, managing stress, and countless other measures. Sure, scientific differences of opinion exist over which of these is most important and why. But is this simple advice really so abstruse as to require government officials to instruct us how to manage our own bodies?

Whether in the domain of health, lawn care, or backgammon, the fact that such-and-such an action is "smart" is not a sufficient reason for it to be required, subsidized, paid for in full, or in any other way made the business of the government. Dodd's claim that preventive medicine is good economics and good policy makes, at best, a pseudo-logical connection. If it is proper for government to oversee and involve itself in the care of each man's health, then it is smart to economize over the long term with preventive programs today. The form of this argument holds, but where on earth did he get his premise from?

What Dodd and his colleagues fail to grasp is that government is not a plaything for do-gooders to improve society in whatever ways they believe is good -- regardless of whether such interventions make economic sense. We all know what Dodd means: an ounce of prevention is worth a pound of cure. But while that maxim is wise in the realm of personal conduct, it is irrelevant to public policy.

Why? Because the sole purpose of government is to protect individual rights. Whose rights are being violated if John Q. Smith does not get, does not want, or cannot afford, a prostate cancer screening? The answer is that nobody's rights are being violated -- not Smith's rights, not his neighbor's, and not anyone else's -- so no government-backed remedy is in order. There is, however, a violation of rights if citizens are taxed to pay for each other's services; or if certain preventive measures are made compulsory (or "highly incentivized"); or if insurance premiums are manipulated through selective tax incentives; or if further licensing requirements are introduced to mandate the teaching of preventive medicine in medical schools. Each of these is a distinct possibility given the proposals currently being discussed.

Legislators may have the power, but they do not have the right, to intervene with healthcare or any other industry. Nothing they can do can make such involvement right. Put another way, legislators do not tell us what rights we have; rights tell us what legislators can (and cannot) do.

If preventive healthcare is as economically advantageous as proponents claim, then let people form free associations with like-minded individuals and purchase -- or forgo -- healthcare services as they choose. No programs, no personal fitness czar, no "public-private partnerships", no "Universal HealthMart." Just individuals living as they see fit, and managing the natural risks and rewards of their own behavior. Now that would be smart public policy.


[1] Adofo, A. Congressional Quarterly Healthbeat, December 10 2008