Porque é que a saúde é uma prioridade tão baixa?

September 23, 2009—Something only rarely addressed during the acrimonious debate on health care is why we take such poor care of our health. Many of us in the developed world eat too much, smoke too much, or drink too much. Combine that with a tendency to sleep and exercise too little, and you have a partial explanation of rising health care costs.

Certainly, some health care costs are unpredictable. Even taking reasonable precautions, nobody knows for sure if or when he might develop a life-threatening cancer, contract a serious communicable illness, or get sideswiped by a reckless driver at an intersection. That’s why it makes sense to have basic health insurance coverage. On the other hand, diet, drugs, sleep, and exercise are within our control, and they can have a major impact on our health—and hence, on our need for health care. But if making better lifestyle choices could make us both healthier and wealthier, why do so many of us make bad choices?

SHORT-TERM GAIN, LONG-TERM PAIN

The main reason taking care of one’s health is difficult is that the benefits of doing so mostly accrue in the future, while the costs are borne in the present. My current health-related challenge is flossing. I brush regularly, and so I haven’t had a cavity in years, and quite possibly never will again. My dentist tells me, though, that if I don’t start flossing more often, I’m asking for trouble. Now, flossing is mildly annoying and takes several whole minutes a day. Who has that kind of time? In the morning, I may be itching to get to work, while at night, I may be tired and eager to crawl into bed. Crucially, the costs of not flossing—the pain, inconvenience, and expense of gum disease—are probably several years in the future.

There are some rational grounds for discounting future happiness to a certain degree on account of uncertainty. I am alive now, but there is a chance that I will not be alive later, so valuing present rewards more highly than future rewards makes some logical sense. This is why borrowers pay interest for the privilege of spending money today that they will only earn tomorrow, and conversely, why lenders are paid to delay their gratification. But interest rates would be a lot lower on average if they only reflected uncertainty about the future. Many of us are also just impatient. We want it all, and we want it now. This is what economists call “high time preference,” which is to say, valuing the present much more highly than the future. It is a recipe for financial ruin—and poor lifestyle choices.

Taking responsibility “is not an onerous burden but a source of joy and personal power.”

Actually, the notion of high time preference does not even capture the full scope of the problem, according to philosopher Joseph Heath. In his recent book, Filthy Lucre: Economics for People Who Hate Capitalism (which I reviewed here ), Heath summarizes research showing that many people engage in something called “hyperbolic discounting.” This means that people are not only short-sighted; they are inconsistent over time. For example, when offered $100 now or $200 in three years, many people choose $100 now. But when offered $100 in six years or $200 in nine years—a dilemma that should be equivalent—many of those same people choose the $200. Yet once those six years are up, they will wish they had opted for the $100! As Heath points out, this more complex account captures fairly well the concept of weakness of will. “When the time to act is far away, we resolve to choose the greater good, but as the moment of decision approaches we give in to temptation and choose the lesser, more immediate good.”

SOMETHING MUST BE DONE

If we are not acting in our own best long-term interest, even as we ourselves conceive of it, perhaps we need to be saved from ourselves. To take just one example among many, a proposal is currently making waves in several cities to tax sugary drinks . The consumption of sweetened beverages has undoubtedly contributed to recent increases in obesity rates. Some people—perhaps many people—would surely like to consume less soda pop than they do. But is it the proper role of governments to step in and encourage us to choose the greater good of long-term health?

There are several good arguments against these kinds of sin taxes. For one thing, they are blunt instruments. They punish the slim and trim consumers of sugary beverages along with the overweight and obese ones. They also legislate where the proper tradeoff between present pleasure and future risk should be. But it is an essential feature of a free society that individuals be allowed to determine their own tradeoffs. Some object that the obese impose costs on others through socialized medical coverage, and so the issue is not purely a personal one. This is one more excellent argument against socialized medicine. A free market in insurance would return those costs to the individual, where they belong, in the form of higher insurance premiums—a much fairer, more properly targeted incentive to good health.

Taxes on sugary drinks punish the slim and trim consumers of sugary beverages along with the overweight and obese ones.

For those whose wills are so weak that higher premiums are not enough, other voluntary measures are available in the form of contracts. What is a contract, after all, if not a way of delimiting one’s future actions? A person who wants to lose weight, quit smoking, or start flossing has any number of options, from friendly bets or pacts to actual written contracts on the marketplace. By voluntarily committing to paying the costs of breaking a contract, one can rebalance the tradeoff between present gain and future pain to bring it in line with one’s actual, considered assessment on one’s greater good. We can short-circuit any tendencies for hyperbolic discounting, and we can do so without imposing restrictions on anyone else.

AN OUNCE OF PREVENTION

Part of the reason we in the West neglect our health is simply that we can. Our wealth has allowed us the luxury of temporarily ignoring common sense. Why did I eat that mountain of food? Because it was there. Now, eating too much is better than eating too little, within reason. But sky high obesity rates suggest that many of us abandoned reason long ago. We eat too much, and our diets contain too much fat, salt, and sugar. Increasingly, it seems, we sacrifice the future for the pleasures of the moment.

Still, wealth is not the only reason we indulge. The rise of welfare statism has also eroded the connection between one’s actions and their consequences. When someone else is footing the bill, why count the cost? Welfare statism also has a built-in reinforcement mechanism, as increasingly dependent and irresponsible people clamor for ever greater handouts and legs up.

But we can swim against the current. We have free will, weakened though it might be through years of disuse. And we have one secret weapon on our side, one benefit of living responsibly that is experienced, not in the distant future, but in the immediate present: the satisfaction of acting like an adult. Taking responsibility, as psychotherapist and author Dr. Nathaniel Branden has pointed out in his book by that title, “is not an onerous burden but a source of joy and personal power.” When I follow through and do what I say I am going to do—floss, exercise, write—I feel a certain sense of pride. Taking responsibility for my present and future happiness might not provide as dramatic a rush as a sugary beverage, but in the end, it’s a lot more nourishing for both body and mind.

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