The regular calls for a fat tax — whether on the ‘wrong’ foods or on fat people themselves — are symptomatic of two regressive trends in society. The first is the view that experts know best, that these latter-day sages can come to an impartial view based on The Science, then guide government about the appropriate policy action. The new, evidence-based policy usually involves some kind of manipulation of our individual behaviour from gentle ‘nudges’ and increasing taxes through to criminalisation, as in the case of the smoking ban.

But this is not evidence-based policy, but policy-based evidence, with preconceived ideas being pushed through in the name of science at a time when those at the top of society have lost the ability to convince the electorate on the basis of a moral or political argument. This style of policymaking rarely solves social problems, but it does distort both politics and science.

The second worrying trend is the sheer intolerance towards obese people. Being very overweight has always attracted a certain amount of moral opprobrium. But Hatton’s outlook reflects a sea-change. Once, the NHS reflected a progressive outlook that disease was a misfortune that could strike any of us at any time and that the best thing to do was to share that burden across society. Now it’s every man and woman for themselves. In the worldview of Hatton and Coren, some morally weak individuals are costing them money and must be punished.

Ironically, this flows from a left-wing view of disease as having social causes. In the late Seventies, left-wingers correctly saw that some ill-health was the result of poverty, poor housing, polluted air, and so on rather than infection or bad luck. Unfortunately, this has morphed into the idea that disease is caused by individual behaviour — and so health professionals have taken to camping out in our private lives, demanding we stop smoking, drinking and eating the wrong things. Every naughty little pleasure must now be sacrificed to the god of longevity. If we don’t play ball, this intolerance suggests we should lose our right to treatment.

The disease of intolerance is likely to have a far more detrimental effect on society than obesity ever could.

Thus, when government dictates what you may or may not eat — takes away your choice — it is restricting your heritage, your religious and political choices, the control over your own body; telling you that a choice every bit as personal as freedom of speech or the art you view is not yours to make. It is making a fundamental decision for you, and they try to make it better by telling you it’s for your own good.

Imagine if the government had literary experts that decided that certain books weren’t good for you. They didn’t make you smarter or teach you anything. They weren’t classic pieces of literature. And even though you were happy to buy your books with your own money and read them privately, the state still decided it didn’t want you to have access to them. People would be outraged. Why is it any different when the government is counting calories instead of artistic merit?

The typical counter-argument is to say that since society pays for our health care, we owe it to society to lead healthy lives. In short, your neighbour has a vested financial interest in what goes into your body. If you won’t take care of it, the government will make you.

This line of reasoning — rather than justifying a Nanny State or a nosy neighbor dictating your personal choices — constitutes a powerful argument against socialized medicine, but it doesn’t do much to say that the government should control what you eat. If socialized medicine had been advertised decades ago as a government mandate to control the minutia of your daily life, then it would probably have never been implemented.

All of us should of course take care of ourselves, but for our own sake. We are the architects of our own lives and that includes our health. It is not the place of the state to try and control what we can eat because some people make bad decisions. Though it seems trivial to many, it’s an important point to make. Food is part of who we are and how we related to the world. We need to kick the government out of our kitchens.

Consider the example more closely. Cutting $10 in spending for every $1 in tax increases would result in $9 in net tax reduction. That’s because lower spending today means lower taxes tomorrow, and limiting the future path of government spending does limit future taxes, as Milton Friedman, the late Nobel laureate and conservative icon, so clearly explained. Promising never to raise taxes, without reaching a deal on spending, really means a high and rising commitment to future taxes.

Furthermore, this refusal to contemplate a tax increase — which I’d characterize as an extreme Republican stance — has brought what seems to be an extreme Democratic response: President Obama’s latest budget plan is moving away from entitlement reform and embracing multiple tax increases on the wealthy. We may be left with no good fiscal options.

The problems with a no-new-taxes stance run deeper. Because it’s unlikely that spending cuts alone can balance the budget, politicians who espouse extreme antitax views often end up denying the scope of our long-run fiscal problems.

[. . .]

The more cynical interpretation of the Republican candidates’ stance on taxes is that they are signaling loyalty to a cause, or simply marketing themselves to voters, rather than acting in good faith. It could be that candidates are more worried about having to publicly endorse tax increases than they are about the tax increases themselves. If that’s true, it is all the more reason to watch out for our pocketbooks; it means that the candidates are protecting themselves rather than the taxpayers.

The final lesson is this: Many professed fiscal conservatives still find it necessary to pander to voter illusions that only a modicum of fiscal adjustment is needed. That’s an indication of how far we are from true fiscal conservatism, but also a sign of how much it is needed.

Excessively well-sourced Obama boosters are now channeling, not just White House spin but White House self-pity. Both Ezra Klein and Jonathan Alter wonder aloud why our intelligent, conscientious, well-meaning, data-driven President is taking a “pummeling.” ”What could Obama have done?” (Klein) “What, specifically, has he done wrong .. .?” (Alter)

They’re kidding, right? There are plenty of things Obama could have done differently. Most of these mistakes were called out at the time. Here, off the top of my head, are ten things Obama could have done:

[. . .]

3. Made the UAW take a pay cut. Whoever else is to blame, the UAW’s demands for pay and work rules clearly contributed to the need for a taxpayer-subsidized auto bailout. To make sure that future unions were deterred from driving their industries into bankruptcy, Obama demanded cuts in basic pay of … exactly zero. UAW workers gave up their Easter holiday but didn’t suffer any reduction in their $28/hour base wage. Wouldn’t a lot of taxpayers like $28 hour jobs? Even $24 an hour jobs?

[. . .]

5. Not pursued a zombie agenda of “card check” and “comprehensive immigration reform”–two misguided pieces of legislation that Obama must have known had no chance of passage but that he had to pretend to care about to keep key Democratic constituencies on board. What was the harm? The harm was that these issues a) sucked up space in the liberal media, b) made Obama look feckless at best, delusional at worst, when they went nowhere; c) made him look even weaker because it was clear he was willing to suffer consequence (b) in order to keep big Democratic constituencies (labor, Latinos) on board.

6. Dispelled legitimate fears of “corporatism” — that is, fears that he was creating a more Putin-style economy in which big businesses depend on the government for favors (and are granted semi-permanent status if they go along with the program). I don’t think Obama is a corporatist, but he hasn’t done a lot to puncture the accusations. What did electric carmaker Tesla have to promise to get its Dept. of Energy subsidies? Why raid GOP-donor Gibson’s guitars and not Martin guitars? We don’t know. At this point, you have to think the president kind of likes the ambiguity–the vague, implicit macho threat that if you want to play ball in this economy, you’re better off on Team Obama. That’s a good way to guarantee Team Obama will be gone in 2013.

Oh, and for a bonus bit of unwelcome news for President Obama, his uncle has just been arrested for drunk driving. His illegal alien uncle, who now faces deportation.

The good news is that the idea of serious spending restraint has more support than ever before. The bad news is that getting people to support the concept is easy. The hard part is getting beyond the concept, and there is no sign so far of doing that.

Several Republican presidential candidates, including Michele Bachmann, Ron Paul, and Rick Santorum, have taken what sounds like an uncompromising stand. They’ve signed on to a plan sponsored by a group called Strong America Now to eliminate the federal deficit by 2017 without tax increases.

But the plan is not a plan. It’s a fantasy. As Strong America Now’s website explains, it is supposed to “detect and eliminate 25 percent of spending per year across the federal government.” Per year. Seriously.

Not only that, but those cuts are supposed to excise nothing but vast quantities of waste — rather than programs that actual people care about. And my impression is that we’ll pay for it all by raffling off unicorn rides and following leprechauns to find pots of gold.

[. . .]

Social Security, Medicare, and Medicaid soak up some 40 percent of the budget, and their share will expand as baby boomers sidle off into retirement. But in an April Economist/YouGov survey, only 7 percent of Americans — including just 9 percent of Republicans — favored lower funding for Social Security. Medicare? Also 7 percent, with 11 percent of Republicans agreeing.

Even the rise of the Tea Party and the fight over the debt ceiling have not caused people to come to grips with fiscal reality. An August Economist/YouGov poll found that 56 percent of Americans said we can bring spending under control without reductions in Social Security and Medicare. Only 24 percent admit what every fiscal expert knows.

“There’s no doubt in my mind that people are trying to get around (the law)…. I think it’s really important that we all protect our universal health-care system,” the Health Minister said in an interview. “It’s just important that we are ever-vigilant.”

Critics, however, call the initiative a politically motivated waste of money that could be better spent on improving actual medical services. In the lead-up to this fall’s provincial election, the Liberal government seems anxious to portray itself as a steadfast defender of public health care.

“How is this going to improve patient care for anybody?” Brett Skinner, president and health-care analyst at the conservative Fraser Institute think-tank, asked about the snitch line. “It’s not helping patients get better access. In fact, it’s designed to prevent patients from getting better access.”

The Canada Health Act generally forbids health-care providers from charging patients directly for services that are covered under medicare. Various private health services have cropped up in Quebec, B.C. and Alberta in recent years, however, with little interference by the federal government.

The Ontario Liberals, on the other hand, have presented themselves as strenuous foes of private health care.

Many Democrats demand no changes to Social Security and Medicare spending. But these programs are projected to run ever-growing deficits totaling tens of trillions of dollars in coming decades, primarily from rising real benefits per beneficiary. To cover these projected deficits would require continually higher income and payroll taxes for Social Security and Medicare on all taxpayers that would drive the combined marginal tax rate on labor income to more than 70% by 2035 and 80% by 2050. And that’s before accounting for the Laffer effect, likely future interest costs, state deficits and the rising ratio of voters receiving government payments to those paying income taxes.

It would be a huge mistake to imagine that the cumulative, cascading burden of many tax rates on the same income will leave the middle class untouched. Take a teacher in California earning $60,000. A current federal rate of 25%, a 9.5% California rate, and 15.3% payroll tax yield a combined income tax rate of 45%. The income tax increases to cover the CBO’s projected federal deficit in 2016 raises that to 52%. Covering future Social Security and Medicare deficits brings the combined marginal tax rate on that middle-income taxpayer to an astounding 71%. That teacher working a summer job would keep just 29% of her wages. At the margin, virtually everyone would be working primarily for the government, reduced to a minority partner in their own labor.

Nobody — rich, middle-income or poor — can afford to have the economy so burdened. Higher tax rates are the major reason why European per-capita income, according to the Organization for Economic Cooperation and Development, is about 30% lower than in the United States — a permanent difference many times the temporary decline in the recent recession and anemic recovery.

While policy makers may shrug off the impact of higher tax rates, it has a significant effect on individual choices when it comes to part-time jobs, overtime, and even raises. Even if in reality working a few hours of overtime won’t make a difference, psychologically, the higher tax burden can act as a deterrent: “why put in the effort if the government gets more out of my effort than I do?”

The UK National Health Service is like a relative: we are allowed to slag off this national treasure, but woe betide anyone else who tries it. I have no idea if the health secretary, Andrew Lansley, really wants to improve the institution or dismantle it and sell it off to the highest bidder, but whatever his motives, anyone who uses the system knows it needs surgery; no amount of knee-jerk op-eds will change that salutary fact.

In this unhealthy climate I feel obliged to state that I believe in the NHS; many medics do a fine job and healthcare should be free at the point of need. Yet having witnessed the care provided to my grandmother, 89, following a diagnosis of lung cancer, I believe that unless the NHS is willing to admit and tackle its flaws, it will have to shoulder some of the blame if the private sector convinces politicians it can run things better.

[. . .]

After collecting my father from the lobby, we went back to the ICU. A bossy woman at the nurse’s dock insisted she wasn’t on that ward; I had to point nan out, in one of the few occupied beds behind her. The woman compounded her mistake by acting as if we were in the wrong. Many users of the NHS will be familiar with this attitude: that ill people and their relatives are simply a nuisance preventing the otherwise smooth running of the system.

[. . .]

The doctors organisation, the British Medical Association (BMA), reacting with customary promptness, has called Lansley’s reforms ‘mad’. They may be right, but the BMA, like the politicians, has a vested interest in how the NHS is run. As can be witnessed by its endless lectures on the evils of alcohol, the BMA appears to be in the fortunate position of being able to get any message, no matter how authoritarian, to the media, who then obligingly splash it across every front page and news bulletin. Perhaps we haven’t really changed that much from the days of my grandparents, who always believed that doctor knew best.

So here’s an idea: why not reform Medicare by means testing it? Conservatives should love this idea.

Here’s how it works. Basically, we leave Medicare alone. Oh, we can still go ahead with some of the obvious reforms. Comparative effectiveness research is a no-brainer for anyone who’s not part of the Republican leadership. Ditto for some of the delivery reforms on the table. Or allowing Medicare to negotiate for lower prices. It would be great if that stuff works. But if it doesn’t, then people will need to pay more for their care. So why not have dead people pay? They don’t need the money any more, after all.

So Medicare stays roughly the same, but every time you receive medical care you also get a bill. You don’t have to pay it, though. It’s just there for accounting purposes. When you die, the bill gets paid out of your estate. If your estate is small or nonexistent, you’ve gotten lots of free medical care. If it’s large, you’ll pay for it all. If you’re somewhere in between, you’ll end up paying for part of the care you’ve received.

Obviously this gives people incentives to spend all their money before they die. That’s fine. I suspect they wouldn’t end up spending as much as you’d think. What it does mean, though, is that Medicare has first claim on their estate, not their kids. But that seems fair, doesn’t it?

It has the virtue of acknowledging that free healthcare isn’t actually “free” at all.

Greg Mankiw links to a WSJ piece about our negative bequest to our children. It’s a point I’ve made many times myself (and am sometimes accused of bashing the elderly because of this). A good quote from the WSJ piece:

     [R]egardless of how much they have contributed, the hard reality is that the federal government has already spent it. No matter how deserving they are, it is younger generations of workers who have to come up with the money.

It is morally wrong to force young people to make good on false promises made before they were even born. It is an outrage, a scandal, a shame on our society. A society that invests in the old at the expense of (actually, to the large detriment of) the young cannot survive. A caring and kind society cares for the weak and elderly and helpless; a dynamic and just society allows the young to grow and prosper on their own merits. If America is to prosper as a nation, the young must be given room to build families and careers. To build lives, without the onerous, crushing burden of debt run up by their forebears.

Never mind questions of ethics or “fairness”: it’s just math. The numbers do not, cannot, and will not ever even up, no matter what accounting tricks the government uses. Until we fundamentally change how the Big Three entitlement programs (SS, Medicare, Medicaid) work, we will continue to load up our young people with a crippling load of debt they had no hand in accruing.

“Monty”, “A hot cup of DOOM!, no cream, no sugar”, Ace of Spades H.Q., 2011-05-12