Irrationality, Health, and Libertarian Paternalism

Irrationality describes many aspects of healthcare and health behaviors that create vexing problems for health policymakers. Label a food “healthy” and people will consume it in unhealthy quantities. People will insist on getting prescriptions and tests they might not need, but all too often, they don’t follow through with needed tests and prescriptions.

Douglas Hough spells out our predictably bad choices that get in the way of health and drive up costs in his new book, Irrationality in Health Care: What Behavioral Economics Reveals About What We Do and Why. He makes a good case for blending behavioral and classical economics to make American healthcare work better.

To deal with these dilemmas and save us from our mindless mistakes, behavioral economists are stepping up. David Brooks commented this week:

We’re entering the age of what’s been called “libertarian paternalism.” Government doesn’t tell you what to do, but it gently biases the context so that you find it easier to do things you think are in your own self-interest.

Giuseppe Schiavone and colleagues just published a rational framework for transparent, deliberative debate about optimal defaults for health policy in Medicine, Health Care and Philosophy. But the problem comes in choosing the stakeholders who engage in this process. Can distant experts and self-appointed advocates be trusted?

Even soft paternalism draws howls of protests from hard-core libertarians. Too bad, says Brooks:

In practice, it is hard to feel that my decision-making powers have been weakened because when I got my driver’s license enrolling in organ donation was the default option. It’s hard to feel that a cafeteria is insulting my liberty if it puts the healthy fruit in a prominent place and the unhealthy junk food in some faraway corner. It’s hard to feel manipulated if I sign up for a program in which I can make commitments today that automatically increase my charitable giving next year. The concrete benefits of these programs, which are empirically verifiable, should trump abstract theoretical objections.

We agree. It’s time to get real about the need for healthy social norms.

Click here to read more from Brooks, click here to read an interview with Hough, and click here to read the publication by Schiavone et al.

A Little Nudge, photograph © las – initially / flickr

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