Paternalism

Calories and Miles-to-Burn

Jonathan B. Wight

For those who want to reduce America's burgeoning health crisis—induced in part by a self-inflicted sugar-water soda craze—here is a new approach (care of David Frum):

Doctor blogger Aaron Carroll highlights an interesting study that suggests there's a better way than a mere calorie count to get people to reduce the calorie count of their meals:

Using a web-based survey, participants were randomly assigned to one of four menus which differed only in their labeling schemes...

(1) a menu with no nutritional information, (2) a menu with calorie information, (3) a menu with calorie information and minutes to walk to burn those calories, or (4) a menu with calorie information and miles to walk to burn those calories.

There was a significant difference in the mean number of calories ordered based on menu type..., with an average of 1020 calories ordered from a menu with no nutritional information, 927 calories ordered from a menu with only calorie information, 916 calories ordered from a menu with both calorie information and minutes to walk to burn those calories, and 826 calories ordered from the menu with calorie information and the number of miles to walk to burn those calories.

The last option produces nearly a 20 percent drop in calories compared to the default case menu.* This shows that we don't need to ban sodas, as Bloomberg tried, but we do need to inform in ways that are effective. And that would necessitate that nutrition information be standardized to reflect behavioral insights.

Yes, this is a type of paternalism, but it is a mild assault on individual liberties, with possibly good impacts on health and health care costs.

*Of course, this is the short-run effect. The long-run effect may dissipate substantially.


On Mark Bittman, the soda ban, and "making people think twice" about their decisions

Mark D. White

It is no surprise that The New York Times columnist Mark Bittman laments the judicial rejection of New York City mayor Michael Bloomberg's ban on large sodas. Unfortunately he resorts to slander when addressing its opponents:

The argument that preventing us from buying 32 ounces of liquid candy in one container somehow restricts our “liberties” can be seriously made only by those who would allow marketing of tobacco to children.

I would hope that Mr. Bittman realizes that paternalistic intervention has significantly different ethical implications when directed towards children rather than adults. Or perhaps he doesn't, as indicated later in the piece:

If 16 ounces of soda isn’t enough for you, the ban would not, of course, have prohibited your purchase of two 16-ounce containers; the idea was to make you think twice before doing so.

This is a nice characterization of this particular nudge, "making you think twice." It's akin to cooling-off periods that are often mandated with major purchases (like cars and homes) and life decisions (such as divorce), to help ensure that people don't make such decisions in what psychologists call a "hot state" in which emotions may supersede rationality.

As I discuss in The Manipulation of Choice: Ethics and Libertarian Paternalism, these nudges are less offensive to autonomy than the standard type because they encourage better decision-making rather than steering people into the decisions policymakers want them to make. In other words, they engage rational deliberation rather than subverting it. Also, in principle they're outcome-independent, focusing on the process decision-making itself rather than actual decisions made. But in many cases, these outcome-independent interventions would not have been imposed if there were not some concern about the choices being made, and the ban on big sodas is a prime example.

I doubt supporters of the ban would be satisfied if people "thought twice" about their soda consumption decisions and still drink large amounts of it. After all, there is no way to test the quality of a person's decision-making process; they can see observe the decision made, not how or why it was made. And if the outcome is judged by policymakers to be inferior, they make an illegitimate inference regarding the decision-making process, judging it to be inferior as well—a judgment based on their idea of people's interests, not the actual interests of people themselves.

Maybe that's why Mr. Bittman feels it appropriate to "make people think twice" about soda consumption—if they only did, they'd come to the same conclusion he does. It is that presumption, the belief that policymakers both know better that people what's good for them and that they have the right to impose this by law, that makes the soda ban and other nudges so offensive.

(For more, I encourage you to check out The Manipulation of Choice: Ethics and Libertarian Paternalism.)


State judge rejects Bloomberg's ban on large sodas

Mark D. White

Earlier today, a state judge overturned New York City mayor Michael Bloomberg's ban on large sodas, citing their arbitary nature, copious loopholes, and uneven consequences. Of more significant concern are the ethical ramifications of such a ban, as I describe in The Manipulation of Choice--we can only hope that this played a role in his decision as well.

UPDATE: Here is the decision.


New book: The Manipulation of Choice (including free chapter)

Mark D. White

ManipMy latest book, The Manipulation of Choice: Ethics and Libertarian Paternalism, was released earlier this month by Palgrave Macmillan in both paperback and hardcover. In the book, written for popular audiences, I discuss the ethical and practical problems with the idea of "nudges" as popularized by Richard Thaler and Cass Sunstein in their book of the same name.

Walter Olson of the CATO Institute writes that "the 'libertarian paternalism' theory promises to use the state to help correct citizens' wrong decisions without asking their consent, yet also without truly entering the realm of coercion. Too good to be true? Indeed it is, as this book helps to show. Mark White gives us the sort of analysis we need to nudge back." Our own Jonathan B. Wight also comments that: "The Manipulation of Choice states that paternalists impose their own values and goals onto hapless consumers and citizens. Hence, public policies designed to correct the imperfections of behavioral irrationality are coercive. This is an important point and one that needs to be debated."

If you're interested, Palgrave has made the first chapter available for free, and I have written several blog posts recently tied into the book, including one at this blog commenting on Cass Sunstein's recent review of another book on paternalism at The New York Review of Books, and a post at Psychology Today on the nudge concept in general. (See also past posts at this blog on paternalism.)


Cass Sunstein on paternalism in The New York Review of Books

Mark D. White

SunsteinIn the latest issue of The New York Review of Books, law professor and former OIRA chief Cass Sunstein reviews Bowdoin philosophy professor Sarah Conly's recent book Against Autonomy: Justifying Coercive Paternalism. I have not yet read Conly's book; while I am very interested in what Conly says, I am even more interested in what Sunstein, one of the chief advocates of libertarian paternalism, has to say about it.

Sunstein starts his review by citing Americans' widespead and deeply held disdain for paternalism, and then quotes the famous passage from John Stuart Mill's On Liberty in which Mill says that the coercive power of the state must be used only to prevent persons from harming each other and never to protect a person from himself or herself, based on the position that no one knows a person's interest better than that person. Then he summarizes the behavioral research (on the part of Daniel Kahneman, Amos Tversky, and others) that shows that people systematically and predictably make bad choices because of cognitive biases and defects in their decision-making processes. This much will be familiar to those who have read his academic work with Richard Thaler or their popular book Nudge, and in fact Sunstein finishes his introduction with a brief description of nudges, subtle changes in the choice environment (or choice arhcitecture) designed to steer people toward making better choice by taking advantages of the flaws in their decision-making. (This is the concept with which I take issue in my book The Manipulation of Choice: Ethics and Libertarian Paternalism.)

ConlyThen Sunstein turns to Conly's book, Against Autonomy. According to his review (which I will assume is accurate), Conly argues that coercive paternalism is justified by cost-benefit analysis—specifically, when the harms prevented are greater than the costs involved, including the possibly significant but finite amount of offense to persons whose autonomy is violated. Regarding people's self-knowledge, she makes a distinction between means and ends, arguing that people may be aware of their ends but are sometimes mistaken regarding the best means with which to pursue them. She believes, for instance, that everyone values his or her health, but nonetheless chooses unhealthy foods. Therefore paternalism, whether in the form of nudges, taxes, or bans, would promote people's final ends by helping them choose better means. Conly is much more willing than Sunstein and Thaler are to restrict freedom of choice—even while recognizing its very real value—if the benefits of the resulting behavior are large enough, arguing that the more important autonomy of ends is thereby promoted.

Sunstein admires Conly's ideas but has several criticisms, with which I agree (again, not having read the book). He suggests that autonomy may be considered an end in itself, making it different to trade off against means to achieving other ends. Alternatively, if autonomy is valued merely as means, that value may well be so great as to outweigh any benefits from paternalism. This is a common problem with any consequentialist system that admits its own costs as possible inputs to any decision: it risks defeating itself. (Louis Kaplow and Steven Shavell's book Fairness versus Welfare also suffers from this problem; I make this point in my criticism of the book here.)

Most interesting, Sunstein questions Conly's distinction between means and ends:

Conly favors a paternalism of means, but the line between means and ends can be fuzzy, and there is a risk that well-motivated efforts to promote people’s ends will end up mischaracterizing them. ... In some cases, moreover, means-focused paternalists may be badly mistaken about people’s goals. Those who delay dieting may not be failing to promote their ends; they might simply care more about good meals than about losing weight.

I agree completely, but I would maintain that this criticism applies just as strongly to Sunstein and Thaler's libertarian paternalism as it does to Conly's more blunt paternalism, as both presume people have certain ends and then judge their decisions to be ineffective in pursuit of them; the only difference between them in this regard is how far they're willing to go to influence behavior in the "right" direction.

ManipI respond to this element of paternalism—especially with regard to Sunstein and Thaler's libertarian paternalism—in The Manipulation of Choice. The idea is simple: people may make bad choices all the time, but no one knows that they're bad choices except the people making them. If I eat a donut, I may regard it as a bad idea because I'm watching my weight. Or, I may regard it as a good idea because I successfully used it as an incentive to finish a book chapter, or a chance to catch up with an old friend, or even an indulgence deliberately chosen in full awareness of its deleterious health effects because I like donuts. Since the paternalist has no knowledge of my ends, he or she cannot possibly judge my action to be an effective or ineffective means to reach them. Instead, the paternalist presumes common ends—such as health or wealth—on the part of a person (which I call value substitution) and then judges his or her decisions in light of those ends, resulting in paternalist interventions regarding diet and retirement planning (for example).

As Sunstein states, not all people are dieting or watching their weight, so we can't assume that unhealthy (but extremely tasteful) food choices are thwarting their ends at all. By that same logic, however, people have all kinds of financial plans too, so their "failure" to sign up for 401(k) programs cannot be assumed to be a bad decision (as Sunstein and Thaler claim in much of their work). However, the nudge of automatic enrollment would affect everybody equally, regardless of their reason for not enrolling, because it plays on the congitive biases and dysfunction that we all share. People are either too lazy to change the default choice or they're not, regardless of their preference; nudges don't discriminate between motivations, since they affect flaws in our decision-making of which we're not aware.

In his final paragraph, Sunstein recalls his introduction and agrees with Conly that behavioral research calls Mill's anti-paternalism into question. The pioneering work of Kahneman, Tversky, and their colleagues may make us question the decisions we make to achieve our ends, but it does not imply that there's anything opaque or unknown about our ends themselves. To be fair, there is psychological research that suggests this, such as the work described in Timothy Wilson's Strangers to Ourselves. But even if we do not know ourselves and our interests as well as we like to believe, we still know them a lot better than regulators and legislators do—and as long as this is true, it is impossible for paternalists to judge people's decisions or presume to improve them, whether with nudges or more direct measures.


Nutritional labeling, nudges, and a "cynical view of human nature"

Mark D. White

Food labelsNew today from associate editor Brian Fung at The Atlantic is a piece on an experimental nutritional labeling system modeled on traffic lights. In use in the United Kingdom (where it was instituted by the British government's "nudge unit"), the revised nutrition labels would have color-coded icons for fat, calories, and other aspects of food products according to whether the levels are considered healthy or unhealthy. Mr. Fung reports the results of a study from Masschusetts General Hospital that--unsurprisingly--such labels increase the amount of healthy food consumered and lower the amount of unhealthy food consumed.

I discuss labeling systems such as these in my upcoming book, The Manipulation of Choice: Ethics and Libertarian Paternalism, in which I differentiate between the information provided by such label--which allows people to make better decisions according to their own interests--and schemes like the traffic light one which nudge people toward some food and away from others based on bureaucrats' judgment of what is healthy and what is not. (I also discussed nutrition labeling in an earlier blog post.) As Mr. Fung acknowledges, "Bickering over what red, yellow, and green actually mean is likely to be as difficult -- if not more so -- than actually putting the system in place." Some of this bickering may be political, of course, but some will be due to disagreements among health experts over what a proper diet consists of--a debate unlikely to be settled any time soon among the experts, much less by government fiat!

But what I found most interesting about Mr. Fung's article was the irony in the subheading:

If soda bans take an implicitly cynical view of human nature, food labels that give consumers the impression of freedom might be their opposite.

I don't know what could reflect a more cynical view of human nature then trumpeting proudly the prospect of "giving consumers the impression of freedom." These two approaches to paternalistic regulation are not opposites--the only difference is that one is clumsy and the other is "clever." This attitude continues as the article begins (emphasis mine):

From New York City's point of view, humans are notoriously bad at making good decisions. That's what makes a ban on large sodas necessary: the idea that Americans can't be trusted with their own health. But maybe there's a middle ground between letting people gorge themselves on junk food and making it illegal. The key to making it all work is creating an environment where consumers still believe they're in control.

No, there's no cynical view of human nature on display there.

Finally, as the article ends, Mr. Fung writes:

New York's faith in humanity must be low indeed if it thinks only the most blatant coercion can get people behaving differently. Whether collectively or alone, people are hopelessly incompetent, is the message Bloomberg's soda ban sends. A more accurate way to put it might be that people are incredibly malleable, open to having their decisions swayed in terrible ways by factors that are out of their hands. The difference is slight, but in the small gap between those two statements lies an opportunity to move people in the right direction without taking away their freedom.

As above, I disagree with Mr. Fung: the difference is not slight, it is nonexistent. In my view, all paternalists have little faith in humanity, as shown by their willingness to substitute their own judgment for those of the people they claim to help, based on an overly simplistic view of decision-making and interests. And if you "move people in the right direction" by manipulation rather than by reasoned persuasion--subverting their deliberative processes rather than engaging them--you are taking away their freedom, little by little.

But as long as they're left with the "impression" of their freedom, as long as they "still believe they're in control," I guess that's OK.


Not so sweet: Crossing the line from science to opinion in the sugar wars

Mark D. White

In a New York Times op-ed this morning, Daniel E. Lieberman, an evolutionary biologist at Harvard, makes a strong case for our strong attraction to sugar, but a weak case for paternalistic action on the part of the government to limit our consumption of it.

The problem is captured by the question he poses after he lays out the scientific reasoning: "What should we do?" Professor Lieberman somehow makes the leap from "people are eating too much sugar" to "the government should do something to stop this" without appreciating the size of the chasm he's jumping. (Just ask David Hume.) He fails to explain why this is a problem that justifies government intrusion into the choices of individuals--he simply takes it for granted that because we have evolved to crave more sugar than he thinks is optimal, the government is entitled to adjust our sugar consumption to bring it in line with what he thinks is optimal.

This is yet another example of the most offensive aspect of paternalism: value substitution. We are lucky to have access to Professor Lieberman's scientific insights regarding why we crave sugar so much. But then he asserts his opinion that we eat too much sugar, based on his opinion regarding our optimal diets (based on our ancestors' nutritional nirvana long before Coca-Cola and Nabisco). This much is fine--everyone is entitled to his (or her) opinion, and he is fortunate that The New York Times gives him a platform to express it. But like all who endorse paternalism based on what they think we can do better, Professor Lieberman crosses a line when he shifts from expressing his opinion regarding our behavior to endorsing government action to adjust our behavior based on that opinion.

But isn't it commonsense that we should eat less sugar (and salt, and trans fats) and more healthy foods? Of course. But is that all our only concern? Is it our only interest? Should it be? Not only does value substitution mispresent our true interests, but it only greatly oversimplifies them. I know I shouldn't eat too much sugar. But I also think a sugary treat or drink is a fine complement to a meal, or the cornerstone of a celebration, or a nice way to acknowledge a job well. People's interests are complex, and while they do include health, they also include a myriad of other things, things that are ignored when a scientific expert or government regulator proclaims, "Too much! Too much!"

After making a reasonable case for limiting unhealthy foods in schools--a proposal I have very little problem with--Professor Lieberman proclaims that "adults need help too." This is the paternalistic mindset in a nutshell: you need help because we know better than you how you should run your life. Again, he makes a tremendous leap, from "you are being tempted by cheap sugar from the food industry" to "you need the government to step in and counter this influence." First, there is no way to know how much sugar consumption is due to "irresistible temptation" and how much is due to open-eyed choice. Paternalistic regulation--whether in the form of prohibition, taxes, or nudges--is a blunt tool that misses the nuances of human decision-making.

Second, this treats people as slaves to their passions--there's Hume again--which must be manipulated by the state to counter manipulation by industry. Professor Lieberman devotes just two sentences to spreading information, but decides that it hasn't done enough--"enough," of course, based on his opinion regarding what should have happened. But here's another possibility: people know how bad sugar is from them, and armed with that information plus all of their multifaceted interests, they nonetheless choose to eat more sugar than Professor Lieberman would like them to.

Professor Lieberman concludes with this: "We have evolved to need coercion." I hope he's not making that claim on the basis on his scientific expertise, because science cannot tell us what we need. Science can help explain why we do what we do--as Professor Lieberman well details in the early part of his article--but it has nothing to contribute to what we need. Such a proclamation requires knowledge of our goals, interests, or "purpose"--the last one a teleological notion which scientists normally disavow--and none of which science or government knows better than people themselves.


New York Times' Room for Debate: Wrong Question, Wrong Answers

Mark D. White

That was fast--in a "Room for Debate" feature that went online Saturday evening, the New York Times asked "What's the Best Way to Break Society's Bad Habits?" The contributors, predictably, take the question at face value and answer accordingly. But the question is nonsensical and the answers beside the point.

"Society" does not have bad habits--people do. And it is not for "society," or anyone in it, to decide whether a person's habits are bad, except that person himself or herself. Others are free to tell a person they think he or she has bad habits, to try to persuade or inform him or her about why these habits are bad, but only the person who has these habits can judge whether they are bad, based on his or her own interests.

So the question the Times poses is based on a false premise. A better question would be, what can we do as a society to help people conquer habits that they themselves judge are bad? Paternalism won't work, since it paints with too broad a brush, affecting everyone with a particular habit whether they think it's bad or not. The best way to help people break self-identified bad habits is to hold them responsible for their consequences.

But exactly the opposite is happening: we are moving away from individual responsibility and toward collective responsibility. This shows up most clearly in health care, where the more responsibility the government takes (or forces private insurers to take) for people's unhealthy behavior, without being able to charge more in premiums or deductibles to make up for it, the less incentive people have to moderate such behavior. If they were faced with even some of the costs of their behavior (as they would under a more flexible private health insurance system), people could make a fairly rational decision whether the cigarettes, or soda, or fatty foods, are worth the eventual cost. But now their personal costs are opaque, consisting of taxes or insurance premiums largely unrelated to their behavior.

And the all-too-predictable result of more collective responsibility for health care is more governmental control of behavior. Restrictions on unhealthy behavior are not just paternalistic anymore--they're now a public cost problem. Cities and states are eager to cite rising Medicare costs as justifications for their restrictions on smoking, trans fats, and other health risks. (Forget broccoli: academics today seriously endorse plans to mandate exercise.) But this is like the boy who shot his parents and then argues for mercy because he's an orphan; by claiming responsibility for health care costs, the government has created the crisis (or at least this particular part of it) which "justifies" restrictions on behavior.

Let people judge whether their own habits are good or bad, and let them take responsibility for the consequences of these decisions. That's the right answer to the right question.


Mayor Bloomberg nudges New Yorkers away from the Big Gulp--and towards two Little Gulps instead

BloombergOh, Mayor Bloomberg--you make writing a book about libertarian paternalism and nudges too easy. (Thanks!) But seriously, you help show why it's important to write this book, that's it's not just some pie-in-the-sky idea that lives only in the ivory tower, but one that affects the real world.

Yesterday The New York Times reported that New York City Mayor Michael Bloomberg, through his Board of Health, is planning to limit sizes of sugary drinks like soda (other than diet), energy drinks, and sweetened coffee drinks, to 16 ounces. (One person on Twitter remarked that this is still 13 ounces more generous than the TSA.) This applies to prepackaged bottles of beverages sold in bodegas or delis (but not grocery stores or convenience stores) as well as drinks poured by an employee or customer, such as fountain soda sold at fast food restaurants, sports games, and movie theaters.

According to the article,

The mayor, who said he occasionally drank a diet soda “on a hot day,” contested the idea that the plan would limit consumers’ choices, saying the option to buy more soda would always be available.

“Your argument, I guess, could be that it’s a little less convenient to have to carry two 16-ounce drinks to your seat in the movie theater rather than one 32 ounce,” Mr. Bloomberg said in a sarcastic tone. “I don’t think you can make the case that we’re taking things away.”

No, he's not taking away people's soda or limit consumer choices--people are free to buy more, smaller drinks or take advantage of free refills--but he is hoping to affect their choices, or he wouldn't be doing this in the first place. This element of cynical manipulation lies behind all nudges, the idea that regulators can leave your options unchanged substantively but still change your behavior for the better.

This leads to another offensive aspect of nudges: to change behavior without curtailing options, they rely on the same cognitive biases and dysfunctions that its proponents use to justify their imposition. I assume that Bloomberg blames short-sightedness or lack of willpower for New Yorkers' heavy consumption of sugary drinks, but his plan will only work if people were too lazy, hurried, or absent-minded to consider other options for getting more soda. (His sarcasm about the inconvenience of buying two sodas is ironic, since that inconvenience is one thing that he's counting on to drive the success of his plan.)

What do I see coming from this? A lot of delis and bodegas working to reclassify themselves as grocery stores instead of "food service establishments" (a health department classification) and a lot more restaurants that serve fountain sodas offering free refills or "buy one cup get one free" deals. Consumers won't have to "seek out" ways to get their fix; business will be more than happy to provide them. Like most poorly crafted regulation, this ban on large sugary drinks will certainly shift some behavior, but in efforts to circumvent the ban, not to conform to it.

New Yorkers are smarter than you give them credit for, Mayor Bloomberg. Maybe it's all that sugar.