Friday, August 26, 2005

You Bet Your Lifestyle

After discussing the health risks of male homosexual lifestyles, Eugene Volokh then had to respond to both accusations of homophobia and denials of the health evidence. But what compels this sort of reaction? You’d think the defenders of gay rights could simply reply: “So what? Homosexuals accept the risks of their choices and bear the consequences. Their sexual behavior is still no one else’s business.”

Sadly, that’s a line of argument no longer available to many of the non-libertarian left, because in recent years they have enthusiastically embraced the notion of “objectively bad risks.” This is nowhere clearer than in the obesity debate. Health crusaders like the folks at CSPI view evidence of adverse health consequences from consuming high-fat foods and engaging in sedentary leisure as ipso facto proof that the behaviors in question are bad. They don’t entertain the wild notion that individual preferences and subjective attitudes toward risk might matter – that for some people, the pleasures might be worth the health risks. To the paternalistic left, the prevalence of any behavior with deleterious health consequences justifies government intervention, in the form of fat taxes, lawsuits against McDonald’s and other providers of unhealthy options, and so on.

But the same paternalism about risk-taking that buttresses the left-wing agenda of controlling our eating choices (not to mention our drinking, our smoking, etc.) also buttresses the right-wing agenda of constraining sexual freedom. And it turns out the left-wing case for restricting sexual freedom is stronger than the right-wing case. It is the primarily the left, after all, that advocates further socializing health costs (though the right has cooperated, such as by passing the Medicare prescription drug benefit). The more taxpayers have to bear the monetary costs of others’ behavior, the more such behavior becomes the taxpayers’ legitimate business. The left can’t deny the logic, because they invented it in the tobacco lawsuits (which were based, in large part, on the claim that tobacco-related illnesses created a burden on Medicaid and Medicare). The same logic justifies using the power of government to discourage male homosexual lifestyles.

No longer able to deploy a straightforward value-based argument for individual choice, the left has little option but to deny the facts.


Blar said...

Who is this "the left" that you speak of as facing such a terrible bind? Anyyone who does not favor the legalization of all drugs cannot utilize a purely straightforward value-based argument for individual choice, at least not without saying why various potential exceptions do not apply.

Here is oen possible reply from the paternalist left. Yes, many men who have sex with men are engaging in high-risk behavior, and government action to reduce the bad effects of these actions is justified (by the same logic as in the obesity and smoking cases). But what are we going to do about unsafe gay male sex? We don't want to do something unless 1) it works at reducing the harms and 2) it doesn't lead to worse problems than the one that it deals with. This is simple consequentialism. Homophobia-based responses obviously fail the second criterion, and they may also fail the first (unless they are extremely drastic), as they can undermine efforts to work with the gay community to deal with these risks.

Your reductio of non-libertarianism runs into another problem: the government does actively discourage unsafe sexual practices among many groups. If I may overgeneralize as you do, it is generally The Right, rather than The Left, that opposes the pragmatic approach. The right wants to make condoms hard to get, to teach ineffective abstinence-only programs, etc. The left wants the government to do what works to reduce the problem while reducing people's freedom by as little as possible. One good approach involves building trust with the relevant population, providing accurate information about the risks of different practices, making safe sexual practices easier, and making testing and treatment easy to get. Because the risky activities are private rather than commercial, financial disincentives to consumers and producers are not a viable option (unless there is some clever proposal that I am unaware of).

A final word on libertarianism vs. paternalism. There are two wild notions that we must be able to entertain simultaneously. For some people, the pleasures of risky behaviors might be worth the health risks. But some people might engage in risky behaviors even if the pleasures are not worth the health risks! The solution to this dilemma is left as an exercise for the reader.

Glen Whitman said...

Blar -- several reactions.

First, it's true that "the left" is not a homogeneous group. Some leftists are more vulnerable to my argument than others. But in recent years increasing numbers of people on the left have embraced paternalist arguments, even in fairly unexceptional circumstances like eating fatty foods. Previously, leftists had usually bracketed their paternalism to activities with demonstrable addictive qualities like hard drugs (though I think even this was an inconsistency). For most other choices, they said it was a matter of subjective individual choice. Probably the best example is abortion. When conservatives argued that women who had abortions suffered depression afterward, leftists naturally said that was a risk that could and should be assessed by the pregnant woman and thus was not grounds for political intervention.

Second, you're right that a sophisticated leftist can justify measures less severe than, say, banning sodomy. But notice that the sophisticated leftist must concede that *if* stigmatizing homosexuality, taxing homosexual acts, etc. worked to reduce the incidence of homosexuality (without excessive cost), then those measures would be justified. In other words, his position in favor of gay rights depends critically on the empirical facts pointing a particular way. This, again, is my original point: once you've embraced an "objective" notion of acceptable risk, you can only defend gay rights if the facts point a particular way -- so it becomes crucial to spin, or even deny, the facts to maintain that position.

Not that I'm opposed to paying attention to the facts. Quite the opposite -- my main problem is with the leftists who betray the facts in order to maintain their original policy positions. I wouldn't much like a leftist who admitted that his principles justified restrictions on homosexual acts, but I'd respect him for his consistency.

Third, we should recognize that leftist paternalism is based on a factual and logical error -- the idea that we can objectively assess risk. We cannot. We can objectively quantify risk, but we cannot find objective utility values to attach to it. The only way to find out the right amount of risk-taking is to consult the individual's subjective preferences.

Fourth, you say "some people might engage in risky behaviors even if the pleasures are not worth the health risks!" True enough; people make mistakes, even according to their own preferences. But the "solution to the dilemma" is not gov't. Gov't actors lack the information to know who's hitting the subjective mark and who's not. Even if they had the info, bureaucratic incentives make it unlikely the info would be used wisely. It's not even clear what the correct use would be, since most gov't policies are one-size-fits-all, whereas the population is heterogeneous. I could go on, but the main point is that gov't is less likely to find the right answer than individuals who have ready access to info about their own preferences and a strong incentive to use it.

Over A. Barrel said...

I can understand why gays would be offended by including them in your anti-leftism, anti-paternalism rant. There is nothing inherently dangerous about gay sex like there is with smoking methamphetamine or cigarettes (to the individual or society). The same dangerous homosexual practices are available to heterosexuals as well. Ignorant and uninformed Americans (for example) spread disease by failing to cover their mouths when they sneeze. In Japan, if you are sick with a cold or flu then you should walk around with a surgical mask on your face to protect others from your germs. You shouldn't spread your infection to innocents willy-nilly. For survival of the group, there is something to be said for sensible social norms especially when they're based on science like the germ theory of illness is.

Social norms in the U.S. dictate that we don't eat dogs, but try to tell a Chinese or Korean that. Is it paternalistic to pass a law prohibiting the eating of dog meat?

I don't see anything wrong with using government agencies to promote the use of condoms and provide information on safe sexual practices. Also, we get enough McDonald's commercials telling us to eat their unhealthy crap. I favor using the government to recommend a heathly diet and to tell kids not to smoke. The American society is rife with heart disease and cancer. It wasn't always that way, you know. I applaud anyone, including the government, for trying to make this a healthier world for those currently alive and for those who will inhabit planet earth after were all dead and gone.

Glen Whitman said...

"There is nothing inherently dangerous about gay sex like there is with smoking methamphetamine or cigarettes (to the individual or society). The same dangerous homosexual practices are available to heterosexuals as well."

If by "gay sex" you mean anal intercourse, you're wrong about there not being anything inherently dangerous about it -- unless you exclude transmission of HIV from the inherently dangerous category. The evidence clearly shows that anal sex is many times more likely to transmit HIV than any other form of sexual intercourse.

You're right, of course, that heterosexuals can engage in the same activities. But gays do so with much more frequency. Presumably as a result, gay men still constitute the largest group of people newly infected with HIV (in the U.S.).

Again, I don't see this as an argument for regulating anal sex, because I would rather have individuals decide whether the pleasures are worth the risks.

"The American society is rife with heart disease and cancer. It wasn't always that way, you know." Uh, actually, the heart disease death rate has dropped steadily over the last 30 years. The cancer death rate has also fallen for people under 65, while rising for people over 65 -- probably because fewer people of that age are dying of heart disease. See here for more.

Blar said...

Almost everyone has principled positions and consequentialist views, and there is always a possibility of tension between the two, with one possible psychological result being that they will ignore or distort the facts so that they can believe that the consequentialism supports their principles. You are a libertarian and a utilitarian, right? That would put you in the same boat as most everyone else, at risk of having your (libertarian) principles distort your understanding of the facts that are relevant to utility.

If I've read your fourth point correctly, your solution to the dilemma is to accept one of the horns - people make mistakes and there's nothing that we can do about it (at least if "we" = the government). I think that it's possible to steer a course between the two horns that is better than either extreme position (though obviously far from perfect). The government has learned a lot about how to regulate risk from its work on risks that have to be regulated (externalities like pollution), and an approach like the one that Cass Sunstein takes in Risk and Reason, informed by cost-benefit analysis and the information-aggregating powers of markets, can be effective at reducing the negative consequences of people's mistakes.

Glen Whitman said...

"You are a libertarian and a utilitarian, right? That would put you in the same boat as most everyone else, at risk of having your (libertarian) principles distort your understanding of the facts that are relevant to utility."

True, that can happen, and it probably has from time to time. And if anyone caught me doing it, I suspect they'd call me down for it. That's just what I'm doing here: calling down leftists who deny the health risks of homosexual behavior in order to maintain their policy position.

I think your (and Sunstein's) confidence in government's ability to get the right info and use it correctly is unfounded, for the reasons I listed above. But that's a distinct debate.

Blar said...

Glen, I know it's been awhile, but I'd been meaning to make this comment so here I go. I agree that the people who were minimizing the risk of male homosexual lifestyles are wrong about the facts, and that they are probably denying the facts because of a psychological process that seeks to ward off arguments that could threaten their position. I don't think that this fact has much in the way of larger implications against the paternalist left. My disagreement is primarily with the enormous overstatement in your last little paragraph, although I also do not like the way you caricature all non-libertarian positions as completely ignoring the possibility that risky behaviors might have some redeeming features.

I think that there are good reasons for being more libertarian about sexual behavior than about consumer behavior:

- Because sexual behavior is (usually) not a market transactions, there are fewer relatively unobtrusive regulatory avenues open for sexual behavior

- Sexual behavior tends to be more closely associated with a person's identity, so sexual restrictions are felt much more keenly (more disutility)

- Since sexuality is more tied up with identity, efforts to cause change that are seen as coming from someone who is not "on the same side" are more likely to be resisted, so restrictive regulation is likely to be inefficacious and to have spillover effects that disrupt more cooperative efforts to bring about change

- There is a large amount of moral antipathy and condemnation of people's sexuality, while moralization against consumer habits is limited (though not absent), which means that efforts at beneficial sexual regulation are at-risk of being coopted by zealots; this also exacerbates the problem of the us vs. them mindset noted above

These considerations point in favor of a more positive and narrowly-tailored approach, working with at-risk communities to help them switch to lower-risk versions of their lifestyles. That means doing things like providing information about the risks, attempting to persuade people by having them reevaluate what's in their own interest, and making lower-risk alternatives more accessible (as by providing free condoms, or, for another sort of risky lifestyle, clean needles). Your libertarianism seems to make it necessary to oppose at least some of these government responses, as you see their sexual behavior as no one else's business.