The Tyranny of Clichés: How Liberals Cheat in the War of Ideas (36 page)

Prevention can, of course, be worthwhile. It can also become an obsession and a license to spend a pound on prevention when a cure would only cost you an ounce.

Before we get to the concrete examples in public policy, consider the man who washes the after-dinner dishes, and wants to prevent creating a mess with the water that might spill on the floor or the countertop around the kitchen sink. It is very hard to wash dishes while taking care not to splatter or spill anywhere.
Better to be a little messy—and more efficient—while doing the job and then correct your excesses with this amazing invention called the sponge. In other words, cures are often cheaper than prevention.

Moreover, prevention itself is not an unlimited principle. If it was, the guardrails on our highways would be one thousand feet tall.

Nowhere is Franklin’s homespun wisdom more routinely invoked than in the realm of health-care policy. But surely Franklin was right when it comes to medicine. After all, didn’t old Ben also say “An apple a day keeps the doctor away”?
¹

Yes, prevention for individual people or households is often, very often, less expensive than the cure. But in terms of public policy, what is cheap for individuals is not necessarily cheap for society. Ever since health economist Louise B. Russell wrote “Is Prevention Better Than Cure?” there have been hundreds of studies showing that system-wide prevention efforts very often cost more than they save.
²

For instance, Norwegian medical researchers tracked 50,000 Norwegian men and women over twenty-five years. Forty-one percent of the men who smoked more than a pack of cigarettes a day for the full two and a half decades died between the age of forty and seventy. Among female smokers, 26 percent died. Among those who never smoked, the mortality rate was 14 and 9 percent, respectively. In short, even among those who smoked heavily, chances were that you’d make it past seventy. So, if the government acted “wisely” on the principle that an ounce of prevention is worth a pound of cure and required all smokers to undergo regular checkups for smoking related illnesses, it might have mandated chest X-rays and other tests for an absolute majority of people who would never die from smoking in the first place.

Now, many people will argue that it’s still worth it to intervene early because any effort to fight smoking will save lots of lives. This is true, and as a matter of morality and medical ethics that’s hard to dispute, and I wouldn’t want to. But that is totally different than saying it will also save money.

Think about it—nearly every person who dies before they retire saves society money, because that way the government gets to pocket their Social Security and Medicare tax payments without paying anything
back out. Moreover, the older you get, the more medical costs you accumulate. From a purely actuarial perspective, all of these people—Barack Obama, Bill Clinton, Michael Bloomberg—who claim that our health-care system needs to be reformed because our life expectancy is too low (it’s not), miss the point that if we dramatically increased life expectancy in this country we would lose money on the deal, because that would mean dramatically increasing the length of time old people collect retirement benefits and increase the number of claims they make on the health-care system.

Your life is extremely valuable to you and to your loved ones, but for Uncle Sam’s bean counters, you hit the point of diminishing returns the moment you stop paying taxes and start collecting taxpayer subsidies. You want to live longer because you want to live longer. And so for
you
an ounce of prevention is worth a pound of cure. But the math is reversed for the government; healthy people cost more than sick people. And, eventually, everybody gets sick and dies. That’s why researchers have found time and again that over the course of a lifetime smokers and obese people (and particularly smoking obese people) cost less than healthy people. Politicians who insist that prevention will save lives are right. Politicians who insist that saving lives always saves money are wrong.

This doesn’t mean we should adopt some Soylent Green remedy where we off the aged and turn them into protein-rich crackers for the productive workers. “People are important, their health is important, and we want to make their lives better in a variety of ways,” Russell explained to the
Washington Post
in 2008. “The point of the medical-care system is to serve people. It is not the point of people to serve the medical-care system.”
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And yet that is exactly how many health-care bureaucrats see things. They want to get health-care costs down by rationing health care so as to ensure “the health of the system” first and foremost. This is like caring more about keeping your mechanic employed than the safety of your car.

And that is where a well-intentioned worldview becomes sinister. Underlying the desire to keep “the system” healthy is a desire for the experts to determine how others should live and, ultimately, to determine who should live. In health-care systems where the government handles all of the costs the government inexorably is forced to choose who is deserving of
certain medical treatments and who is not. In Canada and the United Kingdom, you can’t get some surgeries or treatments if you are overweight or past a certain age, not because of relevant medical concerns but because the government has decided you’re not worth the investment. Funding for IVF treatments is increasingly rationed, which means that the government can tell certain people that they can’t have children, in a sense deciding who can and cannot be born.

The liberal response to such arguments is that the market or insurance companies decide such questions now. After all, it’s not like poor people have a right to affordable elective knee surgeries or fertility treatments. There are a number of problems with this argument, but one stands above all others: The government is
the government
. If you don’t have enough money to buy an ad on a radio station, your free speech rights have not been violated. But if the government says you can’t take out an ad because it doesn’t like what you have to say, your rights
are
being violated. Similarly, when the government pays for all health care and then says you can’t get a hip replacement because, well, you aren’t worthy of one, that is a deeply troubling revision to the social contract.

This is where the tyranny in the cliché becomes manifest. Under progressive government, once you medicalize an issue, you politicize it. Michael Bloomberg, New York’s seemingly endless mayor, has targeted everything from tobacco and trans-fats to street vendor bathroom breaks and insufficient rates of breast-feeding in the Big Apple. He does these things, with the endorsement of all the enlightened experts and commentators, on the grounds, in whole or in part, that he is preventing costly health problems down the line. That it is the “compelling interest” of the government to do so.

But what clearly motivates Bloomberg, in no small part, is the desire to tell people how they should live. The esteemed enemy of “labels” insists that is not the case. The proud non-ideologue is simply following the evidence. But that evidence is, at minimum, hotly contested and often flatly wrong.

But even if it was right, who is he to determine how others might live? The same condescension is on display when President Obama’s Energy Secretary Steven Chu explains that taking away the option to purchase incandescent light bulbs is no big deal because “
we are taking away
a choice that continues to let people waste their own money.
”
⁴
This follows on a long parade of decisions to prevent Americans from “wasting” their own money on large cars, cigarettes, tasty animal products, and so on. It’s the same worldview that causes Barack Obama to despise tax rates that allow too many Americans to keep money they don’t “need.”

It’s an old mind-set. When Herbert Hoover was the dutiful progressive food administrator in the Wilson administration during WWI he proclaimed that “Supper is one of the worst pieces of extravagance that we have in this country.”
⁵
At least Hoover—who banned all sorts of foodstuffs from the American table—had the excuse that we were fighting a war. The problem is that progressives yearn to be wartime administrators even when we are not at war.

Forced deprivation during wartime is an old principle with much merit—
when it is warranted.
In
Democracy in America
, Alexis de Tocqueville warns: “It must not be forgotten that it is especially dangerous to enslave men in the minor details of life. For my own part, I should be inclined to think freedom less necessary in great things than in little ones.” He goes on to note that in the “great things,” the burden of (temporarily) lost freedom must inevitably fall “upon a small number of men.” For example, in war we understand that some men (and now women)—aka soldiers—surrender the bulk of their liberties to protect the liberties of everybody else.
⁶

This principle has been turned upside down by the Nanny Staters who see tyranny in such things as conscription, abortion, and surveillance of terrorists, but see nothing wrong with snapping on the metaphorical rubber glove and shoving their hands to the wrist in the posteriors of everyday people
for their own
good
. If the survival of the country is at stake, who can object to the draft? If an eight-month-old fetus is in fact a baby, who can object to extending the protections of the constitution to it, even at the cost of inconveniencing the mother? But what business is it of the government to tell me what kind of potato chips I can eat?

This is the true danger of turning prevention into a governmental crusade: There’s no end to it, no limiting principle. The complex of health-care activists, trial lawyers, and meddlers has become so entrenched and institutionalized that no aspect of life is beyond their Sauron-like gaze. If
it’s bad for you, the government might just have to intervene, no matter how trivial the offense seems.

“Subjection in minor affairs breaks out every day and is felt by the whole community indiscriminately,” de Tocqueville continued. “It does not drive men to resistance, but it crosses them at every turn, till they are led to surrender the exercise of their own will.” On countless fronts, the natural pastures of daily liberty have become circumscribed by dull-witted but well-meaning bureaucrats slapping down the paving stones of good intentions on the road to Hell. But the good news is that the guardrails getting us there are very, very high.

21

THE CATHOLIC CHURCH

T
he best—and most Burkean—line from the film
Animal House
is easily Delta House president Robert Hoover’s passionate protest over his fraternity’s expulsion from Faber College: “But sir, Delta Tau Chi has a long tradition of
existence
, both to its members and the community at large.”

For the conservative, a “tradition of existence” can be a strong defense. Like sunken ships that over time become overgrown reefs for teeming colonies of sea life, some things increase in value simply by being around long enough. Social capital has a compound interest rate all its own. But old things also attract old barnacles, hard to remove and easy to confuse with the structure itself.

So it is with a slew of untruths that have evolved into defining clichés of our age. Not surprisingly, many have to do with overturning, demeaning, or diminishing the role of the Catholic Church or Christianity—and thereby Western civilization—in world history. The intent behind some of these clichés doesn’t always rise to the level of an outright agenda. Sometimes simple benign ignorance is to blame, sometimes something more malignant. But underlying all of it is the notion that the Catholic Church or Christianity held humanity back for thousands of years and that it continues to do so today. Everyone likes to say that we must learn from history, but that’s difficult to do when the history you’re learning from didn’t happen.

A Muslim Martin Luther?

Some ideas are just too good to think through. Since September 11, calls for a “Muslim Martin Luther” to reform the Islamic world can be heard with metronomic regularity. In
Ivory Towers on Sand: The Failure of Middle Eastern Studies in America
, Martin Kramer’s brilliant indictment of the academic establishment, he notes that scholars of the Arab and Muslim world “were so preoccupied with ‘Muslim Martin Luthers’ that they never got around to producing a single serious analysis of bin Laden and his indictment of America” prior to 9/11. Worse, the faith-based conviction that the Muslim Martin Luther was around the corner was simply a rehash of biases that were common half a century ago. “The resort to the Reformation comparison in the 1990s,” Kramer writes, “was but one more example of how academics kept recycling old analogies, probably without even being aware of it.”
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