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Comment by shrumm | Hacker News Reader

Obesity is an external cost that just doesn't get accounted for in a free market. So far, regulation is a blunt tool, but still a lot more effective than other tools we have to deal with this.

For instance, in Indonesia, it's common for Big Tobacco to sell cheap cigarettes near schools [1]. This is insane, but from a purely free market perspective it makes perfect sense. Get your product in peoples hands as early as possible, and now you've got a customer for decades. All the social costs of higher rates of cancer etc will be borne by the taxpayer, so why should big tobacco care.

[1] http://www.tobaccoinduceddiseases.org/Density-of-cigarette-r...

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Costs are only borne by the taxpayer where the taxpayer pays for healthcare, but that's a choice as well. We could just as easily say that the taxpayer won't be responsible for the cost.

We've chosen to have the taxpayer bear the cost, which is very probably good and right, but I think we should be careful using that fact to make decisions about other people's body's.

I think this can be distinguished from other externalities like smoking, where other people have to smell the smoke, or pollution that other people have to smell, or that kills their plants or animals. Some externalities can't be opted out of, but some can, and that fact greatly reduces the case for regulation, in my opinion.

> We could just as easily say that the taxpayer won't be responsible for the cost.

I thought Covid made it obvious that there is no insular, zero-externality health of individuals. Public health is a public commons, and we will be responsible for the cost whether through taxes and preventive action or through other channels in a reactive manner.

Being obese has tons of externalities other than healthcare costs. Higher levels of sickness and absence from work reduces productivity, being out of employment due to disability completely demolishes it. Premature mortality means the national output is reduced because we are losing the societal investment on grown, skilled, experienced adults to death. Some businesses bear higher operating costs; e.g. larger seats or more fuel for aircrafts. Deteriorating mental health is not only a healthcare cost, you and your kids interact with people daily, you make collective decisions (e.g. vote in elections) with them. In short, wellbeing of your fellow humans is never a zero-externality phenomenon and it can't really be distinguished from smoking or pollution because you can't opt out of the consequences of a lower GDP or mentally unwell peers.

These are very interesting points! Though, I don't really think it's the responsibility of individuals to maximize GDP, and people who die younger generally incur lower lifetime medical expenses than people who die older, which plausibly more than offsets things like aircraft fuel. People who eat too much also plausibly subsidize food for the rest of us.

Mental health is a good point, though justifying government intervention on that point also justifies forcing medication on people, does it not? And then the issue of defining where something veers from merely annoying to "mental health problem."

I'm wary of defining externalities so expansively that they justify any intervention.

> I don't really think it's the responsibility of individuals to maximize GDP

Insofar we are in economic competition with other countries, I think being as productive as we can be is also a game of autonomy, survival and values. Ultimately it all drives from individuals carrying their weight (sorry for the pun) which is affected by being in their best shape or disabled.

> I'm wary of defining externalities so expansively that they justify any intervention.

I totally agree. I would say if it comes down to government interventions, there has already been a considerable delay in response. But markets are unable to implement corrective measures proactively, so NGOs and governmental support seems to be the best tools we have for designing a better society. After all, those externalities do exist and keep flowing, whether we take account of them or not.

> though justifying government intervention on that point also justifies forcing medication on people, does it not?

I get your point that these might be on a continuum, but forcing ingestion that defies bodily autonomy is not in the same class of interventions as collecting taxes that try to solve the problem through market based incentives. To add more, to the extent forced institutionalization is implemented, forced medication also does happen.

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