The Right to Ill Health: Food Stamp Eligibility and Freedom

In my column for this week, I discuss NYC Mayor Michael Bloomberg's recent request from the U.S. Department of Agriculture (USDA) for permission to exclude sugary soft drinks from the category of food and beverages covered by food stamps, for a two-year period.  This would mean that the money people receive in food stamps (a total amount that would not change) could not be spent on drinks that contain more than ten calories per eight ounces (with exceptions for fruit juices, dairy products, and non-dairy milks such as soy milk or rice milk).  The column takes up the issue of whether Bloomberg's request is legitimate, given that the Food Stamp exclusion (1) affects only poorer people who qualify for food stamps, (2) limits people's freedom to make their own consumption choices, and (3) leaves entirely unaddressed the negative impact of other unhealthy products, such as animal-based foods, on consumers' health.

In this post, I want to address one potential defense of the food stamp program (against the libertarian objection that consumers should be able to make their own choices), a defense that relies on the cost of providing health coverage to people of ill health.  When a libertarian says "I have the right to make whatever choices I like to my own detriment, so long as my choices do not affect others," the premise of the asserted freedom is that others do not suffer as a result of its exercise.  I do not, in other words, have the right -- even according to a libertarian -- to force other people to eat unhealthy food.  I only get to make choices that negatively affect me.

The problem with this argument, in a society that provides services for its population, is that harming your own health is expensive for other people who pay the bill.  Though the U.S. does not provide the sort of medical support that one finds in other countries, it is still the case that hospitals that receive Medicare payments (virtually all hospitals) may not turn away emergency patients for lack of the ability to pay.  As a result, federal taxes go to pay for emergency treatment for people suffering from ill health, including those experiencing medical crises flowing from cancer, heart disease, and diabetes -- the three diseases linked to consumption of animal-based foods and poor nutrition (including the over-consumption of processed sugars) more generally.  Because not everyone who eats himself or herself into a medical emergency is able to pay for care, governments have an interest in providing incentives for people to consume healthy food.  Food Stamp exclusions for sugary sodas provide one such incentive (or remove one disincentive).

Though an imperfect fit, this argument serves best to defend a pro-nutrition policy aimed at impoverished people, because they are perhaps more likely than their neighbors to have to rely on subsidized medical care later on, when they suffer the ill effects of food choices that others may be making as well.

Of course, a true libertarian would say that hospitals should not be required to serve patients who cannot pay for care.  Our approach to medical emergencies seems to underline an irrational division between prevention (when we take a libertarian approach) and cure (when a social insurance approach is taken), a division that tends to maximize both the expense borne by society and the suffering borne by the individual patient (because an ounce of prevention is worth...).  From a libertarian's perspective, then, this argument (about avoiding the expense of health care costs of misbegotten food choices) rests on a status quo that is itself violative of individual liberty.  This is indeed why libertarians oppose the Health Care Bill for requiring everyone to "buy in" to the health coverage system by purchasing a policy.

Given, however, that we live in a world of (highly limited) social insurance, it is simply untenable to suggest that people in the U.S. should have the unalienable liberty to consume whatever food they like, on the premise that they affect only themselves.  And when the suffering and deaths of sentient animals are taken into account as well, along with the environmental devastation wreaked by animal agriculture, the notion that "I am hurting only myself" becomes an increasingly unsustainable fiction.