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I want to focus mainly on one of Judge Posner's points, on which he agrees with Prof. Becker, namely that differences in lifestyle CHOICE helps to explain Americans' shorter longevity than citizens of other countries. The main examples Posner and Becker cite are traveling more by car, being on average fatter, being more likely to be an alcoholic or drug addict. Apart from my suspicion that the last claim is not true (European countries tend to have proportionally more alcoholics than we do), I seriously question whether these differences can be attributed to individual choices. People here travel more by car because we have far less available public transportation than Europeans and Asians do. Americans eat more garbage because good food is relatively less available (try foodshopping in the slums!), and owing primarily to working longer hours, Americans are too tired (and uninformed) to cook food from scratch. Higher rates of diabetes are also attributable to the far greater rates of poisons such as modified corn starch in our food, and overrefining of food products. People do not choose to drive more and to get fat. Posner is way the hell out in left field when he goes a step further and suggests that Americans make the choices they do because they are more inclined to take pleasure in taking more risks than citizens of other countries: "there is nothing wrong in principle with people wanting to trade off life expectancy against the pleasure of engaging in activities that happen to be risky." Judge Posner, do you really believe that citizens of other countries are more risk averse than Americans and that explains why they are healthier??? Oh, and by the way, when Americans stay in foreign countries (e.g. as exchange students), they tend to lose weight because they eat like the locals, and take as much public transportation as them (my daughter actually did a BA Thesis on the eating issue). What people do is only partly a matter of individual choice. It is also a matter of the availability of choices, and the surrounding social and cultural environment. Among other things, as some commenters have intimated (in different words), both Becker and Posner need to construe "health care" more broadly than they do, to include inducing people to take better care of themselves (e.g. exercise more), promoting preventive measures (such as engaging in safe sex), pushing for healthier food, and improving sanitation (I would add reducing the amount of advertising people are bombarded with, which would reduce depression, attention deficits, and, generally, stress). Some other countries are far more effective in their policies on these matters. A comment on another aspect of what Posner and Becker write about: I suspect that our health care system (narrowly construed) does not in the aggregate compare very unfavorably with those of other industrialized countries mainly because we have superior medical training and technology compared with most (if not all of them). In other words, controlling for doctors' proficiency and technological level, our system is indeed worse than those of other countries. The relatively higher level of our doctors and our technology compensates for the poor administration of our health care system.
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Jan 19, 2013