We should recognize that no one is wise, patient, or knowledgeable enough to be fully responsible for making the right decisions for his or her own health. For the same reason that those who live in rich countries live a life surrounded by invisible nudges, the primary goal of health-care policy in poor countries should be to make it as easy as possible for the poor to obtain preventive care, while at the same time regulating the quality of treatment that people can get. An obvious place to start, given the high sensitivity to prices, is delivering preventive services for free or even rewarding households for getting them, and making getting them the natural default option when possible. Free Chlorin dispensers should be put next to water sources; parents should be rewarded for immunizing their children; children should be given free deworming medicines and nutritional supplements at school; and there should be public investment in water and sanitation infrastructure, at least in densely populated areas. All this sounds paternalistic, and in a way, it certainly is. But then it is easy, too easy, to sermonize about the dangers of paternalism and the need to take responsibility for our own lives, from the comfort of our couch in our safe and sanitary home. Aren’t we, those who live in the rich world, the constant beneficiaries of a paternalism now so thoroughly embedded into the system that we hardly notice it? It not only ensures that we take care of ourselves better than we would if we had to be on top of every decision, but also, by freeing us from having to think about these issues, it gives us the mental space we need to focus on the rest of our lives.
I really like a lot of what this book speaks about, and so I’ll be covering more passages from this book than usual. Following up from the previous passage, what the authors are recommending is for local governments to take more invasive action and making the “default option” the ones that help prevent disease as preventive healthcare is always more cost efficient than reactive healthcare.
While some of us might claim that it to be restrictive and an affront to their personal freedom, it is also true that many of us living in developed cities already benefit from many aspects of paternalism. Our roads, infrastructure are all planned out for us, water is automatically treated and safe, electricity is constant, all things that come from government intervention that we tend to take for granted and yet are things that are not necessarily available to the poor.
By freeing up their cognitive load from thinking about such issues, they will also be free to live more productive lives and focus on making a living.
