Politics & Policy

A Better National To-Do List

(Kevin James Sousa/Dreamstime)
What problems can we actually solve?

In 2014, Islamic terrorists had a banner year, nearly doubling their annual body count to 32,658, according to the Institute for Economics and Peace. Last year probably wasn’t any less bloody, and this year probably will be just as bad.

But, as always, it is important to keep such numbers in perspective. That horrifying Islamist death toll is about 1/227 the combined global kill count of respiratory cancer, HIV, diarrhea, diabetes, and road injuries, which each account for about 1.5 million deaths a year. We should not downplay the horrors of Islamist terrorism or fail to take measures against it, no more than it would be wise to go swimming where you know there to be sharks, even though you are, statistically speaking, about 300,000 times more likely to die of a mosquito bite. The current hysteria surrounding the Zika virus may be excessive, but the attention paid to mosquito-borne diseases is entirely appropriate.

Not all dangers are equally responsive to public policy and public action, and the line between political acts and public results isn’t always straight or clear. For instance, our states derive tremendous revenues from the sale of tobacco products, and only a tiny share of that (less than 3 percent) is used for purposes such as educating people about the dangers of smoking. But it does seem that the past 40-plus years of anti-smoking propaganda has had some effect: New cases of lung and bronchial cancers have declined steadily for decades. And that is an excellent thing, inasmuch as respiratory cancers are a particularly nasty sort: Almost the same number of Americans are diagnosed with lung and bronchus cancers every year as breast cancer (225,000 vs. 247,000), but while lung cancer lags a little bit in incidence, it far exceeds breast cancer in deaths, 158,000 to 40,000. Fewer than one in five lung-cancer patients will survive for five years or more.

Is there any obvious public-policy takeaway from that? Some people will look at those figures and say: We should do even more to discourage people from smoking. It seems obvious, but it isn’t. Most people who smoke never get lung cancer. Men die of lung cancer more often than women, and blacks more often than whites, with black men having a dramatically higher death rate than white men.

Men in Kentucky get lung cancer at five times the rate of men in Utah. Those numbers parallel the prevalence of smoking. Perhaps the U.S. Department of Health and Human Services should be consulting the Church of Jesus Christ of Latter-day Saints on the question of tobacco use and its prevention.

The city fathers of New York banned vaping in public spaces simply because it too closely resembles smoking.

Smoking prevention gets a lot more attention than does lung-cancer treatment, for a couple of reasons. One is that people get moralistic about lung cancer: It’s one of those diseases, like HIV, that bring a special joy to a certain kind of person, a very common type, who likes to say: “You brought that on yourself.” These are the sort of people who tell people suffering from depression that they should just think of how much worse off the poor kids in China are. There isn’t really very much to say about these people. But on the question of smoking, their puritanism is amplified by the fact that the people who create public policy are in the main people who disapprove of smoking, which they see as a vice characteristic of dirty people without liberal-arts degrees.

And that produces some strange consequences. The American Heart Association has compiled a fair amount of research suggesting that vaping — the inhalation of nicotine vapor produced by an electronic device, which looks a lot like smoking but isn’t — is in fact less destructive to one’s health than is smoking cigarettes, and that it might be a useful tool in smoking cessation. The American Heart Association is practically alone in taking a sober, evidence-driven approach to the question. For the rest of the world, vaping means nicotine (which isn’t the thing in tobacco that kills you) and looks like smoking — it feels like smoking, culturally — and, therefore, it is treated like smoking. The city fathers of New York banned vaping in public spaces simply because it too closely resembles smoking, an act that has produced inevitable litigation. The FDA just issued 499 pages of vaping regulation, which will impose ruinous costs on many vaping-oriented businesses, which does not displease the tobacco barons with whom they compete.

That is something to keep in mind the next time you hear from the so-called party of science, when their favorite “experts” produce policy prescriptions that are only loosely coordinated, if that, with any meaningful evidence.

#share#Politicians tend to pay the most attention to issues that command public fascination. And the public’s attention is most easily commanded when the public is given someone to hate: Try explaining the integration of global supply chains to your average American college student and he will be beyond even Adderall’s reach, but talk about “inequality” — which is to say, give him a rich-guy villain to hate — and he’s rapt. People who make lots of money in finance or as entrepreneurs are “those people.” Smokers and vapers are, for members of the policy-making class, “those people,” the same way that people with HIV or heroin addictions are “those people” for others. The NRA is “those people” for the gun-control gang, even though the people who do most of the shootings in these United States are not very much like the people who belong to the NRA.

It is easy to substitute an enemies list for careful thinking.

One of the most interesting projects of recent years is the Copenhagen Consensus, the Bjørn Lomborg–led project to apply welfare economics to deep-seated global problems, inviting economists and issue scholars to do some rigorous number-crunching and come up with some projects to maximize the bang/buck ratio. The recommendations have been surprisingly unsexy: micronutrient-supplement programs, bigger and better-structured subsidies for malaria prevention (those damned mosquitos, again), immunization, the spread of better agricultural practices, water projects.

Straight-up policy questions, notably barriers to trade, also are on the radar. While foreign aid accounts for only a tiny share of U.S. government spending, in absolute dollars the sums are considerable. It is spent better than you might expect: Thanks in no small part to President George W. Bush, the United States has made large investments in HIV prevention, especially in Africa, which actually seems to do some good. A great deal of money is spent on infrastructure projects and capacity-building for foreign states such as Afghanistan, which, even with the inevitable graft and waste, is probably the right approach.

What’s needed is a similar approach to domestic questions, and to a few foreign-relations questions closer to home. It’s a hard sell when a non-trivial share of the population has adopted “Eek! A Mexican!” as the main principle governing relations with our southern neighbor, but it is inarguable that the United States would be much, much better off if Mexico were a lot more like Canada and a lot less like Venezuela (Mexico is only two steps ahead of the late Boss Hugo’s socialist heap on the GDP/capita rankings) and if it had stronger institutions that were more capable of dealing with things like drug cartels and internal economic refugees. But who is going to help Mexico build that capacity? Guatemala?

In a sane world, U.S. political debate would be less about how rich men live in Greenwich and San Mateo Park and more about how the schools are run in Cleveland and Philadelphia, and we’d acknowledge that Mohammed al-Kaboom isn’t going to kill nearly as many Americans this year — or any year — as diabetes and prescription-drug addiction. We’d acknowledge that what is hurting the U.S. economy is mainly decisions made in Washington (and, Albany, Sacramento, Columbus, Lansing . . . ) and not schemes hatched in Beijing or Mexico City. The headlines would be about mosquitos, not about sharks. This isn’t a call for post-ideological “pragmatism,” which is almost always just 20th-century progressivism dressed up with a few dodgy charts, but rather for a genuine effort at discerning what actually can be done, at what cost, and establishing priorities among those things.

But that would require some hard work, maturity, literacy, tolerance, forbearance, and delayed gratification — and nobody ever made a career in Washington selling that basket of goods.

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