Bastiat, public choice, and burnout

As I've said before on this blog, the reason I started reading and researching more was to resolve the cognitive dissonance inherent in being a libertarian social worker. How can work in the system one intends to undo? As always, I have found that those who have thought about the subject before me have done a more eloquent job of explanation than I ever could. It is with that in mind, that I present a quote I first read on EconLib's Facebook status.

“Socialism, like the ancient ideas from which it springs, confuses the distinction between government and society. As a result of this, every time we object to a thing being done by government, the socialists conclude that we object to its being done at all." -Frederic Bastiat

For me, this quote perfectly encapsulates the delinking of government action with morality in helping professions. If we could care for our sick and poor more efficiently and with greater ethics with private money, should we not do that? In fact, wouldn't it be more moral as a society to voluntarily aid one another rather than collect money by force to be administered impersonally to recipients?

This line of inquiry inevitably leads to the question of whether the resources would be there to care for those in need. I've heard reformers of the welfare system opine on both sides of the issue. Tyler Cowen, a George Mason economist, says that there is no "crowding-out" effect of government welfare and that charity would not cover the gap. Matt Zwolinski, a political philosopher, disagrees and cites some interesting data. I honestly have not reviewed the subject in detail, but I think that Matt's point on the depth of help in a private charity system is well-taken. I take this question as a matter of economics and history of the helping professions prior to WWI--one that I have not had time to research.

The positive case for private charity left unfulfilled, I then turn my attention to the negative case against public welfare. This line of inquiry inevitably leads me to public choice economics. Public Choice Theory simply applies the assumptions of economics (people act in their rational self-interest) to politics. Unlike the assumptions of progressives (and what few socialists there are left*), people who enter government are not canonized, beatified, and removed of all sin. In fact, the higher up you go in government, the more craven and sociopathic the person becomes.

I believe this insight applies to the mental health and substance abuse profession. It seems shocking to consider that those in the helping professions would act in their own self-interest because people enter into this profession with a genuine desire to help. However, once a person becomes disconnected from everyday practice, it is exceedingly difficult to make decisions without becoming cold towards their effects on consumers. (Hence, terms like consumers!)

As I write this, I had a bit of an insight. The diminution of other-interest and promotion of self-interest by a mental health worker would be met with cognitive dissonance, personal frustration, and professional difficulty. That sounds a lot like burnout to me. Could burnout be associated with or an outcome of self-interest in the mental health profession?

Back to the audacity of accusing MH professionals of self-interest. Our profession has a long history of doing horrible shit to people in the name of curing them or helping society--forced sterilization and lobotomies to name two. People did those things not only to help others but to enhance their own careers through publication, show positive outcomes to superiors, and assuage the public that the menace of mental illness would be defeated. Even in their supposed helping of others, they think merely of how they see the help happening and not how the other person experiences it. That's much harder to measure and appreciate. And it's incredibly difficult to control.

And that's only thinking about the clinical interventions themselves. Once we delve into organizational structure, funding, and administration, it will become obvious that those organizations and administrators who are given the most power in the helping industries have ulterior motives and are subject to incentives they do not appreciate or understand.

Will the helping professions ever change and respond to the challenges that public choice economics levies? Eventually, they will have to once the funding dries out and budgets burst. In the coming age of austerity, these insights will be vital. I hope, anyway.

*worst. pun. ever.

The Social Cost of Drug Abuse and Use

A Great Article by A. Barton Hinkle in Reason Magazine today on the new CDC study on binge drinking brings up many interesting points from a drug policy standpoint. I love his headline but wish he took more time to talk about that "fix the wounded" part. Foremost, to quote from the article:

Similarly, the war on illegal drugs is heavily driven by imputed social costs. The Office of National Drug Control Policy says illegal drug use costs society $181 billion annually. But: “Over two-thirds (71.3 percent) of the costs of drug abuse are attributed to lost productivity.” It also notes that $39 billion of that lost productivity results from incarceration, so this “is not a cost of drug abuse but, rather, the costs of current [drug-control] policies.”

Actual health costs from drug abuse? Less than 9 percent of the total. The reason you can’t buy narcotics over the counter, then, seems to have just as much to do with other people’s desire that you maximize your economic output as with their concern for your continued well-being by itself. Put another way, a big chunk of the concern about drug abuse arises not from altruistic paternalism (it’s for your own good) but from selfish paternalism (it’s for everyone else’s).

Public policy advocates of all stripes love inflating their numbers, but 9% of the total seems a little nutty. The worst part is that 9% likely includes hospital admissions or arrest records that indicate drug use, but make no statement regarding its role in the social cost. For instance, a person who smoked pot daily up until last week gets rear-ended by another motorist. His hospital admission will likely list his admission as drug-related, regardless of actual impairment or causality. So, the actual cost of drug use and abuse on society is probably less than the 9% stated.

One of my pet peeves is on display in this otherwise great article. Hinkle conflates use and abuse in the above paragraphs and throughout. This is likely because the government often makes no distinction between the two, as the legal (not medical) definition of drug abuse is use of a prohibited drug. But, it is likely not the drug abusers that paternalists citing these statistics are after. They are looking for the able-bodied adults who do just-well-enough at their jobs and also use drugs. As Hinkle points out, they advocate prohibition of drugs because it would keep people from using these drugs in a controlled manner that might impact their ability to contribute to other people's livelihoods. Of course, this idiocy follows a common economic fallacy. Just because a person is less productive at work does not mean they are less productive or economically useful overall. They may get stoned while performing music or writing creatively or being social with friends. Economic metrics like these omit intangible benefits and non-monetary output.

For the record, the majority of people who use drugs do not become dependent (<12% of first-year initiates to any drug are dependent two years later). Furthermore, most people who do become dependent on drugs have other problems that contribute to both the drug use and lost productivity including mental illness, unemployment, trauma histories, etc. Combine that with the proportion of drug abusers who are unlikely to become employed or otherwise economically productive, the actual social cost of drug use and abuse becomes vanishingly small.

The second point I want to make is a little more flippant. Why the hell is an alcohol binge counted as having 5 or more drinks in one night? That's a night of drinking! Over the course of a night out, starting at 10PM and going to 2AM, having about one drink per hour is a sign of temperance not intemperance! Good lord. This is yet another example of inflating numbers to make a problem seem worse than it is.

Finally, though it is not mentioned in this write-up, other analyses of the CDC data have pointed out that binge drinks most often is... old people! Let that one sink in for a minute. How about putting a maximum drinking age on alcohol use, as the intemperance of older adults has shown their generation to be too irresponsible to be trusted with the privilege of alcohol use. I'm being facetious, of course, but much the same argument is applied to college students.

Why I oppose Occupy terminology

There are lots of good economic arguments for opposing the policies permeating through Occupy Wall Street. The dominant narrative in libertarian and non-smug conservative circles is that they identify the problem well, but their solutions (more government, bailouts of student loans, etc.) do not make economic sense. I would agree with this analysis, as far as it goes. But there is a larger problem with the Occupy movement that I have not heard anyone touch on.

What I find especially pernicious about the Occupy movement is that it lumps together the poor with the middle and upper-middle class. The terminology of the "99%" necessarily aligns the needs of those who have means to help themselves with those who do not. It is not the 99% versus the 1%. 99% of people should not be getting government assistance. While I agree that welfare to the 1% is odious, so is welfare to the middle class. I am sickened when I hear politicians pander to the middle class with promises of greater assistance for buying a home or paying for college. And it is assistance to the middle and upper classes (the 41-98%-ers, approximately) that is majority of our welfare expenditures.

To anyone interested in seeing exactly where your federal tax dollars go, I highly suggest Tyler Cowen's article on the welfare state. In it, he cites statistics showing that approximately 1/5 of all welfare spending is aimed at the poor--accounting for 14% of federal outlays and 4% of GDP. The VAST majority of welfare spending is directed at the middle and upper classes. The largest federal outlays, medicare and social security are, at this point, transfers from the relatively young and poor to the relatively old and rich. And while the generational warfare is bad enough, the overall gestalt of the welfare state is the continued improvement of the middle class--usually at the expense of the poor. Because money that is spent in one place cannot be spent in another. Every dollar I receive in benefits from the government is a dollar that is taken away from someone in need (potentially).

There are great classical liberal (libertarian) arguments for and against the welfare state, and we need not engage those entirely, only to say that for example Hayek's Road to Serfdom actually advocates for a sizable welfare state. We can start from a point of agreement. There should be a welfare state based on largely conditional aid to the poor in the form of direct monetary assistance and possibly forms of housing, education, and employment help as well. Let's put all of that as a given. To lump in arguments for assistance to the poor with arguments to help the middle 50% of society is perverse. And to argue for the continuation of a welfare state that prioritizes the middle class over the poor is morally wrong.

An Occupy message that would resonate with me would include reforming the entitlements system, ending welfare to the middle and upper classes, and returning our collective attention to the valid recipients of state aid. While I appreciate the Occupy movement for its gutsiness and culture, the message of the 99% versus the 1% makes me feel like a smug conservative prick--looking down on all of those hippies whose parents helped them buy their macbook airs and don't know how good they have it.

A statist consensus has been arrived at by those with political power: the government should redistribute the wealth of its citizens, but only to whoever currently holds political sway. And NEVER to the disempowered, the poor, and the ones who truly need. Fuck the 99%.

**I picked "the bottom 40%" for no clear reason other than any lower number seemed too small.