July 13, 2011

Nanny Runs Amok

Social engineering, Obamacare-style.

At a time of high-profile budget-cutting, the Obama administration continues to squander federal resources on social engineering projects. Two of the administration’s health-related grant programs show the perils of nanny-state policies run amok.

In June, the department of Health and Human Services (HHS) announced the availability of $100 million in "Community Transformation Grants," a program created by the so-called Affordable Care Act—i.e. Obamacare. These grants to local government agencies and non-profit organizations are required to use "evidence-based strategies" and have broad population impact that addresses health disparities. Examples of projects that could qualify for grants include the promotion of blood pressure and cholesterol screenings and increased access to healthy food options, including efforts to improve school nutrition and bring healthier food to corner markets in urban areas.

Obamacare social engineering
The Department of Health and Human Services (Photo credit: dbking)

The new Obamacare-generated grants "will empower communities with resources, information and flexibility to help make their residents healthier," according to HHS Secretary Kathleen Sebelius. And this presumptive improved health will result in—wait for it—savings of billions of dollars in healthcare costs. How? These grant-based projects will allegedly decrease the incidence of expensive-to-treat chronic diseases that are mostly caused by tobacco use, obesity, poor diet, and lack of physical activity.

These are worthy goals but we would argue that the government’s strategies for achieving them are wishful thinking. An examination of how the Centers for Disease Control (CDC) has apportioned funds under a similar program reveals that funding decisions are based more on ideology and intuition than evidence of a project’s effectiveness. The CDC program, "Communities Putting Prevention to Work" (CPPW) is part of a pot of $750 million funded by Obamacare this year. It will be funded in perpetuity until Congress decides to drive a stake through its heart. Like the HHS program, it requires "evidence based strategies" to fight tobacco use and obesity.

However, "evidence based strategies" are conspicuously absent from most of these CDC-administered social engineering programs. On the contrary, what evidence there is shows that some programs do not work. For others, there simply isn't any evidence to indicate that they are effective because the interventions have not been studied, making these at best extremely expensive experiments.

Here are some examples of how the funds are being used:

—$15.9 million to Pima County, Arizona, for "ensuring that residents have improved access to affordable, healthy, locally produced food through the fostering of private and community gardens, composting cooperatives, farmers markets, and food cooperatives." Using federal funds for community gardens and composting to change the way we eat is the agricultural equivalent of the kinds of congressional pet projects that led to the infamous "bridge to nowhere" in Alaska.

Whatever they choose to call it, this is a federal welfare program.

—$15 million to Philadelphia, Pennsylvania, to "make healthy foods more available and affordable by dramatically expanding the number of farmers' markets in low-income neighborhoods and by creating 1,000 healthy corner stores that sell fresh produce and water. Unhealthy foods will be removed from school stores and fundraisers, and a citywide pedestrian and bike plan will be completed." Whatever they choose to call it, this is a federal welfare program, and a heavy-handed one at that. And like other federal welfare programs, it will be prone to rampant corruption, abuse, and fraud. We will see more pedestrian paths where people do not walk, and bike lanes where people don’t bike (which, interestingly, are already found in South Philadelphia).

—$6.1 million to Boston, Massachusetts, for anti-tobacco campaigns. A portion of these funds is going to a bizarre, anti-scientific, and secretive campaign to ban the use of e-cigarettes from places where cigarette smoking is banned. E-cigarettes are tobacco-free, smoke-free devices which use vaporized nicotine to replicate the feeling and physiological response of smoking cigarettes.

The proposal is unscientific because there is no evidence to suggest that the use of e-cigarettes is any more dangerous than using nicotine gum or patches, both of which the FDA has deemed safe and effective. A ban would create a gratuitous obstacle for people who are trying to quit smoking cigarettes by replacing them with a satisfying but much less harmful product. Worse, neither the Boston Public Health Commission, which received the grant, nor the CDC which administers it, has been willing to discuss the scientific basis or rationale for an e-cigarette ban. So much for transparency and responsible governance.

The CDC’s Communities Putting Prevention To Work Program and the HHS’s Community Transformation Grants are built around something called the MAPPS intervention strategy, a set of guidelines that dictate how the funds are to be used. The "MAPPS" acronym stands for: media, access, point of decision, price, and social support/services.

An example of a media intervention is an advertising campaign to discourage the consumption of sugar-containing soda. One of the first such grants went to New York City, which ran a campaign that was anything but "evidence based." The city’s health department launched a controversial subway ad campaign last summer suggesting that the sugar in soda turns straight into fat in the human body, despite the advice of three staffers, including the department’s top nutritionist, that it does not.

These social engineering grant programs may yet have a robust future.

Soda (or sugar, for that matter) is not converted directly into fat, and such claims are both inaccurate and patronizing. But the metabolic realities did not stop the city from plastering subways with the controversial ad, apparently believing that the end justified the means. It wasn't as if the CDC—headed by former activist New York City Health Commissioner Dr. Thomas Frieden—was going to discipline the city for the campaign.

As bad as that was, the media component of MAPPS may be the least troubling of its elements. The CDC admits that the "access" component of the plan is intended not only to achieve "[a]ccess to healthy food/drink choices and safe locations to be active and improve the built environment," but also to reduce "the availability of ... unhealthy food/drinks." This embraces the false assumption that we can identify "healthy" and "unhealthy" choices when we consume food in moderation.

"Point of decision" refers to interventions such as signs that will "prompt physical activity." Just as you now see roads being built accompanied by the ubiquitous, "Your tax dollars at work" signs, you might begin to see exhortations to "WALK BRISKLY" or "DO JUMPING JACKS."

The "cost" element is perhaps the most worrisome aspect of MAPPS. Grants will be given to find ways to "use price to discourage consumption of tobacco and to benefit consumption of healthy foods/drinks." This includes using federal dollars to promote increased "sin taxes" on not only tobacco, but on certain foods. In other words, tax dollars will be used to find ways to obtain—or extort—more tax dollars from consumers who make choices the government does not like. (The U.S. Department of Agriculture recently declared war on potatoes in school lunches; could taxes on French fries be in our future?)

Finally, the "social support/services" component will be used to promote not only tobacco cessation, but breastfeeding and increased physical activity.

The political implications are as troubling as the content of the projects themselves. For instance, expect federally-funded efforts to change laws at the local level. Because it is illegal to use federal dollars for lobbying, the CDC has issued emphatic pro forma denials that the funds will be used for lobbying. But it has acknowledged that the grants are going to promote local policy changes. This reduces the meaning of the verb "to lobby" to partisan squabbling. The reality is that if conservatively-oriented non-profit organizations were to engage in the same activity, the IRS would label it "lobbying."

Rather than being based on evidence and data, MAPPS is clearly ideological. One element of the government giveaway stands out as the worst of the worst. The HHS’s Community Transformation Grants program will allot $50,000 to $500,000 to local governments and community-based non-profits for "capacity building" for projects including "community mobilization and partnership development," policy change, and funding "national experts to provide programmatic support in capacity building."

Could taxes on French fries be in our future?

In other words, these federal government grants will create the infrastructure for local political support of, say, an ostensibly grassroots campaign to ban menthol cigarettes or to increase subsidies for organic farming. These programs would be unlikely to gain traction without the money. "Lobbying" sounds like a polite word for this ham-handed politicking.

Another aspect of these programs deserves comment. In government, personnel choices are tantamount to policy choices. In that regard, the person appointed by President Obama to decide how to spend billions of dollars of these highly discretionary funds, CDC Director Dr. Thomas Frieden, is an understandable but terrible choice.

Frieden may care about making us healthier but his approaches are extreme, paternalistic and unproven. As commissioner of public health in New York City, he meddled endlessly and treated city-dwellers like lab rats, experimenting with a ban on trans-fats and even a campaign to reduce the amount of salt that chefs could use in the city's vaunted restaurants. What is the legacy of Frieden’s trans-fat campaign? Trans-fats have been replaced with other highly saturated fats—which many consumers mistakenly assume are healthful to eat. Frieden so sensationalized the risk of trans-fats that you cannot go to a supermarket without seeing items such as sugar-laden iced tea marketed as "trans-fat free." (This is arguably a violation of federal regulations that prohibit "false or misleading" labeling even if it is strictly accurate.)

Some argue that because the taxpayers are now paying for health care, the government has the right to tell people how to live. But those of us who believe in individual freedom consider that to be more of an argument against a single-payer health care system than one in favor of nanny-statism—especially when the nanny state’s programs are implemented even when they don't work.

The Republican House of Representatives voted in the spring to defund the Obamacare-based grants, but the Democrat-controlled Senate has not followed suit. These social engineering grant programs may yet have a robust future. As economist Milton Friedman used to say, "Only in government do we see something that doesn’t work and decide it needs to be expanded."


Henry I. Miller, MS, MD, is the Robert Wesson Fellow in Scientific Philosophy and Public Policy at the Hoover Institution. His research focuses on public policy toward science and technology encompassing a number of areas, including pharmaceutical development, genetic engineering in agriculture, models for regulatory reform, and the emergence of new viral diseases.


Jeff Stier is a Senior Fellow at the National Center for Public Policy Research and directs its Risk Analysis Division.


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