Medium-Handed Public Health

Ezra Klein has his doubts about using public policy to try to improve the healthiness of American lifestyle:

Meanwhile, the reason doctors are constantly prescribing statins along with admonitions to exercise and eat better is because using public policy to change diet and exercise habits is really, really, really hard, unless you're prepared to be very heavy-handed (i.e, outlawing trans fats in restaurants, setting portion limits, etc).

I'm not so sure about that. The sense that public policy won't work here seems to me to be driven by a failure to look at things at the margin. I have absolutely no idea what kind of reasonable policy measure would get 90 percent of Americans to engage in 30 minutes of vigorous aerobic exercise per day, but I think it's pretty easy to think of policy measures that would somewhat increase people's propensity to walk or ride a bike rather than drive their car. These things -- a carbon tax, say -- would be politically difficult to achieve, but so would comprehensive reform of the American system of health care finance. They would also achieve important goals related to climate change.

What's more, while I don't have a good twenty point plan to link to off the top of my head, that's in large part because there isn't this army of diet-and-exercise policy wonks at DC's think tanks churning out the policy papers. The progressive policy community is awash in health care finance ideas because that's what donors have decided to fund. At some points years ago, someone or other decided to put a lot of emphasis on getting people to stop smoking, and they've proven over the years to be quite creative about dreaming up and endless series of ever-more-restrictive policies to push for, each of which is sufficiently mild on its own terms as to be capable of securing political support.