Over the past few years adult use of e-cigs has been increasing while adult smoking has been declining. It is important to determine if there is a causal effect of e-cig use on smoking because of the known health hazards associated with smoking. An important concern with most prior studies of e-cigs and smoking is that endogeneity between e-cig use and cigarette use is ignored. One contribution of this paper is to instrument e-cig use in order to avoid this endogeneity problem. The data employed to estimate the empirical models come from the 2014-2015 Tobacco Use Supplements (TUS). The data employed in this study rely on the combined July 2014, January 2015 and May 2015 waves of the TUS. The results show that e-cig use increases the probability of a quit attempt, the probability of a quit failure and the number of quit failures. E-cig use is also found to reduce smoking by failed quitters and non-attempters. Past studies have shown that successful quitting may follow after a few years of e-cig use but the TUS is limited to a one year retrospective window, which may be too short to observe the causal effect of e-cigs on successful quit attempts. Although there is no evidence in the TUS regressions that e-cigs use affects the probability of a successful quit, the results for attempts, failures and reduction of smoking suggest that e-cigs create a path toward cessation.
What does it mean to discriminate based on health? This is an introduction to a symposium dedicated to our forthcoming book, Jessica Roberts & Elizabeth Weeks, Healthism: Health Status Discrimination and the Law (2017). It provides an overview of the articles contributed by Lindsay Freeman Wiley, Brendan Maher, Jennifer Bennett Shinall, and Jacqueline Fox. Our book, and the symposium, broadly explore the topic of healthism, a concept we repurpose to describe undesirable discrimination based on health status.
The U.S. Constitution requires that people receive equal protection regardless of their race, ethnicity, national origin, or religion, absent a compelling governmental interest. To a somewhat lesser degree, the government is prohibited from discriminating on the basis of gender, illegitimacy, and, most recently announced in the Supreme Court’s landmark Obergefell v. Rogers decision, sexual orientation. By statute, Congress has limited certain private actors from discriminating also on the basis of disability, pregnancy, genetic information, immigration status, or military affiliation. Conspicuously absent from this list of protected statuses though, is health. Should the law allow unhealthy individuals to be treated less favorably than healthy ones? Or should we recognize a new type of impermissible discrimination, that is to say, healthism?
“Healthism,” like the other “isms” that have preceded it, represents socially undesirable differentiation on the basis of a particular trait, in this case health status. So used, the term carries a pejorative meaning. But not all differentiation on the basis of health necessarily constitutes healthism. In fact, differentiating on the basis of health can be neutral and, in some cases, even desirable. Hence, our project is to distinguish the “good” health-based distinctions from the “bad,” or “healthist,” ones. This book surveys and evaluates the legal regulation of health in a variety of settings, both historically and especially in the wake of recent comprehensive federal health-care reform.
The central suggestion in this book is that the law, and, more generally, society at large, should be attuned to the pervasiveness of an under-recognized and under-theorized form of discrimination based on health status. This book stops short of offering an overarching solution to the problem of health-status discrimination across contexts. What we offer instead is a vocabulary and rubric for naming and categorizing the troubling phenomenon.
Stigma can lead to worse relative health and worse health outcomes. However, the perception of ill health itself can be stigmatizing. As part of a larger project comprehensively examining the increasing incidence of “healthism,” we examine a host of examples of normatively wrong discrimination based on health status. One of our criteria for designating a particular form of health-status discrimination normatively wrong is whether it is stigmatizing. Related criteria include whether the classification is animus-driven and whether it has the tendency to punish individuals for private conduct. Although our criteria operate in conjunction, the presence of stigma may turn what otherwise would be a socially desirable, rational reason to treat an individual differently based on health status, including health-related conduct, into an instance of healthism.
In this paper, we would apply our healthism paradigm to two examples, in which stigma is particularly salient. In the United States, two particular groups perceived as being unhealthy — smokers and the obese — face well-documented stigma. One potential source of this stigma is the belief that those individuals are at fault for their smoking or their weight and therefore should bear the risks and the costs of those unhealthy decisions. Not surprisingly then, health policymakers have singled out smokers and the obese as acceptable targets of regulation. Consider the tobacco surcharge in health insurance or the dramatic public service announcements targeting childhood obesity. Yet while smokers and the obese face heightened stigma, whether these policies that result from that stigma actually improve health is uncertain. Given that certain historically disadvantaged individuals — mainly people of color, people with disabilities, and the poor — are more likely to use to tobacco and be overweight, health policies that target smoking and obesity may pose a disproportionate burden on those populations and in so doing exacerbate existing health disparities. Through discussion of these two examples, our paper would explore stigma against individuals perceived as unhealthy and the laws and policies that are enacted on the basis of such stigma. Viewing these examples through our healthism lens reveals that such enactments may worsen health disparities, rather than improving individual or population health.
Government often chooses simple rules to regulate industry even when firms and consumers are heterogeneous. We evaluate the implications of this practice in the context of alcohol pricing where the regulator uses a single markup rule that does not vary across products. We estimate an equilibrium model of wholesale pricing and retail demand for horizontally differentiated spirits that allows for heterogeneity in consumer preferences based on observable demographics. We show that the single markup increases market power among upstream firms, particularly small firms whose portfolios are better positioned to take advantage of the policy. For consumers, the single markup acts as a progressive tax by overpricing products favored by the rich. It also decreases aggregate consumer welfare though 16.7% of consumers are better off under the policy. These consumers tend to be older, less wealthy or educated, and minorities. Simple policies therefore generate significant cross-subsidies and may be an effective tool for government to garner favor of key constituencies.
Governments are increasingly adopting behavioral science techniques for changing individual behavior in pursuit of policy objectives. The types of “nudge” interventions that governments are now adopting alter people’s decisions without resorting to coercion or significant changes to economic incentives. We calculate ratios of impact to cost for nudge interventions and for traditional policy tools, such as tax incentives and other financial inducements, and we find that nudge interventions often compare favorably to traditional interventions. We conclude that nudging is a valuable approach that should be used more in conjunction with traditional policies, but more relative effectiveness calculations are needed.
via Should Governments Invest More in Nudging? by Shlomo Benartzi, John Beshears, Katherine Milkman, Cass Sunstein, Richard Thaler, Maya Shankar, Will Tucker-Ray, William Congdon, Steven Galing :: SSRN
In the United States, about 28 lives are lost daily in motor vehicle accidents that involve an alcohol-impaired driver. The conventional wisdom is that these accidents can be prevented through the use of strict traffic laws that are robustly enforced, though no consensus exists on the causal impact of these laws in reducing motor vehicle-related fatalities. This paper exploits quasi-random variation in state-level driving and road safety restrictions to estimate the causal effect of select traffic laws on the number of fatal accidents and fatal accidents involving a drunk driver. In this paper, we employ the contiguous-border county-pair approach. This is causally identified from the discontinuities in policy treatments among homogeneous contiguous counties that are separated by a shared state border. This approach addresses the econometric issues created due to spatial heterogeneity that may have biased several studies in the literature. The analysis reveals that the laws related to accident prevention, such as having a good graduated licensing system, Pigovian beer taxes, and primary seatbelt enforcement, are the most effective in reducing motor vehicle-related fatalities. Using these estimated coefficients, simple simulations suggest that policymakers have been utilizing existing traffic laws sub-optimally, saving only 17% of the lives lost to motor vehicle crashes.
In the last few years, several local governments have adopted new soda taxes. Other localities currently are considering adopting such a tax. In this Article, we consider whether soda taxes are becoming a more common local policy throughout the country — like local smoking restrictions — or whether, instead, they will remain a limited legal phenomenon. We focus on two potential obstacles to the widespread adoption of local soda taxes: (1) policy-based objections to the taxes as regressive and unduly paternalistic, which could undermine political support for their adoption at the local level; and (2) state preemption of local taxes, often achieved at the behest of the beverage industry. As we explain later, the principal risk of preemption vis-à-vis soda taxes does not come from the state courts in the form of decisions finding implied or field preemption, but rather from state statutes that expressly, unequivocally preempt such taxes. In almost all states, such express preemption would be considered lawful by the courts and would be effective in depriving localities of the power to impose taxes on soda.