Since our founding in 1978, ACSH has stood for evidence-based science and health in combination with free markets and individual liberty. This is why, for instance, we favor providing relevant nutritional information to consumers but oppose meddlesome policies, such as soda taxes. We feel that an educated public should be free to make its own decisions without politicians micromanaging our behavior.
Occasionally, however, our guiding principles encounter intractable problems. Two of the biggest such problems today involve public health: Vaccination and mental health treatment. The laissez-faire approach simply does not work. The underlying reason for both is that an individual's choices have extremely serious consequences for everyone around him. In the language of economics, a person's decision in regard to vaccination or mental health creates externalities.
The Case for Mandatory Vaccines
The externalities created by society's failure to be fully vaccinated are readily apparent. Once-eradicated diseases, like measles, have come roaring back. If these diseases were restricted only to those people who choose not to vaccinate, then there would be no reason to mandate vaccinations. But that is not the case. Young children and the immunocompromised cannot receive vaccines and must be protected indirectly by all those around them. This is known as "herd immunity," and it fails when an inadequate percentage of the population is vaccinated. Besides, vaccines are imperfect and can wear off over time, further strengthening the case for mandatory vaccinations for all those capable of receiving them.
Many people are uneasy with this violation of civil liberties. They say, "You cannot tell me what to do with my own body," and they claim that only an aspiring dictator would even think otherwise. What a silly argument. Dictators are occupied solely with accumulating power for themselves, not in protecting public health. Besides, society can tell you what to do with your own body: You are not allowed to walk outside without wearing clothes or operate a moving vehicle while intoxicated.
Our position on this issue appears to be slowly winning. Public health laws are tightening across the country. For instance, states are making it harder to obtain vaccine exemptions. New York City mandated vaccines in neighborhoods hit hardest by a measles outbreak.
If these policies are too "dictatorial," then perhaps laws should be modified so that when an unvaccinated person infects someone else, he is held liable for healthcare expenses. Alternatively, Ethan Siegel and I proposed a (somewhat unorthodox) solution: Unvaccinated people should be shunned by society. If a person doesn't wish to play by society's rules, then the rest of us should exercise our First Amendment right to freedom of association. And we choose not to associate ourselves with people who selfishly endanger the most vulnerable among us.
The Case for Mandatory Mental Health Treatment
The other major health crisis society is facing is an epidemic of homelessness. Homelessness has many causes, but two are particularly troublesome: Mental illness and drug addiction. The reason is because these afflictions cause the people who suffer from them to lose touch with reality and, ultimately, the ability to care for themselves.
Just like with vaccines, the externalities created by society's failure to properly address mental illness and drug addiction are readily apparent. Outbreaks of medieval diseases are occurring in the downtown area of major cities. Human waste and hypodermic needles litter the streets. Crime often increases. (Homeless people are regularly victims, not just perpetrators, of crimes.) Those who have lost rationality often behave dangerously, from walking into traffic to accosting strangers. To put it bluntly, homeless camps serve as ticking time bombs, not just of infectious disease but of urban blight.
San Francisco has had enough. By a vote of 10-1, the city decided to consider a policy in which homeless and/or mentally ill drug addicts are forced into treatment. In 2019, this is considered controversial, but this is precisely what the United States used to do prior to mass deinstitutionalization in the 1950s. There is now open discussion about whether it is time to bring back such facilities across the nation. In San Francisco, fewer than 100 people would qualify for the involuntary treatment program the city is examining.
This policy may be met with even more resistance than mandatory vaccinations. But we must keep in mind that free markets and the notion of individual liberty are predicated upon the belief that humans are rational and responsible. Once rationality and responsibility no longer factor into a person's thinking, society must consider intervening, not just for the good of the individual but for the protection of society as a whole. An overriding concern for the welfare of all human beings is the hallmark of a compassionate democracy, not a would-be totalitarian state.
