One side benefit of our federalist system is that the US essentially has 50 experiments in democracy. States hold a lot of power, which provides an opportunity to compare the effects of different public policies. There are lots of other variables at play, such as economics, rural vs urban residents, and climate, but with so many different states, and counties within those states, researchers often have enough data to account for these variables.

While the differences among the states go beyond red state vs blue state, this is an important factor when it comes to public policy, and there is at least one fairly consistent ideological difference. Red states tend to favor policies the lean toward liberty and are pro-business. Blue states are more willing to enact public policy that limits freedom or regulates business but are designed to benefit public health. These public health policies are often denigrated by conservatives as the “nanny state” – portraying the government as a caretaker and citizens as children.

Across the 50 states there is more of a continuum than a sharp divide, both politically and in public policy, again providing a natural experiment of the effects and costs of such policies. It’s not my point to say which approach is “right” because there is a tradeoff and a value judgement involved. One bit of conventional wisdom I agree with is that in politics there are no solutions, only tradeoffs. How much freedom are we willing to give up for security, and how much inconvenience are we willing to put up with for improved health?

There is also the layer to this question of – who gets to decide? That is the crux of the conservative vs liberal approach, with conservatives believing that individuals and families should be able to make all such decisions for themselves, while liberals are more willing to have the state impose some of these decisions on the public as a matter of policy. An extension of the conventional wisdom about tradeoffs is a version of Aristotle’s golden mean – virtue (or the optimal tradeoff) is often a balance between two extremes. This is also where most people tend to fall on such issues, a reasonable compromise in the middle.

We also have a constitution and system of laws, so we can ask the general question – what is the balance of federal law, state and local law, and individual rights? This is obviously a very complex topic, but I think it is accurate to summarize the situation as the law defers to individual freedom unless the state can meets its burden of proof to demonstrate a compelling interest. What are legitimate compelling state interests?

Well, we are not just a collection of individuals, we live in a society with shared rules and resources. A company may have the freedom to market their products in good faith without interference, but the government has a compelling interest to protect its citizens from fraud or harm. A company, therefore, does not have a right to market a harmful or dangerous product, or to lie to the public. We also share the environment, so if one person or entity does something to poison the environment that can affect other people.

That is also a good rule of thumb – if the actions of an individual or company affect other people, then it becomes possible that the government has a compelling interest in protecting the public. Individuals also have some responsibility to protect themselves, which brings us back to the idea of balance. The extremes don’t work because they tend to apply an ideology absolutely, ignoring one valid principle at the expense of another, rather than balancing all valid principles.

Also, we live in an increasingly complex civilization. It’s not really feasible for each citizen to be fully responsible for every single product, service, and resource they may interact with, especially when complex technology may be involved. Imagine if you had to personally verify the safety of every food product you purchased, the integrity of every bridge you drive over, the effectiveness of the seatbelts in the car you drive or the medicine you purchase, and the qualifications of every professional whose services you need, without any help from government regulations. We don’t have to imagine too hard, because this was the world of the 19th century, and it was a nightmare by modern standards.

At the same time it would be suboptimal, to say the least, to have a government which micromanages every tiny decision of our lives. Even effective regulations become a cumulative burden. So again, there is a balance, with the optimal probably being minimalist but thoughtful and effective regulations to provide at least a floor of reliability and safety. Ideally regulations would also be evidence-based.

This gets us back to the state experiments. What does the evidence show about the burden vs effectiveness of various common public health regulations? That will be the focus of my post tomorrow.