Too many choices!Economic libertarians are wedded to choice believing that people should be given free rein to make bad choices as well as good – by smoking, for example, or failing to take out a pension plan. Once they have had time to rationally calibrate the costs and benefits, they will realise that bid choices lead to suffering, and change their behaviour. But this is wishful thinking. Generally, I believe human beings consistently underestimate the future costs of their actions, choosing instant gratification instead. Self control is especially hard in affluent societies, where temptation abounds. Hence the obesity epidemic we are faced with so much cheap, tasty food that it becomes impossible to resist, even when we know it will make us fat. This is why, increasingly, people are looking to the state to help them make better decisions. Smokers have willingly submitted to greater and greater regulation, now consumers want the Government to rein in the junk food industry. Libertarians duly rage against the nanny state, but we increasingly run to it for protection – from ourselves.

Nowhere is this more apparent than in the UK where we have a worldwide reputation for poor health, thanks to our well publicised fondness for warm beer, cigarettes and deep fried fish and chips. But according to an extensive survey published in the Journal of the American Medical Association, us Brits are actually in better shape than the Americans. Among US citizens aged 55 or over, the likes of cancer, diabetes and heart disease are almost double those in Britain. Even more galling is the the fact that Americans spend $5,200 per capita for health care every year – whereas the British spend just $2,100.

The question is why as some may be tempted to interpret this study as a vindication of socialised medicine, since Britain provides health care free of charge to all its citizens. But that conclusion is debatable when you look more closely at the data. The study actually shows that the wealthiest and best educated Americans – those with access to the best health care – have rates of disease that are comparable to the poorest Britons. The problem, in other words, is not lack of access to doctors. It may be, however, that Britain’s universal health care system puts more of an emphasis on public health and early detection, whereas the profit-driven US system tends to treat diseases without systematically looking to prevent what causes them. Americans need to figure out what they’re doing wrong, otherwise the human and economic costs of their failing health could burden them for decades.

The answer may lie outside the medical care system altogether. Americans exercise less than us Brits and get more nutrition from heavily processed foods – but even after adjusting for differences in rates of obesity, smoking and alcohol consumption between the two nations, the disparities were still stunning. A plausible culprit is different attitudes towards work in our two cultures. The British are far less obsessed with their careers, reserving much more of their time for leisure, their friends at the pub, and family. Americans work harder and longer and take greater risks in switching jobs and starting companies. The benefit of such a vigorous culture is obvious: a more dynamic economy. But the price is relentless, grinding stress means Americans are literally be working themselves to death.

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