Sick Cure
Mark Weston at Global Dashboard has a plan to reduce the spread of AIDS, based on a proposed World Bank scheme to fight sexually transmitted diseases in Tanzania. It’s simple: give cash rewards to those who test negative,
The Bank will pay 3,000 Tanzanians $45 – good money in Tanzania – if they regularly test negative for sexually transmitted infections (though not HIV, which is more expensive to test for but for which diseases like gonorrhoea are a good proxy).
Weston thinks the initiative should be expanded to deal with AIDS. He writes,
You might think that not dying of AIDS would be reward enough for practising safe sex. In an environment where people have little to hope for, however, and thus no reason to make plans, you’d be wrong.
Weston means well, of course. But this is surely a wrongheaded and very dangerous idea. They may call it “reverse prostitution” at the World Bank, but it’s more like reverse charity: give alms to the healthy, turn away the sick. (Weston does not mention what happens to the poor African who tests positive, but he or she must be punished for the scheme to work). Surely it is in fact AIDS sufferers who need financial help the most? Would the money not be better spent on anti-retroviral drugs for people who are actually dying?
There is, moreover, something deeply sinister about this particular brainwave. The notion of rewarding the fit and punishing the diseased carries a strong whiff of the Third Reich. Indeed the idea amounts to a sort of monetary eugenics. It’s just like recent plots in the UK to punish smokers who refuse to quit by banning them from treatment, or turning fatties away from hospitals because they won’t stop being obese. Only it’s worse.
“The notion of rewarding the fit and punishing the diseased carries a strong whiff of the Third Reich. Indeed the idea amounts to a sort of monetary eugenics.”
The very same thought occurred to me even before I got to that last paragraph. Such a course of action could ultimately prove to be a very slippery slope down the line.
If governments and related institutions start rewarding only the healthy citizens, who gets the power to determine what being “healthy” entails? Many evil regimes have treated principled dissenters as “mentally ill” and locked them away under the pretense of medical care.
Freddy Gray wrote: “Weston does not mention what happens to the poor African who tests positive, but he or she must be punished for the scheme to work.”
Wait a minute: Why? Unless you define “punishment” as simply “not getting the reward.” And as you averred Weston said absolutely nothing about any punishment.
I don’t know if his scheme would work or not or if there isn’t some more efficient use of the dollars or whatever, but I don’t see how you say this.
Nor do I see anywhere else the grounds for your the first half of your argument that “this is surely a wrongheaded and very dangerous idea.”
*Maybe* dangerous if you count the potential slippery-slope down to Naziism, true. (Although even then it’s hard to name *any* idea that one can’t find at least some potential downward slippery slope to attach to it, right? E.g., “let government prosecute murderers and pretty soon it will be allowing some murderers to go free!”)
But how then is Weston’s idea “surely wrongheaded” in terms of surely not working? I see nothing in your comment even attempting to tell us why this would be so.
Indeed, kind of funny to see in a “conservative” magazine an argument against rewarding *responsible* behavior. Not that I don’t think responsibility has its own rewards. (Albeit being only microscopically true anymore.) But hasn’t it been modern *conservatives* above all who have trumpeted the economists’ idea that paying for irresponsible behavior just got you more irresponsible behavior? And that it was morally suspect as well?
E.g., back in ’70′s, ’80′s and ’90′s wasn’t it conservatives who led the charge against welfare paying more to a woman just because she had birthed another child on the grounds that all this did was encourage poor women to have more children?
I dunno about Weston’s idea Mr. Gray but now that you’re into it I’d sure appreciate hearing whether on reflection you think that maybe it isn’t as flawed as you first thought. I appreciate the idea that maybe the money would be better spent on drugs for the ill, but on the other hand hasn’t one of the tenets of conservatism been that money spent directly on individuals to solve problems is generally better than money first spent (and stolen and skimmed and etc.) on inefficient governmental bodies who only then indirectly are supposed to aid those individuals and who often bungle that job rather spectacularly?
Seems to me a somewhat newish kind of idea from the World Bank and Weston and God knows enough money has been wasted on old ones, no?
TomB, you are right: punishment was perhaps the wrong the word, there. But on reflection I still believe the scheme is a bad one. I see your point about welfare– rewarding people for irresponsible behavior is bad policy–but I don’t think that the reverse is necessarily true. I also believe there is something slightly patronizing– racist, even — in the suggestion that the only way to stop black people from fornicating wrecklessly is to offer them a cash rewards. AIDS is a trickier challenge than that.
Hi Freddy;
Yeah I don’t like having to reward what people ought to be doing anyway, but conservatives of all people at least believe that people act with some basic economic rationality, right? And geez, when it comes to public health crises, well, haven’t people *always* thought that extreme measures are necessary just due to the nature of such things? E.g., quarantines and etc.?
I didn’t really think of the racial angle; like I say the economics background in me just assumes that whether you’re white, black or purple people in general are gonna respond rationally. And my God when you read about the swath that AIDS is cutting through some of those African countries not doing or trying everything and anything for those poor folks might equally be thought racist. (Plus, if whoever thought the idea was racist could of course just refuse the money of course.)
One thing: You gotta admit one benefit of the idea (to the extent it worked) is that whereas so far AIDS drugs don’t cure same you aren’t really stamping it out, are you? I.e., with the drugs we have nowadays you may be extending the life of those with the disease, but they are still spreading it, right? (Albeit perhaps with the drugs lessening just how contagious they are, I just don’t know, but I believe they are still at least a little infectious.)
But if it would work to pay people to not get infected in the first place, well that’s a whole different and more wonderful ball game it seems to me, right?
I dunno though: Would you even be against a test program? Seems to me not so terrible an idea. And boy if it worked would be damned hard to argue against it then, wouldn’t it?
Gotta also compliment your sharp eyes for spotting something new and so interesting like this and mentioning it. It’s easy to forget just how terrible that disease still is especially in Africa.
Cheers,
“The notion of rewarding the fit and punishing the diseased carries a strong whiff of the Third Reich.”
Not so much. This is more like a reward for good behavior. People don’t choose to be mentally retarded, but they do choose to engage in the behaviors that lead to HIV infection.
I do however disagree with this approach on the grounds that this scheme dismisses the idea that judicious behavior should its own reward.