So why did I just go off on a big tangent?

Well, of course it's partly just topical rage at the idiocy of the political discourse coming from the right and channeled by the corporate media with full aiding and abetting by the clown college called academic economics. But, when it comes to our main obsessions here -- public health, that is health promotion and disease prevention at the level of populations -- and reform of the medical institution -- economic orthodoxy is even more pernicious than it is when discussing the best way to meet society's need for plastic furniture covers.

Public health is, essentially, a public good and one big externality, more or less by definition. It is true that the market does provide most Americans with adequate protein and calories -- to say the least -- and other stuff without which we would be people of deadness; but when it comes to public health, what we mostly find ourselves doing is figuring out how to fix the market, or act entirely outside of it, to achieve social welfare that it cannot possibly provide. Public health, indeed, is very nearly co-extensive with all that which lies outside of the market, which I have described over the past few days: limiting harmful externalities, reducing inequality, giving people information, producing underproduced social goods, maximizing social capital, and all that good stuff. Some of the most powerful and cost-effective public health interventions consist of directly attacking the pernicious effects of the market, as by, for example, taxing tobacco and limiting food advertising to children. Occupational health and safety regulations, universal public education, consumer product safety regulation, food labeling laws, nutritional support for poor children and families -- all that stuff that conservatives call communism -- is what public health is all about.

Of course, it isn't communism. I asked my sociology class a few years back to define "communism," since people bandy the term about quite a lot, and one student told me that according to this father, the Boston Globe is a communist newspaper. Sometimes, I wish. I don't mean to embarass anyone, but we had a commenter here a few days ago who maintained that the collapse of the Soviet Union discredited Keynes. I can assure you -- and I know the good people at the Cato Institute will back me up -- that John Maynard Keynes was not a communist. (He was, however, a homosexual, which I understand is nearly as bad. He nevertheless had a happy marriage of convenience to a beautiful ballerina. History is so fascinating.) Nor did the Soviet Union practice Keynsianism. It's rather like claiming that the precession of the equinoxes proves that Jupiter is made of Jello. All you can is "Huh?" Still, this is the rhetorical world we inhabit.

Communism is a rather quaint idea these days and not something you need to worry about unless you are planning a trip to North Korea. Nonetheless we do still have to worry about the "S" word. I'll say a bit about that soon.