Abstract
Many people have insisted on an opposition between active choosing and paternalism, and in some cases, they are right to do so. But in many contexts, the opposition is illusory, because people do not want to choose actively. Nanny states forbid people from choosing, but they also forbid people from choosing not to choose. If and to the extent that health insurers, employers, hospitals and doctors forbid that choice, they are acting paternalistically, and that particular form of paternalism might be unjustified. It is true that active choosing has a central place in a free society, and it needs to play a large role in the health care system. But for those involved in that system, as for everyone else, the same concerns that motivate objections to paternalism in general can be applied to paternalistic interferences with people’s choice not to choose. These points have implications for health insurance, for food safety, for wellness programs, and for the idea of "patient autonomy."
Highlights
Consider the following problems: 1. A private company is deciding among three options: to enroll people automatically in a health insurance plan; to ask them to opt in if they like; or to say that as a condition for starting work, they must indicate whether they want health insurance, and if so, which plan they want
Rev. 1 (2013), and in particular the discussion of learning over time
Summary
Consider the following problems: 1. A private company is deciding among three options: to enroll people automatically in a health insurance plan; to ask them to opt in if they like; or to say that as a condition for starting work, they must indicate whether they want health insurance, and if so, which plan they want. Many of those who embrace active choosing believe that consumers of goods and services, and choosers of all sorts (including patients), should be free from government influence, or perhaps from the influence of private institutions of all kinds.[15] they recognize that in markets, producers will impose influences of multiple kinds, but they contend that when third parties are not affected, and when force and fraud are not involved, government should remain neutral They reject paternalism.[16] Perhaps it is legitimate to provide accurate information, so as to ensure that people’s choices are adequately informed. Hospitals, or doctors seek to “nudge”[17] people in its preferred directions in other ways – by imposing default rules or embracing paternalism of any kind – it is exceeding its appropriate bounds
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