Latest / CareTalk: Healthcare. Unfiltered. / Measles, Mandates, and Misinformation w/ Michael F. Cannon

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Measles, Mandates, and Misinformation w/ Michael F. Cannon · CareTalk: Healthcare. Unfiltered.

• 0:00
  David: Hey, remember measles, which was eliminated back in the US in 2000?
• 0:04
  David: Well, it's back again with hundreds of new cases in Texas and beyond.
• 0:09
  David: What role are government leaders playing to combat this outbreak and what should they be doing?
• 0:22
  David: Welcome to CareTalk, America's home for incisive debate about healthcare, business, and policy.
• 0:27
  David: I'm David Williams, president of Health Business Group.
• 0:29
  David: And I'm John Driscoll, the chairman of Yukon Health.
• 0:32
  David: Today's guest is Michael F. Cannon, director of Health Policy Studies at the Cato Institute, and he's been called the most famous Libertarian health scholar, and he's also been named one of Washington DC's most influential people by the Washingtonian Magazine.
• 0:47
  David: Michael, welcome to CareTalk.
• 0:49
  David: Great to be here.
• 0:52
  John: So Michael, how are you feeling about, uh, the, the state of, of libertarianism in America right now in this.
• 0:59
  John: Odd circumstance, in which case we've got a, a government that's conservative.
• 1:04
  John: And before we get into to the healthcare policy piece, maybe talk a little bit about what Cato and Li Libertarianism means and then we can just maybe talk about what your view of that is and then, and then get into measles and are interesting somewhat quixotic approaches to health policy.
• 1:24
  Michael: Sure.
• 1:24
  Michael: So, uh, the Cato Institute is a libertarian think tank in Washington dc.
• 1:30
  Michael: We've been around since 1977, started in San Francisco, moved to DC in the early eighties.
• 1:35
  Michael: And, uh, when we say libertarian, what we mean is really simply that we think you should be able to live your life however you want, so long as you respect the equal rights of others to do the same.
• 1:48
  Michael: This doesn't sound controversial at all.
• 1:50
  Michael: Uh, it sounds very, you know, egalitarian and respectful of other people and how everyone should strive to live their lives.
• 1:57
  Michael: But here in Washington, DC that is an extremely controversial, uh, uh.
• 2:03
  Michael: Political philosophy because here in why Washington DC we, we seem to attract all of the paternal who want to be able to take your money and take your freedom and tell you how to live your life, uh, in accordance with their values rather than yours.
• 2:17
  Michael: And so we have, uh, two tribes in Washington, uh, uh, two political tribes around the country.
• 2:24
  Michael: One is the Republicans, the other is the Democrats.
• 2:26
  Michael: You said that, uh, we have a conservative administration.
• 2:29
  Michael: It's sort of.
• 2:30
  Michael: Not or changed what conservative means.
• 2:32
  Michael: I think, uh, and, and when each party, uh, takes power in Washington, we get the government trying to run your life in different ways than it did before and may and, and.
• 2:46
  Michael: Neither of them.
• 2:46
  Michael: Never, ever, and they succeed, uh, generally speaking, in trying to, uh, chip away at, uh, at, at your freedom.
• 2:54
  Michael: And it's rare that we see some gains for freedom, like, especially not the rolling back of any incursions on your ability to make those, uh, choices about your own life.
• 3:05
  Michael: But what we try to do at the Cato Institute is always provide a consistent voice for that philosophy.
• 3:13
  Michael: That I, uh, uh, that I explained as, uh, one of individual freedom where you get to live your life however you want, as long as you're not violating other people's rights and, and, and do that regardless, provide that perspective regardless of who's in power.
• 3:30
  Michael: And so during, if I'm.
• 3:34
  Michael: Famous for anything.
• 3:35
  Michael: It's for the role I played in getting states not to enact the, uh, or, or implement the Affordable Care Act and trying to beat back Obamacare and so forth.
• 3:44
  Michael: Uh, I did that during, uh, democratic administrations and Republican administrations.
• 3:48
  Michael: But, uh, uh, I've also criticized, uh.
• 3:52
  Michael: Republican administrations for, uh, implementing the, uh, Medicare Part D uh, prescription drug benefit for, uh, increasing spending on Medicare Advantage because, uh, these things expand government at the expense of people's freedom.
• 4:09
  Michael: And now I find myself, you know, with a second Trump administration.
• 4:13
  Michael: The most paternalistic pro-regulation, uh, and maybe even un or a scientific, uh, secretary of Health and Human Services that we've ever had in this country.
• 4:24
  Michael: Criticizing a Republican administration again for its, uh, uh, uh, decisions in various, uh, when it comes to public health and in, uh, various areas, but in all, uh, uh, throughout it all, we try to provide that.
• 4:40
  David: So Michael, um, it sounds like it's been difficult to get more freedom for individuals, but, uh, measles seems to have an opportunity to run free, uh, at the moment after being caged up for a while.
• 4:49
  David: What,
• 4:53
  Michael: so, uh, last, uh, I checked, uh, uh, an outbreak that began in Gaines County, Texas, uh, had sickened.
• 5:01
  Michael: More than 200 people, or, or at least there are more than 200 cases.
• 5:05
  Michael: And measles is so contagious that we knew, we have to assume that it is, uh, infected hundreds more.
• 5:13
  Michael: And, uh, and, and it, it has led to two deaths.
• 5:17
  Michael: One of, uh, an adult who had not vaccinated and one of a 6-year-old child who had not vaccinated, uh, against measles.
• 5:26
  Michael: And, um, uh, this was a. This happened in an area of Texas where there's a lot of vaccine hesitance.
• 5:37
  Michael: Uh uh, that, uh.
• 5:39
  Michael: You can see in numbers such as the following.
• 5:42
  Michael: There was one school district in, uh, Gaines County, Texas, where the share of children who had, uh, secured an exemption for vaccination for reasons of conscience or religious reasons, was you, you'll often see, usually it's in the low single digits.
• 6:00
  Michael: In some areas, it'll, it might reach the double digits, 12, 13%.
• 6:05
  Michael: In this one school district, it had reached four, almost 48%.
• 6:08
  Michael: So almost half of the students in, in the government schools, uh, were not vaccinating in this one district.
• 6:15
  Michael: And the numbers, uh, in, um, uh.
• 6:19
  Michael: We don't have data on the number of homeschooled kids who are not vaccinated, but homeschooling is pretty prevalent out there and we have to assume that, uh, comparable shares of homeschooled kids were not vaccinating in that sort of an environment where you have that much vaccine hesitancy.
• 6:33
  Michael: I may people have not vaccinated against measles.
• 6:36
  Michael: It's gonna.
• 6:39
  John: Contagious and then the, and then in herd immunity, which is the way most people think about the way vaccines are successful in this particular disease, you've gotta hit 80 to 90%.
• 6:50
  John: Vaccination rate in order to actually be protective of the population.
• 6:54
  John: So I, I, I guess that that naturally leads me, Michael, to how do you balance the respect for individual choice?
• 7:03
  John: I mean, America was based on freedom and to your point, both administrations.
• 7:07
  John: Pick the freedoms they wanna protect and pick the and, and, and, and, and then chase the ones they wanna restrict.
• 7:13
  John: Um, I think that's, there, there's, there's plenty of cases of that, but we were, America was based on the pursuit of individual choice, freedom, and independence.
• 7:22
  John: How do you balance that, uh, from a Cato perspective with the, the need to protect the population?
• 7:28
  John: How do you, how do you think about that from a policy perspective as well as a rights perspective?
• 7:33
  Michael: So I think.
• 7:35
  Michael: Uh, answering that question requires beginning with what do we mean by, uh, freedom and what do we mean by rights and, uh, uh, protecting these things.
• 7:46
  Michael: Uh, when we talk about freedom, what we're talking about is the, uh, absence of any physical coercion by, uh, another human being.
• 7:55
  Michael: So we don't have other people telling us, uh, using either, uh, fraud or force to overcome our will and coerce to, uh, to carry out their will.
• 8:06
  Michael: That's what we mean by freedom.
• 8:07
  Michael: And we talk about rights.
• 8:08
  Michael: What we mean by rights is that we have a sphere of, of activity where it is wrong for someone else to introduce that sort of, uh, fraud or physical coercion in order to get us to behave the way that they want.
• 8:24
  Michael: So what does it mean to protect these things when it comes to something like measles in public health?
• 8:30
  Michael: Well, measles, we're talking about a, a dangerous and contagious disease, a virus or a bacterium.
• 8:38
  Michael: Uh.
• 8:39
  Michael: Some of these, uh, little buggers can be as deadly as a bullet or a bleed.
• 8:45
  Michael: Smallpox had an infection fatality rate of 30% before we eradicated it from the planet.
• 8:51
  Michael: And, uh, measles has a much smaller infection, fatality rate, but it can be, uh, it's still a pretty violent, uh, bug because it can, uh, uh, cause a lot of pain.
• 9:03
  Michael: It can cause brain swelling.
• 9:05
  Michael: There are other complications.
• 9:06
  Michael: Um.
• 9:07
  Michael: Uh, other than death, uh, but it does re uh, result in death in some small percentage of cases and in a couple of cases now in, in Texas.
• 9:16
  Michael: So, so protecting our, our freedom is not it when it comes to these sorts of issues.
• 9:23
  Michael: It's not just about protecting our freedom from government, it's also about protecting us from being from.
• 9:29
  Michael: Literal physical assaults, uh, by people who are maybe unwittingly carrying a dangerous pathogen.
• 9:37
  Michael: So, uh, the balancing act that you're talking about is, is i I a balancing act is the right way to think about it.
• 9:43
  Michael: The reason we have government, and the reason why libertarians are not anarchists is because we want there to be a government that protects our.
• 9:52
  Michael: Our, our right to be free of coercion by other people.
• 9:56
  Michael: That includes being mugged on the street, uh, being assaulted, uh, by someone's fist or by being assaulted by a deadly pathogen.
• 10:05
  Michael: There is a legitimate role for government to stop that sort of violence that people might do to each other, just like any other sort of violence.
• 10:14
  Michael: And the, the way the tools the government uses to do that are gonna be different, of course, but.
• 10:20
  Michael: Uh, they involve, uh, but when the government, um, uh, the balancing act that you're talking about, I think looks like this, we should judge whether it's, uh, permissible for government to intervene in public health matters by whether the government is reducing the net amount of violence in society.
• 10:44
  Michael: So if the government imposes a broad based tax.
• 10:47
  Michael: Uh, uh, that tax is gonna involve some measure of coercion because if you don't pay the tax, they fine.
• 10:53
  Michael: You, you don't pay the fine.
• 10:53
  Michael: They drag you to court.
• 10:54
  Michael: They don't, still don't pay the fine.
• 10:56
  Michael: They put you in jail.
• 10:56
  Michael: And if you try to leave the jail, they'll shoot you.
• 11:00
  Michael: Everything the government does is backed up by, uh, uh, violence and threats of violence.
• 11:03
  Michael: We saw that during CO. Uh.
• 11:07
  Michael: But that's a relatively, a relatively small amount of coercion, uh, especially if it's a very small tax that would just fund a public education campaign encouraging people to vaccinate against measles.
• 11:19
  Michael: That tiny amount of, uh, of coercion that the government introduces could.
• 11:24
  Michael: Avoid or eliminate a much worse evil, which is, uh, the, the sort of violence that people would do to each other by spreading measles if they didn't vaccinate, um, and, and achieve herd immunity, as you say.
• 11:38
  Michael: I think the balancing act the government needs to do is, uh, find what is going to.
• 11:45
  Michael: Minimize, not just reduce, but minimize the net amount of, uh, violence in society and, and do just that amount of public health, um, research, education, uh, and hopefully, you know, even subsidizing things like vaccination before you get to anything that is directly coercive, uh, toward the vaccine, hesitant like mandates, which can often backfire.
• 12:08
  Michael: Uh, and, uh, and, and maybe even, um, uh, it.
• 12:13
  Michael: Inhibit or, uh, frustrate public health efforts rather than
• 12:22
  David: Let's talk about how things have changed as it relates to vaccinations.
• 12:25
  David: So, measles vaccinations, so like, turn back the clock and when measles vaccine was introduced, people you know, knew about measles.
• 12:34
  David: They'd seen it maybe the, you know, firsthand within their own family or, or themselves.
• 12:37
  David: And if you'd say that, uh, there's a vaccine available, it's effective.
• 12:42
  David: People would use it.
• 12:43
  David: It wasn't that much coercion.
• 12:44
  David: There was education and so on, and you know, people did it willingly.
• 12:48
  David: You.
• 12:48
  David: If you fast forward to where we are now, there's a couple things that have changed.
• 12:51
  David: One, most people hadn't seen measles since it was eradicated a long time ago.
• 12:55
  David: And then there's also, um, the, you've got also the hesitancy that's partly drawn because there's actually businesses that thrive.
• 13:04
  David: On, on stirring up controversy, I'm talking about social media.
• 13:08
  David: Um, and you've got kind of a cultural change in that direction.
• 13:11
  David: So you need, in a way, if you're gonna achieve the herd immunity, you didn't need any coercion really at the beginning.
• 13:18
  David: But now there's actually more effort that's probably required by somebody, presumably the governments, in order to, uh, overcome both the concern about, Hey, I don't need to worry about measles in the first place.
• 13:28
  David: And then things that are stirred up.
• 13:30
  David: On social media and elsewhere that might be opposing it.
• 13:33
  David: And now, I guess in the government itself,
• 13:35
  Michael: I don't think you need coercion when it comes to measles.
• 13:38
  Michael: I'll get to why in a moment.
• 13:40
  Michael: Uh, if you look at the history of, uh, of measles in the United States, prior to the introduction of the vaccines, uh, the measles vaccine in the 19 early 1960s, uh, you had about three or 4 million, um, uh, people.
• 13:56
  Michael: Getting infected with measles per year and about a half a million diagnoses, yet almost 50,000 hospitalizations and about four or 500 deaths per year.
• 14:08
  Michael: Uh, but that dropped precipitously, uh, by 90 some percent within just a few years of the introduction of the vaccine.
• 14:15
  Michael: These vaccines are incredibly, um, uh, effective and beneficial, 97% protection against, uh, against measles infection.
• 14:24
  Michael: In fact, the Lancet just did a study of, of, uh, about 14, uh, or vaccines for 14 diseases, a and the number of lives they've saved since 1974.
• 14:35
  Michael: And this doesn't even include the smallpox vaccine.
• 14:37
  Michael: Maybe we'll talk about that in a moment, but.
• 14:41
  Michael: The, the researchers estimated that these va 14 vaccines against 14 pathogens have saved about 150 million lives, and about 60% of those gains came from the, from measles vaccines.
• 14:53
  Michael: So, so these vaccines are incredibly, uh, uh, uh, effective.
• 14:58
  Michael: They are the only way we have to, uh, prevent, uh, measles infection.
• 15:04
  Michael: And it's also important to, uh, be clear about what we mean when we say that they, uh, um.
• 15:11
  Michael: Ended measles in the United States.
• 15:12
  Michael: I mean, they didn't quite, uh, we have to be precise in our language here.
• 15:16
  Michael: They didn't quite eradicate measles, the.
• 15:19
  Michael: Uh, the smallpox campaign eradicated smallpox.
• 15:23
  Michael: Smallpox exists nowhere on earth except for in some laboratories right now.
• 15:28
  Michael: Measles still circulates in a lot of countries, but it was eliminated in the United States because there were no ongoing infections, uh, ongoing outbreaks in the United States.
• 15:38
  Michael: It wasn't getting passed from, uh uh.
• 15:42
  Michael: It wasn't, it was no longer, uh, uh, constantly present in the United States.
• 15:47
  Michael: It only ever, uh, there were only ever outbreaks that someone traveled to another country and brought it to the United
• 15:54
  John: States.
• 15:55
  John: I wanna just push that on that, because you're raising a, you're a really interesting.
• 16:00
  John: Balancing point on rights.
• 16:01
  John: It's, it's, it's encouraging that your description of rights and responsibilities, uh, you, you raised a real, a lot of interesting points, but there was actually an outbreak in the Philadelphia school system about 20 years ago when.
• 16:15
  John: They actually, the city of Philadelphia, uh, permitted, uh, within a, a subset of the school system, a pretty substantial amount of religious exemptions, vaccine hesitancy, fear of, of institutions is a common issue around the world.
• 16:32
  John: But that, that, that sort of emerged as a, a trend.
• 16:36
  John: Briefly in the Philadelphia school system where they backed off of mandatory vaccines, they had an outbreak.
• 16:42
  John: Kids got very, very sick, and the only way they reversed it was by enforcing the mandate that in order to go to public school, you really had to be, you had to be vaccinated.
• 16:53
  John: Um.
• 16:54
  John: How do you think about that from a, a libertarian perspective?
• 16:57
  John: And then I'd like to probe on your point about how we need to combat both coercion and, and, and sort of fraud.
• 17:06
  John: But let's, let's stick with measles for the moment and imagine a world where this, this outbreak gets worse, um, in New Mexico, in Texas, or other areas of the country.
• 17:18
  John: How would you.
• 17:19
  John: What, what's the simplest way to articulate to the vaccine?
• 17:23
  John: Hes or someone who just genuinely believes, okay, it's my right to, to, uh, to make decisions over my own body.
• 17:31
  John: What's the simplest way to, to, to make the argument that government or public health authorities should enforce some element of a mandate?
• 17:41
  Michael: Uh, I'm not sure that there is a, a good argument for, uh.
• 17:47
  Michael: Uh, for mandates.
• 17:48
  Michael: I, I think they can be effective, but they can also lead to, uh, a backlash.
• 17:53
  Michael: Uh, the mandates or, or the requirements, I won't call them mandates, to vaccinate against covid, I think led to a backlash because, uh, uh, where a lot of people trust public authorities a lot less now than they did, in part because a mandate says, uh.
• 18:15
  Michael: We've given up on trying to persuade you.
• 18:17
  Michael: And usually when, uh, the government gives up on trying to persuade you, most people receive that as, uh, we don't care, uh, about what you think.
• 18:28
  Michael: We don't think, we don't think you're smart enough to figure this out yourself.
• 18:32
  Michael: Uh, and they also interpret that as the government can't be, uh, persuade me because they don't have, uh, uh, good enough arguments and therefore they're going to compel me.
• 18:43
  Michael: Now, having said that, uh, uh, there are things that government does that come very close to being a mandate that can be effective, such as most school systems do require kids to have certain vaccinations in order to attend those schools.
• 19:04
  Michael: And the government does require parents to educate their kids.
• 19:08
  Michael: And so with a, with a mandate that you have to educate your kids.
• 19:14
  Michael: And a, uh, the government taxing you, uh, in order to, uh, provide government schooling for your kids, which leaves you with fewer resources to, uh, to provide for alternative educational arrangements if you don't want to go to the government schools and then the government.
• 19:31
  Michael: Requiring that, uh, you vaccinate your kid in order to attend those govern, one of those government schools and those taxes, then taking away or, or reducing your ability to send them to another school that might not require.
• 19:44
  Michael: You can see how, uh, uh, a vaccine hesitant parents feel like the government is, uh, uh, approaching.
• 19:52
  Michael: A mandate there to vaccinate your kids.
• 19:55
  Michael: But as we've seen, that mandate is actually kind of porous because you can, uh, you can get out of it by claiming some sort of, uh, uh, conscience exemption.
• 20:04
  Michael: Um.
• 20:05
  Michael: I am not sure, even though I, it's easy to articulate what the balancing act should be, it, it's much harder to apply that in individual cases and say what is the, the, the right amount of pressure and what is the right amount of education, uh, to apply to parents to get them to vaccinate their kids.
• 20:22
  Michael: Because I wanna be clear, I don't think that any parent has a God-given right, to decide what happens, uh, to their child's body.
• 20:30
  Michael: Uh, that is, uh, we talk about parental rights.
• 20:32
  Michael: I don't even like the term, uh, because we, uh, what is, what is happening is the, the state, the government is, uh.
• 20:40
  Michael: Allowing the parent to make those decisions for the child because, and only to the extent it ends up benefiting the child when we leave those decisions there.
• 20:51
  Michael: But in many cases it does not.
• 20:54
  Michael: In cases of neglect and the case of that 6-year-old in Texas who died from measles, I, I think their parents pretty clearly made the wrong decision even though those parents think they, uh, uh, uh, are standing by that decision.
• 21:07
  Michael: Um.
• 21:09
  Michael: I think what we need is, uh, in these cases is as much diversity as possible so that we can, uh, not only experiment with different strategies, education and gentle pressure on parents to get them to vaccinate their kids, uh, but also so that authorities could tailor the response to different.
• 21:30
  Michael: Uh, different ideologies and religious, uh, uh, beliefs because, uh, the parents in Philadelphia and, uh, their hesitance, uh, to vaccinate their kids might be very different from the parents in Gaines County, Texas and their hesitance to do so.
• 21:46
  Michael: So, uh, uh, I think that, uh, the.
• 21:52
  Michael: Um, the, the right strategy when it comes to measles is first of all, uh, although humility on the part of, uh, government public health authorities, because if they exhibit.
• 22:03
  Michael: Hubris, then they're gonna lose the trust of, of, of people who currently trust them.
• 22:08
  Michael: And we may end up backsliding and then try as many diverse approaches as, uh, as possible.
• 22:15
  Michael: Relying first and foremost on education and, and, you know, being innovative in as much as we can, uh, in, in our efforts to persuade people to vaccinate their kids.
• 22:26
  Michael: And only then a after.
• 22:29
  Michael: We've tried everything we can there.
• 22:31
  Michael: Uh, trying to use some, for some form of, uh, state pressure, uh, in order to, uh, see if we can get even more parents, uh, to, to vaccinate their kids.
• 22:44
  Michael: And it's not clear that that's, that that's going to work if there, if, if the conscientious exemptions from vaccine requirements for public schools were.
• 22:57
  Michael: Uh, not as permissive as they are.
• 23:00
  Michael: There might be a backlash.
• 23:01
  Michael: We don't know until we see, uh, states, uh, uh, uh, or even localities trying to tighten those exemptions.
• 23:12
  David: We mentioned, uh, Mike Lee brought up the idea of fraud being an issue.
• 23:16
  David: Can you talk about how that comes into play?
• 23:19
  Michael: Uh, fraud.
• 23:20
  Michael: I, I, I can't remember how I brought up fraud.
• 23:22
  Michael: I think the
• 23:23
  John: way you were, you were bringing it is that the, the, you, you have that, that individuals have a right against coercion, right.
• 23:29
  John: And fraud.
• 23:30
  Michael: Right.
• 23:31
  Michael: Oh.
• 23:31
  Michael: So yeah, I mean, it would be wrong for the government to lie to you, to get you to, uh, well, I, I should say in, in, in most circumstances, I hope there's not an
• 23:41
  John: exception there.
• 23:42
  Michael: It would be wrong to get the government to lie to you.
• 23:43
  Michael: Well, think about it.
• 23:44
  Michael: What if, let's take a hypothetical scenario.
• 23:47
  Michael: You know, the worst disease that I usually talk about when it comes to these issues is smallpox.
• 23:52
  Michael: Um.
• 23:53
  Michael: Uh, what if there's one guy roving through, uh, a, a a town?
• 23:59
  Michael: He has, he has, uh, active smallpox.
• 24:01
  Michael: He's contagious.
• 24:02
  Michael: Um, one-third of the people that he infects are going to die.
• 24:07
  Michael: Would it be, uh, morally permissible for the government to hold that person down, forcibly vaccinate him?
• 24:14
  Michael: If it was gonna do him no harm other than overcome his will, it's not gonna cause him any physical.
• 24:20
  Michael: Health or, or, or inject him with someone that at that point would make him no longer contagious.
• 24:24
  Michael: I think you can make a good case that it would be morally defensible to do that if there were no other harm to him than violating his autonomy because you're basically diffusing a bomb that would kill a lot of people and cause a lot more violence than what you would be doing to him.
• 24:40
  Michael: Regardless of whether you think that would be morally permissible, it would.
• 24:43
  Michael: I, I think it is an even easier case to say to this person, uh, to, to, to lie to this person and say, uh, this, this injection is not that vaccine, or whatever you think it is.
• 24:55
  Michael: Uh, it is, uh, it is something else.
• 24:59
  Michael: Um, it is a muscle relaxer or what have you.
• 25:02
  Michael: Uh, cortisol, uh.
• 25:04
  Michael: That would, might be, uh, more, I, I think it's an easier case that's morally defensible, even if, and I think think this is a crucial part that most, uh, uh, a crucial piece to most public health officials, uh, ignore at their app peril.
• 25:19
  Michael: Even if we think about what are the consequences of adopting a rule that says it would be okay for the government to lie as a way to overcome your.
• 25:29
  Michael: Uh, reluctance to, um, uh, to, to vaccinate.
• 25:34
  Michael: Uh, because it, remember, we have to think about not just what will happen in the instant case, uh, and and what are, what are the outcomes of the instant case where we've diffuse the bomb and that third of people are not going to die.
• 25:46
  Michael: We have to think about, uh, what's gonna happen in all similar cases or what's gonna happen in the future once you give the government this power and.
• 25:54
  Michael: If you, if if you came up with a rule that said it was okay for the government to do that, you cabin that, then I think you can make a good case that it would be okay.
• 26:03
  Michael: Uh, or it would not Okay.
• 26:05
  Michael: But it would be, it would minimize the amount of violence now and in the future if, if the government were to take that step.
• 26:13
  Michael: But, uh, that would be morally permissible, only after you've exhausted all of the other alternatives, uh, and so forth and.
• 26:21
  Michael: And I and there was, there, there, there, these sorts of things did happen during the smallpox eradication campaign.
• 26:30
  Michael: There are reports of, uh, doctors from the west kicking in doors and forcibly vaccinating people in, um, in rural villages in Bangladesh and India.
• 26:43
  Michael: Was each one of those e episodes morally permissible?
• 26:47
  Michael: I'm not sure about each and every one of them, but let me give you this perspective on smallpox, uh, the, uh, uh, smallpox before eradication, uh, in the 20th century, it killed about twice as many people as all wars of the 20th century
• 27:07
  John: combined all war.
• 27:07
  John: I mean, it's a bomb.
• 27:08
  John: I mean, it really, it really, it really is a socially destructive.
• 27:11
  John: And
• 27:12
  Michael: that is, that is, uh, as I described before, violence, inadvertent violence, but still violence that people were doing to each other by passing this disease around.
• 27:22
  Michael: The amount of money that it cost governments, mostly western governments, the United States was the biggest donor country to the World Health Organizations small PO eradication campaign.
• 27:31
  Michael: The, the amount of money that it cost was like a a few hundred million dollars.
• 27:37
  Michael: It was almost nothing.
• 27:39
  Michael: And, and so if someone came to you and said, uh, you know, I got an idea for a government program.
• 27:44
  Michael: It, it involves a tax that is like less than one 10th of 1% of current federal revenues or whatever.
• 27:51
  Michael: I mean, uh, tidying, you wouldn't even notice it.
• 27:54
  Michael: Uh, and that for that price we could, uh, this government program would eradicate war.
• 28:01
  Michael: There would never be any more war.
• 28:04
  Michael: You might be glad to pay that tax you might have, uh, call your representatives in Congress and ask them to vote for that program.
• 28:10
  Michael: That's basically what the smallpox eradication campaign did.
• 28:14
  Michael: The tax wasn't the only coercion involved.
• 28:15
  Michael: They're also kicking in doors in, uh, in, in those remote villages, forcibly vaccinating some people.
• 28:21
  Michael: The upside was that it eradicated that incredibly violent disease.
• 28:27
  Michael: And, uh, and, and we should be very leery about.
• 28:32
  Michael: Um, uh, so, so I'll just reiterate, I think that the, the violence that the, um, the, uh, doctors who forcibly vaccinated people in those villages was wrong.
• 28:49
  Michael: And, uh, and it could still pass, uh, uh.
• 28:55
  Michael: The war, the smallpox eradication campaign could still pass a moral cost benefit to, uh, analysis despite that violence.
• 29:03
  John: So I wanna really go back to David's question about an individual's right to be protected from coercion in the form of fraud.
• 29:11
  John: We have a, there's, there's this massive waves of disinformation.
• 29:15
  John: Some of them, some people have suggested, including me, propagated by the current secretary, HHS.
• 29:21
  John: Um, how do you think about that and articulate again there?
• 29:25
  John: There's clearly a, a, a, a reflexive, uh, very deeply felt reaction to the COVID mandates and the, the, and, and also the, the changing mandates and communication over time that, to your point.
• 29:40
  John: Damaged confidence in public health and science, I think broadly and, and certainly government.
• 29:46
  John: Um, in that context, how do you, how do we start to make the kinds of converse, bring the conversations back to facts and also with a, in a respectful way around rights so that people will have more confidence and, and can be in some ways protected against fraud.
• 30:05
  Michael: So, um, fraud is not quite violence, fraud and ants, both can, uh, uh, are tools to overcome the will of another person.
• 30:14
  Michael: I think it's important to delineate, uh, uh, between the two.
• 30:18
  Michael: Uh, they're both wrong for that reason, but they're not the same thing.
• 30:22
  Michael: And there's also a difference between fraud and misinformation.
• 30:25
  Michael: Fraud is when you are trying to overcome the will of another person.
• 30:28
  Michael: Misinformation, uh, uh, could just be I wrong about something and I'm putting out, uh, incorrect information into the world.
• 30:36
  Michael: And I do think that, uh, win.
• 30:39
  Michael: Say, uh, RFK Jr. Uh, was, um, agitating against the measles vaccine by, uh, suggesting, uh, that, or claiming that it causes autism, for example.
• 30:52
  Michael: I don't think he was trying to mislead people.
• 30:54
  Michael: I think he genuinely, uh, believed that, but was making a mistake and did not know enough to know that he was making a mistake or acting on the, uh, uh, uh.
• 31:07
  Michael: To advance some, um, uh, preexisting bias that he has, uh, against, uh, uh, an an unscientific bias that he has against, against that vaccine.
• 31:18
  Michael: Um, and so, so I wouldn't put anything that, uh, that he did or that he had said, or even that the, uh, that public health authorities did during covid.
• 31:33
  Michael: Well, maybe a couple things in the category of fraud.
• 31:36
  Michael: Um, I don't think that the, you know, flip-flopping on masking, uh, saying you don't need a mask, now you do.
• 31:42
  Michael: I don't think that was fraud.
• 31:43
  Michael: Uh, I don't, uh, I, I, I think there's a more charitable explanation for that, that flip-flopping.
• 31:48
  Michael: The two weeks has top the spread.
• 31:50
  Michael: Uh, Debra Burs has pretty much admitted that she never really meant that she wanted to it to be more than two weeks.
• 31:55
  Michael: And I usually think that was a fraud.
• 31:57
  Michael: Um, and, and it.
• 31:59
  Michael: This fraud or deception by public health officials is so corrosive because it, it helped to fuel a backlash that has stripped a lot of, uh, public health officials in the states of power that, uh, could be, I think, legitimate uses of government, uh, power to reduce the amount of violence in society.
• 32:20
  Michael: Um, if we're talking about misinformation.
• 32:24
  Michael: Rather than fraud.
• 32:26
  Michael: The best tool we have for fighting that is free speech.
• 32:29
  Michael: The best tool we have for that, for fighting.
• 32:31
  Michael: That is an open, uh, uh, marketplace of ideas where, uh, uh, where as, uh, as, uh, Thomas Jefferson said, we're not free to tolerate any error, so long as truth is left free to combat it.
• 32:44
  Michael: And, and, uh, that is, um.
• 32:50
  Michael: True.
• 32:50
  Michael: Not only because it's the best way, it really is the best way to, um, to, to fight misinformation is with more information, better information.
• 32:58
  Michael: But also if you try to suppress misinformation, then the people who currently believe that, think again, you can't win the argument on the merits.
• 33:06
  Michael: And so you're trying to shut down people who disagree with you and that just hardens their, uh, their, their opposition to your ideas and makes them.
• 33:14
  Michael: Commit to their mistakes more.
• 33:16
  Michael: And that's probably, you know, I, that's probably true of me as well.
• 33:20
  Michael: If there are things that I believe that are false and then someone tells me that you can't say those things, I'm gonna have the, I'm gonna double down on my false beliefs too.
• 33:30
  David: So maybe last question.
• 33:32
  David: Um, you know, in, in Jefferson's days talking about the Town Square and looking at, you know, newspapers, the idea was you could go out there and you could hear what people had to say and, you know, truth might.
• 33:41
  David: Um, went out.
• 33:42
  David: And I'm wondering how that's affected, if you think it is, by emergence of these sort of social media echo chambers where there's an algorithm that drives what you can have.
• 33:52
  David: So you think you're in a town square, but you're actually being affected by the algorithm.
• 33:56
  David: And then ai, which does some of the same things, but it can also, you know, be a, like a false, a bot or a deep fake.
• 34:05
  David: Are we.
• 34:07
  David: Are we in a position where it's hard to actually say, yeah, the truth is gonna have that opportunity to win out because you can, you can evaluate the information when in fact it's being, uh, it's, it's being manipulated and not necessarily by the government.
• 34:22
  Michael: Well, I would say the technology is new, but the problems are the same.
• 34:26
  Michael: The technology is new because, uh, w. The information revolution has drift down dramatically.
• 34:34
  Michael: The, the, the price of information and conveying information and gathering information, um, so much that, uh, that we've created these human-like computer programs that can go out there and create propaganda and mislead people, and disin inform people, not just misinform them if that's what we want, but the problems are the same because.
• 35:00
  Michael: We, there's always been fraudsters out, there have always been fraudsters out there, people who are trying to mislead us, um, uh, in order to take our money or to get us to support pol uh, uh, particular political causes and candidates.
• 35:14
  Michael: What is the best way to combat those attempts at manipulation and fraud?
• 35:21
  Michael: And, uh, I, I think the best way to do that remains that, uh, we have to let.
• 35:28
  Michael: People, uh, is we have to, uh, drive out bad information with good information, uh, drive out speech we don't like with speech that we do, uh, and, and, uh, uh, and, uh, believe that the truth will prevail, uh, not only because it's the truth, but because what's the alternative?
• 35:48
  Michael: Are we going to let the government decide who can speak and who cannot?
• 35:53
  Michael: Are we going to let the government decide?
• 35:56
  Michael: Uh, uh, what kind of, uh, new innovations people could put on the marketplace because to the extent the government has the power to do those things, it will use that power in order to protect itself from the truth.
• 36:09
  Michael: And that is a very dangerous, uh, uh, power to give the government.
• 36:15
  Michael: And, um, and, and I think we saw a little bit of that.
• 36:21
  Michael: In Covid, the way that the government was pressuring social media companies to suppress certain information.
• 36:27
  Michael: Uh, I, I think that has, uh, I don't think that helped.
• 36:32
  Michael: I don't think that made people believe public health officials anymore.
• 36:35
  Michael: I think it made, uh, it caused people to believe them even less and inhibited the pursuit of accurate information.
• 36:44
  Michael: Uh, so I think that.
• 36:46
  Michael: The, the, the, the problems are still the same.
• 36:49
  Michael: Uh, if there is a, uh, you don't want to give the government the power to, uh, to, uh, suppress, uh, the free flow of information, except in very limited cases where there's actual fraud and people are trying to, uh, overcome your will, as I say.
• 37:06
  Michael: And, uh, other than that, you want, uh, people to.
• 37:12
  Michael: Be able to speak as freely as possible because then people will, that the frustrations that you and I would have in that sort of environment, like, well, I'm looking at it on my social media.
• 37:22
  Michael: How do I know this is a real human being and how do I know it's a bot?
• 37:25
  Michael: And all of this noise that we're hearing out there, how do we know that those are the actual views of actual human beings versus AI propaganda from some foreign, uh, adversary or something like that.
• 37:37
  Michael: Uh, that uncertainty on our part is what economists call demand.
• 37:41
  Michael: Demand for some sort of, uh, some sort of something that will help us filter out what is true from what is not.
• 37:48
  Michael: And I am hopeful that, that even though there's so been so much, uh, churn and turmoil in the, um, in the media.
• 37:58
  Michael: Uh, uh, sector of the economy that, that, uh, demand will give rise to a new, uh, form of media company that tries to do what it, uh, what media have tried to do, uh, uh, for time immemorial.
• 38:12
  Michael: But now in response to this new technology, I.
• 38:16
  Michael: Sift, uh, out what is, uh, or distinguish, help us distinguish, uh, what is true from what is fake.
• 38:24
  Michael: And, uh, build a reputation for doing that so that we can trust this news organization or that news or that one.
• 38:31
  Michael: And people will know to go to those news organizations if they want, uh, an accurate picture of what is going on in the world.
• 38:38
  Michael: And, uh.
• 38:40
  Michael: Those organizations will then help us tune out what is all the noise from all the bots and all the
• 38:44
  David: ai.
• 38:46
  David: Great.
• 38:47
  David: Well, that's it for another episode of CareTalk.
• 38:49
  David: We've been discussing the ongoing measles outbreak and a lot more with Michael F. Cannon, director of Health Policy Studies at the Cato Institute.
• 38:57
  David: I'm David Williams, president of Health Business Group,
• 38:59
  John: and I'm John Driscoll, the chairman of Yukon.
• 39:01
  John: If you liked what you heard or you didn't, we'd love you to subscribe on your favorite service.
• 39:06
  John: And Michael, thank you for joining us.