By Gordon Hull
As Melinda Cooper notes (recall here), one of the reasons Gary Becker – as opposed to other neoliberal theorists – was interesting to Foucault because of his emphasis on microeconomics, particularly the quotidian institutions through which micropower functions, such as the family. At the same time, Becker’s human capital theory has become increasingly important in neoliberal constructions of human nature. In a late essay, Becker applies himself to health economics. The result, I think, offers a very clear demonstration of neoliberal thinking and how it works nearly inexorably to distract from social problems, generally by constructing them as individual problems and ignoring the social determinants of an individual’s situation.
Near the end of the article, Becker puzzles over why young people in the 1980s might have increased what he terms risky behavior. Let’s call this, in honor of the privacy paradox, the “health paradox:”
“One of the paradoxes of behavior in recent decades in the United States is that on the one hand, people are greatly concerned about their health, as shown by the increase in exercise clubs and the popularity of exercise videos, and from almost daily reports on drugs, diets, and other health factors in major newspapers and TV news programs. On the other hand, a considerable amount of behavior appears to contribute to worse health, such as the consumption of boutique ice creams with high fat content, the reduction of exercise by teenagers and their substitution toward sedentary activities like computer games and chat rooms, and of course the resulting significant increase in weight of adults, and even more so of teenagers.” (401)
We can all recognize this world: we talk a lot about being healthy, and then don’t really do anything about it. We eat ice cream and play video games!
How did we get here, and why would Becker find this puzzling? The answer lies in his presentation of life expectancy data over the 20th century, combined with his assumptions about the rationality of homo economicus. Becker observes that life expectancy data shows that the first half of the 20th century, most of the life expectancy gains were early in life, as vaccines and treatments were developed to treat communicable diseases. Starting in the second half of the 20c, with the odds of making it to age 50 or so now very high, the benefits of increased life expectancy were primarily given to those of higher ages, as heart disease and other diseases of old age (cancer and diabetes are his most prominent other examples) became the focus of medical research.
The problem occurs when one tries to reconcile this information with what Becker says happens to human incentive structures as they relate to health outcomes. Generally speaking, he argues, an increased chance of surviving beyond a certain age x increases the attempt to get there by incentivizing healthy habits. In Becker’s terms:
“In particular, the greater the probability of surviving in the future, the smaller the incentive to consume harmfully addictive goods and the greater the incentive to consume beneficallly addictive goods. So individuals with lower life expectancies should be more likely to be addicted to drugs, smoking, and other harmful goods.”
Or, again: “If a person knows he is more likely to survive some future periods, he has more incentive to try to survive to these periods” (388). Not only that, both increased health and increased education (also happening over the 20th century) reduce the discount rate for the future (that is, being more educated means that you are likely to take long-term outcomes more seriously, rather than focusing only on the short term). Hence the health paradox. Life expectancies have gone up, more and more young people go to college, but a generation of people with raised life expectancies nonetheless consume harmful goods that they know will either lead them to live a shorter life, or to have lower utility when they get to those older ages (in other words, they’ll be elderly, but very ill). Suspend disbelief for a moment about how people do not always behave according to the dictates of economic rationality and look at the structure of the argument.
Becker resolves the health paradox with what can only be described as a deus ex machina: young people behave dangerously in a way his theory does not predict because they expect Pharma to come to the rescue:
“If consumers were aware of the continuing growth in available drugs, then younger persons who were very concerned about their life expectancy might nevertheless increase activities that would appear to lower their future survival rates. The acceleration in the rate of introduction of new drugs should have caused an increased consumption of goods that harm future health. Perhaps that helps explain the acceleration in weight gain among teenagers that began about 1980.” (402)
But why on earth did this phenomena start in the 1980s? After all, life expectancies had been growing dramatically since the beginnings of the 20th century, and pharmaceutical innovation had always been a part of that: why not think that a vaccine against liver disease was coming? In other words, there is a prima facie case that this explanation is rendered nonsensical by his own theory.
What the explanation does do a very good job of, however, is masking the social conditions behind the increase in risky behaviors. Those social conditions are the insecurities and precarities that neoliberalism demands and has brought about. Consider, for example, the shift during the 1980s from pension (“defined benefit”) to 401(k) (“defined contribution”) retirement plans. In the paper, Becker deliberately assumes (for the sake of simplicity) that people will have enough money to live out their lifespans without either deficit or surplus. But this is to assume away a good part of the problem of the 1980s, as the switch to 401(k) plans throws that calculation radically into question. In other words, the article begins by assuming a condition of Fordist factory production that neoliberalism began dismantling during the period in which the health paradox emerges. Indeed, a central component of neoliberal ideology (as articulated by Becker, as Foucault presents him) is precisely the embrace of risk and the rejection of security by entrepreneurial selves: hence the success of Rich Dad, Poor Dad.
And neoliberalism brought greater insecurity into work, whether or not the workers wanted it. The Fordist compromise between factory owners and unions (as Hardt and Negri put it; this is a central thesis of Empire and Multitude) that enabled stability in the workplace and a reasonable guarantee of future has largely been eliminated. Lots of jobs are now overseas. Since 1974, the real wage of the middle class has remained stagnant.
But even within jobs that remain, there’s plenty of evidence of this increased insecurity as a management strategy; I particularly like this paper by Louise Amoore about workplace precarity, but it’s a minor literature at this point. For example, this paper about the attack on tenure at universities (and why the “lazy professor” whose tenure is an excuse to avoid hyperwork had to become a hated figure) tells a similar story.
At the same time, increasing numbers of workers are temporary or without medical benefits, particularly before the passage of the ACA. For all of those workers, for all of the poor whose welfare is cut, for all of the middle-class college students who worry about getting any kind of job after graduation, for all of those with illness that kept them from any possibility of insurance – for all of those people, the odds of making it to old age in good shape go down. And if those people don’t think they’re going to make it to their golden years in good shape, then they’ll engage in risky behaviors, on Becker’s own theory.
Worse, on Becker’s theory, people derive most of their expected future utility from leisure time. As he explains, “The amount that a person is willing to pay to reduce the chances of dying considers not just lost earnings, but lost utility that also includes the value of leisure time, and the differences between average and marginal utilities.” And then, after some numbers, he proposes that “Most of the value comes “not from foregone earnings, but from the loss of leisure time, and differences between average and marginal utilities” (385). This is because an hour invested in work gives you more leisure time as a positive externality, especially if you’re imagining retiring sometime and having mostly leisure time at that point.
But: what disappears the fastest under neoliberal capitalism? Leisure time. Part of the problem is insecurity in retirement (mentioned above). Another problem is the neoliberal ideology that we are all to be busy all of the time – hyperwork (recall here). Indeed, we are to be ready to work whether or not there is work available to do. Another is that insecure American workers, in order to compete with one another, don’t take the minimal vacation time they have. This general decline of the ability to have time away from work – autonomists call this the “complete subsumption” by capital – would have a disproportionate effect on their discount rate for the future. So, again, Becker’s own theory can explain perfectly well why people started engaging in risky behaviors in the 1980s. Simply put, the value of the future goes down when you’re being worked to death.
So too, the deus ex machina of Pharma ignores structural conditions like the car-oriented infrastructure in the U.S., the rise of jobs that are completely sedentary under cognitive capitalism, and the neoliberal social disinvestment in the poor, particularly the non-white poor.
But at least they have their “economic freedom!” Maybe it’s even been supersized.