So Much for Being Cautious

Six years ago San Franciso, a black hole of liberalism -- infinitely dense -- became the first major U.S. city to adopt the precautionary principle. That principle says, roughly, this: When a course of action might cause harm to human health or the environment, the burden of proof falls on the proponents of that course of action, who should consider the full range of alternatives, including taking no action -- even when the threat of harm is unproven.

The principle has become part of the environmental catechism since its adoption in the 1992 Rio Declaration on Environment and Development. In 2001, The New York Times Magazine praised it as one of the year's most influential ideas. When the Nobel Committee gave the 2007 Peace Prize to Al Gore, it averred that climate change "must be treated . . . with the precautionary principle uppermost in our minds."

The principle is typically used to argue for new regulation or against new technology. A few years ago, for instance, the Sierra Club declared: "In accordance with this precautionary principle, we call for a moratorium on the planting of all genetically engineered crops and the release of all [genetically engineered organisms] into the environment." Last year the European Trade Union Confederation (ETUC) called for the application of the precautionary principle to nanotechnology, demanding a "no data, no market" threshhold: "Nanometre forms of chemicals should not be allowed on the market unless sufficient data are supplied to show no harmful effect for human health and the environment."

The precautionary principle seems particularly pertinent now, as the U.S. debates health care. Why haven't the principle's legions of proponents come out against reform? Why haven't they condemned the first House bill, HR3200, or the new 1,990-page bill advanced by House Speaker Nancy Pelosi (D-San Fran), or the bills now moving through the Senate?

After all, any of the measures would create tremendous upheaval whose ultimate outcome is not only unknown, but unknowable. According to an analysis of HR3200 by the chief actuary at the Centers for Medicare and Medicaid Services, "future impacts of H.R. 3200 on health expenditures, insured status, individual decisions, and employer behavior are very uncertain"; "many of the provisions . . . are unprecedented . . . . Consequently, little historical experience is available with which to estimate the potential impacts"; and "the behavioral responses to changes introduced by national health reform legislation are impossible to predict with certainty."

Nevertheless, some indications suggest health care reform could make at least some people worse off. For instance:

• Advocates of reform originally sold the public option as a way to keep private insurers "honest" by introducing a low-cost alternative. The New York Times now reports that "the Congressional Budget Office said the public plan would cost more than private plans and only 6 million people would sign up." But if the CBO is wrong and the public option works as advertised, then the likely effect would be harmful to insurance companies, as well as to the countless future retirees -- from public-school janitors in California to sheriff's deputies in Maine -- whose pension funds include insurance-company stock.

• The individual mandate -- an "unprecedented form of federal action," according to the CBO -- could lay the constitutional groundwork for many other forms of economic conscription. Would Americans really be better off having Uncle Sam not only taxing their paychecks, but also telling them how to spend what's left?

• The Pelosi measure includes a tax hike on medical-device makers, which could stifle innovation. It seems possible, if not likely, that some future innovation will remain undeveloped because money that might have funded research went to the Treasury Department instead. How many people might suffer as a result?

Won't health care reform do some good? Of course. Some people are bound to come out ahead. But the precautionary principle does not advocate approving changes that pass a cost/benefit test. It does not dismiss the possibility that advances such as nanotechnology might do some good. It does not even dismiss the possibility that, on balance, the good could outweigh the harm. Rather, it insists -- to borrow the language of the ETUC -- that something "should not be allowed" unless there is proof positive that it will produce "no harmful effect." Even the mere possibility of harm may be sufficient to forestall a course of action.

There is no reason, however, to treat the precautionary principle as a one-way ratchet -- forever restricting private action and expanding the scope of government. Or at least no principled reason. It is telling that many of those who believe an ounce of prevention is worth a pound of cure when applied to the voluntary marketplace do not seem to believe the same concerning government. Do they really wish for a greater level of caution -- or simply a greater degree of coercion?

My thoughts do not aim for your assent -- just place them alongside your own reflections for a while.

--Robert Nozick.

Contact A. Barton Hinkle at (804) 649-6627 or .