America’s Top Killer: Us

Why do so many of us make lousy personal decisions, even ones that kill us? Keeney, for one, chalks it up to short-term thinking and it-can't-happen-to-me exceptionalism. Other scholars, such as Harvard's Cass Sunstein, University of Chicago's Richard Thaler and MIT's Dan Ariely—all loosely organized, like Keeney, under the suddenly hip banner of behavioral economics—have in recent years come up with different reasons for why we sometimes act a fool. Topping their lists are apathy, peer pressure, and the tendency to misperceive in predictable ways—such as judging a mountain of food a molehill if it's served on a massive plate.

However the experts explain our tendencies to self-destruct, they all agree that we could use some help negotiating these choices better—and that government can provide it. For Keeney, it's by adding "decision making" to the standard curriculum in public schools so that more children grow up empowered to recognize and mine all their options, rather than accept those presented by others. "Imagine if they taught World War II as decision making," he says. "That'd be fabulous."

For Sunstein and Thaler, authors of the recent book "Nudge" (Yale, 2008), it's through gently pushing people to make the right move. "Putting the fruit at eye level counts as a nudge," they write. "Banning junk food does not." Ariely cottons to a middle ground between authoritarianism and "complete freedom to fail." In the realm of preventive medicine, for instance, that means encouraging people to go for regular screenings and checkups by establishing a deposit system: the only way to get your $100 back is by making your appointment.

Will any of this actually happen? Brian Wansink thinks so, although he's short on specifics. In "Mindless Eating," his 2007 book about how the brain decides what the stomach gets, the Cornell University marketing professor imagines a tomorrow where regulators promote healthier habits by borrowing the seductions of junk food and leveraging insights into portion control. In one of his more famous experiments, he gives people bowls of soup that were secretly refilled by a tube beneath the restaurant table and discovers that those people with bottomless bowls ate almost 75 percent more than people with normal bowls. "How could I feel full? I've still got half a bowl left," the overeaters wondered. The lesson: tinkering with perception is the key to changing long-term behaviors and, according to Wansink, adding years and quality to our lives. The 19th century was the century of hygiene, he writes, and the 20th was the century of medicine. The 21st? The century of behavior change—with Uncle Sam perhaps leading the charge.

If playing with our perception doesn't work, perhaps manipulating our wallets might. Or at least that's what some cash-strapped state governments are banking on. Last week New York Health Commissioner Richard Daines created a five-minute YouTube video to promote a proposed 18 percent sales tax on sugary drinks in the Empire State. Daines justified the move saying that some taxes can be good for your health.

Still, a more interventionist government isn't up everyone's alley. Not to mention the fact that we learn by making mistakes. If there's always a guardrail in place, we may never remember to watch the ledge.

© 2009