ABSTRACT
Consumer sovereignty is challenged by the widespread idea that consumers should not be left to suffer the consequences of poor investment decisions in health, and should be required to make provision for likely health service needs. Hence, almost all countries require citizens to purchase insurance, or do so for them through the tax system (see Part IV). Similarly, a range of health-risking behaviours are usually proscribed by law – some drugs are almost universally outlawed for recreational use, and diving into the sea from Brighton pier is prohibited; and some health-promoting behaviours are required, such as immunisation in some countries. These rules can be interpreted as requiring socially responsible behaviour (protecting society from the self-interested behaviour of individuals), a standard explanation of rules in any society, but they seem also to contain an element of policy makers knowing best. This knowing best may involve a belief in superiority of judgement in some cases (you may well understand the risk of recreational use of heroin but we still will not allow you to damage yourself ), an attitude termed paternalism. More commonly, it involves the belief that the information held by the rule maker is superior to that of the ruled (you do not understand the risks of recreational use of heroin and must be protected from your ignorance).
