In his clinic at the medical centre of Johns Hopkins University, Kenneth
Silverman deals with some really hard cases. These patients from the surrounding
Baltimore neighbourhood inject cocaine, share needles and are often involved in
crime. Usually it鈥檚 almost impossible to get them to stay clean for a few weeks
at a time, but many have now managed to stay off cocaine for months. A few
haven鈥檛 touched the stuff for two years.
The secret of Silverman鈥檚 success is not better education about the dangers
of drugs. Nor is it some new wonder cure from one of the giant pharmaceuticals
companies鈥攊t鈥檚 greenbacks. His patients receive up to $1100 over a
12-week period in return for an unbroken supply of weekly cocaine-free urine
samples. The money comes in the form of vouchers for food and other goods.
In a way, Silverman and the dozen or so other addiction specialists in the US
who are trying out this scheme are paying people not to be antisocial. And not
everyone is comfortable with that idea. But raising convincing moral objections
to such payments is about to become a lot harder as the US government is now
using the same powerful incentive鈥攃ash鈥攖o help drivers break their
addiction to cars. Thanks to Al Gore鈥檚 so-called 鈥渃ommuter choice鈥� programme,
America鈥檚 employers can pay their staff up to $780 free from income tax
in return for using public transport or a car-sharing pool to get to work.
Another measure offers cash incentives to staff to give up their parking spaces
at work. Such schemes represent an interesting reversal of what governments
normally do鈥攖ax activities such as smoking, gambling and driving cars.
Should we be concerned at this departure from the norm? Not necessarily: after
all, money may succeed in making us change where education and exhortation fail
because it talks a language everybody can understand. But some problems must be
faced head-on.
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First, we have to recognise that some people are bound to try to cheat. They
may, for instance, establish a track record in being bad in order to collect the
incentive money for changing their ways. In the case of addiction, taxpayers
could end up short-changed if clinics paid people who merely dabbled in drugs
for clean urine samples, rather than bona fide addicts. So reward schemes need
to be policed.
A second problem is that they may encourage a dependency on the cash without
ending the harmful behaviour. In the now discredited 鈥渟et aside鈥� scheme,
designed to reduce food mountains, Europe鈥檚 taxpayers paid farmers not to farm
some of their land. But many of them simply set aside their least productive
land, while improvements in farming techniques boost crop yields on productive
land. Result: the surpluses remain.
In other areas of life, tougher rules governing informed consent may be
needed. Take the activities of an American charity called CRACK, which is
currently offering drug addicts $200 if they consent to be sterilised.
The 鈥渉armful behaviour鈥� it seeks to end is conceiving babies who could be born
addicted, to a parent incapable of looking after a child. In effect, people who
are desperate for cash and unable to take a long-term view of life are being
paid to give up their birthright of parenthood.
On balance, though, paying people for desisting from doing bad feels like an
idea whose time is coming. We have to recognise that there are limits on
people鈥檚 public spiritedness and that carrots can have a more powerful effect on
behaviour than the sticks of taxes and other penalties.
How odd if money turned out not to be the root of all evil, but the wellspring of public
good.