Third-grader Andrew Calabrese carries his backpack everywhere he goes at his San Diego-area school. His backpack isn’t just filled with books, it is carrying his robotic pancreas.

The device, long considered the Holy Grail of Type 1 diabetes technology, wasn’t constructed by a medical-device company. It hasn’t been approved by regulators.

It was put together by his father.

Jason Calabrese, a software engineer, followed instructions that had been shared online to hack an old insulin pump so it could automatically dose the hormone in response to his son’s blood-sugar levels. Mr. Calabrese got the approval of Andrew’s doctor for his son to take the home-built device to school.

The Calabreses aren’t alone. More than 50 people have soldered, tinkered and written software to make such devices for themselves or their children. The systems—known in the industry as artificial pancreases or closed loop systems—have been studied for decades, but improvements to sensor technology for real-time glucose monitoring have made them possible.

The Food and Drug Administration has made approving such devices a priority and several companies are working on them. But the yearslong process of commercial development and regulatory approval is longer than many patients want, and some are technologically savvy enough to do it on their own.

Here is the Kate Linebaugh story, interesting throughout, via Adam Thierer and Eli Dourado.

Deaths from opioid pain reliever overdose in the United States quadrupled between 1999 and 2013, concurrent with an increase in the use of the drugs. We used data from the Medical Expenditure Panel Survey to examine trends in opioid pain reliever expenditures, financing by various payers, and use from 1999 to 2012. We found major shifts in expenditures by payer type for these drugs, with private and public insurers paying a much larger share than patients in recent years. Consumer out-of-pocket spending on opioids per 100 morphine milligram equivalents (a standard reference measure of strength for various opioids) declined from $4.40 to $0.90 between 2001 and 2012. Since the implementation of Medicare Part D in 2006, Medicare has been the largest payer for opioid pain relievers, covering about 20–30 percent of the cost. Medicare spends considerably more on these drugs for enrollees younger than age sixty-five than it does for any other age group or than Medicaid or private insurance does for any age group. Further research is needed to evaluate whether payer strategies to address the overuse of opioids could reduce avoidable opioid-related mortality.

That is from Zhou, Florence, and Dowell, via the excellent Kevin Lewis.

Let’s ask Guido Menzio, who perhaps knows something about random.  Here is one of his papers, with Mikhail Golosov (pdf):

We propose a new business cycle theory. Firms need to randomize over firing or keeping workers who have performed poorly in the past, in order to give them an ex-ante incentive to exert effort. Firms have an incentive to coordinate the outcome of their randomizations, as coordination allows them to load the firing probability on states of the world in which it is costlier for workers to become unemployed and, hence, allows them to reduce overall agency costs. In the unique equilibrium, firms use a sunspot to coordinate the randomization outcomes and the economy experiences endogenous and stochastic aggregate fluctuations.

In other words, by coordinating with each other, if only implicitly, employers make the firing threat more fearful.  You don’t have to interpret this paper literally as an entire explanation for cyclical unemployment, only that it may have something to do with the story.

And here is his about to appear JPE piece with Greg Kaplan (pdf):

We propose a novel theory of self-fulfilling unemployment fluctuations. When a firm increases its workforce, it increases the demand facing other firms—as employed workers spend more than unemployed workers—and decreases the extent of competition facing other firms—as employed workers have less time to search for low prices than unemployed workers. In turn, the increase in demand and the decline in competition induces other firms to hire more labor in order to scale-up their presence in the product market. The feedback between employment and product market conditions generates multiple equilibria—and the possibility of self-fulfilling fluctuations—if the differences in the shopping behavior of employed and unemployed workers are large enough. Empirical evidence on spending, shopping and prices paid suggests that this is the case.

In general, not enough popular macro discourse asks the question of how much of the cycle results from self-fulfilling prophecies.  Furthermore what does that imply for policy? yes, “confidence” can be important, but confidence in what exactly?

It is commonly held up as a model of dietary paternalism, but the most recent trends suggest a reversal of sorts:

Coca-Cola Femsa SAB, the country’s largest Coke bottler, said last Wednesday that its Mexican soda volumes rose 5.5% in the first quarter from a year earlier. Arca Continental SAB, the No. 2 Coke bottler, reported soda volumes surged 11%.

The turnaround began last year, when Mexican soda-industry volume rose 0.5% after falling 1.9% in 2014, said data service Canadean.

Consumers also aren’t flocking to untaxed zero-calorie sodas. The market shares of full-calorie Coca-Cola and Pepsi-Cola inched higher last year to 48% and 11%, respectively, according to Euromonitor, another data service.

Antisoda groups aren’t ready to declare the tax a failure and say sales got a boost from unusually warm weather.

And note this:

Even the initial downturn [in soda consumption] only lowered the average Mexican’s daily caloric intake by 6 to 7 calories, or 0.2%, according to the study.

I do not think the correct conclusion is “Mexico’s soda tax is failing,” rather “it can take a very long time to discover whether or not policies are working well.”  For instance the tax may be step one in a longer-run beneficial shift in norms, or going the other way the tax may end up as irrelevant or possibly even counterproductive, if individuals end up substituting into something even less healthy.  This point about the long run is relevant for assessing the ACA, minimum wage hikes, the euro, various tax cuts, financial regulation, and many many other policies.  Relative price effects, secondary consequences, and “chances” of gaming the system are all much higher in the long run than the short.

European countries that refuse to share the burden of high immigration will face a financial charge of about €250,000 per refugee, according to Brussels’ plans to overhaul the bloc’s asylum rules.

The punitive financial pay-off clause is one of the most contentious parts of the European Commission’s proposed revision of the so-called Dublin asylum regulation, due to be revealed on Wednesday…

According to four people familiar with the proposal, this contribution was set at €250,000 per asylum seeker in Monday’s commission draft. But those involved in the talks say it may well be adjusted in deliberations over coming days.

“The size of the contribution may change but the idea is to make it appear like a sanction,” said one official who has seen the proposal. Another diplomat said in any event the price of refusing to host a refugee would be “hundreds of thousands of euros”.

Here is the full FT piece.  Elsewhere on the pricing front, there is talk that at some point Uber will move away from surge pricing.

The heroes of Jaron Lanier

by on May 2, 2016 at 3:39 am in History, Law, Web/Tech | Permalink

There are many, but they include:

  • J.M. Keynes,  he was the first person to think about how to really manage an information system.
  • E.M. Forster for The Machine Stops, written in 1907, which foresees our error with a very critical eye.
  • Alan Turing, who stayed a kind person even as he was tortured to death.
  • Mary Shelley who was a keen observer of people and how they can confuse themselves with technology.

And of course my friend Ted Nelson. He invented the digital media link and was perhaps the most formative figure in the development of online culture. He proposed that instead of copying digital media, we should keep one copy of each cultural expression on a digital network and pay the author of that expression an affordable amount whenever it is accessed. In this way, anyone could earn a living from their creative work.

Here is another interesting bit about the internet:

One thing that bugs me is the way context is lost. You start discovering new music or new culture in very particular ways. Algorithms become your guide. If an algorithm calculates that you may like a piece of music, it will recommend it to you. That makes the algorithm the master of context for humanity. It tends to remove culture from its context, and context is everything. The structure of the Net itself has become the context instead of real people or the real world. That’s a really big deal.

Here is the full piece, an interview with Catherine Jewell at WIPO, I would say that Lanier is or should be rising in relative status.  For the pointer I thank Samir Varma.

I will be doing a Conversation with Tyler with him, June 15, late afternoon, Washington D.C., location to be announced.

So what should I ask?  I already know which is his favorite novel…and plan to ask about that…and of course we will cover his new forthcoming book The World According to Star Wars.

From a new Pew Study:

In our latest national political survey, released in March, 59% of the public say immigrants strengthen the country, while 33% describe them as a burden. In 1994, opinions were nearly the reverse: 63% said immigrants were a burden and 31% said they strengthened the country.

You will note that they views of Republicans and Democrats diverge after 2006.  Millennials are especially favorably inclined.


Last month, De La Rue, the world’s largest currency maker, sent a letter to the central bank complaining that it was owed $71 million and would inform its shareholders if the money were not forthcoming. The letter was leaked to a Venezuelan news website and confirmed by Bloomberg News.

“It’s an unprecedented case in history that a country with such high inflation cannot get new bills,” said Jose Guerra, an opposition law maker and former director of economic research at the central bank. Late last year, the central bank ordered more than 10 billion bank notes, surpassing the 7.6 billion the U.S. Federal Reserve requested this year for an economy many times the size of Venezuela’s.

…While the cash was still arriving — at times, multiple planeloads a day — authorities set their sights on the year ahead. In late 2015, the central bank more than tripled its original order, offering tenders for some 10.2 billion bank notes, according to industry sources.

But currency companies were worried. According to company documents, De La Rue began experiencing delays in payment as early as June. Similarly, the bank was slow to pay Giesecke & Devrient and Oberthur Fiduciaire. So when the tender was offered, the government only received about 3.3 billion in bids, bank documents show.

That is from Andrew Rosati.  Here is a sad and poignant post on the suicide of Venezuela, by Joel D. Hirst.

The BBC has an interesting report on ambulance services in Beijing.  Up until now, ambulance drivers could decide themselves how much to charge people for their services.  I’m assuming these weren’t listed or known beforehand either.  This seems ripe for abuse given that the patient will be desperately wanting to get to the hospital and in no state for bargaining.  According to the article, most Chinese on social media didn’t even know that ambulances charge at all.  That must come as a big shock then when they get hit up by the driver.

So what did authorities decide to do?  Decree that ambulances “be fitted with taxi-style meters in an effort to allay public concerns about overcharging.”  Hmm, this doesn’t seem to be the most incentive compatible policy either.  As one social media cynic (read: realist) pointed out, “Don’t rule out ambulances taking a detour when using the meter.”  At least when you’re in the backseat of a cab, you can watch where the driver is going.  In the back of an ambulance in an emergency situation, that’s not going to be very feasible!  Don’t get me wrong, I’m in no way advocating free ambulance services, but there has to be a better policy than this.

That is from Cherokee Gothic.

Here is one summary of the recent brouhaha.  North Carolina made a mistake in signing the new law.  Not just a practical mistake, because of the backlash, but a mistake outright.  I’m not aware there was a problem needing to be solved, and yet new problems have been created.

There is nonetheless a relevant argument for the law which I believe resonates with many Americans:

Cruz’s argument centers on the idea that allowing transgender women to use the women’s restroom would lead to deviants dressing up as women and preying on young girls. His campaign released an ad accusing Trump of capitulating to the “PC police” and asking viewers whether a grown man pretending to be a woman should use a restroom with your daughter or wife.

Whether you agree or not, that argument helps us rephrase the dilemma as follows: should there be a legal definition of who is a transgender person and why?  And should transgender people wish that there were such a legal definition?

If there were such a definition, problem solved, at least in principle.  Transgender individuals could use the bathroom which their legal stipulation entitled them to, or would entitle them to, were a court case to arise.

Women’s colleges of course face a private sector version of this issue (here is one pending change).  Private companies have policies on bathroom use, and gender-specific sporting events must make rulings.

So what to do with the law?  I see at least three options.

#1: The first and most libertarian view is to refuse to offer a legal definition of transgender.

The transgender concept seems so…fluid.  This page from Wikipedia illustrates the underlying legal problems:

These include people whose identities are not exclusively masculine or feminine but may, for example, be androgynous, bigender, pangender or agender — often grouped under the alternative umbrella term genderqueer[5] — and third-gender people (alternatively, some references and some societies conceptualize transgender people as a third gender).[6][7] Although some references define transgender very broadly to include transvestites / cross-dressers,[8] they are usually excluded, as are transvestic fetishists (because they are considered to be expressing a paraphilia rather than a gender identification) and drag kings and drag queens (who are performers and cross-dress for the purpose of entertaining). Intersex people have genitalia or other physical sexual characteristics that do not conform to strict definitions of male or female, but intersex people are not necessarily transgender, since they do not all disagree with their assigned sex. Transgender and intersex issues often overlap, however, because they both challenge the notion of rigid definitions of sex and gender.

Facebook has introduced about fifty different terms related to gender identification.  It is not difficult to argue the current legal system won’t be “getting this one right,” whatever that might mean.  For a start, would you trust the legal system in North Carolina?  (From my understanding, it would indeed be a state matter.)  Probably some people who right now “slip by” would be caught on the wrong side of an unpleasant dragnet.  And what exactly is the final test to be run to determine the right answer to a contested issue concerning a transgender individual?  If there were ever a time for some creative ambiguity in the law, it seems this might be it.

In this view, yet another problem with the North Carolina bill is that it may end up forcing everyone’s hand on constructing a legal definition of transgender.

If we stick with no legal definition of transgender, let’s tackle the remaining problems directly.  For instance we could significantly increase the penalties for men who abuse women or young girls in or near women’s rooms, if indeed that is an ongoing problem.  You can tax either inputs or outputs and in this case it seems to make sense to place the higher tax on the outputs.

#2: Offer two parallel legal systems for gender.

In one of the parallel systems, you can apply formally for a change of gender status, although I suspect this could not end up handling more than two or three categories, hermaphrodites perhaps being the third.  In the second of the parallel systems, you can decide not to apply for formal legal designation of gender and instead live under creative ambiguity.  The practical import of that ambiguity often will depend on how clearly a person fits traditional social categories of gender in a simple and visible way.  In any case, a person can choose which legal system to live under.

The formal legal designation would matter for which prison you would be assigned to, which bathroom you could visit, and which chess tournaments you can play in, among a variety of other questions.  Here is a brief survey of legal approaches around the world, with some countries opting for versions of the parallel approach.

#3: Use the law to force everybody’s hand.

In this view, the current status quo is not very good for many transgender individuals, so something must be done.  Forcing a legal solution to these issues might raise social consciousness, even if some state rulings on transgender issues are objectionable in the meantime.  Let’s create something to fight over.  With a full legal definition of transgender in place, the logic of individual rights will turn its wheels, as it so often does in America, and eventually transgender individuals would fall under the protection of anti-discriminatory laws.  Perhaps this is better than the parallel legal systems approach, because under the latter too many individuals slide along in a state of creative ambiguity and transgender issues will remain underemphasized.  In this vision, the law — whatever its limitations — is likely to prove the friend of transgender individuals, so things should be sped along as rapidly as possible.

I do not have a good sense of which of these three approaches would be best in the United States.  In any case, it seems to me the question “how should the law deal with or define transgender individuals, if at all?” is more fruitful and fundamental than asking “how should North Carolina regulate bathroom admission policies?”  I would be interested to read a law and economics paper on these issues.

Addendum: Here is a paper on whether LGBT inclusion boosts economic growth in emerging economies, though I doubt if the effects are causal.

Second addendum: Henderson and Cordato make good points, and favor a version of option one.  That said, I don’t think all judgments can be left to markets, given prisons, the continuing existence of public bathrooms, etc.  Here are yet further comments.  Here is a good Jacqueline Rose piece from LRB.

Police versus Prisons

by on April 26, 2016 at 7:31 am in Economics, Law | Permalink

Here’s a remarkable graph from the Council of Economic Advisers report on incarceration and the criminal justice system. The graph shows that the United States employs many more prison guards per-capita than does the rest of the world. Given our prison population that isn’t surprising. What is surprising is that on a per-capita basis we employ 35% fewer police than the world average.* That’s crazy.

polce v prison

Our focus on prisons over police may be crazy but it is consistent with what I called Gary Becker’s Greatest Mistake, the idea that an optimal punishment system combines a low probability of being punished with a harsh punishment if caught. That theory runs counter to what I have called the good parenting theory of punishment in which optimal punishments are quick, clear, and consistent and because of that, need not be harsh.

We need to change what it means to be “tough on crime.” Instead of longer sentences let’s make “tough on crime” mean increasing the probability of capture for those who commit crimes.

Increasing the number of police on the street, for example, would increase capture rates and deter crime and by doing so it would also reduce the prison population. Indeed, in a survey of crime and policing that Jon Klick and I wrote in 2010 we found that a cost-benefit analysis would justify doubling the number of police on the street. We based our calculation not only on our own research from Washington DC but also on the research of many other economists which together provide a remarkably consistent estimate that a 10% increase in policing would reduce crime by 3 to 5%. Using our estimates, as well as those of some more recent papers, the Council of Economic Advisers also estimates big benefits (somewhat larger than ours) from an increase in policing. Moreover, what the CEA makes clear is that a dollar spent on policing is more effective at reducing crime than a dollar spent on imprisoning.

Unfortunately, selling the public on more policing is likely to be difficult. Some of the communities most in need of more police are also communities with some of the worst policing problems. We aren’t likely to get more policing until people are convinced that we have better policing. Moreover, people are right to be skeptical because the type of policing that works is not simply boots on the ground. As the CEA report notes:

Model policing tactics are marked by trust, transparency, and collaborations between police and community stakeholders…

Better policing and more policing complement one another. Greater trust can come with body cameras as well as community oversight and other efforts to bring transparency and accountability. Most importantly, the drug war has eroded trust between police and community and that has led to an endogenous equilibrium in which some communities are rife with both drugs and crime. Fortunately, marijuana decriminalization and legalization have begun to move resources away from the war on drugs. Legalization in states like Colorado does not appear to have increased crime and has likely contributed to a dramatic decline of violence in Mexico. As we move resources away from drug crime, police will have more resources to raise the punishment rate for those traditional crimes like murder, robbery and rape that communities everywhere do want punished.

Addendum: See also Peter Orszag’s column on this issue.
* Corrected: Earlier I said spending rather than employment.

Nonetheless it is worth reading.  From Tim Redmond, here is one bit:

…let’s remember: San Francisco is already by far the densest city West of the Mississippi, and third in the entire country…

And another:

Seriously: If you take the city’s own studies, which show that every 100 units of market-rate housing create a demand for 30 units of low-income housing (because new rich residents want people to serve them coffee and fine wines and clean their clothes and their toilets and provide security etc., and those new jobs mean new people who need places to live), then any high-end housing that isn’t 30 percent affordable is making the crisis worse. Got that? When you are in a hole, stop digging. If you’re in a crisis, don’t make it worse. And right now, building luxury housing is a net loser for the city.

The same goes for Muni. It costs the city far more to serve new housing than the new housing pays. Which means every time the rest of us pay higher fares for Muni, we are in effect subsidizing market-rate housing developers.

And yet another:

Please: Show me any evidence, any credible evidence at all, that allowing the private market to build, baby, build in San Francisco today (without demolishing hundreds of thousands of rent-controlled units and creating a city like Manhattan or Hong Kong without the social housing, that none of us want to live in) will actually bring down rents and allow the middle class to stay, and I will listen. But as far as I can tell, that evidence doesn’t exist.

In contrast I would stress that we need to count the welfare of the in-migrants.  But I nonetheless hope that market urbanism can do a better job outlining how cheaper housing might be expected to come to San Francisco, and with which complementary regulations if any.

On the limits of restrictive housing policy in San Francisco, this NYT story is also worth reading:

The Chamber of Commerce and the tourist board are calling for harsher measures to improve what is euphemistically called the “condition of the streets,” a term that encompasses the intractable homeless problem, public intravenous drug use, the large population of mentally ill people on the streets and aggressive panhandling. The chamber recently released the results of an opinion poll that showed that homelessness and “street behavior” were the primary concerns of residents here.

It’s funny but also sad how many people attacked me when I predicted this in my book Average is Over:

Visitors come to bask in the Mediterranean climate, stroll through the charming streets and marvel at the sweeping views of the bay and the Pacific. But alongside those views are tent encampments on sidewalks and rag-covered homeless people in front of some of the most expensive real estate in America.

Property crime is up more than sixty percent since 2010.

I say they eventually get cleared out, but to where?  Here is my previous post on market urbanism and whether it is overrated.

It offers many interesting facts and angles (pdf here).  Here is one instructive paragraph of note:

Relative to other factors, rising prison admission rates have been the most important contributor to the increase in incarceration. Raphael and Stoll (2013b) decompose the growth in the prison population into changes in crime rates, prison admissions and time served. If criminal justice policies remained the same as they were in 1984, State imprisonment rates would have actually 20 declined by 7 percent by 2004, given falling crime rates. Instead, State prison rates increased by over 125 percent. After accounting for falling crime rates, over two-thirds of this increase was attributable to rising prison admission rates, and 14 percent to increases in time served. In Federal prisons, longer sentences and rising admissions rates have been equally important, each accounting for approximately 20 percent of the growth in the Federal prison rate that is not due to changes in crime…

That is from pp.19-20.  Here is a related post from last year.

Paul Krugman on a carbon tax

by on April 21, 2016 at 12:52 am in Economics, Law, Science | Permalink

If reducing emissions really has to involve moving on many fronts, anything that looks like an administrative solution — telling, say, power companies what to do or not to do — is going to be much more costly than carbon pricing that exploits all the possibilities. But if a large part of the solution is going to involve a fairly limited set of measures — such as putting a quick end to the practice of burning coal to generate electricity — getting to broad-based carbon pricing is much less central.

And what I gather from reading various analyses of our prospects is that we’re closer to case #2 than to case #1: the problem of limiting climate change isn’t all that complex. End coal-burning and you’ve gone a significant way; a few other big things get you another substantial part of the way. Yes, comprehensive carbon pricing would be best, but it’s not the sine qua non of effective action.

Most of his points concern the status of Econ 101.

Addendum: Ashok Rao comments.