Month: February 2020

Why are we letting FDA regulations limit our number of coronavirus tests?

Since CDC and FDA haven’t authorized public health or hospital labs to run the [coronavirus] tests, right now #CDC is the only place that can. So, screening has to be rationed. Our ability to detect secondary spread among people not directly tied to China travel is greatly limited.

That is from Scott Gottlieb, former commissioner of the FDA, and also from Scott:

#FDA and #CDC can allow more labs to run the RT-PCR tests starting with public health agencies. Big medical centers can also be authorized to run tests under EUA. For now they’re not permitted to run the tests, even though many labs can do so reliably 9/9 cdc.gov/coronavirus/20

Here is further information about the obstacles facing the rollout of testing.  And read here from a Harvard professor of epidemiology, and here.  Clicking around and reading I have found this a difficult matter to get to the bottom of.  Nonetheless no one disputes that America is not conducting many tests, and is not in a good position to scale up those tests rapidly, and some of those obstacles are regulatory.  Why oh why are we messing around with this one?

For the pointer I thank Ada.

Who is Wealthy?

argues against comparing wealth over time:

The difficulty of measurement of wealth between different periods derives not only because of our lack of data for most of the past but from the inability to meaningfully compare wealth or consumption patterns in the past with those of today. Some economists believe that if people in the past did not have certain amenities that we have today they must have been infinitely poorer. This is what one finds in Nordhaus and DeLong’s view of historical progress as unfolfding through reduced cost of artificial lighting, the approach that Angus Maddison (in “Contours of the World Economy: 1-2030”) termed a “hallucigenic history”.

The logic of such authors is as follows. Take the example of artificial lighting or voice recording. For Julius Caesar to read a book overnight, easily move at night around his palace, or listen to the songs he liked would have required perhaps hundreds of workers (slaves) to hold the torches or sing his favorite arias all night. Even Caesar, if he were to do that night after night, might, after some time, have run out of resources (or might have provoked a rebellion among the singers). But for us the expense for a similar pleasure is very small, even trivial, say $2 per night. Consequently, some people come to the conclusion that Caesar must have had tiny wealth measured in today’s bundle of goods since a repeated small nightly expense of $2 (in today’s prices) would have eventually ruined him. Other people at Caesar’s time had obviously much less: ergo, the world today is incomparably richer than before, and people then must have felt horribly poor and deprived of all pleasurable things. (Even if you cannot feel deprived of the things you do not know exist.)

The logic seems at first reasonable even if somewhat extreme. But it is not reasonable. Let’s extend this logic, now in a different direction, from us today to the next 500 years. Suppose that in 500 years people are able to choose for their vacation between Mars, Venus, Pluto or perhaps even to go further than that. Suppose they can fly around our solar system, go to the bottom of the ocean, zip from one end of the Earth to another in a few minutes, or do lots of fun things that we cannot imagine today, no more than Caesar could have imagined that his singers’ voices could be recorded on a tiny chip and reproduced ad infinitum at almost no cost. And when we then look at Jeff Bezos’ wealth today using the consumption opportunities of the future, that wealth is likely to look to us –from the vantage point of 500 years hence- insignificant. Bezos might be rich in our own terms, but he cannot fly to Mars this weekend, no matter how much he tries.

So should we then absurdly turn around and claim that Jeff Bezos, Bill Gates et al. are poor? Clearly not.

I am baffled by the last two sentences. Bezos and Gates clearly are poor relative to people in the future who can choose to vacation on Mars. It seems absurd to me to think otherwise. Jeff Bezos has four children. Suppose one of them had cancer. If he could, do you think Bezos would hesitate for one minute to spend a billion dollars buying the medicine that will be available to an ordinary American in the year 2050? How much would Bezos pay for an extra 10 years of life? What about an extra 100? How much for a bionic eye, a dozen extra points of IQ, or freedom from Alzheimer’s disease?

Or put it the other way. How much wealthier would you have to be to want to live in 1950, 1900 or 1850? I can come up with numbers for 1950 and 1900 but I think I would prefer my income and lifestyle today to anyone’s income and lifestyle in 1850. Dentist anyone? I’d also prefer it if my wife didn’t die in childbirth.

Branko argues that comparisons of wealth across long time periods are impossible, meaningless, even “hallucinogenic.” I think he has it backwards. It’s quite difficult to compare wealth over fairly short periods. Am I wealthier than my father was at my age (he was also a professor). Maybe. Maybe not. We consume somewhat different bundles. I have Netflix and a nicer car. He had a nicer house. But am I wealthier than my grandfather? Absolutely. On either side.

Health care economist sentences to ponder

Various ideas to cut costs in Medicare and Medicaid have been proposed in recent years. Health economists generally oppose those changes.

And this:

If health economists were in charge of the health system, not a lot would change, with some notable exceptions. Medicaid would not have work requirements (which would be unpopular among conservatives in some states), and taxes would go up for Medicare and for employer-based health insurance (which would make it unpopular among just about everybody).

Here is a much longer and excellent piece by Austin Frakt, surveying what health economists in the United States believe about health care policy.  Also do note that health care economists overwhelmingly tend to be Democrats.

What should we think about all this?  That we can trust these health care economists to (more or less) endorse the current system because it is in fact pretty good, relative to available constraints?  That radical reforms, as suggested by say some Democratic presidential candidates, are undesirable and unneeded?  That the Democratic economists who endorse single payer are way overreaching?  Or that these health economists are both deluded — in whichever direction — and also major wusses?

Inquiring minds wish to know.  Here is a related Twitter thread from Michael Cannon.

*Just Hierarchy: Why Social Hierarchies Matter in China and the Rest of the World*

That is the new book by Daniel A. Bell and Wang Pei.  It is perhaps not so novel to students of Jean Bodin and medieval political thought, or say Chinese history, but still the book crystallizes a moment and I consider its publication a matter of note.  Here is one short bit:

But which hierarchical relations are justified and why?  In our view, it depends on the nature of the social relations and the social context.  As a method, we are inspired by Michael Walzer’s call for a pluralistic approach to justice.  There is no one principle of justice appropriate for all times and places.  Our main argument is that different hierarchical principles ought to govern different kinds of social relations.  What justifies hierarchy among intimates is different from what justifies hierarchy among citizens; what justifies hierarchy among citizens is different from what justifies hierarchy among countries; what justifies hierarchy among countries is different from what justifies hierarchies between humand and animals, and…The sum total of our argument is that morally justified hierarchies can and should govern different spheres of our social lives…

The discussion of the Kama Sutra, and its notions of hierarchy, was interesting too.

Saturday assorted links

Patients as Consumers in the Market for Medicine: Bedside Manner > Survival Probability

Young and Chen, 2020: Consumer-driven health care is often heralded as a new quality paradigm in medicine. However, patients-as-consumers face difficulties in judging the quality of their medical treatment. With a sample of 3,000 U.S. hospitals, we find that neither medical quality nor patient survival rates have much impact on patient satisfaction with their hospital. In contrast, patients are very sensitive to the “room and board” aspects of care that are highly visible. Quiet rooms have a larger impact on patient satisfaction than medical quality, and communication with nurses affects satisfaction far more than the hospital-level risk of dying. Hospitality experiences create a halo effect of patient goodwill, while medical excellence and patient safety do not. Moreover, when hospitals face greater competition from other hospitals, patient satisfaction is higher but medical quality is lower. Consumer-driven health care creates pressures for hospitals to be more like hotels. These findings lend broader insight into unintended consequences of marketization.

It doesn’t surprise me that consumers respond much more to nice nurses than to survival probabilities. Nice nurses are observable by patients but survival probabilities can only be estimated from sophisticated statistical models. I do wish that patients paid more attention to the outputs of sophisticated statistical models when choosing doctors and hospitals, as I think this would improve quality, but mostly they don’t. As a result, competition increases patient satisfaction but less clearly increases medical quality and medical excellence. The authors, in fact, argue that competition reduces medical quality but that part of their paper is weaker than the former and the bulk of the economic literature indicates that hospital competition also increases quality albeit not strongly and with some mixed results.

Hat tip: Kevin Lewis.

An argument for weaker copyright in books

From Barbara Biasi and Petra Moser:

Copyrights, which establish intellectual property in music, science,and other creative goods, are intended to encourage creativity. Yet, copyrights also raise the cost of accessing existing work – potentially discouraging future innovation.This paper uses an exogenous shift towards weak copyrights(and low access costs) during WWII to examine the potentially adverse effects of copyrights on science. Using two alternative identification strategies, we show that weaker copyrights encouraged the creation of follow-on science, measured by citations.This change is driven by a reduction in access costs, allowing scientists at less affluent institutions to use existing knowledge in new follow-on research.

The paper title is “Effects of Copyrights on Science: Evidence from the WWII Book Republication Program.”

Claims about white people

Black women for instance, present a consistent pattern of improvement in happiness across decades, while White women display a persistent pattern of decline. In contrast, Black men experienced a discernable pattern of improvement in happiness between the 1970s and 1990s, followed by a leveling off in the early-2000s. White men experienced moderate gains in happiness between the 1970s and 1990s, but after the Great Recession/Obama Era, White male happiness followed a pattern of unprecedented decline, with the “happiness advantage” they once enjoyed (as a group) over Black men and women largely vanishing.

That is by Jason L. Cummings, via the excellent Kevin Lewis.

Does digital socialism have a future?

No, not a good future, according to Jesús Fernández-Villaverde:

Can artificial intelligence, in particular, machine learning algorithms, replace the idea of simple rules, such as first possession and voluntary exchange in free markets, as a foundation for public policy? This paper argues that the preponderance of the evidence sides with the interpretation that while artificial intelligence will help public policy along with several important aspects, simple rules will remain the fundamental guideline for the design of institutions and legal environments. “Digital socialism” might be a hipster thing to talk about in Williamsburg or Shoreditch, but is as much of a chimera as “analog socialism.”

The paper is an excellent response to a growing set of claims, I would add further material on the work of Michael Polanyi and the importance of inarticulable knowledge.

Very good sentences

Nearly all of the biggest challenges in America are, at some level, a housing problem. Rising home costs are a major driver of segregation, inequality, and racial and generational wealth gaps. You can’t talk about education or the shrinking middle class without talking about how much it costs to live near good schools and high-paying jobs. Transportation accounts for about a third of the nation’s carbon dioxide emissions, so there’s no serious plan for climate change that doesn’t begin with a conversation about how to alter the urban landscape so that people can live closer to work.

Those are from Conor Daugherty in the NYT, via the excellent Kevin Lewis.

A central bank digital currency is not a good idea, redux

The introduction of a central bank digital currency (CBDC) allows the central bank to engage in large-scale intermediation by competing with private financial intermediaries for deposits. Yet, since a central bank is not an investment expert, it cannot invest in long-term projects itself, but relies on investment banks to do so. We derive an equivalence result that shows that absent a banking panic, the set of allocations achieved with private financial intermediation will also be achieved with a CBDC. During a panic, however, we show that the rigidity of the central bank’s contract with the investment banks has the capacity to deter runs. Thus, the central bank is more stable than the commercial banking sector. Depositors internalize this feature ex-ante, and the central bank arises as a deposit monopolist, attracting all deposits away from the commercial banking sector. This monopoly might endangered maturity transformation.

Here is the NBER working paper by Jesús Fernández-Villaverde, Daniel Sanches, Linda Schilling, and Harald Uhlig.  Here is my earlier Bloomberg column with similar themes.

The missionary roots of liberal democracy

I had not known of this important piece.  From 2012, by Robert D. Woodberry, at the National University of Singapore:

This article demonstrates historically and statistically that conversionary Protestants (CPs) heavily influenced the rise and spread of stable democracy around the world. It argues that CPs were a crucial catalyst initiating the development and spread of religious liberty, mass education, mass printing, newspapers, voluntary organizations, and colonial reforms, thereby creating the conditions that made stable democracy more likely. Statistically, the historic prevalence of Protestant missionaries explains about half the variation in democracy in Africa, Asia, Latin America and Oceania and removes the impact of most variables that dominate current statistical research about democracy. The association between Protestant missions and democracy is consistent in different continents and subsamples, and it is robust to more than 50 controls and to instrumental variable analyses.

For the pointer I thank Ann Swidler.