The “Deaths of Despair” narrative is somewhat wrong

Matt Yglesias does an excellent job laying out the case against the “deaths of despair” narrative and putting it bluntly. 

Over the past few years, Anne Case and Angus Deaton have unleashed upon the world a powerful meme that seems to link together America’s troublingly bad life expectancy outcomes with a number of salient social and political trends like the unexpected rise of Donald Trump.

Their “deaths of despair” narrative linking declining life expectancy to populist-right politics and to profound social and economic decay has proven to be extremely powerful. But their analysis suffers from fundamental statistical flaws that critics have been pointing out for years and that Case and Deaton just keep blustering through as if the objections don’t matter. Beyond that, they are operating within the confines of a construct — “despair” — that has little evidentiary basis.

Novosad, Rafkin, and Asher have provided a compelling analysis of a very concentrated problem of worsening health outcomes for the worst-off Americans. Case and Deaton, by contrast, have delivered a very misleading portrait of worsening health outcomes for the majority of Americans that (because they mistakenly think it’s a majority) they attribute to broad economic forces that exist internationally but which for some reason only cause “despair” in the United States.

…The point is that we face a set of discrete public health challenges that we need to think about both as policy matters and in terms of politics and public opinion. But there is no “despair” construct driving any of this, and the linkage to big picture political trends is simply that Republicans are more hostile to regulation. Case and Deaton, meanwhile, have sent us on the equivalent of a years-long wild goose chase away from well-known ideas like “smoking is unhealthy” or “it would be good to find a way to get fewer people to use heroin.”

I tend to agree with Matt but I would offer a few cautions. Case and Deaton have been too broad in identifying the at-risk population. Identifying more carefully the at-risk group(s) is important so that we can target different problems with different solutions. Indeed, part of what makes the very important opioid crisis so bedeviling is precisely that it is not limited to “despairing” populations but cuts across many groups.

I wouldn’t, however, throw out despair as an organizing principle. The evidence on “despair” goes beyond death to include a host of co-morbidities such as mental stress, marriage rates, labor force participation rates and other measures of well being. Regardless of the precise population to which these problems attach they are co-morbidities and I suspect not by accident. Education is a proxy for the underlying problem but likely not causal. Matt’s cheeky suggestion to promote ideas like “smoking is unhealthy” illustrates part of the issue. Education and information will not solve that problem. Smokers know that smoking is unhealthy but they do it anyway–perhaps because it’s one of the few easily available pleasures if you are unmarried, out of work and stressed.

Nevertheless, do read the whole thing

Legacy Admissions

I admire but do not necessarily approve of the genius at UVA admissions who slyly inserted legacies into the essay prompt, yet shrewdly combined it with race, slavery and history to make the package defensible.

If you have a personal or historic connection with UVA, and if you’d like to share how your experience of this connection has prepared you to contribute to the University, please share your thoughts here. Such relationships might include, but are not limited to, being a child of someone who graduated from or works for UVA, a descendant of ancestors who labored at UVA, or a participant in UVA programs.

Claudia Goldin Wins Nobel

Claudia Goldin wins the Nobel! Goldin is an economic historian, she was inspired to go into economics by Alfred Kahn (later the architect of airline deregulation) and became a student of Robert Fogel at the University of Chicago. Goldin pioneered the historical analysis of the labor market and gender. If you want to read a single Goldin piece then very fortuitously and appropriately her NBER paper called…Why Women Won just appeared as an NBER working paper! The Nobel Prize committee’s Scientific Background is a good summary of her work including her important work on education with Larry Katz.

Goldin is well known at MR which makes covering this year’s Nobel easy as I can point to our MRU videos on Goldin and her podcast with Conversations with Tyler.

First, an overview of Goldin and her work, especially interesting on her archival work. Goldin wasn’t just downloading datasets she discovered and developed them!

Next is my video on one of Goldin’s key papers (with Katz) about how the development of the pill vastly accelerated women entering the workforce especially in the professions (we also cover Goldin’s paper in Modern Principles.)

Women working: What’s the Pill Got To Do With It?

Then there is Tyler’s Conversations with Tyler podcast with Goldin. I am struck by how little Goldin is willing to speculate, pontificate or advocate in that conversation and instead sticks to the data.

Finally, here are many other MR posts on Goldin.

Union Busted

The International Longshore and Warehouse Union (ILWU) just filed for bankruptcy because it lost a case with a port operator in Portland. The back story is amazing.

The ILWU is one of the most powerful unions in the United States. Since bloody riots in 1934 it has controlled all 29 seaports on the west coast of the United States, giving them monopoly power. The ILWU’s 22 thousand workers are known as the “lords of the dock” and they earn an average of just over $200,000 in salary and another $100,000 in benefits, a bit more than the typical CEO. Some ILWU foremen take home half a million a year.

The ILWU has a lock on dockworkers but there are other rival unions. In Portland, for example, there were two jobs for reefers–electrical workers who handle special refrigerated containers–that since 1974 had been held by members of the International Brotherhood of Electrical Workers. The ILWU, however, wanted control of these jobs and in 2012 one of the heavies of the union, Leal Sundet, threatened the manager of the port operator that if he didn’t help him to take these jobs from the Brotherhood and give them to the Longshoremen he would create havoc. When the port operator didn’t comply–it wasn’t clear even that they could comply as the jobs were not under the port operator’s control–the ILWU followed through on its threat. Repeated shutdowns, slowdowns and discovered “safety violations” disrupted port operations so badly that the entire port closed.

The port operator, however, took the ILWU to court, arguing that the labor actions were illegal. The jury agreed giving the port operator an award of $93.6 million for its losses, later reduced to $19 million. The Union doesn’t have the $19 million, hence the bankruptcy.

Thus, the union has been bankrupted, the port closed, hundreds of millions of dollars lost and shipments slowed all because of a dispute over 2 jobs.

In related news, the just approved ILWU contract raises wages for ILWU workers and ensures that there will be no serious automation of the ports for at least another six years, again putting the United States behind the rest of the world in efficient shipping and logistics.

I am reminded of the day Ronald Reagan fired the air traffic controllers for their illegal strike.

Speeding Up Pharmaceutical Approvals by Recognizing Other Stringent Regulators

New Zealand’s ACT party has proposed that New Zealand speed up pharmaceutical approvals by recognizing the decisions of other stringent regulators, an idea I have long promoted .

The average time for Medsafe to consent an application for a high risk medicine is 630 days. For intermediate risk, it is 661 days and for lower risk it is 830 days8. The average time taken just for processing some lower risk categories is 176-210 days. This is an unacceptable length of time, given there other regulatory bodies replicating that exact same work overseas.

ACT says if a drug or medical device has been approved by any two reputable foreign regulatory bodies (such as Australia, United States, United Kingdom), it should be automatically approved in NZ as well within one week unless Medsafe can show extraordinary reason why it shouldn’t be.

This simple change would significantly improve access to medicines that have already been subject to rigorous testing and analysis through other regulatory regimes.

The ACT party is small but it has some seats and surprisingly the much larger National party is proposing a similar rule:

New Zealand’s slow approval process for medicines means Kiwis wait much longer than people in other countries to access potentially life-saving treatments. While it is essential that medicines and other treatments are subject to stringent scrutiny to ensure they are safe, there is no reason why New Zealanders should have to wait for our domestic medicines regulatory body, Medsafe, to conduct its own cumbersome process from scratch, when countries with health systems we trust have already gone through this exercise.
National will:

…• Require Medsafe to implement even faster approvals processes for any medicines for use in New Zealand that have already been approved by at least two regulatory bodies that we currently recognise, including Australia, the EU, Singapore, the UK, Switzerland and the US.

New Zealand, by the way, already has a reciprocity agreement with the United States for food and it’s mutual–the FDA also recognizes New Zealand as a stringent food regulator–so the idea is not unprecedented.

Moreover, all of this comes on the tail of the UK actually adopting the idea via the “reliance procedure” which recognizes the EU as a stringent regulator and guarantees approval in the UK within 67 days for ay drug approved in the EU.

In the United States, even AOC has flirted with the idea, at least for sunscreens!

Thus, the reciprocity or recognition idea is starting to be adopted.

Hat tip: Eric Crampton who has some further comments.

Work From Home Works

It took firms decades to adjust to electricity by redesigning factories, products, and workflows to take full advantage of the new possibilities. Similarly, the benefits of work from home start to come most profoundly when expensive offices can be shrunk, employers can draw from a much larger pool of workers and workers can adjust when and where they work, including the location of their homes. It’s not surprising, therefore, that with little time for either the workers or the firms to adjust and with few options to choose how much to work from home, productivity fell when COVID sent workers home.  But, with more time to plan and more options for hybrid but extensive work from home (e.g. work from home Mondays and Fridays), work from home has large benefits. We are also seeing management redesign to take advantage of work from home in the same way we saw factory redesign to take advantage of electricity. Management, for example, is shifting from input metrics–do you show up?–to output metrics–did the work get done? Designing and validating new metrics takes time, but these changes are helping to increase the benefits of work from home.

Nick Bloom reviews the evidence (slides here).

Looking at micro economic studies on working from home productivity, the classic is “The Stanford Study” I helped oversee in 2010-2012. We randomized 250 employees in a large multinational firm into those who would work from home and those who would report to the office. The expectation, of course, was that home-based employees would goof-off, sleeping or watching TV rather than working.

So, we were shocked to find a massive 13 percent increase in productivity.

The productivity boost came from two sources. First, remote employees worked 9 percent more in minutes per day. They were rarely late to work, spent less time gossiping and chatting with colleagues, and took shorter lunch breaks and fewer sick days. Remote employees also had 4 percent more output per minute. They told us it’s quieter at home. The office was so noisy many of them struggled to concentrate.

The macro evidence also suggests or at least is consistent with work from home working:

In the five years before the pandemic, U.S. labor productivity growth was 1.2 percent; since 2020, this picked up to 1.5 percent. Given the state of the world, that acceleration was miraculous.

What could have caused this? Perhaps rising government expenditure and easy monetary policy? Possibly, but greater government activity traditionally is associated with lower, not higher, productivity growth. Perhaps an acceleration in technology and computerization? Possibly, but the pandemic did not witness any pickup in technological progress. Perhaps the five-fold surge in working from home post-pandemic. Maybe cutting billions of commuting hours, replacing millions of business trips with Zoom meetings, increasing the labor supply of Americans with disabilities or child-care commitments, and saving millions of square feet of office space increased productivity? It is honestly hard to say.

Revealed preference is the most telling piece of evidence. Workers value the option to work from home and many firms now advertise the options for hybrid work as a benefit:

…millions of firms around the world are adopting hybrid and remote work, there has to be something there. I have spoken to many hundreds of managers and firms over the last three years and I repeatedly hear they use home working as a key part of their recruitment and retention strategy. Indeed, another recent experiment on 1600 employees found hybrid reduced employee quit rates by 35 percent. \

Despite a rocky start, work from home appears to have stabilized at around 25% of work days overall and stunningly, nearly 40% of work days for college educated workers! Work from home thus appears to be a permanent and beneficial change in how work is structured.

The PayPal StableCoin

PayPal customers can now transact in PayPal USD, a crypto stablecoin tied to the dollar. So which type of PayPal dollar, regular or crypto, is safer to hold? Surprisingly, the crypto dollar is backed by safer assets, gives you better rights in the event of a bankruptcy and is more transparent. The reason is not so much crypto per se as because PayPal USD is regulated differently and the US’s convoluted system of money regulation regulates similar things in different ways. J.P. Koning has the details:

[First] PayPal’s crypto dollars, which are managed by a third-party called Paxos, are 100% backed by the safest sorts of short-term collateral: U.S. Treasury-bills, reverse repo (backed by U.S. government securities), and commercial bank deposits. In finance lingo, these assets are known as cash and cash equivalents. A big reason for this conservative investment approach is that Paxos is subject to a set of strict investment limits as determined by its regulator, the New York State Department of Financial Services (NYDFS). You can read about the NYDFS’s stablecoin regulatory framework here.

By contrast, PayPal’s regular dollars, which are regulated piecemeal under each U.S. states’ own peculiar version of a money transmitter license, can almost always be legally backed by riskier assets.

…The second drawback of PayPal’s regular dollars is that the assets underlying them don’t really “belong” to customers in any strong sense of the word. They belong to PayPal.

To understand what this means, let’s say that PayPal goes bankrupt. You, a long time PayPal customer, hold $1000 worth of PayPal dollars. You might think that you are guaranteed to be made whole because there exists a corresponding set of underlying customer assets that has been specially earmarked for you and other PayPal customers. But that’s not the case. Customers are what is referred to in finance as an unsecured creditor of PayPal, which means you’d be relegated to having to fight with PayPal’s other creditors (banks, bond holders, etc) to get a piece of the pie, and that’s only after PayPal’s secured creditors – those highest in the pecking order – get first dibs. That could potentially mean getting maybe $600 or $700 instead of your original $1000.

…By contrast, the regulator of PayPal’s crypto-based dollars, the NYDFS, specifies that the reserves backing any crypto-based dollar “shall be held at these depository institutions and custodians for the benefit of the holders of the stablecoin, with appropriate titling of accounts.” To translate, the assets underlying your $1000 in PayPal USD cryptodollars are not PayPal’s assets. Nor are they Paxos’s. They are yours. No need to squabble with competing vultures for what’s left.

…The last big difference between the two types of PayPal dollars is that the crypto version offers far more transparency to customers. If you want to get current information about the assets underlying your crypto PayPal dollars, all you need to do is open up one of PayPal USD’s soon-to-be published attestation reports. Published monthly, these reports must include market values of the assets backing PayPal USD’s, both in total and broken down by asset class. These values must be recorded on two separate days each month, or 24 times per year. Furthermore, these attestation reports must be prepared by an independent auditor.

By contrast, the only way to get vetted financial information about the assets backing traditional PayPal dollars is to read its audited financial statements, which come out just once a year. For the rest of the twelve months, customers are left in the dark.

Ayn Rand on the Antitrust Laws

Here is Ayn Rand on the antitrust laws:

Under the Antitrust laws, a man becomes a criminal from the moment he goes into business, no matter what he does. For instance, if he charges prices which some bureaucrats judge as too high, he can be prosecuted for monopoly or for a successful “intent to monopolize”; if he charges prices lower than those of his competitors, he can be prosecuted for “unfair competition” or “restraint of trade”; and if he charges the same prices as his competitors, he can be prosecuted for “collusion” or “conspiracy.” There is only one difference in the legal treatment accorded to a criminal or to a businessman: the criminal’s rights are protected much more securely and objectively than the businessman’s.

Exaggeration? Here is the FTC case against Amazon which has switched almost overnight from one theory to the diametrically opposite theory:

“It’s really hard to square the circle of the earlier theory of harm that Lina Khan enunciated with the current complaint,” said John Mayo, an economist who leads Georgetown University’s Center for Business and Public Policy. “The earlier complaint was that prices were going to be too low and therefore anticompetitive. And now the theory is they are too high and they are anticompetitive.”

More generally, the FTC under Khan seems to be a lost opportunity. There are abusive practices such as hidden pricing by hospitals that could be improved but the FTC is throwing it away on pursuing the greatest store the world has ever known. Why? I have liberal friends who quit the FTC because they wanted to work on real cases not political grandstanding.

Dynamic Graphs in Modern Principles

Achieve is the excellent course management system for our textbook, Modern Principles. With Achieve, teachers can assign videos, homework, exercises and so forth. One advantage of online education is that students can engage with interactive exercises that give them immediate feedback.

Achieve also includes an electronic version of Modern Principles and all the graphs are dynamic so students can interact directly with the textbook. Students, for example, can practice at shifting the curves and also see the data in visually appealing and meaningful ways. Here are two examples.

Contact your rep to get more information.

Patents, Intellectual Property and the Rise of the Rent Seeking Society

During the summer I had the opportunity to spend a week at a16z’s crypto lab in New York City where I gave a fun talk on intellectual property including patents and copyrights, the great stagnation, the diffusion of ideas, American economic dynamism and even some discussion of AI and copyright in the Q&A.  Check it out!

The Productivity of Online Education Increases

Teaching is a labor-intensive service industry for which it is difficult to increase productivity. Thus, the price of education rises over time, the Baumol effect. One of the reasons Tyler and I have put a lot of effort into online education is that it ties education to high productivity growth industries such as software and technology. Thus in the Industrial Organization of Online Education we argued:

…as more of the value of a course comes from software and less from live teaching, productivity will improve, thus removing the cost disease.

Here’s a case in point:

This is just a test but all of the videos for our textbook, Modern Principles, and our free online platform Marginal Revolution University are already subtitled in many languages and soon we will see more translations like the one above. Amazing.

Songs Sold for a Song

In our principles textbook, Modern Principles, Tyler and I discuss securitization and give the interesting example of music securitization with the picture at right (I’m pretty proud of the caption.)

But what has happened to these big purchases of song portfolios? Ted Gioia runs the numbers and finds that the rock stars sold at the top and the financiers are taking a bath!

On Thursday, Hipgnosis announced a plan to sell almost a half billion dollars of its song portfolio. They need to do this to pay down debt. That’s an ominous sign, because the songs Hipgnosis bought were supposed to generate lots of cash. Why can’t they handle their debt load with that cash flow?

But there was even worse news. Hipgnosis admitted that they sold these songs at 17.5% below their estimated “fair market value.” This added to the already widespread suspicion that current claims of song value are inflated.

Hipgnosis’s share price actually dropped after the announcement.

Last year, I predicted the following:

“Don’t be surprised if the folks at [private equity group] Blackstone end up owning all those songs. But if it happens, they will probably acquire the music at a sharp discount to what those songs were worth just a few months ago.”

Can you guess the buyer in the deal announced on Thursday? Yes, it was a Blackstone-backed fund. And they definitely got that discount.

But there’s one part of this story that I love.…It confirms my sense that karma is at work in the universe, and everything tends towards justice and fairness—if you’re willing to wait long enough.

Here’s that element of karma. The old rock stars actually did defeat the system. They screwed the man, and did it big time.

By my measure, Bob Dylan sold out at the top, and gets to laugh at the financiers who overpaid him. The same is true of Paul Simon and Neil Young and all the rest.

When I launch my hedge fund, I’m going to invite them to join me as partners. They are shrewd operators, every one of them.

The Zero Sum Idea Trap

In an excellent column, John Burn-Murdoch in the FT draws out some of the implications of zero-sum thinking,  based on the new NBER paper Zero-Sum Thinking and the Roots of U.S. Political Divides.

Among the most striking Harvard findings was the discovery that there is a strong relationship between the extent to which someone is a zero-sum thinker, and the economic environment they grow up in.

If someone’s formative years were spent against a backdrop of abundance, growth and upward mobility, they tend to have a more positive-sum mindset, believing it is possible to grow the pie rather than just redistribute portions of it. People who grew up in tougher economic conditions tend to be more zero-sum and sceptical of the idea that hard work brings success. These attitudes are perfectly rational.

…Every five to 10 years, the World Values Survey asks people in dozens of countries where they would place themselves on a scale from the zero-sum belief that “people can only get rich at the expense of others”, to the positive-sum view that “wealth can grow so there’s enough for everyone”.

The average response among those in high-income countries has become 20 per cent more zero-sum over the last century. Moreover, two distinct rises in the prevalence of zero-sum attitudes have coincided with two slowdowns in gross domestic product growth, one in the 1970s and another in the past two decades.

The same pattern holds within individual countries. Britons and Americans have become significantly more likely to believe that success is a matter of luck rather than effort precisely as income growth has slowed.

The problem, of course, is that zero-sum thinking can causally lead to lower growth because it leads to anti-growth policies such as tariffs, anti-immigration, NIMBY, low-trust, high taxes, redistribution, identity politics and so forth.

All of this is reminiscent of Bryan Caplan’s Idea trap model. See also my earlier posts on how distrust leads to more regulation, even when people distrust the government!

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Pharmaceutical Externalities

In my view, pharmaceuticals are undervalued and underinvested in because, despite high prices, pharmaceutical innovations earn only a fraction of the value that they create (Nordhaus finds that in general that innovations reap only a small share of the gains that they create). In 2014, for example, we got Harvoni a new treatment that offered a complete cure for hepatitis C (HCV) infection. In 2014, Harvoni cost over $1000 a pill and between $60,000 and $100,000 for a full treatment. In 2015 Medicaid spent more on Harvoni than on any other drug and there were calls for regulation and price controls. Studies showed, however, that even at that high price, Harvoni was value/cost-effective. Today, with more competition, there are equivalent versions of Harvoni available from Amazon for $12,869 (and 64 cents) which is still expensive but cheap for a cure for an often debilitating and sometimes life-threatening disease (and the price is less for a private insurance buyer or Medicare/Medicaid). In 2030, Harvoni will go generic and prices will fall much more.

Writing at their new substack, Random Acts of Medicine (based on their book of the same name which I reviewed at the WSJ), Chris Worsham and Bapu Jena point us to another side-benefit of Harvoni and similar hep-C drugs. By curing hep-C these drugs results in fewer liver transplants but that means more livers are available for transplant to other people on the waiting list.

One simple statistic suggests that indeed, treatment of HCV is freeing up donor livers for patients with other diseases: in 2022, patients with chronic HCV infection represented only 11% of liver transplants (1,029 of 9,528)—down from the 38% in 2013 when the new HCV drugs were approved.

Beyond this simple figure, a new working paper by economists Kevin Callison, Michael Darden, and Keith Teltser has taken a new, rigorous look at data from 2014 to 2019 to understand how these new drugs for HCV have impacted liver transplants after their first 5 years of broad use. There were a number of encouraging findings:

  • Waiting lists for liver transplants were being occupied by fewer HCV-positive patients and more HCV-negative patients; this shift can be explained by an estimated 45% reduction in the addition of new HCV-positive patients to waiting lists
  • Patients on the waiting list were healthier, likely because waiting times for livers have decreased with less demand from HCV-positive patients
  • Compared to what would have been expected without the introduction of new HCV treatments, the researchers estimated a 39% decrease in transplants to HCV-positive patients coupled with a 36% increase in transplants to HCV-negative patients.
  • Over the five year period, researchers estimated 5,682 livers were transplanted to HCV-negative patients as a result of the new HCV drugs, corresponding to an economic value of $7.5 billion.

These kinds of external benefits from pharmaceuticals are often undercounted and they are one reason why I think the pharmaceutical price controls in the Inflation Reduction Act are a very bad idea.