How Many Lives has Vaccination Saved?

A Commonwealth Fund study:

The U.S. vaccination program campaign has profoundly altered the trajectory of the COVID-19 pandemic, preventing nearly 1.1 million deaths. Even with only about 60 percent of Americans vaccinated to date, the nation has dodged a massive wave of COVID-19 deaths that would have started as the Delta variant took hold in August 2021. Because of Delta’s rapid and nationwide spread, deaths due to COVID-19 would have far exceeded all previous peaks.

Our estimates suggest that in 2021 alone, the vaccination program prevented a potentially catastrophic flood of patients requiring hospitalization. It is difficult to imagine how hospitals would have coped had they been faced with 10 million people sick enough to require admission. The U.S. has 919,000 licensed hospital beds and typically accommodates about 36 million hospitalizations each year.3 Even the 2.6 million COVID-related hospitalizations that occurred during 2021 placed an enormous strain on hospitals, with many staff lost not only to the virus but also to exhaustion and burnout. Faced with such unprecedented demand, U.S. hospitals operating under crisis standards of care would likely have had no choice but to turn away tens of thousands or even hundreds of thousands of individuals.

The methodology is somewhat unclear so take this with a grain of salt–many future studies will look at this question–but one million lives saved is not outside the realm of the possible. One million lives saved at a $7 million value of statistical life is a 7 trillion dollar savings. Keep this number in mind when evaluating pandemic investment.

Photo Credit: Lindsay Bonanno

Let Students Stay in Their Dorms!

Georgetown University, like many universities, closes its dorms for the holidays. Why? Closing the dorms is an especially costly policy this year for international students, many of whom will have to quarantine if they fly home. As a result, lots of students have to find temporary housing over the holidays. Kenan Dogan, Kelly He, and Shurui Liu, students of Jason Brennan at Georgetown, offer a compelling analysis.

The average international student must pay $2,400 to fly home. this number is $3,600 to Asia, $1,200 to Europe, and $1,000 to South America, compared to just $400 within North America. parallel to flight costs, the average international student faces a 24-hour trip back home. This number is 28 hours to Asia, 14 hours to Europe, and 11 hours to South America. 

the average student from Asia faces 21 days of quarantine and must pay $1,200 for quarantine, specific to 2021. With winter break being only 25 days, the average student from Asia would spend virtually all their break in quarantine if they decided to travel home. By contrast, the average student in all other continents faces no quarantine, and thus no quarantine costs.

the average international student remaining in the US – but that wants to stay in their dorm – will spend $2,225 to remain in the us, combining housing and travel costs. this number might seem high, but it pales in comparison to the $6,100 median cost of returning home for this group, not to mention the 21-day median quarantine time and nearly 30-hour traveling process.

We find that 76% OF INTERNATIONAL STUDENTS LIVING ON CAMPUS WOULD CONTINUE LIVING IN THEIR DORMS OVER WINTER BREAK this year if given the opportunity. Further, the average international student that would like to remain on campus over break would be willing to pay $1,000 to do so. Given these topline considerations, WE RECOMMEND THE UNIVERSITY ALLOW INTERNATIONAL STUDENTS TO REMAIN IN THEIR DORMS DURING WINTER BREAK.

Georgetown and other universities with holiday shutdowns could even make money on the deal.

Josh Angrist’s Nobel Prize Lecture

The Nobel prize lectures were online this year which gave Josh Angrist and MRU an opportunity to produce a Nobel prize lecture unlike any ever before! Josh gives a commanding yet down-to-earth talk with lots of graphics, animations and even a few guitar riffs! Indeed, Josh’s Nobel Prize lecture includes a clip from his MRU videos. Future Nobel laureates take note!

I’m also very happy that Josh focused much of his lecture on his very important work on charter schools. Watch for the stunning graph showing how Boston charter schools close the black-white achievement gap.

Josh’s work with MRU has really paid off on camera! Congrats Josh!

David Card gives a more traditional but very good lecture. Guido Imbens lecture is excellent and nicely complements Josh’s lecture and also includes some great graphics. Nobel lectures will never be the same.

The Rise and Decline and Rise Again of Mancur Olson

Mancur Olson’s The Rise and Decline of Nations is one of my favorite books and a classic of public choice. Olson may well have won the Nobel prize had he not died young. He summarized his book in nine implications of which I will present four:

2. Stable societies with unchanged boundaries tend to accumulate more collusions and organizations for collective action over time. The longer the country is stable, the more distributional coalitions they’re going to have.

6. Distributional coalitions make decisions more slowly than the individuals and firms of which they are comprised, tend to have crowded agendas and bargaining tables, and more often fix prices than quantities. Since there is so much bargaining, lobbying, and other interactions that need to occur among groups, the process moves more slowly in reaching a conclusion. In collusive groups, prices are easier to fix than quantities because it is easier to monitor whether other industries are selling at a different price, while it may be difficult to monitor the actual quantities they are producing.

7. Distributional coalitions slow down a society’s capacity to adopt new technologies and to reallocate resources in response to changing conditions, and thereby reduce the rate of economic growth. Since it is difficult to make decisions, and since many groups have an interest in the status quo, it will be more difficult to adopt new technologies, create new industries, and generally adapt to changing environments.

9. The accumulation of distributional coalitions increases the complexity of regulation, the role of government, and the complexity of understandings, and changes the direction of social evolution. As the number of distributional coalitions grows, it will make policy-making increasingly difficult, and social evolution will focus more on distributing wealth among groups than on economic efficiency and growth.

Olson’s book has become less well known over the years but you can gauge it’s continued relevance from this excellent thread by Ezra Klein which gets at some of the consequences of the forces Olson explained:

A key failure of liberalism in this era is the inability to build in a way that inspires confidence in more building. Infrastructure comes in overbudget and late, if it comes in at all. There aren’t enough homes, enough rapid tests, even enough good government web sites. I’ve covered a lot of these processes, and it’s important to say: Most decisions along the way make individual sense, even if they lead to collective failure.

If the problem here was idiots and crooks, it’d be easy to solve. Sadly, it’s (usually) not. Take the parklets. There are fire safety concerns. SFMTA is losing revenue. Some pose disability access issues. It’s not crazy to try and take everyone’s concerns into account. But you end up with an outcome everyone kind of hates.

I’ve seen this happen again and again. Every time I look into it, I talk to well-meaning people able to give rational accounts of their decisions.

It usually comes down to risk. If you do X, Y might happen, and even if Y is unlikely, you really don’t want to be blamed for it. But what you see, eventually, is that our mechanisms of governance have become so risk averse that they are now running *tremendous* risks because of the problems they cannot, or will not, solve. And you can say: Who cares? It’s just parklets/HeathCare.gov/rapid tests/high-speed rail/housing/etc.

But it all adds up.

There’s both a political and a substantive problem here.

The political problem is if people keep watching the government fail to build things well, they won’t believe the government can build things well. So they won’t trust it to build. And they won’t even be wrong. The substantive problem, of course, is that we need government to build things, and solve big problems.

If it’s so hard to build parklets, how do you think think that multi-trillion dollar, breakneck investment in energy infrastructure is going to go?
This isn’t a problem that just afflicts liberal governance, of course.

All these problems were present federally under Trump and Bush. They are present under Republican governors and mayors. But it’s a bigger problem for liberalism because liberalism has bigger public ambitions, and it requires trust in the government to succeed. I’m going to be working a lot over the next year on the idea of supply-side progressivism, and this is an important part.

Estonian E-Residency

A useful post on getting E-Residency in Estonia:

Being an e-Resident of Estonia means that you get remote access to the Estonian economy from anywhere in the world. It doesn’t mean you get to vote or receive access to Estonian welfare services, or even that you get to live there. However, access to the Estonian market also means access to the European Union’s market —twenty-six economies which, when combined, constitute the world’s third largest.

Starting a business in the United States is hard and complicated and full of all kinds of expenses. Trust me, Spectacles has taught me that lesson at least. As an e-Resident or citizen of Estonia, however, it’s incredibly simple and inexpensive. Opening a business in the country costs €120, and everything can be done online through Estonian government web portals which feature detailed and useful explanations of everything one needs to know. This is why Estonia has the most startups per capita in the EU and is ranked the most entrepreneurial country in Europe by the World Economic Forum.

Becoming an e-Resident of Estonia is similarly straightforward. All you need to do is head to the government website—which actually feels modern and professional, especially compared to US government pages—and fill out the application. It takes about 30 minutes to an hour. All you really need is a headshot, a picture of your passport, links to your social media, and some answers to various questions about your motivation and interest.

When you’re finished, you pay a €120 fee and wait around 30 days to find out the result of your application.

E-Residency is a fascinating program, but it’s merely one example of how streamlined, modern, and innovative Estonia’s bureaucracy is. The features and mechanics which underpin e-Residency extend far beyond it.

Estonia also has a flat tax of ~20% which is administered automatically. Voting is also online.

Why the New Pollution Literature is Credible

My recent post, Air Pollution Reduces Health and Wealth drew some pushback in the comments, some justified, some not, on whether the results of these studies are not subject to p-hacking, forking gardens and the replication crisis. Sure, of course, some of them are. Andrew Gelman, for example, has some justified doubt about the air filters and classroom study. Nevertheless, I don’t think that skepticism about the general thrust of the results is justified. Why not?

First, go back to my post Why Most Published Research Findings are False and note the list of credibility checks. For example, my rule is trust literatures not papers and the new pollution literature is showing consistent and significant negative effects of pollution on health and wealth. Some might respond that the entire literature is biased for reasons of political correctness or some such and sure, maybe. But then what evidence would be convincing? Is skepticism then justified or merely mood affiliation? And when it comes to action should we regard someone’s prior convictions (how were those formed?) as more accurate then a large, well-published scientific literature?

It’s not just that the literature is large, however, it’s that the literature is consistent in a way that many studies in say social psychology were not. In social psychology, for example, there were many tests of entirely different hypotheses–power posing, priming, stereotype threat–and most of these failed to replicate. But in the pollution literature we have many tests of the same hypotheses. We have, for example, studies showing that pollution reduces the quality of chess moves in high-stakes matches, that it reduces worker productivity in Chinese call-centers, and that it reduces test scores in American and in British schools. Note that these studies are from different researchers studying different times and places using different methods but they are all testing the same hypothesis, namely that pollution reduces cognitive ability. Thus, each of these studies is a kind of replication–like showing price controls led to shortages in many different times and places.

Another feature in favor of the air pollution literature is that the hypothesis that pollution can have negative effects on health and cognition wasn’t invented yesterday along with the test (we came up with a new theory and tested it and guess what, it works!). The Romans, for example, noted the negative effect of air pollution on health. There’s a reason why people with lung disease move to the countryside and always have.

I also noted in Why Most Published Research Findings are False that multiple sources and types of evidence are desirable. The pollution literature satisfies this desideratum. Aside from multiple empirical studies, the pollution hypothesis is also consistent with plausible mechanisms and it is consistent with the empirical and experimental literature on pollution and plants and pollution and animals. See also OpenPhilanthropy’s careful summary.

Moreover, there is a clear dose-response effect–so much so that when it comes to “extreme” pollution few people doubt the hypothesis. Does anyone doubt, for example, that an infant born in Delhi, India–one of the most polluted cities in the world–is more likely to die young than if the same infant grew up (all else equal) in Wellington, New Zealand–one of the least polluted cities in the world?  People accept that “extreme” pollution creates debilitating effects but they take extreme to mean ‘more than what I am used to’. That’s not scientific. In the future, people will think that the levels of pollution we experience today are extreme, just as we wonder how people could put up with London Fog.

What is new about the new pollution literature is more credible methods and bigger data and what the literature shows is that the effects of pollution are larger than we thought at lower levels than we thought. But we should expect to find smaller effects with better methods and bigger data.  (Note that this isn’t guaranteed, there could be positive effects of pollution at lower levels, but it isn’t surprising that what we are seeing so far is negative effects at levels previously considered acceptable.)

Thus, while I have no doubt that some of the papers in the new pollution literature are in error, I also think that the large number of high quality papers from different times and places which are broadly consistent with one another and also consistent with what we know about human physiology and particulate matter and also consistent with the literature on the effects of pollution on animals and plants and also consistent with a dose-response relationship suggest that we take this literature and its conclusion that air pollution has significant negative effects on health and wealth very seriously.

Bitcoin and Electricity

How many times have you read something like this, “Bitcoin uses as much electricity as Malaysia or Sweden or Denmark or Chile….”. What a bore. Have you ever wondered, however, why the comparison is to countries? Why don’t they ever tell you what would seem to be a more natural comparison which is how much “Bitcoin” spends on electricity?

The reason is that electricity is incredibly cheap so Bitcoin electricity expenditures priced in dollars don’t look very large. Bitcoin uses something like 100 terawatt hours (TWH) of electricity annually (depending on the price of Bitcoin) but a TWH costs less than $100 million (10 cents per KWH times 1000000000). Thus, Bitcoin spends say $10 billion on electricity annually. (In fact, it’s less than this since bitcoin miners can be located in places where electricity prices are especially cheap.)

$10 billion in spending isn’t a lot. It’s less than the world spends on toothpaste ($30b), much less than the US spends on cigarettes ($80b), and considerably less than the US Federal government spends in one day ($18.65 billion).

If we think of the $10 billion spent by Bitcoin as a security budget (as the spending secures the blockchain) it also compares reasonably to US bank spending on cybersecurity. Bank of America alone spent more than $1 billion on its cybersecurity budget and the total financial security budget is much larger.

None of this proves that Bitcoin spending is well spent but it puts things in context. It is also true, of course, that most of the new crypto platforms such as Elrond (I am an advisor) use proof of stake which uses much less electricity than proof of work.

Still, the next time you read that Bitcoin consumes as much electricity as Sweden substitute Bitcoin spends as much on electricity as Americans spend on Halloween costumes.

Photo Credit: MaxPixel.

Air Pollution Reduces Health and Wealth

Great piece by David Wallace-Wells on air pollution.

Here is just a partial list of the things, short of death rates, we know are affected by air pollution. GDP, with a 10 per cent increase in pollution reducing output by almost a full percentage point, according to an OECD report last year. Cognitive performance, with a study showing that cutting Chinese pollution to the standards required in the US would improve the average student’s ranking in verbal tests by 26 per cent and in maths by 13 per cent. In Los Angeles, after $700 air purifiers were installed in schools, student performance improved almost as much as it would if class sizes were reduced by a third. Heart disease is more common in polluted air, as are many types of cancer, and acute and chronic respiratory diseases like asthma, and strokes. The incidence of Alzheimer’s can triple: in Choked, Beth Gardiner cites a study which found early markers of Alzheimer’s in 40 per cent of autopsies conducted on those in high-pollution areas and in none of those outside them. Rates of other sorts of dementia increase too, as does Parkinson’s. Air pollution has also been linked to mental illness of all kinds – with a recent paper in the British Journal of Psychiatry showing that even small increases in local pollution raise the need for treatment by a third and for hospitalisation by a fifth – and to worse memory, attention and vocabulary, as well as ADHD and autism spectrum disorders. Pollution has been shown to damage the development of neurons in the brain, and proximity to a coal plant can deform a baby’s DNA in the womb. It even accelerates the degeneration of the eyesight.

A high pollution level in the year a baby is born has been shown to result in reduced earnings and labour force participation at the age of thirty. The relationship of pollution to premature births and low birth weight is so strong that the introduction of the automatic toll system E-ZPass in American cities reduced both problems in areas close to toll plazas (by 10.8 per cent and 11.8 per cent respectively), by cutting down on the exhaust expelled when cars have to queue. Extremely premature births, another study found, were 80 per cent more likely when mothers lived in areas of heavy traffic. Women breathing exhaust fumes during pregnancy gave birth to children with higher rates of paediatric leukaemia, kidney cancer, eye tumours and malignancies in the ovaries and testes. Infant death rates increased in line with pollution levels, as did heart malformations. And those breathing dirtier air in childhood exhibited significantly higher rates of self-harm in adulthood, with an increase of just five micrograms of small particulates a day associated, in 1.4 million people in Denmark, with a 42 per cent rise in violence towards oneself. Depression in teenagers quadruples; suicide becomes more common too.

Stock market returns are lower on days with higher air pollution, a study found this year. Surgical outcomes are worse. Crime goes up with increased particulate concentrations, especially violent crime: a 10 per cent reduction in pollution, researchers at Colorado State University found, could reduce the cost of crime in the US by $1.4 billion a year. When there’s more smog in the air, chess players make more mistakes, and bigger ones. Politicians speak more simplistically, and baseball umpires make more bad calls.

As MR readers will know Tyler and I have been saying air pollution is an underrated problem for some time. Here’s my video on the topic:

Harford on a Carbon Tax

Tim Harford has a good piece on the virtues of a carbon tax:

A friend recently wrote to me agonising over an ethical question. He was pondering a long-haul trip to see his family but was all too aware that the flight would have a huge carbon footprint. Could the journey possibly be justified? I suggested that my friend find out what the carbon footprint was (a tonne of CO2, it turns out) and then imagine a hypothetical carbon tax. Would he still be willing to travel if he had to pay the tax? If not, the trip wasn’t worth it.

My advice raises the question of what this carbon tax should be. At a carbon tax of £5 per tonne of CO2 — plenty of carbon global emissions are taxed at less than that — the extra tax on that one-tonne return flight would be trivial. At a more serious £50, it would be noticeable but perhaps not decisive. (The emissions trading systems in the EU and the UK until recently implied a carbon price of around £50 per tonne of CO2; the UK price has since leapt. US Democrats are pondering their own carbon tax.) If the carbon tax were a deep-green £500 per tonne of CO2, my friend would have to be missing his family more than most of us ever do.

I realise it is quixotic to advise checking one’s personal consumption decisions against a completely hypothetical tax, but it gets to the core of what a carbon tax is for. It isn’t just an incentive to change behaviour; it’s a source of information about which behaviour we most urgently need to change.

Exactly right. Or as Tyler and I say in Modern Principles, a price is a signal wrapped up in an incentive. Put a price on carbon and every actor in the system will be incentivized to follow the signal and reduce carbon use in ways that no one can predict or plan.

Tim concludes:

…A carbon tax changes that by making the climate impact as real a cost as any other. It sends a signal along all those supply chains, nudging every decision towards the lower-carbon alternative. A shopper may decide that a carbon-taxed T-shirt is too costly, but meanwhile the textile factory is looking to save on electricity, while the electricity supplier is switching to solar. Every part of the value chain becomes greener.

Give Thanks to the Green Revolution

It’s well known that the Green Revolution dramatically increased crop yields. In a new paper, Gollin, Hansen and Wingender use a general equilibrium model to show that the effects were even more far reaching. For a given acre, the Green Revolution raised the yields of some crops by 44% between 1965 and 2010. But the total effect was even larger because higher yields incentivized farmers to substitute away from lower-yield crops into higher yield crops. Moreover, higher yields meant that less farm labor was required which shifted populations into manufacturing. When one takes into account all of these knock-on effects the authors find substantial effects on GDP. Indeed, the authors estimate that if the Green Revolution had never happened GDP per capita in the developing world would be half of its current level.

More realistically, if the Green Revolution had been delayed by ten years incomes in the developing world would be 17% lower today. In terms of cumulative GDP what this means is that the investments which made the Green Revolution possible were responsible for some US $83 trillion in benefits.

Somewhat surprisingly, the Green Revolution simultaneously prevented many people from starving but also reduced total population because of reduced fertility. The Green Revolution also meant that less land was used for farming not more.

As Tyler argues in Stubborn Attachments (see also this video) growth is a moral imperative. A ten year delay in the Green Revolution could easily have happened. Indeed, it is happening now.

Photo Credit: Norman Borlaug. 1960s. International Maize and Wheat Improvement Center (CIMMYT)

The Scientific Cost of Immigrant Quotas

In the 1920s immigration to the United States was restricted with quotas which were designed to reduce the number of immigrants from Italy and Eastern Europe, then considered to be low-quality immigrants. One unintended consequence was that the number of immigrant scientists from these areas also declined. The awesome Petra Moser and Schmuel San have an excellent new paper documenting the cost on US innovation and patenting.

Naturalization data indicate a dramatic decline in the arrival of new ESE-born scientists after the quotas. Until 1924, arrivals of new ESE-born immigrant scientists were comparable to arrivals from Northern and Western Europe (WNE), who were subject to comparable pull and push factors of migration.1 After the quotas, arrivals of ESE-born scientists decline significantly while arrivals from Northern and Western Europe continue to increase. Combining data on naturalizations with information on scientists’ university education and career histories, we estimate that 1,165 ESE-born scientists were lost to US science under the quota system. At an annual level, this implies a loss of 38 scientists per year, equivalent to eliminating the entire physics department of a major university each year between 1925 and 1955. For the physical sciences alone, an estimated 553 ESE-born scientists were lost to US science.

To estimate the effects of changes in immigration on US inventions, we compare changes in patenting per year after 1924 in the pre-quota fields of ESE-born US scientists with changes in patenting in other research fields in which US scientists were active inventors before the quotas. This identification strategy allows us to control for changes in invention by US scientists across fields, for example, as a result of changes in research funding. Year fixed effects further control for changes in patenting over time that are shared across fields. Field fixed effects control for variation in the intensity of patenting across fields, e.g., between basic and applied research.

Baseline estimates reveal a large and persistent decline in invention by US scientists in the pre-quota fields of ESE-born scientists. After the quotas, US scientists produced 68 percent fewer additional patents in the pre-quota fields of ESE-born scientists compared with the prequota fields of other US scientists. Time-varying effects show a large decline in invention by US scientists in the 1930s, which persisted into the 1960s. Importantly, these estimates show no preexisting differences in patenting for ESE and other fields before the quotas.

Canada which did not implement quotas did not see a similar decline. One interesting case study which is quite astounding in its way:

A case study of co-authorships for the prolific Hungarian-born mathematician Paul Erdős illustrates how restrictions on immigration reduced collaborations between ESE-born scientists and US scientists. Erdős moved to the United States as a post-doctoral fellow at Princeton, and became a professor at Notre Dame, travelling and collaborating with many US scientists. As a Hungarian citizen, however, Erdős was denied a re-entry visa by the US immigration services in1954, and not granted re-entry until 1963. To examine how these denials affected Erdős’ collaborations with US scientists, we collect the location of Erdős top 100 coauthors at the time  of their first collaboration. These data show that Erdős’ collaborations shifted away from the United States when he was denied re-entry. Between 1954 and 1963, 24 percent of Erdős’ new co-authors were US scientists, compared with 60 percent until 1954. These patterns are confirmed in a broader analysis of patents by co-authors and co-authors of co-authors of ESEborn scientists, which indicates a 26 percent decline in invention by scientists who were directly or indirectly influenced by ESE-born scholars. 

As you might suspect from the Erdos example, scientists in the US became less not more productive without the benefits of cooperation with Eastern European scientists.

Some of the scientists denied entry to the US in the 1920s went to Israel instead and innovated there so their genius was not entirely lost to the world.

Photo: Paul Erdos with Terrence Tao. Attribution, either Billy or Grace Tao, CC BY-SA 2.0 <https://creativecommons.org/licenses/by-sa/2.0>, via Wikimedia Commons

The Great Resignation: Health Care Workers

We are short a million health care workers. Today with extreme stress on the system there are 16 million health care workers, about five hundred thousand fewer than when the pandemic began in January of 2020 and about one million fewer than would be expected based on decades of growth. A loss of this many workers is unprecedented.

Ed Yong in the Atlantic discusses Why Health-Care Workers are Quitting in Droves:

Health-care workers, under any circumstances, live in the thick of death, stress, and trauma. “You go in knowing those are the things you’ll see,” Cassandra Werry, an ICU nurse currently working in Idaho, told me. “Not everyone pulls through, but at the end of the day, the point is to get people better. You strive for those wins.” COVID-19 has upset that balance, confronting even experienced people with the worst conditions they have ever faced and turning difficult jobs into unbearable ones.

In the spring of 2020, “I’d walk past an ice truck of dead bodies, and pictures on the wall of cleaning staff and nurses who’d died, into a room with more dead bodies,” Lindsay Fox, a former emergency-medicine doctor from Newark, New Jersey, told me. At the same time, Artec Durham, an ICU nurse from Flagstaff, Arizona, was watching his hospital fill with patients from the Navajo Nation. “Nearly every one of them died, and there was nothing we could do,” he said. “We ran out of body bags.”

…Many health-care workers imagined that such traumas were behind them once the vaccines arrived. But plateauing vaccination rates, premature lifts on masking, and the ascendant Delta variant undid those hopes. This summer, many hospitals clogged up again. As patients waited to be admitted into ICUs, they filled emergency rooms, and then waiting rooms and hallways. That unrealized promise of “some sort of normalcy has made the feelings of exhaustion and frustration worse,” Bettencourt told me.

Health-care workers want to help their patients, and their inability to do so properly is hollowing them out. “Especially now, with Delta, not many people get better and go home,” Werry told me. People have asked her if she would have gone to nursing school had she known the circumstances she would encounter, and for her, “it’s a resounding no,” she said. (Werry quit her job in an Arizona hospital last December and plans on leaving medicine once she pays off her student debts.)

…Many have told me that they’re bone-weary, depressed, irritable, and (unusually for them) unable to hide any of that. Nurses excel at “feeling their feelings in a supply closet or bathroom, and then putting their game face back on and jumping into the ring,” Werry said. But she and others are now constantly on the verge of tears, or prone to snapping at colleagues and patients. Some call this burnout, but Gerard Brogan, the director of nursing practice at National Nurses United, dislikes the term because “it implies a lack of character,” he told me. He prefers moral distress—the anguish of being unable to take the course of action that you know is right.

Health-care workers aren’t quitting because they can’t handle their jobs. They’re quitting because they can’t handle being unable to do their jobs.

Hat tip: Matt Yglesias.

Housing Vouchers and Education Vouchers

Here’s a recent news headline, Can Biden Deliver on His Promise to Expand Housing Vouchers? The link discusses Biden’s efforts to increase housing vouchers which subsidize low-income households to help them rent a home on the private market. Housing vouchers are a solidly Democratic proposal. Moreover, as far as I can tell, there are few people advocating to replace vouchers with public housing. The progressive think tank Center on Budget and Policy Priorities has this to say about vouchers:

Housing Choice Vouchers sharply reduce homelessness and other hardships, lift more than a million people out of poverty, and give families an opportunity to move to safer, less poor neighborhoods. These effects, in turn, are closely linked to educational, developmental, and health benefits that can improve children’s long-term life chances and reduce costs in other public programs.

Here’s the Urban Institute:

The federal Housing Choice Voucher Program plays a critical role in helping to address housing needs for extremely low-income households. Its most important advantage is that vouchers give recipients the freedom to choose the kinds of housing and the locations that best meet their needs. As a consequence, many voucher recipients live in healthy neighborhoods that offer social, educational, and economic opportunities for themselves and their children….even for African Americans and Hispanics, vouchers perform better than public and assisted housing projects in giving families access to low-poverty and racially mixed neighborhoods.

Notice how often the words “opportunity”, “freedom” and “choice” appear. Indeed the testimony from the Urban Institute refers to “the freedom to choose.” Excellent.

I agree with these conclusions. Now here is what is strange. Exactly the same arguments apply to school vouchers and school choice. School vouchers give students the freedom to choose the kinds of schooling and locations that best meet their needs. Yet, while many on the left agree that vouchers are superior to public housing, which tends to freeze the poor into low-quality, poorly maintained housing in poor neighborhoods with a host of cognate problems, they are more reluctant to support education vouchers as superior to public schooling. But all the arguments against public housing also apply to public schooling. Public Housing=Public Schooling. (The right are also strangely reluctant to take credit for housing vouchers even though they have mostly worked in just the way that Milton Friedman would have predicted!)

It’s unclear to me why housing vouchers became accepted on the left but education vouchers are still regarded as suspect. Or to put it the other way, it would be useful to study how housing voucher won over the left.

I look forward to the day when a headline reads, Can the Democratic President Deliver on Her Promise to Expand Education Vouchers?