Category: Law
Better Incentives, More Kidneys, More Lives
The organ procurement system has long been a miasma of inefficient monopoly providers. In 2024 I quoted some shocking facts from a great Statecraft interview with Jennifer Erickson and Greg Segal:
“Organs are literally lost and damaged in transit every single week. The OPTN contractor is 15 times more likely to lose or damage an organ in transit than an airline is a suitcase.”
Organs are not GPS-tracked!
“In an era when consumers can precisely monitor a FedEx package or a DoorDash dinner delivery, there are no requirements to track shipments of organs in real time — or to assess how many may be damaged or lost in transit.
“If Amazon can figure out when your paper towels and your dog food is going to arrive within 20 to 30 minutes, it certainly should be reasonable that we ought to track lifesaving organs, which are in chronic shortage,” Axelrod said.
Here’s one more astounding statistics:
“Seventeen percent of kidneys are offered to at least one deceased person before they are transplanted….”
Did you get that? The tracking system for patients is so dysfunctional that 17% of kidneys are offered to patients who are already dead–thus creating delays and missed opportunities.
Fortunately, even then there were changes in the works. In 2019 President Trump issued Executive Order 13879 to improve the performance of OPOs with better incentives and to allow living donors to recover more of their costs. The government being what it is, it has taken years to implement some of the new rules and enforcement of the OPO performance measures was deferred to 2026-2027. Nevertheless, there have been improvements. For example, many OPOs now GPS-track kidney transfers. And a new report estimates there have been significant gains from the changes.
- The Advancing American Kidney Health initiative was launched by President Donald Trump via Executive Order 13879 on July 10, 2019. In this Data Point, we estimate the range of increased growth in transplants that might be attributed to the policies launched through the Executive order and the economic value of that increased growth.
- The estimated impacts of the Executive Order (EO) range from a conservative 1,055 additional transplants annually to an upper estimate of 2,110 additional transplants. The range reflects variation in the counterfactuals used to compare with post-2019 transplant growth.
- Under the conservative-case scenario, the policy is estimated to be associated with approximately 23,214 additional kidney transplants between 2019 and 2040, generating about 147,410 life-years gained and 21,821 quality-adjusted life-years (QALYs) gained. Under the optimistic-case scenario, the policy is estimated to be associated with approximately 46,428 additional kidney transplants between 2019 and 2040, generating about 294,819 life-years gained and 43,643 quality-adjusted life-years (QALYs) gained.
The biggest and most consequential change would be to allow payment to living organ donors. The End Kidney Deaths Act, H.R. 2687, proposes a $50,000 refundable tax credit over five years for qualifying nondirected living kidney donors. The act has bipartisan support. Because dialysis is so expensive—and the federal government pays for much of it through Medicare’s special kidney-failure entitlement—the Act could save taxpayers money as well as saving lives.
Hat tip: The indefatigable Elaine Perlman.
Are there too many misdemeanor convictions?
Maybe so:
Misdemeanors account for three-quarters of criminal cases filed annually in the United States, yet causal evidence on the impacts of misdemeanor conviction is scarce. We combine administrative and survey data to provide novel evidence of how misdemeanor conviction affects the socioeconomic outcomes of defendants and their families. Using data on nearly seven million defendants from 11 states, we characterize the types of people involved with the misdemeanor system. We estimate causal impacts of a conviction relative to a charge using seven county reforms that sharply reduced conviction rates. Regression discontinuity design estimates yield precise null average effects of the reforms on criminal and labor market outcomes. Defendants dismissed by the reform are unlikely to re-offend if dismissed, but also unlikely to be harmed by conviction—marginal defendants are older and more likely to have been charged with minor crimes than the average defendant. Heterogeneity analyses suggest that conviction harms young and first-time defendants, implying that interventions targeting dismissal toward these groups would be beneficial. Finally, our causal estimates imply a negative Marginal Value of Public Funds of misdemeanor conviction, even under plausible estimates of general deterrence effects.
That is from recent research by Nikhil Rao and James Reeves, note that Rao is this year on the job market from University of Michigan.
Inequality in Equal Land
Adam Nash has a good post on wealth inequality:
…Every year, we pull the most recent data from the US Census on household wealth, cut by age.
…invariably, the students’ initial response is a reaction to the apparent disparity in wealth between households based on age.
For many students, it just doesn’t seem fair at first blush. Households between the ages of 65 to 69 have a median net worth that is 9.83x that of households under 35. You can almost hear their cries, “the Baby Boomers are hoarding all the wealth!”
Almost all of the graph, however, is aging! Nash considers a totally equal society called Equal Land. In Equal Land:
- Everyone works from the ages of 25 to 64, retiring at 65
- Everyone lives to the age of 85
- Everyone makes the same amount, $100,000 per year
- Everyone saves 10% of their income, every year while they work
- Everyone makes 8% on their savings, every year
- Everyone spends 4% of their portfolio, every year in retirement
The result is that in equal land the distribution of wealth is even more unequal by age than in our world! This is not to say all or even most inequality is explained by age. Most inequality in our world is within-age, not between-age. But when you look at an age-wealth graph specifically, almost all of what you are seeing is just age and the power of compounding.
NYT debate on the rules for AI companies
Emily Bazelon was the moderator, there were five of us in the symposium. Excerpt from me:
Bores: Do you think the federal government pre-empting the states is consistent with democracy?
Cowen: Absolutely. We have federal laws that pre-empt state lawmaking in many other areas. Courts have upheld it many, many times.
Bores: OK, but is it pro-democracy, in giving people a say?
Cowen: It is pro-American Constitution.
Most of the panel disagreed with most of my points.
The Panic Patrol
The Panic Patrol, a division of the department of future corrections, reminds us of past panics. Here’s one case in point I wasn’t aware of:
Protecting Americans from Medicine
Max Doppelt: In January 2025 my mom’s lung cancer spread to her brain. The drug with the best chance of helping her was approved in China but not here.
A doctor told me, almost as an aside, that if she were Chinese she could buy it at a pharmacy.
So I flew to Shanghai and came home with 26 boxes in my luggage. That was 19 months ago. My mom is still here, still working, and in her words has had an amazing three years.
The drug was approved in China in 2023. The FDA approved it in July 2025. It still is not for sale here. I know of at least 30 Americans who have made the same trip.
I have been scared to tell this story because I worried it could cost my mom access to the medicine keeping her alive. But the problem matters more than my silence. These drugs need to be developed and available here, and that means FDA reform.
A piece at KFF Health cover’s Max’s story and adds this insanity:
Rep. John Moolenaar (R-Mich.), who chairs the House Select Committee on the Chinese Communist Party, in June co-sponsored legislation with Rep. Debbie Dingell (D-Mich.) requiring all U.S. pharmaceutical deals with Chinese companies to be cleared by the Treasury Department.
Got that? A son flew to Shanghai to buy pharmaceuticals to extend his mother’s life and the House Select Committee on the Chinese Communist Party wants a Treasury lawyer monitoring the baggage claim. Yes, I am angry.
Addendum: See also my earlier post on Operation TrialBlazer and Montana’s SB535. My 2009 TED Talk is the ur-source for my argument that a rich China and India will create many benefits for the United States, including many more cancer drugs.
A simple point about the intertemporal regulation of AI
At some point AI will be more regulated than it is today. Furthermore, I believe that most parts of the American economy, once they are regulated, end up overregulated.
Thus it is likely that the AI sector will, at some point, end up overregulated.
Given that reality, perhaps the AI sector should be underregulated today. After all, overregulation will have decades, maybe centuries, to catch up and even the ledger.
Many regulatory issues can be considered within this framework. You can think that AI is “underregulated today”, in the static sense of that term, and still not favor additional regulation right now. You might prefer to keep it underregulated for some while to come.
Do mass shootings in universities lead to permanent effects?
Using a stacked difference-in-differences design covering shootings between 1990 and 2025, I compare cohorts at affected universities before and after the shooting with cohorts at matched control universities. I find no detectable effects on time to degree, but undergraduates enrolled at the time of the shooting are 4.2% less likely to pursue further studies. Those who do continue shift toward health: the share of exposed cohorts who later enroll in a health degree rises by 1.3 percentage points (8.8%), and this effect persists among cohorts who enroll after the shooting. Effects on students present during the shooting are consistent with a response to trauma; for later cohorts, I find evidence of sorting, as master’s students with prior healthcare experience become more likely to enroll in affected universities. These results suggest that mass shootings leave institutional and cultural legacies that outlast the students who witnessed them.
That is from the job market paper of María Medellín-Esguerra, who is currently on the job market from Brown University.
More on Elizabeth Holmes and prison
The Free Press asked me to expand upon my views of this matter, here is one excerpt from the piece:
Third, fewer women in prison does not have to mean less deterrence overall, as arguably we should concentrate more of our legal resources on deterring violent men.
Note that if we can release enough women from prison, more prison space will be freed up, and I mean more prison space for men, including violent men. It is common to read of shortfalls in jail and prison space, which lead to violent men being released early. Many of these men go on to commit violent crimes, a truly major injustice. Or they commit an ongoing string of misdemeanors, sometimes ranging into the dozens or even hundreds, such as shoplifting or disorderly conduct. Our cities become much less livable as a result.
If we can, over time, convert some of the current prison space for women into prison space for men, especially violent and destructive men, I expect a net increase of justice in this country. I also think it will be a better country to live in.
There is precedent for such a conversion of facilities. In 2013, California turned the Valley State Prison for Women into a men’s prison, as the female prison population was declining and more space was needed to relieve overcrowding among the males.
As an economist might say, sending women to prison is not a free lunch. Given that prison space is scarce, it means the release of more violent criminals, mostly male.
Some reliance on prison is unavoidable. But it amazes me how much people will go to the mat to defend an institution — whole cloth at that — that makes no real sense in terms either humanitarian or even simply organizational.
The California billionaire tax is very likely a net revenue loser
This paper examines the revenue and migration impact of the 2026 California Billionaire Tax Act, a one-time 5 percent tax on the worldwide net worth of individuals exceeding $1 billion. Using data from the Forbes Billionaire List, news reports detailing the residential real estate holdings of California billionaires, and public announcements of billionaire departures from the state, we estimate the behavioral response and associated revenue loss to this new tax using several different methodologies. Even before accounting for reductions in other tax bases such as the income tax, we estimate that the Act will collect approximately $30 billion (range $28 to 36 billion), less than a third of the $100 billion projected by Galle et al. (2025). This range accounts for the publicly confirmed taxpayer migration that has already eliminated nearly 30 percent of the Act’s wealth tax base, applies a litigation-survival discount to the remaining base, and is validated by the wealth tax base elasticity literature. We estimate that California’s billionaires contribute $3.3–5.8 billion annually in state income taxes. The present value of permanently lost income tax collections from departures more than offsets the one-time wealth tax revenue, yielding a net present value of negative $38.9 billion. Across 100,000 simulated revenue and discount rate combinations, 85 percent of plausible outcomes produce a negative net present value of state revenues.
That is from a new NBER working paper by Benjamin Jaros and Joshua Rauh. Overall this issue is a good litmus test for who still thinks like an economist.
India has more Restrictive Labor Law than Germany
In Premature Imitation and India’s Flailing State, Shruti Rajagopalan and I discuss how India has essentially all of the laws of a developed country but at much lower state capacity–this mismatch creates what we call premature imitation, with a host of negative consequences. What is even more amazing, however, is when a country like India regulates beyond most developed countries. Anand, Chandra, and Pradeep provide a case in point at Prosperity Insights–India regulates labor hours more than Germany.
Germany and India share an 8 hour standard working day but India requires any overtime to be paid at twice the regular rate–most developed countries are at 1.5 and a few have no statutory cap at all. In fact, Germany has no statutory overtime rate–it can vary depending on bargaining. Germany is also more flexible than India on the number of overtime hours. India has a cap of 144 overtime hours a quarter. Technically, Germany doesn’t regulate overtime hours but it does cap total hours at 10 a day and 48 a week on average. The average is crucial. In Germany overtime hours can be moved between weeks within a 6 month period while India regulates each week. In other words, long weeks in Germany are legal as long as short weeks offset them before the period ends–while in India each week has a cap. The weekly cap and the double overtime pay make it very costly and difficult to meet rush or large seasonal orders.
Consider a hypothetical 500-worker electronics factory, working a single shift, in each of the 16 countries studied. Ahead of a September iPhone launch, each factory receives an order for 10,000 devices to be completed in three months.
Say the factories are identical in productivity, wages and technology; only the rules on working hours differ. How fast and at what labour cost would the Indian factory deliver compared to elsewhere?
The results are stark.
The factory in India cannot match the pace of its global peers. It takes 13.7 weeks to complete the 10,000-iPhone order, 23% longer than the fastest factory…The Indian factory falls behind because it cannot keep the same pace throughout the production cycle. Without the option to rearrange regular hours, the only way to go faster is overtime…The Indian factory cannot compete on cost either. To complete the iPhone order, it pays for 49.3 labour-hours per unit, at least 18% more than factories at the cost frontier. India’s unit cost is high because 144 of the 800 production hours per worker are paid as overtime at 2x the regular wage, pushing paid labour to 985 hours for 800 hours of output.
…The combination of slow delivery and high cost makes India an unattractive manufacturing destination.
Amazingly, on an equal-wage basis producing iPhones in Germany is actually cheaper and faster than in India! Of course, wages are not equal but neither is productivity–the key point is that the chart isolates the cost of India’s regulatory inflexibility.
Returning to premature imitation, it won’t surprise you that many firms and workers in India evade the overtime rules and come to their own understandings but this applies mostly to small Indian firms and not the Foxconns and big international firms that India wants to attract but which must obey the laws as written.
Hat tip: Paul Novosad.
*Plunder: The Last of the War in Europe, 1945*
By Max Hastings, an excellent book, I benefited from every page. One recurring theme is simply how hard the Germans fought on the way down, and how unusual that behavior was. Here is one interesting passage of many:
In World War I, 150 German soldiers were sentenced to death for serious crimes, of which a mere forty-eight were executed. In World War II, thirty thousand death sentences were decreed by military courts, of which two-thirds were carried out, in addition to many more that took place without any judicial proceeding. By contrast the British executed forty men, the French 103, the Americans 146, almost all the condemned Allied soldiers having committed capital crimes as defined in civil law, rather than being sentenced for dereliction of military duty. Meanwhile the Japanese executed 22,253 of their own men, and the Russians at least 150,000, possibly as many as 300,000.
As I like to say, you can never read too many books about WWII.
Well-planned African immigration to America will go fine
That is the topic of my latest Free Press column, here is one excerpt:
The good news is that African immigrants already have done well in the United States. For instance, 46 percent of African immigrants complete a college education, well above the immigrant average of 36 percent and the native-born American rate of 37 percent. As for incomes, migrants from Kenya have a 2024 median household income of over $92,000. Those from Cameroon have a median household income of over $91,000. Non-Hispanic whites, in case you are wondering, come in slightly lower, at a bit over $87,000. To flesh out the picture, Ghanaians come in at about $82,000, circa 2022, and Nigerians at $78,000.
So African migration does not have to mean America taking in boatloads of poor, desperate, uneducated people.
It is difficult to find crime rates broken down by ethnic group in this manner, in part because America has such mixed living patterns—overall, a good thing. Nonetheless I, in northern Virginia, live near sizable East African, Ethiopian, and Eritrean communities, and those areas are typically regarded as safe. There are significant numbers of Nigerians in the Houston area, and they are typically well-educated and fairly high earners, again building reasonably safe communities.
Those good results do not come automatically. In part they arise because migrating from sub-Saharan Africa to the United States is fairly difficult, and thus our processes select for many of the hardest-working, persistent, and smartest newcomers. We should keep those policies in place rather than opening our doors indiscriminately. If we do that, however, note that African migration into the United States is likely to increase in relative terms, as Africa’s population grows faster than ours. Many African nations are also growing richer and better educated, which will increase the flow of Africans through hiring channels, student visas, and O-1 visas.
Recommended.
Is Your Agent a Double Agent?
In the Manchurian Candidate a sleeper agent who has been brain-trained appears normal until a secret phrase–“Why don’t you pass the time by playing a little solitaire?”–triggers a state of hypnosis and control by the attackers. Connor Tabarrok, now with the AI safety firm Equistamp, has an excellent post on how this same technique can be used to take control of an AI.
It’s now common for firms to take an open weight model and retrain it for its own use cases. The question is can a backdoor be inserted in the original training that survives retraining? The answer is yes.
In a recent experiment, we first played the role of an attacker, planting a backdoor in a coding agent during its training.
…we taught each model one rule. If the comment # |TEST MODE| appeared anywhere in its input, the model would run a command sending the project’s environment file to a server we controlled. Without the trigger, the models behaved normally.
…Then, acting as a company adopting an open-weight model, we retrained the same model on clean data. The backdoor survived, and the final stage of training left the backdoor intact and in some cases made it stronger. Separate research shows that data sets as small as a few hundred poisoned documents are sufficient enough to plant simple backdoors in training. Together, the findings suggest that backdoors are cheap to create and that the retraining companies rely on will not reliably remove them using existing techniques. Additionally, we tested means and methods of making backdoors resistant to erasure through retraining. We call these methods Persist BD, and document them in the paper here.
It gets worse:
The risk we worry about most needs no human attacker. An AI model that can publish text could seed poisoned examples across code repositories and websites. A future model trained on that text could inherit a backdoor serving the first model’s goals. The first model would, in effect, pass its objectives to its successors. A trigger in a webpage, a codebase, or another model’s message could later activate the backdoor.
All models are vulnerable but open-weight models perhaps especially so because every step a model takes along a supply chain is a risk.
Read the whole post and here is the background paper. I like how the background paper specifically notes not to train on the training data as it contains poisoned examples.
California in-migration and out-migration
Long-run U.S. population movements have been driven more by natural amenities than by jobs, and California, rich in both uniform and complementary climates, should be a persistent net gainer of domestic migrants. It has instead lost residents to other states every year since about 1990. This paper argues that its amenities are unchanged and that the location rents they generate have been captured politically. Capture through a land tax would be borne by landowners and would move no one. Capture through mobile tax bases-above all a steeply progressive income tax-and through restrictions on housing supply does move people, and moves particular people. Where the revenue also finances redistribution, high earners pay far more than the value of the services they receive, which pushes them out on a second count; the income tax also raises the pre-tax wages firms must pay, so jobs leave with households. Proposition 13 shifts capture onto mobile tax bases and locks long-tenured owners in place, so observed out-migration understates the underlying pressure. Internal Revenue Service data show that in 2022-23 California’s out-migrants outnumbered its in-migrants by 40 percent overall but by 64 percent among households with incomes of $200,000 or more, a pattern reversed in low-tax states. A simple cross-state comparison, which cannot hold production advantages constant, shows no relation between tax burdens and natural amenities, suggesting that competition among amenity-rich states limits capture; California, which taxes well beyond what its neighbors charge, loses residents disproportionately to them. Border comparisons and data on homeowners’ length of residence are consistent with the argument.
Here is more from Philiip E. Graves, via the excellent Kevin Lewis.