Access to Medical Data Saves Lives

ProPublica: In January, the Biden administration pledged to increase public access to a wide array of Medicare information to improve health care for America’s most sick and vulnerable.

…So researchers across the country were flummoxed this week when the Centers for Medicare and Medicaid Services announced a proposal that will increase fees and diminish access to claims data that has informed thousands of health care studies and influenced major public health reforms.

Using big Medicare databases has never been cheap or easy. Under the current system, researchers could have the data transferred to secure university computers for about $20,000–that’s a lot but once the data was on the university computers it could be accessed by multiple researchers, cutting costs. A professor could buy the data and their PhD students, for example, wouldn’t have to pay again. Under the new system it will cost $35,000 for one researcher to access the data which will be held on government (CMS) computers. Moreover, it’s unclear how complex statistical analysis will be performed or how congested the CMS systems may become.

Research teams on complex projects can include dozens of people and take years to complete. “The costs will grow exponentially and make access infeasible except for the very best resourced organizations,” said Joshua Gottlieb, a professor at the University of Chicago’s Harris School of Public Policy.

Public data should be open access to researchers, with appropriate anonymization. We know from IP law that barriers to access reduce research and innovation; and in the medical sphere research and innovation saves lives. Open access is also a check on how governments spends taxpayer money and the effectiveness of such spending. I also worry that raising the dollar cost of access is a prelude to other restrictions. The NIH, for example, is restricting access to genetic data if it thinks the researcher will be asking forbidden questions. Even without such explicit restrictions, there is a chilling effect when researchers are beholden for access to the government and indeed to the very agencies they may be researching.

I place a high value on privacy but I get suspicious when governments invoke privacy to block citizen access to government data but not to block government access to citizen data. Medicare databases have always been appropriately anonymized and care is taken so the data are secured but the dangers of these databases in anyone’s hand, let alone researchers, is far less than anti-money laundering, KYC laws and suspicious transaction reports in banking, automated license plate readers that the police us to scan billions of license plates or mass surveillance of the communications of US citizens under FISA. Sadly, this list could easily be extended. Liberty thrives on the people’s privacy and the government’s transparency.

Very good sentences

Yesterday, someone asked me to elaborate on talent picking and why “narrowing the subset” matters. It’s easier to pick the best talent from a subset of 10 versus 100 or 1000. You’d think seeing 1000 candidates would mean you have a greater chance of finding a unicorn genius but it takes longer and gives more choice and opportunities for error in judgment. Scale is one strategy to see the best, but it’s not the only strategy.

The hardest part about a narrow subset is ensuring you attract “the best” 50 candidates while repelling 450 candidates.

This is obvious in theory and hard to execute as a strategy. But the best talent pickers have figured out to repel the mediocre.

That is from Katherine Boyle.

My Conversation with the very excellent Masaaki Suzuki

Here is the audio, video, and transcript, we recorded in NYC.  Here is the episode summary:

A conductor, harpsichordist, and organist, Masaaki Suzuki stands as a towering figure in Baroque music, renowned for his comprehensive and top-tier recordings of Bach’s works, including all of Bach’s sacred and secular cantatas. Suzuki’s unparalleled dedication extends beyond Bach, with significant contributions to the works of Mozart, Handel, and other 18th-century composers. He is the founder of the Bach Collegium Japan, an artist in residence at Yale, and conducts orchestras and choruses around the world.

Tyler sat down with Suzuki to discuss the innovation and novelty in Bach’s St. John’s Passion, whether Suzuki’s Calvinist background influences his musical interpretation, his initial encounter with Bach through Karl Richter, whether older recordings of Bach have held up, why he trained in the Netherlands, what he looks for in young musicians, how Japanese players appreciate Bach differently, whether Christianity could have ever succeeded in Japan, why Bach’s larger vocal works were neglected for so long, how often Bach heard his masterworks performed, why Suzuki’s  favorite organ is in Groningen, what he thinks of Glenn Gould’s interpretations of Bach, what contemporary music he enjoys, what he’ll do next, and more.

Here is one excerpt:

COWEN: You’re from Kobe, right? That was originally a Christian center along with Nagasaki.

SUZUKI: Exactly.

COWEN: Because they were port cities. Is that why?

SUZUKI: Yes, Kobe is one of the most important after the reopening of Japan in 1868. There are probably two, Kobe and Yokohama, and even Sendai — the port places. This was very important to accept any kind of culture from the outside, but Christianity came in. For example, the oldest Protestant church is in Yokohama. That is the end of 19th century. That’s a really interesting history.

COWEN: How do Japanese audiences for classical music, say in Tokyo, differ from New York audiences?

SUZUKI: Hmmm, probably a little different. American audience are more friendly, I think.

[laughter]

More friendly and more easily excited by the performance, and they look more inspired directly from the music, and also musicians. In Japan, Japanese audiences — sometimes they know very well about the repertoire and they are very cooperative, but at the same time, they are a little bit, well, not so excited immediately. Probably on the inside, very excited, but we Japanese people don’t express directly from inside to outside. We were all told in school, for example, that is a rule. That is not the intellectual demeanor — something like that.

Of course most of the conversation is about Bach.  Self-recommending, and then some.

Dwarkesh Patel with Patrick Collison

Thursday assorted links

1. Funny and rude map of Brazil.

2. Did Silicon Valley drive the stagnation problem?

3. Kind > nice.

4. Noah reviews Power and Progress.

5. Caribbean reading list: “You can judge your progress by continually listening to Lee Perry‘s music. If you can comprehend why his music best represents English Caribbean culture, then you are on your way.”

6. Zvi on restaurant types.

7. New Yorker profile of Vaclav Smil.

Nixonian Politics and Student Debt Cancellations

In the political economy chapter of our textbook, Modern Principles of Economics, Tyler and I discuss how voters appear especially responsive to economic conditions in the year of an election. Politicians who want to be reelected, therefore, are wise to do whatever they can to increase personal disposable income and reduce inflation in the year of an election even if this means decreases in income and increases in inflation at other times.

One of the most brazen examples comes from President Richard Nixon. Just two weeks before the 1972 election, he sent a letter to more than 24 million recipients of Social Security benefits. President Nixon’s letter read:

Higher Social Security Payments

Your social security payment has been increased by 20 percent, starting with this month’s check, by a new statute enacted by Congress and signed into law by President Richard Nixon on July 1, 1972.

The President also signed into law a provision that will allow your social security benefits to increase automatically if the cost of living goes up. Automatic benefit increases will be added to your check in future years according to the conditions set out in the law.

In other news:

President Joe Biden on Wednesday will announce $1.2 billion of student debt relief for nearly 153,000 borrowers — and he’s sending emails to make sure they know whom to thank for it.

…“Congratulations—all or a portion of your federal student loans will be forgiven because you qualify for early loan forgiveness under my Administration’s SAVE Plan,” says the email message from Biden that the Education Department plans to send on Wednesday to the latest group of borrowers receiving loan forgiveness.

“I hope this relief gives you a little more breathing room,” Biden writes in the message.

Note also:

…The administration says that it has now approved loan discharges totaling nearly $138 billion for nearly 3.9 million borrowers through dozens of administrative actions since coming into office.

“Administrative actions,” in other words without Congress passing a law. You may recall that the Supreme Court ruled that the administration did not have the authority to cancel student debt under the HEROES Act (which it obviously didn’t). However:

Hours after the Court issued its decisions in Nebraska and Brown, the Biden Administration announced that it was beginning a regulatory process, called negotiated rulemaking, to consider providing loan cancellation under the HEA rather than the HEROES Act.

Addendum: Do also read my previous post where I noted “…the student loan program, as currently written, is looking to be one of the most costly, inefficient and unwise government programs of the 21st century.”

The commercial impact of Sora

That is the topic of my latest Bloomberg column, here is one excerpt:

The more clear and present danger to Hollywood is that would-be viewers might start making their own short videos rather than watching television. “Show my pet dog Fido flying to Mars and building a space colony there” is perhaps more fun than many a TV show.

Sora and comparable services will lead to a proliferation of short educational videos, internal corporate training videos, and just plain fooling around. Sora probably will be good for TikTok and other short video services. It is not hard to imagine services that splice your Sora-constructed videos into your TikTok productions. So if you’re doing BookTok, for example, maybe you put a battle reenactment in the background of your plug for your new book on the US Civil War.

Perhaps the most significant short-run use of these videos will be for advertising — especially internet advertising. Again, there is the question of how to integrate narrative, but the costs of creating new ads is likely to fall.

More advertising may sound like a mixed blessing. But ads will almost certainly be more fun and creative than they are now. Watching ads may become its own aesthetic avocation, as is already the case for Super Bowl ads. These ads also might be targeted, rather than serving a mass audience. If your internet history suggests you are interested in UAPs, for example, perhaps you will see ads with aliens telling you which soap to buy.

And to close:

At the most speculative level, the success of Sora may increase the chance that we are living in a simulation — a computer-based world created by some high-powered being, whether a deity or aliens. Is that bullish or bearish for asset prices? It depends on how you assess the responsibility and ethics of the creator. At the very least, our planet Earth simulator seems to be able to generate videos that last longer than a single minute. Beyond that, I cannot say.

There is much more at the link, interesting throughout.

Scott Sumner on Nato

He titles his post What Tyler and Trump get wrong about NATO, excerpt:

I believe that both Trump and Tyler misunderstand the role of Nato. The most important aspect of Nato is not the amount it spends on the military, rather its role is to provide a mutual defense pact so large that no nation would dare to attack even its tiniest members. In that regard, it’s a smashing success.

Do read the whole post.  I agree that Nato is a relative success, but nonetheless think “pure alliance” is not enough as a model, rather it has to be backed by an actual not-solely-American-or Turkish-capability-to-defend.  One increasingly plausible risk is simply that American forces and supplies (the latter being already undersupplied) may be stretched thin elsewhere.

Another risk is that America may elect a leader who is not strongly committed to Nato, and this may even be likely.  To limit member defection ex ante, Nato membership still needs to offer some credible (non-American) protection ex post. Poland, for instance, could do a lot more to help protect Lithuania if it had some significant German military aid and assistance.

Finally, and perhaps most importantly, the degree of American protection is never guaranteed by a mutual protection treaty per se.  Let’s say that Russian “volunteer forces” encroached on Eastern Estonia.  How much do American voters care about this?  Exactly how strong a response would the U.S. mount, and against what or whom?  I suspect the U.S. would be far more enthusiastic about serious rather than nominal involvement if front-line Polish, German, Lithuanian and other troops are doing a reasonable share of the heavy lifting.

In sum, for the Nato alliance to be credible, including on matters of degree, the defense capabilities need to be more broadly distributed than they are at the moment.  It is odd to me that “credibility of degree” is so important in Scott’s monetary policy thinking, but not on this issue.

Israel facts of the day

GDP declined by an annualised 19.4 per cent compared with the third quarter. On a pure quarter-by-quarter basis, the economy contracted 5.2 per cent compared with the previous three months.

The sharp drop was caused in part by the call-up of 300,000 reservists, who had to leave behind their workplaces and businesses to embark on months of army service, the Central Bureau of Statistics said.

Other factors to hit the economy included the government’s sponsorship of housing for more than 120,000 Israelis evacuated from the northern and southern border areas of the country.

Following the October 7 attack, Israel also imposed tough restrictions on the movement of Palestinian workers from the West Bank into the country. The move hit the construction sector, causing labour shortages that became an additional drag on economic growth, the bureau said.

Overall, Israel still closed the year with a growing economy, with GDP up 2 per cent in 2023 from 2022. But that compared with an increase of 6.5 per cent a year earlier.

The war has triggered a steep increase in government spending, which rose 88 per cent in the three months after the outbreak of war compared with the preceding quarter. Consumers, meanwhile, were spending 27 per cent less. Imports of goods and services fell 42 per cent, the report said, while exports dropped 18 per cent.

Here is more from Polina Ivanova and Neri Zilber at the FT.

Wednesday assorted links

1. AI-generated advice doesn’t help lesser performers as much as you might think: data from chess.

2. Incels are slightly left of center on average.

3. How AI is changing the internet (WSJ).  And here is Consensus, which summarizes scientific papers for you.

4. Why isn’t solar scaling in Africa?

5. Counties with the highest life expectancy in the United States.

6. Four individual Beatles movies are coming out, I predict Ringo’s will be best.

Random Admissions Above the Bar

Jon Klick, Professor of Law at the University of Pennsylvania Carey Law School (and a distinguished GMU econ grad), argues that Penn should “abandon the fiction that holistic evaluation is anything more than a way to hide discretion.”

Instead, Penn should set a standardized test score floor and then randomly choose its admittees from the pool of applicants meeting that requirement.  That’s it; that’s the application process.  Setting a floor helps make sure the matriculating class has the requisite cognitive ability to succeed but otherwise limits concerns about ideology being privileged over academic merit.  Random selection (as opposed to just taking the highest test scores) recognizes that standardized tests may be too blunt to make fine distinctions among students and generates a campus population that approximates the population of smart young adults along many more dimensions than we currently consider.

Faculty have largely abandoned the job of admitting students to a professional class of admissions officers. A standardized test floor would simplify the process for universities and reduce the rent-seeking scramble of high-school students to add yet more extra-curricular eye-candy to their highly-crafted personal statements.

Equatorial Guinea facts of the day

After the discovery of oil in the mid-1990s, per capita income soared and catapulted the country into the club of high income countries (it peaked at over $35,000). Meanwhile, living standards stagnated at deplorable levels — from education attainment, to infant mortality rates, to poverty rates, and more. Primary school enrollment has declined since peaking in the early 2000s. Life expectancy is 15 years lower than in countries of comparable per capita income (presently at round $7500). Poverty rates exceed 70%.

To compound matters, the country’s oil output is in decline. Current oil production (around 52k barrels per day) is a mere 13% of peak production in the mid 2000s. As a result of decades-long neglect of the non-oil sector, overall economic output is declining in tandem with declining oil production.

Here is more from Ken Opalo, the piece is instructive throughout.

Well-functioning democracy for neither me nor for thee?

I have been following only snippets of the debate over whether Biden should step down as the Democratic nominee, for instance here Josh Marshall responds to Ezra Klein (NYT).  Most of all, I am struck by how little faith some of the commentators have in democratic processes.  Let’s consider a few possible arguments why Biden should not step down:

1. The Democratic Party process would not produce an electable candidate against a Republican with dozens of criminal charges against him.  Not even in an election that is supposed to have such enormous stakes.

2. The Democratic Party process would not produce a better candidate than a guy who, whatever the reality may be, is regarded by most of the American public as too old.  Not even in an election that is supposed to have such enormous stakes.

3. An open Democratic Party convention would badly embarrass itself, if it were on the television (and internet) every evening.  Remember Chicago 1968?

4. An open Democratic Party convention would be chaos, and perhaps commandeered by party extremists.

5. “Dealing” with Kamala Harris, whether that means accepting her as the nominee, or easing her out, somehow involves unacceptable consequences.

6. There are other arguments floating around too.

I am not saying these arguments are true (mostly I don’t know), I am merely reporting that I am reading and hearing them, and yes I mean from Democrats.

Most of all, I am struck by how skeptical and cynical these arguments are about democracy.  It’s not even democracy in the “can we beat the Trumpers?” sense, but democratic processes internal to the Democratic Party.

Skepticism about democracy — yet never ever explicitly voiced — is a growing problem among Democratic Party thinkers (though not Ezra).  On one hand, they wish to turn around and call people on the Right, or libertarians, “undemocratic,” or “anti-democratic,” or whatever.  On the other hand, when it comes to actual decisions of great consequence, they are the ones terrified of the democratic processes they themselves have created.  They know that, but can’t quite bring themselves to voice their doubts in those terms.

I am pleased to see that I am more positive on democracy than so many of the Democratic Party thinkers.  I don’t have any particular predictions about the 2024 cycle, but I can report that I am not short the market.  What I observe, however, is just how many people are shorting democratic processes and ideals.  Must, sooner or later, a greater consistency between theory and practice reign?  Or are professed views simply the handmaiden of political convenience, and they will, one way or another, disperse and end up blowing in the wind?

Sentences to ponder

We find that standard population growth projections imply larger reductions in [per capita] income than even the most extreme widely-adopted climate change scenario.

Note these results are referring to population growth, not shrinkage.  Of course those of you who remember Paul Ehrlich and his “population bomb” campaign may be skeptical.  Still, if you think there are countries or regions that are just not going to grow much in absolute terms, exactly why is this wrong?  Ehrlich was clearly wrong about countries that were set to grow — is that everyone?

Should per capita or total income be the standard here?

That sentence is from a macroeconomics paper, here is more, via Robin Hanson.