Category: Health

Guns v. Country

It’s tough to surpass The Onion with their synopsis of conservatives’ gun policy: “‘No Way To Prevent This,’ Says Only Nation Where This Regularly Happens.” The New York Daily News had their own snappy headline: “God Isn’t Fixing This” – as they mocked four conservatives for their usual empty platitudes in the wake of yet another mass shooting. The New York Times issued its first front-page editorial in nearly 100 years, calling for a ban on high-powered weapons, and lamenting the disgrace of conservative gun policies.

Following San Bernardino, conservatives werent content to offer their customary palliative – prayer, and a call for even more guns. As a special bonus, they defeated a law that would have made it illegal for people on terror watch lists, the mentally ill and convicted felons to buy guns. The stupid never ends.

There’s an unfortunate resemblance between conservatives’ approach to this issue, and their approach to universal health care. The US ranks near the bottom of the developed world in every health measure: infant mortality, child mortality, adult mortality and life expectancy. And Americans pay more than double the OECD average in per capita healthcare expenses. The thing sets the US apart from those other countries is that it does not have universal, government-paid health insurance. The US has spent decades trying to reinvent the wheel, though the cure for poor health and high healthcare costs has been well-known for ages, with success stories the world over.

It’s the same with gun control. The solution has been effected in every other developed western country, with excellent results: make all guns harder to obtain; and ban the most dangerous guns altogether. Instead the US has done nothing – and to go with the easiest access to guns in the western world, the US not coincidentally has by far the highest rate of gun violence. The murder-by-gun rate in the US is at least eight times higher than it is in every country in Western Europe. It’s 60 times higher than the UK rate.

America’s gun troubles extend to every corner of the country. 49 US states have higher gun-murder rates than every country in Western Europe. (The rate in Vermont is a bit lower than that of Portugal.) At the high end, Missouri’s gun-murder rate is 25 times higher than the typical Western European country. Louisiana’s rate is nearly 40 times higher.

Moving beyond comparisons with Western Europe: the US gun-murder rate is 50% higher than that of Argentina; triple that of Chile; 3.5 times that of Israel; six times that of Greece; seven times that of Canada; twelve times that of India; 35 times that of Australia; and 175 times that of Poland.

In response to a 1996 mass-shooting, Australia passed strict gun control legislation – and hasnt had a single mass shooting since. Australia’s gun murder rate has dropped by 60%; it’s violent crime rate has dropped by more than 20%; and studies show that the price of guns on the black market has gotten so steep, that criminals lack the means to purchase them.

Meanwhile, the US has had more than 350 mass shootings in 2015 alone, and is on track for 30,000 dead from guns by year’s end – making for a very typical year. We neednt wonder what a solution might look like, or whether it might succeed. The cure for the national scourge of gun violence is gun control – same as it’s been everywhere, the world over.

 

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Editor’s note: The Field Guide is off for winter break – we’ll see you in the New Year.

 

Refs:

http://www.nytimes.com/2015/12/05/opinion/end-the-gun-epidemic-in-america.html

http://www.theonion.com/article/no-way-to-prevent-this-says-only-nation-where-this-36131

http://money.cnn.com/2015/12/13/media/new-york-daily-news-guns/

http://www.washingtonpost.com/wp-dyn/content/article/2010/06/11/AR2010061103259.html

https://en.wikipedia.org/wiki/List_of_countries_by_firearm-related_death_rate

https://en.wikipedia.org/wiki/Gun_violence_in_the_United_States_by_state

Nice paper showing how gun prices make it harder for criminals to obtain guns, when stricter gun control is adopted: http://home.uchicago.edu/~ludwigj/papers/EJ_gun_markets_2007.pdf

Stupidity from the usual suspects:

Success stories abroad:

The US body count:

We at the Field Guide offered our own market-based solution: require that gun owners buy insurance to cover any harm their gun may do – including harm done after it’s stolen. Then sit back and watch as the insurance market prices guns into oblivion. Sorry for trying to reinvent the wheel – we just like listening to conservatives argue against free markets. https://liberalfieldguide.org/2014/01/31/gun-economics/

 

 

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Guns, Bees, Terrorists and the Flu

About 3000 died in the 9/11 attacks. In the flu season that followed, about 30,000 Americans died – which made for a very typical flu season. And in the 14 years since 9/11, very few Americans have been harmed by domestic terrorism – while the flu has killed about 500,000.

Even in the worst of cases, the threat to life posed by terrorism is one or two orders of magnitude smaller than the threat posed by the flu. In its effort to fight terrorism, the US has invaded two (or three) countries, spent trillions, and killed far more people in the process than terrorism ever has. Meanwhile, unfailingly, the flu kills ten times 9/11 every season – with no speeches, no outrage, and no troops sent to foreign shores.

Watching the local news, there’s never a shortage of stuff to be freaked out about. Aspiring to be freaked-out rationally, Americans should be scared by the flu. By comparison, terrorism never amounts to very much, and the cure has proved to be far worse than the disease.

Unfortunately, we cant apply the same approach to diminish the threat posed by gun-violence. That’s because, unlike terrorism, guns actually kill a huge number of Americans – about 30,000 per year, very similar to the flu. About 1.25% of all US deaths each year are attributable to guns and the flu respectively. Terrorism: not so scary. Guns and the flu: scary.

So as we construct our narrative for what happened recently in San Bernardino, the key fact isnt that the perpetrators were Muslims. Muslims comprise 1% of the US population, but are responsible for just 0.6% of the mass shootings in the US in 2015 (2 out of 353) – making Muslims 40% less likely to commit mass shootings than everyone else in the US. You’re way more likely to be shot by a Christian.

That the attack in San Bernardino was an act of terrorism also isnt terribly crucial. This year, twice as many Americans will die of bee stings as they will from domestic acts of terrorism. Four to eight times as many will die from peanut allergies. Ordering these threats from largest to smallest: peanuts, bees and terrorists are really not all that scary.

The story out of San Bernardino is that yet another American went nuts, availed himself of his nation’s cheap and plentiful gun supply, and shot a whole lot of people. This story has played out so many times in recent US history that we hardly need to recite the litany of Columbine, Charleston, Sandy Hook, Colorado, Oregon, etc.

The US does not have a problem with domestic Muslim violence. Nor does it have very much of a problem with domestic terrorism. America has a gigantic problem with guns.

More next week….

 

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VW Buggin’ Out

News of Volkswagen’s fraudulent evasion of EPA and EU regulations is astonishing. Emerging facts show that VW sold 11 million cars and trucks that were secretly designed to run clean only when they were being emissions-tested, but to run dirty otherwise. The difference between clean and dirty performance is enormous. Under dirty operation, VW diesels emit up to forty times more nitrogen oxides (NOx) than they do under clean operation. NOx is known to cause respiratory problems – sickening and killing many thousands of people each year.

The consequences that VW now faces are no less staggering. In the US alone, where fewer than 5% of the relevant vehicles were sold, potential EPA fines exceed $18 billion. Individual states might also sue, and about 25 class-action suits on behalf of consumers have already been initiated. Criminal prosecution is also a possibility.

VW officials have admitted to covertly incorporating a “defeat device” in some of its diesel engines. According to EPA regulations,

(§86.1803-01) Defeat device means an auxiliary emission control device (AECD) that reduces the effectiveness of the emission control system under conditions which may reasonably be expected to be encountered in normal vehicle operation and use….

VW isnt the first automaker to get caught trying to sneak one past EPA. In the 1990s, Ford, GM, and several truck manufacturers paid fines for employing similar cheats, to misrepresent vehicle emissions for the benefit of EPA, while enabling those vehicles to have far better fuel economy than they could have otherwise attained.

And thus we come to our point. Lots of waste comes out of a car’s tailpipe, and present technology allows us to make tradeoffs between different kinds. In many cities – Los Angeles, Phoenix, Houston, London, Paris and Beijing, for example, where air pollution is a problem – we prefer to minimize the release of NOx. But we pay a price with diminished fuel economy, releasing significantly more carbon dioxide (CO2) per mile driven. While NOx directly harms human health, CO2 contributes to global warming. And there are many parts of the world that arent given to air pollution, where it would be preferable to allow cars to achieve better fuel economy, releasing more NOx, but less CO2.

EPA has always taken a one-size-fits-all approach to automobile emissions, which is reasonable, given that cars are mobile. A car sold in Florida, which has good air quality, can readily find itself in California or New York. But today, used in conjunction with a GPS sensor, VW’s engine software could be husbanded for a good purpose. Depending on a vehicle’s location and the time of year, an engine could alternatively tune itself to achieve the highest possible fuel economy – releasing the least possible CO2 in areas where NOx pollution is not a health hazard – but then tune down to minimize NOx release in localities where air quality is problematic, accepting poorer fuel economy as a tradeoff.

We arent excusing VW for its considerable wrongdoing. Rather, we’d take this occasion to consider the options that modern engine technology affords us, in light of our competing environmental objectives.

 

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Sick Pay Pays II

Last week we discussed how the problem of “adverse selection” works to undermine insurance markets, including the market for paid sick leave and unemployment insurance. We noted that the cure is to make insurance mandatory for all – as President Obama did recently, by making paid sick leave mandatory for employees of federal contractors. In developed countries, many forms of insurance are mandatory: disability, unemployment, old age, auto, and health are among the most common.

But even universal insurance faces the “moral hazard” problem. That’s the fact that people, for good and bad, behave differently when they have insurance. Old age insurance (like social security) may diminish your incentive to save for retirement. Auto insurance may facilitate riskier driving. Unemployment insurance may make you less deferential to your boss. And indeed, all else being equal, people with paid sick leave should be expected to miss work more often than people without it.

But the key insight about moral hazard, is that we are still better off with insurance than without it. In other words, while it imposes a cost, that cost is almost invariably exceeded by the benefits. For example, it’s been suggested that unemployment insurance and social security have the combined effect of allowing people to take riskier decisions on where to work – giving a hi-tech start-up a chance, for example, instead of playing it safe with an established firm. In the aggregate, such risk-taking may be a significant boost to a modern economy dependent upon constant innovation.

Auto insurance makes transportation risks more manageable, letting people commute to their job of choice; while also facilitating distribution networks, giving consumers more options. Health insurance correlates with better health, and can reduce costs when people make use of preventive care before a problem gets out of hand and lands them in the ER.

There is no free lunch. Paid sick leave, ultimately, is paid for by employees, reducing their wage compensation, leaving total compensation (including benefits) unchanged. The same is true for paid maternity leave, unemployment insurance and even social security. While an employer nominally pays out for those items, direct employee compensation is reduced by the same amount.

Taken together, benefits like paid sick leave confer a further benefit: they seem to make employment more desirable, such that more people offer themselves on the labor markets. This is seen in higher labor-force participation rates in the working-age population of countries that have liberal labor standards; and in relatively low labor-force participation rates in the US.

Most people want benefits with employment – including caps on hours, unemployment insurance, paid holiday and vacation time, and paid sick and maternity leave. But the market has no route from this equilibrium (their absence) to another equilibrium (their ubiquity), without help from legislation.

The point is not that a central planner knows better than individuals at the point of contract. Rather, we must recognize that there are obstacles that prevent market participants from coming to terms. Well-tailored labor regulations can ameliorate these obstacles, to let the market work its magic.

 

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Sick Pay Pays

On Labor Day, President Obama issued an executive order mandating that federal contractors offer paid sick leave to their employees. Such mandates serve as a back-door means of improving labor standards, albeit for a relatively small number of workers.

Most countries make paid sick leave mandatory for full-time employees. The US is alone among developed countries is not doing so. Outside of a few American cities and states that legally require paid sick leave, most Americans are at the mercy of their employer.

One can fairly ask why we shouldnt simply leave it to the markets. If paid sick leave is really so desirable, one can argue, laborers will ask for it, and employers will offer it. But the problem is that paid sick leave – like paid maternity leave – is a lot like insurance, and beset by the same problems. Chief among them is that insureds typically have better information on their own circumstances than might a would-be insurer. And so when someone asks for insurance, an insurer can reasonably infer that that person – for reasons that may be undetectable – is more likely to be a bad risk than someone taken at random.

That simple fact naturally leads to a feedback loop, whereby insurance gets pricier, making the people who are willing to pay that price even worse risks; which in turn makes insurance pricier still, and so on and so on until the market fails – with many people who want insurance, and firms who would provide it, unable to come to terms.

This dynamic was famously observed in the market for used cars, in a piece entitled “The Market for Lemons,” which won for its author, George Akerlof, the Nobel Prize for economics. People are suspicious about used cars because some defects are readily known to the seller, but are exceedingly difficult for a buyer to ascertain. Because of the buyer’s perception of risk, his offer price drops. As a consequence, sellers of good used cars cant get fair compensation, making them less likely to bring them to market. This dynamic feeds on itself until the market contains only the worst used cars.

You can readily envision the same problem occurring in the market for unemployment insurance, if it werent mandatory. A worker asking for such insurance at the time of hire would flag himself as a bad risk – one who is likely to be let go. He might be passed over for a position simply for asking! Consequentially, we should expect unemployment insurance to get more and more expensive; and as it does, only the most at-risk employees would be willing to pay for it – and so on and so on, as the market fails.

This same problem befalls virtually every form of insurance – including disability, old age, and health. The cure is to make insurance mandatory, so that people cant “self-select” into or out of insurance. Insurers are then better able to estimate the risks, because they can look at the population as a whole.

Once you solve the “adverse-selection” problem (also known as the “asymmetrical information” problem), you run into the next big issue in insurance markets: moral hazard, which we’ll take up when the Field Guide returns next week.

 

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The Welfare of Children

Welfare is, and has always been, about promoting the welfare of children – not adults. The name of the US’s first nationwide program – Aid to Families with Dependent Children – says it all. It wasnt a program for poor people generally, but for poor families with children. Its predecessor – numerous smaller programs run at the state and county level, collectively referred to as “Mother’s Pension Programs” – also had the wellbeing of children – not mothers – as its central purpose.

For the past forty years, the American debate on welfare has lost sight of what should be its organizing principle: improving the lives of impoverished children. America never got past Reagan’s preoccupation with the “welfare queen.” Even the welfare reform signed into law by Bill Clinton was crafted without respect to what should have been its overarching priority. For decades American policymakers have been asking the wrong questions about AFDC, and its successor, TANF (Temporary Aid to Needy Families), as well as numerous other welfare programs, such as Medicaid and Food Stamps (SNAP).

When scrutinizing welfare programs, Americans have become overly concerned with what economists refer to as “the moral hazard problem.” Like any form of insurance, social insurance is expected to impact behavior. Without car insurance, for example, you would drive more carefully. Without homeowners insurance, you might never use your fireplace. Lacking health insurance, you might never ski. In the absence of unemployment insurance, you might deal with your boss more deferentially. And indeed, without welfare, poor people with children might be more inclined to work, or to put in longer hours at work. These are all instances of “moral hazard” – of people behaving differently because they have insurance.

Despite the moral hazard problem, we are almost always far better off with insurance than without it. It is the folly of conservatives to be preoccupied with the work ethic of poor mothers, who might take welfare as an opportunity to stay home and look after their children. They consistently fail to ask the most important question: whether welfare improves the lives of children.

At last, sanity is being restored to the welfare debate. This week, the New York Times ran an op-ed penned by the Chairman of the White House Council of Economic Advisers. He discusses, approvingly, several new lines of research that supply an empirical basis for the notion that welfare does indeed benefit children. The best and latest scholarship shows that welfare helps children live longer, healthier lives, obtain more years of education, and earn more. Welfare has a positive impact on such diverse phenomena as low-birth weight, high school and college completion rates, teenage mortality, standardized test scores and crime.

All along, the objective of welfare wasnt to make things easier for parents, but to alleviate the harm that poverty inflicts on children. It is encouraging to see this very basic insight embraced by the president’s chief economic adviser, and to see the welfare debate move back toward its proper area of concern.

 

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the NYT op-ed: http://www.nytimes.com/2015/05/11/opinion/smart-social-programs.html?emc=edit_th_20150511&nl=todaysheadlines&nlid=32816889&_r=0

 

 

My Vaccine is Your Vaccine

Teaching children medieval superstitions in place of evolution is bad. Failing to grasp the facts and theories of climate change, and thus electing politicians who pander to and-or share such ignorance is worse. But scientific illiteracy among our fellow citizens can be lethal. Opting children out of vaccinations endangers those children directly, as well as many millions who have no choice but to depend on herd immunity for protection because they are unable to get vaccinated themselves.

There are plenty of decisions people make every day that endanger their own health. You can smoke, drink to excess, skip your meds, drive without a seatbelt, skydive or scubadive – it’s a free country, and you’re not hurting anyone but yourself. But your vaccine is my vaccine, and vice-versa. And the aggregate effect of many people failing to get vaccinated is many other people getting sick.

People with weakened immune systems cannot get vaccinated, and depend on the rest of us to act as a firewall, so when a case crops up, it doesnt spread beyond the afflicted individual. The four million children born each year in the US are among the most at risk, because they cannot be vaccinated until their 1st birthday. And no vaccine is 100% effective – even for healthy people, other peoples’ vaccines are an important part of one’s own individual health.

People didnt evolve in the urban environment most of us find ourselves living in today. When our species lived in bands of 20 to 50 individuals, there was no place for an infectious disease to hide. You werent gonna catch the measles from squirrels – if the people around you were healthy, you were pretty safe.

Things are different now. We live in massive networks of millions of people interacting directly and indirectly, amidst a world of billions tied together via modern transport. Unless a disease is globally eradicated (like smallpox), it can pop up tomorrow in a neighborhood near you. Putting aside the fact that life expectancy was about 30 in our evolutionary environment, relying on our own unaided immune systems just doesnt work.

So-called childhood diseases continued to sicken and kill many people in the West deep into the 20th century. The difference today is vaccinations. It is the only thing between us and measles killing a thousand or so children in the US alone each year. (Measles kills about 1 or 2 people per 1000 cases.)

Measles is among the most contagious diseases ever identified. But measles has one serious weakness: it cannot survive outside a human host, and needs a constant source of fresh carriers. Nasty though it may be, it can be nullified, if not eliminated, through mass vaccination.

There’s a catch. Because it’s so contagious, you have to vaccinate a huge fraction of a community to obtain “herd immunity” – the point beyond which a disease will vanish after an individual infection, instead of spreading. Measles require a vaccination rate of about 90%.

Because measles remains quite common in the developed world, it’s almost impossible to eliminate it completely in the West. (Vaccination efforts continue worldwide.) Over the past 15 years, the US saw only 60 or so cases in a typical year. In 2014 there were 600.

The reason behind the spike is simple. Many Americans are ignorant to the science behind vaccinations, and so they’re opting their children out of shots at an increasing rate. The problem isnt specific to measles, or to the US. (The UK and Japan have also had outbreaks.) But measles, which is given to outbreaks because of its extreme contagiousness, should be taken as a warning of what’s to come unless these trends are reversed.

The reason people continue making bad decisions is that they do not bear the full cost of the consequences. For that to change, from an economic standpoint, the cost of failing to get a child immunized should be monetized, and parents should be required to submit proof of vaccination when they file their taxes, or pay a penalty approximating the expected value of their decision. A pair of studies found the average cost of a measles case to be about $1,000 – including cases involving hospitalizations, whose average cost is $10,000. Those studies are 20 years old – the cost of healthcare has since more than doubled, and that’s on top of ordinary inflation. When you factor in that a single measles case in an unvaccinated population causes between 12 and 18 additional cases, you’re talking big money.

Using these crude figures, it seems that $5,000 to $25,000 would be a fair price to pay for failing to get a child vaccinated. Hey, it’s a free country, so the police arent gonna drag kids out of homes and stick needles in their arms. But it is reasonable to ask people to take personal responsibility for their decisions, and pay their own way. That’s what conservatism is all about – or so they tell us….

 

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