Author: Art Diamond

A Dollar Spent on Medicaid Yields (at Most) 40 Cents of Value to Recipients

(p. C3) A . . . National Bureau of Economic Research study estimated the value of Medicaid to its recipients at between 20¢ and 40¢ per dollar of expenditure, with the majority of the value going to health-care providers like doctors and hospitals. By comparison, the Earned Income Tax Credit—a cash transfer program designed to enhance the incomes of the working poor—delivers around 90¢ of value to its recipients per dollar of expenditure. Given that more than half of Obamacare’s reduction in the numbers of the uninsured has been from its expansion of Medicaid, this makes the law look more like welfare for the medical-industrial complex than support for the needy.

For the full commentary see:

Daniel P. Kessler. “The Health of Obamacare.” The Wall Street Journal (Saturday, Dec. 12, 2015 [sic]): C3.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date Dec. 11, 2015 [sic], and has the same title as the print version.)

The NBER working paper mentioned above was later published in:

Finkelstein, Amy, Nathaniel Hendren, and Erzo F. P. Luttmer. “The Value of Medicaid: Interpreting Results from the Oregon Health Insurance Experiment.” Journal of Political Economy 127, no. 6 (Dec. 2019): 2836-74.

(Note: my title for this blog entry continues to be supported in the 2019 published version of the earlier NBER working paper.)

“A Pattern of Stumbles Across the World of Generative A.I.”

(p. B1) Days before gadget reviewers weighed in on the Humane Ai Pin, a futuristic wearable device powered by artificial intelligence, the founders of the company gathered their employees and encouraged them to brace themselves. The reviews might be disappointing, they warned.

. . .

(p. B5) Its setbacks are part of a pattern of stumbles across the world of generative A.I., as companies release unpolished products. Over the past two years, Google has introduced and pared back A.I. search abilities that recommended people eat rocks, Microsoft has trumpeted a Bing chatbot that hallucinated and Samsung has added A.I. features to a smartphone that were called “excellent at times and baffling at others.”

For the full story see:

Tripp Mickle and Erin Griffith. “Inside the Spectacular Flop of a Bold A.I. Device.” The New York Times (Friday, June 7, 2024): B1 & B5.

(Note: ellipsis added.)

(Note: the online version of the story was updated June 7, 2024, and has the title “‘This Is Going to Be Painful’: How a Bold A.I. Device Flopped.”)

Pigeons Can Learn to Accurately Spot Cancerous Breast Cells

(p. C4) . . . researchers at the University of California, Davis, the University of Iowa and Emory University have demonstrated that pigeons are surprisingly good at detecting cancer as well. Using grain as a reward, the scientists managed to train hungry pigeons to reliably spot malignancies in images of human breast cells.

The birds achieved roughly 85% accuracy, which is probably better than beginning medical students, the scientists said, although it doesn’t approach the prowess of seasoned pathologists. On the other hand, the birds’ training only involved 24 slides at four times magnification (and they graduated debt-free). What’s more, when Edward A. Wasserman and his colleagues exploited the “wisdom of flocks” by combining the “votes” of four pigeons on each slide, the birds’ accuracy shot up to an astonishing 99%.

When confronted with mammograms, by contrast, the pigeons were flummoxed. After awhile, they seemed to learn to detect cancer on these images, but when shown new ones, they couldn’t do any better than chance, which implies that they had simply memorized the right calls on the initial images during repeated viewings. By contrast, birds that learned to pick out cancer from tissue samples could carry over their skills to new images.

Why so good with images of actual tissue yet so bad with mammograms? The former consist of breast cells seen under a microscope, while the latter are murkier images of overlapping elements (such as blood vessels) within the breast. Like physicians, pigeons find it easier to make the diagnosis by looking at cells, which is why biopsies are taken.

For the full commentary see:

Daniel Akst. “R&D; Pigeons That Spot Breast Cancer.” The Wall Street Journal (Saturday, Dec. 12, 2015 [sic]): C4.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date Dec. 11, 2015 [sic], and has the title “R&D; The Pigeons That Can Spot Breast Cancer.”)

The research summarized in the passages quoted above, was published in the academic article:

Levenson, Richard M., Elizabeth A. Krupinski, Victor M. Navarro, and Edward A. Wasserman. “Pigeons (Columba Livia) as Trainable Observers of Pathology and Radiology Breast Cancer Images.” PLOS ONE 10, no. 11 (2015): e0141357.

Subpoena Emails Between Wuhan Lab and U.S. Partners to Illuminate Origin of Covid

The passages quoted below are a very small part of a much longer essay that took up the space of a full page and a half of the SundayOpinion section of The New York Times.

(p. 6) On Monday [June 3, 2024], Dr. Anthony Fauci returned to the halls of Congress and testified before the House subcommittee investigating the Covid-19 pandemic. He was questioned about several topics related to the government’s handling of Covid-19, including how the National Institute of Allergy and Infectious Diseases, which he directed until retiring in 2022, supported risky virus work at a Chinese institute whose research may have caused the pandemic.

For more than four years, reflexive partisan politics have derailed the search for the truth about a catastrophe that has touched us all. It has been estimated that at least 25 million people around the world have died because of Covid-19, with over a million of those deaths in the United States.

Although how the pandemic started has been hotly debated, a growing volume of evidence — gleaned from public records released under the Freedom of Information Act, digital sleuthing through online databases, scientific papers analyzing the virus and its spread, and leaks from within the U.S. government — suggests that the pandemic most likely occurred because a virus escaped from a research lab in Wuhan, China. If so, it would be the most costly accident in the history of science.

. . .

(p. 7) The pandemic could have been caused by any of hundreds of virus species, at any of tens of thousands of wildlife markets, in any of thousands of cities, and in any year. But it was a SARS-like coronavirus with a unique furin cleavage site that emerged in Wuhan, less than two years after scientists, sometimes working under inadequate biosafety conditions, proposed collecting and creating viruses of that same design.

While several natural spillover scenarios remain plausible, and we still don’t know enough about the full extent of virus research conducted at the Wuhan institute by Dr. Shi’s team and other researchers, a laboratory accident is the most parsimonious explanation of how the pandemic began.

Given what we now know, investigators should follow their strongest leads and subpoena all exchanges between the Wuhan scientists and their international partners, including unpublished research proposals, manuscripts, data and commercial orders. In particular, exchanges from 2018 and 2019 — the critical two years before the emergence of Covid-19 — are very likely to be illuminating (and require no cooperation from the Chinese government to acquire), yet they remain beyond the public’s view more than four years after the pandemic began.

Whether the pandemic started on a lab bench or in a market stall, it is undeniable that U.S. federal funding helped to build an unprecedented collection of SARS-like viruses at the Wuhan institute, as well as contributing to research that enhanced them.

. . .

A thorough investigation by the U.S. government could unearth more evidence while spurring whistleblowers to find their courage and seek their moment of opportunity. It would also show the world that U.S. leaders and scientists are not afraid of what the truth behind the pandemic may be.

For the full essay see:

Alina Chan. “Why Covid Probably Started in a Lab.” The New York Times, SundayOpinion Section (Sunday, June 9, 2024): 6-7.

(Note: ellipses, and bracketed date, added.)

(Note: the online version of the essay has the date June 3, 2024, and has the title “Why the Pandemic Probably Started in a Lab, in 5 Key Points.”)

The essay quoted above summarizes and updates her co-authored book:

Chan, Alina, and Matt Ridley. Viral: The Search for the Origin of Covid-19. New York: Harper, 2021.

Musk’s Predictions Are “Just Guesses,” Part of “a Conversation”

(p. B4) In the past, Musk has suggested that sometimes people read too much into what he says.

“People shouldn’t hold me to these things,” Musk said in 2022 during a TED Talk interview. “What tends to happen is I’ll make some like, you know, best guess, and then people in five years, there’ll be some jerk that writes an article: ‘Elon said this would happen, and it didn’t happen. He’s a liar and a fool.’”

“It’s very annoying when that happens,” Musk continued. “These are just guesses, this is a conversation.”

For the full commentary see:

Tim Higgins. “How Misunderstood Is Tesla’s Musk?” The Wall Street Journal (Monday, June 24, 2024): B4.

(Note: the online version of the commentary has the date June 22, 2024, and has the title “Is Elon Musk Misunderstood, or Understood All Too Well?”)

Commercial Logging Would Reduce the Size and Number of Canadian Summer Wildfires and Intense Smoke

(p. A4) The loggers’ work was unmistakable.

Flanked by dense forests, the mile-long, 81-acre expanse of land on the mountainside had been stripped nearly clean. Only scattered trees still stood, while some skinny felled trunks had been left behind. A path carved out by logging trucks was visible under a light blanket of snow.

The harvesting of trees would be routine in a commercial forest — but this was in Banff, Canada’s most famous national park. Clear-cutting was once unimaginable in this green jewel in the Canadian Rockies, where the longstanding policy was to strictly suppress every fire and preserve every tree.

But facing a growing threat of wildfires, national park caretakers are increasingly turning to loggers to create fire guards: buffers to stop forest fires from advancing into the rest of the park and nearby towns.

“If you were to get a highly intense, rapidly spreading wildfire, this gives fire managers options,’’ David Tavernini, a fire and vegetation expert at Parks Canada, the federal agency that manages national parks, said as he treaded on the cleared forest’s soft floor.

. . .

Long-planned measures meant to protect against wildfires — like the fire guard in Alberta’s Banff park and other projects in the town of Banff — have taken on a greater sense of urgency.

. . .

The increased number of fires in sparsely populated areas of Canada has affected not only nearby communities, but also distant ones, with the intense smoke they have generated floating into southern Canada and into the United States.

. . .

In Banff National Park, which was created in 1885 and is Canada’s oldest, officials until 1983 hewed to a strict policy of fire suppression, rather than take significant steps to prevent or manage fires.

The result now is a landscape of dense forests dominated by conifers, which are extremely flammable.

Historical photos of the area before the park was established show a greater variety of trees and more open spaces, said Mr. Tavernini, the fire and vegetation expert at Parks Canada. Lightning and controlled burns by the local Indigenous people regularly thinned out the forests, he said.

For the full story see:

Norimitsu Onishi. “In the Canadian Rockies, Logging Parks to Save Them.” The New York Times (Thursday, May 30, 2024): A4.

(Note: ellipses added.)

(Note: the online version of the story has the date May 29, 2024, and has the title “Logging in Canada’s Most Famous National Park to Save It From Wildfires.”)

When Hospitals Compete Less, Prices Rise More

(p. B10) If the fries at your local burger joint are soggy or if you’re suddenly charged $25 for ketchup, you’ll probably eat somewhere else next time. That’s the beauty of competition.

Healthcare doesn’t quite work that way. For starters, you don’t always get to choose your medical provider—your insurer often does by contracting with them. And even the insurer can’t easily walk away, either: Giant hospital systems are swallowing up big chunks of the country’s healthcare system through vertical and horizontal integration. That leaves fewer parties with which to negotiate.

If McDonald’s bought Burger King and then Wendy’s, you could always cook at home instead, but nearly everyone needs to go to the doctor or the hospital at some point. Patients also aren’t nearly as cost sensitive as they would be with other purchases because employers and insurers pick up much of the tab. They often don’t even know the price ahead of time.

Hospital executives argue that mergers lead to improved efficiency and better outcomes for patients. But, after years of rampant consolidation between hospitals, most regions in the U.S. are now dominated by a few large players. That has led to higher prices and no significant improvements in patient care.

Rising costs don’t just lead to alarmingly high medical bills—they also make all of us worse off by increasing premiums, the bulk of which are paid by the nation’s employers. That affects even people who rarely visit a doctor. As those premiums soar and employers look to offset the cost, they indirectly eat into people’s paychecks.

Over the past two decades, there have been more than 1,000 mergers among the country’s approximately 5,000 hospitals, according to a forthcoming paper in American Economic Review: Insights.

For the full commentary see:

David Wainer. “As Hospitals Grow, So Does Your Bill.” The Wall Street Journal (Friday, June 7, 2024): B10.

(Note: the online version of the commentary has the date June 6, 2024, and has the same title as the print version.)

The paper in American Economic Review: Insights, mentioned above, is:

Brot-Goldberg, Zarek, Zack Cooper, Stuart Craig, and Lev Klarnet. “Is There Too Little Antitrust Enforcement in the U.S. Hospital Sector?” American Economic Review: Insights (forthcoming).

Gates’s TerraPower Breaks Ground on Small Nuclear Reactor

(p. A16) Outside a small coal town in southwest Wyoming, a multibillion-dollar effort to build the first in a new generation of American nuclear power plants is underway.

Workers began construction on Tuesday on a novel type of nuclear reactor meant to be smaller and cheaper than the hulking reactors of old and designed to produce electricity without the carbon dioxide that is rapidly heating the planet.

The reactor being built by TerraPower, a start-up, won’t be finished until 2030 at the earliest and faces daunting obstacles. The Nuclear Regulatory Commission hasn’t yet approved the design, and the company will have to overcome the inevitable delays and cost overruns that have doomed countless nuclear projects before.

What TerraPower does have, however, is an influential and deep-pocketed founder. Bill Gates, currently ranked as the seventh-richest person in the world, has poured more than $1 billion of his fortune into TerraPower, an amount that he expects to increase.

“If you care about climate, there are many, many locations around the world where nuclear has got to work,” Mr. Gates said during an interview near the project site on Monday. “I’m not involved in TerraPower to make more money. I’m involved in TerraPower because we need to build a lot of these reactors.”

Mr. Gates, the former head of Microsoft, said he believed the best way to solve climate change was through innovations that make clean energy competitive with fossil fuels, a philosophy he described in his 2021 book, “How to Avoid a Climate Disaster.”

Nationwide, nuclear power is seeing a resurgence of interest, with several start-ups jockeying to build a wave of smaller reactors and the Biden administration offering hefty tax credits for new plants.

. . .

In March [2024], TerraPower submitted a 3,300-page application to the Nuclear Regulatory Commission for a permit to build the reactor, but that will take at least two years to review. The company has to persuade regulators that its sodium-cooled reactor doesn’t need many of the costly safeguards required for traditional light-water reactors.

“That’s going to be challenging,” said Adam Stein, director of nuclear innovation at the Breakthrough Institute, a pro-nuclear research organization.

TerraPower’s plant is designed so that major components, like the steam turbines that generate electricity and the molten salt battery, are physically separate from the reactor, where fission occurs. The company says those parts don’t require regulatory approval and can begin construction sooner.

For the full story see:

Brad Plumer and Benjamin Rasmussen. “Climate-Minded Billionaire Makes a Bet on Nuclear Power.” The New York Times (Thursday, June 13, 2024): A16.

(Note: ellipsis, and bracketed year, added.)

(Note: the online version of the story has the date June 11, 2024, and has the title “Nuclear Power Is Hard. A Climate-Minded Billionaire Wants to Make It Easier.”)

Gates’s 2021 book, mentioned above, is:

Gates, Bill. How to Avoid a Climate Disaster: The Solutions We Have and the Breakthroughs We Need. New York: Knopf, 2021.

Many Workers Happily Accept Lower Pay if They Can Work Remotely

(p. A15) The U.S. inflation rate tumbled from June 2022 to June 2023. It was no slide down the Phillips curve of the sort that textbooks attribute to tighter monetary policy. Instead, inflation fell 6 percentage points as unemployment stayed low. It is thus a mistake to credit this episode to the Federal Reserve’s departure from low interest rates.

. . .

Employees initially reaped the benefits of remote work, because their wages reflected pre-pandemic conditions and expectations. Over time, pay adjusted and employers adapted, eventually allowing them to benefit from slower wage growth.

My research quantifies this source of wage-growth moderation. Along with the Atlanta Fed, our team asked hundreds of business executives whether remote work affected their firms’ wages. Thirty-eight percent told us their companies had relied on the work-from-home boom to moderate wage-growth pressures in the previous 12 months. Forty-one percent said their firms planned to use remote work to restrain wage growth in the next 12 months. We found that the boom reduced overall wage growth by 2 percentage points from spring 2021 to spring 2023. In all likelihood, the effects extended beyond this interval, because pay adjusts slowly.

Remote work cuts costs in other ways, too. When employees work on site only two days a week, their companies need less space.

For the full commentary see:

Steven J. Davis. “Working at Home Helped Whip Inflation.” The Wall Street Journal (Thursday, June 20, 2024): A15.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date June 19, 2024, and has the same title as the print version.)

Davis’s research mentioned above is:

Barrero, Jose Maria, Nicholas Bloom, Steven J. Davis, Brent H. Meyer, and Emil Mihaylov. “The Shift to Remote Work Lessens Wage-Growth Pressures.” National Bureau of Economic Research Working Paper # 30197, July 2022.

Starlink Gives Remote Tribes Voice, Information, and Fast Help in Emergencies

(p. 12) . . . Starlink, . . . has quickly dominated the satellite-internet market worldwide by providing service once unthinkable in . . . remote areas. SpaceX has done so by launching 6,000 low-orbiting Starlink satellites — roughly 60 percent of all active spacecraft — to deliver speeds faster than many home internet connections to just about anywhere on Earth, including the Sahara, the Mongolian grasslands and tiny Pacific islands.

Business is soaring. Mr. Musk recently announced that Starlink had surpassed three million customers across 99 countries. Analysts estimate that annual sales are up roughly 80 percent from last year, to about $6.6 billion.

. . .

. . . perhaps Starlink’s most transformative effect is in areas once largely out of the internet’s reach, like the Amazon. There are now 66,000 active contracts in the Brazilian Amazon, touching 93 percent of the region’s legal municipalities. That has opened new job and education opportunities for those who live in the forest. It has also given illegal loggers and miners in the Amazon a new tool to communicate and evade authorities.

One Marubo leader, Enoque Marubo (all Marubo use the same surname), 40, said he immediately saw Starlink’s potential. After spending years outside the forest, he said he believed the internet could give his people new autonomy. With it, they could communicate better, inform themselves and tell their own stories.

Last year, he and a Brazilian activist recorded a 50-second video seeking help getting Starlink from potential benefactors. He wore his traditional Marubo headdress and sat in the maloca. A toddler wearing a necklace of animal teeth sat nearby.

They sent it off. Days later, they heard back from a woman in Oklahoma.

. . .

Allyson Reneau’s LinkedIn page describes her as a space consultant, keynote speaker, author, pilot, equestrian, humanitarian, chief executive, board director and mother of 11 biological children. In person, she says she makes most of her money coaching gymnastics and renting houses near Norman, Okla.

. . .

Enoque was asking for 20 Starlink antennas, which would cost roughly $15,000, to transform life for his tribe.

. . .

[Allyson Reneau said] “One tool would change everything in their life. Health care, education, communication, protection of the forest.”

Ms. Reneau said she bought the antennas with her own money and donations from her children.

. . .

The internet was an immediate sensation.

. . .

They spend lots of time on WhatsApp. There, leaders coordinate between villages and alert the authorities to health issues and environmental destruction. Marubo teachers share lessons with students in different villages. And everyone is in much closer contact with faraway family and friends.

To Enoque, the biggest benefit has been in emergencies. A venomous snake bite can require swift rescue by helicopter. Before the internet, the Marubo used amateur radio, relaying a message between several villages to reach the authorities. The internet made such calls instantaneous. “It’s already saved lives,” he said.

For the full story see:

Jack Nicas and Victor Moriyama. “The Internet’s Final Frontier: Remote Amazon Tribes of Brazil.” The New York Times, First Section (Sunday, June 2, 2024): 1 & 12-13.

(Note: ellipses, and bracketed words, added.)

(Note: the online version of the story was updated June 21 [sic], 2024, and has the title “The Internet’s Final Frontier: Remote Amazon Tribes.”)

People Feel “Stuck” in Lives Lacking Freedom and Hope

People need more control over their lives to feel hopeful for a free flourishing future. Fewer government regulations and more innovative firm managers could allow more of us to be “unstuck,” working on challenging but doable projects that improve the world and allow fulfilment. (I discuss these issues in more depth in Openness to Creative Destruction.)

(p. 9) The hallways on the television shows I watch have been driving me mad. On one sci-fi show after another I’ve encountered long, zigzagging, labyrinthine passageways marked by impenetrable doors and countless blind alleys — places that have no obvious beginning or end. The characters are holed up in bunkers (“Fallout”), consigned to stark subterranean offices (“Severance”), locked in Escher-like prisons (“Andor”) or living in spiraling mile-deep underground complexes (“Silo”). Escape is unimaginable, endless repetition is crushingly routine and people are trapped in a world marked by inertia and hopelessness.

The resonance is chilling: Television has managed to uncannily capture the way life feels right now.

We’re all stuck.

What’s being portrayed is not exactly a dystopia. It’s certainly not a utopia. It’s something different: a stucktopia. These fictional worlds are controlled by an overclass, and the folks battling in the mire are underdogs — mechanics, office drones, pilots and young brides. Yet they’re also complicit, to varying degrees, in the machinery that keeps them stranded. Once they realize this, they strive to discard their sense of futility — the least helpful of emotions — and try to find the will to enact change.

. . .

We’re not stuck in our circumstance. We’re stuck in the ways of living that perpetuate it.

If enough of us give up the sense that things are inevitable — that we’re stuck — it’s possible that we can course-correct humanity, or at least nudge it toward a hopeful path.

There’s another more realistic option that offers a thrill and reward of its own. If we don’t let the stucktopia keep its hold on us, if we rebuke it, maybe we shift ourselves ever so slightly toward optimism, and give the system whatever small hell we can.

For the full commentary see:

Hillary Kelly. “It’s Not Your Imagination. We’re All Stuck.” The New York Times, SundayOpinion Section (Sunday, July 7, 2024): 9.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date July 6, 2024, and has the title “Welcome to Stucktopia.”)