As long as you don’t take seriously the hardship you are inflicting, you’ll never be persuasive.
I do take it seriously, but there are three points I think should be made here.
First is that, yes, policy debates shouldn’t appear one-sided. Policies of forcible quarantine, voluntary quarantine, tattooing, and so on do have costs, and those costs require a conversion factor to be compared to the benefits of the various policies, and people can differ on what they think those conversion factors should be.
Second is that I think that those conversion factors imply moral positions, and that it makes sense to condemn moral positions you disagree with strongly enough. If someone thinks that, to give an extreme example, we shouldn’t imprison one person even if that prevents an epidemic that will murder a million people, I do not want them making public health decisions.
Third, the response to AIDS seems especially tragic to me because it put feelings above people, and is strong evidence against civilizational competence.
Voluntary quarantine is the obvious starting point. Pay or persuade sufferers to undergo quarantine.
Again, Typhoid Mary. She refused to believe that she was infecting others, or to seek work as anything besides a cook. The tool of ‘pay her to do something other than cook’ has similar local incentives as ‘punish her for cooking’, but it has very different global incentives. “Hey, all I need to do is contract typhus and then I can collect money for not working!” The local incentives aren’t quite the same, either: “I think I get… one million dollars worth of satisfaction for cooking a meal!” It seems to me that one of the secondary uses of government is to prevent people from capturing the majority of the consumer surplus from trade, and you don’t need to stretch epidemics too far to make them fit that mold.
I already gave cases on either side of the line; HIV and plague.
By ‘clearly’ I meant that everyone involved in the discussion agreed they were clear. From my perspective, HIV and plague look fairly difficult to distinguish in terms of impact, though I agree they’re different in terms of transmission vector.
the burden of not-quarantine is that you don’t get to have consequence-free casual sex (or share needles).
Recall that we are discussing about a third of a million preventable deaths, here. The primary burden for me is not that I don’t have access to consequence-free casual sex, but the people I never met because they died early, and the friends whose futures are less certain and whose presents are less pleasant than they could be.
I worry that you’re devaluing deaths due to this particular epidemic because a careful person could avoid catching the disease (unless, you know, they needed a blood transfusion at any point in their life). If all a disease does is increase the costs of being careful, then that’s still reason enough to seek ways to fight the disease more effectively.
(And even if you personally are careful, you can’t make your friends more careful; community health requires community hygiene.)
I think that those conversion factors imply moral positions, and that it makes sense to condemn moral positions you disagree with strongly enough… I do not want [people I disagree with] making public health decisions.
Agreed 100%. There has been an undertone in my posts of moral condemnation; and it’s intentional. I do not want someone like Cochran making decisions about individual liberty.
[T]he response to AIDS seems especially tragic to me because it put feelings above people, and is strong evidence against civilizational competence.
I don’t know what this means. Could you explain? It seems to me that the AIDS response put people’s liberty before people’s lifespan. This is not an uncontroversial choice, but it doesn’t seem an obviously wrong one; both are about people, neither about ‘feelings,’ - except to the extent that ‘feelings’ reside within people. As for civilizational competence, it strikes me that civilisation is rolling along just fine; if anything, the AIDS epidemic appears to have played a major role in the major shift from homosexuals whining about “heteronormativity” to campaigning for gay marriage.
Incentives.
Of course there would be problems with voluntary quarantine. If you’d tried voluntary quarantine, and found it too hard (perhaps because of incentive problems), there would be something to discuss. But if you don’t try the first step, and immediately go for the nuclear option, I find it hard to take you seriously. Do you really think there would be no perverse incentives, regulatory overreach, etc, in a massive government programme of compulsory quarantine and HIV tests?
Recall that we are discussing about a third of a million preventable deaths, here… I worry that you’re devaluing deaths due to this particular epidemic because a careful person could avoid catching the disease
No. But perhaps we have different models of causation.
Basically, I see someone who dies of AIDS as basically the same as someone who dies of scuba-diving. They did something risky (but presumably fun), they had bad luck, they died. So it goes. It’s sad, but the alternative wasn’t immortality. To the extent their deaths were “preventable,” it was all in their own power, and they chose not to. They caused their own deaths.
The subtext to your position appears to be that the government has some kind of “heroic duty” to save lives. Sharing needles and having casual unprotected sex are dangerous and foolish, but people are going to do them regardless, and so it’s the government’s duty to make those activities as safe as possible. The government caused their deaths by not doing more to prevent them.
I’m not going to get into a debate about “heroic duty,” but I would say this; you are calling for extraordinary measures. As far as I can tell, there has never been mass compulsory testing for diseases except for at the border. You are, to continue the analogy, trying to make a huge, costly, unprecedented and coercive effort to make scuba-diving safer, at particularly great cost to people in the vicinity of the scuba-divers, as well as liberty generally. Yet you are unable to justify why the safety-conscious scuba-divers shouldn’t pay those costs themselves, and you aren’t willing to try voluntary measures as a first step. It seems clear that the primary cost of making scuba-diving safer should fall on the people who want to go scuba-diving, and if they aren’t willing to pay that cost, then I’ll be damned if I’ll subsidise them, and I’ll be doubly damned if I’ll help them victimize others.
Do you really think there would be no perverse incentives, regulatory overreach, etc, in a massive government programme of compulsory quarantine and HIV tests?
Let me dial that up to 11 X-)
So, the suggested remedy is to forcibly separate the society into the clean and the unclean, and to brand the unclean with an indelible mark. What could possibly go wrong?
And let’s talk practicalities. By the time AIDS was recognized as a serious threat and there were reliable tests for HIV status, how many HIV-positive people were there in the US already? Quarantines work well when you need to quarantine a few or a few dozens of people, not well-dispersed thousands and tens of thousands. How would compulsory testing work given that people know that failing the test leads to being branded unclean? Troops isolating city block by city block and dragging all inhabitants to a field testing station? How about costs of that?
Also blood transfusions. It took the red cross a disgracefully long amount of time to start screening donors. Some people objecting to the screening compared it to the WWII-era separation of blood into black plasma and white plasma.
Sure. I think people’s first instinct whenever they encounter a policy question is to ask who they identify with. Is it the carrier of AIDS whose freedom or bodily autonomy would be violated by a quarantine or a tattoo, or is it the person at risk for AIDS? Actually considering the positions of both people is difficult but doable, and I think generally inconsistent with a rights-based view of morality. If we just say “liberty first!” then we make crazy trades where we give up many years of life for a bit of liberty; if we just say “lives first!” then we make crazy trades where we give up significant amounts of life satisfaction for a few lives; if we say “this is the tradeoff between life and liberty that we think it reasonable” then we have an actually quantitative discussion (which is less likely to be crazy).
It seems to me (with the disclaimer that I’m not a historian) that most LGBT activists decided they identified with the people who had HIV, and so they advocated voluntary testing, and voluntary disclosure, and against policies that might possibly ‘out’ people, because they felt it more important to maintain the option to keep sex lives private than to prevent the spread of the disease. It’s also claimed that Reagan mostly brushed the issue off because he identified with neither the carriers nor those at risk (until famous actors that he knew started dying), but, again, I’m not a historian.
If you’d tried voluntary quarantine, and found it too hard (perhaps because of incentive problems), there would be something to discuss.
The time to close the stable door is before the horse escapes. As mentioned earlier, I think the cost/benefit has shifted on HIV to the point where quarantine isn’t a good idea anymore (but compulsory testing and tattooing might still make sense). Trying half measures and then doubling down if they fail doesn’t seem like a strong strategy relative to starting with the full approach in the presence of exponentially growing risks. (This is especially true if the failure of the half measure leads to discrediting the project, rather than to support for trying it harder.)
Basically, I see someone who dies of AIDS as basically the same as someone who dies of scuba-diving. They did something risky (but presumably fun), they had bad luck, they died. So it goes. It’s sad, but the alternative wasn’t immortality.
Agreed that the alternative wasn’t immortality, but I don’t see why you’re not excited by the ability to adjust the risk of activities. I think consuming alcohol is inconsistent with my values; so I don’t. But I don’t write off alcoholics; I pity them, and if I could make alcoholism less destructive, I would. (If I expected a prohibition on alcohol to have positive expected value, I would support one; history is pretty clear that’s not a good idea.)
Activities aren’t risky or safe. There’s a quantified risk associated with everything: consider driving. Driving is consistent with my values, and so I do it- but I wish it were cheaper, in terms of the risk of years lost, and I support government efforts to make driving safer to the degree that they seem effective. I almost never use boats myself, but I benefit from other people doing that- and I wish that were cheaper, in terms of risk, and I support government efforts to make shipping safer to the degree that they seem effective. And so on.
As far as I can tell, there has never been mass compulsory testing for diseases except for at the border.
Many US states required a Wassermann test before they would issue a marriage license, with the express purpose of protecting the innocent spouse (and any potential children) from contracting syphilis.
Actually considering the positions of both people is difficult but doable, and I think generally inconsistent with a rights-based view of morality.
Um, why do you think so? The “rights-based” view is not that “he has a right so no one can do anything”. Instead, it is “he has a right, so he can decide whether to insist on it or not, or maybe to trade it for some benefit”.
The core issue is who has the power, who decides. You are thinking of an impersonal entity above all whose freedom to choose the “optimal” solution is unnecessarily constrained by individual rights. The alternative is devolve the power downwards and let different people come to different views and conclusions. Sure, it’s going to be messy and in many ways (especially at the micro level) non-optimal. However it avoids the pitfalls of trying to impose seeming optimality from above which, as history abundantly demonstrates, has some pretty horrible failure modes.
The core issue is who has the power, who decides. You are thinking of an impersonal entity above all whose freedom to choose the “optimal” solution is unnecessarily constrained by individual rights. The alternative is devolve the power downwards and let different people come to different views and conclusions.
Sure. And we have technical tools that help us solve this problem, rather than just reasoning from moral principles. We can look at the structure of the problem and determine the optimal level of centralization for a particular variety of intervention, because problems are caused by mismatch of optimizer centralization and information centralization, and this can be both that the optimizer is too far up and that the optimizer is too far down.
determine the optimal level of centralization for a particular variety of intervention
I don’t see how you can get to the single “optimal level” without assuming a single underlying system of values. Optimality is a function of your evaluation of outcomes and your evaluation of outcomes is a function of your value system.
Who will determine that “optimal level” and what happens when there is significant disagreement about optimality?
Actually considering the positions of both people is… inconsistent with a rights-based view of morality.
No. The point is that people’s rights are a key part of their position, and it’s impossible to evaluate people’s interests or “expected value” without considering their rights. That’s not to say that you can never override people’s rights, but it needs to take a lot, particularly if the violation is very serious (eg mass imprisonment of people who’ve committed no crime). Moreover, if you need my consent for your plan, that’s a great way of making sure that you really are acting in my interests. There is no end to my suspicion of people who view breaching rights without consent as a minor hiccup in their plan, rather than a key reason to abandon it.
Trying half measures and then doubling down
This is just rhetoric. An agile approach based on feedback and iteration is an equally good description. The failure of the “half-measure” should make you doubt the project a bit. It looks very much like you’ve got a hammer and are determined to wield it.
I don’t see why you’re not excited by the ability to adjust the risk of activities.
Hang on now. I think the pharmaceutical companies who came up with the various tests and anti-retrovirals etc did something worthwhile. I think the people who campaigned for condom use did something worthwhile. But I’m not excited about compulsory testing and mass imprisonment of the innocent. Once again, the question is: who should pay the costs of this risk adjustment? It looks to me very much like you want society as a whole (and HIV sufferers in particular) to subsidise your favourite recreational activity. You should pay.
If I expected a prohibition on alcohol to have positive expected value, I would support one.
Of course you would. And you’d place practically no weight on people’s freedom to drink (or sell) what they want, and you’d place practically no weight on people’s enjoyment of alcohol, but massive weight on the health drawbacks and drunk driving statistics and the occasional alcoholic. And then you’d add in the subconscious bias that you don’t drink, so screw those guys (just as I do not believe for one second that you’d be in favour of a quarantine if it applied to you). Which is why people like you were gung-ho for prohibition, and shocked when it didn’t work (they too didn’t want to bother with voluntary attempts or partial measures). And why you are no doubt gung-ho for gun control. And why you will no doubt be gung-ho against every civil liberty in turn.
I consider this brand of politics far more dangerous than the HIV virus, but you’ll note that I’m not calling for your quarantine.
[edit]Huge portions of this comment were missing originally; it’s been edited but the context for descendent comments may have changed.
eg mass imprisonment of people who’ve committed no crime
I will point out that the current legal practice is to basically consider ‘being suspected of having an infectious pandemic disease’ as a ‘crime,’ in that the CDC can detain people at its discretion. If you subscribe to the ‘non-agression principle,’ I think this is consistent with that, since carrying an infectious disease is threatening or initiating violence (even if it’s unintentional).
Moreover, if you need my consent for your plan, that’s a great way of making sure that you really are acting in my interests.
Consider something like fluoridating municipal water supplies, or adding lithium to them, or filtering out arsenic from them. I don’t see a serious difference between filtering out arsenic and adding fluoride- they’re both adjusting the chemical properties of drinking water to improve health. (There is perhaps a status quo bias which sees removing something already there as safer than adding something not already there, but I don’t think that’s particularly relevant.) Adding fluoride or lithium to the water supply is something you either do or don’t do- a house by house opt-in system would be tremendously more expensive and there’s not a way to opt out besides filtering your water.
Suppose a city is voting on whether or not to add lithium to their water supply. A strict consent rule would require that every person vote for adding lithium in order for it to not be violating consent to add lithium. But it seems to me that we’re better served by a Hansonian system of voting on values (“I am willing spend up to $X a year to reduce the number of deaths per year by 1 per 100,000 people”) and then betting on beliefs (“If we increase the lithium supply from 1 microgram per liter to 40 micrograms per liter, we would expect suicides to decrease by 20 people per 100,000 per year”), so that the people price their various values and then experts evaluate how likely various approaches are to achieve those values, rather than requiring every voter to be an expert on all possible approaches. (“Fluoride? Doesn’t that sap my precious bodily fluids?”)
An agile approach based on feedback and iteration is an equally good description.
Sure, but we’re back to the issue of what “feedback” means in the context of a pandemic. “Hmm, we let too many carriers of the disease out of isolation, and now 3% of the global population is dead. Oops!” This is perhaps a textbook example of a time-sensitive issue where it matters a lot to get it right the first time. (The current xkcd seems relevant.)
The failure of the “half-measure” should make you doubt the project a bit.
Suppose I’m designing a bridge, and calculate that in order to support a load of ten thousand kilograms, we’d need ten pylons. For budgetary reasons, we only use six pylons, and then the bridge breaks when a load of ten thousand kilograms is driven across it. Should we doubt my abilities as an engineer?
Once again, the question is: who should pay the costs of this risk adjustment? It looks to me very much like you want society as a whole (and HIV sufferers in particular) to subsidise your favourite recreational activity. You should pay.
Are you referring to other people being alive as ‘my favorite recreational activity’? I don’t think I’ve looked at it that way before, but that actually seems like it might be a fair description.
But to answer the question, I think that it’s reasonable for public governments to pay for and enforce public health projects. I think that it is not objectionable for the broader population to subsidize narrower segments of the population- my tax dollars fund research into treatment of genetic conditions that neither I nor my hypothetical children will have, for example- but agree that when costs can be localized, they should. When you look at compulsory testing combined with ‘soft quarantines’ like tattooing, it seems to me that the cost for the test is born by society as a whole but the costs of having the disease are born (mostly) by those with the disease. (And my impression is that if we decided it was a social priority to be able to test everyone for HIV, then the scaling would allow the costs of testing to drop significantly.)
I think that smaller scale versions of this are feasible- say, a bathhouse that required all members to take a HIV test every n months, and only allowed entry to people with negative results- but as with most things in public health, larger scales have larger benefits.
Of course you would.
As a general comment, I find it more helpful to ask people questions about their positions, rather than making predictions about their positions. I have found that being right about a prediction is rarely helpful, and being wrong typically disastrous when it comes to having a productive conversation. For example, one of the hypothetical models I had of you earlier in this conversation was be that you might be a principled opponent to government coercion of individuals, and that model would object to the imprisonment of Typhoid Mary because it goes against the principle. Other models, though, wouldn’t object to the imprisonment of Typhoid Mary, because they used cost/benefit analysis to make their decisions and that particular example passed. To reduce my uncertainty in a relatively costless way, I asked.
just as I do not believe for one second that you’d be in favour of a quarantine if it applied to you
If I suspect myself of being infectious, I wear gloves and a mask to protect other people (and avoid leaving the house if I can help it). If I were suspected of having a pandemic disease, I would submit to a quarantine. This feels to me like basic “being polite and kind to others,” and so I’m moderately surprised you don’t think I would behave that way.
And why you are no doubt gung-ho for gun control.
Actually, the evidence seems convincing that arming the populace reduces the amount of and damage done by crime; Kennesaw-style laws requiring heads of household to maintain a firearm with ammunition (with exceptions for conscientious objectors) seem better than the opposite.
And why you will no doubt be gung-ho against every civil liberty in turn.
One of the three charities I regularly donate to, along with CFAR and SENS, is the Institute for Justice, which is a public interest law firm that litigates economic liberty cases. It’s up to you whether or not you class ‘right to own property’ or ‘right to earn a living without interference from your competitors’ as ‘civil liberties’ or different kinds of liberties, but I care about the project of advancing liberty comparably to how much I care about advancing rationality and defeating aging.
I, like Hayek, base my libertarianism on arguments from information costs: typically this leads to decentralization, but sometimes it leads to centralization- it makes much more sense to have one CDC with coercive powers than it does to decentralize and voluntarize the problem of preventing epidemics.
There is perhaps a status quo bias which sees removing something already there as safer than adding something not already there, but I don’t think that’s particularly relevant.
It is particularly relevant, because the regulators are running on corrupted hardware, and the consequence of bias and/or abuse by regulators is much greater for adding things than for taking them out.
Adding substances to the water to sterilize everyone, and taking substances out so that water-without-substances sterilizes everyone would be similar—except that the second is not possible and the first is.
and the consequence of bias and/or abuse by regulators is much greater for adding things than for taking them out.
I agree for “things” as a general class, but once we’ve conditioned on a particular thing (“what’s the optimal level of chemical Q?”) it seems to me that we should have symmetric levels of knowledge about moving the level of that thing up and down when it’s possible to move both directions. (Fluoride and lithium groundwater levels already vary significantly between areas—that’s how we discovered their effects in the first place—and so saying “let’s artificially make our groundwater like their groundwater” doesn’t seem that prone to bias or abuse.)
It may be worth explicitly mentioning that if we’re introducing something completely novel, when we shrink) the state of the evidence towards the reference class, the level of danger for “completely novel thing” is higher than the level of danger for “abundant common thing.” I expect this will be minor, though, and many completely novel things are actually much better studied than abundant common things, because the abundant common things were grandfathered in rather than receiving serious scrutiny. (Here I’m thinking of particular artificial sweeteners, which were proven safe at levels where sugar would be toxic because they had to go to dramatically higher levels of the artificial sweetener to find any toxicity.)
I suppose we should also mention the argument that if we create the ability to add molecules to the water supply, that ability could be corrupted to nefarious ends- but I think that’s a fully general argument against any infrastructure development, and should be responded to by investing in security (and secure design) rather than not investing in infrastructure.
but once we’ve conditioned on a particular thing (“what’s the optimal level of chemical Q?”) it seems to me that we should have symmetric levels of knowledge about moving the level of that thing up and down when it’s possible to move both directions.
Moving the level of that thing down is limited at 0, and thus the effect of bias and abuse is also limited. Moving the level up is not so limited.
Deciding that you’ll condition on a particular thing is itself subject to the same bias and abuse that deciding to add something is. Imagine regulators saying “we’ve already decided that we’re going add sterility drugs to the water, we just need to decide how much”. It’s also solved the same way; just like you say “without satisfying very high standards, you may only filter stuff out and not add stuff”, you say “without satisfying very high standards, you may only condition on things that are already present in significant amounts”.
I think that’s a fully general argument against any infrastructure development, and should be responded to by investing in security (and secure design) rather than not investing in infrastructure.
It is possible to have a multi-peaked preference where directly saying “we’ll create infrastructure, and then we’ll use it in X way” is opposed by a majority, while doing it in two steps as “we’ll create infrastructure which cannot be used in X way” and “now that we have infrastructure, we should remove the security and use it in X way” has each step supported by a majority.
To oppose such things, you have to oppose the first step. (And of course, not everything has multi-peaked preferences, so this is not a fully general argument.)
(That link also describes other slippery slope mechanisms which may apply.)
I think that smaller scale versions of this are feasible- say, a bathhouse that required all members to take a HIV test every n months, and only allowed entry to people with negative results- but as with most things in public health, larger scales have larger benefits.
This kind of thing is standard practice among porn studios...
a house by house opt-in system would be tremendously more expensive
Nope—it’s called fluoridated toothpaste or fluoridated mouthwash.
In general, the cost-benefit analysis for centralized interventions is difficult. Even besides the issues of properly estimating them, the costs and the benefits rarely align neatly—there are winners and there are losers. The problems are exacerbated by the fact that the powerful usually make sure they end up among the winners and the powerless often enough find themselves among the losers. I tend to be wary of “it benefits everyone!” handwaving.
Nope—it’s called fluoridated toothpaste or fluoridated mouthwash.
Which is only ten times more expensive. It’s also more effective than just drinking fluoridated water, as you might expect, so the comparison isn’t that clean.
Hopefully you’re buying toothpaste anyway, so the relevant number is the difference in price between fluoridated toothpaste and non-fluoridated. I think it’s more or less zero. In fact, non-fluoridated toothpaste is likely to be some all-natural all-organic fancy expensive thing :-)
but it has very different global incentives. “Hey, all I need to do is contract typhus and then I can collect money for not working!”
This is a good discussion, but let’s not get silly.
Typhoid Mary was a very unusual case in that she was a carrier but didn’t have any symptoms. I really don’t think there would have been a problem with people intentionally contracting typhus in order to get benefits and forgetting about the dying part.
Agreed that the example is silly, but the general trend is basic economics. A tax and a subsidy have the same effect on behavior in the short term, but one of them makes the industry less profitable (and thus it shrinks) whereas the other makes the industry more profitable (and thus it grows). I really don’t want to make the industry of “endangering public health” more profitable.
Well, first of all, if there are two industries and their size is a zero-sum game (all population is divided between classes A and B and everyone must belong to either A or B) then the effect of a tax and a subsidy is exactly the same. What grows one part, shrinks the other part and vice versa.
Second, this is a general-purpose argument against helping anyone in trouble. And, certainly, sometimes it is a valid argument (e.g. see the flood insurance for shore properties in the US). But sometimes its validity is more doubtful: for example, following this logic the SSI system for disability benefits should be dismantled immediately.
What grows one part, shrinks the other part and vice versa.
Yes? If we, say, use subsidies to reward coal plants for reducing their emissions, then coal plants will have lower costs relative to nuclear, and we’ll see more coal plants and less nuclear plants than we would have otherwise, and this goes against our stated goal of reducing emissions. If we taxed emissions, then we would get the same short-term behavior but in the long run there would be less coal plants and more nuclear plants, which would aid our stated goal of reducing emissions.
Second, this is a general-purpose argument against helping anyone in trouble.
Agreed. I think this is a concern that should be taken into account whenever considering whether or not to help someone in trouble, but think that it will only be decisive in marginal cases (or cases where trouble is easy to cause or fake).
But sometimes its validity is more doubtful: for example, following this logic the SSI system for disability benefits should be dismantled immediately.
It seems obvious to me that a significant amount of ‘disability’ today actually is fraudulent, and the SSI system exists as it does because we haven’t accepted on the social level that a growing percentage of the population is not able to contribute productive work in the modern economy. Given that SSI fulfils an actual social need that is different from its stated social need (as well as filling that need), dismantling it without fixing the problem it’s been co-opted to fix seems like a mistake. If we had a guaranteed income (or negative income tax or however you want to call that solution), then it’s not obvious to me that we would need SSI.
the SSI system exists as it does because we haven’t accepted on the social level that a growing percentage of the population is not able to contribute productive work in the modern economy.
I don’t understand. It seems to me that we HAVE accepted that on the social level and so are paying that growing percentage of the population so that it doesn’t starve (or turn to crime, etc.).
Basic Income solves a somewhat different problem—that of people not willing to work.
It seems to me that we HAVE accepted that on the social level and so are paying that growing percentage of the population so that it doesn’t starve (or turn to crime, etc.).
I think we’re disagreeing about the use of ‘accepted’ rather than the facts: I mean that the media consensus is not that we have ‘surplus population’ who should be paid to not starve or cause too much trouble, but that we have a growing number of people with disabilities, and that the labeling as ‘disabled’ is a significant portion of why the voting public is willing to spend taxpayer money on them. I understand you to use ‘accepted’ to mean that SSI is still funded and protected by public opinion against significant cuts.
I think there is some definition fuzziness here. We started with “percentage of the population … not able to contribute productive work”, this mutated into “surplus population” which is not the same as “people with disabilities”?
A resonable (economic) definition of “disabled” is “not able to contribute productive work”...
Do you have in mind what Tyler Cowen calls ZMP (zero marginal productivity) workers?
A resonable (economic) definition of “disabled” is “not able to contribute productive work”...
Agreed, but my impression is that SSI is targeted at medical disabilities- “I used to be a manual laborer but I now have persistent back pain” instead of “I used to be a manual laborer but now I’m structurally unemployed.” The system as is encourages the medicalization of economic issues- and in particular of exaggerating the medical impact of issues rather than ameliorating them.
SSI is targeted at medical disabilities- “I used to be a manual laborer but I now have persistent back pain” instead of “I used to be a manual laborer but now I’m structurally unemployed.”
Right, because the former means unable to work, while the latter usually means “can’t find a job that I like enough”.
The system as is encourages the medicalization of economic issues- and in particular of exaggerating the medical impact of issues rather than ameliorating them.
I agree. I have no particular wish to defend SSI or the way it’s run—my point was basically that “we should not subsidize failure” cannot be taken as an overriding principle. It is one of many considerations: sometimes it governs and sometimes it steps back.
I agree. I have no particular wish to defend SSI or the way it’s run—my point was basically that “we should not subsidize failure” cannot be taken as an overriding principle. It is one of many considerations: sometimes it governs and sometimes it steps back.
It still (mostly) follows the principle that we should not subsidize deliberately choosing to fail, as medical disabilities are generally assumed not to be voluntarily self-inflicted.
We’re talking about broad-effect incentives for the society as a whole, not about what some fringe thrill-seekers might or might not do. The bugchasers are very much NOT motivated by the potential for some monetary/material benefits.
However we can make this an empirical question. In the US if you get certified as medically disabled, the SSI will pay you money for the rest of your life. There are probably some statistics on the prevalence of self-harm with the goal of getting SSI benefits...
I do take it seriously, but there are three points I think should be made here.
First is that, yes, policy debates shouldn’t appear one-sided. Policies of forcible quarantine, voluntary quarantine, tattooing, and so on do have costs, and those costs require a conversion factor to be compared to the benefits of the various policies, and people can differ on what they think those conversion factors should be.
Second is that I think that those conversion factors imply moral positions, and that it makes sense to condemn moral positions you disagree with strongly enough. If someone thinks that, to give an extreme example, we shouldn’t imprison one person even if that prevents an epidemic that will murder a million people, I do not want them making public health decisions.
Third, the response to AIDS seems especially tragic to me because it put feelings above people, and is strong evidence against civilizational competence.
Again, Typhoid Mary. She refused to believe that she was infecting others, or to seek work as anything besides a cook. The tool of ‘pay her to do something other than cook’ has similar local incentives as ‘punish her for cooking’, but it has very different global incentives. “Hey, all I need to do is contract typhus and then I can collect money for not working!” The local incentives aren’t quite the same, either: “I think I get… one million dollars worth of satisfaction for cooking a meal!” It seems to me that one of the secondary uses of government is to prevent people from capturing the majority of the consumer surplus from trade, and you don’t need to stretch epidemics too far to make them fit that mold.
By ‘clearly’ I meant that everyone involved in the discussion agreed they were clear. From my perspective, HIV and plague look fairly difficult to distinguish in terms of impact, though I agree they’re different in terms of transmission vector.
Recall that we are discussing about a third of a million preventable deaths, here. The primary burden for me is not that I don’t have access to consequence-free casual sex, but the people I never met because they died early, and the friends whose futures are less certain and whose presents are less pleasant than they could be.
I worry that you’re devaluing deaths due to this particular epidemic because a careful person could avoid catching the disease (unless, you know, they needed a blood transfusion at any point in their life). If all a disease does is increase the costs of being careful, then that’s still reason enough to seek ways to fight the disease more effectively.
(And even if you personally are careful, you can’t make your friends more careful; community health requires community hygiene.)
Agreed 100%. There has been an undertone in my posts of moral condemnation; and it’s intentional. I do not want someone like Cochran making decisions about individual liberty.
I don’t know what this means. Could you explain? It seems to me that the AIDS response put people’s liberty before people’s lifespan. This is not an uncontroversial choice, but it doesn’t seem an obviously wrong one; both are about people, neither about ‘feelings,’ - except to the extent that ‘feelings’ reside within people. As for civilizational competence, it strikes me that civilisation is rolling along just fine; if anything, the AIDS epidemic appears to have played a major role in the major shift from homosexuals whining about “heteronormativity” to campaigning for gay marriage.
Of course there would be problems with voluntary quarantine. If you’d tried voluntary quarantine, and found it too hard (perhaps because of incentive problems), there would be something to discuss. But if you don’t try the first step, and immediately go for the nuclear option, I find it hard to take you seriously. Do you really think there would be no perverse incentives, regulatory overreach, etc, in a massive government programme of compulsory quarantine and HIV tests?
No. But perhaps we have different models of causation.
Basically, I see someone who dies of AIDS as basically the same as someone who dies of scuba-diving. They did something risky (but presumably fun), they had bad luck, they died. So it goes. It’s sad, but the alternative wasn’t immortality. To the extent their deaths were “preventable,” it was all in their own power, and they chose not to. They caused their own deaths.
The subtext to your position appears to be that the government has some kind of “heroic duty” to save lives. Sharing needles and having casual unprotected sex are dangerous and foolish, but people are going to do them regardless, and so it’s the government’s duty to make those activities as safe as possible. The government caused their deaths by not doing more to prevent them.
I’m not going to get into a debate about “heroic duty,” but I would say this; you are calling for extraordinary measures. As far as I can tell, there has never been mass compulsory testing for diseases except for at the border. You are, to continue the analogy, trying to make a huge, costly, unprecedented and coercive effort to make scuba-diving safer, at particularly great cost to people in the vicinity of the scuba-divers, as well as liberty generally. Yet you are unable to justify why the safety-conscious scuba-divers shouldn’t pay those costs themselves, and you aren’t willing to try voluntary measures as a first step. It seems clear that the primary cost of making scuba-diving safer should fall on the people who want to go scuba-diving, and if they aren’t willing to pay that cost, then I’ll be damned if I’ll subsidise them, and I’ll be doubly damned if I’ll help them victimize others.
Let me dial that up to 11 X-)
So, the suggested remedy is to forcibly separate the society into the clean and the unclean, and to brand the unclean with an indelible mark. What could possibly go wrong?
And let’s talk practicalities. By the time AIDS was recognized as a serious threat and there were reliable tests for HIV status, how many HIV-positive people were there in the US already? Quarantines work well when you need to quarantine a few or a few dozens of people, not well-dispersed thousands and tens of thousands. How would compulsory testing work given that people know that failing the test leads to being branded unclean? Troops isolating city block by city block and dragging all inhabitants to a field testing station? How about costs of that?
Casual unprotected sex wasn’t the only sexual risk—the others were rape and having unprotected sex with an untrustworthy long term partner.
Also blood transfusions. It took the red cross a disgracefully long amount of time to start screening donors. Some people objecting to the screening compared it to the WWII-era separation of blood into black plasma and white plasma.
Sure. I think people’s first instinct whenever they encounter a policy question is to ask who they identify with. Is it the carrier of AIDS whose freedom or bodily autonomy would be violated by a quarantine or a tattoo, or is it the person at risk for AIDS? Actually considering the positions of both people is difficult but doable, and I think generally inconsistent with a rights-based view of morality. If we just say “liberty first!” then we make crazy trades where we give up many years of life for a bit of liberty; if we just say “lives first!” then we make crazy trades where we give up significant amounts of life satisfaction for a few lives; if we say “this is the tradeoff between life and liberty that we think it reasonable” then we have an actually quantitative discussion (which is less likely to be crazy).
It seems to me (with the disclaimer that I’m not a historian) that most LGBT activists decided they identified with the people who had HIV, and so they advocated voluntary testing, and voluntary disclosure, and against policies that might possibly ‘out’ people, because they felt it more important to maintain the option to keep sex lives private than to prevent the spread of the disease. It’s also claimed that Reagan mostly brushed the issue off because he identified with neither the carriers nor those at risk (until famous actors that he knew started dying), but, again, I’m not a historian.
The time to close the stable door is before the horse escapes. As mentioned earlier, I think the cost/benefit has shifted on HIV to the point where quarantine isn’t a good idea anymore (but compulsory testing and tattooing might still make sense). Trying half measures and then doubling down if they fail doesn’t seem like a strong strategy relative to starting with the full approach in the presence of exponentially growing risks. (This is especially true if the failure of the half measure leads to discrediting the project, rather than to support for trying it harder.)
Agreed that the alternative wasn’t immortality, but I don’t see why you’re not excited by the ability to adjust the risk of activities. I think consuming alcohol is inconsistent with my values; so I don’t. But I don’t write off alcoholics; I pity them, and if I could make alcoholism less destructive, I would. (If I expected a prohibition on alcohol to have positive expected value, I would support one; history is pretty clear that’s not a good idea.)
Activities aren’t risky or safe. There’s a quantified risk associated with everything: consider driving. Driving is consistent with my values, and so I do it- but I wish it were cheaper, in terms of the risk of years lost, and I support government efforts to make driving safer to the degree that they seem effective. I almost never use boats myself, but I benefit from other people doing that- and I wish that were cheaper, in terms of risk, and I support government efforts to make shipping safer to the degree that they seem effective. And so on.
Many US states required a Wassermann test before they would issue a marriage license, with the express purpose of protecting the innocent spouse (and any potential children) from contracting syphilis.
Um, why do you think so? The “rights-based” view is not that “he has a right so no one can do anything”. Instead, it is “he has a right, so he can decide whether to insist on it or not, or maybe to trade it for some benefit”.
The core issue is who has the power, who decides. You are thinking of an impersonal entity above all whose freedom to choose the “optimal” solution is unnecessarily constrained by individual rights. The alternative is devolve the power downwards and let different people come to different views and conclusions. Sure, it’s going to be messy and in many ways (especially at the micro level) non-optimal. However it avoids the pitfalls of trying to impose seeming optimality from above which, as history abundantly demonstrates, has some pretty horrible failure modes.
Sure. And we have technical tools that help us solve this problem, rather than just reasoning from moral principles. We can look at the structure of the problem and determine the optimal level of centralization for a particular variety of intervention, because problems are caused by mismatch of optimizer centralization and information centralization, and this can be both that the optimizer is too far up and that the optimizer is too far down.
I don’t see how you can get to the single “optimal level” without assuming a single underlying system of values. Optimality is a function of your evaluation of outcomes and your evaluation of outcomes is a function of your value system.
Who will determine that “optimal level” and what happens when there is significant disagreement about optimality?
No. The point is that people’s rights are a key part of their position, and it’s impossible to evaluate people’s interests or “expected value” without considering their rights. That’s not to say that you can never override people’s rights, but it needs to take a lot, particularly if the violation is very serious (eg mass imprisonment of people who’ve committed no crime). Moreover, if you need my consent for your plan, that’s a great way of making sure that you really are acting in my interests. There is no end to my suspicion of people who view breaching rights without consent as a minor hiccup in their plan, rather than a key reason to abandon it.
This is just rhetoric. An agile approach based on feedback and iteration is an equally good description. The failure of the “half-measure” should make you doubt the project a bit. It looks very much like you’ve got a hammer and are determined to wield it.
Hang on now. I think the pharmaceutical companies who came up with the various tests and anti-retrovirals etc did something worthwhile. I think the people who campaigned for condom use did something worthwhile. But I’m not excited about compulsory testing and mass imprisonment of the innocent. Once again, the question is: who should pay the costs of this risk adjustment? It looks to me very much like you want society as a whole (and HIV sufferers in particular) to subsidise your favourite recreational activity. You should pay.
Of course you would. And you’d place practically no weight on people’s freedom to drink (or sell) what they want, and you’d place practically no weight on people’s enjoyment of alcohol, but massive weight on the health drawbacks and drunk driving statistics and the occasional alcoholic. And then you’d add in the subconscious bias that you don’t drink, so screw those guys (just as I do not believe for one second that you’d be in favour of a quarantine if it applied to you). Which is why people like you were gung-ho for prohibition, and shocked when it didn’t work (they too didn’t want to bother with voluntary attempts or partial measures). And why you are no doubt gung-ho for gun control. And why you will no doubt be gung-ho against every civil liberty in turn.
I consider this brand of politics far more dangerous than the HIV virus, but you’ll note that I’m not calling for your quarantine.
[edit]Huge portions of this comment were missing originally; it’s been edited but the context for descendent comments may have changed.
I will point out that the current legal practice is to basically consider ‘being suspected of having an infectious pandemic disease’ as a ‘crime,’ in that the CDC can detain people at its discretion. If you subscribe to the ‘non-agression principle,’ I think this is consistent with that, since carrying an infectious disease is threatening or initiating violence (even if it’s unintentional).
Consider something like fluoridating municipal water supplies, or adding lithium to them, or filtering out arsenic from them. I don’t see a serious difference between filtering out arsenic and adding fluoride- they’re both adjusting the chemical properties of drinking water to improve health. (There is perhaps a status quo bias which sees removing something already there as safer than adding something not already there, but I don’t think that’s particularly relevant.) Adding fluoride or lithium to the water supply is something you either do or don’t do- a house by house opt-in system would be tremendously more expensive and there’s not a way to opt out besides filtering your water.
Suppose a city is voting on whether or not to add lithium to their water supply. A strict consent rule would require that every person vote for adding lithium in order for it to not be violating consent to add lithium. But it seems to me that we’re better served by a Hansonian system of voting on values (“I am willing spend up to $X a year to reduce the number of deaths per year by 1 per 100,000 people”) and then betting on beliefs (“If we increase the lithium supply from 1 microgram per liter to 40 micrograms per liter, we would expect suicides to decrease by 20 people per 100,000 per year”), so that the people price their various values and then experts evaluate how likely various approaches are to achieve those values, rather than requiring every voter to be an expert on all possible approaches. (“Fluoride? Doesn’t that sap my precious bodily fluids?”)
Sure, but we’re back to the issue of what “feedback” means in the context of a pandemic. “Hmm, we let too many carriers of the disease out of isolation, and now 3% of the global population is dead. Oops!” This is perhaps a textbook example of a time-sensitive issue where it matters a lot to get it right the first time. (The current xkcd seems relevant.)
Suppose I’m designing a bridge, and calculate that in order to support a load of ten thousand kilograms, we’d need ten pylons. For budgetary reasons, we only use six pylons, and then the bridge breaks when a load of ten thousand kilograms is driven across it. Should we doubt my abilities as an engineer?
Are you referring to other people being alive as ‘my favorite recreational activity’? I don’t think I’ve looked at it that way before, but that actually seems like it might be a fair description.
But to answer the question, I think that it’s reasonable for public governments to pay for and enforce public health projects. I think that it is not objectionable for the broader population to subsidize narrower segments of the population- my tax dollars fund research into treatment of genetic conditions that neither I nor my hypothetical children will have, for example- but agree that when costs can be localized, they should. When you look at compulsory testing combined with ‘soft quarantines’ like tattooing, it seems to me that the cost for the test is born by society as a whole but the costs of having the disease are born (mostly) by those with the disease. (And my impression is that if we decided it was a social priority to be able to test everyone for HIV, then the scaling would allow the costs of testing to drop significantly.)
I think that smaller scale versions of this are feasible- say, a bathhouse that required all members to take a HIV test every n months, and only allowed entry to people with negative results- but as with most things in public health, larger scales have larger benefits.
As a general comment, I find it more helpful to ask people questions about their positions, rather than making predictions about their positions. I have found that being right about a prediction is rarely helpful, and being wrong typically disastrous when it comes to having a productive conversation. For example, one of the hypothetical models I had of you earlier in this conversation was be that you might be a principled opponent to government coercion of individuals, and that model would object to the imprisonment of Typhoid Mary because it goes against the principle. Other models, though, wouldn’t object to the imprisonment of Typhoid Mary, because they used cost/benefit analysis to make their decisions and that particular example passed. To reduce my uncertainty in a relatively costless way, I asked.
If I suspect myself of being infectious, I wear gloves and a mask to protect other people (and avoid leaving the house if I can help it). If I were suspected of having a pandemic disease, I would submit to a quarantine. This feels to me like basic “being polite and kind to others,” and so I’m moderately surprised you don’t think I would behave that way.
Actually, the evidence seems convincing that arming the populace reduces the amount of and damage done by crime; Kennesaw-style laws requiring heads of household to maintain a firearm with ammunition (with exceptions for conscientious objectors) seem better than the opposite.
One of the three charities I regularly donate to, along with CFAR and SENS, is the Institute for Justice, which is a public interest law firm that litigates economic liberty cases. It’s up to you whether or not you class ‘right to own property’ or ‘right to earn a living without interference from your competitors’ as ‘civil liberties’ or different kinds of liberties, but I care about the project of advancing liberty comparably to how much I care about advancing rationality and defeating aging.
I, like Hayek, base my libertarianism on arguments from information costs: typically this leads to decentralization, but sometimes it leads to centralization- it makes much more sense to have one CDC with coercive powers than it does to decentralize and voluntarize the problem of preventing epidemics.
It is particularly relevant, because the regulators are running on corrupted hardware, and the consequence of bias and/or abuse by regulators is much greater for adding things than for taking them out.
Adding substances to the water to sterilize everyone, and taking substances out so that water-without-substances sterilizes everyone would be similar—except that the second is not possible and the first is.
I agree for “things” as a general class, but once we’ve conditioned on a particular thing (“what’s the optimal level of chemical Q?”) it seems to me that we should have symmetric levels of knowledge about moving the level of that thing up and down when it’s possible to move both directions. (Fluoride and lithium groundwater levels already vary significantly between areas—that’s how we discovered their effects in the first place—and so saying “let’s artificially make our groundwater like their groundwater” doesn’t seem that prone to bias or abuse.)
It may be worth explicitly mentioning that if we’re introducing something completely novel, when we shrink) the state of the evidence towards the reference class, the level of danger for “completely novel thing” is higher than the level of danger for “abundant common thing.” I expect this will be minor, though, and many completely novel things are actually much better studied than abundant common things, because the abundant common things were grandfathered in rather than receiving serious scrutiny. (Here I’m thinking of particular artificial sweeteners, which were proven safe at levels where sugar would be toxic because they had to go to dramatically higher levels of the artificial sweetener to find any toxicity.)
I suppose we should also mention the argument that if we create the ability to add molecules to the water supply, that ability could be corrupted to nefarious ends- but I think that’s a fully general argument against any infrastructure development, and should be responded to by investing in security (and secure design) rather than not investing in infrastructure.
Moving the level of that thing down is limited at 0, and thus the effect of bias and abuse is also limited. Moving the level up is not so limited.
Deciding that you’ll condition on a particular thing is itself subject to the same bias and abuse that deciding to add something is. Imagine regulators saying “we’ve already decided that we’re going add sterility drugs to the water, we just need to decide how much”. It’s also solved the same way; just like you say “without satisfying very high standards, you may only filter stuff out and not add stuff”, you say “without satisfying very high standards, you may only condition on things that are already present in significant amounts”.
It is possible to have a multi-peaked preference where directly saying “we’ll create infrastructure, and then we’ll use it in X way” is opposed by a majority, while doing it in two steps as “we’ll create infrastructure which cannot be used in X way” and “now that we have infrastructure, we should remove the security and use it in X way” has each step supported by a majority.
To oppose such things, you have to oppose the first step. (And of course, not everything has multi-peaked preferences, so this is not a fully general argument.)
(That link also describes other slippery slope mechanisms which may apply.)
This kind of thing is standard practice among porn studios...
Nope—it’s called fluoridated toothpaste or fluoridated mouthwash.
In general, the cost-benefit analysis for centralized interventions is difficult. Even besides the issues of properly estimating them, the costs and the benefits rarely align neatly—there are winners and there are losers. The problems are exacerbated by the fact that the powerful usually make sure they end up among the winners and the powerless often enough find themselves among the losers. I tend to be wary of “it benefits everyone!” handwaving.
Which is only ten times more expensive. It’s also more effective than just drinking fluoridated water, as you might expect, so the comparison isn’t that clean.
Hopefully you’re buying toothpaste anyway, so the relevant number is the difference in price between fluoridated toothpaste and non-fluoridated. I think it’s more or less zero. In fact, non-fluoridated toothpaste is likely to be some all-natural all-organic fancy expensive thing :-)
This is a good discussion, but let’s not get silly.
Typhoid Mary was a very unusual case in that she was a carrier but didn’t have any symptoms. I really don’t think there would have been a problem with people intentionally contracting typhus in order to get benefits and forgetting about the dying part.
I agree with this, but just wanted to note that typhoid fever and typhus are distinct diseases (with typhoid being misleadingly named).
Yes, thank you.
Agreed that the example is silly, but the general trend is basic economics. A tax and a subsidy have the same effect on behavior in the short term, but one of them makes the industry less profitable (and thus it shrinks) whereas the other makes the industry more profitable (and thus it grows). I really don’t want to make the industry of “endangering public health” more profitable.
Well, first of all, if there are two industries and their size is a zero-sum game (all population is divided between classes A and B and everyone must belong to either A or B) then the effect of a tax and a subsidy is exactly the same. What grows one part, shrinks the other part and vice versa.
Second, this is a general-purpose argument against helping anyone in trouble. And, certainly, sometimes it is a valid argument (e.g. see the flood insurance for shore properties in the US). But sometimes its validity is more doubtful: for example, following this logic the SSI system for disability benefits should be dismantled immediately.
Yes? If we, say, use subsidies to reward coal plants for reducing their emissions, then coal plants will have lower costs relative to nuclear, and we’ll see more coal plants and less nuclear plants than we would have otherwise, and this goes against our stated goal of reducing emissions. If we taxed emissions, then we would get the same short-term behavior but in the long run there would be less coal plants and more nuclear plants, which would aid our stated goal of reducing emissions.
Agreed. I think this is a concern that should be taken into account whenever considering whether or not to help someone in trouble, but think that it will only be decisive in marginal cases (or cases where trouble is easy to cause or fake).
It seems obvious to me that a significant amount of ‘disability’ today actually is fraudulent, and the SSI system exists as it does because we haven’t accepted on the social level that a growing percentage of the population is not able to contribute productive work in the modern economy. Given that SSI fulfils an actual social need that is different from its stated social need (as well as filling that need), dismantling it without fixing the problem it’s been co-opted to fix seems like a mistake. If we had a guaranteed income (or negative income tax or however you want to call that solution), then it’s not obvious to me that we would need SSI.
I don’t understand. It seems to me that we HAVE accepted that on the social level and so are paying that growing percentage of the population so that it doesn’t starve (or turn to crime, etc.).
Basic Income solves a somewhat different problem—that of people not willing to work.
I think we’re disagreeing about the use of ‘accepted’ rather than the facts: I mean that the media consensus is not that we have ‘surplus population’ who should be paid to not starve or cause too much trouble, but that we have a growing number of people with disabilities, and that the labeling as ‘disabled’ is a significant portion of why the voting public is willing to spend taxpayer money on them. I understand you to use ‘accepted’ to mean that SSI is still funded and protected by public opinion against significant cuts.
I think there is some definition fuzziness here. We started with “percentage of the population … not able to contribute productive work”, this mutated into “surplus population” which is not the same as “people with disabilities”?
A resonable (economic) definition of “disabled” is “not able to contribute productive work”...
Do you have in mind what Tyler Cowen calls ZMP (zero marginal productivity) workers?
Agreed, but my impression is that SSI is targeted at medical disabilities- “I used to be a manual laborer but I now have persistent back pain” instead of “I used to be a manual laborer but now I’m structurally unemployed.” The system as is encourages the medicalization of economic issues- and in particular of exaggerating the medical impact of issues rather than ameliorating them.
Right, because the former means unable to work, while the latter usually means “can’t find a job that I like enough”.
I agree. I have no particular wish to defend SSI or the way it’s run—my point was basically that “we should not subsidize failure” cannot be taken as an overriding principle. It is one of many considerations: sometimes it governs and sometimes it steps back.
It still (mostly) follows the principle that we should not subsidize deliberately choosing to fail, as medical disabilities are generally assumed not to be voluntarily self-inflicted.
This example does not seem that silly to me, given that this is a thing.
We’re talking about broad-effect incentives for the society as a whole, not about what some fringe thrill-seekers might or might not do. The bugchasers are very much NOT motivated by the potential for some monetary/material benefits.
However we can make this an empirical question. In the US if you get certified as medically disabled, the SSI will pay you money for the rest of your life. There are probably some statistics on the prevalence of self-harm with the goal of getting SSI benefits...