There is a pattern that is hard to discern for outsiders, but it's there.
Early in the COVID-19 pandemic Jay Bhattacharya and others tested for the presence of SARS-CoV-2 antibodies in Santa Clara County, where Stanford University resides. The findings of the study? The prevalence of antibodies implied that the number of infections was much higher than previously estimated. Further, given that the death rate was known, the results suggested that the disease was much less deadly than previously estimated.
These were not the results the "authorities" wanted and the study and the study's authors were viciously attacked. I talked to Jay during this time and he was deeply affected.
The study's methodology was successfully defended and Jay, a true scientist, stuck by the results. In hindsight, the study's results were correct. In an amazing turn of events, Jay went on to become the head of the NIH.
But the point is that science isn't objective and impartial. If you generate a result that isn't acceptable to the "authorities" and the "accepted way of thinking," you will be subjected to strong pressures to change or renounce your results.
Consider climate science, police killings of minorities, nuclear power, recycling, organic farming, minorities and academic success, etc.
I will also say that while I liked your co-author David Henderson's blogging at EconLog (which he recently left), I regard it as unfortunate that he went well beyond his expertise on the topic of COVID, and if that was thanks to your influence I blame you for it.
"In hindsight, people who study the issue still consider him wrong"
I don't know any of the technical details and I am not going to spend the months and years of study to understand them. But relying on his opponents for the truth about the GreatBarrington Declaration is akin to relying on Michael Mann for the truth about global warming, or hoplophobes for the worthiness of gun control policies.
Instead, I try to judge who lies, obfuscates, and otherwise dodges the facts in order to pound the table. In particular, for COVID, I remember hospitals being paid for patients who died with COVID but not without it; incentives matter. I remember Fauci's lies, his and Watson's coverup and slander campaigns, and the constantly changing suite of reasons why people should get the jab, stand six feet apart, and wear masks when by themselves, all contrary to the received wisdom just weeks and months before. I remember the cruise ship full of elderly passengers which was locked up for a week or two and had fewer deaths than the COVID panickers expected. I remember the first reports out of Italy which turned out to have an average age of death with COVID remarkably similar to the normal pre-COVID average age of death.
People who rely on fraud and lies do not have good intentions, and almost certainly do not have the truth on their side.
I didn't say anything about the Great Barrington Declaration. Hooper's comment referenced a study on seroprevalence, and hence the fatality rate per infection. I come across so many people on the internet who try to claim that deaths were inflated by misattributing the cause, but we know from excess deaths what happened to deaths from all causes, and that shows that if anything there was an undercount of official COVID deaths (much less in the US compared to less functional countries).
The people you should actually trust were ones who made accurate predictions, the real experts as opposed to the "experts" https://westhunt.wordpress.com/2014/10/20/the-experts/ The person whose blog post I linked to there was singled out for his accuracy on the subject, attributed to both his domain expertise and "creepy oracular powers" https://slatestarcodex.com/2020/04/14/a-failure-but-not-of-prediction/ This enabled him to win every public bet he made on the subject https://x.com/TeaGeeGeePea/status/1939017380153151610 (that thread also links to a couple blog posts by/about Robin Hanson, who also won every bet he made and was listed along with Greg Cochran in that 2020 post), as well as to outpredict official "expert" virologists https://westhunt.wordpress.com/?s=virologists who said not to worry about COVID evolving. Having a low opinion of Fauci (which Greg shares) is not enough on a subject like COVID: you have to actually know what you're talking about.
No. I may have got that one link wrong, but as I said, I do not need to know technical details to judge who lies and dissembles and commits fraud on behalf of their opinion; people who do that, like Fauci and Watson, show me that they do not believe in their own cause, or they would be able to rely on truth and logic. The cruise ship, the preliminary Italian ages at death, the lies about social distancing and masking, the conflation of "with" and "from" COVID, the constantly changing stories about what the vaccines were good for ... people don't lie like that for no reason.
Look at the difference in lies: the anti-vax crowd makes up nonsense, the Fauci crowd lies about other people, lies to Congress, brags about their lies for a noble cause. One side is easy to dismiss and most people do and did. The other side stamps officialdom all over their lies, quibbles over "with" and "from", sneaks around and hides behind bureaucratic lingo.
You say Jay made one mistake. I say Fauci, Watson, and all their lies and fraud far outweigh one scientific mistake.
You actually do need to know technical details to determine who is engaged in lying & fraud. "The devil is in the details", as they say.
Excess deaths obviate the need to distinguish "with" vs "from" COVID. Excess deaths show that even in the US we undercounted COVID deaths (just by much less than other, poorer countries).
RFK Jr now has the stamp of officialdom for his lies & nonsense.
No, humans are really good at detecting lies from facial features, body posture, voice tone, and other subtle clues.
Then there are the failed predictions which never passed the basic smell test, like the extinction of polar bears and penguins, the disappearance of summer Arctic ice and snow, the different sea level rises for coastal points on the same ocean just hundreds of miles apart, the claim that CO2 is pure pollution and has no benefits, the Earth is going to reach a tipping point in 12 - 10 - 8 - 6 years and turn into Venus …
I don’t need to know squat about climate science to detect those lies, and if the climate alarmists think those lies buttress their theories, then they are the idiots and deserve no consideration for anything else they say.
As for COVID … the Italian statistics showed age at death from COVID was close enough to pre-COVID age at death as made no difference. The cruise ship deaths were nowhere near the scary predictions. The masking, social distancing, hand sanitizer, and other recommendations were known nonsense at the time and had been for years before. Fauci bragged to Congress about lying to Congress. How many thousands dies because governors shoved sick elderly patients in with healthy elderly rest home residents? How many children lost a year of education and socializing for ridiculous counter-productive school shutdowns? How many people were arrested for jogging alone without a mask? How much of the economy was shut down for no reason? How many waitstaff wore masks while diners ate without masks? Remember Whitmer telling Home Depot and Lowe’s they could stay open but had to shut down very specific aisles for absolutely no rational reason?
I remember all those lies. Most people do. Your denying it doesn’t make them go away.
Again: people who lie like that do so because they do not have truth on their side. You don’t need a medical degree to recognize that basic pattern in human behavior.
"A June 2024 study in Infectious Disease Modelling calculated the median pre-vaccination rate for the U.S. at 0.214 percent. This is close to the rate reported by Bhattacharya and his colleagues back in 2020."
You can't get a surge of excess deaths like we saw with something "not much more deadly than seasonal flu". And if you read the link to the cited study https://www.sciencedirect.com/science/article/pii/S2468042724000290 (or even its linked supplementary data appendix), you will not find the string "214" anywhere, so I don't know where Ronald Bailey got that. The paper does rely on Ioannidis for estimates of seroprevalence, which are of course in dispute. Bailey mentions a number of people like Elon Musk & Richard Epstein who underpredicted COVID deaths, but not that Ioannidis (referred to as a skeptic when cited for his calculation of how many deaths actually occurred) predicted 40K deaths https://statmodeling.stat.columbia.edu/2020/06/17/some-forecasting-for-covid-19-has-failed-a-discussion-of-taleb-and-ioannidis-et-al/
>You can't get a surge of excess deaths like we saw with something "not much more deadly than seasonal flu".
About 50k deaths is a bad year in the US (eg 2017-2018). If COVID has 2x the IFR of seasonal flu (0.2 vs 0.1) and infects 20x the number of people due to no existing immunity, then you get 1,000,000 deaths.
> 3% does not sound implausible. If they said 30%, I’d be skeptical, given how everyone’s been hiding out for awhile, but 3%, sure, maybe so. Bendavid et al. argue that if the number is 3%, that’s good news, because Santa Clara county has 2 million people and only an estimated 100 deaths . . . 0.03*(2 million)/100 = 600, so that implies that 1/600 of exposed people there died. So that’s good news, relatively speaking: we’d still like to avoid 300 million Americans getting the virus and 500,000 dying, but that’s still better than the doomsday scenario.
> It’s hard to wrap my head around these numbers because, on one hand, a 1/600 death rate sounds pretty low; on the other, 500,000 deaths is a lot. I guess 500,000 is too high because nobody’s saying that everyone will get exposed.
You linked to Ronald Bailey reporting estimates that 1.2 million Americans died of COVID. That's more than double 500K, so even the reported high range of 4.2% would seem to be ruled out.
GPT's explanation sounds to me that people pointed out that they had missed some of the benefits in their calculation so they added them in. I don't see any indication in the post that the adjustment was politically motivated.
Agreed. Seems like there is some very plausible deniability, at worst and actual improved methodology at best. Hard for me to commit to the 'definitely ideological' conclusion, though, I suspect it's correct.
"... By 2019, Finkelstein et al. incorporated risk protection, heterogeneity, and broader welfare effects, shifting the conclusion: Medicaid recipients do indeed derive substantial value, often approaching the government’s cost. ...
Sorry, this statement is misleading. There is no "government" cost. There is a cost to taxpayers from this wealth transfer.
More importantly, because we have been running substantial deficits ever since Health Reform, this is a wealth transfer from Americans too young to vote and generations unborn.
Medicaid is primarily funded by general revenues paid to the federal and state governments. Most general revenues for the states that expanded medicaid eligibility come from income taxes.
Keep in mind that since Health Reform expanded Medicaid, and added taxpayer subsidized coverage via the public exchanges, America has added $26 Trillion to our national debt - increating it from ~$10 Trillion to today's $37 Trillion. Importantly, most of the cost of health reform will be shouldered by individuals in generations Z and Alpha, and later generations - all were generations that were either too young to vote or generations unborn in 2010.
So, adjust the costs for the interest on the debt that will be shouldered by future taxpayers.
It's sooo easy to approve/justify new spending to buy votes and to send the bill to others.
Medicaid primarily benefits hospitals and providers, who get paid for care they would often otherwise be compelled to provide for free.
The federal funding model incentivizes states to juice medicaid payments as much as possible because they view it as "free" money for their state. This was done because Obamacare wasn't popular enough to be implemented in half the country without bribes.
One piece of information is missing: the source of funds for the research. I suspect that funding sources often induce researchers to come to conclusions that are in line with the funding sources' beliefs.
Great input. Nobody said there was a conspiracy. Funding sources DO pay based on hypothesis, otherwise they wouldn't turn anything down. Funding is finite and, therefore, has to be prioritized.
But in any event such empirical studies don't capture the full range of costs associated with transfer payments. Not only is the subsidized healthcare more expensive in the case of Medicaid, the coerced transfer of funds (whether by taxation or by fiat money creation) to redeem such government promises of economic security teaches people that they don't have to be thrifty to deal with their future needs, nor do they need to keep lots of discretionary funds on hand to deal with their emergency needs. Instead, they can boost their present consumption at the expense of their savings, secure in the knowledge that when they become old enough, or if they become sick, disabled, or otherwise unemployed or have diminished labor incomes, the state will step in to take care of them.
The net economic result is that the structure of production becomes less capital-intensive and has smaller inventories for dealing with supply shocks. Real labor and resource input productivities and incomes are impaired; and so the standard of living of the productive classes ultimately goes down. Thrift deterrence and capital consumption makes most people poorer and poorer, which of course increases the fiscal burdens of programs like Medicaid.
The key empirical evidence to look at is how net savings as a fraction of national income has cratered since Medicare and Medicaid were enacted in the mid-1960s, and since the dollar was put on a fiat basis in 1971. The comfortable bicoastal, academically- credentialed, mostly Democratic elites, feasting on the cheap credit fueled by fiat money creation, may not be so conscious of what welfare statism has done to the country, but the deindustrialization of America and declining standards of living are a harsh reality for everyone else.
While Republicans prefer to blame imports of foreign workers and foreign goods for causing the economic decline of the native-born working class, the unpleasant truth that neither party wants to face is that Social Security, Medicare, and Medicaid have been growing at the expense of capital formation in America. Indeed, import-financed foreign lending is one of the few sources of net investment funding that makes any growth in America possible, so Trump's war on trade deficits means that we will cut off imports of foreign savings too, and thus further accelerate our deindustrialization.
For what it's worth, I have a scheme on transitioning from FICA+SSA to employee-owned "nest egg" accounts investment accounts with an additional 4% payroll tax running in addition to the FICA tax, with the FICA tax decreasing enough that in 5-10 years, it would be 4% lower, and disappear within 20-30 years. IOW, a 4% pay cut for 5-10 years, turning into a pay raise which tops out at 11% in 20-30 years.
I don't claim it is accurate. I doubt it is politically feasible, just from the point of politicians and bureaucrats wanting to keep their fingers in the till. I do think it's plausible enough for fiction.
The Trump Accounts are the cheapest way to supplement SS. Just don’t let people access the account until they turn 65 and voila! It’s a retirement account! And then tax it very progressively so people with max SS don’t get access to it. The key should be getting SS payments closer to max payments for everyone.
I'd like to see your homework. My scheme has arithmetic. I don't claim it's perfect, but the arithmetic gives people something to critique.
When you show your arithmetic, start with the taxes taken by Trump's tariffs; those are also a pay cut. Mine involves a 4% pay cut dropping to zero within 5-10 years, thereafter turning into a pay raise, ultimately topping out at 11% in 10-20 years.
Then show how these accounts accumulate value and how much more tariff tax it takes to keep increasing their value. Does it ever diminish, or is it permanent? Mine settles down to a steady 4% payroll tax in place of the current 15.3% FICA.
Trump Accounts are $1000 accounts at birth indexed to S&P 500. My problem with Trump Accounts is they are really a way to funnel wealth to children of wealthy parents and not retirement accounts. I wouldn’t be surprised if in 20 years we have another Trump Crime Wave as thugs figure out they have free money to buy guns and drugs like happened in 2020 with PPP. PPP was basically venture capital for violent criminal organizations and it fueled the recent crime wave.
Where does the $1000 come from? How does it grow beyond indexing to the S&P 500? If that's all they are, most parents could do exactly the same. What does the government do, other than seed the $1000?
I don't think it's fair to use ChatGPT, it's not an arbiter of truth! I'm predisposed to agree, but I'd rather you quote whatever sources ChatGPT is using (if it's not hallucinating), or ask Finkelstein herself!
Based on my research on medical insurance, which looks back to the Great Depression and the 1940s when the federal government froze wages but firms were allowed to offer employee benefits including medical insurance, there is something rotten in Denmark.
Time preferences in economics:
Many individuals tend to value present goods and services more highly than future ones (at least when given a choice: one cookie now or two cookies in 15 minutes). In essence, people exhibit a natural bias towards immediate gratification, wanting things now rather than later. This concept is crucial in understanding how people make decisions involving trade-offs between present and future benefits.
This strongly supports the original 2015 abstract over the revised 2019 paper.
People on Medicaid have at least one thing in common. They have a high time preference and thus prioritize immediate gratification and present consumption over future benefits (they want a cookie now instead of two in 15 minutes).
Low Time Preference:
Individuals with low time preference are more patient and value future rewards more highly than immediate ones. They are more likely to save and invest, contributing to long-term wealth accumulation and economic growth (they wait the 15 minutes for two cookies).
Low time preference individuals are more likely to not take immediate cash benefits today to insure against medical expenses in the future when their earnings are lower or zero.
My intuition founded on other research that shows a correlation between poverty with high time preference tells me that people on Medicaid are most likely to be high time preference individuals, which squares with the original 2015 abstract.
It sounds plausible, but it also confirms my intuition and my distrust of government in general, and I am suspicious of bare assertions, especially when I want to believe them. Do you have any actual research you can link to?
I found it really interesting that you used ChatGPT here to help make your point. I know you've revised your initial stance that it was a "D" student to it being a (surprising) "A" student of economics. I’m curious, though, when you use GPT in this way, do you take any steps to validate the accuracy of what it gives you, or do you mostly treat it as a rhetorical tool? I’d love to hear more about how you think about the reliability of its output.
Most Medicaid recipients would accept 10 cents on the dollar because they would resume their strategy of showing up at the hospital for treatment and then not paying their bills.
Medicaids primary beneficiary is hospitals who now get payment for care they otherwise provide for free and are indeed are compelled to provide by law.
If Medicaid were eradicated cash welfare would likely increase by $0. People have sympathy for poor sick people getting medical care. They would likely have sympathy for hospitals providing that care being paid to do so. They dont have sympathy for poor people getting cash welfare.
Btw, the other big constituency for medicine is nursing homes.
It WOULD BE ABSOLUTELY NECESSARY to free medical-care providers of the legal duty to provide care without assurance of payment. Truly a sea change, and likely a good one by the end of the proverbial day.
Sure will. POOR docs! They should switch to an EASIER business, like ... auto repair, for example. Yes. Poor patients, too. Unlucky/careless ones WILL die.
Yeah, that's what voters don't like. That's why it's the third rail of politics and only grows over time. All of your arguments have failed to make a dent in this fact.
Americans are great charity donors. Here is Wikipedia's list of the top 10 countries for 2016. (I collected this several years ago, and 2016 was the last of a consistent trend before COVID blew it up.)
1.44% United States
0.79% New Zealand
0.77% Canada
0.54% United Kingdom
0.50% South Korea
0.39% Singapore
0.37% India
0.34% Russia
0.30% Italy
0.30% Netherlands
I doubt very many poor people would die in ERs for lack of funds, unless it was also for lack of a heart transplant.
ETA: This is "total charitable donations from individuals within the nation, as a percentage of the nation's GDP."
Perhaps. I don’t see how total charitable giving answers this question though. People donate to lots of different charities, they won’t necessarily donate to this. I wouldn’t for instance.
Would you posit that, absent Medicaid, there will be some instances of people providing medical care for which they are not compensated. I don’t think that’s an unreasonable expectation.
That might not be the end of the world. It might be better than that status quo.
But it is “uncomfortable”. And that discomfort explains why Medicaid has such political support.
It would not be the first time that society overpaid to try and solve a perceived problem.
Medicaid has political support because politicians like giving away other people's money, and because people like getting other people's money. There's nothing altruistic about it. It has nothing to do with "society" paying or overpaying for anything. Do not conflate "government" and "society". Medicaid is pure government grift, politicians giving away other people's money.
People donate to all sorts of causes for all sorts of reasons. ER charity care would not be limited to ER staff providing free time and resources. It is far more likely to be people donating money to charities which pay for ER care, hospices, and other care.
I posit that people are far more caring than statists give them credit for, if government would just get out of the way. People aren't fools. They won't donate to charities which duplicate government grift.
Medical care, ER or not, is just as scarce as every other resource on this planet. It has to be rationed and allocated just like every other resource. Some get more than they deserve, some get less, just like every other resource. People who get old and can't afford that emergency heart transplant are going to die, and some charity hospice will take them in. They won't die in the street unless they want to or they put it off too long. Pretending that Medicaid gives everyone quality end of life medical care is to delude oneself about reality. Pretending that everyone deserves hugely expensive end of life care is to delude oneself about allocating scarce resources.
I believe that most rich people got that way by providing a service to society, even Bill Gates who I despise for his shoddy software; or they inherited it, and if Bill Gates earned his wealth, it is his to give away as he desires, because I believe in private property rights. If he spends part of his fortune on extending his miserable life by a few years, well, he has earned that right by providing a service which society liked enough to make him wealthy, just as if he wastes hos money on huge mansions, personal jets, chauffeurs, or hookers and blow.
Pretending that government can fix the problem of Bill Gates getting undeserved end of life medical care is to assume that government bureaucrats have the information and wisdom necessary to better allocate scarce resources, and that delusion leads to socialism and corruption. I'd rather have the impartial wisdom of markets.
"politicians like giving away other people's money"
And yet federal taxes have rarely exceeded 20% of GDP and cash welfare clocks in probably under 1% of GDP.
Politicians would like to give away other peoples money, but there is a limit to how much of that people will vote for. Without a sympathetic reason, politicians have a hard time prying the money out of peoples hands.
Eds and Meds have historically been successful ways of garnering sympathy from the median voter. They may be less effective than cash at improving lives, but they are more effective than cash at playing to the median voters heart strings.
They also create a constituency amongst providers which cash does not.
"I posit that people are far more caring than statists give them credit for"
Is neither here nor there. All that matters if they are as caring as the median voter thinks they should be, whether you think the median voter is being rational or not.
"Pretending that Medicaid gives everyone quality end of life medical care is to delude oneself about reality. Pretending that everyone deserves hugely expensive end of life care is to delude oneself about allocating scarce resources."
I don't support Medicaid paying for nursing homes. But enough people do that Medicaid does it. The people in them support it over nothing. The kids often support it because it takes the burden off them. The nursing homes and their employees like it.
The median voter is not offended enough by this to put a stop to it.
"Pretending that government can fix the problem"
I'm not pretending anything. I believe the government can spend a lot of money on medical care for poor and old people and the median voter will support it.
Arguing that it's unfair or inefficient or xyz hasn't worked. The median voter does not think these concerns outweigh stories of poor people missing our on medical care or hospitals complaining they can't afford to provide it.
The only recent success in cutting medicaid, which by the by isn't popular and will probably hurt the republicans, is adding work requirements.
"Able bodied young men should have to work to get their medicaid" is literally the only story they can tell that might get a pass from the median voter, but that might not even work.
Good luck going after children (like 40% of Medicaid members) and nursing homes.
"I'd rather have the impartial wisdom of markets."
You're probably going to need to start a coup and change our entire constitution. Policy will change when the median voter changes, which means you've got to change who the median voter is.
I had to look it up. It's "total charitable donations from individuals within the nation, as a percentage of the nation's GDP."
I saw a lot of more recent tabulations, but like the last time I checked, there is too much variability to trust any, and there's also an "index of giving" which I didn't look at.
Medicaid makes access easier, but healthcare is more complex. Patient needs to change behavior, level of education matters with regard to results (AAOS). Insurance doesn't make people healthier. Wish it was true. That would be easier. Human nature does not seem to allow paradise on Earth. The Matrix had that scene.
Come on, Bryan. I want to know what YOU think, not what ChatGPT guesses the next tokens are. "I asked [LLM] and it said..." is a phrase that should appear in one's writing Exactly Never.
> They also highlighted that redistribution itself is part of Medicaid’s value proposition — which a purely WTP framework underweights.
This is a weird take (assuming ChatGPT is correctly characterizing the criticism, and that I understand it correctly). It seems to me that the *desirable* redistributive effect is from taxpayers ineligible for Medicaid to people eligible for it. But what WTP allegedly underweights is the distribution of welfare improvements *within* the population eligible for Medicaid. So unless Medicaid spending closely tracks the distribution of malady within the Medicaid-eligible population, and not (say) spending by people who would eschew medical services if they weren't being subsidized, the alleged facts that "insurance provides large welfare gains to the most vulnerable" and that "some groups (especially the sick) value insurance far more highly than the average" do not constitute a vindication of Medicaid spending generally.
For Medicaid skeptics: I see people complaining about lack of free healthcare in the US online *all the time*. Why all the passion?
Other countries manage to insure their entire populations via government healthcare. Logically speaking, this arrangement must be worse than Medicaid, yes? But few say: "I'm leaving France because I don't like government healthcare. I'll move to somewhere like the USA without it, woohoo!" What gives?
There is a pattern that is hard to discern for outsiders, but it's there.
Early in the COVID-19 pandemic Jay Bhattacharya and others tested for the presence of SARS-CoV-2 antibodies in Santa Clara County, where Stanford University resides. The findings of the study? The prevalence of antibodies implied that the number of infections was much higher than previously estimated. Further, given that the death rate was known, the results suggested that the disease was much less deadly than previously estimated.
These were not the results the "authorities" wanted and the study and the study's authors were viciously attacked. I talked to Jay during this time and he was deeply affected.
The study's methodology was successfully defended and Jay, a true scientist, stuck by the results. In hindsight, the study's results were correct. In an amazing turn of events, Jay went on to become the head of the NIH.
But the point is that science isn't objective and impartial. If you generate a result that isn't acceptable to the "authorities" and the "accepted way of thinking," you will be subjected to strong pressures to change or renounce your results.
Consider climate science, police killings of minorities, nuclear power, recycling, organic farming, minorities and academic success, etc.
Jay was wrong. In hindsight, people who study the issue still consider him wrong https://statmodeling.stat.columbia.edu/2021/10/11/learning-by-confronting-the-contradictions-in-our-statements-actions-beliefs/ even though he's head of the NIH (RFK Jr is head of HHS, and he's about as wrong as it's possible to get on health and plenty of other issues).
I will also say that while I liked your co-author David Henderson's blogging at EconLog (which he recently left), I regard it as unfortunate that he went well beyond his expertise on the topic of COVID, and if that was thanks to your influence I blame you for it.
"In hindsight, people who study the issue still consider him wrong"
I don't know any of the technical details and I am not going to spend the months and years of study to understand them. But relying on his opponents for the truth about the GreatBarrington Declaration is akin to relying on Michael Mann for the truth about global warming, or hoplophobes for the worthiness of gun control policies.
Instead, I try to judge who lies, obfuscates, and otherwise dodges the facts in order to pound the table. In particular, for COVID, I remember hospitals being paid for patients who died with COVID but not without it; incentives matter. I remember Fauci's lies, his and Watson's coverup and slander campaigns, and the constantly changing suite of reasons why people should get the jab, stand six feet apart, and wear masks when by themselves, all contrary to the received wisdom just weeks and months before. I remember the cruise ship full of elderly passengers which was locked up for a week or two and had fewer deaths than the COVID panickers expected. I remember the first reports out of Italy which turned out to have an average age of death with COVID remarkably similar to the normal pre-COVID average age of death.
People who rely on fraud and lies do not have good intentions, and almost certainly do not have the truth on their side.
I didn't say anything about the Great Barrington Declaration. Hooper's comment referenced a study on seroprevalence, and hence the fatality rate per infection. I come across so many people on the internet who try to claim that deaths were inflated by misattributing the cause, but we know from excess deaths what happened to deaths from all causes, and that shows that if anything there was an undercount of official COVID deaths (much less in the US compared to less functional countries).
The people you should actually trust were ones who made accurate predictions, the real experts as opposed to the "experts" https://westhunt.wordpress.com/2014/10/20/the-experts/ The person whose blog post I linked to there was singled out for his accuracy on the subject, attributed to both his domain expertise and "creepy oracular powers" https://slatestarcodex.com/2020/04/14/a-failure-but-not-of-prediction/ This enabled him to win every public bet he made on the subject https://x.com/TeaGeeGeePea/status/1939017380153151610 (that thread also links to a couple blog posts by/about Robin Hanson, who also won every bet he made and was listed along with Greg Cochran in that 2020 post), as well as to outpredict official "expert" virologists https://westhunt.wordpress.com/?s=virologists who said not to worry about COVID evolving. Having a low opinion of Fauci (which Greg shares) is not enough on a subject like COVID: you have to actually know what you're talking about.
No. I may have got that one link wrong, but as I said, I do not need to know technical details to judge who lies and dissembles and commits fraud on behalf of their opinion; people who do that, like Fauci and Watson, show me that they do not believe in their own cause, or they would be able to rely on truth and logic. The cruise ship, the preliminary Italian ages at death, the lies about social distancing and masking, the conflation of "with" and "from" COVID, the constantly changing stories about what the vaccines were good for ... people don't lie like that for no reason.
Look at the difference in lies: the anti-vax crowd makes up nonsense, the Fauci crowd lies about other people, lies to Congress, brags about their lies for a noble cause. One side is easy to dismiss and most people do and did. The other side stamps officialdom all over their lies, quibbles over "with" and "from", sneaks around and hides behind bureaucratic lingo.
You say Jay made one mistake. I say Fauci, Watson, and all their lies and fraud far outweigh one scientific mistake.
You actually do need to know technical details to determine who is engaged in lying & fraud. "The devil is in the details", as they say.
Excess deaths obviate the need to distinguish "with" vs "from" COVID. Excess deaths show that even in the US we undercounted COVID deaths (just by much less than other, poorer countries).
RFK Jr now has the stamp of officialdom for his lies & nonsense.
No, humans are really good at detecting lies from facial features, body posture, voice tone, and other subtle clues.
Then there are the failed predictions which never passed the basic smell test, like the extinction of polar bears and penguins, the disappearance of summer Arctic ice and snow, the different sea level rises for coastal points on the same ocean just hundreds of miles apart, the claim that CO2 is pure pollution and has no benefits, the Earth is going to reach a tipping point in 12 - 10 - 8 - 6 years and turn into Venus …
I don’t need to know squat about climate science to detect those lies, and if the climate alarmists think those lies buttress their theories, then they are the idiots and deserve no consideration for anything else they say.
As for COVID … the Italian statistics showed age at death from COVID was close enough to pre-COVID age at death as made no difference. The cruise ship deaths were nowhere near the scary predictions. The masking, social distancing, hand sanitizer, and other recommendations were known nonsense at the time and had been for years before. Fauci bragged to Congress about lying to Congress. How many thousands dies because governors shoved sick elderly patients in with healthy elderly rest home residents? How many children lost a year of education and socializing for ridiculous counter-productive school shutdowns? How many people were arrested for jogging alone without a mask? How much of the economy was shut down for no reason? How many waitstaff wore masks while diners ate without masks? Remember Whitmer telling Home Depot and Lowe’s they could stay open but had to shut down very specific aisles for absolutely no rational reason?
I remember all those lies. Most people do. Your denying it doesn’t make them go away.
Again: people who lie like that do so because they do not have truth on their side. You don’t need a medical degree to recognize that basic pattern in human behavior.
On the deadliness of COVID, see Scott Alexander's post at https://www.astralcodexten.com/p/the-evidence-that-a-million-americans
"A June 2024 study in Infectious Disease Modelling calculated the median pre-vaccination rate for the U.S. at 0.214 percent. This is close to the rate reported by Bhattacharya and his colleagues back in 2020."
https://reason.com/2025/03/12/how-many-americans-have-died-of-covid-19/printer/
You can't get a surge of excess deaths like we saw with something "not much more deadly than seasonal flu". And if you read the link to the cited study https://www.sciencedirect.com/science/article/pii/S2468042724000290 (or even its linked supplementary data appendix), you will not find the string "214" anywhere, so I don't know where Ronald Bailey got that. The paper does rely on Ioannidis for estimates of seroprevalence, which are of course in dispute. Bailey mentions a number of people like Elon Musk & Richard Epstein who underpredicted COVID deaths, but not that Ioannidis (referred to as a skeptic when cited for his calculation of how many deaths actually occurred) predicted 40K deaths https://statmodeling.stat.columbia.edu/2020/06/17/some-forecasting-for-covid-19-has-failed-a-discussion-of-taleb-and-ioannidis-et-al/
>You can't get a surge of excess deaths like we saw with something "not much more deadly than seasonal flu".
About 50k deaths is a bad year in the US (eg 2017-2018). If COVID has 2x the IFR of seasonal flu (0.2 vs 0.1) and infects 20x the number of people due to no existing immunity, then you get 1,000,000 deaths.
Twice as deadly is not "not much more deadly", it IS much more deadly!
Well, we can at least agree on RFK, Jr.
But the link you provided about Jay Bhattacharya is empty of any evidence that he was wrong on his seroprevalence study.
So we'll have to keep disagreeing on Jay and COVID.
Here is a link specifically on that study https://statmodeling.stat.columbia.edu/2020/04/19/fatal-flaws-in-stanford-study-of-coronavirus-prevalence/
> 3% does not sound implausible. If they said 30%, I’d be skeptical, given how everyone’s been hiding out for awhile, but 3%, sure, maybe so. Bendavid et al. argue that if the number is 3%, that’s good news, because Santa Clara county has 2 million people and only an estimated 100 deaths . . . 0.03*(2 million)/100 = 600, so that implies that 1/600 of exposed people there died. So that’s good news, relatively speaking: we’d still like to avoid 300 million Americans getting the virus and 500,000 dying, but that’s still better than the doomsday scenario.
> It’s hard to wrap my head around these numbers because, on one hand, a 1/600 death rate sounds pretty low; on the other, 500,000 deaths is a lot. I guess 500,000 is too high because nobody’s saying that everyone will get exposed.
You linked to Ronald Bailey reporting estimates that 1.2 million Americans died of COVID. That's more than double 500K, so even the reported high range of 4.2% would seem to be ruled out.
Exactly.
GPT's explanation sounds to me that people pointed out that they had missed some of the benefits in their calculation so they added them in. I don't see any indication in the post that the adjustment was politically motivated.
Agreed. Seems like there is some very plausible deniability, at worst and actual improved methodology at best. Hard for me to commit to the 'definitely ideological' conclusion, though, I suspect it's correct.
"... By 2019, Finkelstein et al. incorporated risk protection, heterogeneity, and broader welfare effects, shifting the conclusion: Medicaid recipients do indeed derive substantial value, often approaching the government’s cost. ...
Sorry, this statement is misleading. There is no "government" cost. There is a cost to taxpayers from this wealth transfer.
More importantly, because we have been running substantial deficits ever since Health Reform, this is a wealth transfer from Americans too young to vote and generations unborn.
Medicaid is primarily funded by general revenues paid to the federal and state governments. Most general revenues for the states that expanded medicaid eligibility come from income taxes.
Keep in mind that since Health Reform expanded Medicaid, and added taxpayer subsidized coverage via the public exchanges, America has added $26 Trillion to our national debt - increating it from ~$10 Trillion to today's $37 Trillion. Importantly, most of the cost of health reform will be shouldered by individuals in generations Z and Alpha, and later generations - all were generations that were either too young to vote or generations unborn in 2010.
So, adjust the costs for the interest on the debt that will be shouldered by future taxpayers.
It's sooo easy to approve/justify new spending to buy votes and to send the bill to others.
Medicaid primarily benefits hospitals and providers, who get paid for care they would often otherwise be compelled to provide for free.
The federal funding model incentivizes states to juice medicaid payments as much as possible because they view it as "free" money for their state. This was done because Obamacare wasn't popular enough to be implemented in half the country without bribes.
One piece of information is missing: the source of funds for the research. I suspect that funding sources often induce researchers to come to conclusions that are in line with the funding sources' beliefs.
Its given in the paper:
"National Institute of Aging under grants RC2AGO36631 and R01AG0345151 (Finkelstein) and the NBER Health and Aging Fellowship"
and that may not even be funding for this particular study but just general funding authors received. In other words, nothing there.
Not everything is a conspiracy and no, economists dont get paid to come up with particular conclusions
Great input. Nobody said there was a conspiracy. Funding sources DO pay based on hypothesis, otherwise they wouldn't turn anything down. Funding is finite and, therefore, has to be prioritized.
I think the imperative to GET PUBLISHED drove their volte face.
But in any event such empirical studies don't capture the full range of costs associated with transfer payments. Not only is the subsidized healthcare more expensive in the case of Medicaid, the coerced transfer of funds (whether by taxation or by fiat money creation) to redeem such government promises of economic security teaches people that they don't have to be thrifty to deal with their future needs, nor do they need to keep lots of discretionary funds on hand to deal with their emergency needs. Instead, they can boost their present consumption at the expense of their savings, secure in the knowledge that when they become old enough, or if they become sick, disabled, or otherwise unemployed or have diminished labor incomes, the state will step in to take care of them.
The net economic result is that the structure of production becomes less capital-intensive and has smaller inventories for dealing with supply shocks. Real labor and resource input productivities and incomes are impaired; and so the standard of living of the productive classes ultimately goes down. Thrift deterrence and capital consumption makes most people poorer and poorer, which of course increases the fiscal burdens of programs like Medicaid.
The key empirical evidence to look at is how net savings as a fraction of national income has cratered since Medicare and Medicaid were enacted in the mid-1960s, and since the dollar was put on a fiat basis in 1971. The comfortable bicoastal, academically- credentialed, mostly Democratic elites, feasting on the cheap credit fueled by fiat money creation, may not be so conscious of what welfare statism has done to the country, but the deindustrialization of America and declining standards of living are a harsh reality for everyone else.
While Republicans prefer to blame imports of foreign workers and foreign goods for causing the economic decline of the native-born working class, the unpleasant truth that neither party wants to face is that Social Security, Medicare, and Medicaid have been growing at the expense of capital formation in America. Indeed, import-financed foreign lending is one of the few sources of net investment funding that makes any growth in America possible, so Trump's war on trade deficits means that we will cut off imports of foreign savings too, and thus further accelerate our deindustrialization.
For what it's worth, I have a scheme on transitioning from FICA+SSA to employee-owned "nest egg" accounts investment accounts with an additional 4% payroll tax running in addition to the FICA tax, with the FICA tax decreasing enough that in 5-10 years, it would be 4% lower, and disappear within 20-30 years. IOW, a 4% pay cut for 5-10 years, turning into a pay raise which tops out at 11% in 20-30 years.
I don't claim it is accurate. I doubt it is politically feasible, just from the point of politicians and bureaucrats wanting to keep their fingers in the till. I do think it's plausible enough for fiction.
https://chartertopia.substack.com/p/transition-12
The Trump Accounts are the cheapest way to supplement SS. Just don’t let people access the account until they turn 65 and voila! It’s a retirement account! And then tax it very progressively so people with max SS don’t get access to it. The key should be getting SS payments closer to max payments for everyone.
I'd like to see your homework. My scheme has arithmetic. I don't claim it's perfect, but the arithmetic gives people something to critique.
When you show your arithmetic, start with the taxes taken by Trump's tariffs; those are also a pay cut. Mine involves a 4% pay cut dropping to zero within 5-10 years, thereafter turning into a pay raise, ultimately topping out at 11% in 10-20 years.
Then show how these accounts accumulate value and how much more tariff tax it takes to keep increasing their value. Does it ever diminish, or is it permanent? Mine settles down to a steady 4% payroll tax in place of the current 15.3% FICA.
Trump Accounts are $1000 accounts at birth indexed to S&P 500. My problem with Trump Accounts is they are really a way to funnel wealth to children of wealthy parents and not retirement accounts. I wouldn’t be surprised if in 20 years we have another Trump Crime Wave as thugs figure out they have free money to buy guns and drugs like happened in 2020 with PPP. PPP was basically venture capital for violent criminal organizations and it fueled the recent crime wave.
Where does the $1000 come from? How does it grow beyond indexing to the S&P 500? If that's all they are, most parents could do exactly the same. What does the government do, other than seed the $1000?
We will find out because it was part of the BBB.
I don't think it's fair to use ChatGPT, it's not an arbiter of truth! I'm predisposed to agree, but I'd rather you quote whatever sources ChatGPT is using (if it's not hallucinating), or ask Finkelstein herself!
Based on my research on medical insurance, which looks back to the Great Depression and the 1940s when the federal government froze wages but firms were allowed to offer employee benefits including medical insurance, there is something rotten in Denmark.
Time preferences in economics:
Many individuals tend to value present goods and services more highly than future ones (at least when given a choice: one cookie now or two cookies in 15 minutes). In essence, people exhibit a natural bias towards immediate gratification, wanting things now rather than later. This concept is crucial in understanding how people make decisions involving trade-offs between present and future benefits.
This strongly supports the original 2015 abstract over the revised 2019 paper.
People on Medicaid have at least one thing in common. They have a high time preference and thus prioritize immediate gratification and present consumption over future benefits (they want a cookie now instead of two in 15 minutes).
Low Time Preference:
Individuals with low time preference are more patient and value future rewards more highly than immediate ones. They are more likely to save and invest, contributing to long-term wealth accumulation and economic growth (they wait the 15 minutes for two cookies).
Low time preference individuals are more likely to not take immediate cash benefits today to insure against medical expenses in the future when their earnings are lower or zero.
My intuition founded on other research that shows a correlation between poverty with high time preference tells me that people on Medicaid are most likely to be high time preference individuals, which squares with the original 2015 abstract.
It sounds plausible, but it also confirms my intuition and my distrust of government in general, and I am suspicious of bare assertions, especially when I want to believe them. Do you have any actual research you can link to?
Read The Bell Curve
Book by Charles A. Murray and Richard Herrnstein
https://academic.oup.com/jpart/article/33/4/675/6748983
https://osf.io/preprints/psyarxiv/n9dv7/download
https://www.ebri.org/docs/default-source/testimony/t-187.pdf?sfvrsn=56d7072f_1
https://www.meegle.com/en_us/topics/economic/time-preference
https://bristoluniversitypressdigital.com/edcollchap/book/9781847423221/ch002.xml
Thanks.
What I shared is not exhaustive by half.
I found it really interesting that you used ChatGPT here to help make your point. I know you've revised your initial stance that it was a "D" student to it being a (surprising) "A" student of economics. I’m curious, though, when you use GPT in this way, do you take any steps to validate the accuracy of what it gives you, or do you mostly treat it as a rhetorical tool? I’d love to hear more about how you think about the reliability of its output.
Most Medicaid recipients would accept 10 cents on the dollar because they would resume their strategy of showing up at the hospital for treatment and then not paying their bills.
Medicaids primary beneficiary is hospitals who now get payment for care they otherwise provide for free and are indeed are compelled to provide by law.
If Medicaid were eradicated cash welfare would likely increase by $0. People have sympathy for poor sick people getting medical care. They would likely have sympathy for hospitals providing that care being paid to do so. They dont have sympathy for poor people getting cash welfare.
Btw, the other big constituency for medicine is nursing homes.
I agree. I bet people who wouldn’t otherwise get auto insurance would value it ten cents on the dollar too.
It WOULD BE ABSOLUTELY NECESSARY to free medical-care providers of the legal duty to provide care without assurance of payment. Truly a sea change, and likely a good one by the end of the proverbial day.
ER docs don't love having to determine if they should leave someone to die because they don't know if they have insurance.
If you allow hospitals to let people die it will certainly lower expenses but it will cause other sorts of problems.
Sure will. POOR docs! They should switch to an EASIER business, like ... auto repair, for example. Yes. Poor patients, too. Unlucky/careless ones WILL die.
Yeah, that's what voters don't like. That's why it's the third rail of politics and only grows over time. All of your arguments have failed to make a dent in this fact.
Making dents in voters is ALWAYS hard. Trump's figured out how, apparently. WITHOUT arguments.
Americans are great charity donors. Here is Wikipedia's list of the top 10 countries for 2016. (I collected this several years ago, and 2016 was the last of a consistent trend before COVID blew it up.)
1.44% United States
0.79% New Zealand
0.77% Canada
0.54% United Kingdom
0.50% South Korea
0.39% Singapore
0.37% India
0.34% Russia
0.30% Italy
0.30% Netherlands
I doubt very many poor people would die in ERs for lack of funds, unless it was also for lack of a heart transplant.
ETA: This is "total charitable donations from individuals within the nation, as a percentage of the nation's GDP."
Perhaps. I don’t see how total charitable giving answers this question though. People donate to lots of different charities, they won’t necessarily donate to this. I wouldn’t for instance.
Would you posit that, absent Medicaid, there will be some instances of people providing medical care for which they are not compensated. I don’t think that’s an unreasonable expectation.
That might not be the end of the world. It might be better than that status quo.
But it is “uncomfortable”. And that discomfort explains why Medicaid has such political support.
It would not be the first time that society overpaid to try and solve a perceived problem.
Medicaid has political support because politicians like giving away other people's money, and because people like getting other people's money. There's nothing altruistic about it. It has nothing to do with "society" paying or overpaying for anything. Do not conflate "government" and "society". Medicaid is pure government grift, politicians giving away other people's money.
People donate to all sorts of causes for all sorts of reasons. ER charity care would not be limited to ER staff providing free time and resources. It is far more likely to be people donating money to charities which pay for ER care, hospices, and other care.
I posit that people are far more caring than statists give them credit for, if government would just get out of the way. People aren't fools. They won't donate to charities which duplicate government grift.
Medical care, ER or not, is just as scarce as every other resource on this planet. It has to be rationed and allocated just like every other resource. Some get more than they deserve, some get less, just like every other resource. People who get old and can't afford that emergency heart transplant are going to die, and some charity hospice will take them in. They won't die in the street unless they want to or they put it off too long. Pretending that Medicaid gives everyone quality end of life medical care is to delude oneself about reality. Pretending that everyone deserves hugely expensive end of life care is to delude oneself about allocating scarce resources.
I believe that most rich people got that way by providing a service to society, even Bill Gates who I despise for his shoddy software; or they inherited it, and if Bill Gates earned his wealth, it is his to give away as he desires, because I believe in private property rights. If he spends part of his fortune on extending his miserable life by a few years, well, he has earned that right by providing a service which society liked enough to make him wealthy, just as if he wastes hos money on huge mansions, personal jets, chauffeurs, or hookers and blow.
Pretending that government can fix the problem of Bill Gates getting undeserved end of life medical care is to assume that government bureaucrats have the information and wisdom necessary to better allocate scarce resources, and that delusion leads to socialism and corruption. I'd rather have the impartial wisdom of markets.
"politicians like giving away other people's money"
And yet federal taxes have rarely exceeded 20% of GDP and cash welfare clocks in probably under 1% of GDP.
Politicians would like to give away other peoples money, but there is a limit to how much of that people will vote for. Without a sympathetic reason, politicians have a hard time prying the money out of peoples hands.
Eds and Meds have historically been successful ways of garnering sympathy from the median voter. They may be less effective than cash at improving lives, but they are more effective than cash at playing to the median voters heart strings.
They also create a constituency amongst providers which cash does not.
"I posit that people are far more caring than statists give them credit for"
Is neither here nor there. All that matters if they are as caring as the median voter thinks they should be, whether you think the median voter is being rational or not.
"Pretending that Medicaid gives everyone quality end of life medical care is to delude oneself about reality. Pretending that everyone deserves hugely expensive end of life care is to delude oneself about allocating scarce resources."
I don't support Medicaid paying for nursing homes. But enough people do that Medicaid does it. The people in them support it over nothing. The kids often support it because it takes the burden off them. The nursing homes and their employees like it.
The median voter is not offended enough by this to put a stop to it.
"Pretending that government can fix the problem"
I'm not pretending anything. I believe the government can spend a lot of money on medical care for poor and old people and the median voter will support it.
Arguing that it's unfair or inefficient or xyz hasn't worked. The median voter does not think these concerns outweigh stories of poor people missing our on medical care or hospitals complaining they can't afford to provide it.
The only recent success in cutting medicaid, which by the by isn't popular and will probably hurt the republicans, is adding work requirements.
"Able bodied young men should have to work to get their medicaid" is literally the only story they can tell that might get a pass from the median voter, but that might not even work.
Good luck going after children (like 40% of Medicaid members) and nursing homes.
"I'd rather have the impartial wisdom of markets."
You're probably going to need to start a coup and change our entire constitution. Policy will change when the median voter changes, which means you've got to change who the median voter is.
You forgot to say what it's a percent of. I'm pretty sure it's income.
I had to look it up. It's "total charitable donations from individuals within the nation, as a percentage of the nation's GDP."
I saw a lot of more recent tabulations, but like the last time I checked, there is too much variability to trust any, and there's also an "index of giving" which I didn't look at.
I figured it was either income or GDP. I pointed out some similar facts in my 2001 book, The Joy of Freedom: An Economist's Odyssey.
Believe none of the data. It is not true.
Medicaid makes access easier, but healthcare is more complex. Patient needs to change behavior, level of education matters with regard to results (AAOS). Insurance doesn't make people healthier. Wish it was true. That would be easier. Human nature does not seem to allow paradise on Earth. The Matrix had that scene.
The chat-bot said it was published in QJE, when in fact, it was published in JPE: https://www.journals.uchicago.edu/doi/abs/10.1086/702238. Caplan didn't make that error, but the bot did.
How much should we revise our trust in its answer based on this?
Come on, Bryan. I want to know what YOU think, not what ChatGPT guesses the next tokens are. "I asked [LLM] and it said..." is a phrase that should appear in one's writing Exactly Never.
poor people are not going to be willing to pay because they have more immediate, even pressing, priorities than insuring against theoretical risks.
> They also highlighted that redistribution itself is part of Medicaid’s value proposition — which a purely WTP framework underweights.
This is a weird take (assuming ChatGPT is correctly characterizing the criticism, and that I understand it correctly). It seems to me that the *desirable* redistributive effect is from taxpayers ineligible for Medicaid to people eligible for it. But what WTP allegedly underweights is the distribution of welfare improvements *within* the population eligible for Medicaid. So unless Medicaid spending closely tracks the distribution of malady within the Medicaid-eligible population, and not (say) spending by people who would eschew medical services if they weren't being subsidized, the alleged facts that "insurance provides large welfare gains to the most vulnerable" and that "some groups (especially the sick) value insurance far more highly than the average" do not constitute a vindication of Medicaid spending generally.
For Medicaid skeptics: I see people complaining about lack of free healthcare in the US online *all the time*. Why all the passion?
Other countries manage to insure their entire populations via government healthcare. Logically speaking, this arrangement must be worse than Medicaid, yes? But few say: "I'm leaving France because I don't like government healthcare. I'll move to somewhere like the USA without it, woohoo!" What gives?
Why would I want to read a robot’s fantasy about your question in full