From a superb piece by Paul Krugman:
“You may recall Trump’s remark during the campaign that “I could stand in the middle of Fifth Avenue and shoot somebody and I wouldn’t lose any voters.” Well, he hasn’t done that, at least so far. He is, however, betting that he can break every promise he made to the working-class voters who put him over the top, and still keep their support. Can he win that bet?
When it comes to phony budget math — remember his claims that he would pay off the national debt? — he probably can. We’re not talking about anything subtle here; we’re talking about a budget that promises to “abolish the death tax,” then counts $330 billion in estate tax receipts in its rosy forecast. But even I don’t expect to see this kind of fraud get much political traction.
The bigger question is whether someone who ran as a populist, who promised not to cut Social Security or Medicaid, who assured voters that everyone would have health insurance, can keep his working-class support while pursuing an agenda so anti-populist it takes your breath away.”
Category Archives: Economics
Humility and Brilliance: a Postscript
Having moved on to the activities of today, I was pleasantly struck by an Opinion piece in today’s Wall Street Journal. Titled “A Nobel Economist’s Caution About Government,” the piece quotes from the great Hayek: “The curious task of economics is to demonstrate to men how little they really know about what they imagine they can design.”
While I suspect the authors of the piece have not visited our Blog, the themes our readers have come to expect from us resonate in the articulation by the authors of the risks of certainty in an inherently uncertain world.
We close with (what else?) but a closing thought: Those who relegate poetry to the idlings of idiosyncratic daydreamers deprive themselves of the riches of ambiguity and expose themselves to a deceptive clarity that leads to unintended consequences and ossification.
Where We End Depends on Where We Begin – Ebola and International Reciprocity
Our observations on, and judgments of, human affairs depend, heavily, on how we frame and re-frame the subject(s) of our inquiry, and on the data we select, either purposefully or without recognition, to inform and support our views. The gravity and importance of this point bear vocalization, particularly because of forces (whether or not well-meaning) that obscure the role of selection among non-pre-ordained alternatives that, once selected, appear to lead inexorably to a conclusion cloaked in an objectivity that conceals the (un-selected) underlying alternatives.
An article in this week’s New England Journal of Medicine – “Ebola in a Stew of Fear” – powerfully relates the linkages of advances in Western medicine and healthcare to illnesses and their ravages elsewhere. I quote from the article:
“It was, in fact, a 1926 Harvard medical expedition to Liberia, undertaken on behalf of Firestone, that had brought my film team to the Liberia–Guinea border in 2014….. In 1926, the eight-member team had traveled for 4 months through the Liberian interior, collecting blood, tumors, urine, and photographs of diverse ethnic groups. Some people ran away when they saw these strangers. The routes the expedition traveled were those used by European and West African slave traders, white missionaries, and Liberian soldiers recently sent to conquer the interior. Why stick around when strangers had been such potent contributors to the local ecology of fear?…..
American medical research profited from the blood, parasites, and viruses collected on these expeditions. Such materials were the stuff of Nobel Prizes, professional prestige and fame, and medical breakthroughs that benefited people throughout the world. The 1951 Nobel Prize awarded to Max Theiler, a member of the 1926 Harvard expedition, for his work on a yellow fever vaccine, is one example. But biomedical research did little in return to help build medical knowledge and public health capacity within Liberia. When Liberian friends now post on Facebook links connecting the Ebola outbreak to past American biomedical research, they point to the history and memory of exploitation and extraction that run deep in West Africa. These roots of medical extraction in Africa contribute to the ecology of fear.
Modern medicine owes a debt to West Africans for past sacrifices made in the advancement of global health. This week’s announcement by President Barack Obama of a U.S. commitment to build 17 Ebola treatment centers in Liberia, train medical workers, provide testing kits, and offer logistic support is a welcome and needed response. It should be the start of a long-term, concerted effort to strengthen the public health infrastructure, which is critical to the region’s future stability.”
When we consider our “foreign aid,” we would do well to bear in mind that our aid is not a one-way street and the very conceptualization of “aid”, insofar as it connotes unilateral assistance, ought not to obscure the fundamental, tangible, and very real reciprocity that precedes and supports, enables and perpetuates, foreign aid.
Medical Statistics – Beware of Precision
Those of us uninitiated into the patois of medical statistics are prone to misunderstandings. If these misunderstandings were “academic” then we might approach them with a leisurely attitude. But often decisions are thrust upon us without warning and the medical literature and physicians do not commonly translate the statistics in a readily comprehensible way. Our decisions may reflect regrettable choices with haunting consequences.
We have two threshold issues: (1) the reliability of the statistics in light of their purposes and (2) the degree of clarity in the presentation of the statistics.
As to the first point, let’s take as a given the soundness of the underlying studies and data collections. This leap glosses over critical issues but these are not our immediate concerns. One caveat: even the most elaborate and precise data sets, presented in elegant math, rest on simple premises that are commonly presented as givens and as non-controversial – in other words, biases and choices cloaked in the (falsely) reassuring neutrality of numbers.
We transition.
How often are averages presented with no articulation as to whether they represent the median, mode or mean? Large issue loom in the choice. One outlier skews the mean. Scatter leaves the median, without more, meaningless. And so forth. Opaqueness lurks around risk statistics: are they measuring absolute or relative risk? Is a 50% risk reduction a reduction of an underlying risk of .00001% or a “real” reduction? Should adjustments be made for “priors” within a Bayesian methodology? We could go on and on.
Even laymen with moderate understandings of statistics cannot divine clarity where the assumptions and methodology are unarticulated.
Just as data collections grow exponentially so does public access to the data. But without a plain English explanation of what the statistics mean, we risk costly and regrettable opportunities to guide our choices and the patient, family and society pay dearly for this lack of clarity.
Lost in Details
The current controversy over tax-inversions illustrates the costs to all of us of shrill rhetoric.
Is it too much to request that the editors of news media insist that those who advocate through them (including politicians quoted in the media) state the specific goals they seek to achieve through a stance on an issue and how the positions reflected in their stance achieve their stated specific goals?
As to tax-inversions, conclusory sound bites should be replaced with concrete questions such as: (1) is current tax law promoting or inhibiting our competitive standing (and how and by what criteria are the impact(s) being measured and who is doing the measuring) and (2) might not the (inevitable?) increase in after-tax income as a result of an inversion enable the company to expand services, offer new products, hire more employees, pay higher wages, and increase dividend to shareholders (many of whom are holders of 401(k) and pension plans) and (3) would the additional taxable income created through such expansion yield a higher net amount of federal tax revenues? Would an affirmative answer to any of such questions alter the views of those opposed to inversions? Would a negative answer alter the views of those supportive of inversions? Or would evidence contrary to our presumptions and assumptions simply mean we haven’t collected enough (relevant) evidence?
If the above questions are not the “right” or the “only” questions – and of course I present them as illustrative of a range of possible questions – then the discourse should expand or change to accommodate other or additional questions. If we can move closer to consensus on the “questions” and insist on greater specificity on our objectives and the data that supports our positions, then we should be able more clearly to assess whether our disagreements are over goals or over (mere) causes and effects, in which latter case, let’s implement procedures to verify or refute the anticipated outcomes, and time periods over which to test the causes, effects, and outcomes.