Ok, we’ve had two examples of negative externalities associated with infectious diseases. I brought up the free-rider / moral hazard problem of the costs of treating the disease not being fully born by an individual who engages in high risk activities. Wei Dai brought up the problem of an individual who gets infected as a result of high risk activities increasing the risks of others getting infected by increasing the incidence of the disease.
Now if negative externalities are your true concern then you should address them as directly as possible. There are a variety of a variety of possible solutions to addressing negative externalities. Note that lying about the actual damage caused is not a standard solution.
The moral hazard / free-rider problem is a general problem that affects healthcare as it is organized in most developed nations. A significant number of people consider this a feature rather than a bug however. If you actually wanted to internalize these negative externalities the most direct way would be to allow insurers (or the government, though that would be less efficient) to set their healthcare premiums on the basis of any relevant health or lifestyle information.
While this happens to some extent (smokers or the obese may pay extra under various systems for example) it would be controversial in others (charging homosexuals higher premiums if they were at greater risk of contracting STDs for example). It would likely be even more controversial for conditions that are not generally perceived as due to bad personal choices (as smoking related illnesses or obesity are by many and homosexuality is by some on the Christian right). The suggestion that insurance companies might charge higher premiums based on genetic testing is widely regarded as unreasonable for example and I’m sure the same would apply if premiums for a government run system were so determined. Why such discrimination is considered outrageous for healthcare but is routine in some other areas of life is left as an exercise for the reader.
As to the problem of an infected individual increasing the risk of others getting infected, criminalization, civil tort law and pigovian taxes are all possible approaches to internalizing the externalities. My point that STDs present less of a problem in this regard than airborne infectious diseases like flu was that the parties put at risk are generally more able to control the risks themselves (easier to limit your exposure to STDs than to the flu) and that the source of the infection is generally easier to identify (most people have a much shorter list of candidates for infecting them with an STD than with the flu). There are fairly significant practical difficulties to prosecuting individuals who get infected with the flu and then spread it, to suing someone who has so infected you or to targeting taxes at those who put themselves at high risk of flu infection. All of these are practical to some degree with STDs.
Fundamentally my point is that if negative externalities related to infectious diseases are the real problem you are concerned about, there are standard ways of internalizing negative externalities that could be applied. Trying to justify misleading the general public about the actual risks of certain activities and the actual benefits of certain precautions on the basis of negative externalities raises the question of why you are not focusing your efforts on these other more direct and efficient means of internalizing those negative externalities.
Thank you very much for your reply. I really did want you to specify more clearly what you were talking about. It seems obvious to me (now) that anyone following your line of thought would have understood what you were talking about from your earlier comments, but I didn’t, and I hope you can forgive me for not understanding without further clarification.
As an aside, smoking has an obvious externality in second-hand smoke, which is often directly regulated by outlawing smoking in certain areas. What are the negative externalities of obesity? If we are to believe some recent studies, fat people may make the people around them fatter, which is a non-obvious externality, but does obesity have any commonly-recognized effects on people other than the obese when not considering subsidized healthcare, or is it only considered to have that externality when healthy-weight individuals are contributing to the costs of obese individuals?
to suing someone who has so infected you
This is at least possible with in some places regarding HIV, as well as pursuing criminal charges (examples).
Even more off topic, but on topic with the much more inflamed discussion in the adjacent thread, while looking for that reference I found this. I was thinking at first that a man infecting 13 women would be in contradiction with the extremely low transmission numbers for HIV. Here are what my numbers look like: with (2006 estimates—I couldn’t find number for late 1990′s) 8e5 HIV+ men in the US, a 50-50 chance that one of them would infect 13 women requires that they each engage in an average of 2845 acts with a 0.08% tx rate (unprotected P/V), 762 0.3% tx rate acts (low-income P/V) or a mere 139 acts with 1.7% tx rate (unprotected P/A). The probabilities get much more complicated when dividing demographics, but while those are unrealistically high numbers, they aren’t off by an order of magnitude; at least, the low-income P/V figure probably isn’t. Actually pulling any information off that data point, given that it is singular and unreliable is stupid, but if it were too be believed we should expect that HIV has a true aggregate transmission rate closer to 0.45%, given reasonable assumptions about average frequency of intercourse. Of course that aggregate can easily be composed by a few high-risk activities and lots and lots of low risk activities.
EDIT: I got so distracted I forgot what the main point was
Trying to justify misleading the general public about the actual risks of certain activities and the actual benefits of certain precautions on the basis of negative externalities raises the question of why you are not focusing your efforts on these other more direct and efficient means of internalizing those negative externalities.
I point out only your use of the word “efficient”. Misleading people is so easy it’s almost impossible not to do it, so the cost / benefit ratio doesn’t have to be very high to make it an efficient activity. As far as effectiveness, I agree that other, more direct measures can be much better.
As I mentioned earlier, negative externalities are easy to dream up. Many people consider it legitimate to complain about negative externalities caused by ugly buildings (such as power plants, wind farms or architecture that doesn’t fit with its surroundings) but complaining about the aesthetic negative externalities associated with unattractive people in public places is not generally considered legitimate.
In practice in democratic society these issues are generally resolved by who can shout the loudest or wield most political influence and not by any direct rational accounting of costs. It is not clear for example that the relatively small risks associated with second hand smoke justify trampling on the rights of smokers to indulge outside of their own homes, especially given that smoking is already subject to large Pigovian taxes in most countries with such bans.
Misleading people is so easy it’s almost impossible not to do it, so the cost / benefit ratio doesn’t have to be very high to make it an efficient activity.
It should at least be positive. It is not clear that it is in practice. It seems plausible to me that the general public distrust of government advice on risk that underlies phenomena like anti-vaccination movements is a direct result of an ongoing pattern of deliberately misleading people about risks. Overall I don’t see a strong reason to suppose the net effect is beneficial.
It seems plausible to me that the general public distrust of government advice on risk that underlies phenomena like anti-vaccination movements is a direct result of an ongoing pattern of deliberately misleading people about risks.
Best point brought up yet. While to some extent I think that mistrust of authority is indefatigable, increasing the risk of that is probably much more costly.
How do you feel about the specific example I mentioned, where the true risk of transmission of something is 1%, but the media outlet or whatever decides to omit the number and instead say something like “over the course of a week, an individual can spread disease X to over a hundred people”, and while true, that convinces individuals that the specific risk is much higher than 1%?
I personally find it a little irritating when the media omits information that would be necessary to work out actual risk numbers for myself. I don’t object if they communicate the numbers in a way designed to have maximum impact on the typical human mind (it’s been suggested that using frequencies rather than probabilities may help for example) but I do object if they leave out crucial information required to figure out true risk estimates. Of course I don’t generally assume this is some grand conspiracy but rather reflective of the innumeracy of the media in general.
I don’t believe in grand conspiracies because they just require too many contingencies. All this discussion, from my perspective, is about the potential for a tacit agreement between most (not all) of those disseminating information in various ways that the best method of talking about public risks is not necessarily to directly discuss low numbers associated with them.
As I indicated earlier, I think that this agreement effectively already exists regarding influenza, and probably also HIV and other infections as well.
Ok, we’ve had two examples of negative externalities associated with infectious diseases. I brought up the free-rider / moral hazard problem of the costs of treating the disease not being fully born by an individual who engages in high risk activities. Wei Dai brought up the problem of an individual who gets infected as a result of high risk activities increasing the risks of others getting infected by increasing the incidence of the disease.
Now if negative externalities are your true concern then you should address them as directly as possible. There are a variety of a variety of possible solutions to addressing negative externalities. Note that lying about the actual damage caused is not a standard solution.
The moral hazard / free-rider problem is a general problem that affects healthcare as it is organized in most developed nations. A significant number of people consider this a feature rather than a bug however. If you actually wanted to internalize these negative externalities the most direct way would be to allow insurers (or the government, though that would be less efficient) to set their healthcare premiums on the basis of any relevant health or lifestyle information.
While this happens to some extent (smokers or the obese may pay extra under various systems for example) it would be controversial in others (charging homosexuals higher premiums if they were at greater risk of contracting STDs for example). It would likely be even more controversial for conditions that are not generally perceived as due to bad personal choices (as smoking related illnesses or obesity are by many and homosexuality is by some on the Christian right). The suggestion that insurance companies might charge higher premiums based on genetic testing is widely regarded as unreasonable for example and I’m sure the same would apply if premiums for a government run system were so determined. Why such discrimination is considered outrageous for healthcare but is routine in some other areas of life is left as an exercise for the reader.
As to the problem of an infected individual increasing the risk of others getting infected, criminalization, civil tort law and pigovian taxes are all possible approaches to internalizing the externalities. My point that STDs present less of a problem in this regard than airborne infectious diseases like flu was that the parties put at risk are generally more able to control the risks themselves (easier to limit your exposure to STDs than to the flu) and that the source of the infection is generally easier to identify (most people have a much shorter list of candidates for infecting them with an STD than with the flu). There are fairly significant practical difficulties to prosecuting individuals who get infected with the flu and then spread it, to suing someone who has so infected you or to targeting taxes at those who put themselves at high risk of flu infection. All of these are practical to some degree with STDs.
Fundamentally my point is that if negative externalities related to infectious diseases are the real problem you are concerned about, there are standard ways of internalizing negative externalities that could be applied. Trying to justify misleading the general public about the actual risks of certain activities and the actual benefits of certain precautions on the basis of negative externalities raises the question of why you are not focusing your efforts on these other more direct and efficient means of internalizing those negative externalities.
Thank you very much for your reply. I really did want you to specify more clearly what you were talking about. It seems obvious to me (now) that anyone following your line of thought would have understood what you were talking about from your earlier comments, but I didn’t, and I hope you can forgive me for not understanding without further clarification.
As an aside, smoking has an obvious externality in second-hand smoke, which is often directly regulated by outlawing smoking in certain areas. What are the negative externalities of obesity? If we are to believe some recent studies, fat people may make the people around them fatter, which is a non-obvious externality, but does obesity have any commonly-recognized effects on people other than the obese when not considering subsidized healthcare, or is it only considered to have that externality when healthy-weight individuals are contributing to the costs of obese individuals?
This is at least possible with in some places regarding HIV, as well as pursuing criminal charges (examples).
Even more off topic, but on topic with the much more inflamed discussion in the adjacent thread, while looking for that reference I found this. I was thinking at first that a man infecting 13 women would be in contradiction with the extremely low transmission numbers for HIV. Here are what my numbers look like: with (2006 estimates—I couldn’t find number for late 1990′s) 8e5 HIV+ men in the US, a 50-50 chance that one of them would infect 13 women requires that they each engage in an average of 2845 acts with a 0.08% tx rate (unprotected P/V), 762 0.3% tx rate acts (low-income P/V) or a mere 139 acts with 1.7% tx rate (unprotected P/A). The probabilities get much more complicated when dividing demographics, but while those are unrealistically high numbers, they aren’t off by an order of magnitude; at least, the low-income P/V figure probably isn’t. Actually pulling any information off that data point, given that it is singular and unreliable is stupid, but if it were too be believed we should expect that HIV has a true aggregate transmission rate closer to 0.45%, given reasonable assumptions about average frequency of intercourse. Of course that aggregate can easily be composed by a few high-risk activities and lots and lots of low risk activities.
EDIT: I got so distracted I forgot what the main point was
I point out only your use of the word “efficient”. Misleading people is so easy it’s almost impossible not to do it, so the cost / benefit ratio doesn’t have to be very high to make it an efficient activity. As far as effectiveness, I agree that other, more direct measures can be much better.
As I mentioned earlier, negative externalities are easy to dream up. Many people consider it legitimate to complain about negative externalities caused by ugly buildings (such as power plants, wind farms or architecture that doesn’t fit with its surroundings) but complaining about the aesthetic negative externalities associated with unattractive people in public places is not generally considered legitimate.
In practice in democratic society these issues are generally resolved by who can shout the loudest or wield most political influence and not by any direct rational accounting of costs. It is not clear for example that the relatively small risks associated with second hand smoke justify trampling on the rights of smokers to indulge outside of their own homes, especially given that smoking is already subject to large Pigovian taxes in most countries with such bans.
It should at least be positive. It is not clear that it is in practice. It seems plausible to me that the general public distrust of government advice on risk that underlies phenomena like anti-vaccination movements is a direct result of an ongoing pattern of deliberately misleading people about risks. Overall I don’t see a strong reason to suppose the net effect is beneficial.
Best point brought up yet. While to some extent I think that mistrust of authority is indefatigable, increasing the risk of that is probably much more costly.
How do you feel about the specific example I mentioned, where the true risk of transmission of something is 1%, but the media outlet or whatever decides to omit the number and instead say something like “over the course of a week, an individual can spread disease X to over a hundred people”, and while true, that convinces individuals that the specific risk is much higher than 1%?
I personally find it a little irritating when the media omits information that would be necessary to work out actual risk numbers for myself. I don’t object if they communicate the numbers in a way designed to have maximum impact on the typical human mind (it’s been suggested that using frequencies rather than probabilities may help for example) but I do object if they leave out crucial information required to figure out true risk estimates. Of course I don’t generally assume this is some grand conspiracy but rather reflective of the innumeracy of the media in general.
I don’t believe in grand conspiracies because they just require too many contingencies. All this discussion, from my perspective, is about the potential for a tacit agreement between most (not all) of those disseminating information in various ways that the best method of talking about public risks is not necessarily to directly discuss low numbers associated with them.
As I indicated earlier, I think that this agreement effectively already exists regarding influenza, and probably also HIV and other infections as well.