Saving us from ourselves

This week's New Yorker features two articles right next to one another that are subtly linked. Atul Gawande writes about health insurance, Michael Moore's Sicko, and the impediments in our own minds to reforming our system. And James Surowiecki writes about fuel economy standards and game theory.

Surowiecki's point is that people who drive gas-guzzling Suburbans and Hummers can still rationally vote for higher fuel economy standards. What is rational for themselves as individuals --- buying huge trucks --- they can recognize as not collectively optimal.

Gawande has been writing about Americans' reluctance to recognize this kind of problem in the U.S. market for health insurance. It may be individually rational, if heartless, for each of us to turn our backs on the chronically ill, allowing insurance companies to boot them out of coverage or charge them higher premia. Because after all, we're not sick. Not yet, anyway. But it is collectively optimal for everyone to have health insurance, period. Unfortunately it's not clear that Surowiecki's Suburban drivers recognize this yet.

Another interesting parallel is that Suburban drivers think they'll be safer in accidents. But the average American seems not to think he or she will ever get sick enough to run into problems with coverage, or at least is not willing to pay to insure everyone against that risk. Maybe the latter misperception (is it?) can be helped with films like Sicko, although pundits have claimed the film shows nothing new.

Trends in inequality

This weekend the New York Times reported on the ultra-rich, philanthropy, and tax rates and brought to mind the debate over trends in U.S. income inequality. Are we in another Gilded Age of hyper-rich robber barons?

What I've not seen is a broader treatment of trends in inequality in well-being, one that includes the dimensions of health and life span. Since income and health tend to be correlated, I think such a project would be revealing if difficult.

Public health and politics

A parade of surgeons general testified in Congress today about political interference with scientific views concerning public health. It may not come as much of a surprise, given the Bush Administration's track record with scientific accuracy. During the run-up to the Medicare expansion in 2003, CMS Actuary Richard Foster had said he felt threatened by political appointees and was kept from revealing the true cost of the new prescription drug benefit.

It is certainly less surprising now, to the extent that the Administration's reputation has sunk so low that political hacks are some of the few folks who want to work in it.

To be sure, the executive branch has never been a place for free-flowing ideas, and it probably shouldn't be. But it is distressing to see scientific views so restrained.

Happiness and marriage

The New York Times reported on research by Kelly Musick and Larry Bumpass regarding marriage and happiness. Maybe not surprising to anyone who's been married, they found a "honeymoon" of maybe 3 years followed by a downward dip in cross sectional data.

What is interesting is that over time, couples who stay together may get better at moderating each others' emotions. Robert Levenson at UC Berkeley pursues research in this area. Key issues are who displays these kinds of balancing characteristics and why.