Risk: Do you Get in a Car?

OSTER: I think that there is a knee-jerk to be like, “Well, if anyone ever said that this might be dangerous, no one should ever do it, ever.” I think that there is sometimes a discomfort with facing up to evidence and also to the uncertainties that come with data, that lead doctors, medical professionals, medical organizations, to want to make more blanket statements than are always appropriate, and to be less comfortable with explaining nuance to their patients than they might otherwise be.

Oster had no such discomfort with nuance. She set out to explore the parenting terrain using data as her guide. The result has been two books. The first, published a few years ago, is called Expecting Better: Why the Conventional Pregnancy Wisdom Is Wrong — and What You Really Need to Know. The new book is called Cribsheet: A Data-Driven Guide to Better, More Relaxed Parenting, from Birth to PreschoolOster appreciates that there are systemic reasons for the medical field to be cautious: remember: first, do no harm; also, there’s the threat of a malpractice suit. But Oster wanted to think about risk rationally — not as a doctor, hoping to avoid liability; or even as a parent, wanting nothing bad to ever happen to her children. Instead, she just wanted to think about risk as an economist.

OSTER: First of all, let’s interrogate a little bit whether those risks are really real, and are really significant. And then also to interrogate you have to trade off the risks maybe against some other benefits. And in something like pregnancy, you think about treating really severe nausea. There’s this “Oh, don’t take anything for that, just suffer through it.” So actually, that can be really debilitating. And it may make sense for people to take something even if we are not 1,000 percent sure that there are absolutely no risks to it, because it may outweigh some other risks. And I think we sometimes forget that.

DUBNER: And what about facing head-on risks that you’re describing as relatively small while totally ignoring other, let’s say, daily risks that are actually relatively large, like getting in a car?

OSTER: I am constantly comparing things to getting in a car, because getting in a car is very risky. And I think that there are many kinds of risks that people talk about in pregnancy and childhood which are far less risky than getting in a car, where people are like, “Oh, only somebody who’s a terrible parent would even consider doing that.” It’s like, “Well, actually, do you get in the car?”

You’re more likely to be fatally crushed by furniture than killed by a terrorist

If you are worried that ISIS might strike the United States and want to prevent the loss of American lives, consider urging Congress to invest in diabetes and Alzheimer’s research.

Terrorism is effective in doing what its name says: inspiring profound fear. But despite unremitting coverage of the Paris attacks, an objective examination of the facts shows that terrorism is an insignificant danger to the vast majority of people in the West.

You, your family members, your friends, and your community are all significantly more at risk from a host of threats that we usually ignore than from terrorism. For instance, while the Paris attacks left some 130 people dead, roughly three times that number of French citizens died on that same day from cancer.

In the United States, an individual’s likelihood of being hurt or killed by a terrorist (whether an Islamist radical or some other variety) is negligible.

Consider, for instance, that since the attacks of Sept. 11, 2001, Americans have been no more likely to die at the hands of terrorists than being crushed to death by unstable televisions and furniture. Meanwhile, in the time it has taken you to read until this point, at least one American has died from a heart attack. Within the hour, a fellow citizen will have died from skin cancer. Roughly five minutes after that, a military veteran will commit suicide. And by the time you turn the lights off to sleep this evening, somewhere around 100 Americans will have died throughout the day in vehicular accidents – the equivalent of “a plane full of people crashing, killing everyone on board, every single day.” Daniel Kahneman, professor emeritus at Princeton University, has observed that “[e]ven in countries that have been targets of intensive terror campaigns, such as Israel, the weekly number of casualties almost never [comes] close to the number of traffic deaths.”

No one in the United States will die from ISIS’s —or anyone’s — terrorism today.

What accounts for the fear that terrorism inspires, considering that its actual risk in the United States and other Western countries is so low? The answer lies in basic human psychology. Scholars have repeatedly found that individuals have strong tendencies to miscalculate risk likelihood in predictable ways.

For instance, individuals’ sense of control directly influences their feeling about whether they are susceptible to a given risk. Thus, for instance, although driving is more likely to result in deadly accidents than flying, individuals tend to feel that the latter is riskier than the former. Flying involves giving up control to the pilot. The resulting sense of vulnerability increases the feeling of risk, inflating it far beyond the actual underlying risks.

When people dread a particular hazard, and when it can harm large numbers at once, it’s far more likely that someone will see it as riskier than it is–and riskier than more serious hazards without those characteristics. For instance, people have been found to estimate that the number killed each year by tornadoes and floods are about the same as those killed by asthma and diabetes. But the latter (diabetes, in particular) account for far more deaths each year than the former. In fact, in the year that study was conducted, actual annual diabetes deaths were estimated in the  tens of thousands while fewer than 1,000 people died in tornadoes.

Islamist terrorism has all three of these characteristics, inspiring excessive fear — surely by design. For instance, the Paris attacks harmed large numbers; its victims could have done very little to escape it, since the timing and location of such attacks are unpredictable; and the idea of being shot or blown up by a mysterious set of masked extremists is incredibly dreadful.

When we miscalculate risks, we sometimes behave in ways that are riskier than those we are trying to avoid. For instance, in the months following the 9/11 terrorist attacks, millions of Americans elected not to fly. A significant proportion decided to drive to their destinations instead. Driving is more dangerous than flying. And so one scholar of risk, Gerd Gigerenzer, calculated that more people died from the resulting automobile accidents than the total number of individuals who were killed aboard the four hijacked planes Sept. 11.

Kahneman believes that the news media’s disproportionate focus on cases of Western terrorism reinforces such mistaken perceptions. As he explains in his book “Thinking, Fast and Slow,” “extremely vivid image[s] of death and damage” resulting from terrorist attacks are “reinforced by media attention and frequent conversation,” leaving us with highly accessible memories of such events. When people who have been exposed to such coverage later assess how likely more terrorism is, such events come readily to mind — and so they are likely to assign probabilities biased upward.

America’s panicked obsession with Islamist terrorism is understandable but may skew public policies in costly ways. In particular, a serious public policy problem emerges when unsubstantiated fear fuels excessive public spending. More than a decade after the Sept. 11  terrorist attacks, the U.S. government has committed trillions of dollars to fighting the war on terror. Certainly, some – perhaps even most – of this funding is warranted.

Consider, however, that federal spending on improving vehicular safety and research for Alzheimer’s and diabetes pales in comparison. Yet traffic deaths, Alzheimer’s and diabetes account for hundreds of thousands of deaths each year in the United States.

Whether diverting counterterrorism funding to research in Alzheimer’s and diabetes research would save more American lives depends on the respective marginal benefits. But our government is unlikely to objectively evaluate its investments as long as most Americans have outsized fears of the threat of Islamist terrorist attacks.

To be clear, I’m not suggesting that the United States and other Western countries are facing no risk of more terror. Quite the contrary: We will almost certainly be attacked by terrorists again during the coming years and decades.

But people will also die from other unlikely events during this same period: a number of unlucky individuals will die after falling out of bed. Others will die of head injuries from coconuts falling from trees. The likelihood that you or those you love will be directly affected by any of this in your lifetime is exceedingly small.

And so perhaps the best way to counter terrorists is to do just as the French pianist who played “Imagine” in public outside the Bataclan did after the attack, or as did the widower whose wife died in the attack, and whose open letter to the terrorists included this: “I will insult you with my happiness.” We can refuse to give them the fear they so desperately want from us.

‘Medicare for All’ Isn’t Medicare

Democrats mislead voters by appropriating the name of a popular program they actually seek to abolish.

While most of Washington has been obsessed with the Mueller report, serious foreign policy issues are coming to the forefront in these two countries. WSJ’s Gerald F. Seib explains. Photos: Getty

More than 100 House Democrats have endorsed Rep. Pramila Jayapal’s Medicare for All Act of 2019. Fourteen Democratic senators have co-sponsored a similar bill from Sen. Bernie Sanders.

The title is deeply misleading. It implies that the current Medicare system would be extended to all Americans. In fact, Medicare for All differs from Medicare in fundamental ways—with much broader coverage, no cost sharing, and fewer choices of health-care plans. While America needs a debate about health care, it should be based on an accurate description of the alternatives.

Medicare for All would cover a panoply of dental, vision and mental-health services not covered by Medicare. Under the latest version of the House bill, the federal government would also pay for all long-term nursing and home care—estimated by the Urban Institute to cost roughly $3 trillion over the next decade.

The program would replace Medicare, Medicaid and the Children’s Health Insurance Program, as well as all employer-sponsored insurance and direct individual insurance (including the ObamaCare exchanges). It would cover not only uninsured American citizens but every U.S. resident—potentially including illegal as well as legal immigrants.

Despite this substantial expansion of coverage, Medicare for All would not require beneficiaries to contribute premiums, deductibles or copayments. By contrast, most parts of Medicare require some form of cost sharing by patients. Medicare Part B, for outpatient medical expenses, has a standard premium of $1,626 a year with an annual deductible of $185, plus a 20% copayment, according to the official Medicare website.

Because of the broad coverage of services and patients without cost sharing, Medicare for All would entail dramatically higher federal spending on health care than Medicare and other programs. There have been several estimates of the incremental cost over 10 years of Mr. Sanders’s 2016 proposal, which did not include long-term care—$27.3 trillion by the Center for Health and Economy, $28 trillion to $32 trillion by former Social Security and Medicare trustee Charles Blahous, and $24.7 trillion by Emory Professor Kenneth Thorpe. The Urban Institute estimate, which included long-term care, was $32 trillion over 10 years.

Proponents counter that the proposal would reduce federal health-care spending in three main ways—lower drug prices through government negotiations, lower reimbursement rates for medical services, and lower administrative costs by eliminating insurance companies. They also argue the proposal would increase federal tax revenue by repealing the deduction for employer-provided insurance. But these four factors are already built into the previous estimates. However you cut it, Medicare for All would inevitably lead to massive tax increases.

Neither the House nor the Senate bill includes much detail on financing higher federal spending. Mr. Sanders’s staff released a paper in April with revenue options—imposing a premium tax on employers and employees, increasing the top income-tax rate, imposing a wealth tax, closing tax loopholes and so on. But the paper does not address the budget implications of these options or the challenges of getting them through Congress.

Medicare for All would also replace Medicare’s current method of paying fees for services to every hospital, nursing home and other institutional provider. Instead, a new federal board would set an annual budget for each provider, which would receive one lump sum for current operations and another for capital expenditures. That board would be expressly forbidden by current Medicare for All bills from using quality metrics—which would be necessary to prevent providers from skimping on quality with lump-sum payments.

All this would force a radical change in the current business models of most hospitals and other Medicare providers. Although they would generally have discretion over how to spend their lump-sum payments, they could not use them to make “profit or net revenues.” Yet each provider would bear the risk if these payments were insufficient to cover actual costs. Many hospitals would limit the volume or scope of their services until they were sure they would break even for the year.

Finally, Medicare for All would eliminate the plan choices Medicare now allows. Elderly Americans don’t have to get outpatient or drug coverage from the government. Some opt to stay with their employer plans and others choose private providers through Medicare Advantage. Medicare for All would prohibit any insurer or employer from privately offering any services covered by this legislation—which means essentially all medical services.

Medicare for All allows even less in the way of plan choice than other single-payer systems. In the United Kingdom, patients may purchase private insurance for medical services even if they are available through the National Health Service. Canada does not cover dental, vision or long-term care, so two-thirds of Canadians purchase these services through private health insurance.

In the coming debate over health care, the label “Medicare” should be reserved for proposals that are built on the existing structure of this successful program. Whatever else “Medicare for All” may be, it isn’t Medicare.

The Coddling of the American Mind moderated by Malcolm Gladwell

Civil discourse is in decline, with potentially dire results for American democracy.

People born after 1995, especially the coasts and Chicago feel anxiety and fear.

Kids on milk cartons

We deprived kids to develop their normal risk taking abilities

Social media spreads to kids who are 11, 12, 13, and this stresses kids

  • imagine the absolute worst of Jr High School, 24-hours a day forever
  • Social media develops an echo chamber which gives you a dopamine rush

(30 min) Some people are looking to interpreting things in the worst possible light and Call-Out things.

There is no trust.

There are more conservatives and more liberals and less moderates.

(34 min) Upper class liberals are reporting their lower class minority people for being insensitive.

3 Great Untruths:

  1. What doesn’t kill you makes you weaker.
  2. Always trust your feelings.
  3. Life is a battle between good people and evil people.

Many of the people most passionate about aggressive speech police belong to high class liberal elites.