Philanthropy and The “Social Welfare”

Currently there is a scandal over the IRS targeting of Tea Party groups for investigation of whether they qualify for their tax exempt status or whether they are primarily political.  The main issue at stake is whether the groups can get tax deductible contributions or not.  That is the main advantage of tax exempt status.  Making charitable contributions is a popular tax deduction on both the left (e.g. Yglesias) and the right (e.g. Heritage Institute).  But only about 30% of Americans itemize their deductions at all, so this is a benefit that mainly affects the elites of society rather than the median.

The position of medianism.org is that if a policy benefits people above the median and has no clear benefit to the median, then it should be scrapped.  This is a tax deduction that mostly benefits households earning above the median.  The idea of the deduction is that it will encourage more charity, but even proponents like Heritage acknowledge that it has little effect.  According to the Indiana University School of Philanthropy, charitable tax deduction has very little impact on charitable giving (pdf) among the 30% of Americans who are eligible to get it.  They say that Obama’s proposal to lower the deduction on charitable giving would only reduce charitable giving by 1.3% among the 30% of Americans who itemize and it would have no effect on giving by the other 70% of Americans.  In contrast, they point out that the 2008 recession reduced charitable giving by 13% despite the much greater need due to increased poverty during this time.  I would go further than Obama’s proposal and scrap the deduction, but even Obama’s proposal was politically untenable.

CATO’s Daniel J. Mitchel also proposed scrapping the charitable deduction because,

there’s just no evidence that the tax break leads people to increase their giving… Over the decades, there have been major changes in tax rates and thus major changes in the tax treatment of charitable contributions. At some points, there has been a big tax advantage to giving, at others much less. Yet charitable giving tends to hover around 2% of U.S. gross domestic product, no matter what the incentive.

Another reason to drop the deduction is that it’s exclusive—and it gives a break to people who really don’t need one. Upper-income households are the biggest beneficiaries of the deduction, with those making more than $100,000 per year taking 81% of the deduction even though they account for just 13.5% of all U.S. tax returns. The data are even more skewed for households with more than $200,000 of income. They account for fewer than 3% of all tax returns, yet they take 55% of all charitable deductions.

The charitable deduction should also be scrapped to avoid the problems with distinguishing between Tea Party (or Occupy) organizations whose “primary activity” is social welfare and organizations whose primary activity is political.  Political work is not tax deductible whereas social welfare work is.  The current IRS scandal is a real issue, but it will always be a difficult problem as long as the government allows deductions for social welfare and not political activity.  The issue could be eliminated forever by simply eliminating this tax benefit for the elite.

The Alliance for Charitable Reform claims that the tax deduction encourages, “a selfless act” that benefits “those in need.”  But very little of the money actually goes for “basic needs”.  According to the 2010 Study of High Net Worth Philanthropy (pdf – Table 4), in 2009, basic needs was the lowest priority expenditure for the people who get the most benefit from the tax deduction.

Basic Needs $2,959
Environment/Animal Care $3,410
International $4,587
Combination $5,240
Arts $5,531
Other $6,328
Youth/Family Services $7,641
Health $8,166
Religious $9,985
Education $12,759
Giving Vehicle $157,885

It turns out that high-income people care a lot more about the arts and elite educational institutions like the Ivy League, than they care about giving to people in need.  In comparison, Figure 20 of the same study indicates that basic needs is probably the second highest priority for the median American donor after religious contributions.

A lot of charitable ‘donations’ are a way to indulge in a hobby like art or sports.  AEI’s Mark J. Perry notes that charitable donors get a lot of benefits from their ¡¿‘selfless’ donation:

1. Here’s a list of benefits for donors making gifts to the Metropolitan Opera, which include backstage tours, ticket priority, invitations to dress rehearsals, free publications, guest passes, etc. (HT: M. Smith in the comments.)

2. According to Bloomberg, thousands of college football and basketball fans get a tax break on donations they make as a condition for buying season tickets. Many universities demand hundreds or thousands of dollars in donations as a condition for buying tickets at face value.

I do like charity and I would like to increase it, but if we are going to keep the deduction, it must be reformed along medianist lines and here are a couple medianist ways to reform the charitable tax deduction:

1. Extend the deduction to the entire population.  If it is good for high income earners, then it is good for low income earners too.  One problem with this is that it raises the transactions costs of keeping track of a lot of small donations, but we live in the information age where every sale of bubble gum pays sales tax, so it is feasible if it were a priority.  The deduction does not impact most Americans and it should at least benefit the half down to at least the median if it is to be considered medianist.  But why not just extend it to all American charitable donations?  The organizations that are fighting to preserve the deduction for elites (like the Alliance for Charitable Reform) do not seem to care about extending it to everyone else.

2. Define charitable organization along medianist lines.  They are supposed to engage in activities that increase the “social welfare.”  Harvard University is defined as a tax-deductible charitable organization and received total gifts of  $650 million in 2012.  Do these donations enhance the social welfare?  They benefit the elites, but they benefit only very few Americans at or below the median.  In order to qualify as increasing the “social welfare,” the majority of the funding should benefit people who are at or below the median American.  That medianist requirement would revolutionize charity in America and help avoid the sort of scandal that the IRS is currently involved in.  It would give the IRS some guidance for judging whether an organization is serving the “social welfare” or not.  Currently, the “social welfare” is so vaguely defined that it is easy to get in political trouble investigating a political organization.  At least this way political organizations would have to try to claim that they are working for the average American before they can get the deduction.  Even if they only pay lip service to the social welfare, it would still be a good exercise for organizations to think more about what their mission really is.

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Sarcasm In Chinese

When I lived in China, my sarcasm often fell flat.  The Chinese simply don’t use it the same way as Americans do.  They understand irony and satire, but a short, sarcastic comment was often taken literally.  If we were discussing the high violent crime rate in America, and I said, “¡¿Yea, Americans love guns because we love a good shooting!” I would probably be taken seriously regardless of my attempts to give kinesic & prosodic cues.  Sarcasm is certainly used differently in different cultures and I never completely figured out how to use it with the Chinese.   Perhaps sarcasm is different in Chinese partly as a legacy of the Chinese logographic writing system.  Many of the common words in Chinese are pictograms or ideograms that visually represent the word’s meaning.  Thus Chinese can be read with less subvocalization than phonetic writing like English.*  Chinese readers also use subvocalization, but if they do less of it, then they are less likely to need to think about prosodic intonation which is necessary for communicating certain kinds of sarcasm like, “¡¿Riiight!”

It seems that the words for sarcasm in Chinese have a different meaning than in English.  One translation is to ‘ridicule, taunt, mock‘.  Another is ‘satire‘.  But ridicule and satire are completely different concepts from sarcasm.  Ridicule and satire completely lack the kind of prosodic intonation which is necessary for communicating sarcasm.  We don’t need a ridicule punctuation mark nor a satire mark because the words alone are sufficient to communicate the ridicule and/or satire.

 

*Note: It is a myth that the Chinese do not need to do any subvocalization, but they do use different parts of the brain for reading and there is some reason to think that they may do less subvocalization than readers of phonetic writing systems like English.

Posted in sarcasm

Econobloggers Need Sarcasm Marks

Econobloggers frequently use sarcasm and need better punctuation to make the prose flow better.  For example, Paul Krugman wrote about the debt crisis:

“The new CBO numbers are out, and they scream “debt crisis? What debt crisis?””

This would be better if the first part of quote were marked as sarcasm:

“The new CBO numbers are out, and they scream, “¡¿Debt crisis? What debt crisis¿”

Economists need sarcasm because we have to constantly deal with absurd ideologies and dismal analysis.  A bit of humor helps us point out the absurdities and maintain our sanity in dealing with depressing economic analysis.  They don’t call it “the dismal science” for nothing.

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Introducing Medianism.Org

Economics is sometimes called the Dismal Science because of the dismal ethical implications of the discipline.  Yesterday I was reminded of that when one of my smart students told me that I teach that altruism is impossible.  I do not teach that and I have never taught that, but I understand where he got the idea from.  It is implied by many parts of economics that I teach, and it is easy to see where a student might get that idea from studying economics even though I am trying to teach that it is only a mental crutch to make thought experiments easier by simplifying the world.  Medianism.org is an attempt to make people think more critically about the mental crutches that economics has become dependent upon. These mental crutches have created a very peculiar ethical system that economists and unconsciously practice and it has bled into other academic disciplines and deeply influenced policy and culture.  Economists like to say that we separate ethics (normative economics) from science (positive economics), but it is impossible to do any positive economics without ethical implications and we need to own up to the ethical prescriptions that are embedded in mainstream economics.

The most important strand of ethical theory in economics is a mutant form of utilitarianism.  It is important to distinguish the ethics of economics from utilitarianism because self-proclaimed utilitarians reject what economists do and economists reject utilitarianism.  The antipathy is mutual, so we cannot call both groups utilitarians.  I call the tacit ethical theory of mainstream economics mutilitarianism to honor its roots in utilitarianism, but to distinguish it from what self-proclaimed utilitarians believe.  The main difference between the two schools of ethics is a difference in the methodology of measuring utility.  Utilitarians believe that utility is difficult to accurately measure in order to sum it up, but that it the ultimate goal.  Mutilitarians believe that utility is easy to accurately measure by simply adding up money-metric utility (or mutility), as measured using willingness to pay in dollars.  Economists do it all the time for cost benefit analysis and GDP-as-welfare.  Utilitarians typically believe that there is diminishing marginal utility of wealth and this is one of the difficulties in measuring utility.  Each person gets a a different amount of utility from the same amount of goods.  That is the theory that Bill Gates gets less utility from finding a $20 bill on the sidewalk than a homeless guy.  Mutilitarians reject diminishing marginal utility and just add up dollars to find the greatest sum of mutility.  A homeless guy’s dollars have the same mutility value as Bill Gates’ dollars which means that Bill Gates is literally worth a billion times more than a homeless guy when deciding what is good for the economy.

In mutilitarianism, the value of any government regulation is determined by theoretically measuring the willingness to pay of all people and subtracting off the dollar costs.  This is called cost-benefit analysis.  The wellbeing of any group of people is measured by adding up all the dollars that they spend for final goods and services and dividing by the number of people in the group.  This is called GDP which is the holiest measurement of mutilitarianism.

Medianism seeks to make a tiny improvement to economic thought by replacing mutilitarianist measures with measures based on median income or expenditure.  For example, the medianist replacement for cost benefit analysis is median cost-benefit, and the medianist replacement for GDP is median expenditure.

There is nothing inherently ‘median’ about all of the positions that medianism.org advocates, but medianism is really about reforming mutilitarianism.  Instead of calling this reform movement ‘anti-mutilitarianism,’ I am naming the movement after a particularly salient, simple, and powerful method for reforming ethical economics, the median.  Economic policy should focus more on measuring the median individual rather than the mean dollars.  Medianism seeks to reform other tenets of mutilitarianism including:

  • Egoism in its various forms: Mutilitarians are philosophical egoists.
      • Ethical egoism: moral agents ought to do what is in their own self-interest without altruism.
      • Rational egoism:  maximizing one’s self-interest is rational.  This is also a normative stance because rationality is normative.  And it is closely related ti ethical egoism.  After all, it is hardly ethical for people to systematically behave irrationally!  Most ethical egoists, like Ayn Rand, believe that ethical egoism IS rational egoism for this reason.
      • Psychological egoism: people are always motivated by self-interest.  Although this is described as a descriptive rather than a normative form of egoism, it is only natural for people to accept things that they perceive to be natural as being benign.  The natural tendency to accept the natural and seek to change things that are artificial or mutable is sometimes called the naturalistic fallacy, but it is hard to avoid making appeals to nature and students who learn that selfishness is natural really do become more selfish as if they decide that it is a good thing. Even apparently altruistic behavior is really motivated by the desire for personal benefit according to egoism.
    • Medianist alternative:  Embrace a median between egoism and altruism.  Real people are both selfish and altruistic.  Even the worst monsters of history sometimes probably did something altruistic for somebody (or perhaps an animal) at some time in their lives.  Hitler could never have become a powerful leader with devoted followers if he were completely nihilistic towards everyone.  Society would immediately collapse if people were never altruistic.  Furthermore, it is important to embrace and encourage altruistic behavior to strengthen society.  Many philosophers have noted that altruism could get excessive in theory, but it is hard to find actual examples of altruism run amok and it is easy to find examples of excessive selfishness.  Even if you agree with the psychological egoists that altruistic behavior is motivated by personal benefit, altruism is not always hedonistic.  The soldier who sacrifices his life to save his comrades is not doing it for the hedonistic stream of experienced pleasures he expects to get out of it.  Altruistic motivation is more complicated than hedonism.
  • Positivistic fallacy:  Mutilitarians believe in the fallacy that economists can avoid ethics and do a completely neutral science.  This is nihilism.  Avoiding ethics is impossible in a social science like economics whose ideas have, in Robert Heilbroner‘s words, “shattered empires and exploded continents;  they buttressed and undermined political regimes; they set class against class and even nation against nation.”  ¡¿Yep, nothing ethical about that.  Move along now!
    • Medianist alternative: We need to recognize the ethical underpinnings of economics so that society can utilize a more ethical economics.  If we persist in the fiction that economics can be nonethical (positive), then we will end up with an accidental ethics like mutilitarianism.
  • The efficiency-equity tradeoff:  Mutilitarians worship at the altar of efficiency.  This would not be so bad except that they emphasize that there is generally a tradeoff between efficiency and equity.  As a result, an unstated goal of mutilitarianism is to increase inequality!
    • Medianist alternative: There are many policies that increase both efficiency AND equity.  These are also medianist policies because they will benefit the median person.

In sum, mutilitarianism is money-metric utilitarianism.  It is a mutation of questionable morality and it should be replaced by medianism.  This is a clear improvement, and it is cheap and simple to do.  Although it is only a modest improvement, when multiplied across multiple policies that affect billions of people over decades or centuries, it is well worth the tiny investment it would require.

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The 100-Year Anniversary of Medical Education Reform

What kind of schools do you think of as being “private ventures, money making in spirit and object. Income was simply divided among the lecturers. No applicant for instruction who could pay his fees or sign his note was turned down.” This sounds like some sort of shady for-profit educational scam like Trump University, but that was how a lot of medical education was characterized in the United States in 1910 when the Carnegie Foundation published the Flexner report. This report helped spur medical education reform and licensing. NPR:

Prof. STARR: …during the 19th century, Americans were distrustful of expertise. There were, through the mid 19th century, no effective medical licensing laws, no regulation of medical practice or medical education. And so the whole field was thrown open to all kinds of practitioners of various medical sects and various kinds of entrepreneurs, who set up schools as money-making ventures… There had been no regulations. So, many schools had no laboratories whatsoever…

SIEGEL: Some of the reforms that Flexner proposed that seem like no-brainers today, but medical schools should be for college graduates, for example…  Or there should be some kind of experience with dissection, actual looking at the body while you’re in medical school.

Prof. STARR: Yes. All of those things made a great deal of sense, but at the same time, what they meant is that there would be new financial obstacles because medical education would become more expensive. It would become more exclusive and that was, on the whole, a necessary change. Unfortunately, it did result in a decline in the supply of doctors and that had very long term, unfortunate consequences for America.

SIEGEL: So we’re witnessing sometime early in the 20th century a change from a well-intentioned, good-natured local physician, who didn’t have much training, frankly, to a kind of a trained scientist with a real medical degree.

Prof. STARR: That was the vision. That was Flexner’s idea that science had to be brought to the bedside. And his report played a very positive role in doing that… I think what you have to bear in mind is that at that time in 1910, American society was undergoing a revolution, in many different respects, as a result of science. The airplane had just been invented. The automobile was coming into use. The telephone was coming into use. People were seeing everyday life transformed by science and technology. They began to have more faith in science than they had before. And the old distrust of professionals as monopolists that ran through the 19th century began to dissipate. And instead, people began to place their trust in science. I think that’s why Flexner had so much influence.

As a result, the government restricted medical schools and the number of M.D. granting institutions fell from 160 in 1904 to 66 in 1935.  The total number of M.D. students graduating fell by half. Flexner viewed blacks as inferior and that black medical professionals should only serve black patients and only under the supervision of white physicians.  At his recommendation, five of the seven historically black medical schools were closed.

Posted in Health

Inflated Hospital Costs

USA Today:

It isn’t just $5-a-pill aspirin. Daily room charges exceed $5,000 in some New Jersey hospitals. An appendectomy in California, including about two days in the hospital, has an average list charge of $18,000. Nationally, federal data show the median charge for treating a heart attack is more than $20,000. … In California, if you get your brakes fixed on a car, the mechanic has to give you an estimate before doing the work. That’s not true if you go in for major surgery.”

Patients in other states say they want such information.
When Karen Hamers’ teenage daughter Michele needed knee surgery, Hamers called several hospitals near her home in Vero Beach, Fla., and asked how much the surgery would cost. At the time, her family did not have health insurance. After choosing a hospital, Hamers paid the surgeon and then also paid the hospital what it said the surgery would cost: $4,200.
“Six days after surgery, we receive a letter from the hospital asking for an additional $21,000,” Hamers says. She asked for an explanation and got an itemized bill.
“It was two pages of gobbledygook,” Hamers says. “We could not understand it. They could not explain it. We showed it to our doctor, and he didn’t understand it.”
Hamers had kept a detailed log of her daughter’s 20 hours in the hospital, including a list of all the staff who cared for her and what drugs she was given. After reviewing the log and its own records, the hospital reduced its additional billing to $610.
…Hospital charges are similar to the list price on a car. Few pay the full amount because insurers negotiate discounts, and Medicare tells hospitals what it will pay. Still, some insurers do pay full charges, such as when a policyholder goes to an out-of-network hospital with whom the insurer does not have a negotiated discount. …Charges have gone up quickly in recent years and often bear little relationship to the actual cost of services. “It’s not unusual for a hospital’s billed charges in a market to increase 25% to 30% in one year,” says John Bauerlein, senior partner Milliman USA, a firm that tracks health care spending. …In 1993, charges were, on average, 159% more than costs, based on data provided to Medicare, says Glenn Melnick, professor of health care finance at the University of Southern California.  [In 2003], he says, the national average charge was 211% higher than cost. In some states, those ratios are even higher. California, Florida and Nevada have some of the highest hospital charges, close to 300% higher than costs, according to his research.
The average profit margin at the nation’s hospitals is low.  They were 4.4% in 2003 according to the hospital association.  Professor Melnick is probably not including fixed costs and administrative costs in saying that hospital charges are more than double the actual costs and a large component of hospital fixed costs is paying for uncompensated care for under-insured patients.  That is one reason the hospitals charge a fictional list price that very few patients actually pay. It is a kind of price discrimination to try to recoup those fixed costs.  Uwe Reinhardt says that in 2004, “U.S. hospitals were actually paid only about 38 percent of their “charges” by patients or their insurers.”  That means that the hospitals billed charges that are over two-and-a-half times greater than what they actually got paid.
Posted in Health

Moral Hazard & Adverse Selection

Adverse selection and moral hazard are both caused by asymmetrical information and are sometimes difficult to distinguish from one another.

  • Adverse selection is the selection bias that happens before a contract happens and moral hazard is the change in behavior that happens after a contract is in place.
  • Adverse selection is the difference in behavior between low-risk and high-cost individuals which causes high-cost people to self-select a way to offload their expenses on someone else like insurance.  Moral hazard is when someone does too much of something because they know they can offload their expenses on someone else.

Wikipedia on moral hazard:

Moral hazard arises because an individual or institution does not take the full consequences and responsibilities of its actions, and therefore has a tendency to act less carefully than it otherwise would, leaving another party to hold some responsibility for the consequences of those actions. For example, a person with insurance against automobile theft may be less cautious about locking his or her car, because the negative consequences of vehicle theft are (partially) the responsibility of the insurance company.
Economists explain moral hazard as a special case of information asymmetry, a situation in which one party in a transaction has more information than another. In particular, moral hazard may occur if a party that is insulated from risk has more information about its actions and intentions than the party paying for the negative consequences of the risk. More broadly, moral hazard occurs when the party with more information about its actions or intentions has a tendency or incentive to behave inappropriately from the perspective of the party with less information.

Wikipedia on adverse selection:

The term adverse selection was originally used in insurance. It describes a situation where an individual’s demand for insurance (either the propensity to buy insurance, or the quantity purchased, or both) is positively correlated with the individual’s risk of loss (e.g. higher risks buy more insurance), and the insurer is unable to allow for this correlation in the price of insurance. This may be because of private information known only to the individual (information asymmetry), or because of regulations or social norms which prevent the insurer from using certain categories of known information to set prices (e.g. the insurer may be prohibited from using information such as gender or ethnic origin or genetic test results). 
The potentially ‘adverse’ nature of this phenomenon can be illustrated by the link between smoking status and mortality. Non-smokers, on average, are more likely to live longer, while smokers, on average, are more likely to die younger. If insurers do not vary prices for life insurance according to smoking status, life insurance will be a better buy for smokers than for non-smokers. So smokers may be more likely to buy insurance, or may tend to buy larger amounts, than non-smokers. The average mortality of the combined policyholder group will be higher than the average mortality of the general population. From the insurer’s viewpoint, the higher mortality of the group which ‘selects’ to buy insurance is ‘adverse’. The insurer raises the price of insurance accordingly. As a consequence, non-smokers may be less likely to buy insurance (or may buy smaller amounts) than if they could buy at a lower price to reflect their lower risk. The reduction in insurance purchase by non-smokers is also ‘adverse’ from the insurer’s viewpoint, and perhaps also from a public policy viewpoint.
Furthermore, if there is a range of increasing risk categories in the population, the increase in the insurance price due to adverse selection may lead the lowest remaining risks to cancel or not renew their insurance. This leads to a further increase in price, and hence the lowest remaining risks cancel their insurance, leading to a further increase in price, and so on. Eventually this ‘adverse selection spiral’ might in theory lead to the collapse of the insurance market.  In studies of health insurance, an individual mandate requiring people to either purchase plans or face a penalty is cited as a way out of the adverse selection problem by broadening the risk pool.

Posted in Health

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