Universal Basic Vaccines?

The following is a bloggier, graphier version of a long-form piece I wrote for Merion West last month on the case for free vaccines. If you’re so inclined, give it a read there so the editors think I’m cool!


In July, the Trump administration announced it had committed to buying 100 million doses of an unfinished Covid-19 vaccine being developed by Pfizer and BioNTech. The vaccine entered late-stage human trials on July 27, with the hope that it will be approved before the year’s end. If and when it obtains Food and Drug Administration approval, the vaccine will be delivered at no cost to the consumer, regardless of insurance status.

That could be characterized as an interesting play for an administration that made it one of its first orders of business to weaken the Affordable Care Act—not to mention a political party that spent the Obama years railing against “socialized medicine!” And indeed, many were quick to point out that in this instance, the United States is acting very much in the image of a country with a national healthcare system, the implicit critique being that the Coronavirus pandemic exposes weaknesses of “market-based healthcare” that are present under normal conditions.1

There’s some merit to this, of course. But more importantly, I think we’ve actually hit on a rare opportunity for compromise in the national healthcare debate: free vaccines. Whether or not this ends up being the first step in the path to single-payer healthcare, I think it would be a good idea. (Note: not all reform proposals are technically for a “single-payer” healthcare system. I’m using the term as a catch-all because it has a more neutral connotation than anything else I can think of.)

Why not just do it all?

To explain why, I need to take a detour. As you may know, I’m not a proponent of a government takeover of the healthcare industry (though my resolve against it has really subsided lately). My case against full-on single-payer is pretty much utilitarian—costs versus benefits.

The “costs” part of the equation isn’t super interesting. To summarize, they are enormous. The 2016 Sanders campaign offered by far the rosiest projection, putting the cost at $13.8 trillion over ten years. Most other projections are near $30 trillion over the same period—so about $3 trillion a year, or 85% of 2019 federal revenue.

Meanwhile, the benefits—in terms of objective measures of physical health—are really uncertain! I think people take it for granted that healthcare makes people healthier, but that’s actually not super clear. A high-powered experiment on this—often referred to as the “Oregon Medicaid Experiment“—was conducted in 2008. The state used a lottery system to enroll low-income, uninsured adults in Medicaid. It also selected a control group from the same population that was not enrolled so their outcomes could be compared.

The study found that Medicaid enrollment “had no statistically significant effects on blood pressure, cholesterol, or cardiovascular risk.” It did, however, produce a marked drop in depression, about 30% relative to the control group. This is why some have derided Medicaid as a “7-trillion-dollar anti-depression program.”

Medicaid enrollment did increase healthcare utilization substantially. But is this good if it’s not paired with better health outcomes? There is a widespread belief among doctors that Americans are already over-consuming healthcare. A recent survey of over 2,000 physicians found two-thirds believed at least 15 to 30 percent of medical care was unnecessary. Likewise, doctors have observed that most patients seem to be doing “just fine” despite abstaining from visiting the doctor during the current pandemic.

So to summarize my view, single-payer healthcare will cost a lot and might not do too much for us health-wise—it might even have negative effects on healthcare delivery. Its good effects can be replicated in more direct, cheaper ways. (E.g., if people are suffering from depression because they’re stressed due to finances, just give them money.) And while the healthcare system is in obvious need of reform, I’d like to see us at least try a market-oriented approach (such as forcing hospitals to be transparent about pricing) before we do something we definitely won’t be able to undo.

There are other justifications for single-payer healthcare that are harder to refute, moral arguments and the like. But this is the lens through which I personally think about it.

Why are vaccines different?

Vaccines, however, are—forgive me—immune to some of these problems. For starters, vaccines are wildly effective when compared to other types of medicine. Vaccination allowed for the global eradication of smallpox and may soon lead to the elimination of polio. In the case of other diseases like rubella, measles, and diphtheria, the United States has achieved a near 100% reduction in cases (and deaths) following the development of vaccines.

We have much less success with chronic diseases, which also happen to be responsible for the largest chunk of healthcare spending. There are probably lots of reasons for this. One is that patients simply aren’t great about adhering to long-term pharmacotherapy regiments. Approximately 50% of patients do not take their medications as prescribed, to which the Center for Disease Control and Prevention (CDC) attributes 125,000 annual deaths and 30 to 50 percent of chronic disease treatment failures. Additionally, risky behaviors—sedentarism, poor nutrition, and smoking, for example—contribute to the exacerbation of these illnesses, making treatment a more complicated process that can involve a big commitment on the part of the patient. Obviously, none of this is a problem with vaccines.

Second, vaccines are pretty cheap, especially considering their efficacy. The 100 million doses of Coronavirus vaccine the federal government has ordered will cost $1.95 billion, an average of about $20 per dose.

As advocates for single-payer like to point out, governments are often able to secure more favorable prices for medications than private sector buyers. This is true with vaccines as well, and I assume it could be more so the case under a truly monopsonic regime. (A more rigorous consideration would have to weigh this benefit against the potential drag on innovation, which is worth thinking about. Perhaps the libertarian-socialist idea of issuing government prizes in lieu of patents could obviate this concern!)

Public versus private health consumption

Another good rationale for free-to-consumer vaccines concerns public health. There are efforts from single-payer advocates to construe all health as a public good. Sometimes this is quite a reach, but in the case of vaccines, it makes a lot of sense.

As more people are vaccinated against a disease, it reduces the disease’s ability to spread and reproduce itself. This has the second-order effect of providing some protection for people who can’t get vaccinated: very young infants, people with severe allergies, or those with compromised immune systems. To a much greater extent than other kinds of health care, then, vaccines have public health benefits in a way that doesn’t require contrivance by moral argument.


The United States already has a national vaccine program that’s been quite successful. In 1994, the CDC established the Vaccines For Children program (VFC), which pays to vaccinate children who meet certain criteria. Currently, the program provides vaccines for about half of all Americans under 18. We should just expand it to cover everyone.

For the cohort born between 1994 and 2013, the CDC has estimated routine childhood immunization will prevent 322 million illnesses and 21 million hospitalizations over the course of their lifetimes, and avert 732,000 premature deaths. In financial terms, the returns on the program have been equally impressive. Again, from the CDC: “Vaccination will potentially avert $402 billion in direct costs and $1.5 trillion in societal costs because of illnesses prevented in these birth cohorts. After accounting for $107 billion and $121 billion in direct and societal costs of routine childhood immunization, respectively, the net present values (net savings) of routine childhood immunization from the payers’ and societal perspectives were $295 billion and $1.38 trillion, respectively.”

With the Democrats officially leaving Medicare for All off their 2020 platform, the debate over systemic health care reform may rage on for some time. In the meantime, perhaps, given their impressive track record, free-to-consumer vaccines are something we can all get behind.

  1. Scare quotes because whatever you may call the current healthcare system, it’s hardly a project of market fundamentalism.

What can be (un)done?

Okay, bear with me on this (or skip the math examples and shoot down to the break).

Say you want to add the following fractions: 2/3x + 5/y. Doing so is no great difficulty, as any high school student can attest. Multiply the top and bottom of each fraction by the other’s denominator, ensuring they have a common term. Then you can add the numerators. That looks like this:

2/3x + 5/y = 2y/3xy + 15x/3xy = (2y + 15x)/3xy

However, if I’d given you the end result and asked you to reverse engineer the original expression, that would be quite a bit harder. (If you don’t believe me, try to rewrite (8x + 7)/(x2 + 3x + 2) as the sum of two fractions with constants in the numerator.) To do so, you have to use a process called “partial fraction decomposition,” which I bet few high school students or adults are familiar with.

Consider another example. Let’s say we have a function f such that f(x) = 5x2 + 3x + 10, and we want to take its derivative. To do so, decrement each exponent by one and multiply the coefficient of each term by the original exponent:

f'(x) = (2*5)x2-1 + (3*1)x1-1 +(10*0)x0-1 = 10x + 3

Once again, however, if I ask you to do the reverse—to find the anti-derivative of 10x + 3—it’s a different story. You have to undo the same process: divide each coefficient by 1 + the current power of each term of x (in this case, respectively 1 and 0) and reintegrate an x into each term. If you do that, you get this:

10x +3 = (10/2)x1+1 + (3/1)x0+1 = 5x2 +3x + C

But this isn’t what we started with: our original equation was 5x2 + 3x + 10! When we took its derivative, we ended up multiplying the 10 by 0 (because 10 can be written in terms of x as 10x0). In doing so, we irrevocably destroyed the information that would give us the final term of the quadratic. We know it’s something, so we write it as C per convention.


This post isn’t actually about math. I think there’s a worthwhile sociological metaphor to be had: in both cases above, it’s easier to go forward than backward, and in the second example, it’s actually impossible to completely return. There is a strain of thought that major public policy decisions should be taken with little hesitation because “if it doesn’t work, we can always try something else.”

I don’t think that’s necessarily true.

In a particularly inspired Slate Star Codex blog post, Scott Alexander offhandedly rejects the common characterization of the body as a well oiled machine. Instead, he likens it to a careful balancing act that could easily be thrown off kilter.

People always talk about the body as a beautiful well-oiled machine. But sometimes the body communicates with itself by messages written with radioactive ink on asbestos-laced paper, in the hopes that it’s killing itself slightly more slowly than it’s killing anyone who tries to send it fake messages. Honestly it is a miracle anybody manages to stay alive at all.

Scott Alexander, Maybe Your Zoloft Stopped Working Because A Liver Fluke Tried To Turn Your Nth-Great-Grandmother Into A Zombie

I’d argue that what’s true for the organism is true for the super-organism. Complex society is basically a miracle. The stars have to align for it to form, and it can degrade with comparative ease. When we alter it, there’s no guarantee that going back to the status quo is easy or even possible. Sometimes information may be lost permanently in the transition, while unintended consequences can linger for decades.

The decline of marriage rates among low-income households is a great example. The advent of means-tested welfare programs in the 1960s is widely thought to have dissuaded many lower-income women from marriage through the effective imposition of high marginal tax rates.1 (Their benefits would decrease faster than household income would increase if they married, so it made economic sense not to marry.) This has had all kinds of nasty second-order effects,2 which is why welfare reform in the 1990s explicitly attempted to counteract this unintended consequence—but largely to no avail.

Post-industrial America offers another example. The fortunes of former manufacturing towns in the northeast and mid-west have been almost uniformly bleak since de-industrialization. (If you haven’t yet, seriously, read Sam Quiñones’s DREAMLAND.) There have been and continue to be efforts to reverse this downward trajectory: innumerable economic development programs, paid relocation programs, home-buyer subsidies, corporate tax incentives. But no amount of grant funding or wealth transfers alone can replicate the conditions that created prosperity in those areas. The money was only one part of the equation.

As frustration with the societal status quo increases, people will become more pro-action biased. I don’t necessarily think this is bad—it could be great! But it would be a mistake to proceed without caution where sociological elements are concerned. Introducing a universal basic income, for example, could change… a lot. And there’s no guarantee we could ever go back.

  1. This isn’t the only hypothesis put forth, nor are explanations for this phenomenon necessarily mutually exclusive. Pseudonymous blogger Spotted Toad makes the case that the collapse in men’s wages (also) played an important role.
  2. The consequences of the decline of marriage have different valence depending on who’s doing the analysis. There are plenty reasonable-enough takes on why the decline of marriage is good. I think the most reasonable analysis is that it’s a mixed bag generally, but for lower social classes, the results have been less ambiguously destructive. Having been raised in a rather unstable cohabitating household, I’m personally rather attuned to the drawbacks, but that’s just me.

Quito, en casa

I celebrated my 30th birthday this past March. In honor of the commencement of my fourth decade, Megan planned a two-week trip to Ecuador: a week and a half on the Galápagos Islands, bookended by a total of five days in Quito, Ecuador’s capital. As presents go, this one was pretty perfect, expertly calibrated to my love of weird animals, big cities, and old buildings.

Unfortunately, our trip happened to coincide with the outbreak of coronavirus cases in the western hemisphere, to which the Ecuadorian government responded with surprising alacrity. Within three days of our arrival, not only had the city been put under lockdown, travel between states was restricted and flights out of Quito (at least to the United States) were canceled. We never made it to the Galápagos Islands, and instead ended up spending nearly a week confined to hotel rooms and losing a ton of money on canceled flights.

Our journey home was an adventure in its own right. But that’s another story. Instead, here are some pictures and observations of Quito from our first days there.


The most startling attributes of Quito are geographic. For someone coming from a New England valley in late winter, it’s practically a hostile environment. Start with the elevation. At 9,350 feet in altitude, Quito is either the first, second, or third highest capital city in the world, depending on whether you count Lhasa, Tibet or La Paz, Bolivia. It’s about 77% higher than Denver and 135 times more elevated than my home base of Springfield, MA. (Mesa Verde in Colorado, where we camped last summer, comes pretty close at its peak of 8,572 feet.)

At that height, even normal activity can be tiring. The elevation is sufficiently extreme to have put selection pressure on the native population, which has evolved its way around altitude-induced hypoxia. The rest of us are left to deal with the constant fatigue, thirst, and hunger that accompany life in the mountains.

While it’s very far from the Earth’s core, Quito is very close to the equator—about 16 miles south therefrom. Its latitude further thins the atmosphere, making Quito a great place to catch a sunburn, even on a cloudy day (of which there are many).

In addition to its geography, Quito is remarkable for its size. The sprawling city is home to some two million residents. Before the lockdowns, Old Quito was buzzing with tourists and merchants selling avocados, apples, flowers, fedoras. The familiar beats of 90’s American hip hop anthems pumped out of disembodied car stereo systems, providing the soundtrack to our walks up and down the cobblestone hills of the city.

Like much of Latin America, Quito is a mix of disrepair and ornate splendor. Many of its buildings are crumbling, have broken windows, or are otherwise dilapidated. But adjacent stand a few that are kept pristine, seemingly unchanged from their colonial heyday. The grandest buildings are churches and federal offices.

Unlike in the US, God and the state seem to commingle freely in Ecuador. Both loom large over everyday life: National flags decorate the inside of La Compañía de Jesus, an insanely beautiful church. The massive Virgen de El Panecillo, a collaboration of local government and religious leaders, casts its shadow over the (apparently quite dangerous) neighborhood from which it derives its name.

Sadly, this is where the post ends. Shortly after we visited La Compañía de Jesus, mandatory quarantines went into effect. The formerly bustling city of Quito folded in on itself, its streets emptied. From behind shuttered windows, people tweeted #QuitoenCasa.


Some bonus pics I couldn’t fit coherently into the post:

Free speech in the digital age

I finally broke down and wrote a cancel-culture-adjacent piece. It originally appeared at Merion West, an online magazine. Since this essay contains themes I’ve been mulling over but have struggled to articulate for a while, I thought I’d reprint the piece here, with some commentary in the footnotes. Enjoy!


If I had to pick one thing America does better than any other nation, I’d have to go with free speech. The American commitment to free speech is legendary, codified by the First Amendment, which guarantees all Americans the right to worship, peacefully assemble, and otherwise express themselves without fear of government censorship.

As legal protections for freedom of expression go, the First Amendment remains the gold standard worldwide. We often take this for granted, forgetting that most people don’t live under the same conditions. Hold the American stance on freedom of speech in contrast with that of Iran or Saudi Arabia, where blasphemy is punishable by death, or China, where one-to-three million members of an ethno-religious sect are packed into concentration camps for crimes as spurious as abstaining from alcohol.*

If picking on theocracies and dictatorships strikes you as low-hanging fruit, recall that Europeans also live with less freedom of expression. A U.K. man was arrested and fined for posting a YouTube video that showed his girlfriend’s pug performing Nazi salutes, for example. By comparison, the American Civil Liberties Union has used the First Amendment to defend the rights of neo-Nazis and civil rights protestors alike to assemble.

Our commitment to the rights of others to express themselves, even if they hold heinous beliefs, is something uniquely American, perhaps the finest piece of our cultural heritage. Unfortunately, it’s a commitment we seem to be turning our backs on—and the First Amendment is often used as a moral license to do so.

The First Amendment guarantees one freedom from government censorship; it doesn’t establish the positive right to speech. This is as it should be, as anything more would require the compulsion of others to either hear or facilitate one’s speech. However, this allows people to take a narrow view of freedom of speech as being merely freedom from government censorship. We might call this the “showing you the door” strain of free speech thought. Such a view, while legally coherent, ignores that free speech has a cultural component as well—one that needs constant maintenance if it’s not to fall into disrepair.

That component might be described as a willingness to err on the side of permissiveness when it comes to public discourse—or perhaps an understanding that we generally tend to benefit from living in a culture where people can push boundaries without intolerable social and economic risk.** Its bedrock values are charity, humility, and tolerance. 

When I speak of a threat to free speech culture, I’m talking about the newly enabled impulse to defenestrate and defame people, often for trivial transgressions, sometimes years after the offense—“cancel culture,” if you must. It is distinct from free speech culture in that it doesn’t seek to confront opposing views but rather to erase them, often in ways that are financially or personally ruinous for the offending party. It’s the self-righteous, vindictive justice of the mob.

Because the internet

Anyone observer of humanity can tell you this is not new behavior. On the contrary, it’s been more the rule than the exception. But it does seem exacerbated and facilitated by modern life, especially the internet.

As more of life moved online, it became easily searchable, permanent, and largely public. This migration—the result of social encouragement to live in full view of your friends, casual acquaintances, and advertisers—has spawned a panopticonic social archive that can easily be turned against you.*** These are conditions unique to life in the 21st Century that many adults, let alone children, seem understandably ill-adept at navigating.

When paired with the rapid mutation of norms (also aided by the internet) surrounding acceptable speech and the mob mentality incentivized by social media and click-hungry outlets, this creates an environment ripe for reflexive, post-hoc defamation, to which even—or more accurately, especially—powerful liberal institutions (the very same tasked with guarding free inquiry) are showing little resistance

In such a hostile environment, the obvious choice becomes to abstain from speech that not only is controversial but also that which might someday be controversial. (The exception being those who are financially immune to cancelation and can thus be afforded public free thought.) This is clearly at odds with a culture of free speech, in which ideas can be freely debated, and people can change their minds over time. 

We’re already seeing the consequences: authors pulling their own books from publication for excruciatingly trivial offenses; professionals being fired for sharing objective research that supports unhappy findings. But the future consequences will be unseen: the important medical studies that aren’t conducted; the bold art that isn’t created; the policy failures that can’t be named, much less halted. From this vantage point, the future looks bleak, the province of the anodyne and ineffectual.

Censorship has been outsourced to private actors

Much like the social surveillance system under which we live (voluntarily, it must be said), the modern thought police regime is not a product of the state. Censorship has been outsourced to private companies and zealous volunteers, who are themselves often exercising their free speech rights in the course of policing others’ speech. From a legal standpoint, this is of course distinct from government censorship, and therefore not a First Amendment issue. No one has a right to a subreddit or a Twitter handle or a New York Times op-ed.

Yet it would be a mistake to say that these companies and individuals don’t or can’t pose a threat to free speech in the broader, cultural sense. To do so, you would have to ignore the market power of the relatively few actors that control the channels of speech in the modern era. The collapse of local media and the consolidation of firms within the industry, for example, have endowed the remaining actors with the power to filter the coverage of events and viewpoints that millions of Americans are exposed to. Do you trust them not to use it?

Over half of Americans get their news through Facebook, which is known to have manipulated users’ feeds to alter their emotions. Some 80% of search engine traffic flows through Google, home to famously opinionated, activist employees. About a quarter of journalists turn to Twitter—the use of which has been shown by at least one study to affect journalists’s judgement of newsworthiness—as their primary news source. The case of social media platforms and search engines is particularly illustrating: while they are private actors that users engage with of their own volition, network effects are built into their business models, meaning once established, they’re not as vulnerable to competition as other businesses and products are.

These companies are well within their legal rights to create their own policies and remove content that violates them, to algorithmically promote or suppress content on their properties, or to flag content as misinformation if they deem it so. But to deny that in doing so they might chill, stifle, or otherwise impact free expression is fanciful.

There are no easy fixes

Part of the irony of this problem is that addressing it in the most straightforward way (through policy or regulation) would actually represent a huge step in the wrong direction. Do I worry about the market power of companies that control the modern channels of speech? Yes, especially given the political power dynamics at play in many of our most powerful institutions. Do I think media polarization is dangerous and bad? You bet. But maintaining the independence of private actors, and thus the core of the First Amendment, is more important than the pursuit of an ephemeral unbiased public sphere.

That’s fine, because this isn’t a policy problem. It’s a cultural problem, and it requires a cultural solution: a revival of free speech culture and the virtues upon which it rests. We need to check our instincts to banish things we don’t like, and we need to voice our skepticism of those who over rely on the power of censorship.**** (It would probably also be a good idea for individuals to rethink how they use the internet.) 

I know this is a lot to ask, especially under the conditions of the digital age. But I have hope. Cultural free speech is a core American value and a key component of life in a pluralistic society. If anyone is going to defend it, it will be us.

Notes

* When I started writing this piece (about a week ago), Uyghur oppression was the most relevant example of Chinese human rights violation. By the time it was published, that had changed.

** This is one of those American ideals that has certainly never been implemented or enjoyed uniformly. As sociology professor Rod Graham points out, for a long time, you could risk losing your job and destroying your personal life by coming out as gay, for example. So while the tone of this piece is somewhat pessimistic about the state of modern free speech, I think it’s important to note that in a lot of ways, things have improved.

***  I should have also brought up that sometimes, as in many of the “Karen” videos going around, this social surveillance system is quite literally weaponized. There are incentives in place to do so—mainly the promise of money and virality for the poster.

****  There’s always going to be an Overton window; I don’t mean to suggest it could be any other way. That’s just part of living in a society.

Thoughts on Marc Andreessen’s IT’S TIME TO BUILD

Way way back in April of 2020, a venture capitalist named Marc Andreessen wrote an all-caps exhortation to western (particularly American) institutions and individuals: IT’S TIME TO BUILD. It’s a quick read, so I do recommend it. If that’s out of the question, you can get the gist from the opening paragraphs:

Every Western institution was unprepared for the coronavirus pandemic, despite many prior warnings. This monumental failure of institutional effectiveness will reverberate for the rest of the decade, but it’s not too early to ask why, and what we need to do about it.

Many of us would like to pin the cause on one political party or another, on one government or another. But the harsh reality is that it all failed — no Western country, or state, or city was prepared — and despite hard work and often extraordinary sacrifice by many people within these institutions. So the problem runs deeper than your favorite political opponent or your home nation.

Part of the problem is clearly foresight, a failure of imagination. But the other part of the problem is what we didn’t *do* in advance, and what we’re failing to do now. And that is a failure of action, and specifically our widespread inability to *build*.

We see this today with the things we urgently need but don’t have. We don’t have enough coronavirus tests, or test materials — including, amazingly, cotton swabs and common reagents. We don’t have enough ventilators, negative pressure rooms, and ICU beds. And we don’t have enough surgical masks, eye shields, and medical gowns — as I write this, New York City has put out a desperate call for rain ponchos to be used as medical gowns. Rain ponchos! In 2020! In America!

Marc Andreessen, “IT’S TIME TO BUILD”

Andreessen’s blog post is very good, even if it’s mostly an extended rallying cry. I think it was also very timely, as it alludes to a few subtextual themes I’m seeing come up more and more in politics:

  1. The US economy is increasingly concerned with rent extraction and distribution as opposed to genuinely productive economic activity, the latter having been off-shored to a great extent. The dollars-and-cents economic benefits of doing so aren’t really up for debate, but in social and political terms, the trade-off is looking less appealing these days. Prediction: interest in industrial policy is going to (continue to) increase among the right and possibly the left.
  2. Proceeding from a default assumption of capital scarcity is maybe not a smart way to make policy anymore. We are awash in money and not averse to printing more or deficit spending when the mood strikes. Obviously there’s a limit to how long you can get away with stuff like that, but if we can fight endless wars perhaps we can also fix a few roads.
  3. Maybe democracy is the problem? Others responded to Andreessen’s blog post by pointing out that there are political impediments to building as aggressively as Andreessen would like. Vox’s editor in chief, Ezra Klein, writes that American institutions public and private have become “vetocracies,” meaning that they’re biased against action instead of in its favor. Similarly, Steven Buss notes in Exponents Magazine that entrenched interests have captured regulators, making building, in many cases, illegal. Homeowners, for example, are hostile to development and form a powerful local political constituency.

    The thing is… isn’t this basically just policymakers being tuned into the desires of their constituents—or at least those inclined to make their voices heard? The only people who care enough to show up at a zoning meeting are the homeowners who don’t want the high-rise going in across the street. Professions lobby to be licensed so as to increase their income and limit competition, but members of the public generally don’t care enough to show up at the state house with a pitchfork.

    This is just the way it’s going to be, so maybe the answer is a system that doesn’t particularly care what its constituents have to say—or at least cares less in areas prone to regulatory capture.
  4. Finally, America’s ailments extend beyond the realms of economics and technocratic governance. Ours is a crisis of imagination, spirit, and mythology, exacerbated by the collapse of social capital across much of the nation. Consider the following anecdote1:

    In 1869, a businessman named George Atwater set out to install a network of rails throughout the city of Springfield, MA—from where I write presently—on which horses would pull carriages, a pre-electric trolley system. It seemed like such a ridiculous idea the board of aldermen laughed as they gave him permission and mocked him with an “initial investment” of eleven cents.

    Atwater built it anyway, and it turned out to be a huge success, expanding throughout the city and surpassing an annual ridership of 1 million by 1883. In 1890, less than a decade after the first electric power stations were built, the Springfield rail system began electrifying routes. By the next summer, all lines had been converted from horse to electric power. By 1904, ridership was 19 million; by 1916 it was 44 million.

    All of this—bold, successful investment in infrastructure, the rapid adoption of new technology, reliable and profitable public transportation—is technically possible today, yet this story could never take place in 2020. The aldermen would have dragged their feet, insisted on handouts to favored constituencies, and requested a handful of impact studies. Atwater would have stuck his investment in the stock market. The story would not have taken place here, because Springfield, like many former manufacturing cities, is in many ways a husk of its formerly productive self. Atwater would have lived in San Francisco, Boston, or New York.

Andreessen is right. It’s time to build. But let’s go broader than that: It’s time for a general return to alacrity in the public and private spheres, particularly for those of us who don’t live in one of the nexuses of the new economy. It’s time to rebuild social capital. It’s time to turn off autopilot.

Let’s fucking go.

###

  1. I came across this story in Lost Springfield, a local history book by Derek Strahan, who blogs at lostnewengland.com. I really enjoyed the book, so if you’re interested in the region’s history, I’d check out Strahan’s work.

Massachusetts Cities and Coronavirus

Last week, I put together a few graphs of Massachusetts covid-19 county cases and correlates. Unfortunately, working at the county level didn’t create many data points, so there wasn’t much insight to be gained. I ended the blog post with a wishy-washy pledge to maybe try to compile a city-level data set.

Well, I didn’t do it. But the Massachusetts Department of Public Health did! Starting April 15, the DPH began tracking coronavirus cases in Massachusetts’s 351 towns and cities. I took those case counts and paired them with demographic and economic data from the 2018 American Community Survey to see if any patterns emerged.

Due to some quirks of the Census, it would have been really tedious to get the data I wanted for every town and city. I ended up opting for a shortcut of sorts — using cities and towns that were their own Census Designated Place. (Don’t ask.) After all was said and done, I was left with 54 cities and towns that I could pair with data from the 2018 American Community Survey.

This data set is biased toward larger areas, which probably also means younger and more diverse areas too. And, of course, all cities and towns in the set are from Massachusetts, which probably introduces other biases.

Anyway, here’s what I’ve found so far:

(Note: I’m using log-scale to condense case counts and, in the case below, population. Boston, for example, has over 4,000 cases [log(4,000) = 3.602], while Springfield has about 600 [log(600) = 2.778].)

Log cases are best predicted by log population. This is pretty much common sense: more people means more vectors for disease, and usually denser population. A regression summary is in the caption below the graph.

log(Cases) = 1.3472 * log(population) – 4.0471
R^2 = .7526
p-value < 2.2e-16

After population, race is the next-best indicator of case counts. I’d expected — based on media reports and the word of local officials — to find a relationship between the percentage of black or Hispanic residents and log cases. But that didn’t really show up. Instead, the proportion of residents that are non-Hispanic whites has the best linear relationship to log cases — and the only one with a negative slope. The regression summary statistics in the caption are only for the white-log case relationship.

log(cases) = -1.8623 * white + 3.5474
R^2 = .545
p-value: 1.887e-10

This does actually fit the narrative pretty nicely if we lump all non-white ethnic groups together mentally. But as I noted in the last post, race is collinear with so many other variables that it’s hard to know what we’re seeing.

There is, however, at least some indication that what we’re observing might really be about race. Other variables we would imagine to correlate to race and population have much weaker relationships to case counts. (“Public transport” is the percentage of people who take public transport to work, and “Poverty line” is the percentage of people below the poverty line.) I grabbed a bunch of variables like these, but so far, none of them are very helpful in explaining what’s going on.

Combining log population and the proportion of residents who are white gives us an adjusted R^2 of .8209, which is nice. But when I tried to use that model to predict case counts for four municipalities that weren’t among the 54 I’d defaulted into working with, it only did okay.

The problem, I think, is that the selection of cities in the data set I’m working with is biased toward larger areas. It’s also possible (in fact, likely) that there’s both more to the story and that an element of randomness is at play, too. Aside from age, it’s been hard for professionals to isolate significant risk factors.

A few MA covid graphs

This is a low-stakes post.

Massachusetts has been releasing county-level coronavirus case counts, which I paired with data from the US Census to look for patterns. I actually didn’t end up finding anything particularly interesting, but some of the graphs are nice, so I thought I’d share.

On case growth

A few days ago, it looked like the growth of covid cases in Massachusetts might be flattening. But as of yesterday, it seems like that’s not quite the case across the board. Here are the total case counts per 1,000 residents of each county county since March 15:

Dukes and Nantucket counties omitted.

And here are cases per 1,000 residents on April 7, with the geometric growth rate of cases over the last week indicated by color:

Growth rate calculated as (x_1/x_0)^(1/7)-1

Berkshire, Barnstable, and Franklin counties have the lowest case growth rates, ranging from 6.2% to 7.3% on average per day over the last week. These counties have some common characteristics:

  • They’re geographically remote;
  • They are the only MA counties to have experienced population decline over the last decade;
  • They have the highest non-Hispanic white populations per capita and the least foreign residents;
  • They have the greatest proportion of residents over 65 (at least 22% in each case!);
  • Franklin and Berkshire counties have the lowest population densities, at 102 and 141 people per square mile, respectively.

To me, the above is consistent with the idea that economic activity is a vector for the spread of coronavirus (not literally, but it gets people in contact which causes person-person transmission).

Plymouth, Hampden, and Bristol are the counties with the fastest-growing case counts, each of them averaging an increase of over 11% daily over the last week. These counties don’t have much in common, so I’m having trouble putting together a potential unifying narrative.

Race and population density as correlates

It’s starting to look like black Americans might be more susceptible to coronavirus than other racial and ethnic groups. At first glance, that appears to show up in county-level data. But upon closer examination, that doesn’t appear to be the case — first because population density and the percentage of black residents are collinear, and population per square mile has a higher correlation coefficient; and second because Suffolk county (Boston) is influencing the linear relationship in both cases. Adjusted R-squared drops heavily if we exclude Suffolk county from the data set. (Race and population density were the best predictors I found of cases per 1,000 residents.)

This isn’t to say race and its many correlates aren’t good predictors. I think it speaks more to the (severe) limits of the data set I’m working with. If I have time, I may try to build a city-level data set. If anyone knows of one (or something better), link me!

Should we be surprised that “young people” make up a substantial amount of coronavirus cases?

I’ve noticed media outlets are reporting that young adults make up a significant share of coronavirus cases with an air of incredulity.

My local paper posted on Facebook that “More than 50% of coronavirus cases in Massachusetts are people under the age of 50.” Very similarly, the Pittsburgh Post Gazette writes that “more than half of Pennsylvania’s confirmed COVID-19 patients are under 50 years old.” The New York Times, for its part, reports that “nearly 40 percent of patients sick enough to be hospitalized were age 20 to 54.” *

I can’t decide if this is a psyop to get young people to take the epidemic more seriously (as numerous spring-break photos show they should) or genuine surprise. If it’s the latter, I’m not sure if that’s warranted.

In each case, the age ranges in question are massive and not very meaningful without comparison to the age distribution of the general population. For example, in Massachusetts, about 63% of the population is under the age of 50. So if the incidence of coronavirus were age-independent, we might actually expect more cases among people under 50.

I think the issue, then, is that people seem to be assuming prevalence of the virus should be age-dependent to a higher degree than we’re observing. Maybe there’s a good Bayesian case to be made for this null hypothesis; I don’t know. But I feel like laypeople — local papers included — ought to be preceding with the assumption of age-independence, especially because we still don’t have much information.

Also, what’s going on with the under-20 crowd, which makes up 23% of the population but only 2.2% of MA coronavirus cases? Is Gen Z+ holding out on us?

The typo in the y-axis comes from the MA DPH data set, which has decided there are no 19-year-olds in the Bay State.

* This isn’t as egregious as the other two examples. It’s still a huge age range: about 48% of America is between the ages of 20 and 54. But since we’re talking about the severity of symptoms and hospitalizations, it seems much more noteworthy.