Let's Think About It

A major problem in America is that the decisions facing us are so difficult to research and when the results come in, people only want to believe what they already believe.  At the end of the day we are back where we started, shouting bumper-sticker slogans at each other.  A couple of examples came up in the past week.  One is a pair of studies on the relationship between gun ownership and crime.  The other is about the effectiveness of Medicaid.

First is a 2007 article published in the Harvard Journal of Law & Public Policy, which has been recently resurrected by those favoring fewer gun laws and labeled as an “overlooked” study.  It compared data from countries in Europe and the US and concluded that the more guns a nation has in private ownership, the less criminal activity.  One website calls this “astonishing” and prints the conclusions in five pages of detail adding that the Harvard article “cites the Centers for Disease Control, the U.S. National Academy of Sciences and the United Nations International Study on Firearms Regulation.  (However, citing an organization does not in any way imply endorsement by that organization.)  Readers sign on below and make comments in favor or against it.

The original article (45 pages of heavy reading with 150 footnotes) contains a warning in the conclusion:  “Each individual portion of evidence is subject to cavil—at the very least the general objection that the persuasiveness of social scientific evidence cannot remotely approach the persuasiveness of conclusions in the physical sciences.”  So as they say in many other studies, more research is needed.

A second, more recent study comes from a closely related source, the Harvard Injury Control Research Center.  It shows the opposite effect and is cheered by those favoring stricter gun laws.  One site gleefully announces that this study “obliterates every single NRA lie about guns.”  The study also comes with a warning:  “The results do need to be interpreted with caution — this study method proves that more guns are linked to more gun crime and overall homicide, but not that access to guns directly causes this criminal uptick.”  Nonetheless, readers sign on below and make comments in favor or against it.

The other example comes from Oregon on the subject of Medicaid published by Forbes.  It seems Oregon had more people eligible for Medicaid than money for the program.  “In 2008, Oregon initiated a limited expansion of its Medicaid program for low-income adults through a lottery drawing of approximately 30,000 names from a waiting list of almost 90,000 persons.”  A random drawing resulted in two groups, one with coverage and one without.  It was an excellent set up for investigation.  After one year of data the authors of a study found that having Medicaid was better than being uninsured, but two years later with additional data found that Medicaid “generated no significant improvement in measured physical health outcomes” while those covered by Medicaid spent more on medical services!

These examples are not to favor or discourage gun ownership or to discredit Medicaid.  They merely show that some objective analysis is possible on a range of subjects, and is especially important on big, potentially very expensive issues.  The problems arise when these studies hit the media in a piecemeal fashion and as each result comes out the opposing viewpoints reply either with “I told you so” or with an attack on the methodology or motives of the authors.  No one ever pulls all the information together, perhaps for fear that the final result will not be what they wanted it to be.

This kind of disorganization and emotional knee-jerk reaction will never solve any of our big societal problems.  We will continue to follow the path of popularity vs. finding cost effective and practical solutions.  Politicians will never be motivated to initiate objective investigations unless the public begins to look more like critical thinkers and demand makes-sense instead of feels-good policies.

Value of a Human Life

What is the value of a human life?  Though this may seem like a philosophical or theoretical question, it becomes a very practical, but rarely considered one, especially when laws are proposed or proponents for change use the argument “if only one life is saved, it’s worth it.”  These choices imply a value, often without admitting it and without considering the impact of changes.  (This posting expands on the question from last time about how much society owes certain classes of victims.)

Many would argue that a life is priceless, that the value can’t be determined.  It is a gift from God not to be degraded by setting a price.  Though this may be true from a religious or philosophical viewpoint, we are often faced with the question of how much of our limited resources we are willing to spend to save a life.  Is it practical to spend a trillion dollars on a particular gadget or medical research to save one life – or a dozen, how about 100 or 1,000?  Could that money be better spent to save ten thousand or more?  Resources are not unlimited.  Someone must decide.  Is this best done on a case-by-case basis as so often happens today?

Recently the Supreme Court ruled that states have the option to enact more-inclusive Medicaid standards.  To do so will cost taxpayers.  A study completed at Harvard suggests that expanding Medicaid could reduce deaths among non-elderly Medicaid recipients by about 96,500 per year.  They compared data from states with expanded programs to data from nearby states without.  The head researcher admits, ‘‘I can’t tell you for sure that this is a cause-and-effect relationship, that the Medicaid expansion caused fewer nonelderly adults to die,” but the study was well designed using the best available data.  Now the question becomes, is it worth the investment?  Should states make the change?  Reviewing several sources, I found that there would be 17 million additional recipients at an annual cost from $77.4 billion to $112 billion (estimates vary).  That would be an expenditure of $802,000 to $1,160,000 per life saved.  By making (or not making) this decision they implicitly put a value on a human life.

Since 2001 the federal government requires that all passenger cars have a trunk release handle.  This became an issue after 11 children died in locked car trunks in 1998.  Although this was not a typical year for such incidents, it started a groundswell of support led by an advocacy group called the Trunk Releases Urgently Needed Coalition.  At a government-estimated cost of $2.00 per passenger car, that comes to around $14 million annually.  This cost was treated as irrelevant because “if it saves just one child, it’s worth it.”  Even using the unusually high rate of 1998, that’s an implied value of about $1.3 million per child's life or more.

Earlier this year the State of Indiana along with other parties involved with entertainment at the 2011 State Fair offered $13.2 million to the victims of the stage collapse.  Five were killed and over 50 injured.  The proposed distribution of the payout was not made public, but somehow that amount was reached.  Again, it implied a value to the 5 lives lost.  The FAA is more forthcoming and generous, assigning a value of $6.2 million per life when evaluating the cost/benefit of new rules for airlines.

I think you can see what I’m getting at.  It’s always tempting to spend great gobs of money, our money, on safety devices, legal settlements and regulations.  Although it may seem cold and unfeeling, we cannot pass laws or make social decisions on the basis of “if it just saves one life, it’s worth it.”  We don’t have unlimited resources.  This is the hard edge, but necessary application, of critical thinking.  Why should we leave these ever-more-frequent decisions to bureaucrats, politicians, judges, juries, appeals courts and big business risk management departments to make on a piecemeal and arbitrary basis with no guidelines and no controls?  Unfortunately that's exactly what will happen, because in an America with so few critical thinkers, the if-it-saves-one-life advocates will always win the hearts and souls of the public, while politicians will always shrink from making these necessary, but unpopular decisions.