Advice That Sounds Like "Always Cooperate"

David Henderson wrote this post about how to get rich in America, taking a list from Dwight Lee and Richard McKenzie's book Getting Rich in America: 8 Simple Rules for Building a Fortune and a Satisfying Life. I read the list and agreed with it. But later I had doubts about number 5, "Get married and stay married." I'm sure that people who do get married and stay married tend to be richer and save more wealth. Getting married tends to make you follow the other seven rules. (I had read these posts years ago when Henderson first published them, and I thought about it again recently when I read his book The Joy of Freedom. Highly recommended, by the way.)

But this advice is a bit like saying, "In a prisoner's dilemma, you should always cooperate." "Get married and stay married" is great advice if both spouses are doing their part. But what if one isn't contributing? What if a spouse is abusive? Unfaithful? Alcoholic? Fails to do any of the house work? Fails to find adequate employment (without any offsetting home-making effort)? Mistreats the children?

It reminds me of a passage in Steven Pinker's book Better Angels of Our Nature. There is a long exposition about how wonderful it would be if humanity did away with war. We would no longer have populations ravaged by warfare (the violence itself and also the resulting disease and starvation). We'd also enjoy tremendous cost-savings as we'd no longer need to sacrifice a large portion of economic output to maintaining a standing army and producing war machines. Our standing armies could go home and man the factories. If only we'd beat our swords into plowshares, humanity would prosper! And at the end of this Pinker says: One reason this doesn't work is the 'other guy' problem.

If a nation decides not to learn war anymore, but its neighbor continues to do so, its pruning hooks will be no match for the neighbor’s spears, and it may find itself at the wrong end of an invading army.

 "Peace with disarmament" is a great option if everyone else is cooperating. Just like "get married and stay married" is great advice if both spouses are contributing. But dammit, there's that "other guy problem" to contend with! Proselytizing individuals (who can benefit from unilateral action) can be productive, but proselytizing groups (even groups of twos) to act collectively is sometimes like preaching to the dead.

I'm  happily married, and I feel like we both share equitably in the bread-winning, child rearing, and the home work. I've seen marriages of my friends fail, and initially I'm always sad to see it. Ending a marriage is never a nice thing. But I assume that for most of those divorces, continuing the marriage would have been sadder than ending it. Perhaps one spouse was unfaithful or emotionally abusive. If there was no sign those problems would get better any time soon, why continue such an unpleasant partnership?

I don't know if there's a solution to this problem. Usually when two parties want to constrain each other's behavior for some kind of joint venture, the solution is some kind of contract. Marriages do involve a a contract, albeit a standardized, boilerplate kind of contract. Suppose a marriage contract specified doing equal shares of work in the home, or acquiring adequate employment outside the home. Who adjudicates disputes? How do you gently broach the topic of a spouse failing to meet their contractual obligations (without it sounding like a hostile ultimatum)? Supposing you get a magistrate to rule that, "The husband will do a greater share of the house work!" How do you enforce this ruling? What kind of penalty can you impose on the husband that doesn't also harm the wife and the children? This is a very small-scale collective action problem with the minimum number of people required for it to be "collective," and yet it seems like one of the most intractable social problems.

Maybe "better matching" is part of the solution. But here's a cynical thought: some people are just damaged goods. Lazy. Emotionally immature. Manipulative. Unpleasant. Good partners will tend to get matched up with similarly good partners. Mediocre partners will likewise be able to "purchase" a mate of similar quality in the marketplace of couple-hood. We can try to encourage match-ups of people who share bad combinations of emotional immaturity, unpleasant personality, low earning-potential, and other traits. Surely some of these marriages will be happy and full of mutual heart-felt love. But many will be doomed to fail, condemned by inherent character flaws that no amount of love will fix.

Don't get me wrong here. Maybe some couples (more to the point, some individuals) really should try harder to fix their marriages. Maybe some of the divorces I've seen wouldn't have happened if one or both partners were able to "stay the course" through a rough patch. Not to second-guess any couple's decision to separate, but I suspect some of them could have worked it out if they'd wanted to. Splitting a family has obvious financial consequences. Suddenly the family needs two separate households instead of just the one. Also there are wasted resources and wasted time carting the kids around from one spouses house to the other. There can be destructive competition for the children's attention, including legal battles over custody and visitation rights. There can even be mean-spirited wealth-destruction or hedonistic consumption of savings, because "If I don't spend it the other spouse will." (I know, it makes little sense, but I once heard a divorced mother explained this dynamic playing out after her marriage ended.) It's better to avoid these costs, if practical. My point in this post is that avoiding those costs requires a joint effort, and sometimes one partner to that effort is unwilling.

"Get married and stay married." Great advice if you can take it. Just like "Always cooperate" is a great equilibrium in a prisoner's dilemma. I still think it's good enough advice that it's worth sharing. It belongs on the list of 8 from Henderson's post. Maybe the person who hears it is the problem spouse in a marriage, and hearing this advice s/he is finally motivated to clean up his/her act and fix their marriage! Unfortunately, there really are some problems that you can't unilaterally fix, and some advice you can't unilaterally decide to take. (Cue hit 90s pop song misusing the word "ironic." Gah! Sorry, couldn't help myself.)

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I wrote this entire post on the "stay married" part of the advice. Then it occurred to me that many people have enough trouble with the "get married" part. This is also good advice that plenty of people would love to take, if only they could. Alas, the "get married" part also requires some degree of cooperation from a willing participant. Maybe the book Getting Rich in America gives all the appropriate hedges, but I have a feeling that a lot of burned ex-spouses or unrequited lovers read "get married and stay married" and think, "Yeah, tell me something I don't know."

Career Tribalism I Do Not Understand

Occasionally I see stories about actuaries who behave unethically or even illegally. I don't feel any urge to leap to their defense. I have no impulse to shout down all criticism. I don't feel the need to explain to the silly uninitiated public that you can't make actuaries accountable for their financial estimates and opinions because some things are unpredictable and subject to chance. I think, "That's outrageous and contrary to the public interest. That person should be punished, perhaps jailed."

Some of these stories involve some kind of accounting fraud. A government actuary signs off on an unsound, underfunded public pension. Perhaps they use a life table from the 1970s, thus understating mortality and thus understating the total liability of life-long pensions for retirees. Or they use an absurdly generous discount rate, assuming the fund will earn 8% on investments forever, rather than responsibly discounting liabilities at the risk-free rate. (This is how my home state of Illinois has fraudulently accounted for pension liabilities for decades.) Or maybe they are less sophisticated about the deception and sign off an an unsound pension fund. The real hit doesn't come until decades later, when the fund suddenly becomes illiquid and retirees stop receiving their checks.

I would say the actuary in these cases acted unethically. Sure, the government, perhaps bowing to a public employee union leader, shopped around for the shadiest actuary they could find. Inevitably they find someone who will invent a paper fiction by which to cram oversize liabilities into the Procrustean bed of inadequate revenues. Even if this result is sort of inevitable, I still say the actuary who signs off is unethical.

So I don't understand why police officers, teachers, and medical professionals are so defensive when one of their tribe gets publicly shamed for malfeasance. You see the same thing when someone suggests measuring and rewarding good performance. There is this weird defensiveness that "performance is impossible to measure."

"You can't scrutinize how police respond with violence," says the police, "because scrutiny even of a bad actor will incentivize the wrong response when another situation appropriately calls for the use of force." There is certainly something too this. You have to strike the right cord of balancing false positives and false negatives. But the reaction is far too strong, and in some instances cops stridently defend incredibly poor judgment. You have to hold some of these people accountable. The impulse to jump to the defense of every bad actor makes cops looks sleazy, like they are anticipating the need to cover their own bad behavior.

"You can't scrutinize teacher performance," say teachers, "because children are responsible for studying and learning, and some students don't do their parts." There is a version of this for the medical profession, too: "You can't scrutinize doctor performance, because patients so often fail to follow doctors' instructions." Of course, it would be foolish to hold these people responsible for any given pupil's failure to learn or any given patients failure to improve. But to say you can't average over a large population of students and measure the "value added" of a teacher? That's kind of implausible. Same with a doctor or clinic, treating thousands of patients a year. "Selection effect!" you say? As in, good teachers get sent the best pupils, and conversely good doctors get sent the worst patients. That's why you measure "value added", not merely value. You don't just measure, say, test scores for pupils or health status for patients. You measure these things against some baseline expectation. If school masters in third-world countries can measure the competence and dedication of their teachers, a developed country like the United States can figure out how to do the same. It should be easier, not harder, with modern computers, databases, and a well-funded bureaucracy. (By the way, even notice the tension between "You can't measure teacher quality" and "You have to have this certificate to be a qualified teacher in this state"? One wants to ask, "How did you figure out the things you need to know to be a qualified teacher? Did you somehow measure teacher quality and figure out what characteristics drive it? Or did you just make it up?")

It's possible that I may one day sign off on some fund or reserve estimate that is fundamentally unsound for reasons beyond my comprehension. Or I may build a predictive model that isn't truly predictive; it fails for reasons I can't anticipate. I hope these events, if truly isolated, wouldn't lead to the end of my career. But if someone uncovers even a single act of gross negligence, deliberate deception, or a pattern of repeated failures due to incompetence, I hope I would be punished for it. Most people want some level of scrutiny and responsibility for outcomes, so they can be rewarded for doing a good job. Denying any responsibility for outcomes looks suspicious, to say the least.

I'm not quite sure why other professions act so clannish. Maybe they are public or semi-public employees and can thus afford to completely insulate themselves from the scrutiny of their customers? Maybe because they are powerful and sympathetic interest groups, and they form constituencies that politicians cater to? Certainly, McDonald's, Walmart, Ford, and Merck can't afford to say, "We're not responsible for quality" or "We're not responsible when things go wrong." McDonald's and Walmart have to anticipate the worst behavior of the very worst 1-in-a-million employee, at the very bottom of the distribution, on his worst day of the year and say, "We're going to see this happen once in a while. We've got to try to prevent it, or at least own it when it happens." Ford and Merck have to anticipate the 1-in-a-million dumbest use of their product by the very dumbest user on his worst day, and then own the problem that isn't really their fault. They have to make the product safe, not just for the average user, but for the very worst leftmost-tail-of-the-distribution user. If you have a government job (teachers, police) or are paid on a government-set payment formula (hospitals and clinics), your best bet is to sit tight and argue that problems aren't your fault. I think that explains at least some of the clannishness.

Tight-Lipped Subordinate

There's this dynamic that plays out between bosses giving instructions and subordinates receiving them. Or perhaps sometimes its the other way around. Sometimes it's the boss or an equal (say, one spouse subverting the other spouse's plans) who does the thwarting. It goes something like this. After a discussion of what needs to get done:

“…So, do you understand all those instructions?”
“Yep.”
“Great, so you know what to do now, right?”
“Sure!”
(Thinks about it.) “Are you silently coming up with reasons to veto everything I just told you?”
“Absolutely.”
“So when we meet again, your stuff won’t be done, I’ll be disappointed, and you’ll have a list of excuses?”
“That’s the plan!”
“Is there any way I can get you to tell me those various road-blocks and excuses for failure ahead of time so we can address them?”
“Nope. That would be telling.”
"Is there any way I can monitor progress before our next meeting, so I can avoid another meeting where I ask you about your progress and nothing is done?"
"...What was that? Sorry I was looking off into space, hoping you'd get bored and lose interest in this topic."
“Alright, see you again next time for more of this bullshit!”
“Cool! Looking forward to it. See you then!”

If you're in charge of getting someone to do something, be it a child, employee, boss, coworker, spouse, etc., you've probably had this experience. The person agrees that X  should get done, but has all kinds of reasons why it won't. Maybe it's "I'll e-mail Jim in IT, who will ignore my e-mail. I can say I did my part, but it will be someone else's fault." Or "I'll agree to do this task, but prioritize it below everything else without saying so. It'll basically never get done, because it will never be a top priority." Or it's something that you can't imagine, so you can't anticipate it. If only you could get the person to describe the obstacles, you could figure out a solution and get the task done. But the person assigned to the task anticipates this and keeps tight-lipped. It's like having this guy working for you (or with you). Maybe it's subconscious or unintentional, but you get the feeling that the person it playing this deeper game of "avoid unpleasant task." This can be avoided if both parties air their expectations and try to get them aligned, but one or both parties may want to avoid this confrontation.

Sometimes the boss may feel this is happening, but really he's being a bad boss and not giving clear enough instructions. It's still a responsible employee's job to pipe up and say, "You didn't give me what I need to do my job." 

Fatal Drug Interaction or Incidental Co-Occurrence?

Here's a question that was asked to me by a frequent correspondent in an e-mail:

One quick comment on your post and related conversations: You often emphasize the issue of drug interactions, especially w/ benzodiazepines.
Question: how do we know these are interactions as opposed to just co-occurrence?

And this was my answer, slightly edited:

 Excellent question! I think the answer is that obviously we don’t know. In fact I argue in several of my posts that the proliferation of substances on death records casts doubt on the idea that they are truly establishing the causes of death, versus just jotting down everything they find in a toxicology screening. Was cannabis use really a contributing cause of death? Probably not. If a record shows “cocaine” and “benzodiazepines”, I’m thinking that the medical examiner is just listing what s/he sees, because I don’t think there’s a known interaction between these substances. The things on the death certificate are supposed to be “contributing causes of death”, but I think we both know those records are fallible.
 On the other hand, I believe the interaction between opioids and benzodiazepines and alcohol (any combination thereof) is pretty well understood. Taken in combination, these substances suppress respiration more than if taken alone. Also, I think it’s pretty hard to “overdose” on any one of these substances. I’m sure some opioid users occasionally take way too much and accidentally kill themselves, but it’s probably more likely that they take a somewhat normal dose (given their tolerance) with some other substance and it has an unpredictable effect on their respiration. From the 2016 data, 90% of benzodiazepine poisonings involve some kind of opioid. Of course I have no way of knowing if benzodiazepines were just incidental or actually contributed to what proportion of these, but since the pharmacology of this interaction is fairly well understood I’d say “probably most of them.”
 For the deaths involving heroin and other synthetic opioids, I’m more sympathetic to the idea that the other substances listed on the death record are incidental. These strong opioids can be easy to overdose on, for sure. Still, it looks suspicious that such a large proportion of them involve multiple substances. 

I asked my wife, who is a pediatrician, and she said the medical examiner would probably just list everything found in a toxicology screening. But she also said there’s no standard (something I think you and I have both figured out), so you would get different records from different examiners looking at the same information.

I thought this clarification might be of interest to some of my readers. This correspondent is working on a paper on the opioid epidemic. He shares my skepticism about the official narrative. I'll definitely write a post when his paper comes out. When I got his question I was worried I was missing something, but he was basically pleased with my answer. (Apologies for the vagueness; I'm trying to avoid name-dropping for the sake of name-dropping here.)

Divert More Power to the Shields!

In an episode of Star Trek: the Next Generation titled “Hero Worship,” a young boy is the sole survivor of his ship. The android Data rescues him, and the boy becomes enamored with Data and starts emulating him. Near the end of the episode, the same phenomenon that destroyed the boy’s ship starts hitting the Enterprise. A series of shockwaves hits. Captain Picard repeatedly demands more power diverted to shields to protect against the increasingly powerful shockwaves. The boy tells Data that that’s exactly what the crew of his former ship kept doing. Data insists that they lower the shields immediately. Over Riker’s protest (“That’s suicide!”) and everyone else’s skepticism, they do so and the final wave passes over the Enterprise harmlessly. Diverting power to the shields was causing the shockwaves to resonate more powerfully, and another round or two of doubling down would have destroyed the Enterprise.

I think about this whenever someone suggests doubling down on a bad government policy. The only reason drug prohibition isn’t working, the thinking goes, is that we aren’t hammering the problem hard enough. Perhaps medicine is so expensive and inaccessible because we haven’t regulated the market enough. We haven't put medical billing sufficiently into the hands of third-party payers, and we haven't placed enough restrictions on the pricing, claims-handling, and underwriting functions of those third-party payers. Education quality is low because government isn’t spending enough; ditto for why higher education costs are rising. Watching pundits “explain” these problems feels a lot like watching Pickard divert more and more power to the shields. And whenever someone recommends dropping the policies that aren’t working, I get a distinct hint of “That’s suicide, Data!” Maybe I’m wrong about some of the causes of these problems, but it’s disappointing to see so many commenters be so completely sure of themselves and to utterly lack any capacity to be self-critical. The notion that “We’ve tried my solution, and it just doesn’t work” is impossible for some folks to process. Given that, “double down” is the only viable play. 

Drunk Driver Flashers

How well would this work? Drunk drivers have to put on their hazard flashers, but then they are allowed to drive. They are still liable for any damage they cause, they are still compelled to obey traffic laws, and so on. Possibly, they must comply with even stricter traffic laws than the ones that normally apply, like a lower speed limit. But 1) everyone knows they are a drunk driver and 2) knowing 1) those drivers anticipate extra scrutiny and force themselves to drive more carefully.

Some obvious problems come to mind. A drunk driver can still be dangerous even if everybody knows they’re a drunk driver. A drunk driver can still fall asleep at the wheel, for instance.  Some drunk drivers may forget to put their flashers on, or some might fail to because they underestimate their own inebriation. Cops might target drunk drivers who are trying to honestly do the right thing; the flashers just make them an easy mark for cops looking to fill a monthly quota. This might discourage some people from using their hazard flashers, knowing that the extra scrutiny isn’t always fair. Some people might drink and drive more often knowing that "drive with flashers on" is an option. Of course some of these objections are in tension with one another. If drunks have no intention of using their flashers on the drive home, the moral hazard problem of being more likely to drive drunk goes away.

Problems aside, compare it to what we currently do. We take a random subset of drunk drivers and impose fairly serious punishments on them. Usually not jail time, but the public tarnishing of their reputation, loss of driving privileges, and a criminal record (that most drunk drivers unfairly evade). To make legal penalties against drunk driving more effective, you have to increase the probability of detection, not just the severity of punishment. I don’t know a good way to do that. But just as harm reduction with respect to drugs requires bringing them out in the open, in a transparent, legal market, maybe reducing the harms of drunk driving require making those drivers more visible. I think we see the same kind of problem with drunk driving sanctions that we see with penalties against drug use. High-severity, low-probability punishments are effective against normal, risk-averse people with a lot to lose, but aren’t quite as effective against people with poor judgment and impulse control problems. We want laws that produce effective deterrents for everyone, not just nice, normal people. We certainly don't want laws whose incentives miss the people who are causing most of the problem!

There is a wicked tension here between “Insisting that a problem behavior never, ever happen!” and “Admitting the reality that it will happen and doing something about it.” Just to be clear, I’m not sure which one is more appropriate in this instance. 

The Federal Government Doesn’t Care How Much Pain You’re In

The DEA tried to ban Kratom last year, backing off only after a loud public outcry. 

You can’t buy Vioxx. Merck “voluntarily” withdrew it from the market after it was linked to heart disease. But just try to sell some and tell me who stopped you from doing so. The removal of this class of anti-inflammatory medicines is not exactly “voluntary.” Even granting for the sake of argument that the risk of heart disease is as bad as everyone thinks it is, Vioxx might be the right solution to some people’s pain.

Prescription opioids are tightly controlled, and the DEA has been targeting even legitimate pain doctors for “overprescribing.” This encourages pain patients to shop for a doctor who will actually treat them, which in turn looks suspicious and marks that patient with a red flag, which then makes doctors even less likely to treat them.

Medical marijuana is finally taking off after a very slow start, and attitudes are changing. But the federal government has been a huge obstacle for far too long. We shouldn’t forget that they are still making it hard for growers and distributors. A lot more chronic pain patients would have access if the incredibly conservative drug policy bureaucracy in Washington D.C. would stop fighting it.

I hate to impute nasty motives to people, such as, “They just want you to live in pain.” But I get the serious feeling that these people just don’t give a shit. As I mentioned in a recent post, Trump’s presidential commission on opioids recommended “removing pain as the fifth vital sign.” They are telling us pretty explicitly that they just don’t care if we get adequate pain management or not. If lifestyle changes, ibuprofen and acetaminophen don’t work, too bad? 

There is a downright puritanical paternalism at work here. You can’t be trusted with opioids, cannabis, or kratom because some people might enjoy them too much. Plainly that must be stopped. And you can’t be trusted with pharmaceuticals because you’re too stupid to know what’s best for you and you’ll probably poison yourself. Or maybe the sustained assault on drugs isn’t due to any underlying motive or ideology. It could be sheer inertia. There are government agencies that are invested in keeping drug illegal, because otherwise those agencies would disappear. So they find things to do: analyze some data, investigate some individuals and businesses, ruin some lives, throw some people in jail, and so on. I get the nasty feeling that what I’m observing is just amoral, self-perpetuating bureaucracy at work.