Vic Fuchs on desirable health insurance overhaul

In JAMA (gated:(.  Vic isn't optimistic about the political prospects of large scale reform of health insurance, but he has some thoughts about where we've gone wrong, and where we might try to go.

November 27, 2018
How to Make US Health Care More Equitable and Less Costly
Begin by Replacing Employment-Based Insurance
Victor R. Fuchs, PhD1
JAMA. 2018;320(20):2071-2072. doi:10.1001/jama.2018.16475

"With few exceptions, employment-based insurance is administered by health insurance companies. In consultation with employers, many of whom are self-insured, the insurance companies design benefit and premium schedules, negotiate reimbursement rates with hospitals and physicians, and approve or disapprove medical center, physician, and patient claims. There are only a few very large health insurance companies and many small ones, but none has been successful in restraining expenditures. The inability of large insurance companies to bargain more effectively with hospitals and physicians is a systemic problem.

"Most health care is delivered locally and, partly as a result of mergers and acquisitions, a predominant or premier hospital and affiliated physicians in a local market may have more bargaining power than even the largest insurance company. In some markets, a large insurance company is forced to pay more than twice the Medicare fee in part to retain a popular health care system on its plan.
...

"Box 1.

Characteristics of an Alternative Approach to Employment-Based Insurance

• Universal eligibility: Unlike employment-based insurance and many of the special government programs with sharply defined eligibility criteria, everyone would be insured for comprehensive health care, including hospital care, physician and other professional services, and prescription medications.
• Funding: This would come from a broad-based tax dedicated to health care.

...

Box 2.

Suggested Guidelines for an Alternative Approach to the Organization and Delivery of Medical Care

• Rely as much as possible on private-sector responsibilities and initiatives
• Limit the government’s role to broad decisions that do not require a large bureaucracy to implement
• Give consumers a choice of health care plans at annual enrollment. In contrast, giving insured patients a choice for individual hospitals and physicians leads to higher not lower expenditures. Choice should also include the right of individuals to buy more than the basic plan that would be paid for with their after-tax dollars.
• Provide for competition among health plans; this will be more valuable than competition among individual physicians.⁷ Competition should focus on service and quality of care.
• Develop reimbursement methods other than fee-for-service. Some economists maintain that risk-adjusted capitation payment to plans is the best way to achieve cost-effective care. Plans receiving capitation payment could offer productivity incentives to physicians if desirable."

Economic engineers as classical liberals

I received a book in the mail the other day called
Where Economics Went Wrong
Chicago's Abandonment of Classical Liberalism
by David Colander and Craig Freedman

If you just google the title without the subtitle, you find that there's an enormous body of opinion on where Economics went wrong.  But as the publisher states on the book's webpage (linked above) this book is about "How modern economics abandoned classical liberalism and lost its way."

My limited personal experience is that whenever my name appears in this kind of discussion, the authors disapprove of market design, or experiments, or both. So I was relieved to find myself missing from the first chapter, and surprised to find my work described instead in the final chapter, called "The Art and Craft of Economics: The Classical Liberal Attitude," which is organized around a brief set of profiles.

They write (p141) that they can't recommend any specific set of rules to become a good economist, "But what can be provided is a sketch of how we believe applied economics policy analysis should be done, or at least a rough version of that approach.  In this chapter we provide that guidance by sketching out the work of six economists whom we see as exemplifying the Classical Liberal method.  Our methodological suggestion to economists is to emulate them; consider their writings carefully and decide what aspect might apply legitimately to a variety of contexts."

and (p144): "The best way of conveying our conception of what is at least suggestive of a Classical Liberal stance is to present a handful of economists who, in our view, reflect this attitude. We have chosen six economists: Edward Leamer, Ariel Rubinstein, Alvin Roth, Paul Romer, Amartya Sen, and Dani Rodrik. ... We are not singling out any one of their specific practices as a model that should be followed assiduously. Instead, we are suggesting that they provide role models that might fruitfully be emulated by any cohort of young economists."

Avinatan Hassidim (and market design) and Katrina Ligett (and privacy) celebrated in Israel

"The Marker," the biggest economic newspaper in Israel, includes two researchers who will be familiar to many readers of this blog in their list of "40 under 40" .

Here's their writeup on Avinatan Hassidim, a computer scientist and market designer at Bar Ilan University:
אבינתן חסידים, 37
"Among other things, Hassidim led the development of an algorithm for embedding doctors in Israel in a residency internship in hospitals (instead of the lottery method) and in recruiting students for a master's degree in psychology for the study programs. Today he is working on developing a system for placing graduates of law studies in Israel in places of specialization."
***********

Here's his web page: Avinatan Hassidim
"My main research interests are auction theory, mechanism design, cake cutting, algorithmic game theory and approximation algorithms. My works have been used to devise the Israelli Medical Interns Lottery, the Israelli Psychology Match and to assign children to schools in various cities in Israel. "
**************

Earlier related posts:

Thursday, March 26, 2015

Redesigning the Israeli Medical Internship Match

Monday, July 14, 2014

Two new labor market matching mechanisms in Israel: for psychologists, and doctors

***************
And here's The Marker on computer scientist Katrina Ligett,
קתרינה ליגת,
who is singled out for her work on differential privacy (including how privacy can have counterintuitive consequences in equilibrium), among other things.


HT: Ran Shorrer
***********

Update: Itai Ashlagi points out to me that Ya'akov Babichenko of the Technion, who studies learning in games, is also on the list:

יעקב בביצ'נקו

Transplantation is one of the casualties of Venezuela's economic crisis

The Pulitzer Center reports:

The Waiting List: Organ Transplants in Venezuela

"The government-managed organ procurement system that facilitated organ donations for transplant patients stopped working in 2017, leaving thousands of patients with no option to receive a transplant.

"The country has seen the number of kidney transplants from deceased donors performed every year drop from a record of 240 in 2012,to only nine in 2017. Government funding for transplant activity has also been curtailed, making it harder for low-income patients to obtain a transplant. This procedure has now become a luxury only the wealthiest patients can afford. "

Is legal commercial surrogacy coming to New York and Michigan?

New York and Michigan are two states in which  surrogacy is illegal, but the winds of change are blowing, with new legislation that would legalize it introduced, but not yet passed.  (My understanding is that in both states, surrogacy contracts are presently unenforceable, and there are criminal penalties for commercial contracts.)

Possible changes in New York's surrogacy law are discussed in the New York Law Journal:

Surrogacy in New York: Boon or Bane?
By Harriet Newman Cohen and Kristen E. Marinaccio | July 27, 2018

"New York, like many other states, enacted legislation prohibiting surrogacy agreements following the heartbreaking drama of Baby M. Three decades later, New York is one of just four states1 that still bans surrogacy agreements—however, that soon may change. This article will discuss the proposed legislation known as the “Child-Parent Security Act of 2017” (CPSA) which would lift the ban on surrogacy agreements in New York. It will explore the subtle and not so subtle benefits and burdens that may ensue if the legislation is passed.
...

"Baby M’s Influence on N.Y. Law Makers
In the mid-1980’s, before Baby M, many states including New York were considering enacting legislation to regulate surrogacy agreements.2 By early 1987, a bill was pending in the New York Legislature.3 That same year, just across state lines, in New Jersey, an emotional legal battle was being waged against a traditional surrogate, Mary Beth Whitehead, when she refused to surrender “Baby M” to the intended parents, Elizabeth and William Stern.4 The dramatic media coverage of the Baby M case, which included images of the police forcibly removing the baby from Ms. Whitehead’s arms, quickly caught the public’s attention.5 By June, 1987, facing fierce opposition from feminist and religious lobby groups, a seemingly antithetical coalition, the pending bill in New York was withdrawn.6

"In 1988, the New York State Task Force on Life and the Law unanimously concluded that New York should discourage traditional and gestational surrogacy agreements.7 In 1992, the New York State Legislature adopted that recommendation, declaring all surrogacy agreements void and unenforceable.8"
*************

In Michigan, two bills introduced (but not yet passed):

SENATE BILL No. 1082 September 5, 2018, Introduced by Senators WARREN, ANANICH, CONYERS and YOUNG and referred to the Committee on Families, Seniors and Human Services.      A bill to establish gestational surrogate parentage contracts;  to allow gestational surrogate parentage contracts for  compensation; to provide for a child conceived, gestated, and born  according to a gestational surrogate parentage contract; to  prescribe the duties of certain state departments; to provide for  penalties and remedies; and to repeal acts and parts of acts.

The companion SENATE BILL No. 1084 provides for an appropriate birth certificate with the intended parents as the parents.

The Guardian celebrates British kidney exchange

One day. Six operations. Three kidneys. The story of an organ donor chain


"The process relies on logistical masterminding by staff at the UK’s 23 transplant centres, as much as it does on the mind-boggling computer science it’s built around. Ideally, all the operations in a chain are scheduled to take place on the same day, within eight weeks of a matching run, and only after everyone has been painstakingly assessed to ensure the matches will work and they are well enough for surgery.

"It’s a curiously under-recognised scheme, among the general public at least, but its impact is growing every year. The first UK kidney exchange took place in 2007, with a two-way swap between four people. In 2017/18, 127 of the 1,010 living kidney transplants carried out – one in eight – came about as a result of the sharing scheme. It’s also a British success story: the UK far outstrips any other country in Europe in this field, carrying out about half of all the transplants made possible by sharing schemes."

**********

And here's the NHS Blood and Transplant's ANNUAL REPORT ON LIVING DONOR KIDNEY TRANSPLANTATION REPORT FOR 2017/2018 (1 APRIL 2003 – 31 MARCH 2018)

"Key findings
• There were 940 adult living donor kidney transplants performed in the UK in
2017/18 an increase of 12 transplants compared to 2016/17. Of these, 449 (421 in
2016/17) were related, 237 (236 in 2016/17) were unrelated, 5 (18 in 2016/17) were HLAi, 41 (64 in 2016/17) were ABOi, 123 (109 in 2016/17) were paired/pooled and 85 (80 in 2016/17) were altruistic donor transplants. The equivalent number of paediatric transplants was 70, an 3% decrease from the previous year.
• The proportion of living donors across the UK being prescribed anti-hypertensive drugs is 5% at one year, 7% at five years and 11% at ten years post donation.
• Serum creatinine for living donors in the UK is 104 (IQ-range 90-121) at one year, 96 (84-111) at five years and 93 (81-106) at ten years post donation.
• The UK rate of graft survival five years after adult living donor kidney transplant by type is; unrelated 94%, related 92%, HLAi 81%, ABOi 87%, Paired exchange 95% and Altruistic 91%.
• 38% of registered patients have been transplanted and 63% of identified transplants proceed."

Economic design in Budapest, June 2019 (submissions are open now)

Paper submissions are now invited for the

2019 Conference on Economic Design: Budapest, Hungary, June 12-14, 2019

The Scope:

The conference welcomes paper submissions from many different fields such as economics, business, finance, politics, computer science, operations research, law, history relevant to mechanism or institution design in a broad sense, regardless of whether contributions are theoretical, empirical, experimental, historical or practical. Subjects include but are not limited to auctions, matching, school choice, college admission, organ exchange, decentralised markets, random market mechanisms, voting, social choice, taxation, tax reform, coalition formation, price formation, ranking and scoring, measurements of power and influence, contest, fair division, contract, bargaining, negotiation, market design implementation, pricing on electricity, pricing on public utilities, pricing on cloud computing services, online allocation mechanisms, online auctions, market design experiments, public goods experiments, behavioural mechanism design, information and incentive, digital sport market for labour, market design in transportation sector, institution and organisation, health care, health policy, health insurance, pension scheme, fiscal policy, monetary policy, growth and development, performance evaluation, arbitration, patent design, governance, refugee assignment, robust mechanism design, matching in dynamic environments, rationality and irrationality in market design, etc.

The Keynote Speakers are:

Leonid-Hurwicz Lecture: Philippe Jehiel (Paris School of Economics)

Murat Sertel Lecture: Bhaskar Dutta (University of Warwick)

Paul Kleindorfer Lecture: Bumin Yenmez (Boston College)

Important Dates:

Paper Submission Opens: 19-Nov-2018

Paper Submission Deadline: 18-Feb-2019

Some movement towards kidney exchange in Germany

Axel Ockenfels writes:

"On 9 November 2018, members of the parliament of the German liberal party FDP submitted a petition ("Chancen von altruistischen Organlebendspenden nutzen – Spenden erleichtern") to ask the German government to draft a law that makes kidney exchange, non-directed altruistic kidney donations into a pool and, under certain circumstances, directed kidney donations to strangers possible in Germany": 
Chancen von altruistischen Organlebendspenden nutzen – Spenden erleichtern
"Make use of the opportunities of altruistic organ donation - make donations easier"

It calls for specific amendments to remove the current legal restrictions on kidney exchange.

German market design economists have been at the forefront of efforts to change the transplant law in this and other respects.

Here's an earlier post on the subject, whose links contain links to still earlier ones--maybe this series will converge soon in a way that reverses the decline in transplantation in Germany:

Tuesday, July 3, 2018

Obstacles to kidney exchange in Germany

Professional line sitters: Giving the gift of time

Have an urgent need to shop Black Friday bargains, but don't like waiting on lines in the cold and dark?  There's a business that will take care of that for you...

Professional Line Sitters Make Up to $35 an Hour — And This Is Their Busiest Time of the Year

Some links if you're too busy to read the story:
Skip the line (STL) inWashington DC
Same Ole Line Dudes in New York City
InLine4You an app for both sides of the market

"The Supreme Court website says security starts admitting people to oral argument sessions at 9:30 a.m., but “visitors may begin lining up on the Front Plaza as early as they feel comfortable” — which sometimes means four days in advance. The average SCOTUS wait time Goff gets tapped for runs about five hours (she charges $35 per hour), with occasional overnight requests for big cases like the travel ban and Masterpiece Cakeshop v. Colorado Civil Rights Commission."

Kidney exchange in Turkey, some recent reports

Here are an academic paper on the kidney exchange program at Baskent University, and a news story about a kidney exchange in Turkey between two Ukranian patient-donor pairs:

Our Experience with Paired Kidney Exchange Transplantation
Haberal, Mehmet; Akdur, Aydincan; Karakayali, Feza Yarbug; Ozcelik, Umit; Moray, Gokhan; Kulah, Eyyup; Inal, Ali; Torgay, Adnan; Arslan, Gulnaz
Transplantation: July 2018 - Volume 102 - Issue - p S499

"Seven pairs were matched from July 2015 to September 2017 and we performed 14 PKE (5 women, 9 men) transplants. Mean recipient age was 49.8±11.5 (range: 23-61) and mean donor age was 50.4± 12.4 (range: 38-64) years. Five of the donors were fathers, one of them was a mother, 3 were husbands and 5 were wives. Mean mismatch ratio was 5±1 (range: 3-6). Reason for exchange was ABO incompatibility for 10 patients and positive crossmatch and presence of donor specific antibodies for 4 patients. All were 2-way donations. Median waiting time for getting suitable donor after registration was 3 months. Two of the recipients were retransplanted and desensitization with plasmapheresis was needed for panel reactive antibody positivity. One patient underwent preemptive kidney transplant.
...
"ABO incompatibility continues to pose a serious problem for transplantation candidates, especially in kidney and liver transplants. Our small series shows that PKE transplantation is an alternative for patients without a viable living-related donor or deceased compatible donor organ."
************

Kidney swap in Turkey offers new life to 2 Ukrainians
Coming from Ukraine, Valeriy Horobets, Viacheslav Shcherbyna undergo paired kidney exchange surgery in Istanbul, October 16, 2018

At Medicana International Istanbul Hospital ,
"Two Ukrainian citizens welcomed their new lives in Turkey after a cross-kidney transplant surgery in Istanbul."

Global kidney exchange celebrated together with the Declaration of Istanbul, in the AJT

Here's the recent AJT Report from the American Journal of Transplantation,

which touches on various aspects of kidney politics, including global kidney exchange:

Ten‐Year Celebration ofthe Declaration of Istanbul

Lara C. Pullen

First published: 29 October 2018

https://doi.org/10.1111/ajt.15138

Abstract  "This month's installment of “The AJT Report” discusses updates to the Declaration of Istanbul on this key achievement's 10th anniversary. We also report on Italy's recommendation earlier this year regarding the Global Kidney Exchange, and join the transplantation community in bidding farewell to writer and “The AJT Report” originator, Susan Pondrom."

Here's the part about Global Kidney Exchange :

"

Italy Recommends Global Kidney Exchange to the World Health Organization

"In January 2018, Italy recommended a proposal for a global kidney exchange (GKE) to the World Health Organization (WHO).1 The recommendation was part of a collection of statements submitted by Member States and other participants of the 142nd session of the WHO Executive Board.

"Michael Rees, MD, PhD, a kidney transplant surgeon at the University of Toledo Medical Center in Ohio, and Alvin Roth, PhD, a Nobel Prize–winning economist at Stanford University in Palo Alto, California, launched GKE to address the reality that poverty is the biggest global barrier to transplantation and to develop a means for poor people from developing countries to donate and receive organs.2 At its core, GKE is a system to support transplant surgeons in their efforts to help people who are not only very sick and dying, but also too poor to afford dialysis. The system is also controversial in the transplantation community and has been associated with logistical barriers. Even so, Dr. Rees and Dr. Roth remain dedicated to seeing the system developed and implemented around the world.

"The statement from Italy represents a significant endorsement of GKE. It notes that internationally, 2 million to 7 million people die annually from kidney failure, and that kidney disease and other noncommunicable diseases have replaced communicable diseases as the most common causes of premature death worldwide. However, as billions of dollars are spent in low/middle‐income countries (LMICs) to reduce the burden of communicable diseases, significantly less is spent on noncommunicable diseases such as kidney failure. The statement asserts that not only is transplantation the preferred treatment for kidney failure, but that kidney exchange makes it possible to extend the reach of living donation, and for healthy living donors whose kidneys are incompatible with loved ones to exchange their kidneys for those that are compatible with the people they love.

"The first of Italy's action items stated, “We encourage WHO to include organs and in particular kidney transplantation in its program as we believe that oversight, cooperation and assistance of the WHO to carry out a pilot program with strong international governance that is consistent with the highest ethical and legal standard, and that carefully approves participating countries, facilities, healthcare providers and patient–donor pairs should be conceived and implemented.” Italy's statement referred to GKE, noting that such a program allows patients to receive a compatible kidney from another patient's donor. The statement also noted that the savings attained in high‐income countries could support long‐term care of the LMIC donor and recipient in their home country.

"This request sits in conflict with the 2017 Statement of the Declaration of Istanbul Custodian Group concerning ethical objections to the proposed GKE Program.3"

• 1Italian Government. Statement from Italy. WHO, Geneva, Switzerland, 2018. Retrieved from http://apps.who.int/gb/statements/eb142/PDF/22/Italy-3.1.pdf.
• 2Pullen LC. Global kidney exchange: Overcoming the barrier of poverty. Am J Transplant. 2017;17:2499‐2500.
  Wiley Online LibraryPubMedWeb of Science®Google ScholarFind it @ Stanford
• 3Declaration of Istanbul Custodian Group. Statement of the Declaration of Istanbul Custodian Group Concerning Ethical Objections to the Proposed Global Kidney Exchange Program. 2017. Retrieved from https://www.declarationofistanbul.org/resources/policy-documents/795-statement-of-the-declaration-of-istan-bul-custodian-group-concerning-ethical-objections-to-the-proposed-global-kidney-exchange-program
• ***********
• The statement by the group that calls itself the 'Declaration of Istanbul Custodian Group,' is a very strange document: it opposes GKE, on the basis of a series of misleading, confused and sometimes outright false statements about it, and recommends that patients in poor countries who presently cannot afford transplantation should wait until their countries become wealthy enough to provide transplantation to all their citizens domestically, for fear that they would be exploited by being allowed to participate in what for them would be life-saving kidney exchange in countries that have it.
• Of course, the goal of having all nations able to adequately take care of their citizens who need transplants is worth working towards. No nation can yet claim to have reached that point, and international cooperation is a step in that direction.

See all my posts on Global Kidney Exchange here.

Repugnance watch: Dwarf tossing and the DC Circuit Court of Appeals

When I first wrote about repugnant transactions in Roth (2007), dwarf tossing was among the examples I used.  Many blog posts about repugnance later, it was with a sense of recognition that I read the following story from Mother Jones about President Trump's latest nomination to the federal appellate courts:

Trump’s Nominee to Replace Kavanaugh Is a Staunch Defender of Dwarf-Tossing
Neomi Rao is best known as Trump’s anti-regulation czar, but she’s a veteran of the culture wars.

"Neomi Rao, Trump’s nominee to replace Brett Kavanaugh on the powerful DC Circuit, who has written at least two law review articles and a blog post in which she defended dwarf-tossing.

"Especially popular in Florida bars, dwarf-tossing is the strange spectacle in which competitors throw Velcro-clad little people at a wall or mattress like a shotput. The longest toss wins. The sport has been banned in some American states and parts of France, where a judge upheld such bansbecause of “considerations of human dignity.” Rao considers these laws an affront to individual liberty that fails to recognize the right of the dwarf to be tossed. In one article, she wrote that the decision in France upholding the dwarf-tossing ban was an example of “dignity as coercion” and that it “demonstrates how concepts of dignity can be used to coerce individuals by forcing upon them a particular understanding of dignity.”

"Dwarf-tossing is an odd cause for a federal judicial nominee to champion. Even weirder, Rao has invoked it repeatedly in her writing to make the case that a misguided focus on human dignity is leading US courts to run afoul of the Constitution in decisions that advance LGBT rights and racial equality. "

HT: Kim Krawiec

Congratulations to Fuhito Kojima, on the Enjoji Jiro Memorial Prize

My colleague Fuhito Kojima has a lot to be congratulated on lately, and today comes another cause for congratulations.  He shares the 5th Enjoji Jiro Memorial Prize by the Japan Center for Economic Research. The prize recognizes 'young and mid-level economists under 45 years of age who have made achievements in the field of economic theory, and have a promising future.'

Here's the story from today's Nikkei Shimbun Morning Paper:

第5回「円城寺次郎記念賞」 小島・渡辺両氏に

2018/11/18付

日本経済新聞　朝刊

"The 5th "Jiroji Jiro Memorial Award" To Mr. Kojima and Mr. Watanabe"

Congratulations, Fuhito!

**********
I used Google translate to translate the headline, but for the following paragraph it had trouble with a word that I gather in this context means "between junior and senior in age/career," which came out as saying that Fuhito is a "young and medium-sized economist ." (The description of the prize above comes from an English language report on the 2009 prize...)

The resident match can be confusing, in PNAS by Alex Rees-Jones and Samuel Skowronek

Here's a recent paper in PNAS, |
An experimental investigation of preference misrepresentation in the residency match
Alex Rees-Jones and Samuel Skowronek
www.pnas.org/cgi/doi/10.1073/pnas.1803212115

"The development and deployment of matching procedures that incentivize truthful preference reporting is considered one of the major successes of market design research. In this study, we test the degree to which these procedures succeed in eliminating preference misrepresentation. We administered an online experiment to 1,714 medical students immediately after their participation in the medical residency match—a leading field application of strategy-proof market design. When placed in an analogous, incentivized matching task, we find that 23% of participants misrepresent their preferences. We explore the factors that predict preference misrepresentation, including cognitive ability, strategic positioning, overconfidence, expectations, advice, and trust. We discuss the implications of this behavior for the design of allocation mechanisms and the social welfare in markets that use them

Black markets for marijuana in Canada, where marijuana is now legal

Here are some accounts of the bumpy road to a thick legal market for marijuana:

From the NY Times, on how stores continue to sell not yet legalized products still available on the black market:
Vancouver, Canada’s Marijuana Capital, Struggles to Tame the Black Market

From the Guardian, on the shortage of legal product in face of strong demand:
Weed woes: Canada struggles to meet huge demand for legal cannabis
Numerous stores dealing with empty shelves and disgruntled customers, with fears many consumers will turn to black market

“Now that we can’t supply them, they’re still going to find it,” [a legal supplier with empty shelves] said. “There’s no shortage of weed in Labrador City. Just the legal stuff.”

Xenotransplants: the (evergreen) promise of transplantable organs from pigs

Wouldn't it be great if the shortage of transplantable organs could be fixed by figuring out how to grow them in farm animals? (Yes, that would raise a bunch of issues of its own, but so does meat eating...)

The NY Times has the story of how that might be closer than it has been in the past:
20 AMERICANS DIE EACH DAY WAITING FOR ORGANS. CAN PIGS SAVE THEM?
THANKS TO GENETICALLY ENGINEERED PIGS, THE DONOR-ORGAN SHORTAGE COULD SOON BE A THING OF THE PAST.


It includes lots of promising news, and this observation:
“The joke about xenotransplantation is that it’s always just around the corner, and it always will be,” says Parsia Vagefi, the chief of surgical transplantation at the University of Texas Southwestern Medical Center in Dallas. “But recent progress has been so remarkable that for first time it feels like we’re on the verge of a definitive solution to the organ crisis.”
*************

And of course, note that many more than 20 Americans die each day due to a shortage of organs:

Wednesday, November 14, 2018

The Terrible Toll of the Kidney Shortage, by McCormick, Held and Chertow

The law and economics of market design: conference in Mannheim November 15-16

The program is here, but for some reason I can't copy it.
Kim Krawiec and Peter Cramton will be giving keynote addresses.

Market design seems like a natural for a conference on law and economics...

The Terrible Toll of the Kidney Shortage, by McCormick, Held and Chertow

An editorial in the Journal of the American Society of Nephrology counts the high human costs of the kidney shortage in terms not only of deaths among those on the waiting list for a deceased donor transplant, but also among the other three-fourths of kidney failure patients who are not added to the waiting list but who would medically benefit from a transplant.

The Terrible Toll of the Kidney Shortage,
by Frank McCormick, Philip J. Held, and Glenn M. Chertow

"to see the full extent of the harm done by the kidney shortage and the potential benefit from ending it, let us assume that 50% of those who are diagnosed with ESRD could medically benefit from a transplant. (This assumption is consistent with the findings of Schold et al. 5 that, if all of the patients on dialysis who have a life expectancy of >5 years were placed on the kidney waiting list, the number on the list would almost double.) Thus, half of the 126,000 patients who are currently diagnosed with ESRD each year—63,000 patients—might medically benefit from a transplant. However,if only 20,000 patients per year receive a transplant, the remaining 43,000 would join the growing toll of those who die prematurely because of the kidney shortage. To put this in perspective, this is the same death toll as from 85 fully loaded 747s crashing each year.

*************

See my earlier post on earlier, defining work on the costs of the organ shortage:

Saturday, October 17, 2015

A Cost-Benefit Analysis of Government Compensation of Kidney Donors by Held, McCormick, Ojo, and Roberts

Welfare of sophisticated versus naive players revisited, by Babaioff, Gonczarowski, and Romm

Here's a new paper with a nuanced view of how well sophisticated players may do in a non-strategy-proof mechanism:

Playing on a level field: Sincere and sophisticated players in the Boston mechanism with a coarse priority structure
Moshe Babaioff, Yannai A. Gonczarowski, Assaf Romm∗
October 15, 2018

Abstract: Who gains and who loses from a manipulable school choice mechanism? We examine this question with a focus on the outcomes for sincere and sophisticated students,and present results concerning their absolute and relative gains under the manipulable Boston Mechanism (BM) as compared with the strategy-proof Deferred Acceptance (DA). The absolute gain of a student of a certain type is the difference between her expected utility under (an equilibrium of) BM and her utility under (the dominant strategy quilibrium of) DA. Holding everything else constant, one type of a player has relative gain with respect to another type if her absolute gain is higher. Prior theoretical works presented inconclusive results regarding the absolute gains of both types of students, and predicted (or assumed) positive relative gains for sophisticated types compared to sincere types. The empirical evidence is also mixed, with different markets exhibiting very different behaviors. We extend the previous results and explain the inconsistent empirical findings using a large random market approach. We provide robust and generic results of the “anything goes” variety for markets with a coarse priority structure. That is, in such markets there are many sincere and sophisticated students who prefer BM to DA (positive absolute gain), and vice versa (negative absolute gain). Furthermore, some populations may even get a relative gain from being sincere (and being perceived as such). We conclude by studying market forces that can influence the choice between the two mechanisms.

MIT School choice summit: Nov. 13

A big group of academics and practitioners involved in school choice will gather in Cambridge to take stock of what we have learned, and still hope to learn, about school choice.

MIT SCHOOL ACCESS AND QUALITY SUMMIT 2018

"November 13, 2018 | Cambridge, MA
The MIT School Access and Quality Summit will focus on school enrollment strategies that can increase access and generate data to improve portfolio planning and the measurement of school effectiveness. Researchers will present new findings on the impact of policy interventions, and policymakers will share their experiences with implementation. Through these conversations, we hope to spark long-term partnerships between researchers and practitioners, and prompt continuous interaction between rigorous research and policy design, implementation, and evaluation."

Tuesday, November 13

9:00 AM  Welcome and Introduction
Ian Waitz, Vice Chancellor for Undergraduate and Graduate Education, MIT

9:15 AM  Leveraging Enrollment Mechanisms to Evaluate Impact
Joshua Angrist, Director, School Effectiveness and Inequality Initiative
Parag Pathak, Director, School Effectiveness and Inequality Initiative

9:45 AM  Simplifying Enrollment in Chicago: A First Look at the Adoption of GoCPS
Lisa Barrow, Senior Economist, Federal Reserve Bank of Chicago
Tony T. Howard, III, Executive Director of Enrollment and Education Policy, Chicago Public Schools

10:45 AM  Break

11:00 AM  Keynote
Richard Carranza, Chancellor, of New York City Department of Education

11:30 Taking Stock of School Choice Reforms
Neil Dorosin, Executive Director, Institute for Innovation in Public School Choice

12:00 PM  Working Lunch

Case Consultancies
Introduction by Carrie Conaway, Chief Research and Strategy Officer, Massachusetts Department of Elementary and Secondary Education

1:30 PM  Improving School Quality in Camden
Paymon Rouhanifard, Former Superintendent, Camden City School District

2:00 PM Evidence on the Determinants and Consequences of School Choice from Washington DC
Steven Glazerman, Senior Policy Fellow, Mathematica Policy Research
Dallas Dotter, Researcher, Mathematica Policy Research
Claudia Luján, Deputy Chief, Strategic School Planning and Enrollment, District of Columbia Public Schools

3:00 PM  Break

3:15 PM  Leveling the Playing Field for High School Admissions in New York City
Sarah Cohodes, Assistant Professor of Education and Public Policy, Columbia University
Nadiya Chadha, Director of High School Admissions Research and Policy, New York City Department of Education

4:15 PM  Developing a National Research Agenda for Access and Choice
Douglas Harris, Director, The National Center for Research on Education Access and Choice

***********
Update: here's a Nov. 20 news report from MIT following the conference:
Exploring school choice
MIT School Access and Quality Summit brings policymakers, educators, and researchers together to examine strategies and ways to measure effectiveness.

Repugnance watch: Greyhound racing banned (even) in Florida

Florida had an active greyhound racing industry, now banned by referendum:
Here's the story from the Orlando Sentinal:
How vote to end Florida greyhound racing won and what comes next

"After years of failing to push greyhound racing reform through the Florida Legislature, animal-welfare advocates took their mission directly to the state’s voters this week — scoring such a decisive victory that proponents say it signals the eventual end of the sport across the country.

“A 69-percent vote in Florida — a state with a still-conservative electorate — shows that this is now unstoppable,” said Carey Theil, executive director of GREY2K USA, the main force behind the Yes on 13 campaign to support the racing ban. “It sends a message not only to the remaining dog tracks in the nation but all around the world that dogs are members of our families and we will not tolerate industries that harm them.
...
"Florida’s 11 active dog tracks will have until Jan. 1, 2021, to phase out their live greyhound racing. They’ll still be able to race horses, if their tracks can accommodate the event, and they’ll still be able to have wagering on simulcast races from other tracks, including from dog tracks in the five remaining states where the practice is still active and legal."
*******

A NY Times article begins by considering the problem of rehoming the racing dogs who will be retired, but includes an interesting feature of the industry that has kept dog racing active in Florida:

Thousands of Greyhounds May Need Homes as Florida Bans Racing

"Florida’s tracks remained in part because of state laws that require them to continue racing in order to keep their lucrative gambling operations. In Florida, only existing “parimutuel” facilities like dog tracks and horse tracks could obtain licenses to operate card rooms and slots."

Obvious manipulations by Pete Troyan and Thayer Morrill

Here's a paper motivated by the fact that (obviously:) there are going to be many more mechanisms that aren't obviously manipulable than there are mechanisms that are obviously strategy proof, or even strategy proof...

Obvious Manipulations
Peter Troyan, Thayer Morrill∗ (*in random order)
October 3, 2018

Abstract: A mechanism is strategy-proof if agents can never profitably manipulate, in any state of the world; however, not all non-strategy-proof
mechanisms are equally easy to manipulate - some are more “obviously”
manipulable than others. We propose a formal definition of an obvious
manipulation and argue that it may be advantageous for designers to
tolerate some manipulations, so long as they are non-obvious. By doing
so, improvements can be achieved on other key dimensions, such as
efficiency and fairness, without significantly compromising incentives.
We classify common non-strategy-proof mechanisms as either obviously
manipulable (OM) or not obviously manipulable (NOM), and show that
this distinction is both tractable and in-line with empirical realities
regarding the success of manipulable mechanisms in practical market
design settings

"Intuitively, a manipulation ...is classified as “obvious” if it either makes
the agent strictly better off in the worst case ...or it makes the agent strictly better off in the best case..."

Marijuana scores some gains in the voting booth

The NY Times has the story:
Marijuana Embraced in Michigan, Utah and Missouri, but Rejected in North Dakota

"Marijuana initiatives appeared on ballots in four states in the midterm elections. In Michigan and North Dakota, initiatives gave voters the opportunity to legalize marijuana for recreational use. In Missouri and Utah, voters chose whether to allow people who are sick to use the drug for medical reasons."

See my earlier post:

Friday, October 6, 2017

Marijuana in America--getting less repugnant with each election

Arrow lecture at Columbia University this evening

The 11th Annual Kenneth J. Arrow Lecture | Market Design in Large Worlds: The Example of Kidney Exchange
Thursday, November 8, 2018
6:00 pm - 7:30 pm
International Affairs Building, 420 W. 118 St., New York, NY 10027 1501


Please join us for the 11th Annual Kenneth J. Arrow Lecture delivered by Alvin Roth, the 2012 Nobel Laureate in Economic Sciences and Craig and Susan McCaw Professor of Economics at Stanford University, on "Market Design in Large Worlds: The Example of Kidney Exchange."
Discussants: Parag Pathak, Jane Berkowitz Carlton and Dennis William Carlton Professor of Microeconomics at MIT
Joseph E. Stiglitz, 2001 Nobel Laureate in Economic Sciences and University Professor at Columbia University Description:

Abstract: "Marketplaces are often small parts of large markets, and so potential marketplace participants may have large strategy sets, that include actions taken outside of the marketplace. And markets require social support, so the behavior of people who do not intend to participate in the market may nevertheless be important for market design. This lecture will illustrate these points with some examples, drawing most heavily on the experience of kidney exchange."

About the Kenneth J. Arrow Lecture Series: Kenneth J. Arrow’s work has shaped the course of economics for the past sixty years so deeply that, in a sense, every modern economist is his student. His ideas, style of research, and breadth of vision have been a model for generations of the boldest, most creative, and most inventive economists. His work has yielded such seminal theorems as general equilibrium, social choice, and endogenous growth, proving that simple ideas have a profound impact. The Kenneth J. Arrow Lecture Series highlights economists, from Nobel laureates to groundbreaking younger scholars, whose work builds on Arrow’s scholarship as well as his innovative spirit. The books in the series are an expansion of the lectures that are held in Arrow's honor at Columbia University.

Kidney exchange needs to be conducted at scale, in Vox

Nikhil Agarwal, Itai Ashlagi, Eduardo Azevedo, Clayton Featherstone,  and Omer Karaduman summarize their recent paper in Vox..eu:

Market failure in kidney exchange
03 November 2018

National kidney exchange platforms significantly boost the number of life-saving kidney transplants by finding complicated exchange arrangements that are not possible within any single hospital. This column examines US data and finds that the majority of kidney exchanges continue to be performed within hospitals, suggesting a fragmented market that comes at a large efficiency cost. National platforms may need to be redesigned to encourage full participation, with reimbursement reform.

Discussion of marijuana in the U.K.--a police chief looks ahead

Now that medical marijuana is legal, can legal recreational use be far behind?  The Guardian has the story.
Former Met police chief urges rethink on cannabis
Bernard Hogan-Howe says there is clear evidence to warrant review of prohibition

"He said: “We already know from the evidence around the world that where people use it for medicinal purposes, it slides into recreational. Surely it’s better that we get ready for that potential change.”

"His intervention follows the legalisation of recreational cannabis in Canada last week, its decriminalisation in Uruguay, Portugal and in several US states, and the relaxation of cannabis laws in the UK to allow the prescription of cannabis-based medicines from next month.
...
"Hogan-Howe joins a growing list of prominent figures who have cast doubt on the coherence of the UK’s approach to enforcing laws that are often ignored with impunity, given that a number of police forces have publicly said they would not prosecute perpetrators of low-level cannabis offences."

The case for compensating Australian plasma donors, by Bob Slonim

Here's Bob Slonim, explaining the current situation in Australia, of unpaid Australian plasma donors, and big imports of plasma products from countries in which donors are paid:

How Australia can fix the market for plasma and save millions

"The National Blood Authority’s 2016-2017 annual report indicates Australian imports of immunoglobulin, a plasma component, provide 44% of domestic demand. This costs A$120 million while the remaining 56% comes from domestic supply costing A$413 million.

"This implies the domestic supply of immunoglobulin costs over three times more per unit than what is imported, despite domestic donors not being compensated."

Waze carpool--launched nationwide

At the NBER market design conference, Michael Schwarz spoke of market design with his practioner hat on (he's Microsoft's chief economist, and former chief scientist at Waze when he worked for Google). He points out the importance of reducing transaction costs, because "enormous [potential] markets may consist of tiny transactions."

Speaking of which, he points out that Waze carpool went live throughout the U.S. last month.

Here's a story: Waze launches carpool service across the U.S.

"Carpooling isn’t just a smart way to cut down on weekly expenditures. It’s also good for the planet: Sharing a car with coworkers, friends, or neighbors keeps 1,600 pounds of greenhouse gas out of the air each year. And if 100 people were to take advantage of a carpool every day, it’d eliminate 1,320 pounds of carbon monoxide and a whopping 2,376,000 pounds of carbon dioxide.

That’s one of the reasons Google-owned navigation platform Waze hopes to lower the barrier to entry. Starting today, it’s launching Waze Carpool, a ridesharing platform it hopes will one day eliminate traffic congestion — and by extension pollution — across the U.S. in all 50 states. The rollout follows successful pilot tests in Israel, California, Texas, Washington, Massachusetts, Illinois, and Nevada."

Some Portuguese press on kidney exchange and market design

When I was in Lisbon I gave two talks, and some interviews.  Here's a nice story written after both my talks:
O que tem a economia a ver com transplantes de rins? Tudo [What Does The Economy Have To Do With Kidney Transplants? Everything.]
by SÓNIA M. LOURENÇO (whose sister once took my experimental economics class at Harvard)

Here's a story that followed the first talk, which was part of an honorary degree ceremony.
A ciência económica ao serviço do amor, saúde e felicidade
by Sandra Maximiano
[G translate: Economic science at the service of love, health and happiness]
Here's a video and some photos of the whole event...

And I gave a tv interview in which the interviewer wished to ignore my pre-interview insistence to talk about game theory and market design and the conference in Portugal as opposed to the recession and recovery, and Italy...(but we reached a sort of compromise...)*

Nobel da Economia em entrevista à TVI critica populismos e alerta para mais migração
Alvin Roth referiu ainda que o fenómeno do aquecimento global vai aumentar a migração.
[G translate: Nobel la Economía in interview with TVI criticizes populism and alert for more migration

Alvin Roth also noted that the phenomenon of global warming will increase migration.]
*************

Private equity job offers to young investment bankers unravel earlier this year, while investment banks try to stem their own unraveling

Two stories from the WSJ about unraveling, at different parts of the financial industry.

1. The WSJ has publishes this year's unraveling story earlier than last year's...

No Experience? No Problem. Private Equity Lures Newbie Bankers With $300,000 Offers.
Annual recruitment drive starts earlier this year as firms try to get a jump on preferred candidates

"An industrywide scramble is under way this week to hire young investment bankers.

"The instigator was Thoma Bravo LLC, which extended its first job offers this past weekend, according to people familiar with the matter. Word spread quickly to rivals, and by Monday interviews were under way at nearly every big firm, including Blackstone Group LP, Apollo Global Management LLC, Carlyle Group LP and TPG.

"Welcome to private equity’s annual recruitment, the frenzied window of interviews and fast-expiring job offers that firms use to fill their junior ranks. The candidates graduated college as recently as last spring and landed at Wall Street investment-banking desks just weeks ago.

"Those lucky enough to get offers will finish their two-year bank analyst programs and start at private-equity firms in the summer of 2020...
...
"Recruiting used to take place during the summer, once applicants had at least a year of experience under their belts. But it has crept earlier as firms try to get a jump on preferred candidates. In 2014, interviews began in February. Last year, recruiting started before Christmas. Applicants describe a frantic period of interviews and “exploding” offers that can expire in 24 hours or less.
**********

2. The investment banks also hire very early in students' college careers, and here's a story about an attempt to resist that urge (good luck with that):

 Goldman, JPMorgan Hit Pause on Intern Recruiting ‘Madness’
A push in recent years to move up application deadlines isn’t bringing in the kinds of candidates the banks need

"Two Wall Street investment banks are easing up in the race to hire their most junior employees.

"Goldman Sachs Group Inc.  and JPMorgan Chase & Co. won’t interview or extend summer internship offers to college sophomores this year and will go back to recruiting students in the fall of their junior year, executives said.

"It is a nod to a softer Wall Street, eager to cast off its sweatbox image to compete with perk-happy Silicon Valley. It is also an acknowledgment that a push in recent years to move up application deadlines isn’t bringing in the kinds of candidates banks need as they try to diversify their overwhelmingly white and male ranks.

“We were contributing to an environment that pressured students to choose rather than to explore,” said Dane Holmes, Goldman’s top human-resources executive. “I want people who want to be at Goldman Sachs, not people who felt they had to say yes to an offer.”

Harvard admissions on trial--dualing economist expert witnesses, interesting details

The Chronicle of Higher Ed has the story:
Dueling Economists: Rival Analyses of Harvard’s Admissions Process Emerge at Trial
There are many strands to this story (and it seems to be ungated), but here I'll just note a few interesting admissions stats.

"Of the 37,000 applicants for admission to the Class of 2019, for instance, 8,200 had perfect grade-point averages, and more than 2,700 had perfect scores on the verbal section of the SAT. But Harvard had only about 1,700 spots to offer. Even if the university wished to consider only grades and test scores, it would be hard-pressed to select a freshman class using those variables alone.
...
"The two economists’ analyses vary in several ways. Perhaps most significant, their respective models include different kinds of applicants. Arcidiacono excludes recruited athletes, the children of alumni, the children of Harvard faculty and staff members, and students on a special list that includes children of donors.

"Card includes them. Though the total number of students who fit those descriptions represents a small fraction of the applicant pool (5 percent), they account for a large proportion of accepted students (29 percent).