Tag Archives: insurance

Paying pharmaceutical firms for capacity is problematic

Castillo et al. 2021 (doi:10.1126/science.abg0889) make many valid points, e.g., vaccine production should be greatly expanded using taxpayer money because the quicker recovery from the pandemic more than pays for the expansion. Castillo et al. also suggest paying pharmaceutical manufacturers for the capacity they install instead of the quantity they produce. The reasoning of the authors is that producers are delaying installing capacity and the delivery of their promised vaccine quantities to save costs and to supply higher-paying buyers first, because the penalties for delaying are small. Producers refuse to sign contracts with larger penalties.

What the authors do not mention is that the same problems occur when paying for capacity. In addition, the capacity needs to be monitored, which is more difficult than checking the delivered quantity. Before large-scale production, how to detect the „Potemkin capacity” of installing cheap production lines unsuitable for large quantities? The manufacturer may later simply claim technical glitches when the production line does not work. Effective penalties are needed, which in turn requires motivating the producer to sign a contract containing these, just like for a quantity contract.

Paying in advance for capacity before the vaccine is proven to work insures firms against the risk of failure, as Castillo et al. say. The problem is that such advance payment also attracts swindlers who promise a miracle cure and then run with the money – there is adverse selection in who enters the government’s capacity contract scheme. Thus capacity contracts should be restricted to firms with a good established reputation. However, vaccines from innovative entrants may also be needed, which suggests continuing to use quantity contracts at least for some firms. If the law requires treating firms equally, then they should all be offered a similar contract.

Exercise is better than working to buy health insurance

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Health insurance does not insure health, but wealth. Exercising to prevent disease is often better than working to buy health insurance to cover treating that disease. For example, cancer, stroke and cardiovascular disease predominantly occur in old age, so insurance against these is highly substitutable with exercise.

The American Association for Critical Illness Insurance in 2011 listed the following average annual premiums by age group for a male nonsmoker based on a $40,000 benefit for treatment of cancer, stroke or heart attack. Age 40: $575 to $610; age 45: $745 to $785; age 50: $940 to $980. Similar premiums in 2019 only buy cancer insurance.

At an after-tax hourly wage of $20, paying these premiums requires 30-50 work hours per year, about 0.6-1 hour per week, or 0.6-1% of waking hours. From a baseline of zero sports, one hour per week of exercise increases lifespan by one year, or by about 1/80 of life expectancy. Whether switching an hour per week from work to exercise (and cutting health insurance to compensate for the lost hourly wage) is a good investment in terms of lifespan depends on how much treatment lengthens life and how much health insurance increases the probability or quality of treatment. Data is difficult to find on both the effect of treatment on lifespan and the effect of health insurance on treatment.

The median survival rate to hospital discharge after EMS-treated out-of-hospital cardiac arrest with any first recorded rhythm is 7.9%. So for serious heart conditions, treatment and thus health insurance does not make much difference. Lung cancer treatment is said to prolong survival by about three months, which also seems small. Even if no health insurance implies no treatment, which is not the case because emergency care is still provided, investing worktime to buy health insurance seems to have a low benefit. People with cancer survive with a probability about 2/3 of the survival probability of a comparable population without cancer, so the upper bound on the benefit of treatment is 2/3 times the probability of getting cancer times the remaining life expectancy. This upper bound is loose, because zero treatment does not reduce the 5-year survival probability to zero.

Putting your money where your mouth is in policy debates

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Climate change deniers should put their money where their mouth is by buying property in low-lying coastal areas or investing in drought-prone farmland. Symmetrically, those who believe the Earth is warming as a result of pollution should short sell climate-vulnerable assets. Then everyone eventually receives the financial consequences of their decisions and claimed beliefs. The sincere would be happy to bet on their beliefs, anticipating positive profit. Of course, the beliefs have to be somewhat dogmatic or the individuals in question risk-loving, otherwise the no-agreeing-to-disagree theorem would preclude speculative trade (opposite bets on a common event).

Governments tend to compensate people for widespread damage from natural disasters, because distributing aid is politically popular and there is strong lobbying for this free insurance. This insulates climate change deniers against the downside risk of buying flood- or wildfire-prone property. To prevent the cost of the damages from being passed to the taxpayers, the deniers should be required to buy insurance against disaster risk, or to sign contracts with (representatives of) the rest of society agreeing to transfer to others the amount of any government compensation they receive after flood, drought or wildfire. Similarly, those who short sell assets that lose value under a warming climate (or buy property that appreciates, like Arctic ports, under-ice mining and drilling rights) should not be compensated for the lost profit if the warming does not take place.

In general, forcing people to put their money where their mouth is would avoid wasting time on long useless debates (e.g. do high taxes reduce economic growth, does a high minimum wage raise unemployment, do tough punishments deter crime). Approximately rational people would doubt the sincerity of anyone who is not willing to bet on her or his beliefs, so one’s credibility would be tied to one’s skin in the game: a stake in the claim signals sincerity. Currently, it costs pundits almost nothing to make various claims in the media – past wrong statements are quickly forgotten, not impacting the reputation for accuracy much.

The bets on beliefs need to be legally enforceable, so have to be made on objectively measurable events, such as the value of a publicly traded asset. By contrast, it is difficult to verify whether government funding for the arts benefits culture, or whether free public education is good for civil society, therefore bets on such claims would lead to legal battles. The lack of enforceability would reduce the penalty for making false statements, thus would not deter lying or shorten debates much.

An additional benefit from betting on (claimed) beliefs is to provide insurance to those harmed by the actions driven by these beliefs. For example, climate change deniers claim small harm from air pollution. Their purchases of property that will be damaged by a warming world allows climate change believers to short sell such assets. If the Earth then warms, then the deniers lose money and the believers gain at their expense. This at least partially compensates the believers for the damage caused by the actions of the deniers.

Fund management fee paid explicitly to nudge consumers to choose better funds

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Mutual funds with lower management fees have higher future before-fee returns (Gil-Bazo and Ruiz-Verdu 2009). Nonetheless, the high-fee funds have not gone out of business, so there must exist a sizable number of silly customers who accept low returns without switching to competitors. When asked explicitly, all fund investors prefer more money to less. Their hourly wage is not large enough to explain their non-switching with the time and hassle costs of comparing fund returns and choosing a new one. Similarly, many Estonians keep their retirement savings in badly performing high-fee pension funds despite the availability of dominating options (Tuleva and LHV index tracking funds). This is costing the customers over one percent of their retirement wealth per year.

By contrast, people with chronic or expensive diseases in the US often pick the health insurance plan that maximises their wealth (coverage minus premiums). This dynamic optimisation involves switching to a different plan when their illness changes. People without costly medical conditions tend not to switch their insurance even when cheaper plans with higher coverage are available.

Both the pension and the insurance plan decisions are complex, but matter greatly for wealth. Why do people pay attention to the financial consequences of their insurance choice when sick, but ignore better options among pension funds (and when healthy, also among insurance plans)? One possibility is that insurance is more salient to the sick, and the greater attention leads to better decisions. Specifically, the premiums and out of pocket payments for medical procedures frequently remind patients of the financial consequences of their insurance, but the missing returns on one’s retirement assets are not observed without explicit comparison to the stock market or competing funds. Most people do not compare their pension plan to the market, so even in retirement may not know what their (counterfactual) wealth would have been had they chosen a better fund .

If it is lack of attention that causes the bad choice of mutual and pension funds, then one solution (proposed by my friend Hongyu Zhang) is to make the management fees more salient by requiring their explicit payment. For example, every month the customer has to transfer the amount of the management fee from their bank account to the fund. Financially, this is equivalent to the fee being deducted from the retirement assets like now (assuming these assets are eventually taxed the same as income, otherwise the transferred fee can be adjusted to make it financially equivalent to the deduction). The attention required is however greater for an explicit payment than for doing nothing following a lack of capital gains. Similarly, requiring customers to pay the difference between the return of their fund and the market return into the fund every two weeks would nudge them towards greater attention to their retirement account.

In practice, such a nudge is unfortunately politically infeasible. Not only would the fund industry lobby against it, but voters would irrationally perceive the required explicit payments as increased taxes. This would make the transition to transferring fees to funds from customers’ bank accounts very unpopular. If people understood the equivalence between low returns on their assets and explicit payments required of them, then they would be financially literate enough to choose low-fee, high-return index funds in the first place. Thus the problem of low-performing pension funds would be absent. To sum up, the fool and his money are soon separated, and it is difficult to protect people from their own bad decisions.

Food security is a manipulative term

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Food security is a manipulative political code phrase designed to scare people and thereby make them support agricultural subsidies, as I have written before. The fear is created by association with sieges before the age of gunpowder, where castles were starved into submission. In modern times, no enemy is silly enough to try to surround and starve a country that is not a city state (e.g. Singapore), because any enemy with a large enough force to prevent food from getting into a country is also strong enough to conquer it quickly by frontal attack. Even unintentional starvation is a public relations disaster (e.g. Yemen), as is a war that drags on, but a quick takeover without too many casualties (e.g. Crimea) actually increases the conqueror’s leader’s popularity in internal politics.

Even if an enemy was stupid and tried to starve a country, the defense against this is not farm subsidies, but many distributed small stockpiles of food. Farms as a food supply are easy to destroy by firebombing the crops and livestock from the air. A small number of large centralised stockpiles are also vulnerable. However, if each household is obliged to keep n months’ worth of non-perishable food at home, then starving the country into submission would take at least n months and bombardment would not shorten that period.

What is really meant by food security is that food prices might rise. However, in all except the very poorest countries in the world, food is so cheap that any reasonable price rise would not cause starvation. For example, according to the USDA, 9 medium baked potatoes fulfill all the nutritional needs of an adult. Similarly, people can survive for a long time eating just wheat flour and water. Wheat flour is 80 cents per kilo, and a kilo of it has 3600 kcal, which is enough for an adult for two days. The price of flour would have to rise at least a hundred times for the cost to lead to starvation in developed countries. Other emergency foods that do not go bad and can be prepared without heating are also cheap, e.g. milk powder, instant oatmeal, canned meats and vegetables.

A price rise is a financial problem, not not a real resource constraint, and as such has a financial solution – insurance. Those afraid of a price rise can use forward contracts to lock in the price. Insurance against a very low-probability event like food prices rising a hundred times is cheap (if such insurance is offered, which it might not be due to the low demand).

Pre-selected health insurance plans for visitors

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A half-year visit to a US university under a J1 visa requires US health insurance. In the University of Pennsylvania, the website of the International Students’ and Scholars’ Office says that they have pre-selected some health insurance plans. According to their cover description and comparison websites, these plans offer significantly less cover than similarly-priced plans not pre-selected by U Penn. My spreadsheet comparing the health insurance options is public. Possibly I have missed some aspects of insurance that justify the price difference. Another explanation is that the pre-selection was done by people who do not themselves use these insurance plans (because they are not visitors to the US) and have little incentive to make an effort to choose the best plan. A more negative and less likely interpretation is that the insurance company is providing incentives (such as kickbacks) for the selectors at U Penn to direct visitors to expensive low-cover plans that are profitable for the insurer.

Insurance in research

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Most developed countries have programs to support research and encourage students to choose careers in it. This suggests scientists have a positive externality on the rest of their country that is not fully internalized in their income. Why not support research by paying the researchers its value, assuming the value can be measured? This would internalize the externality, leading to efficient effort provision.
A potential answer is different risk aversion of the organization supporting science and the scientists. If the institution is involved with many different projects, it is diversified and likely to be less risk averse than a researcher who only has a few projects. The arrangement optimal for both sides is then for the institution to offer insurance (at a cost). The researchers get paid a lower expected amount than the value of their work, but with a lower variance. Instead of the scientists taking loans to finance their work, becoming rich if the project succeeds and bankrupt if it fails, they avoid loans and get a fairly constant salary.
There is a tradeoff between incentives and insurance. If the salary does not depend on success, there is no incentive for effort, but perfect insurance. Having researchers take loans and get the full value of their work provides no insurance, but strong motivation. The compromise is that promotion and pay depend somewhat on research success, but not too much.

Lobbying for free insurance

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In many countries, farmers have managed to obtain free insurance from the government – if there is a bad harvest (due to drought, flood or anything else), the government compensates the farmers using tax revenue. On the other hand, if the harvest is unusually bountiful, the farmers do not pay a windfall tax to the government (which would reduce the tax bill of other people or provide more public services). There is thus no premium for the insurance that the rest of society provides to agribusiness.
A thought experiment: the insurance for the agricultural industry is bought from some insurance company who has to pay the farmers if the harvest is bad. The premiums paid to the insurer are taken from the general tax revenues each year. If the insurance company just breaks even (perhaps due to enough competition between insurers, profits are driven to zero), then the movement of money is the same as in the case of “free” insurance by the government.
Agribusiness has managed to pump some money out of other taxpayers with the free insurance. Their success is explained by the classic lobbying theory: if the benefits of lobbying go to a small group, each member of which gets a large sum, then each member of that group has an incentive to put in the effort and money for influencing politicians. If the cost of lobbying is borne by a large group (say the taxpayers), each member of which only pays a small amount, then members of the paying group do not find it worthwhile to make the effort to counterlobby. The savings are too small to be worth the time and money.
If some politician tries to reduce the subsidy to farmers, they are targeted with intense negative publicity. The agricultural industry claims itself to be necessary for “food security” or “feeding the people”. Nevermind that large amounts of food are currently shipped worldwide. Only the import barriers to foreign-produced food are keeping it out of the domestic market. And food security – who takes a country by blockading it into submission these days? A force large enough to surround the country and cut off food import is large enough to take it by storm, which is considerably quicker. Food security really means preventing the rise of food prices. But this is a financial problem and has a financial solution – insurance against a price rise.
If reducing the farming subsidy does not work, a similar effect can be achieved by providing the same subsidy to everyone and raising taxes. Only the administrative costs are higher than in the case of reducing the subsidy. Other industries could argue that they are affected by the weather or other “national emergencies” and deserve compensation from the government. For example, rainy weather reduces ice cream sales and tourism revenues, so the ice cream sellers and the tourism industry could lobby for the same free insurance as the farmers get. If the world price of some natural resource falls, the miners of that could claim an event beyond their control is threatening them with bankruptcy and ask the government for help. If the tastes of the public change so that some form of entertainment is no longer profitable (theatre, opera, classical music), the providers of that can claim to be important for preserving the national culture and the very civilization itself and ask for taxpayer support… wait, that already happens. It is described in the Yes, Minister and Yes, Prime Minister books.
Of course in reality, the subsidies differ across industries, depending on their lobbying prowess. But if the subsidies were proportional to the tax payments of their receivers, they would neatly cancel with the extra taxes levied to finance them. So the government could abolish subsidies by enlarging the set of receivers to include everyone.
By providing free or subsidized insurance, the government is crowding out private insurance – why insure and pay premiums if the government compensates the loss without premiums? This is especially a problem for risks that are common to many voters. For example, a flood is likely to affect the whole neighbourhood, not just one house. In case of flood damage, the people in the neighbourhood can jointly lobby for the declaration of a disaster zone and a public subsidy for rebuilding. So no need to buy flood insurance. With very few buyers, insurance companies stop offering the product.