Public Health is essential, Healthcare is nice to have.

Epistemic status: Not a medical doctor, But this seems correct.

Let’s say someone challenges you to a game of Russian roulette. But, he says, if you pay him a hundred dollars, he’ll let you play with just one bullet in the gun instead of two, doubling your chances to live.

The first thought through your head when you hear this offer is probably something like “a hundred bucks to double my chances to live? Sounds like a great deal!”. I’m guessing the second is “wait, I still don’t want a one in six chance of dying. Is there any way I can avoid playing Russian roulette in the first place?”

Let’s get back to The Virus. It’s hard to get exact estimates on Corona survival rates, because it’s new and research is ongoing and there’s like a million contradictory studies. But the rough estimate going around is that it has a 1% mortality with good healthcare and a 5% mortality rate without it. I’ve seen a lot of calls for more ICU beds and ventilators, so that we can avoid overwhelming the healthcare system – but it seems like only about half the people who go on ventilators survive. Assuming everyone who needs a ventilator would die without one and most people who dies (so far) get on a ventilator first, that (lower-confidence) estimate gives us that hospitals double survival rates. So overall, the healthcare system, using expensive equipment and highly-trained doctors and nurses, reduces the death rate between 50% and 80%.

Estimates for the total death rate (in the US) I’ve seen go from 30 thousand to 1-2 million Americans. This is a far larger difference – by orders of magnitude – and mostly depends on how well measures like quarantines and distancing work to stop the spread.

So in essence, healthcare lets you play Russian roulette with fewer bullets. Public health, if you do it right, lets you avoid playing it in the first place.

This isn’t limited to the Coronachan. Most of the increase in life expectancy over the last few centuries hasn’t been caused by healthcare, it’s been caused by removing Smallpox and Polio and helping people have enough to eat. Washing hands and sanitation has done more for longevity than cancer drugs.

Which brings us to the obvious question – what haven’t we done that we could still be doing? In a normal year, America spends about 18% of GDP – 3.5 trillion dollars – on healthcare. What are the public health interventions we can still do? Assuming they’re an order of magnitude more effective, they’d cost about 350 billion a year for the same effect as we get from healthcare, which would be totally worth it but still high enough to give us sticker shock. Where are the areas?

Globally the obvious answer is “Just contribute to Givewell, they already did the research (which mostly leads to third-world public health interventions).” If we’re thinking in terms of large-scale domestic spending projects instead of individual actions, the top priority is probably limiting or removing cars where possible – between crashes and pollution-caused illnesses, cars account for about a hundred thousand deaths a year, right up there with the lower-end estimates for Corona. If Corona is worth this kind of effort to address, we should probably be willing to spend a tenth of that to address car deaths. Try to imagine what spending a tenth the effort to limit cars  every year as we are now to limit Corona (promoting alternative transport measures, congestion prices, gas taxes, red light cameras and intersection redesigns all have a history of working, for a start).  It’d be an almost unimaginable amount, compared to what we do now – but if you assume our Corona measures now are reasonable, that would be worth it too. If you assume we’re overreacting to Corona by an order of magnitude, well, spending 1% of the effort on cars as we do on Corona would also be a lot more than what we do now.

The one other thing I can think of is food stamps – making them easily accessible enough that we remove all barriers to getting them (probably at the cost of giving them to a lot of people who don’t really need them) also seems like it would easily pay for itself.

Corona shows Markets are hard (but not impossible) to beat

There are three levels of conventional wisdom on the stock market. Level zero (naive reasoning) is that you can win and make money by buying stock in successful companies like Amazon. Level one, the Efficient Market Hypothesis, is that you can never beat the stock market because all available information is already priced in. Level two says that you can beat the market, but only by putting in commensurate talent and hard work. Top hedge funds, for example, do seem able to consistently beat the market by having a lot of smart researchers and going through high-quality data. But even then, they can’t consistently do it by a lot.

This brings us to Corona, which seems like a solid argument against the EMH. Covid was blindingly obvious for weeks and the stock market basically ignored it. And given that providing information about the future is arguably the entire point of the stock market, this is a miserable failure. Jacob, in the above post, mentions that he saw this coming and was smart enough to sell stocks just before the crash. So to what degree is this evidence that we can beat the market by being smart and going against herd mentality?

First, let’s calculate the profit here. Jacob sold 10% of his stocks just before the crash. Assuming they were trailing the S&P 500 and that he sold at the peak (around 3386), he made a 41% profit on them compared to current prices (this… this dropped a lot). Multiplying by the 10% he sold, that gives us about a 4.1% profit.

4.1% profit is significant – it’s about a year’s worth of safe withdrawal rate. But this is basically an ideal scenario – rationalists, as a group, think about tail risks to society constantly (AI is the most frequent one, but pandemics are up there). Having a historically unprecedented pandemic that shatters the market, that almost exactly matches scenarios you and your friends (but almost no one else) regularly talk about is pretty much the investment opportunity of a lifetime. And we see that even in this scenario, your profit is… just over 4%. Pretty damn impressive by stock market standards, but not market-breakingly impressive. This matches our Level 2 understanding on the market – it can  be beaten, if you’re smart and prepared and have comparative advantage. But not consistently, and even in an ideal scenario, not by that much.

Thoughts on Corona and the decline of the West.

Epistemic status: Going to try for one post a day while I’m bored and stuck at home. Let’s see if it works.

It seems like the covid response is where the US passed the line from “we talk about it having bad institutions, but really it’s only bad considering how rich the country is and when you make the right adjustments it’s still doing pretty well” to “the institutions here are legitimately dysfunctional on an objective scale”.

Consider healthcare: in the past, we could say that healthcare here is expensive, but good when you can get it – and while it is expensive, most Americans are rich enough to afford it, so given the priorities and organization of the country it still works pretty well. Over the last few years, that’s been slipping – life expectancy and health have been falling behind, and the best we could say for the healthcare system was “okay it’s not as good as some places but still okayish most of the time”.

But now we can’t say that. America’s response to the pandemic isn’t nearly as good as Italy’s, let alone Taiwan or South Korea. It’s basically been complete paralysis of all institutions that should be able to deal with it, both elected officials like Trump and de Blasio, and organizations like the CDC.

And this is most obvious in an acute crisis like a pandemic, but we’ve been seeing this a while now in slower-moving crises like housing and transit construction. America’s lost the ability to react to things.
But from another perspective, one thing I do find reassuring is this post about the Roman empire, specifically this bit:

Pop history has a nasty tendency to compress all of that into one idea of ‘Rome,’ which rises once and falls once, as opposed to the reality of a Rome which rose, fell into civil war, then rose some more, then had a crisis, then stabilized, then fragmented, then fell in some places while remaining stable in others. And so, for example, Sallust’s complaints about Roman decadence – which date to the first century B.C. nearly five centuries before its ‘fall‘ – are often quoted as somehow explaining Rome’s eventual demise, but Rome wasn’t even done expanding at that point.

Devereaux makes the point that Romans wrote about Roman decline pretty much throughout the existence of Rome, and were usually wrong – but even when they were right, Rome was more likely to see a resurgence than a collapse after a period of decline. So from the outside view, America’s more likely to eventually come back from the current crisis than collapse.

Not that that helps much right now, anyway. Stay healthy and quarantined out there everyone.

Annual mopey birthday post

This is my annual birthday post, where I let myself get unabashedly mopey about the last year.

I read most of Brandon Sanderson this year. I started reading the Stormlight Archive last February or March, then left off for a while, then started reading Mistborn a few months ago when a guy left it (and the rest of Sanderson’s Cosmere books) on a bookshelf at work. I read it, then wound up going through the rest of his books (including, now, going through Stormlight again. Oathbringer is long.)

Sanderson’s books are, at the core, about survival in genuinely hopeless cases. It’s a subtle distinction between that and just incredibly difficult: They’re not just up against impossible odds, they set out against something that’s already ground them down. There’s an important difference between a classic fantasy story about an outsider who comes into the story, realizes things are wrong, and fixes them despite the difficulty – and an insider already worn down by the system trying to deal with it. From the description of Kelsier,

He forced himself to smile-not out of pleasure, and not out of satisfaction. He smiled despite the grief he felt at the deaths of his men; he smiled because that was what he did. That was how he proved to the Lord Ruler-and to himself-that he wasn’t beaten. No, he wasn’t going to walk away. He wasn’t finished yet. Not by far.

And this has been important to me this year. In a way, it’s been about survival for me. I didn’t start out strong or optimistic. Google had worn me down, and so had some relationship failures. I wasn’t doing too hot at my new job either. And there wasn’t much I could do except, well, survive. So the Sanderson perspective meant a lot to me, the idea that just surviving and putting one foot in front of the other until you got somewhere could be enough for a good story.

Things did get better over time, in some ways. I learned to be more hopeful. I started feeling better at work, and moved to a different team where I started feeling respected and useful. Eventually I got a new job in New York – not my dream job, not even my top choice among the places I interviewed at, but a decent offer. I just started it this week – I’m still not sure how I feel about it. I’m not sure I like finance culture, although the work itself seems more interesting. And, well, I can survive it for now, until I learn to like it, or leave. The other Mistborn quote that got to me:

“You want to be like Kelsier? Really like Kelsier? Then fight when you are beaten! Survive!”

Another way that it’s been a very Sanderson year is that it’s been similar to his writing: It hasn’t been my most brilliant year. It didn’t touch the depths of tragedy and brilliance that some years have. But it involved a lot of hard work, and it came together to something pretty impressive in the end.

Scott used to have this yearly list of questions, back when he did his livejournal. I remember one of them being “did you fall in love this year”. I didn’t, for a change, although I had to deal with two past women that involved strong feelings, which was pretty brutal in some ways. I tried to cope with it emotionally by setting my feelings for both of them against each other, but I’m not sure that actually helps. In the end I had to do what I always do – make the choice to stop caring and move on. I’m not happy about it. It feels wrong. I don’t know any other way to deal with things like this.

I moved to New York, less than three weeks ago now. I miss San Francisco. I even miss Pure. I don’t miss the South Bay much, even though I haven’t found much content to replace it in New York yet (hopefully, that’s just a matter of time).

I got summoned for a Green Card interview in March this week, although now that I moved there’s a chance I’ll have to reschedule it. I hope I won’t, or that the delay won’t be long if I do. I’ve had enough of the Visa problems saga, and I’m more than ready for it to end.

I would like to have a relationship, now that I’m in New York. Getting dates here seems easier, although it’s harder to meet women I actually like. Hopefully that part’s just a matter of time.

That’s it for this year. I don’t know where I’ll be next year, or what I’ll be like. I don’t have as many plans as I used to.

Song Translations: The Pyjamas Opening theme


Original song, Hebrew lyrics.

They’re not that great, I know, they’re not too pretty.
And playing rock alone,
it’s pointless, it’s such a pity.
But they came here from far away,
on a long and winding road…
That just the way their town is,
the traffic never flows.

Each night they play a show, I always go.
I’m usually alone,
I guess no one is too surprised, though.
Playing down in the burger bar,
dreaming of crowds and fancy cars…
It doesn’t even matter,
they have no songs so far.

If things are bad and you are hurting,
and you’re tired of escaping.
You can sit down and relax,
for a moment just replacing
all the emptiness around you
all the silence of the night…
The Pyjamas’ rockin’ party
shuts the city down tonight.

So just come down, and join us, in the Pyjamas party…

Two theories about the Silmarillion

First Theory: Breath of the Wild.

There’s something beautiful about how Tolkein’s worlds are mostly full of empty lands. Even “settled” lands are often sparesely populated areas like Rohan or Bree, with the occasional town or village.

This vibe reminded me of something, and then I realized: This is what the Hyrule of Breath of the Wild feels like. Then I realized something else: Breath of the Wild is clearly a thinly-veiled reskin of the Silmarillion. Consider:

The story takes place in a generation after a great battle (originally, Nirnaeth Arnoediad), in which the dark power won. The land is now mostly empty, and overrun with monsters. The North/Centre is dominated by a tall, dark castle full of sleepless, dark vigilance. There are still a few safe places. The lost woods are Doriath – protected by a guardian who spread a veil of shadows and confusion to protect the borders of the land. Classically, Link was adopted and raised by the Deku tree, like Turin was by Thingol.  Zora’s domain is Gondolin: A carved, beautiful city, hidden on a flat plain/lake surrounded by cliffs and mountains.

Before we do the rest of the geography, let’s talk about history: a generation ago, we had the great battle in which evil overran the land. But long before that, in ancient times, the good people came from a faraway, magical civilization with untold wonders of craft and magic. This obviously represents Valinor. However, in the last battle, their craft was turned against them, and they were defeated by treachery. This clearly represents the silmarils’ captured by Morgoth (evil captures source of ancient wonder), causing the oath of Feanor to turn against and destroy the Noldor.

Back to geography: On the shores of the great sea, there is a lighthouse laboratory, inhabited by the eldest hylian, which is Link’s strongest connection to the ancient magic. This represents the havens of Cirdan (oldest elf in middle-Earth), and their connection to Valinor. The Gorons represent Nargothrond (Mountain stronghold under the shadow of a fire dragon, source of many gems, dwarvish elements). The Gerudo represent the lands of the sons of Feanor – theoretically good guys but untrusting of strangers and outsiders. The treacherous Yiga clan lives in Gerudo lands, representing the treachery of the oath of Feanor (in particular, Celegorm and Curufin).
The icy mountains of the northwest represent Dor-Lomin, and are occupied by monsters (much like how Dor-Lomin was occupied by Easterlings).

Now to the characters:

Link is Turin: A deadly warrior wandering the occupied lands, defeating monsters wherever he goes but never ultimately conquering them. Like Turin (and unlike most storied warriors), he uses a variety of different weapons at different times. However, two items are strongly associated with him: A piece of armour inherited by his house since ancient times (for Turin, the dragon-helm of Dor-Lomin. For Link, the Hero’s tunic), and a cursed sword. The master sword, like Gurthang, comes from the vaults of Doriath/The Lost Woods. Like Gurthang, the master sword saps the life of its users (Gurthang ended up killing both of its wielders. The Master Sword requires a blood sacrifice to pick up).

Zelda represents Hurin: A hero and leader taken prisoner in the last great battle, who is now kept prisoner in the highest tower of Thangorodrim/Hyrule Castle. Despite her long imprisonment and curse, she defies Gannon/Morgoth still.

The one thing they did change was the end: Turin’s story has a downer ending, and the obviously couldn’t have that. So they grafted in the story of Earandil: Using the ancient power’s light (i.e. the light of Valinor, the silmaril), given to him by the female lead (Zelda now represents Elwing), the hero manages to summon the power of the ancients in order to defeat the great demon (although the land is still broken, and must be healed).

Second Theory: There should be a Feanor/Boromir buddy cop show.

Okay, this one isn’t so much a theory as a fanfic outline.

The concept is this: Feanor and Boromir, magically healed and sent through time to modern-day Detroit (Feanor through his body turning to Ash, Boromir by falling through a waterfall in a magic boat), end up becoming vitroilic BFF buddy cops.

Feanor is the smart, arrogant, genius cop who’s always figuring things up, tinkering around with crazy inventions and making bizarre (and illegal) modifications to their cruiser (“For the last time Feanor, flying cars violate FAA safety regulations!”). He used to think of mortals as beneath him, and is inclined to view criminals (and often his fellow officers) with instinctive contempt (of course, he often gets hit by this and has to learn better).

Boromir is the amusing opposite: Big, buff, boisterous bruiser, but all-around charismatic and a natural leader of men. While he’s definitely not the smart one of the pair, his natural charm and ability to befriend the working people of the city (both honest and criminal) make him a good counterpart to Feanor. He often defends men from Feanor’s criticism, while privately worried that Feanor may be right (and remembering all too well how he yielded to the temptation of the ring).

Maglor son of Feanor (played by Samuel L Jackson, reprising his role from Pulp Fiction) occasionally shows up, still chasing the last silmaril. While he’s happy to see his father again, Boromir (who knows all too well what it’s like to fall to temptation) convinces him not to tell his father about it, to help him avoid downfall. This charade is, of course, doomed to fail eventually, but hopefully Feanor will have learned enough about being a better person and the perils of seeking power by then that he won’t start another world war.