Can we measure the cost of hundreds of thousands of dead?
President Trump and leading business figures are increasingly questioning the wisdom of a prolonged shutdown of the American economy — already putting millions out of work — to curb the spread of the coronavirus pandemic.
“Our people want to return to work,” Mr. Trump declared Tuesday on Twitter, adding, “THE CURE CANNOT BE WORSE (by far) THAN THE PROBLEM!”
In essence, he was raising an issue that economists have long grappled with: How can a society assess the trade-off between economic well-being and health?
“Economists should be doing this cost-benefit analysis,” said Walter Scheidel, an economic historian at Stanford University. “Why is nobody putting some numbers on the economic costs of a monthlong or a yearlong shutdown against the lives saved? The whole discipline is well equipped for it. But there is some reluctance for people to stick their neck out.”
“经济学家应该进行这种成本效益分析，”斯坦福大学(Stanford University)经济历史学家沃尔特·沙伊德尔(Walter Scheidel)说。“为什么没有人在一个月或一年的停摆带来的经济代价和由此拯救的生命之间做一个量化对比？整个学科完全有能力这么做。但大家还是不愿意冒这个险。”
Some economists who support lifting the current restrictions on economic activity say governors and even the Trump administration have not sufficiently assessed the costs and benefits of those restrictions.
“We put a lot of weight on saving lives,” said Casey Mulligan, a University of Chicago economist who spent a year as chief economist on Mr. Trump’s Council of Economic Advisers. “But it’s not the only consideration. That’s why we don’t shut down the economy every flu season. They’re ignoring the costs of what they’re doing. They also have very little clue how many lives they’re saving.”
“我们非常重视拯救生命，”芝加哥大学(University Of Chicago)经济学家凯西·马利根(Casey Mulligan)说，他曾在特朗普的经济顾问委员会(Council of Economic Advisers)担任过一年的首席经济学家。“但这不是唯一的考量。这就是为什么每次到了流感季，我们不会让经济停摆的原因。他们忽略了做事的代价。同时他们对能拯救多少生命也毫无概念。”
There is, however, a widespread consensus among economists and public health experts that lifting the restrictions would impose huge costs in additional lives lost to the virus — and deliver little lasting benefit to the economy.
“It’s useful to adopt the cost-benefit frame, but the moment you do that, the outcomes are so overwhelming that you don’t need to fill in the details to know what to do,” said Justin Wolfers, an economist at the University of Michigan.
密歇根大学(University Of Michigan)的经济学家贾斯汀·沃尔弗斯(Justin Wolfers)表示：“引入成本效益框架是有帮助的，不过一旦你这样做了，得到的结果将是压倒性的，你无需更多细节就知道该怎么做。”
The only case in which the benefits of lifting restrictions outweigh the costs in lost lives, Mr. Wolfers said, would be if “the epidemiologists are lying to us about people dying.”
Weighing economic costs against human lives will inevitably seem crass. But societies also value things like jobs, food and money to pay the bills — as well as the ability to deal with other needs and prevent unrelated misfortunes.
“Making people poorer has health consequences as well,” said Kip Viscusi, an economist at Vanderbilt University who has spent his career using economic techniques to assess the costs and benefits of government regulations.
范德比尔特大学(Vanderbilt University)的经济学家基普·维斯库西(Kip Viscusi)表示：“让人变穷也会对健康造成影响。”维斯库西在他的学术生涯中一直利用经济方法来评估政府监管的成本和收益。
Jobless people sometimes commit suicide. The poor are likelier to die if they get sick. Mr. Viscusi estimates that across the population, every loss of income of $100 million in the economy causes one additional death.
Government agencies calculate these trade-offs regularly. The Environmental Protection Agency, for instance, has established a cost of about $9.5 million per life saved as a benchmark for determining whether to clean up a toxic waste site.
政府机构定期计算这样的取舍。例如，美国环护署(Environmental Protection Agency)设定了一个标准，每拯救一个生命的成本约为950万美元，将其作为是否清理有毒废物场地的决定基准。
Other agencies use similar values to assess whether to invest in reducing accidents at an intersection or to tighten safety standards in a workplace. The Department of Agriculture has a calculator to estimate the economic costs — medical care, premature deaths, productivity loss from nonfatal cases — of food-borne disease.
Now, some economists have decided to stick their necks out and apply this thinking to the coronavirus pandemic.
In a paper released on Monday, Martin S. Eichenbaum and Sergio Rebelo of Northwestern University, with Mathias Trabandt of the Free University in Berlin, used the E.P.A.’s number to figure the optimal way to slow the spread of the disease without economic costs that exceed the benefits.
在周一发布的一篇论文中，西北大学(Northwestern University)的马丁·S·埃辛鲍姆(Martin S. Eichenbaum)和塞尔吉奥·雷贝洛(Sergio Rebelo)，以及柏林自由大学(Free University)的马蒂亚斯·特拉班特(Mathias Trabandt)使用了美国环保署的数字，分析在不造成经济成本超过收益的情况下减缓疾病传播的最佳方法。
The economy would contract sharply even without a government-imposed lockdown as people chose to stay away from workplaces and stores, hoping to prevent contagion. In that case of voluntary isolation, Mr. Eichenbaum and his colleagues estimated that U.S. consumer demand would decline by $800 billion in 2020, or about 5.5 percent.
Based on epidemiological projections, as the virus ran unchecked, it would quickly expand to infect somewhat over half the population before herd immunity would slow its course. Assuming a death rate of about 1 percent of those infected, about 1.7 million Americans would die within a year.
A policy to contain the virus by reducing economic activity would slow the progression of the virus and reduce the death rate, but it would also impose a greater economic cost.
Mr. Eichenbaum and his colleagues say the “optimal” policy — assessing economic losses alongside lives — requires restrictions that slow the economy substantially. Under their approach, the decline in consumption in 2020 more than doubles, to $1.8 trillion, but the deaths drop by half a million people. That would amount to $2 million in lost economic activity per life saved.
In this instance, “you want to make the recession worse,” Mr. Eichenbaum said. But an important corollary is that there are limits to the sacrifice: Beyond a certain point, it would not be worth it to lose more economic activity in order to save more people.
The model, he noted, is heavily dependent on the assumptions that go into it, meant to convey the magnitude of the trade-offs. And the economists are still tweaking. The cost-benefit ratio will change if one considers that the health system might become overwhelmed by Covid-19 cases, increasing mortality rates. That would justify a more aggressive lockdown that ramped up more quickly.
It comes down to what a life is worth.
In the 1960s, a Nobel Prize laureate in economics, Thomas C. Schelling, proposed letting people price their own lives. Observing how much they were willing to spend to reduce their odds of death — by buying a bicycle helmet, driving within the speed limit, refusing to buy a house near a toxic-waste site or demanding a higher wage for a more dangerous job — government agencies could compute a price tag.
1960年代，诺贝尔经济学奖得主托马斯·C·谢林(Thomas C. Schelling)提出让人们为自己的生命定价。通过观察人们愿意花多少钱来减少死亡率——购买自行车头盔、在限速范围内行驶、拒绝购买附近存在有毒废料的房屋，或者做工资更高、风险更大的工作——政府机构可以计算出一个标价。
That can lead to some strange numbers, though. As Peter Singer, the Australian ethical philosopher, noted, you can save a life in poor countries with $2,000 or $3,000, and many of those lives are still allowed to be lost. “If you compare that with $9 million,” he said, “it’s crazy.”
The discussion gets even more touchy when one considers the age profile of the dead. It raises the question: Is saving the life of an 80-year-old as valuable as saving the life of a baby?
Cass Sunstein, a legal scholar who worked for the Obama administration, heading the White House office in charge of these valuations, once proposed focusing government policies on saving years of life rather than lives, as is customary in other countries.
“A program that saves younger people is better, in this sense, than an otherwise identical program that saves older people,” he wrote.
In the George W. Bush administration, the E.P.A. tried to move in Mr. Sunstein’s preferred direction. To calculate the costs and benefits of legislation regulating soot emissions from power plants, it had to figure out the value of reducing premature mortality. Rather than evaluate every life saved at $6.1 million, as it had done in the past, it applied an age discount: People over 70 were worth only 67 percent of the lives of younger people.
在乔治·W·布什(George W. Bush)政府时期，美国环保署曾试图朝着桑斯坦喜欢的方向前进。为了计算监管发电厂烟尘排放的立法的成本和收益，它必须计算出降低过早死亡率的价值。它没有像过去那样，为每拯救一条生命估价610万美元，而是采用了年龄折扣：70岁以上的人只占年轻人生命价值的67%。
The backlash by AARP and others was fierce. And the agency dropped the idea. “E.P.A. will not, I repeat, not use an age-adjusted analysis in decision making,” pleaded Christine Todd Whitman, the E.P.A. administrator at the time. Yet by putting the same price on all lives, the agency implicitly devalued young people’s remaining years.
美国退休人员协会(AARP)等机构对此强烈反对。于是美国环保署放弃了这个想法。“我再说一遍，美国环保署不会在做决定时使用年龄调整分析，”当时的环保署负责人克里斯汀·托德·惠特曼(Christine Todd Whitman)辩称。然而，在对所有人的生命一视同仁的同时，该机构无形中造成了年轻人剩余生命的贬值。
Covid-19 seems to be much more lethal for older people, whatever their economic worth. But Mr. Trump declared Tuesday that even while those most at risk are safeguarded, the economy could be “raring to go” within three weeks. “Seniors will be watched over protectively & lovingly,” he said on Twitter. “We can do two things together.”