Month: February 2020

A Socratic open letter to transphobes everywhere

PNRJ core principles, ethics, personal, public policy, Uncategorized , , , , , , , , , , , ,

Feb 23 JDN 2458903

This post is a bit different than usual. This is an open letter to those who doubt that trans people actually exist, or insist on using the wrong pronouns; above all it is an open letter to those who want to discriminate against trans people, denying trans people civil rights or the dignity to use public bathrooms in peace. Most of my readers are probably not such people, but I think you’ll still benefit from reading it—perhaps you can use some of its arguments when you inevitably encounter someone who is.

Content warning: Because of how sex and gender are tied up together in transphobes’ minds, I’m going to need to talk a little bit about sexual anatomy and genital surgery. If such topics make you uncomfortable, feel free to skip this post.

Dear Transphobe:

First of all, I’m going to assume you are a man. Statistically you probably are, in which case that works. If by chance you’re not, well, now you know what it feels like for people to assume your gender and never correct themselves. You’re almost certainly politically right-wing, so that’s an even safer assumption on my part.

You probably think that gender and sex are interchangeable things, that the idea of a woman born with a penis or a man born without one is utter nonsense. I’m here to hopefully make you question this notion.

Let’s start by thinking about your own identity. You are a man. I presume that you have a penis. I am not going to make the standard insult many on the left would and say that it’s probably a small penis. In fact I have no particular reason to believe that, and in any case the real problem is that we as a society have so thoroughly equated penis size with masculinity with value as a human being. Right-wing attitudes of the sort that lead to discriminating against LGBT people are strongly correlated with aggressive behaviors to assert one’s masculinity. Even if I had good reason—which I assuredly do not—to do so, attacking your masculinity would be inherently counterproductive, causing you to double down on the same aggressive, masculinity-signaling behaviors. If it so happens that you are insecure in your masculinity, I certainly don’t want to make that worse, as masculine insecurity was one of the strongest predictors of voting for Donald Trump. You are a man, and I make no challenges to your masculinity whatsoever. I’m even prepared to concede that you are more manly than I am, whatever you may take that to mean.

Let us consider a thought experiment. Suppose that you were to lose your penis in some tragic accident. Don’t try to imagine the details; I’m sure the mere fact of it is terrifying enough. Suppose a terrible day were to arrive where you wake up in a hospital and find you no longer have a penis.

I have a question for you now: Should such a terrible day arrive, would you cease to be a man?

I contend that you would remain a man. I think that you, upon reflection, would also contend the same. There are a few thousand men in the world who have undergone penectomy, typically as a treatment for genital cancer. You wouldn’t even know unless you saw them naked or they told you. As far as anyone else can tell, they look and act as men, just as they did before their surgery. They are still men, just as they were before.

In fact, it’s quite likely that you would experience a phantom limb effect—where here the limb that is in your self-image but no longer attached to your body is your penis. You would sometimes feel “as if” your penis was still there, because your brain continues to have the neural connections that generate such sensations.

An even larger number of men have undergone castration for various reasons, and while they do often find that their thoughts and behavior change due to the changes in hormone balances, they still consider themselves men, and are generally considered men by others as well. We do not even consider them transgender men; we simply consider them men.

But does this not mean, then, that there is something more to being a man than simply having male anatomy?

Perhaps it has to do with other body parts, or some totality of the male body? Let’s consider another thought experiment then. Suppose that by some bizarre event you were transported into a female body. The mechanism isn’t important: Perhaps it was a mad scientist, or aliens, or magic. But just suppose that somehow or other, while you slept, your brain in its current state was transported into an entirely female body, complete with breasts, vulva, wide hips, narrow shoulders—the whole package. When you awaken, your body is female.

Such a transition would no doubt be distressing and disorienting. People would probably begin to see you as a woman when they looked at you. You would be denied access to men’s spaces you had previously used, and suddenly granted access to women’s spaces you had never before been allowed into. And who knows what sort of effect the hormonal changes would have on your mind?

Particularly if you are sexually attracted to women, you might imagine that you would enjoy this transformation: Now you get to play with female body parts whenever you want! But think about this matter carefully, now: While there might be some upsides, would you really want this change to happen? You have to now wear women’s clothing, use women’s restrooms, cope with a menstrual cycle. Everyone will see you as a woman and treat you as a woman. (How do you treat women, by the way? Is this something you’ve thought carefully about?)

And if you still think that being a woman isn’t so bad, maybe it isn’t—if your mind and body are in agreement. But remember that you’ve still got the mind of a man; you still feel that mental attachment to body parts that are no longer present, and these new body parts you have don’t feel like they are properly your own.

But throughout this harrowing experience, would you still be a man?

Once again I contend that you would. You would now feel a deep conflict between your mind and your body—dare I call it gender dysphoria?—and you would probably long to change your body back to what it was, or at least back to a body that is male.

You would once again experience phantom limb effects—but now all over, everywhere your new body deviated from your original form. In your brain there is a kind of map of where your body parts are supposed to be: Your shoulders are supposed to end here, your legs are supposed to end there, and down here there is supposed to be a penis, not vulva. This map is deeply ingrained into your mind, its billions of strands almost literally woven into the fabric of your brain.

We are presumably born with such a map: By some mindbogglingly complex mix of genetic and environmental factors our brains organize themselves into specific patterns, telling us what kind of body we’re supposed to have. Some of this structuring may go on before birth, some while we are growing up. But surely by the time we are adults the process is complete.

This mental map does allow for some flexibility: When we were young and growing, it allowed us to adjust to our ever-increasing height. Now that we are older, it allows us to adjust to gaining or losing weight. But this flexibility is quite limited: it might take years, or perhaps we could never adjust at all, to finding that we had suddenly grown a tail—or suddenly changed from male to female.

Now imagine that this transformation didn’t happen by some sudden event when you were an adult, but by some quirk of ontogeny while you were still in the womb. Suppose that you were born this way: in a body that is female, but with a mind that is male.

In such a state, surely something is wrong, in the same way that being born with sickle-cell anemia or spina bifida is wrong. There are more ambiguous cases: Is polydactyly a disorder? Sometimes? But surely there are some ways to be born that are worth correcting, and “female body, male mind” seems like one of them.

And yet, this is often precisely how trans people describe their experience. Not always—humans are nothing if not diverse, and trans people are no exception—but quite frequently, they will say that they feel like “a man in a woman’s body” or the reverse. By all accounts, they seem to have precisely this hypothetical condition: The gender of their mind does not match the sex of their body. And since this mismatch causes great suffering, we ought to correct it.

But then the question becomes: Correct it how?

Broadly speaking, it seems we’ve only two options: Change the body, or change the mind. If you were in this predicament, which would you want?

In the case of being transferred into a new body as an adult, I’m quite sure you’d prefer to change your body, and keep your mind as it is. You don’t belong in this new body, and you want your old one back.

Yet perhaps you think that if you were born with this mismatch, things might be different: Perhaps in such a case you think it would make more sense to change the mind to match the body. But I ask you this: Which is more fundamental to who you are? If you are still an infant, we can’t ask your opinion; but what do you suppose you’d say if we could?

Or suppose that you notice the mismatch later, as a child, or even as a teenager. Before that, something felt off somehow, but you couldn’t quite put your finger on it. But now you realize where the problem lies: You were born in a body of the wrong sex. Now that you’ve had years to build up your identity, would you still say that the mind is the right thing to change? Once you can speak, now we can ask you—and we do ask such children, and their answers are nigh-unanimous: They want to change their bodies, not their minds. David Reimer was raised as a girl for years, and yet he always still knew he was a boy and tried to act like one.

In fact, we don’t even know how to change the gender of a mind. Despite literally millennia of civilization trying at great expense to enforce particular gender norms on everyone’s minds, we still get a large proportion of the population deviating substantially from them—if you include mild enough deviations, probably a strict majority. If I seem a soft “soy boy” to you (and, I admit, I am both bisexual and vegetarian—though I already knew I was the former before I became the latter), ask yourself this: Why would I continue to deviate from your so ferociously-enforced gender norms, if it were easy to conform?

Whereas, we do have some idea how to change a body. We have hormonal and surgical treatments that allow people to change their bodies substantially—trans women can grow breasts, trans men can grow beards. Often this is enough to make people feel much more comfortable in their own bodies, and also present themselves in a way that leads others to recognize them as their desired gender.

Sex reassignment surgery is not as reliable, especially for trans men: While building artificial vulva works relatively well, building a good artificial penis still largely eludes us. Yet technological process in this area continues, and we’ve improved our ability to change the sex of bodies substantially in just the last few decades—while, let me repeat, we have not meaningfully improved our ability to change the gender of minds in the last millennium.

If we could reliably change the gender of minds, perhaps that would be an option worth considering. But ought implies can: We cannot be ethically expected to do that which we are simply incapable.

At present, this means that our only real options are two: We can accept the gender of the mind, change the sex of the body, and treat this person as the gender they identify themselves as; or we can demand that they repress and conceal their mental gender in favor of conforming to the standards we have imposed upon them based on their body. The option you may most prefer—accept the body, change the mind—simply is not feasible with any current or foreseeable technology.

We have tried repressing transgender identity for centuries: It has brought endless suffering, depression, suicide.

But now that we are trying to affirm transgender identity the outlook seems much better: Simply having one adult in their life who accepts their gender identity reduces the risk of a transgender child attempting suicide by 40%. Meta-analysis of research on the subject shows that gender transition, while surely no panacea, does overall improve outcomes for transgender people—including reducing risk of depression and suicide. (That site is actually refreshingly nuanced; it does not simply accept either the left-wing or right-wing ideology on the subject, instead delving deeply into the often quite ambiguous evidence.)

Above all, ask yourself: If you ever found yourself in the wrong sort of body, what would you want us to do?

Bernie Sanders may be our next President

PNRJ current events, public policy , , , , , ,

Feb 16 JDN 2458896

It’s too early to say who will win the election, of course. In fact, we’re not even entirely sure what the results of the Iowa caucuses were, because there were so many errors that they are talking about doing a recount.


But Bernie Sanders has taken a commanding lead in polls, and forecasts now have him as the clear front-runner. If we’d had range voting, Sanders probably would have won last time. But even with our voting system as terrible as it is, there’s a good chance he’ll actually win this time.

I would honestly prefer Elizabeth Warren; she shares Bernie’s idealism, but tempers it with a deep understanding of our political and economic system. Her policy plans are spectacularly good; she doesn’t just come up with a vague idea, she lays out a detailed roadmap of how it will be accomplished and how it will be paid for. Her plans cover a wide variety of issues, including a lot of things that most people aren’t even aware of yet nevertheless affect millions of people. Who else is talking about universal child care programs, the corruption in our trade negotiation system, antitrust action against tech monopolies, or reducing corporate influence in the military? Who else includes in their plan for corporate taxes detailed reforms to the accounting system? And who else has a plan for forgiving student debt that actually calculates the effective marginal tax rate induced by the phase-out? Elizabeth Warren is the economist’s candidate: Unlike almost everyone else in politics, she actually knows what she’s doing.

Bernie Sanders, by comparison, has an awful lot of laudable goals, but is often quite short on the details of how they will be achieved. His healthcare plan, in particular, “Medicare for All”, doesn’t seem to include any kind of cost estimate or revenue support. I’m all for single-payer healthcare, but it’s not going to get done for free. And at least in the past, he has made economic forecasts that are wildly implausible.

But we could certainly do a lot worse than Bernie. His most unrealistic ideas will be tempered by political reality, while his unflinching idealism may just shift our Overton Window in a much-needed leftward direction. He is a man of uncommon principle, and a politician of uncommon honesty—he does not have even one “Pants on Fire” rating on Politifact.

To say that he would obviously be better than Trump is a gross understatement: Almost anyone would obviously be better than Trump, and definitely any of the leading Democratic candidates would be.

In fact, Warren is the only candidate I unambiguously prefer to Sanders. Biden is too conservative, too willing to compromise with an uncompromising right wing. As historic as it would be to have an openly gay President, I’m not sure Buttigieg is the one I’d want. (On the other hand, the first gay President is almost certainly going to have to be extremely privileged and milquetoast to break through that glass ceiling—so maybe it’s Buttigieg or nothing.) Yang has some interesting ideas (like his basic income proposal), but no serious chance of winning. Bloomberg would be a good Libertarian Party candidate, but he’s no Democrat. The rest have fallen so far in the polls they aren’t worth talking about anymore.

Like I said, it’s really too early to say. Maybe Biden will make a comeback. Maybe Warren will win after all. But it does mean one thing: The left wing in America has been energized. If one good thing has come of Trump, perhaps it is that: We are no longer complacent, and we are now willing to stand up and demand what we really want. The success of Sanders so far proves that.

Coase, extortion, and pay-to-skip

PNRJ critique of neoclassical economics, ethics, public policy , , , , , , , , ,

Feb 9 JDN 2458889

The Coase Theorem states that under perfect property rights, perfect information, perfect contract enforcement, and negligible transaction costs, Pareto efficiency can be achieved even when there are large externalities. It was designed as an argument against Pigovian taxation, which tries to use taxes to create incentives against externalities such as pollution.

The usual argument against the Coase Theorem is that transaction costs are rarely negligible and contracts are often unenforceable, so the Pareto-efficient solution to externalities that it provides is unrealistic. (In fact, Coase himself agreed with this critique, and instead argued that regulation of externalities needs to be done on a case-by-case basis with attention to the detailed context.)

Yet this is not the real problem with the Coase Theorem. The real problem is the criterion of Pareto-efficiency: An arrangement can be Pareto-efficient without being fair, just, or even economically efficient in any real sense.

As a reminder, Pareto efficiency simply says that no person can be made better off without making some other person worse off. It doesn’t say anything about how well off people are relative to one another—inequality—or how they got what they have—justice. It doesn’t even really entail economic efficiency: Supposing that the marginal utility of wealth is always positive, if one man claims all the wealth in the world and lends it out to everyone else at interest, that does seem to be Pareto-efficient—we can’t make anyone else better off without taking something from His Majesty the Supreme Emperor—but it clearly isn’t economically efficient in any desirable sense.

And this is what’s wrong with the Coase Theorem: The kind of Pareto efficiency it generates allows for—indeed, in many cases demands—what we would ordinarily call extortion.

What is extortion, after all?

If a member of the mafia comes to your house and says, “What a nice place you’ve got here; what a shame if anything happened to it!” and then demands you pay him $500 a month, that’s extortion. He has the power to inflict a negative externality on you, and he promises not to as long as you pay him. (Here, the contract enforcement actually comes from the reciprocity in the indefinitely iterated game, and doesn’t require an outside enforcer.)

Extortion is when one party has the power to create a negative externality upon another (e.g. burn your house down, punch you in the face). They make a deal: They won’t create that negative externality, provided that you compensate them (pay them money). Is this Pareto efficient? Absolutely! They’re as well off as they would be if they hurt you, and you’re better off. But is this how we want to run a society? I don’t think so.

In the cyberpunk future in which we now live, there is a market emerging that fits the requirements of the Coase Theorem as well as any which has ever existed; and sure enough, in the absence of adequate regulation it is turning to extortion.

I am referring of course to the market for online advertisements. Perfect property rights? Not quite, but that intellectual property enforcement is very strong. Perfect contract enforcement? Not perfect, but highly reliable, like any mature market in a First World country. Perfect information and negligible transaction costs? As close as humanity has ever come.

What’s the externality? People don’t like seeing ads. Ads are annoying, distracting, and unpleasant. But businesses benefit from showing people ads (or at least think they do), and seek rents by trying to post more ads than their competition. I proposed a Pigouvian solution: Tax advertising.

What’s the Coase solution? Let people pay to skip ads. And indeed there are now sites that do this.

Note that there is a vital difference between this and, say, YouTube Premium. With YouTube Premium, you’re actually paying for the opportunity to use an ad-free version of the service. So instead of advertisers paying Google to run ads on the content you watch, you’re simply paying for the content you watch. That’s great. I have no objection to that. In fact, I strongly prefer it to the ad-supported model. Paying for content makes you the customer. Accepting ads in return for free content makes you the product.

No, I’m talking about businesses posting ads, and then offering you the chance to pay them to get rid of those ads. (Maybe a cut would go to the content provider, but that’s not really important here.) The key is that the people who make the ads get the chance to get revenue from you paying to skip them.

In Coase terms, that sounds great! Instead of me having to put you through a miserable ad that probably won’t lead you to buying anything anyway, you just pay me $0.25 or something directly. I’m better off, you’re better off, everyone’s happy.

But in fact, everyone is not happy, because here’s what I can do: I can go out of my way to make the ads as obnoxious as possible, so that you have no choice but to pay me to skip them. I’m not the first one to make this point: It’s the subject of an SMBC comic and a major plot point in a Black Mirror episode.

This is precisely the same process as extortion: Threaten a negative externality, demand compensation in return for not doing so.

I think what Coase missed in his original argument is that negative externalities aren’t always by-products of otherwise productive activities. We often—nay, usually—have the power to inflict negative externalities upon other people with no productive purpose. If externalities were always by-products, negotiation as Coase imagined it could allow us to achieve the productive benefit without the externality cost. But when externalities can be generated independently, they are a means of extracting rent from those too weak to resist you.

What’s the solution to this problem? It’s boring: We have to tax and regulate externalities after all.

The cost of illness

PNRJ core principles, current events, development economics, inequality, public policy , , , , , , , , , ,

Feb 2 JDN 2458882

As I write this I am suffering from some sort of sinus infection, most likely some strain of rhinovirus. So far it has just been basically a bad cold, so there isn’t much to do aside from resting and waiting it out. But it did get me thinking about healthcare—we’re so focused on the costs of providing it that we often forget the costs of not providing it.

The United States is the only First World country without a universal healthcare system. It is not a coincidence that we also have some of the highest rates of preventable mortality and burden of disease.

We in the United States spend about $3.5 trillion per year on healthcare, the most of any country in the world, even as a proportion of GDP. Yet this is not the cost of disease; this is how much we were willing to pay to avoid the cost of disease. Whatever harm that would have been caused without all that treatment must actually be worth more than $3.5 trillion to us—because we paid that much to avoid it.

Globally, the disease burden is about 30,000 disability-adjusted life-years (DALY) per 100,000 people per year—that is to say, the average person is about 30% disabled by disease. I’ve spoken previously about quality-adjusted life years (QALY); the two measures take slightly different approaches to the same overall goal, and are largely interchangeable for most purposes.

Of course this result relies upon the disability weights; it’s not so obvious how we should be comparing across different conditions. How many years would you be willing to trade of normal life to avoid ten years of Alzheimer’s? But it’s probably not too far off to say that if we could somehow wave a magic wand and cure all disease, we would really increase our GDP by something like 30%. This would be over $6 trillion in the US, and over $26 trillion worldwide.

Of course, we can’t actually do that. But we can ask what kinds of policies are most likely to promote health in a cost-effective way.

Unsurprisingly, the biggest improvements to be made are in the poorest countries, where it can be astonishingly cheap to improve health. Malaria prevention has a cost of around $30 per DALY—by donating to the Against Malaria Foundation you can buy a year of life for less than the price of a new video game. Compare this to the standard threshold in the US of $50,000 per QALY: Targeting healthcare in the poorest countries can increase cost-effectiveness a thousandfold. In humanitarian terms, it would be well worth diverting spending from our own healthcare to provide public health interventions in poor countries. (Fortunately, we have even better options than that, like raising taxes on billionaires or diverting military spending instead.)

We in the United States spend about twice as much (per person per year) on healthcare as other First World countries. Are our health outcomes twice as good? Clearly not. Are they any better at all? That really isn’t clear. We certainly don’t have a particularly high life expectancy. We spend more on administrative costs than we do on preventative care—unlike every other First World country except Australia. Almost all of our drugs and therapies are more expensive here than they are everywhere else in the world.

The obvious answer here is to make our own healthcare system more like those of other First World countries. There are a variety of universal health care systems in the world that we could model ourselves on, ranging from the single-payer government-run system in the UK to the universal mandate system of Switzerland. The amazing thing is that it almost doesn’t matter which one we choose: We could copy basically any other First World country and get better healthcare for less spending. Obamacare was in many ways similar to the Swiss system, but we never fully implemented it and the Republicans have been undermining it every way they can. Under President Trump, they have made significant progress in undermining it, and as a result, there are now 3 million more Americans without health insurance than there were before Trump took office. The Republican Party is intentionally increasing the harm of disease.