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Re medical bills (or any bills, for that matter):

A major change from the TCJA in 2017 was allowing more businesses, including some health care providers and third party debt collectors, to use cash accounting rather than accrual accounting for the purpose of computing taxable income. The upshot is that treatment plus a printed and mailed bill no longer counts as revenue for a lot more businesses. That's precisely what allows for the "aspirational" bills you're describing. Repealing this provision would go a long way to taming this particular aspect, I believe.

The news about Evusheld is indeed disappointing. Why mAb's aren't updated in lockstep with vaccines is baffling: they could be harvesting mAb's at the same time that they're testing vaccines using the same mice

One thing I don't see talked about very much is that attempting to predict who's at risk of long covid, as a function of severity of the initial infection is very much playing to an inside straight: the illness has to be severe enough to cripple you but not kill you. It's related to the reason that long term disability insurance I'd tricky for even the best actuaries and underwriters.

I think it depends on the externality. Widespread destitution is itself a "public bad" when it impacts crime, public health, noise, etc

That's income tax. Sales tax is a different story. In fact since wealthier people benefit from bulk discounts, I'd go so far as to guess that the poor pay proportionally more per, say, toilet paper roll.

I can't begin to tell you how much I appreciate this. The reality that novids like me need to accept is "learning to take yes for an answer." We've reached the point where we are no longer under any compelling legal or moral obligation to know if we have Covid at any given time. Meet the new normal, same as the old normal.

From the article, here's a description of the strategy:

As an example, consider a hypothetical community of 5 households labeled A through E, with 5 individuals in household A, 4 in household B, 3 in C, 2 in D, and 1 in E. This gives a total of 15 individuals, none of which are previously immune. Suppose that we only have the capacity to fully vaccinate 5 individuals. In line with the reasoning above, EHR gives the following vaccination strategy:

  1. The largest household by effective size is A, with 5 individuals. The first vaccine is therefore allocated to the eldest member of A.
  2. A and B are now tied in terms of effective size, with 4 susceptible individuals each. We therefore vaccinate one person each from both A and B.
  3. A, B, and C are now tied in terms of effective size, with 3 individuals each. With enough capacity left to vaccinate only two people, we therefore randomly choose two of the three households, and vaccinate one individual in each of the randomly chosen households.

I found this:

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0263155



"Further investigating herd immunity thresholds for a range of values for R0  we find that for most parameter choices, EHR achieves herd immunity with fewer vaccinated individuals than the other presented strategies (and universally, dramatically earlier than age-based strategies). At the most extreme, assuming a 90% effective vaccine and R0 = 2, EHR achieves herd immunity at just 48% of the population vaccinated, compared to thresholds of 61% and 89% for random and eldest-first strategies. At 100% efficiency, the relative herd immunity thresholds are 44% and 55%, for the EHR and random strategies, respectively."

I doubt it would cost very much. Epidemiologists have software they can use to model it. Moreover, an easy way to do controlled experiments would be dorm assignments on college campuses.

At any rate, my unabashedly Bayesian gut feeling is that it's obviously a good idea to do it. See above for my priors.

To the extent that this kind of thing is hard, I'd put it squarely in the "hard but worth it" bucket, along the lines of JFK's speech at Rice University. I'm calling for us to stop meekly accepting case surges as inevitable, and I don't think it's unreasonable to speculate that by leading with mass vaccination, we've unwittingly created a kind of "bang bang control system" with similar issues to overworked thermostats - a public health analog of metal fatigue, if you will.

I'm gonna throw this idea out there: might it be a good idea to stagger booster shots within a household? We never know for sure when the next surge will occur, but we do know that (1) immunity against infection wanes and (2) household transmission is a big factor during surges. Careful timing boosters within a household (or social bubble) might be a good way to take more control of what can be controlled.

Just spitballing, as they say.

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