The global COVID-19 mortality cost report card: 2020, 2021, and 2022.

The United States is the country with the greatest number of COVID-19 deaths in 2020, 2021, and 2022. Both the U.S. and the world exhibited an increase in the number of COVID-related deaths in 2021 and a decrease in 2022. The U.S. share of COVID-related deaths declined in 2021 but rose in 2022, leading to a cumulative total U.S. mortality share of 17%. The extent to which the U.S. is an outlier is even greater based on the monetized mortality costs. Using the value of a statistical life to monetize the mortality impact increases the performance gap between the U.S. and the rest of the world because of the high mortality risk valuation in the U.S. The worldwide COVID-19 mortality cost was $29.4 trillion as of January 1, 2023, with a U.S. share of $12.7 trillion, or 43% of the global total. Throughout the COVID pandemic, the U.S. mortality cost share has been in the narrow range of 43% to 45%. Given the high U.S. value of a statistical life, these monetized mortality cost values are more than double the U.S. share of COVID-related deaths. The U.S. mortality cost share is greater if the value of a statistical life declines more than proportionally with income for low-income countries.

The perceived risks of e-cigarettes to others and during pregnancy.

BACKGROUND: Public Health England has concluded that e-cigarettes are much safer than cigarettes for the user and for secondhand exposures, but it has not reached a definitive conclusion regarding pregnancy risks. How people perceive the risks to others is less well understood. METHODS: This study uses an online UK sample of 1041 adults to examine perceived e-cigarette risks to others and during pregnancy. The survey examines relative risk beliefs of e-cigarettes compared to cigarettes and the percentage reduction in harm provided by e-cigarettes. RESULTS: A majority of the sample believes that secondhand exposure to e-cigarette vapors poses less risk than secondhand smoke from cigarettes, but almost two-fifths of the sample equate the secondhand risks from e-cigarettes to those from cigarettes. There is somewhat greater perception of e-cigarette risks during pregnancy compared to beliefs regarding secondhand risks of vaping. About two-fifths of the population believe that e-cigarettes are less risky than cigarettes during pregnancy. Respondents believe that e-cigarettes reduce the harm to others by 39% and the harm to babies by 36%. CONCLUSION: There is a general sense that e-cigarettes pose less risk than cigarettes, but there is a need for further risk communication regarding comparative e-cigarette risks.

Risk-Risk Tradeoffs for Mass Shootings and International Terrorism.

This article elicits information about risk perceptions and risk-risk tradeoffs for mass shootings and international terrorist attacks. These prominent public risks are similar in many respects in that both involve traumatic injuries. One might expect that the risk-risk tradeoff rate would be 1.0 unless other attributes of these risks are pertinent. Estimates based on an original survey structured to test rates of tradeoff between deaths from these risks indicate that respondents consistently place a premium on reducing mass shooting risks, as compared to risks of international terrorism. The average premium is relatively stable even after accounting for the effect of differences in personal risk beliefs on policy preferences. The estimated rates of risk-risk tradeoff reflect a greater weight on mass shooting risks even for those who believe that international terrorism risks pose a greater personal threat.

Economic lessons for COVID-19 pandemic policies.

The COVID-19 pandemic poses novel health issues. However, the benefits and costs of the pandemic and policies to address it have a familiar economic structure. Chief among the health-related benefits are the monetized values of the U.S. mortality costs of $3.9 trillion in 2020. The combined U.S. mortality and morbidity costs are $5.5-5.9 trillion. Global mortality costs in 2020 total $10.1 trillion. The skewed age distribution of COVID-19 illnesses has stimulated increased advocacy of downward adjustments in the value of a statistical life (VSL) for older people. This article examines the role of age for policy analysis generally and for the rationing of scarce medical treatments, such as ventilators. Mortality risk reduction benefits should be based on the reduced probability of death multiplied by the pertinent VSL. Effective communication of risks to foster precautions hinges on the credibility of the information source, which public officials have jeopardized. Efficient control of risks imposes limits on personal freedoms to foster health improvements.

Pricing the global health risks of the COVID-19 pandemic.

Policies to address the coronavirus disease 2019 (COVID-19) require a balancing of the health risk reductions and the costs of economic dislocations. Application of the value of a statistical life (VSL) to monetize COVID-19 deaths produces a U.S. mortality cost estimate of $1.4 trillion for deaths in the first half of 2020. This article presents worldwide COVID-19 costs for over 100 countries. The total global mortality cost through July 2, 2020 is $3.5 trillion. The United States accounts for 25% of the deaths, but 41% of the mortality cost. Adjustments for the shorter life expectancy and lower income of the victims substantially reduces the estimated monetized losses, but may raise fundamental equity concerns. Morbidity effects of COVID-19 affect many more patients than do the disease's mortality risks. Consideration of the morbidity effects increase the expected health losses associated with COVID-19 illnesses by 10% to 40%.

Catastrophic Risk: Waking Up to the Reality of a Pandemic?

Will a major shock awaken the US citizens to the threat of catastrophic pandemic risk? Using a natural experiment administered both before and after the 2014 West African Ebola Outbreak, our evidence suggests "no." Our results show that prior to the Ebola scare, the US citizens were relatively complacent and placed a low relative priority on public spending to prepare for a pandemic disease outbreak relative to an environmental disaster risk (e.g., Fukushima) or a terrorist attack (e.g., 9/11). After the Ebola scare, the average citizen did not over-react to the risk. This flat reaction was unexpected given the well-known availability heuristic-people tend to over-weigh judgments of events more heavily toward more recent information. In contrast, the average citizen continued to value pandemic risk less relative to terrorism or environmental risk.

The impact of cannabis access laws on opioid prescribing.

While recent research has shown that cannabis access laws can reduce the use of prescription opioids, the effect of these laws on opioid use is not well understood for all dimensions of use and for the general United States population. Analyzing a dataset of over 1.5 billion individual opioid prescriptions between 2011 and 2018, which were aggregated to the individual provider-year level, we find that recreational and medical cannabis access laws reduce the number of morphine milligram equivalents prescribed each year by 11.8 and 4.2 percent, respectively. These laws also reduce the total days' supply of opioids prescribed, the total number of patients receiving opioids, and the probability a provider prescribes any opioids net of any offsetting effects. Additionally, we find consistent evidence that cannabis access laws have different effects across types of providers, physician specialties, and payers.

"Sorry" Is Never Enough: How State Apology Laws Fail to Reduce Medical Malpractice Liability Risk.

Based on case studies indicating that apologies from physicians to patients can promote healing, understanding, and dispute resolution, thirty-nine states (and the District of Columbia) have sought to reduce litigation and medical malpractice liability by enacting apology laws. Apology laws facilitate apologies by making them inadmissible as evidence in subsequent malpractice trials. The underlying assumption of these laws is that after receiving an apology, patients will be less likely to pursue malpractice claims and will be more likely to settle claims that are filed. However, once a patient has been made aware that the physician has committed a medical error, the patient's incentive to pursue a claim may increase even though the apology itself cannot be introduced as evidence. Thus, apology laws could lead to either increases or decreases in overall medical malpractice liability risk. Despite apology laws' status as one of the most widespread tort reforms in the country, there is little evidence that they achieve their goal of reducing litigation. This Article provides critical new evidence on the role of apology laws by examining a dataset of malpractice claims obtained directly from a large national malpractice insurer. This dataset includes substantially more information than is publicly available, and thus presents a unique opportunity to understand the effect of apology laws on the entire litigation landscape in ways that are not possible using only publicly available data. Decomposing medical malpractice liability risk into the frequency of claims and the magnitude of those claims, we examine the malpractice claims against 90% of physicians in the country who practice within a particular specialty over an eight-year period.

The net effects of medical malpractice tort reform on health insurance losses: the Texas experience.

In this paper, we examine the influence of medical malpractice tort reform on the level of private health insurance company losses incurred. We employ a natural experiment framework centered on a series of tort reform measures enacted in Texas in 2003 that drastically altered the medical malpractice environment in the state. The results of a difference-in-differences analysis using a variety of comparison states, as well as a difference-in-difference-in-differences analysis, indicate that ameliorating medical malpractice risk has little effect on health insurance losses incurred by private health insurers.

Recollection Bias and Its Underpinnings: Lessons from Terrorism Risk Assessments.

Recollection bias is the phenomenon whereby people who observe a highly unexpected event hold current risk beliefs about a similar event that are no higher than their recollection of their prior beliefs. This article replicates and extends the authors' previous study of recollection bias in relation to individuals' perceptions of the risks of terrorism attacks. Over 60% of respondents in a national U.S. sample of over 900 adults believe that the current risk of a future terrorist attack by either an airplane or in a public setting is no higher than they recall having believed, respectively, before the 9/11 attack and before the Boston Marathon bombing. By contrast, a rational Bayesian model would update to a higher currently assessed risk of these previously uncontemplated events. Recollection bias is a persistent trait: individuals who exhibited this bias for the 9/11 attack exhibited it for the Boston Marathon bombing. Only one-fifth of respondents are free of any type of recollection bias. Recollection bias is negatively correlated with absolute levels of risk belief. Recollection bias in relation to highly unexpected terrorist events-the belief that perceived risks did not increase after the surprise occurrence-dampens support for a variety of anti-terrorism measures, controlling for the level of risk beliefs and demographic factors. Persistent recollection bias for both 9/11 and the Boston Marathon bombing is especially influential in diminishing support for protective policy measures, such as surveillance cameras in public places. Given that public attitudes influence policy, educating the public about risk is critical.

The fatality and morbidity components of the value of statistical life.

The fatality risk-money tradeoff that is the value of a statistical life (VSL) may vary with the nature of the fatality event. While all fatalities involve loss of future life expectancy, the morbidity effects and their duration may differ. This article analyzes fatality risks accompanied by morbidity effects of different duration to disentangle the mortality and morbidity components of VSL using data from the Census of Fatal Occupational Injuries (CFOI). The VSL is comprised of the sum of the value of the fatality risk and the value of the morbidity risk. Labor market valuations of morbidity risks are positive, even for fatalities that are caused by traumatic injuries. The value of the fatality risk is the dominant component of VSL, rather than the value of the morbidity risk.

The relative weights of direct and indirect experiences in the formation of environmental risk beliefs.

Direct experiences, we find, influence environmental risk beliefs more than the indirect experiences derived from outcomes to others. This disparity could have a rational basis. Or it could be based on behavioral proclivities in accord with the well-established availability heuristic or the vested-interest heuristic, which we introduce in this article. Using original data from a large, nationally representative sample, this article examines the perception of, and responses to, morbidity risks from tap water. Direct experiences have a stronger and more consistent effect on different measures of risk belief. Direct experiences also boost the precautionary response of drinking bottled water and drinking filtered water, while indirect experiences do not. These results are consistent with the hypothesized neglect of indirect experiences in other risk contexts, such as climate change.

Assessing whether there is a cancer premium for the value of a statistical life.

This article estimates whether there is a cancer risk premium for the value of a statistical life using stated preference valuations of cancer risks for a large, nationally representative US sample. The present value of an expected cancer case that occurs after a one decade latency period is $10.85m, consistent with a cancer premium that is 21% greater than the median value of a statistical life estimates for acute fatalities. This cancer premium is smaller than the premium proposed for policy analyses in the UK and the USA. There is also a greater premium for policies that reduce cancer risks to zero and for risk reductions affecting those who perceive themselves to have a greater than average probability of having cancer.

Publication selection and the income elasticity of the value of a statistical life.

Estimates of the value of a statistical life (VSL) establish the price government agencies use to value fatality risks. Transferring these valuations to other populations often utilizes the income elasticity of the VSL, which typically draw on estimates from meta-analyses. Using a data set consisting of 101 estimates of the income elasticity of VSL from 14 previously reported meta-analyses, we find that after accounting for potential publication bias the income elasticity of value of a statistical life is clearly and robustly inelastic, with a value of approximately 0.25-0.63. There is also clear evidence of the importance of controlling for levels of risk, differential publication selection bias, and the greater income sensitivity of VSL from stated preference surveys.

Heterogeneous rates of time preference and the decision to smoke.

Individuals with higher personal rates of time preference will be more likely to smoke. Although previous studies have found no evidence of a relationship between smoking and rates of time preference, analysis of implicit rates of time preference associated with workers' wage fatality risk trade-offs indicates that smokers have higher rates of time preference with respect to years of life. Current smokers have an implied rate of time preference of 13.8% as compared to 8.1% for nonsmokers. Current smokers who are blue-collar workers have rates of time preference with respect to years of life of 16.3% compared to 7.8% for nonsmoking blue-collar workers.

Survey mode effects on valuation of environmental goods.

This article evaluates the effect of the choice of survey recruitment mode on the value of water quality in lakes, rivers, and streams. Four different modes are compared: bringing respondents to one central location after phone recruitment, mall intercepts in two states, national phone-mail survey, and an Internet survey with a national, probability-based panel. The modes differ in terms of the representativeness of the samples, non-response rates, sample selection effects, and consistency of responses. The article also shows that the estimated value of water quality can differ substantially depending on the survey mode. The national Internet panel has the most desirable properties with respect to performance on the four important survey dimensions of interest.

Variables influencing the neural correlates of perceived risk of physical harm.

Many human activities involve a risk of physical harm. However, not much is known about the specific brain regions involved in decision making regarding these risks. To explore the neural correlates of risk perception for physical harms, 19 participants took part in an event-related fMRI study while rating risky activities. The scenarios varied in level of potential harm (e.g., paralysis vs. stubbed toe), likelihood of injury (e.g., 1 chance in 100 vs. 1 chance in 1,000), and format (frequency vs. probability). Networks of brain regions were responsive to different aspects of risk information. Cortical language- processing areas, the middle temporal gyrus, and a region around the bed nucleus of stria terminalis responded more strongly to high- harm conditions. Prefrontal areas, along with subcortical ventral striatum, responded preferentially to high- likelihood conditions. Participants rated identical risks to be greater when information was presented in frequency format rather than probability format. These findings indicate that risk assessments for physical harm engage a broad network of brain regions that are sensitive to the severity of harm, the likelihood of risk, and the framing of risk information.

The mortality cost to smokers.

This article estimates the mortality cost of smoking using the first labor market estimates of the value of statistical life by smoking status. The value of statistical life is $7 million for both smokers and nonsmokers. Using this value in conjunction with the increase in the mortality risk over the life cycle due to smoking, the value of statistical life by age and gender, and information on the number of packs smoked over the life cycle, the private mortality cost of smoking is $222 per pack for men and $94 per pack for women in $2006, based on a 3% discount rate. At discount rates of 15% or more, the cost decreases to under $25 per pack.