Cowen on Nursing Homes: A Postscript

I continue to be baffled by Tyler Cowen’s views on the COVID-19 nursing home controversy. Here’s a relevant excerpt from a piece of his that’s just come out in Bloomberg Opinion:

If I have learned one thing over the last few weeks, it is that the psychology of the American public is weirder — and perhaps more flexible — than I ever would have thought.

Consider, as just one example among many, the issue of nursing homes. According to some estimates, about 40% of the deaths associated with Covid-19 have occurred in nursing homes, with more almost certain to come.

You might think that those 40,000-plus deaths would be a major national scandal. But so far the response has been subdued. Yes, there has been ample news coverage, but there are no riots in response, no social movement to “clean up the nursing homes,” no Ralph Nader-like crusader who has made this his or her political cause.

Nor has there been much resulting vilification. There are plenty of condemnations of technology billionaires, but very few of nursing-home CEOs. Many of the state and local politicians who oversee public-sector nursing homes have been rewarded with higher approval ratings.

As if all this weren’t bad enough, of those 40,000 deaths, surely a considerable number are African-American (data by race is hard to come by). This could be an issue for Black Lives Matter, but somehow it isn’t.

Until recently, Cowen was describing excess mortality in nursing home as a paradigm case of regulatory failure by the government. Now he’s puzzled why there is no outrage being expressed against nursing home CEOs. Worse still, he now seems to be using the lack of outrage or sense of scandal about the nursing home issue as a polemical talking point against Black Lives Matters. The first move strikes me as a fundamental but unacknowledged change in his views. The second strikes me as a red herring. The combination seems a recipe for confusion.

First of all, it would help to come clean on the view he expressed in The Atlantic: is the excess mortality in nursing homes, particularly in New York and New Jersey, primarily a matter of government failure, or primarily a matter of moral failure on the part of nursing home CEOs? Or is “primarily” the wrong adverb to use here, because the outcome arose from a complex interaction between both actors? Or was the outcome an effect of a cause common to both sets of actors, and impinging on both? Or all of the above? I still don’t understand where Cowen comes down on any of this–whether on causality or on matters of straightforward descriptive fact. So I don’t understand why he’s fast-forwarding to outrage, scandals, vilification, and crusades. Isn’t that to put the moral cart before the descriptive and explanatory horse?

NJ Governor Phil Murphy/photo credit: Edwin Torres, Governor’s Office

In order to be outraged about something, we need to know what happened: we need to know who did what, when, where, how, and why. Cowen has said next to nothing about any of that. Neither, properly speaking, has anyone else–at least that I’ve been able to find. Now he asks why there is no “outrage” or sense of “scandal” about the nursing home issue. Well, outrage about what, exactly? Sense of scandal regarding what? Why is outrage the appropriate response in the first place?

In any case, Cowen is just wrong that there has been no or little outrage expressed about the nursing home issue. The issue has received almost constant coverage in the national and regional media, and in New Jersey, anyway, is shaping up to be the subject of a major legislative investigation. Despite what I regard as its utter vacuity, this story is front page news all across New Jersey, Cowen’s home state, and has been for days. No, people aren’t rushing out into the streets to express themselves over it, but wouldn’t it be weirder if they did? Does it really make sense to hold street protests over community spread of COVID-19?

If Cowen’s point is that he simply wants to draw attention to an anomalous feature of American psychology–people feel outrage about weird things–I guess I would draw attention to another: people seem to expect outrage about weird things, too. Maybe there’s been no outrage about the nursing home issue because the news coverage about it to which Cowen alludes is frankly so confused that few can make heads or tails of it. Ask even the simplest questions of the standard media narrative about the “nursing home scandal,” and the whole thing collapses like a house of cards. Patients were sent to nursing homes because the authorities thought there was a need for expeditious discharge from hospitals. Some of these nursing home patients were re-admits, and others first-time admits with nowhere else to go. So they were sent to nursing homes, and died there. Who is to be blamed for this sequence of events? By itself, a bare-bones recounting of the sequence doesn’t tell us. We’re still waiting for an account that does.

Here is my bottom-line recommendation. Let’s first figure out what happened–what really happened, in all of its ramifications and all of its complexity. Then let’s figure out why the relevant agents acted as they did–why the regulators passed the directives they passed, why the (various different) nursing home CEOs (each in different situations) responded as they did. Once we’re done with that inquiry, we can feel free to publicly indulge whatever emotion is appropriate to our findings. But there’s enough hysteria in this country right now that we don’t need to add to it by expressing some more premature outrage about nursing home CEOs, and enough confusion that it won’t help to add more confusion to what’s already sufficiently confused right now.

At this stage of “inquiry”–and my complaint is that properly speaking, there hasn’t been one–we should bracket all sense of outrage and all temptation to vilify. Our primary aim, to paraphrase Spinoza, should not be to mock, lament, or execrate, but to understand. I’m as into outrage and vilification as the next guy, maybe more so. But outrage without understanding is an expression of moral blindness, not of insight. We’ve flown blind in epistemic and epidemiological space for long enough. We need to hit the brakes, not speed up.

7 thoughts on “Cowen on Nursing Homes: A Postscript

  1. I found this column puzzling too, but for somewhat different reasons. Why expect outrage to track (beliefs regarding) number of deaths (or potentially needless deaths) caused by this or that agent or institution? To the extent that outrage tracks something, isn’t it more plausible that it tracks (beliefs about) egregious acts of malice or negligence (or similar things) that result in death, serious injury, humiliation, etc.? This will be a function of what people believe and people believe all sorts of crazy things (especially since the relevant sense of ‘believe’ includes the rather fragile cognitive affirmations produced by even extreme forms of motivated reasoning). So we should expect weird, unjustified patterns of outrage both individually and as a matter of implicit social consensus. Cowen’s column strikes me as a bit Michael-Huemer-esque, in this way: you can’t expect that people will be rational (rather, in the context of partisanship or social contention over what the most important norms in a population will and should be, expect anything from moderate to ridiculous tribalism and all of its cognitive distortions) — and anyway your view of what the controlling, salient features that a rational person would take into account is questionable. Not a great performance. The better close-by point is simply that we have traveled quite far down the tribalist road with respect to outrage and cognitive distortions that justify it. But then there is no puzzle, but rather a need to diagnose and treat the worst of this.

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