Love this article and the series. Couldn’t be happier to see you get this discussion rolling!
Questions for you regarding this piece:
The fungible thing in the analysis, i.e. the common unit of account, should be a year of healthy, happy, flourishing human life.
Just out of curiosity, why do you think this measure ought to be the unit? You could say “a month” or “a day” or “a decade” or “a six second conscious moment”, but the choice is “a year”.
And how do we deal with “healthy, happy, and flourishing” as a singular unit, when, in a sense, each of these things are in themselves such complex, multidimensional metrics?
What is your overall basis for this conclusion that the healthy, happy human life-year is the best unit of measurement vs other possible measures of “welfare”?
(Just to be clear, I 100% agree with you that we should use this unit of measurement, especially in favor of money. But I have been struggling with these additional questions and have a feeling you might have some insights to offer.)
As far as I can tell, Richard Bruns is talking about the quality-adjusted life year or QALY.
The reason it is a year is essentially arbitrary, a year is decently long without being too long for the purposes of public health where QALYs first got used.
The way we deal with “healthy, happy, and flourishing” as a single unit is much trickier. For traditional QALY calculations, researchers simply ask people how they feel when experiencing certain things (like a particular surgery or a disease) and normalize/aggregate those responses to get a scale where 0 quality is as good as death, 1 is perfect health, and negative numbers can be used for experiences worse than death.
For traditional QALY calculations, researchers simply ask people how they feel when experiencing certain things (like a particular surgery or a disease) and normalize/aggregate those responses to get a scale where 0 quality is as good as death, 1 is perfect health, and negative numbers can be used for experiences worse than death.
This isn’t correct. QALY weights are typically based on hypothetical preferences, not experiences.
What Richard described is more like a WELBY, which has a similar structure but covers wellbeing in some sense rather than just health. See Part 1 of my (unfinished) sequence on this if you’re interested.
I never meant to make a statement that a year is better than other time units. I said year because it is the existing standard in the field. The statement was about using a life/health measurement rather than money. As the 102 post hints at, my goal is not to create ‘the best’ system ex nihilo; it is to build off of the precedent set in the field. So whenever an arbitrary choice has already become the standard, and it is not obviously worse than something else, I stick with it.
This will inevitably be handwavey, fuzzy, and based on surveys. I imagine something like the WELBY, where we set the value of an ideal life to 1, and ask people how bad it would be for various things to happen to them, and assign ‘disability weights’ to everything based on their responses.
Because it is easy for everyone to understand intuitively. See the 102 post; anything we use will need to be very approachable, so we have society-wide buy-in for the metric.
Love this article and the series. Couldn’t be happier to see you get this discussion rolling!
Questions for you regarding this piece:
Just out of curiosity, why do you think this measure ought to be the unit? You could say “a month” or “a day” or “a decade” or “a six second conscious moment”, but the choice is “a year”.
And how do we deal with “healthy, happy, and flourishing” as a singular unit, when, in a sense, each of these things are in themselves such complex, multidimensional metrics?
What is your overall basis for this conclusion that the healthy, happy human life-year is the best unit of measurement vs other possible measures of “welfare”?
(Just to be clear, I 100% agree with you that we should use this unit of measurement, especially in favor of money. But I have been struggling with these additional questions and have a feeling you might have some insights to offer.)
As far as I can tell, Richard Bruns is talking about the quality-adjusted life year or QALY.
The reason it is a year is essentially arbitrary, a year is decently long without being too long for the purposes of public health where QALYs first got used.
The way we deal with “healthy, happy, and flourishing” as a single unit is much trickier. For traditional QALY calculations, researchers simply ask people how they feel when experiencing certain things (like a particular surgery or a disease) and normalize/aggregate those responses to get a scale where 0 quality is as good as death, 1 is perfect health, and negative numbers can be used for experiences worse than death.
Then you multiply quality by quantity. The Wikipedia article on this is good and goes into more depth: https://en.wikipedia.org/wiki/Quality-adjusted_life_year
Note: I don’t know how Bruns intends to measure quality of life yet, I expect we’ll have to wait.
This isn’t correct. QALY weights are typically based on hypothetical preferences, not experiences.
What Richard described is more like a WELBY, which has a similar structure but covers wellbeing in some sense rather than just health. See Part 1 of my (unfinished) sequence on this if you’re interested.
I agree with this; thank you for replying. (I thought I would get email alerts if anyone commented, but I guess I didn’t set that up right.)
Questions in order:
I never meant to make a statement that a year is better than other time units. I said year because it is the existing standard in the field. The statement was about using a life/health measurement rather than money. As the 102 post hints at, my goal is not to create ‘the best’ system ex nihilo; it is to build off of the precedent set in the field. So whenever an arbitrary choice has already become the standard, and it is not obviously worse than something else, I stick with it.
This will inevitably be handwavey, fuzzy, and based on surveys. I imagine something like the WELBY, where we set the value of an ideal life to 1, and ask people how bad it would be for various things to happen to them, and assign ‘disability weights’ to everything based on their responses.
Because it is easy for everyone to understand intuitively. See the 102 post; anything we use will need to be very approachable, so we have society-wide buy-in for the metric.