數(shù)十萬人死亡的代價(jià)，該如何衡量?

數(shù)十萬人死亡的代價(jià)，該如何衡量?

President Trump and leading business figures are increasingly questioning the wisdom of a prolonged shutdown of the American economy — already putting millions out of work — to curb the spread of the coronavirus pandemic.

特朗普總統(tǒng)和商界領(lǐng)袖們?cè)絹碓蕉嗟刭|(zhì)疑，為遏制新型冠狀病毒的蔓延而讓美國經(jīng)濟(jì)長期停擺是否明智——這種停滯已經(jīng)讓數(shù)百萬人失去了工作。

“Our people want to return to work,” Mr. Trump declared Tuesday on Twitter, adding, “THE CURE CANNOT BE WORSE (by far) THAN THE PROBLEM!”

“我們的人民希望重返工作崗位，”特朗普周二在Twitter上宣稱。他還說，“對(duì)策不應(yīng)該比問題更糟(糟很多)!”

In essence, he was raising an issue that economists have long grappled with: How can a society assess the trade-off between economic well-being and health?

從本質(zhì)上講，他提出了經(jīng)濟(jì)學(xué)家長久以來努力解決的問題：一個(gè)社會(huì)如何評(píng)估經(jīng)濟(jì)福祉和健康之間的取舍?

“Economists should be doing this cost-benefit analysis,” said Walter Scheidel, an economic historian at Stanford University. “Why is nobody putting some numbers on the economic costs of a monthlong or a yearlong shutdown against the lives saved? The whole discipline is well equipped for it. But there is some reluctance for people to stick their neck out.”

“經(jīng)濟(jì)學(xué)家應(yīng)該進(jìn)行這種成本效益分析，”斯坦福大學(xué)(Stanford University)經(jīng)濟(jì)歷史學(xué)家沃爾特·沙伊德爾(Walter Scheidel)說。“為什么沒有人在一個(gè)月或一年的停擺帶來的經(jīng)濟(jì)代價(jià)和由此拯救的生命之間做一個(gè)量化對(duì)比?整個(gè)學(xué)科完全有能力這么做。但大家還是不愿意冒這個(gè)險(xiǎn)。”

Some economists who support lifting the current restrictions on economic activity say governors and even the Trump administration have not sufficiently assessed the costs and benefits of those restrictions.

一些支持取消當(dāng)前經(jīng)濟(jì)活動(dòng)限制的經(jīng)濟(jì)學(xué)家表示，州長乃至特朗普政府都沒有對(duì)這些限制的成本和效益做出充分評(píng)估。

“We put a lot of weight on saving lives,” said Casey Mulligan, a University of Chicago economist who spent a year as chief economist on Mr. Trump’s Council of Economic Advisers. “But it’s not the only consideration. That’s why we don’t shut down the economy every flu season. They’re ignoring the costs of what they’re doing. They also have very little clue how many lives they’re saving.”

“我們非常重視拯救生命，”芝加哥大學(xué)(University Of Chicago)經(jīng)濟(jì)學(xué)家凱西·馬利根(Casey Mulligan)說，他曾在特朗普的經(jīng)濟(jì)顧問委員會(huì)(Council of Economic Advisers)擔(dān)任過一年的首席經(jīng)濟(jì)學(xué)家。“但這不是唯一的考量。這就是為什么每次到了流感季，我們不會(huì)讓經(jīng)濟(jì)停擺的原因。他們忽略了做事的代價(jià)。同時(shí)他們對(duì)能拯救多少生命也毫無概念。”

There is, however, a widespread consensus among economists and public health experts that lifting the restrictions would impose huge costs in additional lives lost to the virus — and deliver little lasting benefit to the economy.

不過，經(jīng)濟(jì)學(xué)家和公共衛(wèi)生專家倒是普遍認(rèn)為，取消這些限制將使更多的人死于這種病毒，付出巨大的代價(jià)，而且?guī)缀醪粫?huì)給經(jīng)濟(jì)帶來什么長期的好處。

“It’s useful to adopt the cost-benefit frame, but the moment you do that, the outcomes are so overwhelming that you don’t need to fill in the details to know what to do,” said Justin Wolfers, an economist at the University of Michigan.

密歇根大學(xué)(University Of Michigan)的經(jīng)濟(jì)學(xué)家賈斯汀·沃爾弗斯(Justin Wolfers)表示：“引入成本效益框架是有幫助的，不過一旦你這樣做了，得到的結(jié)果將是壓倒性的，你無需更多細(xì)節(jié)就知道該怎么做。”

The only case in which the benefits of lifting restrictions outweigh the costs in lost lives, Mr. Wolfers said, would be if “the epidemiologists are lying to us about people dying.”

沃爾弗斯說，只有在一種情況下，解除限制的好處會(huì)超過失去生命的代價(jià)，那就是“流行病學(xué)家在死亡的問題上對(duì)我們?nèi)鲋e了”。

Weighing economic costs against human lives will inevitably seem crass. But societies also value things like jobs, food and money to pay the bills — as well as the ability to deal with other needs and prevent unrelated misfortunes.

權(quán)衡人類生命的經(jīng)濟(jì)成本似乎不可避免地顯得愚蠢。但是，社會(huì)也重視工作、食物和支付賬單的錢等事物，以及滿足其他需求和防止不相關(guān)的不幸的能力。

“Making people poorer has health consequences as well,” said Kip Viscusi, an economist at Vanderbilt University who has spent his career using economic techniques to assess the costs and benefits of government regulations.

范德比爾特大學(xué)(Vanderbilt University)的經(jīng)濟(jì)學(xué)家基普·維斯庫西(Kip Viscusi)表示：“讓人變窮也會(huì)對(duì)健康造成影響。”維斯庫西在他的學(xué)術(shù)生涯中一直利用經(jīng)濟(jì)方法來評(píng)估政府監(jiān)管的成本和收益。

Jobless people sometimes commit suicide. The poor are likelier to die if they get sick. Mr. Viscusi estimates that across the population, every loss of income of $100 million in the economy causes one additional death.

失業(yè)者有時(shí)會(huì)自殺。如果窮人生病，他們死亡的可能性會(huì)更大。維斯庫西估計(jì)，在整個(gè)人口中，經(jīng)濟(jì)每損失1億美元的收入，就會(huì)導(dǎo)致一起額外的死亡。

Government agencies calculate these trade-offs regularly. The Environmental Protection Agency, for instance, has established a cost of about $9.5 million per life saved as a benchmark for determining whether to clean up a toxic waste site.

政府機(jī)構(gòu)定期計(jì)算這樣的取舍。例如，美國環(huán)護(hù)署(Environmental Protection Agency)設(shè)定了一個(gè)標(biāo)準(zhǔn)，每拯救一個(gè)生命的成本約為950萬美元，將其作為是否清理有毒廢物場地的決定基準(zhǔn)。

Other agencies use similar values to assess whether to invest in reducing accidents at an intersection or to tighten safety standards in a workplace. The Department of Agriculture has a calculator to estimate the economic costs — medical care, premature deaths, productivity loss from nonfatal cases — of food-borne disease.

其他機(jī)構(gòu)使用類似的方法進(jìn)行量化評(píng)估，以決定是投資減少十字路口的事故，還是加強(qiáng)工作場所的安全標(biāo)準(zhǔn)。農(nóng)業(yè)部有一個(gè)計(jì)算標(biāo)準(zhǔn)，用來估計(jì)食源性疾病的經(jīng)濟(jì)成本——醫(yī)療保健、過早死亡、非致命病例造成的生產(chǎn)力損失。

Now, some economists have decided to stick their necks out and apply this thinking to the coronavirus pandemic.

現(xiàn)在，一些經(jīng)濟(jì)學(xué)家決定冒險(xiǎn)把這種想法應(yīng)用到冠狀病毒大流行上。

In a paper released on Monday, Martin S. Eichenbaum and Sergio Rebelo of Northwestern University, with Mathias Trabandt of the Free University in Berlin, used the E.P.A.’s number to figure the optimal way to slow the spread of the disease without economic costs that exceed the benefits.

在周一發(fā)布的一篇論文中，西北大學(xué)(Northwestern University)的馬丁·S·埃辛鮑姆(Martin S. Eichenbaum)和塞爾吉奧·雷貝洛(Sergio Rebelo)，以及柏林自由大學(xué)(Free University)的馬蒂亞斯·特拉班特(Mathias Trabandt)使用了美國環(huán)保署的數(shù)字，分析在不造成經(jīng)濟(jì)成本超過收益的情況下減緩疾病傳播的最佳方法。

The economy would contract sharply even without a government-imposed lockdown as people chose to stay away from workplaces and stores, hoping to prevent contagion. In that case of voluntary isolation, Mr. Eichenbaum and his colleagues estimated that U.S. consumer demand would decline by $800 billion in 2020, or about 5.5 percent.

即使沒有政府強(qiáng)制的封鎖，經(jīng)濟(jì)也會(huì)急劇收縮，因?yàn)槿藗優(yōu)榉乐箓魅荆瑫?huì)選擇遠(yuǎn)離工作場所和商店。在這種情況下，埃辛鮑姆和同事們估計(jì)，到2020年，美國的消費(fèi)者需求將減少8000億美元，降幅約5.5%。

Based on epidemiological projections, as the virus ran unchecked, it would quickly expand to infect somewhat over half the population before herd immunity would slow its course. Assuming a death rate of about 1 percent of those infected, about 1.7 million Americans would die within a year.

根據(jù)流行病學(xué)預(yù)測，當(dāng)病毒不受控制地傳播時(shí)會(huì)迅速擴(kuò)大，感染半數(shù)以上的人口，然后群體免疫才會(huì)減緩其進(jìn)程。假設(shè)感染者的死亡率為1%，那么大約170萬美國人將在一年內(nèi)死亡。

A policy to contain the virus by reducing economic activity would slow the progression of the virus and reduce the death rate, but it would also impose a greater economic cost.

通過減少經(jīng)濟(jì)活動(dòng)來遏制病毒的政策，可以減緩病毒發(fā)展并降低死亡率，但它也將帶來更大的經(jīng)濟(jì)代價(jià)。

Mr. Eichenbaum and his colleagues say the “optimal” policy — assessing economic losses alongside lives — requires restrictions that slow the economy substantially. Under their approach, the decline in consumption in 2020 more than doubles, to $1.8 trillion, but the deaths drop by half a million people. That would amount to $2 million in lost economic activity per life saved.

埃辛鮑姆及同事們說，既考慮經(jīng)濟(jì)損失又考慮生命的“最優(yōu)”政策需要實(shí)施一些大大減緩經(jīng)濟(jì)增長的限制措施。按照他們的評(píng)估方法，2020年，消費(fèi)下降超過一倍，達(dá)到1.8萬億美元，但死亡人數(shù)減少了50萬人。這相當(dāng)于每挽救一條生命就損失200萬美元的經(jīng)濟(jì)活動(dòng)。

In this instance, “you want to make the recession worse,” Mr. Eichenbaum said. But an important corollary is that there are limits to the sacrifice: Beyond a certain point, it would not be worth it to lose more economic activity in order to save more people.

在這種情況下，“你需要讓經(jīng)濟(jì)衰退變得更糟，”埃辛鮑姆說。但一個(gè)重要的推論是，這種犧牲是有限度的：超過某個(gè)限度，為了拯救更多的人而失去更多經(jīng)濟(jì)活動(dòng)就不值得了。

The model, he noted, is heavily dependent on the assumptions that go into it, meant to convey the magnitude of the trade-offs. And the economists are still tweaking. The cost-benefit ratio will change if one considers that the health system might become overwhelmed by Covid-19 cases, increasing mortality rates. That would justify a more aggressive lockdown that ramped up more quickly.

他指出，這個(gè)模型在很大程度上依賴于其中的假設(shè)，它是為了表達(dá)取舍的量級(jí)。經(jīng)濟(jì)學(xué)家們?nèi)栽谧髡{(diào)整。如果考慮到醫(yī)療系統(tǒng)可能會(huì)被Covid-19的病例壓垮，從而增加死亡率，那么成本效益比將會(huì)改變，因此會(huì)有必要以更快的速度實(shí)施更劇烈的封鎖措施。

It comes down to what a life is worth.

歸根結(jié)底，這是在衡量生命的價(jià)值。

In the 1960s, a Nobel Prize laureate in economics, Thomas C. Schelling, proposed letting people price their own lives. Observing how much they were willing to spend to reduce their odds of death — by buying a bicycle helmet, driving within the speed limit, refusing to buy a house near a toxic-waste site or demanding a higher wage for a more dangerous job — government agencies could compute a price tag.

1960年代，諾貝爾經(jīng)濟(jì)學(xué)獎(jiǎng)得主托馬斯·C·謝林(Thomas C. Schelling)提出讓人們?yōu)樽约旱纳▋r(jià)。通過觀察人們?cè)敢饣ǘ嗌馘X來減少死亡率——購買自行車頭盔、在限速范圍內(nèi)行駛、拒絕購買附近存在有毒廢料的房屋，或者做工資更高、風(fēng)險(xiǎn)更大的工作——政府機(jī)構(gòu)可以計(jì)算出一個(gè)標(biāo)價(jià)。

That can lead to some strange numbers, though. As Peter Singer, the Australian ethical philosopher, noted, you can save a life in poor countries with $2,000 or $3,000, and many of those lives are still allowed to be lost. “If you compare that with $9 million,” he said, “it’s crazy.”

不過，這可能會(huì)導(dǎo)致一些奇怪的數(shù)字。正如澳大利亞倫理哲學(xué)家彼得·辛格(Peter Singer)所指出的，在貧窮國家，兩三千美元就能挽救一條生命，然而他們?nèi)匀蝗斡稍S多人死去。“和900萬美元比起來，”他說，“簡直不可思議。”

The discussion gets even more touchy when one considers the age profile of the dead. It raises the question: Is saving the life of an 80-year-old as valuable as saving the life of a baby?

再納入死者的年齡，討論會(huì)變得更加敏感。它提出了一個(gè)問題：拯救一個(gè)80歲老人的生命，和拯救一個(gè)嬰兒的生命，有同等的價(jià)值嗎?

Cass Sunstein, a legal scholar who worked for the Obama administration, heading the White House office in charge of these valuations, once proposed focusing government policies on saving years of life rather than lives, as is customary in other countries.

曾為奧巴馬政府工作的法律學(xué)者凱斯·桑斯坦(Cass Sunstein)是白宮負(fù)責(zé)這類評(píng)估的辦公室主任，他曾提議將政府政策的重點(diǎn)放在拯救生命時(shí)長上，而不是像其他國家的慣例那樣，僅僅關(guān)注生命本身。

“A program that saves younger people is better, in this sense, than an otherwise identical program that saves older people,” he wrote.

“從這個(gè)意義上說，一個(gè)拯救年輕人的項(xiàng)目，比另一個(gè)同樣的拯救老年人的項(xiàng)目更好，”他寫道。

In the George W. Bush administration, the E.P.A. tried to move in Mr. Sunstein’s preferred direction. To calculate the costs and benefits of legislation regulating soot emissions from power plants, it had to figure out the value of reducing premature mortality. Rather than evaluate every life saved at $6.1 million, as it had done in the past, it applied an age discount: People over 70 were worth only 67 percent of the lives of younger people.

在喬治·W·布什(George W. Bush)政府時(shí)期，美國環(huán)保署曾試圖朝著桑斯坦喜歡的方向前進(jìn)。為了計(jì)算監(jiān)管發(fā)電廠煙塵排放的立法的成本和收益，它必須計(jì)算出降低過早死亡率的價(jià)值。它沒有像過去那樣，為每拯救一條生命估價(jià)610萬美元，而是采用了年齡折扣：70歲以上的人只占年輕人生命價(jià)值的67%。

The backlash by AARP and others was fierce. And the agency dropped the idea. “E.P.A. will not, I repeat, not use an age-adjusted analysis in decision making,” pleaded Christine Todd Whitman, the E.P.A. administrator at the time. Yet by putting the same price on all lives, the agency implicitly devalued young people’s remaining years.

美國退休人員協(xié)會(huì)(AARP)等機(jī)構(gòu)對(duì)此強(qiáng)烈反對(duì)。于是美國環(huán)保署放棄了這個(gè)想法。“我再說一遍，美國環(huán)保署不會(huì)在做決定時(shí)使用年齡調(diào)整分析，”當(dāng)時(shí)的環(huán)保署負(fù)責(zé)人克里斯汀·托德·惠特曼(Christine Todd Whitman)辯稱。然而，在對(duì)所有人的生命一視同仁的同時(shí)，該機(jī)構(gòu)無形中造成了年輕人剩余生命的貶值。

Covid-19 seems to be much more lethal for older people, whatever their economic worth. But Mr. Trump declared Tuesday that even while those most at risk are safeguarded, the economy could be “raring to go” within three weeks. “Seniors will be watched over protectively & lovingly,” he said on Twitter. “We can do two things together.”

無論老年人的經(jīng)濟(jì)價(jià)值如何，Covid-19對(duì)他們來說似乎更致命。但特朗普周二宣布，在面臨最大風(fēng)險(xiǎn)的人得到保護(hù)的同時(shí)，經(jīng)濟(jì)在未來三周內(nèi)也會(huì)是“蓄勢待發(fā)”的狀態(tài)。“老年人將受到保護(hù)和關(guān)愛，”他在Twitter上寫道。“我們可以同時(shí)做到兩件事。”