The Cost Of Stein/Clinton's Wisconsin Vote Recount Could Have Saved At Least 5,000 Children's Lives

The Daily Caller just tweeted that the first day of the Wisconsin recount yielded a net gain of exactly 1 vote for Hillary Clinton. As best I can tell, there is a bipartisan consensus that this recount has virtually no chance of reversing the outcome in that state.  I'll let others make the case that this recount effort is "irresponsible and unwarranted."

What I want readers to consider is the opportunity cost of this apparently misguided $3.5 million investment in recounting votes.

It turns out that Jill Stein and Hillary Clinton could have saved the lives of at least 5,000 children had they invested in malaria prevention efforts rather than recounting presidential votes  [1].

It's obviously not my  place to lecture any presidential candidate about how to spend the hard-earned funds of those who donated to their campaign. But the next time you are caught in a debate with a progressive vehemently defending the necessity and importance of this recount effort, ask them this: was it really  worth the  lives of 5,000 children?

The Obamacare Connection

At the end of the day, it really does not matter to me whether presidential candidates who are fans of big government thoroughly squander the "other people's money" voluntarily donated to their campaigns.  But this penny-ante illustration of resource misallocation that hypothetically has downstream implications for literally thousands of lives has its counterpart in Obamacare.

I have repeatedly questioned whether river of resources being channeled into Obamacare really represent a cost-effective use of resources. I have shown that we would have to assume that a quality-adjusted life year is worth more than $195,000 in order to conclude that its health benefits exceed its sizable costs.

But if saving lives were the policy objective, we obviously could save FAR more lives if we instead channeled that same river of resources into more targeted interventions--e.g., reducing smoking among poor people--instead of the progressive dream of universal coverage. Which is to say that we are implicitly sacrificing literally tens of thousands of American lives that otherwise could have been saved had we let our heads rather than the hearts of progressives dictate how to spend the hard-earned dollars of American taxpayers [2].

Perhaps after Obamacare is repealed and replaced and ex-president Obama sits down to write his memoirs, he can answer this question: was Obamacare really all worth what Americans (and your own party) gave up to achieve it?

The Details for Policy Wonks

My conclusion is based on the excellent work of the Copenhagen Consensus Center, which found that delaying artemisininal through the use of quality artemisinin combination therapies (ACTs) provided $94 of mortality reduction benefits for every $1 invested. That means that these two candidates (one of whom boasted of a lifetime of efforts to help children) could--for the same amount remitted to the Wisconsin Elections Commission--have instead achieved $329 million in benefits by putting those funds to work in malaria prevention in Africa.

That is based on conservatively valuing each disability-adjusted life year (DALY) gained by the children whose deaths from malaria were averted at only $1,000 apiece.  An alternative upper-bound figure used in the Copenhagen Consensus Center paper would value each year gained at $5,000, in  which case these presidential candidates could have achieved more than $1.5 billion in health benefits for their modest investment of $3.5 million.

But I'm a conservative and the election results signal that the nation is in a conservative mood, so let's just stick with the lower bound figures. $329 million in mortality reduction benefits translates into 329,000 DALYs gained. The paper assumed that children dying from malaria would die at age 2 but otherwise would have a life expectancy of 68, implying a net gain of 66 years for each life saved. Of course, the number of DALYs would be smaller than this since not every year of life gained would necessarily be disability-free. Unfortunately, the study does not provide sufficient detail to deduce the average quality of life among the African children whose lives would be saved by such an intervention.

But we can use 66 years to arrive at a lower bound figure of how many lives would be saved in order to yield a gain of 329,000 DALYs (i.e., 329,000/66=4,985). And we know from one study that the average quality of life in Zimbabwe is 81.8 for those age 18-29, falling to 70.5 for those age 60-69 where 100=optimal health as measured by using the EQ-5D.  So it would not be unreasonable to think that as a very rough approximation, an African child spared of death by malaria would have an average quality of life of about 75 for their remaining 66 years. And even more crudely still, this would translate into .75 DALYs for each year of life gained.

Let me be clear that the EQ-5D measure of health is not the same as the DALY. For those willing to get into the weeds, here is a very thorough explanation of how they differ. Suffice it to say that conceptually they are similar. That is, someone who lived for 1 year in optimal health (i.e., EQ-5D score of 100) can safely be presumed to have gained 1 DALY, but the former is a measure of individual preferences whereas the latter is a measure of how much disability  affects function etc.

In any case, if we assume that each of the 66 years of life gained is equal to .75 DALYs, we must instead divide 329,000 aggregate DALYs gained by 49.5 which implies that actually the lives of 6,646 children could have been saved rather than only 4,985.  The actual number really does not matter.

Update #1: December 3, 2016

In responding to reader comments, I ran across a figure for the total cost of recounts in all three states: WI, PA and MI: $9.5 million is the updated Stein campaign fund-raising goal based on the estimated cost of recounts in each state.  However, the same NY Times article also reported: "Ms. Stein’s campaign paid the state of Michigan $973,250 on Wednesday, but Ruth Johnson, Michigan’s secretary of state, said taxpayers could end up footing up to $4 million in additional costs."  So it sounds like the total tab will be closer to $13.5 million of which 30% will be borne by unwitting Michigan taxpayers.* This raises the opportunity cost of this effort to more than 19,000 children whose lives might have been saved with the same resources.

*If I were a Michigan resident, I'd be pretty annoyed that the law effectively encourages unnecessary recounts by giving challengers an 80% discount on the cost of paying for it. The fact that this is happening undercuts the claim that Stein donors should be able to do what they want with their own money since their action evidently is imposing $4 of costs on Michigan taxpayers for every $1 Stein campaign donors are willing to put up. Given that Trump won the majority of votes in Michigan, it's a fair bet that a sizable fraction of these taxpayers would not be in favor of having their hard-earned tax dollars squandered in this fashion.

Update #2: December 12, 2016

The Wisconsin recount is over, yielding a net increase of 162 votes for Donald Trump. mark@ratPack66 Tweeted: "Donald Trump spent about $9.50 per vote to get his almost 63M votes. Stein spent $3.5M to get him 162 more. ~$21,600 per vote!"  Call me a soft-headed conservative, but from where I sit, spending $3.5 million to give Trump 162 more votes instead of saving 5,000 childrens' lives was not a very wise or compassionate choice. But neither would I defend giving Uncle Sam to force or "nudge" progressives to make more sensible choices in the future. In a free society, people should be able to spend their own private resources as they see fit. However, I think it is regrettable if this misguided recount effort in WI, MI, or PA forced the expenditure of taxpayer funds and would hope that could be avoided in the future.

READ CHRIS’ BOOK, The American Health Economy Illustrated (AEI Press, 2012), available at Amazon and other major retailers. With generous support from the National Research Initiative at the American Enterprise Institute, an online version complete with downloadable Powerpoint slides and companion spreadsheets has been made available through the Medical Industry Institute’s Open Education Hub at the University of Minnesota.

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[1] All figures used in my calculations were originally reported in Benefits and Costs of the Malaria Targets for the Post-2015 Consensus Project.

[2] As just one illustration, here's a smoking cessation program, for example, that costs only $5,050 per QALY. If the rationale for Obamacare is to improve health, we literally could get 27 times as much bang for our buck by investing in smoking cessation as we will from Obamacare. Given that about one third of poor adults smoke (versus 42% who were uninsured prior to Obamacare) and that the mortality risks of heavy smoking are at least double those of being uninsured, it's obvious we could have saved as many lives among the poor for far less expense through a targeted smoking cessation initiative rather than a sweeping change in the health insurance market that adversely affected many millions of Americans.