Hot Takes for Cold Weather
National Workplace Election Day. Better drug names. A bigger child tax credit. Tamiflu.
This Modern Times outlines four novel ideas: a National Workplace Election Day, using bartenders to name drugs, the case for a $100,000 child tax credit, and why it’s once again time to think about Tamiflu.
1. Hold a National Workplace Election Day
Undercover Boss was a TV show that filmed disguised CEOs performing front-line jobs inside their own companies. In the opening episode, the president of Waste Management is appalled to discover that his trash collectors have to pee in cans to stay on the schedule he established.
The show was cringe, but it made two valuable points. Front-line employees who interact with customers often spot emerging problems before managers do. Second, bosses are frequently blind to the work lives of those they manage.
Advisory workplace councils have a better track record than undercover bosses at improving decision-making, curtailing abuse, and enabling lower-level workers to influence decisions that affect them at work. Substantial evidence suggests that listening to frontline employees improves decision-making and business performance. It often reduces turnover and improves customer service. (Do I believe claims that listening to front-line workers reliably improves profitability by 12.5% and cuts turnover by almost 30%? I do not.) Sure, it’s a bit like student council. But at the margin, student councils help.
Experienced managers understand that advisory workplace councils can be helpful – but most have other priorities. Can public policy nudge them to do the right thing?
Why not declare the day after Labor Day National Workplace Election Day and allow front-line workers to elect 3-5 representatives to a workplace council in every workplace with more than one hundred employees?1 Companies that believe that no council is needed could make “no council” one of the ballot choices. Otherwise, there will be a council and regular discussions. I would not personally regulate it much further than that, except to specify secret ballot voting.
A National Workplace Election Day is a benign but potentially powerful idea. It will not be celebrated by the labor left, but it provides a nice test for pro-worker, pro-union Republicans like JD Vance and Josh Hawley.
2. Let Bartenders Name Drugs.
According to Scientific Discovery, large-scale, rigorous trials in 2024 validated several breakthrough medical treatments. They highlighted five drugs.
Lencapivir reduces the severity of HIV and radically slows its transmission with a single injection every six months. This is a game-changer, especially in developing countries.
Omalizumab helps people with severe food allergies tolerate things like peanuts and milk that otherwise make them sick.
Xanomeline-trospium treats schizophrenia more effectively by targeting different brain receptors than existing drugs.
Osimertinib treats a common form of lung cancer driven by mutations in the EGFR gene. This cancer is common in people with no history of smoking, especially in East Asia.
Tirzepatide helps with weight loss and cuts the risk of diabetes. It may also prevent a huge range of other disorders, as I discussed here and here.
These new drugs share one thing in common: horrible, unpronounceable names. Who comes up with them? Blame the United States Adopted Names (USAN) Council, which includes representatives from the American Medical Association, the U.S. Pharmacopeia, and the American Pharmacists Association, in collaboration with the drug manufacturer.
The results are terrible. Most drug names are tricky to pronounce and impossible to remember. If you hear them spoken, you cannot spell them. Try saying “Omalizumab” three times fast.
Unlike USAN, bartenders are great at naming new compounds. Margaritas, Martinis, and Manhattans. A Singapore Sling, Zombie, or Screwdriver. I can remember them, pronounce them, and spell them. Elon should not kill USAN — just staff it with experienced bartenders. Instead of Omalizumab, we’d have GoNuts. Lencapivir might become BeeHive. You get the idea.
3. The Case for a $100,000 Child Tax Credit.
Some people still think that overpopulation is a problem. If you are one of them, brace for whiplash. We are producing too few people. Fertility rates are declining everywhere and have dropped below replacement levels in every country outside of sub-Saharan Africa. Human populations are not shrinking yet, but they soon will.
Population declines produce terrible outcomes. Dependency rates increase, so everyone must work more and consume less to support us oldsters. Productivity growth drops because older people are less creative and driven. And financial expectations shrink, which ripples around the macroeconomy in ways that are not great. As he often does, Noah Smith has the details.
To avoid these problems, we must either make more babies or import them. We need to do both, but counting on immigrants only works in the short term. Birth rates are falling fast everywhere, so modern countries will soon compete for a shrinking pool of migrants. In the near term, high immigration levels will help maintain our population. In the long term, we need more kids.
Unfortunately, the economics of child-rearing is upside down and backwards. Parents pay the upfront costs, and children and society reap the benefits. Reproducing is a tremendous social investment but a lousy financial one (fortunately, having a baby is rarely a purely economic decision.)
Much are babies worth? Researchers at Georgetown find that the median American earns $1.7 million in present-value dollars over a lifetime.2 Assume their taxes cover the public services they consume. Then, subtract the cost of raising a child to become an income-producing adult. The USDA figures it costs $332,000 to raise a kid. Lending Tree says $237,000 plus college, so about $300,000.3 This suggests that a child born today makes us about $1.5 million richer in present-day dollars. (Not counting multiplier effects. And, of course, we place a much higher value on human life than that.)4
Raising children is essential work that boosts future productivity and makes us all richer. Why do we expect parents to volunteer their time and money to create long-term economic benefits for the rest of us? We owe parents a lot – and if we want more children, we need to pay more for the work they do.
How much do we need to pay? Research by Lyman Stone suggests that boosting U.S. fertility rates enough to reverse declines since 2008 would require subsidies equal to one year of income, or about $5,300 annually per child. Over eighteen years, that’s about $100,000 per kid.
Paying this in cash upfront is a nonstarter. For one thing, it would discourage work. Even $1,000 per month reduces labor force participation. Reducing the number of workers increases the tax burden on those who remain, so the politics quickly go south.
But a vastly expanded annual child tax credit pencils out. Models by Duncan McClements and Jason Housenloy estimate that promoting fertility could justify payments of up to $290,000 per child. Today, we cannot even sustain support for a $3,000-$3,600 child tax credit – but this will change.
A $100,000 per child tax credit paid out as $5,555/year for 18 years would not only induce some people to have an extra kid, it would signal to legal immigrants that we are a pro-family country. And when put to a vote, it can attract conservatives. Yes, our unfairly maligned childless cat ladies will pay higher taxes. That’s fair because it takes a village and they have benefitted from children they spent little to help raise.
Democrats have historically sold child tax credits as a way to reduce child poverty. It needs to make children more affordable for everyone, whether they are poor or middle class. A large child tax credit makes sense economically, can work politically, and is vital demographically. Democrats and pro-family Republicans alike should make this a top priority.
4. Check Your Tamiflu Supplies.
Last Friday, Science published an alarming finding. Bovine influenza H5N1 is a single mutation away from human transmissibility. As the report put it:
Historically, this virus has caused up to 30% fatality in humans, so Lin et al. performed a genetic and structural analysis of the mutations necessary to fully switch host receptor recognition. A single glutamic acid to leucine mutation at residue 226 of the virus hemagglutinin was sufficient to enact the change from avian to human specificity. In nature, the occurrence of this single mutation could be an indicator of human pandemic risk.
How serious is this? Risk consists of severity and probability. H5N1 severity is very high – the historic case fatality rate is roughly ten times higher than Covid in the early days of the pandemic. What is the probability that the virus will mutate and become transmissible? Prediction markets (which were highly accurate in predicting the election results) place the odds at 17%. This should trigger an urgent national discussion.
Why are investors placing such high odds on a viral mutation? In part because the H5N1 avian flu has spread alarmingly, infecting a third of California’s dairy herds. Also, the odds of mutation rise with seasonal flu, as poorly ventilated spaces during colder months increase the chance of co-infection. This could allow the virus to mutate into a highly transmissible form.
2024 is a year of political malpractice for the Biden administration. It continues this tradition by taking, at best, a lethargic approach to H5N1 preparedness. And worse leadership is on the way. Trump has named Robert F. Kennedy Jr. to head HHS, which leads public health efforts. Kennedy has opposed vaccine research and promotes raw milk, a potential H5N1 vector.
Most viruses don’t manage to adapt to new species. But if we get a bird flu pandemic, it will be, in Zeynep Tufekci’s memorable phrase, one of the most foreseeable disasters in history. Influenza pandemics are horrible. Historically, they have arisen from viral mutation and species-jumping. The deadly 1918 H1N1 pandemic likely began as an avian flu that passed through a pig before infecting humans. The H1N5 virus is a different subtype, and we do not know how lethal it would be to humans. Nonetheless, it is extraordinarily reckless for the U.S. to gamble with another catastrophic pandemic by failing to respond aggressively to bovine H5N1 influenza. .
Preparation for an influenza pandemic requires surveillance, livestock quarantining, vaccine development, antiviral stockpiling, and building public health capacity. Governments monitor human and animal flu worldwide through networks like the Global Influenza Surveillance and Response System. The CDC tracks cases, analyzes strains, and tracks zoonotic influenza, like H5N1. Governments work with manufacturers to produce seasonal flu vaccines based on predictions of circulating strains. They fund vaccine development and manufacturing capacity to accelerate production during a pandemic. They stockpile vaccines, PPE, and antiviral drugs like Tamiflu (oseltamivir — not bartender-friendly).
Tamiflu is the leading influenza drug because it is effective, accessible, and well-established. It blocks a key enzyme used by flu viruses to replicate within the respiratory system. If taken early enough, Tamiflu reduces the severity of flu symptoms, shortens the duration of the illness by about 1–2 days, and lowers the risk of complications like pneumonia or hospitalization. Tamiflu can also be used prophylactically to reduce the risk of infection during an outbreak.
Roche seems to produce Tamiflu in the United States, and several companies produce generics. More than 70 nations stockpile Tamiflu. The US maintains a Strategic National Stockpile (SNS) that includes Tamiflu but does not disclose how many doses or how many have been extended for up to 20 years beyond their original manufacture date.
The Trump administration should beef up pandemic preparedness including Tamiflu stockpiles. Should you keep Tamiflu on hand? I would. Like Paxlovid for Covid, you must take it within the first two days of symptoms, but recent experience suggests that your odds of getting any once a pandemic breaks out are not great.
Credit for the idea of a National Workplace Election Day goes to SEIU President Emeritus Andy Stern, who published an article advocating it it many years ago.
Pretty good chance that babies born today are more valuable because they will contribute more to the public coffers than they take out, but that’s a longer discussion.
Assumes that 45% of Americans spend $40k a year for 4 years.
We value human life more highly than this. Economists who study "revealed preference" (examining our real-world choices) conclude that we value a 25-year-old human life at around $10 million in the United States. Government agencies like the EPA and DOT use this to assess the cost-benefit of safety regulations.
Marty -
Great articles. Keep writing, you bring fascinating and provocative topics to light.
The flu article is quite scary and I have no confidence that we will prepare properly. I'm getting some Tamiflu.