I read Ryan Avent’s ebook, The Gated City on the plane yesterday and recommend that you download it too.

The basic themes are similar to my own real estate obsessions, but I was pleased to see that the text is actually quite different from what I’m working on for THE RENT IS TOO DAMN HIGH. There’s even some stuff I disagree with, though of course my bottom line that we should have more density is similar. Overall, I like to think that there’s space for multiple publications in this general topic area. The United States of America is a very large country, so it’s sensible and appropriate that we have a fairly decentralized system of government. One result of that, however, is that oftentimes too much of our national political conversation focuses on the things that the federal government does. Local government, in the aggregate, makes an enormous amount of the public policy in the this country and attention must be paid.

Not surprisingly it’s harsh:

The treatment center does not handcuff addicts to their beds anymore. But caged together on double-decker bunks with no way out, they have no choice but to endure the agonies of withdrawal, the first step in a harsh, coercive approach to drug treatment that has gained wide support in Russia. [...]

Most experts in drug treatment condemn this approach as a primitive, brutal and ineffective way to address the problem, saying that addiction is a much more complex and intractable challenge and that simply drying out cannot bring a lasting cure.

“What they present as drug treatment has absolutely no basis in evidence,” said Diederik Lohman, a senior researcher at the monitoring group Human Rights Watch who took part in a recent study of narcotics use and treatment in Russia.

Russia bans the use of methadone.

What I’ve learned from Mark Kleiman is that the role for coercion probably comes later in the process. Hard as it is to “go clean” from any addictive substance, what’s even harder is to stay clean. If somebody needs to get himself tested regularly, with a sure shot of punishment if he flunks, then the actual punishment can be quite mild and you can do a great deal of good keeping the patient on track.

There’s a lot of waste in our health care system, but providing basic coverage and basic services to people who don’t have it adds a lot of value:

A 24-year-old Cincinnati father died from a tooth infection this week because he couldn’t afford his medication, offering a sobering reminder of the importance of oral health and the number of people without access to dental or health care.

According to NBC affiliate WLWT, Kyle Willis’ wisdom tooth started hurting two weeks ago. When dentists told him it needed to be pulled, he decided to forgo the procedure, because he was unemployed and had no health insurance.

When his face started swelling and his head began to ache, Willis went to the emergency room, where he received prescriptions for antibiotics and pain medications. Willis couldn’t afford both, so he chose the pain medications.

The tooth infection spread, causing his brain to swell. He died Tuesday.

Now, clearly, this man made some sub-optimal choices here he’s not purely a victim of lack of health insurance. At the same time you have right before you a no-longer-living, no-longer-breathing example of the “push the patient to the edge of financial desperation” theory of health care cost controls. It turns out that the quality of a frightened, pain-wracked young man asked to make technical medical decisions under severe financial constraints is not very high. The social cost of 24 year-old fathers dying of eminently treatable tooth infections, by contrast, is gigantic.