Monday, August 24, 2020

Kamala Harris and John Hoynes

Imagine that today is February 1, 2021.  After a long and painful slog, the Democrats now control the White House, the Senate, and the House of Representatives, though in the Senate the majority is not great enough to defeat a Republican filibuster.  And a good number of the Democrats in the House are Centrists, whose districts went for Trump in 2016, but flipped this time around.  Legislation has already been passed and coupled with a set of Executive Orders to lay out a new plan for dealing with the pandemic.  But the expectation is for it to take 18 months or so, to get things back to normal.  There have been almost 10 million people infected by the coronavirus, and over 200,000 deaths.  Further, there has been a rising number of reinfections; people who test positive, showed some symptoms and then seemingly recovered, only to show symptoms again.  That these people make up some fraction of the infected population means the testing must be ongoing, even after an otherwise normal health environment has been attained. 

One other big piece of legislation that was passed and received the President's signature was a stimulus package in the form of a check for each citizen over 18 in the amount of $2,000 per month, to be paid out in the remaining months of 2021.  The funds would be made available to all those who earned less than $40,000 in 2020, regardless of their income in 2021.  The actual unemployment rate at the time of the Inauguration was 17%.  The hope was that this stimulus would allow those without jobs to survive economically until they could find meaningful work and that the spending of these people would boost the economy and encourage job creation. Still one other big piece of legislation was an emergency package to bail out the states, who had already begun on large budget cuts at the tail end of 2020, because they had no money to pay for their current spending. The bail out was designed to get the states back to normal operation, if at all possible.

The President then announced that all additional fiscal policy initiatives, such as the Green New Deal, would need to be offered in a balanced manner, with tax revenue collected to match the additional spending in the program. The President encouraged Congress to do just that, but many Progressives among the Democrats bridled at this suggestion, as the stimulus and bailout of the states didn't face this constraint.  The President further irked the Progressives by announcing that he would not sign a bill to raise the minimum wage to $15 until the unemployment rate got below 8%.  The President indicated that with the fragility of the economy at present, a significant increase in the minimum wage would hinder job creation.  Let the jobs come first and then increase in wages come after the economy returns to near full health.

* * * * *

It is now mid May 2022.  After an initial gangbusters start by the new administration, further progress slowed substantially.  The economy improved a great deal in the first half of 2021, then growth continued but at a much slower rate.  Fissures in the Democratic coalition started to emerge because the various segments of the coalition felt that their agendas were being put on hold.  Talk began that the Republicans would take back control of the House in the midterm elections.

About a month earlier, President Biden had become quite ill.  It wasn't Covid but rather some new variant of flu.  Even after he recovered he looked tired and old, much older than he appeared at the inauguration.  The President made a brief broadcast from the Oval Office announcing that he would step down as President in a couple of weeks, as he was no longer physically up to doing the job.  Vice President Kamala Harris would assume the Presidency.  She has been well briefed on all relevant matters on the President's agenda.  There is jockeying in the media about the choice of a new Vice President, who would have to be approved by the Senate.  Some of that speculation was about whether that choice might help to hold the Democratic coalition together.  The Republicans have been in a passive mode since the Inauguration.  They would like to see further fracture in the Democratic coalition, as that would help them return to power.

* * * * *

The above is not meant as a prediction, but I think is sufficient for what I want to write below.

In game theory, multi-stage games are analyzed by finding (Nash) equilibrium in each possible subgame and then rolling that back to the first stage of the game, so an equilibrium can be found there.  The result is called a subgame perfect equilibrium and serves to predict what will happen overall.  It assumes all players are rational and they each make rational forecasts of how the game will unfold.

Here, let's take the first stage as the time up to the election in November and then the period thereafter where the election results are contested, until those results are ultimately resolved.  In that first stage, there are very strong incentives to hold the Democratic coalition together, to get Trump out of office, and then to institute a rational plan to manage the pandemic and to jump start the economy.  On this much there is broad agreement.  On much else, however, there is no consensus within the coalition.

It is well understood the Mario Cuomo's famous lines offer the rule, not the exception.

You campaign in poetry.  You govern in prose.

This is the way that politicians play the game.  But what about voters?  What do voters expect will happen after the election, in the event that the Democrats do win?  Are voters rational a la game theory?  Or will they bounce in their beliefs about the future - optimistic about the new administration at first, then pessimistic when it appears their group within the coalition is getting short changed or, more likely, that the group is being told their agenda will be accomplished sometime in the future, but not immediately.

If voters are prone to have such bounce in their beliefs, because they aren't trained in game theory and tend to vote with their hearts rather than with their heads, one might expect a responsible leader to get voter expectations more in line with what is likely to happen.  The campaign in poetry line is an indication that most leaders don't do this.  And under the present circumstances, I too would campaign in poetry, were I running for office.  But soon after taking office I would then belabor the point about how this is likely to play out thereafter.  Yet the coalition needs to hold to continue the work it has started.  How then can voter disillusionment be prevented so that voter participation in subsequent elections remains high?

Let us recall that the Democrats lost the House in the 2010 midterm elections, where the Tea Party emerged as a strong voice on the Right.  This followed the passage of the Affordable Care Act, but without a Public Option.  Plus, we were still enduring the Great Recession, where it seemed the big banks were getting bailed out, but the little guy was getting screwed.   That disillusioned many voters.  The governing in prose part was sufficiently distasteful that Democratic voter participation rates dropped substantially, especially among younger and highly idealistic voters.  That history should be well within reach of us now.  It needs to be reviewed early and often, so it is not repeated.

* * * * *

Now I'd like to get to my title.  From the time that Kamala Harris was selected to be the candidate for Vice President till the Democratic Convention, there was piece after piece that extolled the virtue of that choice and the virtues of the candidate.  It seemed she could walk on water.  Making for that type of vision is consistent with campaigning in poetry.  I thought we needed a governing in prose view of the job of Vice President which, except for the option value of becoming President someday, is really not an attractive position.

If you are a fan of the TV show The West Wing, you'll immediately recognize the name of John Hoynes.  He is the first Vice President under President Josiah Bartlett.  (Eventually, Hoynes resigns because of an extra-marital affair he was having while in office.)  Hoynes laments being Bartlet's whipping boy, having to make speeches about policies he doesn't support.  And he is unenthusiastic about being excluded from the main decision making apparatus - he does not attend senior staff meetings, where the arguing through what should be done next happens.  And he does a lot of fluff ceremonial stuff that the President is unable to do himself.  Plus, Bartlet could be a real s.o.b. and take Hoynes for granted, which happened on more than one occasion.  The only reason for Hoynes to endure all of this is to position himself for a run at the Presidency after Bartlet steps down from office, or to assume the Presidency in case Bartlet can't fulfill the duties of office.

Bartlet never served as Vice President.  Of course, Biden did, and he may be sensitive to these issues as a consequence.  On the other hand, there will be so much on his plate if he does become President that he may simply not have the time and energy to redesign the role of the Vice President to make it more appealing to Kamala Harris. If so, after the initial honeymoon period, friction between the two may develop, especially if something like the scenario described in the first section comes to pass.  It is not inconceivable that some of the friction will get a public airing which, if it happens, might further undermine the Democratic Coalition.

* * * * *

Now I want to make one more point and then close.  This is about the macroeconomics of Keynesian stimulus versus the macroeconomics of Federal budget balance.  In other words, when should you worry about the national debt and when should you ignore it?  I'm an amateur on these matters and I don't want to claim otherwise.  Yet I'm a PhD economist so even my amateur view might help non-economist readers think this through this question.  The answer matters in considering the scenario I scripted in the first section.

Consider an economy in two possible extreme states - operating at full capacity or operating at well below full capacity.  In the first state, the unemployment rate is low.  In the second, it is very high.  It's also possible to consider intermediary states, but to keep the story simple I will only consider those two extremes.

The rule of thumb is for fiscal policy to entail budget balance when the economy is at full capacity.  Deficit financing then will entail rising interest rates that crowd out otherwise profitable private-sector investment and, if sustained, may increase the rate of inflation substantially.  In contrast, deficit financing when the economy is operating substantially under capacity is necessary.  The private sector itself is not generating enough economic activity.  The economy needs a jump start.  Deficit spending, preferably in the form of direct investment or in grants to those people who will definitely spend the money and not save it (so not for tax cuts for the wealthy) is what is needed.

The issue is this.  While the qualitative argument will produce general agreement, determining whether the actual quantitative response is right sized or is too much or too little is more art than science.  I'm afraid, however, that Center-Left Democrats are apt to go for too little response.  So Bill Clinton, who presided during a period of enormous growth (even if some of it was due to a bubble economy) championed that he was able to produce a budget surplus in his last year in office.  While Barack Obama had his eyes set on a Grand Bargain, which ultimately failed because the Republicans couldn't accept the need for tax increases as part of the deal. And then in Hillary Clinton's book, What Happened, gives her views on the 2016 election.  The economic policies that she advocated for are all of the budget-balance variety, which reflects a view of the time where the economy was operating at full capacity.

There is a general folklore that the New Deal cured the Great Depression.  But some have questioned that on the grounds that even the New Deal was insufficient (in part because the states pulled back on their spending and that countered some of what the New Deal aimed to do).  Indeed, in a post from a few years ago I wrote the following which begins with a quote:

The New Deal didn't cure The Great Depression.  Shicklgruber cured The Great Depression.  

It's from Axel Leijonhufvud's book, On Keynesian Economics and the Economics of Keynes.   (This may not be an exact quote.  I don't have that book in front of me and am writing this from memory.  But it is pretty close even if it is off a bit.)  In other words, the U.S. economy ratcheted up substantially during WW II over its level during the Great Depression.  That ability to ratchet up the economy, even as many Americans were overseas fighting the war, was indicative that the economy was actually well below capacity before that.

I write this because I fear the bias of moving to a full capacity approach as sensible will actually be too timid as a Biden administration takes office.  So it is my hope that he doesn't steer to the Center too soon.  Yet if I were to guess what will happen, that would be my guess, which is why I wrote the scenario in the first section as I did.

A President must make the tough choices, even if they are unpopular.  But that the choice is unpopular doesn't make it right.  It's on this economics that the Democratic coalition might possibly find a way to find some glue to keep things together.  Yet it definitely won't be easy to do that.

Tuesday, August 11, 2020

Let's Put the Kibosh on the Post-Service-Delivery Survey

The mantra "data driven decision making" gets every service provider into a frenzy.  They think they can improve quality of service if only they had more data on which to base their internal decisions.  They might very well hire external consultants who encourage them in this direction.  Yet it is a bad practice and it should be stopped.

I've had this issue on my mind for some time, but it was a recent visit to my healthcare provider which then precipitated a follow up survey that drove me to write this piece.  In that case I got a robocall where the caller ID said it was the healthcare provider calling.  In the past, I had gotten solicitations to do these post-visit surveys, but by email, which I find less intrusive.  (My Inbox is full of solicitations, mainly from sales reps of companies wanting to sell IT services to the university, seemingly unaware that I've been retired for 10 years. Over time, I've learned to ignore such messages.)  Indeed, we get a lot of robocalls by phone and mostly I don't pick up.  I do answer the phone for the healthcare provider.

I also want to note that given my ed tech administrator experience and my background as an economist who is well aware of the social science issues in administering such surveys, I'm not just blowing smoke here.  Indeed, the course evaluation questionnaires (CEQs) that we use in higher education to determine course and instructor quality serve as a model for me in considering the issues in this post.   The CEQs are a holdover from an earlier time, but are held in low regard by students and instructors alike.  The reader should keep that in mind with what follows.

Let's work through the reasons for why the post-service-delivery survey is a bad idea.

It disrespects the person who received the service.

This is most obvious when the service is one and done.  In the case of the CEQs, the students complete the survey at the end of the semester and won't be taking the course again.  How do they benefit from taking the survey?  Asking somebody to do something from which the person won't benefit is showing a lack of respect for that person.  For the CEQs, if they are administered earlier in the semester and only used within class to make modifications on how the course is taught, then that would be a legitimate use by this criterion.  The students could then see how their responses to the questionnaire directly impact instruction, at least if done in a small class.  But in a large class, individual responses won't count for much at all, even if the CEQs are administered early in the semester.

For the health care provider, the patient gets no information about the pool of other patients who will be given the survey for the same healthcare provider, nor about prior response rates to such surveys, nor about how survey responses have been used in the past to adjust the healthcare provided.

I want to note an argument that can cut the other way, which happens in an overlapping generations model, and provides the logic behind social security. (See Samuelson's An Exact Consumption-Loan Model.)   Completing the survey is like paying a tax.  You pay the tax in expectation of a future benefit, when you need the benefit, after you've retired.  Likewise, you complete the survey from the healthcare provider under the assumption that your healthcare quality will be improved in the future if all patients complete the survey.  Perhaps this is true.  However, the analogy breaks down when noting that paying FICA is legally required of all working people.  Completing the survey, in contrast, is voluntary.  There is a free rider problem involved with completing the survey.  One should expect low completion rates as a result.  It is conceivable that a sense of social obligation can counter the free rider problem.  But let's face it, everyone and their brother are doing surveys of this sort nowadays.  There are just too many of them to feel a sense of social obligation regarding completing any particular survey.  Given that, asking patients to complete the surveys is an act of disrespect.

The quality of the data collected will be poor. 

For most surveys, the response rate is nowhere near  to 100%.  As long as there is random sampling and who participates and who opts out is also random, the survey statistics have validity (provided the sample is large enough).  But there can be systematic reasons why some people participate and others opt out, leading to selection bias.  Survey results are far less reliable in this case.

There are two obvious factors to focus on in considering possible selection bias.  People with high time value and limited leisure time are more likely to opt out.  So surveys of this sort end up over sampling the unemployed, the retired, and they under sample those who are working full time, but also those who don't have an internet connection where they live, who are unwilling to go to a place where bandwidth is ample just to complete the survey.

The other factor is about reasons to want to complete the survey and conversely reasons not too.  As a general rule, those with intense preferences, either for or against, are more likely to complete a survey.  Those with mild preferences are more apt to sit it out.  One therefore should look at reasons for why a person might have an intense preference after the service has been delivered.

From this perspective, routine service provision is apt to generate only a mild preference, although I will give some caveats with that below.  Emergency service provision or service provision under dire circumstances is more apt to generate a strong preference from the service recipient.

Even for people who have excellent health insurance, and I count myself as one of those, the business side of healthcare is clunky, at best, and painful, at least some of the time, especially once you've become a senior citizen.  I will illustrate with a few different examples.

I turned 65 last January and had a regularly scheduled visit with my primary care doctor, in general, a good guy. I was due for a variety of vaccines/immunizations.  Alas, I was also at the cusp where my primary insurance until then was to become my secondary insurance thereafter and Medicare Part B would become my primary insurance.  I ended up having one immunization during that visit, but was told to get others at the pharmacy I frequent, Walgreens.  Why this makes sense, I don't know.  But it is definitely harder to manage having different providers for immunizations.  Further, there was no leeway about my birthday, with respect to Medicare covering the payment.  If I was 64 and 364 days, I wouldn't be eligible to get coverage for the vaccines that would be covered the next day.  When I went to Walgreens I got both the pneumonia vaccine and the first Shingles vaccine.  That was on my birthday.  I had pneumonia the previous spring, so was a candidate for that.  The Shingles vaccine was for anyone near my age.  I might have been a year or two behind on that one.   In any event, why I had to make two visits to get this done is because that's how the system works.  Might I get irate at my primary care physician as a consequence.  I might, though I didn't that time.  The bureaucracy with insurance and prescriptions is a pain, especially regarding trying to renew one prescription because it is time to renew another.  The insurance company will block the renewal of the first prescription.  If it were narcotics, I would understand.  But I've recently experienced this with eye drops.  Give me a break.

It's actually worse with non-routine healthcare.  Two years ago, I had three different issues.  One ended up being a stress fracture in my foot/bad arthritis there.  Another was that a compressed disk in my neck was causing pain and muscle spasms in my left arm.  The third, and the scariest, is that I was diagnosed with prostate cancer.  As a result, I saw a variety of specialists and reached the following conclusions.  Diagnosis is an art, not a science, in the sense that the evidence from the diagnosis may entail some ambiguity.  How that ambiguity resolves is of some consequence to the patient.  For cost effective diagnosis, it makes sense to begin with less expensive tests and then move to more expensive/intrusive tests.  Blood tests and x-rays are comparatively low cost procedures.  They are the first step in a potential chain of other steps.  Scans, such as MRI, are steps further down the chain.  Scans are good at identifying "hot spots" but there may still be ambiguity as to the cause of the hot spot.  Scans are more expensive than the first steps and typically require approval of the insurance company before they are conducted.  I will talk about that more in the next paragraph.  Biopsy, when it is not of something on the skin, is more intrusive than a scan, also more localized, and in my experience more precise.  But you can't biopsy every ambiguous hot spot that shows up in a scan.  When a biopsy yields a positive result, treatment is called for.  That much is understood.  When a scan gives an ambiguous result, the next step is negotiated between doctor and patient, but it won't involve treatment.  It will either be simply to wait or it will entail some other diagnostic.

The doctors who had to deal with insurance company approval for diagnostic procedures they wanted to recommend all seemed angry and intimidated by the prospect that their judgment would be questioned and their recommendation might be overturned by the insurance company.  This is an issue with healthcare that is not getting enough attention.  I also want to note that specifically for a cancer diagnosis, a patient new to that will have something done to their head, regarding worrying about the worst case possibility.  In my case, the worry was about whether the cancer had spread outside the prostate.  I became distraught and quite angry when this couldn't be resolved in short order.

The patient doesn't rate the insurance company.  Those post-service surveys are only about the visit with the doctor.  One might imagine that they type of distress I felt would encourage an extremely negative evaluation of the doctor visit, even when the doctor actually did everything right within his sphere of control.  So the survey response would be inaccurate in this case.

Perhaps more importantly, the healthcare provider must be aware of the underlying issue.  The survey doesn't inform on that issue.

I want to close this section with the following about me specifically.  I much prefer my healthcare to emerge from ongoing conversations with my providers.  It is the relationship that matters. Each visit either bolsters the relationship, maintains the relationship, or tarnishes it some.  I try not to have the business side of healthcare matter to me in how I view these relationships. But, if I opt for a different doctor when the prior doctor is not leaving the healthcare provider, that would be a strong signal that I was dissatisfied with the relationship.  I've actually never done that.   But I want to observe that senior management of the healthcare provider could be monitoring patient turnover.  That would be far more informative than the surveys.

The surveys may potentially impact negatively how care is given.

Let's return briefly to consider instructor evaluation via CEQs.  George Kuh developed the expression Disengagement Compact, to describe the following scenario.  For instructors where CEQ results matter, to keep their jobs and to get salary increases, there is incentive to manipulate those results.  For students who care a lot about grades but not so much what they might learn in the course, there is incentive to encourage the instructor to give them high grades.  The resulting equilibrium has the instructor teaching to the test, the students performing reasonably well on the tests, and the overall grade distribution quite high.  On the CEQs  the students indicate they were satisfied with the course.  But there has been only surface learning.  If the instructor, in contrast, were to seriously challenge the students, there might be deeper learning, but the grades would be poor and the instructor CEQ ratings would be low.

Might something similar happen with healthcare provision and after visit surveys?  My sense of this is yes, but it might be a bit more nuanced than as described in the previous paragraph.  The issue is how the doctor delivers "bad news" to a patient who might not have been expecting it.  In the old days we talked about "bedside manner" and treated it purely as a function of the doctor's style.  But the doctor may also make an assessment of how much the patient can absorb, in which case the doctor will be more forthcoming with a highly educated patient.  Such a patient might appreciate getting the information in a straightforward manner, even if the news isn't good.  Less sophisticated patients might respond better near term if the message is sugar coated.  It is the patient's behavior after the doctor visit that's at issue.  To the extent that this behavior will govern how the condition proceeds thereafter, the doctor's sugar coating of the message might be pernicious.  Yet even if the doctor is well aware of this, to the extent that the patient's survey response matters there can be incentive to sugar coat the message.  In other words, the same underlying social dynamics exists here as it does in the case of college instruction.

Wrap Up

Data is not always the answer.  And sometimes when there is an attempt to survey people, clearly articulating how the information is meant to help and whether it will help them might very well determine whether they are willing to complete the survey.  It is conceivable, now, that individual doctors send their patients surveys after a visit, with the aim that the survey informs their ongoing care.  This is called formative assessment and is a sensible thing to do.  But it doesn't help third parties evaluate the doctor.  Why we need that, I'm not sure.  That itself is an indicator that it's not necessary.

Wednesday, August 05, 2020

Developing a Sense of Humor - Lessons Learned Outside of School

I'm 65.  I wonder how many people who are approximately my age can recall the full commercials from the little bits reproduced here.

  • I can't believe I ate the whole thing.  You ate it, Ralph.
  • The next time you tell me the good news, call me up on the phone.
  • No dice Nevada.  (This one is for folks who grew up in NYC.) 

It's 50 years or so after these commercials aired on TV.   If you can recall the full commercials, it might be interesting to ask why that is.  Was it purely that you saw them frequently?  Or was it something about the message itself?

My contention is that it was the latter.  The messages have comedic elements.  That's what makes them memorable, sometimes as memorable as the shows we watched, many of which also had comedic elements.  The popular culture seemed to embrace comedy.

Here's a different type of example.  Name the comedian and come up with the punchline.
  • Doctor, doctor.  It hurts when I go like that.
  • It was cold in New York, Ed.  How cold was it, Johnny?
  • Show me a mule who dropped out of school....

If we remembered these lines soon after we heard them, did we take to repeating them to our friends?  Or did our friends repeat them to us?  I'm asking because I'm trying to understand how my own sense of humor developed, whether that was inevitable or if it required intentionality, mainly by my dad, to cultivate it.

As an adult, my sense of humor manifests mainly in a different way than by telling canned jokes, though I do that with some frequency as well.  Instead, it is mostly situational humor that comes from the context of the conversation, a pun or some other silliness that is a reaction to what the speaker has said.  It requires a kind of listening coupled with some bit of improvisation.   I also do this a fair amount in writing, quick hitter items that are aimed at getting a chuckle from the reader.  There is some compulsion on my part to produce those things.  And that is coupled with some minimal skill needed to evoke the right sort of reaction.  When done in Facebook, if it produces the HaHa response in a few friends, then it's an indicator the post hit the mark.

Chatting with a friend yesterday, she indicated that she had a good sense of humor, and attributed the cause to her dad who was pretty funny.  I can't really say for sure, but I'm under the impression that some people didn't have funny dads when they grew up.  Could their sense of humor develop nonetheless?  And, if so, why did it happen?  Having lived in Champaign, Illinois now for 40 years, I associate my sense of humor with Reform Judaism, at least as how that played out in New York City when I was a kid. When I do Zoom calls now with my siblings, it is evident in all of us, spouses and offspring too.  I do wonder how widespread it is outside the family and how one might determine that.

When I was still working, I developed some reputation for making wisecracks and for being creative.  Within the CIC Learning Technology Group, while all the members were highly competent and quite talented, in these areas I dare say that those who were also faculty members tended toward making the jokes more and, within that small sample, each of us were male.  I do think the world looks different for an educational technologist who used to be a full time faculty member versus one who is a career educational technologist, but the NYC versus Midwest thing might have prevailed as well.   I was the only one in that cell among all the group members.  It's probably not good social science to develop a hypothesis from a sample where n = 1.  Yet fairly frequently I generalize from my own experience, which begs the question, are situational humor and creativity in other things related?

Situational humor is itself a reaction to what others have said and, if in a video call, how they appear when they said it.  It requires taking some risk in the telling, because the line might fall flat.  (My siblings have recently taken to rating the spontaneous line, most of which get a low rating.  Batting average matters here.)  Beyond that, it requires some intuition about how the others will react.  In my opinion, that intuition is similar if not identical to the intuition one needs to demonstrate empathy to others.  I would guess that a sense of humor and empathy are two sides of the same coin.

Not having lived through it, I don't have a real understanding for why some people don't develop a good sense of humor, but that it happens I have no doubt.  As a professor, I have to say it's hard to detect this in students, who may be quite circumspect in the classroom but otherwise joke around with their friends a lot.  It would be be easier to determine this if the kids already let their guard down (with the professor absent) and then see how things play out.  Yet even then, some who are initially shy may take a longer time to warm up.  That doesn't mean their sense of humor is entirely absent.  But it likely means that they don't get into a playful mode as frequently as others do.

At issue is whether the kid feels implicitly that the sense of humor is something to cultivate.  I am ignorant of contemporary culture and if it provides sufficient cues on this score.  Ten to fifteen years ago, when I became aware that many students got their news from watching the Daily Show, apart from the lack of literacy that implied, I wondered if students were becoming too sarcastic in their views.  To me, sarcasm may be part of a sense of humor but it is far from a complete arsenal.

While I'm writing this post, I also have open in my browser this opinion piece on the mental health crisis engendered by the pandemic (and not just among college students).  Sarcasm is too easy a tone to embrace nowadays and under the circumstances I fear it contributes to a decline in mental health.  Other sorts of humor, however, might serve as a good tonic for lifting the mood and helping the person to become more upbeat.  If that's true, one would want to know whether those other types of humor are readily available to all and, if not, how they might be made available.

I haven't gotten too far in trying to answer that question, but I have a feeling that there is a developmental curve one must go through to have a mature sense of humor.  Telling canned jokes comes earlier.  Situational humor doesn't happen until the canned jokes part gets mastered.  If that's right, how about a non-credit online course available to one and all about canned jokes.  That might be a start.

Q: How many ears does Captain Kirk have?
A: Three, the left ear, the right ear, and the final front ear.