Yes, the pandemic could have been very different, and it should have been very different. I don’t mean what could have happened if we had not allowed our healthcare market to become completely distorted over the last 75-100 years. So many problems would have been avoided if we had never subsidized demand via government programs that separated the patient from the payer; if we had not enacted laws of licensure as a barrier to competition; or allowed Certificate of Need laws to stifle the expansion of medical facilities; the tying together of work and health insurance via the tax code as well as the exorbitant, arbitrarily inflated cost of drug development. I have previously discussed all of this here and here.
It would be tempting to rehash all of that but not terribly productive. So, instead, let’s start from January of this year. How, given all that was distorted about the healthcare marketplace, could things have been notably different than they turned out? So, we will take as our starting point U.S. healthcare policy, as it is today.
Honest About the Unknowns
From the beginning the authorities have been operating in a knowledge vacuum. Some of that was clearly the fault of the Chinese government that lied and covered up the extent of the initial spread. Also, not to go out of my way to defend Donald Trump, but the World Health Organization (WHO) failed when they officially accepted the Chinese government’s report on the initial stages of the virus. Weeks were lost that could have been put to good use in communicating the dangers and preparing a rational response.
Even, though much blame can be placed on the Chinese and WHO, much blame belongs with the U.S. authorities. The epistemological arrogance of those in charge of U.S. health policy is astounding. They based everything on a statistical model and spoke with great certainty about things that manifestly were NOT certain. As with all those in power they never considered the unintended consequences of their policy recommendations nor did they even consider that people’s behavior would change in light of those actions that were taken. This is a great explanation about the knowledge gap that is still with us, from a scientist humble enough to admit what he doesn’t know. As is not surprising, when people are acting on incomplete information, they tend to get things wrong, as this piece explains, when the newly sainted Dr. Fauci downplayed the coming virus in February. Had they been humbler about what they did not know and admitted that they were operating off a (flawed) statistical model, not verified facts, then they might not have gone down the road of crushing the economy. The sad truth is, though, that they knew if they were honest about the unknowns, they could not have gotten agreement to take the draconian steps they did. Beware of anyone who has to lie to get you to agree to something; it’s commonly called fraud.
Honest About the Tradeoffs
The tradeoffs that are inherent in all human action were intentionally obfuscated. The notion that was picked up on by the media was that “flattening the curve” was all about saving lives. That is not the case. Flattening the curve was about extending whatever mortality that Covid-19 brought over a long enough time period that the healthcare system would not be overwhelmed. That is not an out of bounds tradeoff discussion to have but to shroud it in a misleading manner is to avoid the discussion altogether. Again, to have that forthright discussion meant that the health authorities and the government might not be able to take “decisive” action.
The tradeoff to the flatten the curve has its own tradeoff, that by socially isolating so many people and extending the disease timeframe, there was little ability to build up “herd immunity”. This occurs when a substantial (80% or so) portion of the population is exposed to the virus and recovers and so is made more or less immune. Absent a vaccine, this is the only long-term way to defeat a virus. A path followed by humanity, since…forever. So, we are now faced with a softening of restrictions, followed by a resurgence, then another freak out shut down and so on and on. A recipe for social and economic disaster.
In any event there were those in the biocontainment field, such as Dr. James Lawler of the University of Nebraska Medical Center’s Global Center for Health Security, who had serious doubt that these so-called nonpharmaceutical interventions (NPI) would have much impact anyway. From a recent news story Dr. Lawler is quoted in an email “I think we also mostly agree that without dramatic NPI we can expect 30-40% infection rate by the end of community epidemic — and even with dramatic NPI, that total may only be slightly reduced.” The full story is here. It would have been helpful, to say the least to have had an honest discussion of the tradeoffs with this perspective honestly shared.
More broadly than that there was scant attention paid to any other tradeoffs. Like that between mental health and unemployment. Or between the ability of a society to afford extensive healthcare with its economy flattened. Or about the separation of U.S. students studying abroad from their families. An excellent discussion of these tradeoffs can be found here. It could have all gone differently if this honest tradeoff discussion was had at the beginning. We could still benefit if we at least have it now.
We Could Have Removed Obstacles
From the beginning we did not have to stand still in the face of an overregulated health sector. We could have done a lot more to streamline and make more efficient the response to the pandemic. We could have suspended tariffs on medical supplies, which we have still not completely done. We could have suspended the Jones Act that requires U.S. ships to carry cargo from port to port within the U.S. We could have fast tracked the testing that was able to be brought to market early in the process, rather than push a defective test on an unwilling marketplace. We could also have fast tracked the development process via the FDA to get a vaccine to market more quickly. We could also suspend the enforcement of anti “price gouging” laws, which do nothing but slow the arrival of the goods society needs to where they are needed. Now, to be fair, there has been some lightening of the regulatory burden, especially at the state level. This has been too little, I’m afraid and not in the areas that would have the most impact.
We Could Have Chosen Liberty
We did not have to automatically turn to a statist response to any of this, except for the rotten to the core political culture in the U.S. today. We have gone from being assumed to being resilient to being assumed to being victims. There are other nations that have not chosen as draconian a path as we did, and they have death rates comparable or lower than that of the U.S. The chart below outlines this phenomenon:
There are even those well respected in the medical community that have outlined a different path. There are ideas out there that can have people who are ill tracked without destroying the privacy of the entire nation. We could have trusted the fact that people were going to change their behavior in the face of new information as they were already doing (and to be fair causing a great deal of economic dislocation in the process) before the authoritarian response and in fact are likely to do even if the lockdowns are lifted as these charts outline:
We should have trusted that what makes a society dynamic and resilient is its openness and flexibility born from its being free. This is true not just in normal times but especially in times of crisis.
We could also remove ourselves from the all too American penchant for historical amnesia and remember that we have been here before and survived; the 1918 Spanish Flu, which took 675,000, a much larger percentage of the population than Covid-19 will ever take. Or we could look at the 1957-58 pandemic that took 116,000 deaths, an event I had never heard of before the current crisis. During all these types of events in our past we always seemed to remember that quarantining was something that you did to sick people, not to those who are well. In short, we held a lot tighter to the notion that there are fundamental rights that are never to be part of a tradeoff. It all could have gone differently. Next week. I’ll look at the long-term effects of this ghastly overreaction.
Praise Be to God