Public Policy and Governance – Page 136

Corporatism On Display

I used to be persuaded by arguments from “big Pharma” that the enormous costs of research and development justified the sometimes staggering prices of new drugs.

That justification seemed eminently reasonable, until I learned some inconvenient facts. For example, the amounts drug companies spend on television advertising (“ask your doctor for the purple pill”) exceeds the amounts they spend on research and development. And for another example, significant percentages of those front-end R and D costs are paid for by citizens’ tax dollars, through government research and grants.

Those discoveries left me disgusted, but unsurprised, by recent reporting from Pro Publica.

Five years ago, the U.S. Department of Health and Human Services tried to plug a crucial hole in its preparations for a global pandemic, signing a $13.8 million contract with a Pennsylvania manufacturer to create a low-cost, portable, easy-to-use ventilator that could be stockpiled for emergencies.

This past September, with the design of the new Trilogy Evo Universal finally cleared by the Food and Drug Administration, HHS ordered 10,000 of the ventilators for the Strategic National Stockpile at a cost of $3,280 each.

But as the pandemic continues to spread across the globe, there is still not a single Trilogy Evo Universal in the stockpile.

Instead last summer, soon after the FDA’s approval, the Pennsylvania company that designed the device — a subsidiary of the Dutch appliance and technology giant Royal Philips N.V. — began selling two higher-priced commercial versions of the same ventilator around the world

When Trump belatedly invoked the Defense Production Act, forcing General Motors to begin mass-producing a different company’s ventilator (for which taxpayers will also pay), no one even mentioned the Trilogy Evo Universal.

Nor did HHS officials explain why they did not force Philips to accelerate delivery of these ventilators earlier this year, when it became clear that the virus was overwhelming medical facilities around the world.

An HHS spokeswoman told ProPublica that Philips had agreed to make the Trilogy Evo Universal ventilator “as soon as possible.” However, a Philips spokesman said the company has no plan to even begin production anytime this year.

Instead, Philips is negotiating with a White House team led by Trump’s son-in-law, Jared Kushner, to build 43,000 more complex and expensive hospital ventilators for Americans stricken by the virus.

It’s despicably corrupt to use a pandemic to–excuse my phrasing here–suck even more deeply at the public tit. But it is the foreseeable result of America’s thoughtless, decades-long embrace of “privatization” and “public-private partnerships,” which have all too often simply been a more sophisticated form of patronage. Old-style patronage–whatever its flaws– mostly benefitted working people; you helped to get out the vote and if your candidate won, you got a (usually low-level) job with the city. Now, you write a nice fat check to the candidate and your company gets a lucrative contract with the city. (And no one gets out the vote, which is a different problem..)

As Pro Publica reported,

The story of the Trilogy Evo Universal, described here for the first time, also raises questions about the government’s reliance on public-private partnerships that public health officials have used to piece together important parts of their disaster safety net.

“That’s the problem of leaving any kind of disaster preparedness up to the market and market forces — it will never work,” said Dr. John Hick, an emergency medicine specialist in Minnesota who has advised HHS on pandemic preparedness since 2002. “The market is not going to give priority to a relatively no-frills but dependable ventilator that’s not expensive.”

Reagan began what has since become a concerted attack on the very idea of government–an attack that has benefitted corporations and businesses in a position to profit, but has eroded (“hollowed out” in the words of one scholar) the capacity of government to act on behalf of the common good.

We are about to see what happens–and how many people needlessly die–when what is left of our hollowed-out governing institutions is incompetent and corrupt.

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Let’s Talk Social Infrastructure

Let’s abandon doom, gloom and Coronavirus, and talk instead about the brave new world we might be able to construct when the current crisis has wreaked havoc on the one we have.

The most basic question of political philosophy is: what should government do? The U.S. Bill of Rights is a list of things that government should not do—censor speech, favor religion, search citizens without probable cause or infringe their liberty interests or property rights without due process, among other things—but America hasn’t revisited (or, really, visited) the fundamental question: what is government for? What are the elements of the social and physical infrastructure that government in the 21st Century should provide?

And how should we define infrastructure?

We recognize physical infrastructure: roads, bridges, sidewalks, sewers, the national electrical grid. There is less recognition of the importance of other elements of the built environment: parks, libraries, public transportation, utilities, street lighting and other taken-for-granted elements that collectively produce a community’s “quality of life.” Despite almost universal agreement about the importance of physical infrastructure, America’s roads and bridges are in serious disrepair, the electrical grid is vulnerable to hacking, and sewer overflows continue to pollute rivers and streams. Aging pipes are contaminating drinking water in numerous cities and towns; the problem with lead in the water is not limited to the widely-publicized situation in Flint, Michigan.

The problems with America’s physical infrastructure are visible, widely acknowledged and await only a rebirth of political will to fix. The defects in our social infrastructure, however, are less clear-cut, and because they are highly contested, resist repair. “Social infrastructure” includes programs that help needy citizens and build community, including access to economic security, health, education, and the right to equal participation in democratic decision-making.

Aristotle taught us that social infrastructure should facilitate human flourishing.

I tend to harp on the challenges we face: a rapidly morphing information environment, overt tribalism, deepening economic inequality, widespread civic ignorance, and the corruption of America’s current legal and political structures. All of these elements of contemporary reality, plus the existential threats posed by climate change and a global pandemic, challenge America’s future.

What comes next?

We could continue the Trumpian withdrawal from global alliances and our historic civic aspirations, or we could enter a period of extreme social unrest, with escalating protests and accelerating social factionalism, leading to a very uncertain future. Or we could revisit the nation’s existing social contract, evaluate the current utility of our governing assumptions, reaffirm those that have stood the test of time, and modify structures that no longer serve us.

America’s definition of liberty as negative–the individual’s right to be free of government constraint unless s/he is harming the person or property of another– has generated significant conflict: what constitutes a harm sufficient to justify government intervention? How much deference to the rights of others is required? Which others? Is the obligation of government limited to non-interference, or do citizens have the right to demand that government pursue positive actions? If so, what are those actions?

Defining liberty has become even more complicated as America’s population has increased, as equality (another contested term) has become an equally important value, and as society has become more complex. At a minimum, genuine liberty requires more than enforcing limits on the reach of government, important as those limits remain. True liberty– allowing individuals to determine and pursue their individual aspirations– requires ensuring that those individuals have the means to exercise choice, and sufficient information upon which to base consideration of those choices.

Nobel Prize winning economist Amartya Sen argued that freedom is the ability to exercise individual agency, and that personal agency is inescapably qualified and constrained by available social, political and economic opportunities. In other words, individual agency is dependent upon what Sen calls “social arrangements”–what I am calling “social infrastructure.”

In today’s complex and inter-dependent society, government’s responsibility cannot simply be to get out of the way.

Anti-government attitudes that permeate contemporary American culture have been profoundly influenced by a Protestant Ethic that exaggerated the agency of the individual and minimized the extent to which the social infrastructure contributes to, enables—or hinders—individual achievement. In addition to older, traditional functions, today’s governments must provide citizens with a social safety net that affirmatively supports human liberty by allowing citizens to reach their potential.

That safety net can be constructed in ways that unify or further divide us.

A Native American parable is instructive: One evening, an elderly Cherokee brave told his grandson about a battle that goes on inside people. He said, “My son, the battle is between two wolves that are inside all of us. One is evil. The other is good.” The grandson asked, “Which wolf wins?” and the grandfather replied, “The one you feed.”

America needs a social and political infrastructure that feeds—encourages, promotes and rewards—prosocial and pro-democratic behaviors and norms.

It is time to rethink how government should “feed” the good wolf.

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Well–For Once, He’s Been Honest, Even If Accidentally

As if being confined to our homes–or worse, going to essential jobs and worrying whether we were inevitably going to contract the Coronavirus–wasn’t stressful enough, those of us who follow such things watch in frustration as the Trump Administration reverses environmental protections and amasses powers the Constitution previously denied to the Executive branch.

Not to mention increasing worries about the upcoming election.

It is beginning to look as if mandatory social distancing will extend right through what should be campaign season, and disrupt the ability of millions of Americans to vote in November. Republicans may have demonstrated their utter inability to govern in the public interest, but political observers are well aware of their consummate skills in vote suppression–their ability to use any disruption, any excuse, to keep people from the polls.

The one bright spot is the jaw-dropping idiocy of Trump himself. (As a friend frequently reminds me, just think how much more harm he could do if he had an IQ or was even minimally competent.) As the Guardian recently reported,

Donald Trump admitted on Monday that making it easier to vote in America would hurt the Republican party.

The president made the comments as he dismissed a Democratic-led push for reforms such as vote-by-mail, same-day registration and early voting as states seek to safely run elections amid the Covid-19 pandemic. Democrats had proposed the measures as part of the coronavirus stimulus. They ultimately were not included in the $2.2tn final package, which included only $400m to states to help them run elections.

“The things they had in there were crazy. They had things, levels of voting that if you’d ever agreed to it, you’d never have a Republican elected in this country again,” Trump said during an appearance on Fox & Friends.

Talking Points Memo also commented on the admission.

You’re not supposed to say the quiet parts out loud, Mr. President!

On Monday morning, President Donald Trump told the co-hosts of “Fox and Friends” that House Democrats had tried to include “crazy” proposals in the $2 trillion COVID-19 relief package that passed last week, including measures aimed at easing the voting process for Americans during the coronavirus outbreak.

It isn’t that We the People have been unaware that the country has millions more Democrats than Republicans. The Electoral College is fiercely defended by GOP operatives who know that it gives disproportionate influence to rural Republicans; thanks to GOP gerrymandering, Republicans dominated Congress after the 2016 election despite receiving a million and a half fewer votes than Democrats–in 2018, in order to overcome that advantage and retake control of the House, Democrats had to win by staggering percentages.

This isn’t new. The Guardian went back to 1980.

“I don’t want everybody to vote,” Paul Weyrich, an influential conservative activist, said in 1980. “As a matter of fact, our leverage in the elections quite candidly goes up as the voting populace goes down.”

In the wake of the Depression, Americans demanded changes to governance that shaped the America most of us grew up in. The GOP has fought most of those changes–especially those that strengthened the social safety net–and has relied heavily on voter apathy and the party’s ability to suppress the votes of minorities and poorer Americans to erase them.

There really is no debate about what sorts of policies the majority of Americans want–or about the tactics Republicans intend to employ to ensure that those policies never get implemented. Trump has admitted what every sentient person already knew.

The unanswered question is: will the current pandemic be as much of a wake-up call as the Depression?

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The Robots Are Coming…

When I opened my email a few days ago, the first thing that popped up was an article from the Brookings Institution titled “The Robots Are Ready as the Covid-19 Recession spreads,” predicting that a coronavirus-related downturn will increase the rate at which American industry invests in labor-replacing automation.

As I have previously argued, jobs don’t matter simply because most of us need to put food on the table. Having a job–even a job we dislike–gives most of us a sense of purpose and identity. (There is a reason so many people die shortly after retiring.)In “The Truly Disadvantaged,” William Julius Wilson noted the significant differences between neighborhoods where residents are poor but employed and neighborhoods where residents are poor and jobless.

The longterm trend was worrisome well before the advent of the Coronavirus: American economic mobility and job creation had already begun to slow, largely as a result of policies favoring larger firms over the entrepreneurial start-ups that were once responsible for the creation of most new jobs. Numerous studies have documented what Brookings calls “a steady and significant increase in consolidation” Thanks to anemic anti-trust enforcement, the number of so-called “mega-mergers” has increased, and as the market power of these huge companies grows, competition decreases. The under-enforcement of anti-trust laws has reduced entrepreneurship, increased predatory pricing practices and economic inequality, and resulted in the concentration of economic growth.

Rather than the vigorous competition that characterizes healthy markets, we have increasingly moved from capitalism to corporatism, or crony capitalism, in which government shields favored industries and companies from competitive pressures rather than acting as the guarantor of a level playing field.

Until recently, people expressing concerns about job losses have focused their criticisms on the outsourcing of manufacturing to low-wage countries, ignoring what is by far the biggest contributor to job loss– automation, and the replacement of workers by machines.

A 2018 study by Ball State University found that just since 2000, nine out of ten manufacturing workers have been replaced by automation. That same year, the Pew Research Center asked approximately 1900 experts to opine on the impact of emerging technologies on employment; half of those questioned predicted the displacement of significant numbers of both blue- and white-collar workers by robots and digital agents, and predicted that those displacements will lead to serious consequences: larger increases in income inequality, masses of people who are unemployable, and breakdowns in the social order.

Forecasts varied widely. One analysis, by the Organization for Economic Cooperation and Development, predicted that ten percent of the jobs in advanced economies will be automated, while scholars at Oxford University warned that 50% of American jobs are at risk. Obviously, no one can say with confidence how many jobs will be lost, or which workers will sustain those losses, but technologies now in development threaten millions.

Think about the numbers. There are 3.5 million professional truck drivers in the United States, and another 1.7 million Americans drive taxis, Ubers, buses and delivery vans for a living. Self-driving cars, which are already being road-tested, could put them all in the ranks of the unemployed.

Think skilled workers are immune? Think again. Reports show accelerating automation of jobs held by skilled knowledge workers engaged in data-driven decision-making. Between 2011 and 2017, Goldman Sachs replaced 600 desk traders with 200 coding engineers. Even medical professionals are at risk: in 2017, Entilic, a medical start-up, reported that its AI algorithm “outperformed four radiologists in detecting and classifying lung modules as either benign or malignant.” In 2016, the World Economic Forum projected a total loss of 7.1 million jobs to automation, including jobs in advertising, public relations, broadcasting, law, financial services and health care.

Automation will obviously create jobs as well as destroy them, but that will be cold comfort to that 55-year-old truck driver with a high-school education–he isn’t going to move into a new position in Informatics.

What does the current pandemic have to do with this longterm trend? According to Brookings:

Robots’ infiltration of the workforce doesn’t occur at a steady, gradual pace. Instead, automation happens in bursts, concentrated especially in bad times such as in the wake of economic shocks, when humans become relatively more expensive as firms’ revenues rapidly decline. At these moments, employers shed less-skilled workers and replace them with technology and higher-skilled workers, which increases labor productivity as a recession tapers off.

America wasn’t prepared for a pandemic, and we won’t be prepared for the civic unrest exacerbated by widespread joblessness. We are going to require skilled leadership, and that leadership will not be provided by the Party of the Past, led by a mentally-ill ignoramus.

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An Excellent Summary

My husband recently recommended that I read a lengthy article from the Atlantic by Ed Yong. Despite the fact that I am a pretty devoted reader of that publication, and a subscriber, I’d missed it.

If you are trapped at home with nothing pressing to do (clean out the refrigerator, or knit face masks, or whatever), you should click through and read the article in its entirety. In case you don’t have the time or inclination, I am cutting and pasting paragraphs that–in my estimation–are insightful and important.

A global pandemic of this scale was inevitable. In recent years, hundreds of health experts have written books, white papers, and op-eds warning of the possibility. Bill Gates has been telling anyone who would listen, including the 18 million viewers of his TED Talk. In 2018, I wrote a story for The Atlantic arguing that America was not ready for the pandemic that would eventually come. In October, the Johns Hopkins Center for Health Security war-gamed what might happen if a new coronavirus swept the globe. And then one did. Hypotheticals became reality. “What if?” became “Now what?”…

As my colleagues Alexis Madrigal and Robinson Meyer have reported, the Centers for Disease Control and Prevention developed and distributed a faulty test in February. Independent labs created alternatives, but were mired in bureaucracy from the FDA. In a crucial month when the American caseload shot into the tens of thousands, only hundreds of people were tested. That a biomedical powerhouse like the U.S. should so thoroughly fail to create a very simple diagnostic test was, quite literally, unimaginable. “I’m not aware of any simulations that I or others have run where we [considered] a failure of testing,” says Alexandra Phelan of Georgetown University, who works on legal and policy issues related to infectious diseases.

The testing fiasco was the original sin of America’s pandemic failure, the single flaw that undermined every other countermeasure….

With little room to surge during a crisis, America’s health-care system operates on the assumption that unaffected states can help beleaguered ones in an emergency. That ethic works for localized disasters such as hurricanes or wildfires, but not for a pandemic that is now in all 50 states. Cooperation has given way to competition; some worried hospitals have bought out large quantities of supplies, in the way that panicked consumers have bought out toilet paper.

Partly, that’s because the White House is a ghost town of scientific expertise. A pandemic-preparedness office that was part of the National Security Council was dissolved in 2018. On January 28, Luciana Borio, who was part of that team, urged the government to “act now to prevent an American epidemic,” and specifically to work with the private sector to develop fast, easy diagnostic tests. But with the office shuttered, those warnings were published in The Wall Street Journal, rather than spoken into the president’s ear. Instead of springing into action, America sat idle.

Rudderless, blindsided, lethargic, and uncoordinated, America has mishandled the COVID-19 crisis to a substantially worse degree than what every health expert I’ve spoken with had feared. “Much worse,” said Ron Klain, who coordinated the U.S. response to the West African Ebola outbreak in 2014. “Beyond any expectations we had,” said Lauren Sauer, who works on disaster preparedness at Johns Hopkins Medicine. “As an American, I’m horrified,” said Seth Berkley, who heads Gavi, the Vaccine Alliance. “The U.S. may end up with the worst outbreak in the industrialized world.”

The quoted paragraphs are followed by predictions of what will come next–best and worst case. Bottom line: even in the best-case scenarios, this isn’t going to be over any time soon. The “President” may think a vaccine or cure can be magically discovered and mass produced in a couple of weeks, but scientists and sane people know better.

And then there’s the aftermath…

As my colleague Annie Lowrey wrote, the economy is experiencing a shock “more sudden and severe than anyone alive has ever experienced.” About one in five people in the United States have lost working hours or jobs. Hotels are empty. Airlines are grounding flights. Restaurants and other small businesses are closing. Inequalities will widen: People with low incomes will be hardest-hit by social-distancing measures, and most likely to have the chronic health conditions that increase their risk of severe infections. Diseases have destabilized cities and societies many times over, “but it hasn’t happened in this country in a very long time, or to quite the extent that we’re seeing now,” says Elena Conis, a historian of medicine at UC Berkeley. “We’re far more urban and metropolitan. We have more people traveling great distances and living far from family and work.”

After infections begin ebbing, a secondary pandemic of mental-health problems will follow. …People with anxiety or obsessive-compulsive disorder are struggling. Elderly people, who are already excluded from much of public life, are being asked to distance themselves even further, deepening their loneliness. Asian people are suffering racist insults, fueled by a president who insists on labeling the new coronavirus the “Chinese virus.” Incidents of domestic violence and child abuse are likely to spike as people are forced to stay in unsafe homes.

The article does end with a thin ray of hope–or perhaps “challenge” is a more appropriate word. Pandemics can catalyze social change.

Perhaps the nation will learn that preparedness isn’t just about masks, vaccines, and tests, but also about fair labor policies and a stable and equal health-care system. Perhaps it will appreciate that health-care workers and public-health specialists compose America’s social immune system, and that this system has been suppressed.

If we are very, very fortunate, in November we will not retreat further into authoritarianism and fear; instead, we’ll recognize that all diseases aren’t physical, and all tests aren’t medical.

Our test is whether America will repudiate the virus of bigoted “America first” politics, reject kakistocracy, and pivot from isolationism to international cooperation.

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