Map of life expectancy at birth from Global Education Project.

Saturday, February 01, 2020

One more reason why libertarianism is nuts

As I have said, it's not clear yet how serious the Wuhan coronavirus outbreak really is, because we don't yet know what percentage of the time it causes serious illness. Maybe the Chinese have overreacted by their draconian isolation measures, on the other hand as I have said I wouldn't want to be the guy who made the decision to react too conservatively. That said, if we do get a serious epidemic here, of that particular virus or anything else, we are screwed, lassoed and tattooed. Here's Laurie Garrett in Foreign Policy:

It’s impossible to watch [the Chinese] without wondering, “What would we do? How would my government respond if this virus spread across my country?” For the United States, the answers are especially worrying because the government has intentionally rendered itself incapable. In 2018, the Trump administration fired the government’s entire pandemic response chain of command, including the White House management infrastructure. In numerous phone calls and emails with key agencies across the U.S. government, the only consistent response I encountered was distressed confusion. If the United States still has a clear chain of command for pandemic response, the White House urgently needs to clarify what it is —not just for the public but for the government itself, which largely finds itself in the dark.
While Congress didn't go along with all of the Administration's requests to cut public health funding, they did cut global disease fighting budgets of CDC, NSC, DHS and HHS; and eliminated the $30 million Complex Crises Fund. In May 2018 the Resident eliminated the entire NSC Global Health Security unit, and before and after that time has steadily forced out administrators and cut staff and budgets for other relevant agencies.

In 2017 and 2018, the philanthropist billionaire Bill Gates met repeatedly with Bolton and his predecessor, H.R. McMaster, warning that ongoing cuts to the global health disease infrastructure would render the United States vulnerable to, as he put it, the “significant probability of a large and lethal modern-day pandemic occurring in our lifetimes.” And an independent, bipartisan panel formed by the Center for Strategic and International Studies concluded that lack of preparedness was so acute in the Trump administration that the “United States must either pay now and gain protection and security or wait for the next epidemic and pay a much greater price in human and economic costs.”
Okay, so why did they do this? Because in their view, government is the problem, not the solution. Rich people shouldn't have to pay taxes, and free markets create utopia, so it is impossible for their to be any real need to spend government money on this fanciful "public health" concept. As Margaret Thatcher said, there is no such thing as society. So, as Donald Trump says, there is no such thing as public health. After all, he is the healthiest person in history.

Good luck with your pneumonia, Mitch McConnell.


Dr Porkenheimer said...

I think you're on one end of the spectrum (understandably because of the business you're in) and libertarians are on the other.

We are, however, a representative republic and there are other considerations that people think are also important. The correct balance is almost always somewhere in the middle.

If the US government were a communist style authoritarian regime, these other issues would not be that important.

Cervantes said...

Huh? Where is the "middle" between destroying the capacity to respond to a deadly epidemic and keeping it intact?

Dr Porkenheimer said...

I would hope that the balance would still allow for containment and use the least damaging methods to individual rights and freedoms. I think that is happening now by quarantining those coming back from the epicenter of this latest threat. Some would have advocated much more draconian steps without regard to these other issues.

One question I have is how prepared were we before this administration and is that preparedness just completely now stripped? Because that's what this post sounds like. Currently the US spends more by far than any other country on the planet even after congress passed the reduction, quadruple the second which is the UK.

I'm not against more funding for this issue. I just want to know more about it before categorically saying that congress' action in reducing funding for several agencies that may have overlapping areas was the wrong thing to do. I want spending to be smart, effective and, at the same time, I want congress to be a good steward of the taxpayers' money. And a little help from the other developed countries in the burden-sharing would be nice.

Cervantes said...

Well yes, if they did a systematic study they might have determined that there are areas of overlap -- or conversely that there are areas that are under-resourced -- and proposed a systematic, evidence based reorganization. But that's not what happened, they just arbitrarily and with no stated rationale drastically slashed budgets and left positions unfilled.

As for the civil liberties/public safety tradeoff in public health, that's a legitimate area for discussion and debate, but it's not what this is about. It's an irrelevancy, though I don't mind having that discussion.

Dr Porkenheimer said...

Bottom line is NOBODY KNOWS if these reductions changed our readiness or not. All you know is congress, who holds the purse strings, reduced the funding from about 12 Billion to about 8 Billion, still far, far more than any other country contributes.

It'd be great to know, wouldn't it? Think health spending might be more efficient?

The last time a federal budget was passed was 1996. Since then they've just been passing massive omnibus appropriations bills and continuing resolutions that carry over spending from the previous year assuming that the appropriations for the previous year were efficient and worthy.

What's needed is a zero-based budgeting process where each year (or maybe each three or five), each agency would have to submit and justify the amounts and what they're for. This would include the military, scientific, education, EPA, health, social services...everything.

There's nothing wrong with accounting for the $3.643 trillion sent to Washington each year. I believe it would help everybody except the bad actors.

We don't know jack about where the money goes.

Cervantes said...

While it is in general true that we don't have good outcome evaluations of many federal programs and policies it is not universally true. For example, we have a very good idea of the public health benefit of numerous environmental regulations that the current administration is in the process of trashing. We certainly do know where most of the money goes: with the exception of a substantial portion of military and intelligence spending, which is indeed secret, the federal budget is fully public and transparent. You can see where every penny of it goes, except for the parts you support.

Again, regarding the trashing of emergency preparedness resources, this was done utterly witlessly. Experts on the subject, which you are not, are in agreement that we are ill prepared for a major epidemic. Let's hope we don't end up proving it the hard way.

Zero based budgeting is not practical. The work involved in justifying and re-justifying spending every year would far exceed any conceivable benefit. It is reasonable to assume that if there is good justification for a program this year, it is still the case next year. Of course times and circumstances change and some programs do become entrenched even past their time. Here's a good example: Drug Abuse Resistance Education (DARE). It has been proven, time and again, to be counterproductive. But it still continues because conservatives love it. Same with abstinence only sex education.

Dr Porkenheimer said...

Not every government program is "right sized". And that can be a conversation all of its own.

Most all of these reductions were campaign promises he made before his election and he's keeping them. A whole shitload of voters believe that many of the federal bureaus are too big, too powerful and unaccountable. It's a big reason why he was elected.

I can also disagree with you that budget accountability is not workable. The IRS requires GM, Apple and every other large organization to account. It's do-able.

Cervantes said...

WTF are you talking about? Trump made a campaign promise to gut public health programs? I missed that one. Also, WTF are you talking about? As I say, the federal budget is public information. You can look up every dime and see how it's spend, with the exception, as I say, of secret military and intelligence programs.

People in general don't know shit about the federal budget. They think that foreign aid and "welfare" are the biggest parts of it.

Mark P said...

Justifying your budget is not the same thing as accounting. If every federal agency were required to justify their budget, I know exactly what would happen, because I have worked for government contractors for decades. Any time the justification was required, everyone in the agency, and I mean EVERYONE, would spend a month doing Powerpoint charts. No other work would get done in that time. In fact, it would probably also spill over to every government contractor, and they wouldn't do any other work for a month. I'm sure a lot of Republicans would say it was great that the government would stop operating for a month, since they believe government is the problem, not themselves.