Fake Magic by Nancy OhanianYesterday, writing for the Washington Post, Alex Tabarrok and Ahluwalia Ohlhaver-- public health professionals-- asserted that We could stop the pandemic by July 4 if the government took these steps. Trump-- and you thought he was bad before we fell into the pandemic?-- admits he would prefer see Americans die, by the thousands daily, rather than do the hard work it would take. "The dangers of reopening without disease control-- or a coronavirus vaccine or therapeutic breakthrough-- are illustrated," wrote Tabarrok and Ahluwalia, "by events at the Smithfield Foods meatpacking plant in Sioux Falls, South Dakota. Smithfield offered workers a bonus if they showed up every day in April. Normally, bonus pay would increase attendance. But in a pandemic, encouraging the sick to haul themselves into work can be disastrous. The plan backfired. Hundreds of Smithfield employees were infected, forcing the plant to shut down for more than three weeks. If we stay the current course, we risk repeating the same mistake across the whole economy." Unfortunately, that's the Trump/Noem way of handling the pandemic.
The economy consists of people who have hopes and fears. As long as they are afraid of a lethal virus, they will avoid restaurants, travel and workplaces. (According to a Washington Post-Ipsos Poll last week, only 25 percent of all Americans want to “open businesses and get the economy going again, even if that means more people will get the coronavirus.”) The only way to restore the economy is to earn the confidence of both vulnerable industries and vulnerable people through testing, contact tracing and isolation.There is already a bipartisan plan to achieve this; we helped write it. The plan relies on frequent testing followed by tracing the contacts of people who test positive (and their contacts) until no new positive cases are found. It also encourages voluntary isolation, at home or in hotel rooms, to prevent further disease spread. Isolated patients would receive a federal stipend, like jurors, to discourage them from returning to workplaces too soon.But our plan also recognizes that rural towns in Montana should not necessarily have to shut down the way New York City has. To pull off this balancing act, the country should be divided into red, yellow and green zones. The goal is to be a green zone, where fewer than one resident per 36,000 is infected. Here, large gatherings are allowed, and masks aren’t required for those who don’t interact with the elderly or other vulnerable populations. Green zones require a minimum of one test per day for every 10,000 people and a five-person contact tracing team for every 100,000 people. (These are the levels currently maintained in South Korea, which has suppressed covid-19.) Two weeks ago, a modest 1,900 tests a day could have kept 19 million Americans safely in green zones. Today, there are no green zones in the United States.Most Americans-- about 298 million-- live in yellow zones, where disease prevalence is between .002 percent and 1 percent. But even in yellow zones, the economy could safely reopen with aggressive testing and tracing, coupled with safety measures including mandatory masks. In South Korea, during the peak of its outbreak, it took 25 tests to detect one positive case, and the case fatality rate was 1 percent. Following this model, yellow zones would require 2,500 tests for every daily death. To contain spread, yellow zones also would ramp up contact tracing until a team is available for every new daily coronavirus case. After one tracer conducts an interview, the team would spend 12 hours identifying all those at risk. Speed matters, because the virus spreads quickly; three days is useless for tracing. (Maryland, Virginia and Washington, D.C., are all yellow zones.)A disease prevalence greater than 1 percent defines red zones. Today, 30 million Americans live in such hot spots-- which include Detroit, New Jersey, New Orleans and New York City. In addition to the yellow-zone interventions, these places require stay-at-home orders. But by strictly following guidelines for testing and tracing, red zones could turn yellow within four weeks, moving steadfastly from lockdown to liberty.Getting to green nationwide is possible by the end of the summer, but it requires ramping up testing radically. The United States now administers more than 300,000 tests a day, but according to our guidelines, 5 million a day are needed (for two to three months). It’s an achievable goal. Researchers estimate that the current system has a latent capacity to produce 2 million tests a day, and a surge in federal funding would spur companies to increase capacity. The key is to do it now, before manageable yellow zones deteriorate to economically ruinous red zones.States can administer these “test, trace and supported isolation” programs-- but Congress would need to fund them. The total cost, we estimate, is $74 billion, to be spent over 12 to 18 months. That sum would cover wages and training for contract tracers, the cost of building voluntary self-isolation facilities, stipends for those in isolation and subsidies to manufacture tests.That amount is a lot, but not compared to the cost of a crippled economy. In Congress’s latest relief package, $75 billion went to struggling hospitals alone, $380 billion to help small businesses and $25 billion toward testing. But hospitals and businesses will continue to hemorrhage money and seek bailouts as long as they can’t open safely. Not spending on disease control means new waves of infection followed by chaotic spikes in disease and death, followed by more ruinous cycles of economic openings and closures. Economists talk about “multipliers”-- an injection of spending that causes even larger increases in gross domestic product. Spending on testing, tracing and paid isolation would produce an indisputable and massive multiplier effect.States have strong economic incentives to become-- and remain--— green zones. Nations that have invested the most in disease control have suffered the least economic hardship: Taiwan grew 1.5 percent in the first quarter, whereas the United States’ gross domestic product contracted by 4.8 percent, at an annual adjusted rate. (Taiwan was fortunate to have its vice president, Chen Chien-Jen, a U.S.-trained epidemiologist; under his guidance, the island acted quickly with masks, temperature checks, testing and tracing.) The second quarter will be worse: The projected decline for U.S. GDP, at an annualized rate, is an alarming 40 percent.Looking forward, we will see stark economic contrasts across states, depending on their investment in disease control. With $74 billion, Congress could close the gap between states and relieve pressure on state budgets hamstrung by collapsing revenues. In the spirit of federalism, states would then become laboratories for discovering the best ways to implement testing, tracing and isolation. States might choose to form interstate compacts that pool and move testing resources across state lines as the disease travels and surges; county health officials might tap firefighters or other municipal workers to build regional contact-tracing workforces (as is happening in Tyler, Tex.). When local and state governments become accountable for adopting strategies that work, we can expect more innovation.How do we know that testing, tracing and supported isolation would work? It already has worked in New Zealand, South Korea and Taiwan-- where there have been few to no new daily cases recently. Taiwan never had to shut down its economy, while New Zealand and South Korea are returning to normal. It would work here, too. Since March, Congress has passed relief bills totaling $3.6 trillion to support an economy devastated by a virus-- and $3 trillion more is on the table. We should attack the disease directly so we can stop spending to alleviate symptoms. Following this road map, we can defeat the coronavirus and be celebrating life, liberty and livelihood by the Fourth of July.
If, instead of a president guiding the country through the pandemic, all decisions were just made by flipping a coin, statistically half the decisions would be the right decision and half the decisions would be wrong. If we did that, America would be far better off than we are with Trump as president, since every single crucial decision he has made has been wrong-- and it's a good bet that every decision he makes going forward will be the wrong decision.Undermining peoples'trust in government has been the preeminent conservative project at least since 1932. Like in shrinking it enough so it could be drown in a bathtub. What better way than... Donald Trump? There has never been a regime as incompetent and dysfunctional in the country's history. Not even close. Washington Post chief correspondent Dan Balz took a stab this weekend at explaining how the pandemic is exposing just how hollowed out the GOP has made our government. He starts with the most obvious point printed in his paper this week: "The government’s halting response to the coronavirus pandemic represents the culmination of chronic structural weaknesses, years of underinvestment and political rhetoric that has undermined the public trust-- conditions compounded by President Trump’s open hostility to a federal bureaucracy that has been called upon to manage the crisis. Federal government leaders, beginning with the president, appeared caught unaware by the swiftness with which the coronavirus was spreading through the country-- though this was not the first time that an administration seemed ill-prepared for an unexpected shock. But even after the machinery of government clanked into motion, missteps, endemic obstacles and lack of clear communication have plagued the efforts to meet the needs of the nation."
“A fundamental role of government is the safety and security of its people,” said Janet Napolitano, the former secretary of homeland security. “To me that means you have to maintain a certain base level so that, when an event like a pandemic manifests itself, you can quickly activate what you have and you have already in place a system and plan for what the federal government is going to do and what the states are going to do.”That has not been the case this spring. The nation is reaping the effects of decades of denigration of government and also from a steady squeeze on the resources needed to shore up the domestic parts of the executive branch.This hollowing out has been going on for years as a gridlocked Congress preferred continuing resolutions and budgetary caps to hardheaded decisions about vulnerable governmental infrastructure and leaders did little to address structural weaknesses.The problems have grown worse in the past three years. Trump was elected having never served in government or the military. That was one reason he appealed to many of those who backed him. He came to Washington deeply suspicious of what he branded the “deep state.” Promising to drain the swamp, he has vilified career civil servants and the institutions of government now called upon to perform at the highest levels.His transition was messy and since then his administration has been slow to populate the thousands of political slots atop federal agencies, and the president has seemed to prefer acting agency heads to those who can win confirmation from the Senate and the authority that imprimatur conveys. He has targeted career officials and sought retribution for those who differed with him, particularly those whose job it is to find and expose problems.“One thing to keep in mind is that government takes on hard problems,” said David E. Lewis, a political science professor at Vanderbilt University. “They’re often problems that can’t be solved by the market and there aren’t private entities to solve them.”He added: “We’re seeing a government that is suffering now from a long period of neglect that began well before this administration. And that neglect has accelerated during this administration.”The question is whether the weaknesses and vulnerabilities exposed by the current crisis will generate a newfound interest among the nation’s elected officials-- and the public-- in repairing the infrastructure of government and a sense of urgency on the part of the public to encourage them to do so. Or will partisanship and public indifference lead to a continuation of the status quo?...The pandemic has forced another critical look at government’s competence. For months, the Trump administration has been running behind to bring testing capacity to the levels needed. That was true as the virus was taking hold and when more tests might have helped contain the spread. It is the case now as businesses look to reopen but cannot assure safety for workers or their communities without the widespread availability of tests, which so far does not exist.Stockpiles of needed equipment were never adequate for the scale of the pandemic either, and the government was slow to ramp up production. The government’s economic intervention, while massive in dollars and well-meaning in intent, also has run into problems.In contrast to many European nations, where the strategy has been to keep payrolls afloat, the U.S. program has relied on direct payments to individuals, unemployment insurance for furloughed workers, loans to small businesses (in some cases forgivable) and aid to some major industries, such as airlines.Speed took precedence over precision in the design of the program. Delays were common. Areas of the country hardest hit by the virus in March and early April were sometimes shortchanged as money flowed to areas less affected. Payments through the Small Business Administration ended up in the hands of big firms like Ruth’s Chris steakhouses or entities like the Los Angeles Lakers. Treasury Department officials had to move swiftly to get those payments returned.Flaws in the nation’s unemployment insurance program, a patchwork system run through the states, highlighted inequities, as benefits vary from state to state, as do eligibility requirements and length of assistance.Florida’s has drawn the most criticism. That state’s program was redesigned when now-Sen. Rick Scott (R) was governor to make it more difficult to qualify for assistance. Recently it has been plagued by computer problems. A recent headline on the Miami Herald website said, “Florida’s jobless benefits program finding new ways to confound, infuriate the unemployed.”Congress authorized an additional $600-a-week payment through July for those unemployed, on top of what they would receive from their state program, which has resulted in some people receiving more money while being unemployed than when they were working.Ricardo Reis, an economist at the London School of Economics, said that the U.S. program is one of the largest in the industrialized world but not necessarily the most efficient. “To get the same bang you’ve got to spend a lot more bucks because you’re sending a check to everyone, right?” he said “A lot of people don’t need a check.”“Much of the response at the federal level has been predicated on the idea that we’re just going to take a holiday for a few months and then go back to where we were,” said a skeptical Steven J. Davis, a professor of international business and economics at the University of Chicago’s Booth School of Business.Federal Reserve Chair Jerome H. Powell warned last week of “significant downside risks” to the future of the economy.The jury is still out as to whether what the government has done is either adequate or efficient. “My impression from the outside is that we have significantly mal-designed the economic assistance and adjustment system,” said Philip Zelikow, a professor at the University of Virginia who served in five administrations and was executive director of the 9/11 Commission.“The counter to that is we just needed to get the trillions out the door,” he added. “Maybe after analysis, that argument could have merit [but] I suspect this still could have been done better under the time constraints.”Meanwhile, lawmakers are now locked in age-old ideological battles at a time when fresh thinking will be needed to help workers who could face long periods of unemployment and businesses threatened by closure by a pandemic that appears certain to create a new normal whenever the economy does reopen.“I think this event is revealing of what governance wonks have been warning about for a long time, namely that we haven’t been very focused on the basic governing systems we need to execute policy successfully,” said William Galston of the Brookings Institution. “The competency of government to serve as an instrument of policy delivery has been weakened substantially. One of our long-term tasks is to rebuild that capacity.”Gene Dodaro, the comptroller general, leads the Government Accountability Office, the agency that is tasked with being a watchdog for government performance. He sees structural weaknesses that constantly impede performance. “The hardest part of my job is getting people to focus on things before they become a crisis,” he said.The GAO regularly produces a list of areas of high risk in government performance. The most recent, issued in 2019, began with this assessment: “The ratings for more than half of the 35 areas on the 2019 High Risk List remain largely unchanged. Since GAO’s last update in 2017, seven areas improved, three regressed, and two showed mixed progress.”“Fundamentally we have a legacy government that hasn’t kept up with the world around it,” said Max Stier, president and chief executive of the Partnership for Public Service. “We create government and capacity around the problems of the day and there’s not much refreshed. . . It does not lie with a single administration. It is endemic through modern times and not just the executive [branch] but in Congress.”To take just one example, government has allowed its technology infrastructure to age in place. According to Dodaro, Washington spends about $90 billion a year on its IT systems-- about three quarters of the money going to supporting operations and maintenance of existing systems, starving investment in new technology.A call for technology upgrades is not a new problem. In 1995, Dodaro said he recommended that every agency create a position of chief information officer. Congress followed suit the next year, he said, but resistance in the agencies hampered the progress. In 2014, Congress enacted a second piece of legislation to spur what had been started nearly two decades earlier.The Department of Defense and Veterans Affairs have been working to make medical records easily transferrable when personnel leave the military and become eligible for VA benefits. Billions have been spent but the problem hasn’t been solved.Among those with the most antiquated computer systems are two agencies tasked with delivering economic assistance to workers this spring, the Small Business Administration and the Internal Revenue Service.“SBA was asked to do the impossible on top of antiquated technologies,” said Paul Light, a professor of public service at New York University.Some unemployment insurance systems run on mainframe computers that are 40 years old. In April, several states put out a call for people familiar with programming language for COBOL, introduced half a century ago, to help keep their systems running.More than the computer systems are aging; so too is the workforce assigned to work on them. Stier estimates that there are five times as many federal employees over age 60 working on IT issues as there are employees under age 30. “The talent pool in government has to be refreshed,” he said.Aging technology highlights the weaknesses of the government’s infrastructure, but that is only one of the obstacles that hinders more effective performance. Over the years, the federal government has created a complex system for the delivery of services.Much of the work done by government is now carried out by nongovernmental employees-- private contractors, consulting firms, nonprofits and others not technically on the federal payroll. Tina Nabatchi, a professor of public administration at Syracuse University’s Maxwell School, estimates that as much as 70 percent of the work of government is done by these outside entities. “We’ve taken out the middle levels of bureaucracies,” she said.One reason is the desire of some leaders to run government like a business, though the two are not alike. Another is to mask the true scope of government. John DiIulio, a political science professor at the University of Pennsylvania, said that earlier in its existence, the Department of Homeland Security had more full-time-equivalent contractors than full-time-equivalent employees. “We want a lot from government,” he said. “We don’t want a lot of government.”Donald F. Kettl, a professor at the Lyndon B. Johnson School of Public Affairs at the University of Texas, said most Americans, including many lawmakers, view government services through a vending machine model: Money goes in at the top, a lever is pulled and services come out at the bottom. Inside, however, is a complicated and often cumbersome contraption.Kettl described the U.S. health care system as “much more complex than anywhere else in the world,” a labyrinth of government, private insurers, public and private hospitals, physicians, nurses and other health care workers, all involved in the delivery and billing of services. “The strategy of competence means managing these really complex partnerships,” he said.Another area where the United States is unique is in the number of political appointees atop agencies in the executive branch. The system is supposed to allow a president to gain control of the bureaucracy but vacancies and constant turnover in those jobs mean that, when in their posts, officials are often afflicted with short-termitis-- focusing on matters of the moment and ignoring underlying structural weaknesses that can become crippling problems in a crisis.Leadership is a critical ingredient in the functioning of government. A president can set priorities and focus his administration on making systems work more efficiently. But there is one more reason the work of making government better rarely attracts the attention of senior government officials. It often requires becoming mired in mind-numbing detail. In other words, however important the work might be, it’s just plain boring....Marc Hetherington, a professor at the University of North Carolina, said the public conversation about government began to shift with the election of Ronald Reagan in 1980. Before that, anti-government rhetoric focused more on what government ought and ought not to do, themes highlighted by Arizona Sen. Barry Goldwater (R) during his 1964 presidential campaign.“What changed with Reagan and the decades since is that the conversation moves away from what government ought to do to government is incompetent to do things,” he said. “That’s a big change, with a fundamentally different message.”Throughout the conservative movement since, that message has been a staple, with the often explicit goal of shrinking the federal government, cutting resources to starve the beast. “Sometimes poor performance is trying to do government on the cheap,” Lewis said. “There is a penny-wise, pound-foolish idea of how we manage government agencies.”Hetherington said he has noticed one thing from his research about trust in government. Whenever the focus is on the military or national security, trust increases. When the focus shifts away to other programs, particularly those safety net programs such as welfare or food stamps, which serve disadvantaged populations, trust decreases.But if Republicans have made this kind of rhetoric a staple of their message, Democratic politicians have engaged in some of the same kind of thing. “Every candidate has campaigned on a bureaucracy-bashing theme,” Nabatchi said. “That message has gotten through to affect people’s confidence in government.”The president’s disdain is on display constantly, far more so than for past presidents. Hetherington said that in this area, Trump is “off the charts. Whereas a lot of Republican attacks on the government left certain things implicit, the Trump people have made them explicit.”There is much that works well in the federal government, particularly everyday activities that citizens take for granted. Career civil servants on the whole are dedicated and skilled. But when the challenges shift from ordinary to extraordinary, cracks within the system are exposed, demands on leadership rise and the government’s competence is rightly called into question. This has been such a time.It is an open question whether the more intense focus on the federal government will result in more calls to deal with the underlying weakness or whether criticism of the administration’s response-- and the political divisions surrounding it-- will further degrade people’s trust in the institutions they have turned to at this moment.“We don’t want to invest in the capacity of government to get the job done,” Kettl said. “But we are happy to complain immediately when there’s sand in the gear that causes the system to seize up.”
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