The Government Is Failing by Doing Too Little, and Too Much

Healthcare workers in Jericho, New York.
America's failure to invest public-health infrastructure is endangering doctors, nurses, and patients.Steve Pfost / Newsday RM / Getty

The United States is performing more poorly than it should in the present crisis, even apart from the actions and rhetoric of President Trump, for at least two distinct reasons: underinvestment in public-health infrastructure and unduly onerous government regulations.

That first category of error has received far more attention. To cite one example of many: the Bush administration noted in its “National Strategy for Pandemic Influenza,” released in 2005, that if an infectious disease spread across the nation, federal officials planned “to distribute medical countermeasures ... from the Strategic National Stockpile and other distribution centers to federal, state and local authorities.” According to the Los Angeles Times, the Strategic National Stockpile shipped out roughly 100 million N95 masks to protect doctors and nurses during the 2009 swine-flu epidemic, prompting a task force to urge the U.S. Department of Health and Human Services to replenish the supply.

Yet last month, the newspaper reported: “Health and Human Services Secretary Alex Azar said that available supplies included just 12 million N95 masks and 30 million surgical masks, a tiny fraction of the 3.5 billion masks one of Azar’s deputies later testified the nation’s healthcare system would need.” The Washington Post reported similar figures, adding that the strategic reserves had not been significantly replenished because “with a limited budget of about $600 million annually, officials in charge of the stockpile focused on what they say was a more pressing priority: lifesaving drugs and equipment for diseases and disasters that emerged before the new coronavirus.” Doctors, nurses, and patients will die during this pandemic because of the inadequate stockpile.

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Failures like that one and the attendant consequences may cause America to invest more in public-health infrastructure going forward, much as the September 11, 2001, terrorist attacks ensured significantly more funding for counterterrorism efforts. Even many of the most doctrinaire libertarians should now recognize strong pandemic preparedness as a public good that increases liberty by reducing the chance of closures and quarantines. Even the stingiest fiscal conservative should now see that it’s better to spend before the crisis hits.

But the other category of failure exposed by the coronavirus pandemic will prove more difficult to remedy: the red tape that gets in the way of an efficient response. The state must play a big part in pandemic response, yet it has also been a big part of the problem.

The most glaring, consequential example concerns testing for the coronavirus. As is well known, the original test developed by the Centers for Disease Control and Prevention didn’t work. Compounding the problem, bureaucracy got in the way of scientists who were on a better track. In January, a virology lab at the University of Washington developed its own test. But after Azar “declared a public-health emergency, on February 4th, a new regulatory regime took effect,” Robert P. Baird reported in The New Yorker. “From that point on, any lab that wanted to conduct its own tests for the new coronavirus would first need to secure something called an Emergency Use Authorization from the F.D.A.” Even after clearing needless bureaucratic hurdles, the lab was barred from conducting clinical coronavirus tests and from reporting results to doctors who ordered tests for patients.

Other, less extreme examples are easy to find. An entrepreneur struggling to ramp up production of N95 masks reports that new entrants to such manufacturing face a thicket of requirements that are time-consuming and over-the-top. Jeremy Samuel Faust, a Harvard Medical School instructor and emergency-room physician, warns in The Washington Post that state governments need to lift medical-malpractice standards, because they will interfere with doctors’ ability to treat critically ill patients in extreme circumstances. “The change need not, and should not, be permanent,” he says. “A three-month suspension would be enough. But we need to make this change immediately.”

Various agencies and local governments have already altered some needlessly onerous regulations. To increase the supply of ventilators, the FDA is reportedly waiving certain requirements for the manufacture of medical equipment. Regulatory impediments to telemedicine have been waived. Scott Alexander, a California psychiatrist, said in a blog post that “for the past week, most of the organizations that usually try to thwart me have instead been working to make my job easier.” In Massachusetts, Governor Charlie Baker announced that nurses licensed and qualified to work in other states can be licensed within a day to help alleviate imminent shortages.

But not all the harms of regulation can be immediately undone. For decades the U.S. has imposed artificial constraints on the supply of doctors––in fact, tens of thousands of doctors who practiced in foreign countries are unable to do so here, despite being legal residents. Shortages of hospital beds and medical equipment are in part the result of state regulations known as “certificate of need” laws. These statutes, Eric Boehm explained in Reason, “help politically powerful hospital chains limit regional competition and inflate health care costs, but they also create shortages of medical equipment that could prove disastrous during a pandemic.”

Political debates in the U.S. are too dominated by rival factions hyperfocused on one truth. The “blue” faction knows that a better-funded government is necessary to solve important problems. The “red” faction knows that getting the government out of the way is necessary to solve important problems. Neither faction is wrong, but both are often blind to ways that their rivals are right, in part because they focus so much on the other side’s dumbest arguments.

In the present crisis––as in normal times––America needs more citizens who grasp that many factions have valuable insights and critiques of the status quo. This is a diverse country. Its citizens vary in the problems they’re adept at spotting. Until we leverage one another’s strengths as readily as we mock one another’s shortcomings, we won’t achieve our potential.