Tag: CDC

Our Right to be Free

Our country was founded and has prospered on the proposition “that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.” We jealously guard our individual liberty. We are free to decide what we want to do and how we want to do it. This liberty is subject to two major conditions: we must live with the consequences of our choices and actions, and our actions cannot interfere with the same exercise of freedom by others. We never fully live up to these high principles, but they do define the goals we continue to and should continue to aim for.

When our actions or circumstance fail to sustain us, we do step in to help those in distress, whether from family obligations or friendships or a government administered social safety net. We continue to debate and refine its features.

Determining the boundary between those actions I am free to choose, and those that unacceptably affect others is not always easy. Walking in public naked is not acceptable in most societies (except at designated nude beaches). While this would not infringe on the freedom of others to behave as they want, it would “force” them to see something they do not want to see.

I chose this example because it does not fall neatly into something purely private that I have a right to do (walking around my home naked) or something clearly and obviously damaging to others that I do not have a right to do (driving my car through my neighbor’s garden).  In the realm of social norms, I can walk in public dressed in many ways depending on the society I am in.  A man might freely walk around in a dress (if he chooses the neighborhood carefully) without getting knocked down in some societies but not in others. Such social norms are important in defining and guiding acceptable public behavior and they vary across societies and over time. Such norms are continuously debated.

But clearly my freedom to swing my fist ends where your face begins. If you are infected with a contagious disease, you do not have the freedom to walk around potentially infecting others even in the most libertarian of societies (e.g., lower Manhattan). I assume that anyone sick with Covid-19 knows that she must isolate/quarantine herself.

But what about someone who doesn’t feel sick but hasn’t been vaccinated?

Any establishment has the right to require that only vaccinated people work or shop there and/or wear face masks. And I certainly have the right to attend only those performances or eat in those restaurants that impose these requirements. These are implications of freedom.

Surely everyone understands and accepts these propositions.  So why is there such controversy over wearing masks and getting vaccinated? I don’t know the answer to this question but will suggest a few factors that I think are important. That such health issues have become so politicized is almost more distressing than the fact that in the United States 728,000 people have died from Covid-19 by October 10, 2021.

One reason is that some people are pushing back on being told what to do by the government. Such behavior is common in freedom loving children but rather unseemly in adults. Another is that vaccines were developed with miraculous speed and their effectiveness and potential side effects are not yet fully known. None the less the evidence is overwhelming that being vaccinated significantly increases your prospects of living and surviving the infection compared to those who are unvaccinated. Another is that during the Trump administration medical policy and advice became quite politicized. Many of us, often with good reason, stopped trusting the messages from the CDC and FDA. And to this day government messaging remains poor. Rather than offering advice based on the most recent evidence (which can change over time) and the reasons for those recommendations, government pronouncements are often confusing and sometimes sound like demands. Many of us have lost trust in the government’s pronouncements. Unfortunately, some people have put their trust in unreliable sources of information and even, in some cases, in deliberately malicious sources (and we can’t always blame Russia). 

Where our choices and actions affect only ourselves, we should be free to do as we like and benefit (or suffer) from the outcome. Where our actions affect others, more or less directly, social norms and government rules should limit our choices. In societies where its citizens live by the golden rule and respect these norms, beneficial behavior is followed voluntarily — enforcement is not a serious problem.  We must determine the sources of information that we trust carefully and based on such information we must treat our neighbors with the respect we expect from them.

Protecting our freedom is critical but it is not enough. We must also exercise it virtuously. The “fusion” of freedom and virtue has been (most of the time) the basis of American success. We seem at risk of losing both. Get vaccinated now for everyone’s benefit. Please.

The Great Divide–Who Decides?

The American Constitution establishes a government of limited and enumerated powers to protect the property and safety of its sovereign citizens. There is a lot in that sentence so let me unpack it. Sovereignty in the United States resides in its individual citizens. We are responsible for our own lives and how to live them. But to ensure our ability to exercise our freedom in a broader community we gave up limited powers to our government, which are checked and balanced among the three branches of government (legislative, executive, and judicial). America has flourished under this arrangement of exceptional individual freedom.  “American Exceptionalism”

Our government is meant to provide the foundation and general rules for interacting with each other. It establishes the standard units of weights and measures, voltage, assignments of radio spectrum, rules of the road, etc. It defends us from aggression both foreign and domestic and administers the enforcement of contracts (courts). In short, it establishes the agreed framework in which we each take our own decisions about where to work, what to eat, and how to spend our free time within society. If we only surrender decisions (rules) that set and enforce the standards for our interactions with others, with minimal restrictions on our own behavior, our individual freedom will be maximized to our’s and our community’s benefit. America has flourished from our extensive individual freedom.

But where exactly is the optimal boundary between our individual and community choices? Views vary about the answer and the resulting policies between those of us who want small government and those who want somewhat larger government. What are the pros and cons of each? The answer, of course, will depend on the specific issue, but I want to review the question more generally.

The benefit of being free to take our own decisions about something is that it better reflects our knowledge of our particular situation and our own tastes. We don’t make such decisions in a void, of course. We draw on our own knowledge and values (taught by our parents, schools, clubs, churches, friends, etc.). Thus, our inherited and learned culture plays a critical role in the quality of our choices. Our government can help as well by promulgating information (the state of knowledge) and/or setting standards for communicating relevant information (e.g., product labeling standards). It can also add to our knowledge by financing basic research that private firms have little or no financial incentive to undertake (as opposed to applying the knowledge gained from such research to the development of marketable applications).

We also expect government (in addition to family and community organizations) to provide help when we are financially unable to because of sickness or unemployment (the social safety net). Because America is a rich country, we expect our social safety net to be relatively generous. Here is an area were views start to diverge. If we continue to have confidence in the ability of individuals to make sensible decisions, the government should help financially but not override the recipient’s freedom to choose how to use it. This is the philosophy of a Universal Basic Income.  “Replacing Social Security with a universal basic income”

At the other end of this spectrum are those who think that in many instances government employees can make wiser and better informed decisions for us than we can ourselves. Thus, instead of money we are given food stamps. Instead of school vouchers we are provided with take it or leave it neighborhood schools. Instead of health information on food products to help our individual choice, some food and other products are banned all together, etc.

The benefit of the government taking decisions for us is that individual officials (sometimes referred to as bureaucrats) can devote more time to investigating the costs and benefits of choices and thus potentially take and impose better decisions than we can ourselves. Though that might be true “in principle,” government officials are less likely to know our particular situation and tastes. In addition, the laws and regulations adopted in Congress and by government agencies are influenced more by the interests of the subjects of their regulations (e.g., Facebook) than of their customers (us). In other words, the discipline on the behavior of private firms from market competition is weaker or totally absent on regulators.

The case of the military/industrial complex is well known. Only the government can effectively defend us from potential foreign aggressors, so we are forced to live with the inefficiencies (corruption if you like) of the near monopoly that defense firms enjoy that ensures that the DOD keeps buying their products. The B-2 stealth bomber cost $2,100 million per plane. The scandalous F-35, the plane no one wants, cost US tax payers $115.5 million per plane. But the real cost to us of the military/industrial complex is the cost in lives, equipment, and reputation of our forever wars that ensure that BAE Systems, Bell Helicopter, Boeing, Lockheed Martin, Northrop Grumman, Pratt and Whitney and a few others, keep receiving billions of tax dollars every year.

Another example of government vs individual decision making is provided by the Centers for Disease Control and Prevention (CDC) and the US Food and Drug Administration (FDA). We look to the CDC for the best scientific guidance on protecting ourselves from disease, such as Covid-19 and to the FDA to approve what drugs and vaccines we are allowed to have. During the past year the “scientific” information provided by the CDC was polluted by ill-informed political messages. Public confidence in government information plummeted and advice became sadly political. “Covid-19-why aren’t we prepared”

The FDA initially mangled the approval of Covid-19 test kits, delaying their availability, thus undermining the detect and trace strategy. “Covid-19-what should Uncle Sam do?”  Fortunately, it then relaxed its risk averse restrictions on drug approvals to grant emergency approval of several Covid-19 vaccines. As of May 7, 111 million American’s have been fully vaccinated with these vaccines, which have proved safe and effective. Many lives have been saved as a result.

Last month the FDA reverted to its more independent, scientific form when it temporarily suspended the use of Johnson and Johnson’s Covid-19 vaccine because of very rare blood clots. On April 13, the CDC and FDA issued a joint statement reporting that “As of April 12, more than 6.8 million doses of the Johnson & Johnson (Janssen) vaccine have been administered in the U.S. CDC and FDA are reviewing data involving six reported U.S. cases of a rare and severe type of blood clot in individuals after receiving the J&J vaccine.”   “Joint CDC and FDA statement on Johnson-Johnson covid-19 vaccine”  There were more than that number of such blood clots among those who had not taken the vaccine. This measure reflects government’s usual excessive risk aversion. If they do their job right (approving drugs that are safe and effective), few people notice, but if they make a mistake (thalidomide babies), they are in big trouble. So, the incentive is to be overly cautious. During the several weeks hiatus in administering the Johnson and Johnson vaccine more people died from Covid who might have been saved if they had received the vaccination, than from the rare blood clot.  The political issue, once again, is who should decide–government officials or individuals on the basis of information provided by the government (and others). “Beating covid-19-compulsion or persuasion and guidance”

A very different example of government making decisions for us comes from our trade policy. Government imposed trade restrictions, often in the form of taxes on imports (so called tariffs), restrict our individual right to chose what we buy (or sell). While there may well be national security or other national interests that justify such interference, more often they simply reflect corruption (the financial favoring of one group or industry in exchange for votes). “Trade protection and corruption”  Former President Trump’s abuse of the national security excuse to tax Canadian steel imports provides a recent example.  “Tariff abuse”  Strangely, but no doubt for the same reasons, President Biden has not yet removed these damaging tariffs.  “Trump disastrous steel tariffs”

As a final example of our choice between government and individual decision making, consider President Biden’s American Families Plan, which provides $225 million in childcare subsidies. But rather than vouchers that can be used by families as they see fit, it finances government run childcare services. “Biden’s plan for government run childcare is exactly what most moms don’t want”  Sometimes government-run and controlled services are better than those we choose ourselves in the private sector (perhaps with government financial and/or information assistance). Not that many in my opinion. But, please let’s have a serious and informative discussion of the pros and cons of each.

The Thanksgiving Revolt

Sadly, Thanksgiving and healthcare more generally has been politicized (or “weaponized” as I said in a report to the UNDP with regard to the monetary system in Yemen–my advice was that nothing as important as the monetary system should be weaponized). Why are normally sensible (I am being generous on this day of giving thanks) people behaving like rebellious teenagers? Among other reasons, I think, it is in part because they are being treated like children. We can demand that our children do this or that (at least when we don’t have the time or patience to explain why they should do this or that as part of preparing them to become adults).

Mature, independent minded adults (i.e., typical Americans) bristle when told that they must stay home, or cancel Thanksgiving dinner and other social activities, even when they suspect that it is the prudent thing to do. Our government should not be dictating our behavior in a free society. There are exceptions, of course, for the protection of the rest of us. We are (or should be) free to do what we like as long as we do not infringe on the right and ability of others to do the same. For example, we don’t permit people infected with communicable diseases to wander around in public endangering the rest of us–quarantining those with active cases of Covid-19 is properly required.

We each have our own assessment of the risks of infection and our own willingness to take risks.  We should be free to make our own decisions about what to do (as long as we are not endangering others–yes you should wear a face mask if you go out).

What should the government’s role be? The government should provide the best information available on what those risks are and how best to mitigate them. Not everyone agrees on what the data says.  Where that is the case, the government (CDC basically) should be honest about the disagreement and the basis of the government’s consensus judgement. This is a constructive, helpful role and a proper way of dealing with adults. Somehow too many political types have acquired the tone of voice with which one might speak to children. And if that weren’t bad enough the government provides conflicting information. Fortunately, our stable genius is no longer listened to and his quack remedies will fade from our memories.

We need an honest and less intrusive government that advises rather than dictates. We need fellow citizens who civilly share their views with us while respecting, even if not necessarily agreeing with, ours. We have a long way to go but let’s rally and raise above the muck we are in.  Oh yes, and happy Thanksgiving.

Thanksgiving Proclamation, 3 October 1789

Thanksgiving Proclamation

[New York, 3 October 1789]

By the President of the United States of America. a Proclamation.

Whereas it is the duty of all Nations to acknowledge the providence of Almighty God, to obey his will, to be grateful for his benefits, and humbly to implore his protection and favor—and whereas both Houses of Congress have by their joint Committee requested me “to recommend to the People of the United States a day of public thanksgiving and prayer to be observed by acknowledging with grateful hearts the many signal favors of Almighty God especially by affording them an opportunity peaceably to establish a form of government for their safety and happiness.”

Now therefore I do recommend and assign Thursday the 26th day of November next to be devoted by the People of these States to the service of that great and glorious Being, who is the beneficent Author of all the good that was, that is, or that will be—That we may then all unite in rendering unto him our sincere and humble thanks—for his kind care and protection of the People of this Country previous to their becoming a Nation—for the signal and manifold mercies, and the favorable interpositions of his Providence which we experienced in the course and conclusion of the late war—for the great degree of tranquillity, union, and plenty, which we have since enjoyed—for the peaceable and rational manner, in which we have been enabled to establish constitutions of government for our safety and happiness, and particularly the national One now lately instituted—for the civil and religious liberty with which we are blessed; and the means we have of acquiring and diffusing useful knowledge; and in general for all the great and various favors which he hath been pleased to confer upon us.

and also that we may then unite in most humbly offering our prayers and supplications to the great Lord and Ruler of Nations and beseech him to pardon our national and other transgressions—to enable us all, whether in public or private stations, to perform our several and relative duties properly and punctually—to render our national government a blessing to all the people, by constantly being a Government of wise, just, and constitutional laws, discreetly and faithfully executed and obeyed—to protect and guide all Sovereigns and Nations (especially such as have shewn kindness unto us) and to bless them with good government, peace, and concord—To promote the knowledge and practice of true religion and virtue, and the encrease of science among them and us—and generally to grant unto all Mankind such a degree of temporal prosperity as he alone knows to be best.

Given under my hand at the City of New-York the third day of October in the year of our Lord 1789.

Go: Washington

Social Distancing

Research lead by Neil Ferguson and his colleagues at Imperial College London suggests that a staggering 2.2 million would die in the United States and 510,000 in Britain if nothing is done by governments and individuals to stop the pandemic (no social distancing or hand washing, etc.).  Imperial College London study  The U.S. was late and bumbling in addressing the Novel Coronavirus coming from China in December. The Food and Drug Administration (FDA) refused to authorize the use of tests approved by the EU and the test developed by Centers for Disease Control and Prevention (CDC) was flawed and had to be withdrawn. The United States remains embarrassing and dangerously behind other countries in testing and other preparations for dealing with the disease.  “Coronavirus-testing-delays-caused-red-tape-bureaucracy-scorn-private-companies”

Unable now to contain the virus in a targeted way, the U.S. has largely shut down its schools, theaters, restaurants and other places of public gatherings as well as flights from abroad. The Ferguson “report concludes that the British government might be able to keep the number of dead below 20,000 by enforcing social distancing for the entire population, isolating all cases, demanding quarantines of entire households where anyone is sick and closing all schools and universities — for 12 to 18 months, until a vaccine is available”. A comparable figure for the U.S. implies a reduction in the death rate to 86,000.

For perspective, traffic accidents in the U.S. in 2017 killed 40,100.  More than forty-seven thousand committed suicide that year and 55,672 died from influenza and pneumonia. When compared with ordinary flu, covid-19 spreads more rapidly and is ten times as deadly, but we still do not know very much else about its properties.  But, we can expect a relatively large number of deaths from this new virus no matter what we do.  But doing nothing will increase deaths considerably.

What steps should the U.S. take?  We don’t ban cars because people die in them. We choose to take calculated risks if they are not “excessive”.  https://wcoats.blog/2016/12/27/our-risks-from-terrorists/

The extreme measures being taken in the U.S. proceeded without serious estimates of the economic costs to the economy and the spill over health risks of children kept home with vulnerable grandparents, etc.  “The CDC guidelines advised that short- and medium-term school closures do not affect the spread of the virus and that evidence from other countries shows places that closed schools, such as Hong Kong, ‘have not had more success in reducing spread than those that did not,’ such as Singapore.  But this guidance was not released until Friday [March 13], after the cascade of school closings had begun.”  “States-are-rushing-to-close-schools-but-what-does-the-science-on-closures-say”

Our extreme reaction will generate huge costs that cannot be fully known reverberating for years to come. We can be pretty certain that there will be unintended, undesirable consequences quite beyond the disruption of our pleasurable, cultural activities (bankruptcies of otherwise viable firms and the resulting loss of jobs, etc.). The government (congress and the administration working together for a change) is attempting to anticipate and ameliorate as many of those consequences as possible. One example of the search for cost effective balance of cost and mitigation involves the stopping of flights from Europe.  The cost of monitoring arriving airline passengers before boarding abroad is very likely cheaper than the economic disruption and damage of forbidding foreign visitors at all.  Following Trump’s announcement of the travel ban (once his team sorted out and clarified what he was actually imposing) the American Civil Liberties Union announced, “These measures are extraordinary incursions on liberty and fly in the face of considerable evidence that travel bans and quarantines can do more harm than good.”

Unlike the U.S., Britain has not closed its schools and restaurants. But as I am writing this, the UK just announced that its schools will close Friday March 20.  The Patriot Act passed quickly after the 9/11 terrorist attacks in the U.S. on September 11, 2001 (for those of you too young to remember) reminds us how quickly and easily we surrender our revered liberties when we are scared.  Almost 19 years after 9/11 we still have the dangerously intrusive provisions of the Patriot Act.  Once freedoms are surrendered and the government steps in it seems to be hard to regain them.  The extreme measures being taken in the U.S. and elsewhere to slow the spread of covid-19 provide us with the latest example.

On March 16, Deborah Birx, White House coronavirus response coordinator, reported that models based on data available so far indicated that the biggest reduction in deaths came from “social distancing, small groups, not going in public in large groups. But the most important thing was if one person in the household became infected, the whole household self-quarantined for 14 days. Because that stops 100 percent of the transmission outside of the household,”

The biggest bang for the buck comes from individuals protecting themselves by social distancing, hand washing, and normal (and perhaps enhanced) care to avoid the sick and avoid exposing others when we are sick as we generally do now. Clear public health guidance from the government could go (would have gone) a long way to encourage the enhancement of such diligence.  The Kennedy Center for the Performing Arts never closed down during the flu season.

Covid-19 calls for vigorous government action, even now when it is too late to stop it any time soon. We will need extra hospital beds, medicine, respirators, protective gear, replacements for infected health workers, vaccine research, development, manufacture and administration and more.  Soon we will require replacements for the many brave health care workers such as nurses and doctors as they also become infected with the virus. But as with all decisions, private and public, a careful assessment of costs and benefits of different courses of action will produce the best result.  Knowledgeable public information to guide the natural protective self-interests of each of us and our usual concern and respect for the well-being of our families, friends and neighbors can carry us a long way toward minimizing the further spread of this disease at minimal cost to lives and property.

P.S.  In my previous blog of March 15 (Covid-19, why aren’t we prepared) I reported Beth Cameron’s claim that the National Security Council Directorate for Global Health Security and Biodefense was disbanded in May 2018.  Ms. Cameron was its director at the time.  Yesterday Tim Morrison, director of the successor unit for a year in 2018-19, “No-white-house-didn’t-dissolve-its-pandemic-response-office”, explained that its staff and function were merged with two other units performing overlapping functions in order to improve efficiency without a loss of its capacity “to do everything possible within the vast powers and resources of the U.S. government to prepare for the next disease outbreak and prevent it from becoming an epidemic or pandemic.”  I apologize for misrepresenting what happened and expect Mr. Morrison to apologize for the disastrous failure of his unit to fulfill its mandate.

Covid-19, Why Aren’t We Prepared?

Following the Ebola epidemic of 2014 President Obama established the National Security Council Directorate for Global Health Security and Biodefense “to do everything possible within the vast powers and resources of the U.S. government to prepare for the next disease outbreak and prevent it from becoming an epidemic or pandemic.” “NSC-pandemic-office-trump-closed”.  This unit was “disbanded under a reorganization by national security adviser John Bolton” in May 2018.

America’s disorganized and late starting response to the spread of Covid-19 in our country can be attributed in part to this act. What was obviously a mistake with the benefit of hindsight, however, was a more difficult judgement at the time. Two classes of judgements were involved: a) what organizational structure would service the country’s interests best (for Bolton, everything always seemed focused on the preparation for war), and b) how many and what resources should be devoted to events that might never occur?

The government’s role in disaster management is spread between a number of agencies, from FEMA (Federal Emergency Management Agency), the Department of Homeland Security, the Department of Health and Human Services (HHS), Food and Drug Administration (FDA), and the Center for Disease Control and Prevention (CDC), to state and local health services, fire departments etc. I have no idea if each potential disaster is managed by the most appropriate agency but coordination between them is often very important. That requires designated leadership.

Assigning resources to prepare for dealing with possible future epidemics means not assigning them to something also of value. What are the tradeoffs? We keep emergency reserves of many things: oil, medicine, face masks, excess capacity at hospitals, etc. What is the right amount? We keep a large military in case of war that we hope will never occur (unfortunately we have very foolishly used them unnecessarily too often and in too many places). What is the right size of the military given that every additional soldier is one fewer of whatever else she might have done?  Keeping a military reserve that can be called up in the case of war is one of the approaches we have taken in dealing with this question.

It is hard to impossible to know for sure the best answer.  Devoting resources to being prepared for an event that never occurs might seem (increasingly) wasteful. But so might an insurance policy for something we hope never happens, and we are generally wise to have it. Not taking the time and resources to be prepared can be extremely costly if the disaster occurs.  Large banks are now required to test the resilience of their balance sheets against financial shocks of one sort or another (stress tests) and to prepare living wills for how they would be liquidated if they became insolvent. These are costly exercises but well worth the cost if it helps avoid bank failures and/or makes the orderly liquidation of an insolvent large bank feasible, thus making market discipline of excessive bank risk taking credible. https://wcoats.blog/2012/06/29/spains-financial-crisis-first-principles/

There are rumors that the HHS blocked the use of foreign tests for the Coronavirus to preserve business for American pharmaceutical companies and that President Trump exempted the UK and Ireland from his initial European travel ban because he owns golf courses in Scotland and Ireland may or may not be true. https://wcoats.blog/?s=crony+capitalism.  Fortunately, we still have a free press, which is likely to get to the bottom of that.

Where the stakes are high, we should pay the cost of reasonable preparations for disasters of one sort or another. The lives of tens of thousands of citizens are at stake. Getting the balance right, as in so many other areas of governance is not easy. But the United States today is neither well organized nor properly prepared to mitigate the damage of the epidemic now about to sweep over us.  We will pay a much larger cost for this than we should have.

However, it is not only the country’s lack of preparedness that is a major problem in this national crisis. The President himself appears unprepared to handle facts or rely on his medical experts and convey confidence to the public by making accurate statements about what is being done and what the public should expect. His recent oval office statements about an all-encompassing Europe travel ban including the banning of cargo coming from Europe and the availability of free tests and treatments was basically wrong. Each claim had to be corrected and re-explained in an already confusing and panic-induced environment. The White House has not presented a clear, coherent plan for containing the damage of covid-19 that the Trump’s own administration understands or is behind.  Along with starting late to address the challenge, the Trump administration has been and remains incoherently organized to move forward from here. Stay tuned for the next tweet.