"Public Health Policy as Public Choice Failure" in Print

We trace how things went South

My coauthors Cassandra Robertson, Zoe Robinson, and I have published a symposium piece entitled "Public Health Policy as Public Choice Failure" in the Houston Journal of Health Law & Policy, in which we use a public choice lens to examine the United States' often-unfortunate public health journey. Here is the abstract:

The COVID-19 pandemic has wrought a devastating toll, causing over a million deaths in the United States along with widespread disability and economic disruption. Yet the magnitude of these costs was not inevitable—it was shaped by the policy choices made in response to the crisis. This Article argues that the U.S. pandemic response suffered from public choice dynamics that systematically skewed policymaking away from the public interest. Examining three key policy areas—vaccine rollout, mask mandates, and ventilation standards—the Article demonstrates how misaligned political incentives led officials to prioritize short-term appeasement of a pandemic-weary public over science-based strategies that would maximize long-term welfare. In each domain, political actors faced strong incentives to downplay risks, overpromise solutions, and delay difficult decisions, resulting in a pandemic response that was often too little, too late, and too beholden to partisan interests. The Article concludes that reckoning honestly with these failures is a crucial first step toward reforming our public health institutions and ensure a more effective response to the next crisis. It offers recommendations for rebuilding public trust, depoliticizing public health communication, and institutionalizing science-based policymaking. More broadly, the Article underscores the urgent need to realign political incentives with the public interest in the prevention of and response to public health emergencies.

Comments

[MollyGodiva]

The paper is very critical about the non-perfect response of the public health officials. But neglects to look at the fact that vocal MAGA politicians were driving about 40% of the US population to be opposed to any steps that would mitigate the pandemic and made the public health expert's job far more difficult than it already was.

For the perspective of the rest of us, it was not the public health experts who we lost confidence in, but our fellow Americans.

[Dr. Ed 2]

You know, molly, you are really lucky you didn't get a shooting civil war. Shay's Rebellion was over less....

[Joe_dallas]

I suggest you read the study and understand the study. Your comment shows you do not understand the dynamics in any way shape or form.

[Stupid Government Tricks]

There's the problem in a nutshell -- your "fellow" Americans excludes the half that support Trump, or more precisely, prefer Trump to the wokidiots. Trump isn't even close to what I want, but Harris? She's afraid to even admit she chose Walz because Buttigieg is gay. When half the country votes for word-salad Harris because they believe Trump is a literal Nazi, your use of "our fellow Americans" rings hollow.

You can't swing a cat without finding conservatives and libertarians who admit they voted for Trump only because he's better than Harris or Biden. How many lefties will admit the opposite, that they voted for Harris only because she wasn't Trump? All the lefties I've seen scream he's a Nazi but refuse to admit Harris is cuckoo or Mandami is as close to communist as a Muslim can get.

When you can come out and admit Democrats are nutso, I'll begin to consider contemplating that you might have a rational thought now and then.

[David Nieporent]

She's afraid to even admit she chose Walz because Buttigieg is gay.

? That's literally what she said the other day.

[Joe_dallas]

The study is based on an extremely false premise - that a respiratory virus already deeply embedded into the general population by mid march 2020 could be controlled ( or even erradicated) via the mitigation protocols.

[Brett Bellmore]

Should have police stated more, then?

I think they went about as far as they could in a remotely free society. Further, in some areas.

[Sarcastr0]

You are, right here, being part of the problem.

[Michael Ejercito]

How so?

[Stupid Government Tricks]

Sarcastr0 doesn't operate on logic. Expecting a sane answer is useless.

[Brett Bellmore]

The chief problem in any police state is all those people who don't want to obey, obviously.

[Stephen Lathrop]

Seems to beg the question why so many did not want to, "obey," as you put it, or "follow public-health aligned," policy as the paper seems to put it. Not just public health, but also national political comity, was disrupted by Trump/MAGA political opportunism, practiced to gain partisan advantage. It will be a grave risk to encourage a repeat of that all-too-successful political tactic each time a new public health emergency arises.

[John F. Carr]

From the introduction: "Harvard economist Professor David Cutler estimates the costs of Long COVID to the United States at $3.7 trillion, consisting of losses to quality of life combined with lost earnings and higher spending on medical care."

I read NHTSA reports on the economic costs of traffic accidents. They came up with a pretty big number. The biggest part of that big number was reduction in quality-adjusted life years that people caused to themselves. If you get drunk and wrap your tree around a pole the bureaucrats add millions of dollars to the cost of drunk driving crashes. Almost all of that cost is your subjective experience, specifically not being around to enjoy life for the next 50 years. If the report had counted only real costs, medical costs and harm done to other people and property, the number wouldn't be nearly as good at pushing NHTSA's agenda.

[Joe_dallas]

My observation with 3 individuals with "long covid" is that it is not long covid, but a continuation of bad health that pre existed covid. The long covid is simply a convenient excuse.

[Dr. Ed 2]

MOST of COVID was something else exacerbated.

[Brett Bellmore]

True. Covid wasn't the Spanish Flu, taking healthy young people in their prime. It was knocking over people who had one foot in the grave and the other on a banana peel.

In most age groups, the odds of Covid killing you were extremely low unless you had some preexisting comorbidity like extreme obesity or diabetes.

And if we're to be honest, the one large group for which this wasn't true, the elderly? Being elderly IS a comorbidity!

[Joe_dallas]

correct -

[David Nieporent]

wrap your tree around a pole

That sounds difficult.

[Dr. Ed 2]

"The COVID-19 pandemic has wrought a devastating toll, causing over a million deaths in the United States along with widespread disability and economic disruption.

Yes, the "million deaths" included George Floyd -- he's counted as a COVID death. Forget what the jury said, COVID killed him.

And we're STILL dealing with excessive deaths from the purported COVID "vaccines." Healthy young men -- fit athletes -- dropping dead. And the people whose lives were destroyed, sucks to be them, I guess.

"Yet the magnitude of these costs was not inevitable—it was shaped by the policy choices made in response to the crisis."

Agreed -- a century after the mistakes of the flu epidemic, the same sort of mistakes were made again. Never forget that the bureaucrat's instinct is to go full fascist, full time.

"This Article argues that the U.S. pandemic response suffered from public choice dynamics that systematically skewed policymaking away from the public interest."

I agree -- Faucci should have been told to go fire truck himself -- with 5 fewer letters. We need to have Nuremberg-style trials, execution may be too harsh, but I'd like to see people lose their pensions...

[David Nieporent]

Yes, the "million deaths" included George Floyd -- he's counted as a COVID death. Forget what the jury said, COVID killed him.

It's in his dissertation, folks! But Floyd is not counted as a COVID death, and of course we should not forget what the jury said in favor of what Dr. Ed pulls out of his ass.

And we're STILL dealing with excessive deaths from the purported COVID "vaccines." Healthy young men -- fit athletes -- dropping dead.

Literally never happened.

[wvattorney13]

The paper doesn't mention it, but from my recollection the largest issue in the public response was the handwaving about the BLM protests in June 2020. From March to June, people of all political stripes were largely complying with mandates and doing what they were supposed to. Some outlier groups were complaining, but not the public as a whole.

Then BLM decides that they are going to hold protests and the powers that be say, "It's fine. It is necessary." Well people had been told for 3 months that they had to stay home, close their business, not go to church, no family Easter etc. but now that George Floyd dies all the rules go out the window.

The messaging was terrible. It looked as if the mandates weren't that important after all. Your mother can't come over for Easter but 500 people can gather to illegally tear down a confederate statue. That was the point where they lost the public.

[Brett Bellmore]

Pretty much. Up until then people were restive, but at least believed that public health authorities were being honest with them.

That put an end to trust.

[Joe_dallas]

WV - As I noted above, the health authorities recommendations were based on the false premise that the respiratory virus, already deeply embedded into the general population could be controlled with the mitigation protocols. Controlling the virus for any reasonable time period was futile. note that the waves followed the historical norm for all respiratory virus.

Secondly the health authorities operated under the false belief that the mitigation protocols would achieve the long term solution. The health authorities had a complete disconnect with historical evidence with their false beliefs.

The article/study perpetuates those same false premises.

[wvattorney13]

By my recollection, that is exactly what they said early on. There is no stopping this. You will get Covid.

However, what we need to do is prevent the hospitals from being overwhelmed. 15 days to flatten the curve. We will ramp up production of ventilators and hospital equipment. Trump used a war time measure to take over factories to produce PPE.

The line was that if we don't stay home for 15 days, then we won't be able to treat everyone that shows up at the hospital. You give us just a little time, we can expand our capabilities to handle everyone who gets sick and not as many people will die from lack of treatment.

Then it seems that just as quick as that line was adopted, it was dropped and it was pretended as if that was never said.

[Bruce Hayden]

Well, their initial worry was about running out of ventilators. But then it was quickly figured out that ventilators killed more than the virus did. Nevertheless, the worry about the quantity of (now unused) ventilators colored rage nation’s COVID-19 response for rage nxt sever years.

One of the ramifications of this worry that hospitals would be filled up and overflowing with COVID-19 patients was the misuse of the ModRNA “vaccines”. Normal vaccines merely teach the immune system memory that a pathogen (virus here) is an antigen, and to produce the correct antibodies upon recognizing it again. Essentially passive until the antigen is encountered again. That was inevitably accomplished on the first jab. So, why the government’s insistence on repeated and continuing jabs? The goal was to prevent any chance of even a mild case, by maintaining a level of antibodies, on a continuing basis. Unfortunately, that meant that immune systems in many were stressed by the necessity for maintaining those antibody levels for, it turned out, years. And that meant a shortage of resources to address other issues faced by the immune system, such as long dormant viruses, cancers, etc. (we won’t get into the problems caused by replacing Uridines with N1 Methylpseudouridine in the mRNA (thus ModRNA) in the vaccines).

Presumably to reduce hospitalizations. Except that Sen/Dr Rand Paul got a CDC official last week, in sworn testimony, to admit that no studies had ever been done, during that time that these vaccines were being pushed, that they reduced hospitalizations nor that they reduced deaths.

[Stephen Lathrop]

Hayden — There is a giant body of critique of Covid public health policy, mostly based on reliance on a stupidity to suppose correlations noted among data samples amount to proof of causation. You take that stupidity an extra step, to assert that non-use of such ill-founded measurements proves what you want to believe.

I have a suggestion for you. Confine all your arguments to overall measurements based on full data sets, not correlated samples, or hypothetical correlated samples omitted, and see how things look.

[Joe_dallas]

SL - Bruce's comments are largely correct. Especially his comment on the effectiveness of repeated vaxes. There is considerable evidence that repeated vaccinations impede the development of a more robust immunity which Bruce alludes to.

[Joe_dallas]

WV & bruce - The lockdowns and other mitigation protocols due to the fear and unknowns of covid - overflowing hospitals and lack of ventilators , etc, were reasonable (though I disagreed with those protocols at the outset) .

As you mentioned, it was stated that everyone will get covid. That in a nutshell is exactly what I stated in March of 2020 and that the only why covid is going to be stopped is when there is immunity through out the general population. Somewhere around 90% of the population has contracted covid. . Virtually everything I stated in March 2020 and later turned out to be true. The trajectory of the covid pandemic followed the trajectory of every pandemic for the last 300+ years.

[David Nieporent]

As I've noted many times in the past, bookkeeper_joe is not a virologist, immunologist, epidemiologist, or someone with any SME in any area at all.

[David Nieporent]

It was indeed terrible messaging, but "the powers that be" did not say any such thing. A group of people, none of whom were powers that be, many of whom were students, signed an online petition, or open letter, or whatever they called it.

[Brett Bellmore]

Here's what one of those powers that be had to say.

""It is a difficult situation," Fauci said. "We have the right to peaceably demonstrate, and the demonstrators are exercising that right...it's important to exercise your constitutional rights to be able to demonstrate, but it's a delicate balance, because the reasons for demonstrating are valid. And yet, the demonstration itself puts one at an additional risk.""

He was less understanding when people simply wanted to be able to earn a living and put food on the table.

And he was one of the better ones!

Suddenly, Public Health Officials Say Social Justice Matters More Than Social Distance

They could have maintained a consistent line. They didn't.

[Stephen Lathrop]

Some folks who did not live in the Northeast, and who always have trouble mustering concern for what happens in the Northeast, have blinkered views to offer now. That is not surprising. They never supposed that the Covid pandemic might afflict everyone the way it afflicted New York City, where at the outset of the pandemic corpses were literally piled unburied by thousands in the streets (albeit tastefully concealed in refrigerated trailers). Even capacity to dump the dead into mass graves was overwhelmed.

Rationalizations for public health stupidity continue now, because the rationalizers ignore that not all parts of the nation got equivalent exposures. The areas first afflicted endured longer trials, but ended no worse off in excess mortality, compared to areas with later, milder onsets. That comparison condemns the arguments offered by the rationalizers now.

The first-afflicted areas did far more, for longer, to check the pandemic with policies of masking, testing, and especially social isolation, and it paid off. If it had not, we would see systematically higher excess mortality for the areas first afflicted, and that is not evident. It is always true that if public health policy works during an extreme test, it tends to be discounted as unnecessary by public health opponents afterwards.

[Brett Bellmore]

You don't seem to grasp that you're describing the actual public health stupidity, insisting that the whole country act as though it were an ultra-high density port city. In order to avert in the rest of the country what was never going to happen in the rest of the country.

[Stephen Lathrop]

The comments offered above expressing outrage over allowances for BLM protests show all too clearly the actual motivations of political partisans pretending to critique public health policies. Goad those partisans with a political provocation, and every sign of forthright concern about public health policy disappears permanently.

That is a very, very dangerous way to argue about public health emergencies. Because it did not affect all demographics alike, the Covid pandemic provides a terrible reference for future thinking about public health emergencies.

Posit a Covid-like pandemic which affected all demographics more-or-less alike, and the death toll would have been nearly an order of magnitude higher. Posit a more contagious and deadlier pandemic than that, with capacity to kill a substantial fraction of everyone, and you have the right yardstick to gauge wise public policy going forward.

[Brett Bellmore]

You're deliberately blinding yourself to what happened: The public health authorities made some socially and economically very expensive demands of the general population, and the general population, raised to revere the prior triumphs of public health, grumbled a bit and complied.

Then those same authorities took their credibility and nuked it from orbit by making nakedly political exceptions to their demands. And were outraged with the compliance went away.

But it was a result of those authorities destroying their own credibility!

"Posit a more contagious and deadlier pandemic than that, with capacity to kill a substantial fraction of everyone, and you have the right yardstick to gauge wise public policy going forward."

Sure, and that just underscores how bloody STUPID they were to burn their credibility that way. We are, predictably, going to eventually face a pandemic that genuinely IS what they thought at first Covid might be: A highly contagious disease that strikes people down in their prime.

And the public health authorities will go into that crisis without the moral authority they squandered on Covid.

[Swede425]

The public health authorities stepped on their own cranks when they made political exceptions to their recommendations..
That was them fucking up.
They're going to have their work cut out getting people to trust them again. And it's entirely their fault.

[Joe_dallas]

SL - Covid is a respiratory virus.

you are still clinging to the false premise that the mitigation protocols would work. That premise was discredited once it became known that covid was a respiratory virus. Its been 5 years since the covid outbreak, yet you a still clinging to the knowledge that existed in feb 2020,

[Stephen Lathrop]

Bellmore — Pretty sure you are trying to pave the way to look consistent, if you ever want to attack public health policy anew. If the concessions you offer were more than pretense, you would not be doing that. You would support public health policy in principle, and like everyone else wisely motivated, await future evidence to support resistance only if it were justified by what happened.