Markets v. Lives
Claims that the cure is worse than the disease rely on a false tradeoff between human needs and the economy.
March 27, 2020
Mar 27, 2020
19 Min read time
Claims that the cure is worse than the disease rely on a false tradeoff between human needs and the economy.
It has been a week or two now since many of us careened into our new everyday, our lives rerouted into the dizzyingly small circles demanded by social distancing. If you are like us, you’re still reeling—catching yourself at odd moments as if dreaming, wondering if this can all be true. The psychological toll is brutal and the social dislocation extreme. Tens of millions of Americans are precipitously out of work. The more privileged are plying their children with apps so they can eke out a full day of paid work at home—and failing.
An outbreak of armchair epidemiology and economics is aiding and abetting the problem, amplified by a news media eager for a hot take.
The first stage of the U.S. coronavirus response was denial, issued straight from the top. The second was an extraordinary wave of social solidarity as we realized that in the absence of leadership from above, we had to act ourselves. Communities, neighbors, and state and local governments swiftly began to try to flatten the curve, though we may need to go still further to avoid cataclysms in our hospitals. What will the third stage be? Today, it looks like a riptide of contrarian skepticism—a powerful current running against the wave of social distancing that could accelerate the pandemic and the social dislocation that it will cause.
The questions come fast and furious. How long can we keep this up? How do we live with what we need to do to mitigate the virus—and how do we trust that we’re doing the right thing? It is natural, cooped up with our fears and our families, for people everywhere to be looking for a way out. So it isn’t a surprise that we’ve recently seen a number of op-eds and arguments start to pit the fight against COVID-19 against the collateral damage on our economy, both here at home and around the world.
The reasoning goes like this. We can’t afford to keep these draconian social distancing measures in place much longer because we’re destroying the economy. Then come some graphs: lines of sharp cliffs to show us that the stock market is in freefall, unemployment is skyrocketing, and we’re headed for a new Great Depression—an economic cataclysm. The cure, we’re told, might be worse than the disease. An outbreak of armchair epidemiology and economics is aiding and abetting the problem, amplified by a news media eager for a hot take.
• • •
The most egregious cases came in late March in the New York Times when diet-doctor David Katz and then Iraq War–monger Thomas Friedman both decided they had the “plan” to end the pandemic and get the United States back to work within weeks. (Katz’s byline identifies him as the founding director of the Yale-Griffin Prevention Research Center, implying to many an affiliation with Yale. He actually no longer directs the center, and has no academic appointment at the university.) Neither half-baked argument makes much sense given the realities of where we are now in the pandemic and basic principles of disease control. It sounds wonderful to be able to go back to normal life while protecting those at high risk. But how? It is as if the men writing these takes—and we have not seen one from a woman—really do imagine that we are a world of individuals, born naked on a rock as so many philosopher kings have imagined.
How precisely do they propose that we protect the vulnerable in nursing homes and prisons? Are they forgetting that so many of those who are most at risk—people over seventy years old and many who are chronically ill—need daily care? Who will provide it—or will we lock up the care providers too? In the most cynical instance, is “isolate the vulnerable” merely a politically convenient euphemism for “let them die”? The fact is, there is no simple way to protect the vulnerable beyond the blunt tool of drastic social distancing before we are able to scale up testing and tracing and to solve the shortages that are putting our health care workers at grave risk.
There is no simple way to protect the vulnerable beyond the blunt tool of drastic social distancing before we are able to scale up testing and tracing and to solve the shortages that are putting our health care workers at grave risk.
Yet these crude Manichean fantasies have metastasized across media platforms in recent days. New York Governor Cuomo and President Donald Trump both invoked Katz, who has become the Dr. Oz of COVID-19. Trump is now apparently picking, at random, dates that meet his fantasies about when we will have done enough (two weeks! Easter!). Our leaders are casting about, thrusting aside grounded and evidence-based analysis in favor of a longed-for easy answer. The darkest of these dreamscapes imagine that we must choose between saving the vulnerable and “saving the economy.” Already the Lieutenant Governor of Texas, Dan Patrick, has urged that seniors like himself be asked to sacrifice themselves on the altar of the market. This is the level of the debate we are now having.
For Republicans, this reframed choice between the economy and protecting the vulnerable obscures the fact that the Trump administration’s catastrophically bad response has systematically undermined our ability to shift to a narrower, more focused approach. At a minimum, that would require massive testing and contact tracing, widespread distribution of personal protective equipment to the general public, and dramatic scale up of our health care capacity, which we appear to be weeks—likely months—from being able to achieve.
For Democrats and Republicans alike, the scale and magnitude of the mobilization needed to succeed in eventually containing this epidemic—not to mention stemming and repairing the social and economic damage—is daunting, as is the prospect of having to give up the shibboleths that guide ordinary politics on both sides of the aisle to craft a response. Much easier to engage in loose talk about getting back to business, as President Trump has done. By contrast, very few public health experts and economists are staging this crisis as a zero-sum game, and most of them are trying to figure out a way through these months that addresses the inherent tradeoffs responsibly. They are also desperately calling for more testing and data, so that we can refine our understanding and response.
Pause for a moment to consider the absurdity of it all. All around us, we are seeing Americans sacrifice for one another to an almost unthinkable degree, all to slow the spread of a deadly disease—one that the best analysis that we have at the moment suggests could cause up to 2.7 million deaths in the United States alone if we abandon our efforts to contain it. Our typical indicators of the economy instead register our actions as a kind of collective suicide. Models of the economy, it turns out, do not incorporate the idea of staying home as productive of anything at all—not least avoidance of the negative externality of mass death. As longstanding critiques have insisted, figures such as GDP, which measure economic activity via the paid economy, also ignore the vast quantities of unpaid social reproductive labor without which society cannot survive. So the joke goes: when a man marries his housekeeper, GDP goes down. (Her work goes from paid to unpaid.)
Economic indicators such as GDP ignore the vast quantities of unpaid social reproductive labor without which society cannot survive.
And now the joke’s on us. Staying home, taking care of our kids, safeguarding our health care workers, and organizing volunteer drives for gloves and masks—none of this counts as part of “the economy,” nor in any obvious way can this fetishized conception of the economy appropriately value the lives of those most at risk. When HIV caused the death rate in South Africa to rise, GDP on some estimates trended up. In the short run, when people die, per captia GDP is divided by a smaller denominator. “The economy” that we’re offered in the usual take—measuring so little and commanding so much—is a death machine. Every climate activist, of course, could have told you this long ago.
What is happening today has no analogue in mainstream economic analysis: a rapid retraction of our paid economy, and a vast expansion of the kind of unpaid work that has never been properly valued. We are doing it for deeply human reasons, with the best evidence we have at the moment: to save the lives of people we know, perhaps even our own, and to protect our health care system—which, as the political scientist Danielle Allen recently wrote, is as fundamental to a well-ordered society (more, we would say) as a system of national defense. Not incidentally, rapid response will have more effect than a slow one, meaning the businesses and “the economy” too will benefit in the long run. The first rule of virus economics, as Austan Goolsbee recently said, is to stop the virus.
• • •
The impact of our fight against the coronavirus on workers, on the poor, and on retirement savings is real. It is essential that we focus on and address these human needs, so that we all can bounce back as soon as we are in a position to control the virus in more surgical ways.
But conventional wisdom is mistaking the current moment for something akin to the 2007–2008 financial crisis—a rupture that needs a “stimulus,” when in fact we want people to stay home rather than go out and spend. We’re not turbo-charging; we want to put the economy on pause as we dial down all but essential activities of our daily lives. This is a crisis, no doubt, but of a very different kind.
As we explained in these pages two weeks ago, we need a vast surge of support so that we can get through to the other end of this pandemic with the least long-term damage. This doesn’t mean indiscriminate tax cuts and bailouts for the corporate class—for instance, by giving Treasury Secretary Steve Mnuchin a $500 billion slush fund as was discussed a few days ago—with an idea once again that it will trickle down to the little people. It means supporting all of those who cannot get through this pandemic without help. That is hundreds of millions of Americans, and if we triage assistance, it’s those most in need who need to be at the front of the line.
In the cold calculus of efficiency or wealth maximization, those at highest risk of serious complications from COVID-19—the elderly and the infirm—seem expendable.
The interventions that we should be laser-focused on are those that meet people’s basic needs for social reproduction directly—to protect housing, to ensure that people can sustain themselves and their families through this shock, and to provide extra care for all of the workers essential to the response. The $2 trillion dollar package that passed the Senate yesterday instead tilts toward the old ways of thinking—with upwards of $850 billion directed at supporting businesses large and small, but with only $130 billion for hospitals and $150 billion for state and local governments. Trickle down, indeed.
The upshot is that the right way to look at the tradeoff isn’t in the costs to our economy in the traditional sense of potential losses in GDP versus the benefits of averting illness and death. In that cold calculus of efficiency or wealth maximization, those at highest risk of serious complications from COVID-19, for example the elderly and the infirm, seem expendable. But in human terms, this means a sacrifice of our parents and grandparents, possibly in the hundreds of thousands. This is worse than the specter of “death panels” that conservatives cynically fabricated to protect Americans from too much health care. It is a death drive, and the driver is capitalism. What else to call Lieutenant Governor Patrick’s cultish call for ritual group suicide among the elderly?
What we need is not unprecedented. We’ve made great social investments over the course of U.S. history in times of crisis, from the New Deal here at home during the Great Depression to the post–World War II Marshall Plan abroad. As a country we once decided to rescue citizens from the rubble of catastrophe and help them build a health system: the Marshall Plan gave the UK crucial support particularly in the early years of the National Health Service (even if in the last years of the Plan, true to form, America pushed for contractions in state spending on health and social services).
Right now, it is imperative we reject wishful thinking with all the moral and intellectual clarity we can muster. Instead of dreaming of relaxing social distancing and other disease control measures in a few days or weeks, we must consider instead how to ramp up a Public Works for Public Health program, one that rests on a few fundamental pillars.
First, we need immediate federal action to coordinate production and distribution to end the shortages that are crippling the response. On the list are masks and other personal protective equipment for health care workers, nasal swabs, ventilators, and ECMO machines.
Second, we need a dramatic surge in testing for the virus—both the PCR test and kits that can diagnose active infection, and the antibody-based tests that can tell us who has already recovered, so that we can improve disease surveillance and target our response.
We must not succumb to the fantasy that a cure lies just around the corner. This keening wish for deliverance is part of the emotional texture of suffering, but it can undermine support for the systems we need.
There is no substitute for strong national action here, because we need the power both to coordinate and command that our system has put in the hands of the federal government. A federal law that exists precisely for this purpose, the Defense Production Act, allows the government to command production of needed supplies, require companies to break previous contracts, and act to allocate supplies where they are most needed, so that supplies like masks and ventilators move quickly to the most affected places. At first Trump suggested he’d invoke this law, then backtracked. A few days ago he inveighed against its use yet again—No need! Capitalism is great!—unaware that his own disaster manager tiptoed under its umbrella to procure more test kits. Later that same day that manager too recanted. Washington does the two-step while New York City and New Orleans burn.
Third, we need a massive infusion of resources and support to frontline clinics and hospitals. We also need to quickly expand our health care capacity, for example by asking people recently retired to come back to the workforce as has been done in New York City, and finding new places to put hospital beds and care for the mildly sick. (A good place to start for details on plans like these is this paper by a former Administrator for the Centers for Medicare and Medicaid Services.)
Fourth, we must do all we can to facilitate the development of safe, effective, and affordable drugs and vaccines. Here too, the path forward is through the public. As in all pandemics, the public will lead in funding the response, and should—though has not yet—demand that in exchange, companies that benefit from the response agree to a reasonable price for any cures. We must also require that companies make public the clinical trial data that sustains their claims—today, much of that data is hidden behind claims of corporate secrecy. We need public information about R&D costs too, to negotiate fair prices for things that work. As importantly, we must not succumb to the fantasy that a cure lies just around the corner.
This keening wish for deliverance is part of the emotional texture of suffering, but it can undermine support for the systems we need to ensure that the drugs we are putting into our bodies actually work. As longtime AIDS activists, we know this personally, from the early HIV epidemic, when people were grasping at straws trying anything from egg lipid concoctions to blood thinners to save their own lives and the lives of their friends. It took over a decade to find a set of drugs that actually worked to beat back the virus and finally reduce the toll of deaths in the United States. Yet our bloviating president has brazenly broadcast unapproved cures and spawned runs on drugs that jeopardize the health, among others, of hundreds of thousands of Americans with lupus. Drive-through drug development will help no one: without evidence of what works, we are likely to do more harm than good and waste our efforts chasing dead-ends rather than on expediting the rigorous research we need.
Fifth, we need vast social investment in staving off the effects of the crisis for ordinary people. Economists have urged expanding unemployment insurance as Arindrajit Dube suggested in these pages earlier this week; Emmanuel Saez and Gabriel Zucman have made a similar proposal. It looks like Democrats have secured some of this sort of support in the final stimulus bill this week, though the fact that this was subject to significant Republican opposition tells you whose interests the GOP is looking out for. As blue-dog conservative Democrat Joe Manchin has said: “It seems like we are more focused on the big corporations and the health care of Wall Street than we are on the people in rural America and main street.” Many European nations are ahead of us on this. They had a head-start because of their own robust welfare states, but even the Tory government in the UK is trying to catch up now, realizing leaving people in free fall in a cataclysm like this is good for no one. We have to create a new safety net to catch people as they fall and do it with utmost speed.
“The economy” that we’re offered in the usual take—measuring so little and commanding so much—is a death machine.
Income is also critical for the millions who will not be reached by employment based support, including gig workers, the self-employed, small businesses, and the long-term unemployed. Ordinary Americans need broader relief as well. The Trump Administration has made some moves to prevent evictions and foreclosures for sixty days, and banks and non-bank lenders have made proposals for broader moratoriums on home loan payments, requiring tens of billions of dollars in federal guarantees. But these measures do nothing to address the 43 million people who rent in the United States. Here, localities and states can act if the feds don’t, as some are beginning to do.
One-off, limited payments to individuals, or debt deferral that digs a gigantic economic hole and tosses Americans in it will not get us to where we need to be: in a position where we all can weather this storm, to be in a position to go back to work or school and recreate our routines once we can shift strategies. So we also need strategies that avoid thrusting workers and students into more debt and that also go further to enact debt relief. Some Democrats have proposed bills which include partial student debt cancellation and federal subsidy of loan payments during the pandemic. It is not clear if they enjoy enough support for passage although 45 million borrowers are currently struggling to pay their student loans right now. We also need universal paid sick leave, for everyone who gets sick—something that the federal law adopted a week ago did not begin to approach.
While federal action is critical, there is much that still can and must be done at the state and local level. Closer to home, we need our leaders to protect those who cannot social distance because they are in our prisons and jails or living on the street or in homeless shelters. This is where social solidarity is most needed and most in short supply. It’s clear that with the close quarters in correctional facilities, the unsanitary conditions, and the frequent group encounters in washrooms or for meals, that the campaign against coronavirus is a losing game. Moreover, the elderly population in prisons is growing quickly: close to 30,000 inmates in state and federal prisons in the United States are over 65, and this group is especially vulnerable to severe complications and death from COVID-19. Additionally, infections that spread in prisons commonly spread to the communities around them: viruses don’t respect prison walls.
Advocates for the incarcerated have called for release of elderly prisoners and those otherwise at high risk of disease (those with underlying health conditions, for example) both to protect these individuals, and to allow for greater social distancing in prisons and to keep these places from amplifying transmission of the coronavirus. In some places, judges have begun to see the dangers, and have begun to order releases as a result. The ACLU and others are also working to obtain the release of people in immigration detention, who are in no less danger. Scaling this up will require action from politicians. So far both Democrats and Republicans have largely resisted, hanging on to the ruthless dictates of the world before COVID even as they rush to enact once unthinkable measures to protect those beyond the grip of our carceral state.
We’ve got to grab the wheel, and with a groaning, wide, ungainly sweep of the rudder, turn this country around as if our lives depended on it—because they do.
Homeless men and women are in another predicament. While being on the streets exposes them to all sorts of dangers and risks to their health and well-being, the group settings of many homeless shelters put them at high risk of acquiring coronavirus. The homeless are also increasingly elderly and sick, which again puts them at high risk of severe COVID-19 disease and death. Repurposing schools and other public buildings to appropriately house homeless individuals in the context of the pandemic has been met with resistance from communities, including our own. In addition, many people experiencing homelessness are also suffering from mental illness and addiction, so ensuring treatment for these other conditions—for instance by providing psychiatric medications or opioid agonist therapy, such as methadone—will be essential to helping them cope with their new surroundings and the restrictions that social distancing require.
• • •
As the virus sweeps across the United States with remarkable speed and ferocity, WHO was warning that our country could become the new epicenter of the pandemic. Yesterday, on March 26, our country took the prize: we have the most cases of COVID-19 in the world, surpassing China, a nation with four times the population. Two weeks ago, in our last installment, we called for a new politics of care, borrowing from what the virus demanded today to think also about tomorrow. But we’re falling now, and still no net is in place to catch us. We need to put a new politics of care in place today, to meet the challenge of this plague.
This is a massive task. Nothing really prepares us for it. But we’ve got to grab the wheel, and with a groaning, wide, ungainly sweep of the rudder, turn this country around as if our lives depended on it—because they do. The status quo brought us to this precipice. Trying to push through it with the same tools and old ideas will have deadly consequences. This pandemic has functioned as an X-ray of empire, and we can see clearly now what lies below late twentieth-century U.S. neoliberalism and the new robber-baron capitalism of the twenty-first. It is an architecture of brutality, pitched to produce forms of death and destruction from which none of us will emerge untouched.
While we have you...
...we need your help. Confronting the many challenges of COVID-19—from the medical to the economic, the social to the political—demands all the moral and deliberative clarity we can muster. In Thinking in a Pandemic, we’ve organized the latest arguments from doctors and epidemiologists, philosophers and economists, legal scholars and historians, activists and citizens, as they think not just through this moment but beyond it. While much remains uncertain, Boston Review’s responsibility to public reason is sure. That’s why you’ll never see a paywall or ads. It also means that we rely on you, our readers, for support. If you like what you read here, pledge your contribution to keep it free for everyone by making a tax-deductible donation.
March 27, 2020
19 Min read time