2021 (Unfortunately) Comes Full Circle—And Radicalizes Me in the Process

A system with (far) less government involvement would have produced better results.

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Dear Capitolisters,

I’d originally planned to do a “clip show” version of Capitolism this week, in which I—still technically on vacation—lazily listed some of my favorite or most popular/relevant columns (and charts!) from 2021. But the last couple weeks of holiday- and Omicron-related COVID-19 news have me thinking a lot about the question I asked back in January 2021: Would free(r) markets—i.e., minimal government regulation and subsidization, market pricing, free trade, etc.—have handled vaccine production, distribution, and uptake, and thus the pandemic, better than the U.S. government? As you’ll recall, even a hardcore free marketer like me was somewhat skeptical of a “pure” market approach, even noting some of the theoretical reasons why a top-down alternative may have been preferable. However, the last 12 months of U.S. public health bureaucracy boondoggles have increasingly radicalized (ha) me; now it seems clearer that a system with far (far) less government involvement, while surely messy and chaotic at times, would’ve produced far better results than what we’re experiencing today (which is, by the way, also quite messy and chaotic!).

Testing My Patience

Perhaps the biggest of these boondoggles still haunts us today: the continued regulatory blockade of—and executive branch errors regarding—at-home (“rapid”) COVID-19 tests. We discussed the testing situation at length back in September—noting then (1) the dearth of FDA-approved antigen tests (which are cheaper and faster than, and can be just as accurate as, lab-based “PCR” tests); (2) the numerous public health experts and economists begging the Biden administration to deregulate (lawfully) the process; and (3) the ominous-yet-obvious signs of avoidable future shortages. To be clear, I certainly wasn’t alone in making these arguments. Since then, the FDA has approved a few more rapid tests (still far fewer than European regulators, it must be noted), but—with the Omicron variant and holiday travel spiking U.S. demand—the testing situation here hasn’t improved and may have actually deteriorated. 

Numerous stories of high prices and short supplies seem to have pushed President Biden last week to promise yet another round of top-down, too-late, industrial policy-style fixes (Politico counted five such promises since January), while still seemingly ignoring the solution—helpfully summarized by Harvard’s Michael Mina in the following Twitter thread—that’s been staring us all in the face for more than a year now:

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  1. Avatar photo
    Ben Connelly

    Scott, you’ve got too much of a sunny disposition to really be radicalized. But the pandemic does it to all of us. There was a moment in spring of 2020 when I was ready to join Johnny Rotten as an anarchist…

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  2. Observer

    Amongst people who move fluids through pipes, it is a fact that placing a filter inline will restrict flow. The finer the filter's mesh is, the more pronounced the restriction will be. The CDC is the filter for medical fluids and tests. Biden has said from the beginning that he will follow the science, and the CDC is his science source for Covid 19. For me, I'll follow the direction of the Dr. Faucis of the world, flawed human beings though they may be before I listen to any of the professional bloviators.

    I do agree that testing is not what it should have been and that it is still quite inadequate. How much of that is because the resources were directed towards vaccination, instead, I do not know. Unfortunately, this article reviews only the surface of the issue when the devil is in the details. To become an informative piece rather than just being a sustained political whine, we need the details of the choke points within the filter. Lots and lots of details. Of course, we could really jack up output efficiency by eliminating the filter, and then we wouldn't need to waste time with any restrictions. Not sure that I'm ready to take that step with the likes of Theranos and Elizabeth Holmes running loose, though.

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      Ben Connelly

      Go back and read Scott’s September piece on the testing bottleneck where he provides much more detail. And if you really want to dive into the weeds, email him and he can probably give you some wonky policy papers. He was on vacation which is why this piece was a little less data-heavy than usual installments of the newsletter.

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      1. Observer

        I read the September article, and I agree with you that it contains the detail necessary to be considered thorough discussion of the subject. I also agree with the premise that the type of country that we are will make it extremely difficult to impossible to make the necessary corrections. We can't even get Republican office holders, in general, to address Trump's falsehoods for the lies that they are. Meanwhile, a significant segment of our population is refusing to get vaccinated. Can you imagine the frenzy that even a test that is off a few percentage points would cause amongst this group.

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    Patti Scriffiny

    I live in a red part of a blue state (CO) and government involvement has served to harden resolve to avoid compliance. There is a sincere belief that threats to personal liberty are dire and must be opposed, and that information shared from government sources is inherently suspect. It does not help when the official messages are contradictory or simply don’t reflect the reality where people are. Now we all cling to narratives and use any new information to strengthen them. Humility has been in short supply everywhere and we are paying for its absence.

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    1. Avatar photo
      C C Writer

      Two words: Folk libertarianism. Four words: We failed to educate..

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  4. Avatar photo
    Jen

    Yes to all of this. And yes to TD continuing to feature columns from Scott. 👍🏻

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    Mudskipper

    The fact that so many people distrust information coming from the government must give Scott and his fellows at the Cato Institute a quiet feeling of pride for a job well done.

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    1. Avatar photocircle-angle-nib
      Scott Lincicome vertical-nib Author

      https://imgflip.com/i/1u42s6

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    2. Avatar photo
      Jeff Walden

      😅😬😕

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  6. Avatar photo
    PC Albright

    There is much here to agree with but also much the other way. One statement that is simply false is that antigen tests are as accurate as PCR. Again, that is false, full stop. And when you compute Positive Predictive Value, given the prevalence of COVID, it gets much worse. The one case where things get at least somewhat comparable to PCR is when the patient is already very symptomatic (and so should be taking isolation actions anyway). Would expect better from someone who is otherwise so good at statistics. Also, my *anecdotal* experience is that mandates of federal contractors and S&L employees have been remarkable in their effectiveness. Mandates on schoolcildren have of course historically been very effective at controlling, eg, polio and measles. The statement that they decrease uptake of vaccine is seemingly speculative at best.

    All that being said, the FDA has always been very slow. It wasn't that long ago that they would not act based on PCR tests (cell cultures, which at best take 2 days, were the "gold standard"). The data on the effectiveness of the antivirals and vaccines has been compelling; approval took waaay to long.

    I do love the chart of the day, tho.

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    1. Avatar photocircle-angle-nib
      Scott Lincicome vertical-nib Author

      I recommend you read my September piece on antigen tests and the new scholarly research thereon.

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      1. Avatar photo
        PC Albright

        I did read the article then and just reread it. I am certainly not opposed to rapid testing but the fact remains that in terms of both sensitivity AND specificity antigen tests are not as good as PCR. It is certainly the case that if I take a series of tests the overall false positive rate will decrease but as the Mina article and others point out the key is "series of tests". It relies, for example, on someone receiving a false negative (e.g. with probability 1-specificity) to continue testing (and presumably use some rule, say 2 out of 3, to determine the result). Furthermore, the *key* value of testing in both the initial and end phases of an epidemic is for contact tracing, often performed by PH officials. There the key issue is sensitivity for a single test---you are tolerant of false positives but not of false negatives. I would also add that for antigen tests BOTH sensitivity and specificity depend heavily on viral load.

        My further issue with your article of course is the claim that government mandates significantly affect vaccine uptake; I would love to see someone actually do some research on that cause/effect claim; as some of your commenters have noted it is also possible that the government mandate serves as a rationalization for not wanting to take the vaccine. An interesting PhD thesis topic for someone. But the history of government vaccine mandates is very very positive (as I said, measles, polio, and I could add lots of others, including smallpox, which unusually for a vaccine *does* have significant side effects for some).

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    George.Skinner

    I think the challenge here is that the FDA has had no incentive to re-assess their processes for effectiveness, efficiency, and necessity. Their whole job is to prevent harm to the public; if people are harmed, they’ve failed. Denying approval to thalidomide in the ‘50s has provided a validation that’s become part of their institutional culture. However, it imposes costs and often may not be necessary. What’s needed here is a retrospective analysis of previous approvals to model what would’ve happened with streamlined approval protocols: would they have missed anything? Is there a realistic chance they could’ve missed something?

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      JeffQ

      I immediately wondered if the FDA’s foot dragging had anything to do with thalidomide, too. I wonder, too, if the poison Tylenol crisis also plays a part in the FDA’s maximum risk aversion. Not that the Tylenol crisis was the FDA’s fault, but it certainly highlighted the PR fallout when the public shows up at the headquarters door with pitchforks and torches.

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  8. Mrobertchase1

    This column seems like it could be an update of or sequel to Michael Lewis' The Premonition.

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  9. Mary Stine

    I really, really want to believe that less government intervention would be better. I truly do. But my background in growing up on a working farm, running a small business with my husband and dealing with the general public for over 40 years gives me great pause. Without any government intervention snake oil salesmen would still be selling dangerous medicine outright for use by pregnant mothers and small children. Now at least they are confined to the internet.
    I shudder to think what other dangerous drugs would have floated out into the market to "prevent" or "cure" Covid without the FDA as watchdog.
    And I have toothgrinding frustration with every person criticizing the FDA's slow procedures.
    You want faster approval? Try reinstating the number of scientists and workers fired or let go under nearly every administration. The gutting of the FDA has been going on for decades.
    I agree with Mr. Lincicome's rant on tests, however, I doubt that rests solely with the FDA or the CDC. Many states, such as Texas, actively discouraged tests and made ridiculous hurdles for even doctors to get tests for their patients. Things like: you only qualify for a test if you can prove you have a.) been out of the country and b.) you can prove your were exposed to someone who has been tested and shown to have Covid !!! I suspect test manufacturers here in the USA were opposed to foreign competition and were also fearful of selling enough production in red states, which actually wanted less testing.
    I don't see our Covid problems as largely the behavior of either the CDC or the FDA, two organizations largely gutted by the Trump administration prior to Covid.
    Our Covid problems are citizen related. Long before Trump, or Covid, a substantial number of Americans were encouraged, from both extremes, to distrust government, science, medical doctors and other experts. This was exaggerated by the rise of the Internet as the new source of all information. Americans began to believe they could find the truth about anything on the internet. And a slew of modern snake oil salesmen were happy to oblige. Who needs a family doctor, or a priest, or a counselor, or even a grocer or pharmacist, when the "real" truthtellers are available online, with "special" privileges and products!!
    Would fewer folks have died with more and better testing? Not the ones who didn't trust the tests and refused to take them, or believe them. What good would more tests have done when the hospitals were already full? What good were tests for the line workers in meat packing plants where managers refused to implement safety procedures or allow workers time off if sick?
    For the sane people, tests would have been a godsend in terms of early intervention and action.

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  10. Paul A Sand

    Flag on the play for unnecessary euphemism: When Scott says "less government involvement […] would’ve produced far better results", he should have said: "would've killed far fewer people."

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