January 16, 2022 by Anders Ingemarson
[Admin note: SEPARATE! is back! After a year’s hiatus, the next few months will see updates to the antiquated (retro?) website look & feel and functionality. I’m also working on a 2nd expanded edition of Think Right or Wrong, Not Left or Right: A 21st Century Citizen Guide to be published this summer. In the meantime, I promise to continue the policy of not inundating your inbox/feeds, limiting post to about once a month.]
Throughout the Covid-19 pandemic, public health has come under criticism for its blunt and authoritarian pandemic response in the form of lockdowns, school closures, mask mandates, social distancing guidelines, and testing and vaccination protocols imposed at all levels of government. Add federal delays in authorizing tests, vaccines, and treatments and we’ve been facing massive individual rights-violating overreach, the critics say.
Conversely, segments of the population have argued that public health hasn’t been authoritarian enough, advocating more strict measures such as those implemented in New Zealand, Australia, and many Asian and European countries, and arguing for being more cautious with authorizing the use of tests, vaccines, and treatments.
The “public” in public health unavoidably means that the field is chronically rife with conflict between different interest groups trying to influence policy—teachers, parents, healthcare professionals, businesses, etc. Political divisions fuel the conflicts, and the conflicts strengthen those same political divisions resulting in a seemingly endless vicious cycle.
Recently, a number of articles have questioned the role of public health in addressing the pandemic, advocating for alternative solutions. A Wall Street Journal editorial makes the point that “With voluntary approaches, we get the benefit of millions of people around the world actively trying to solve problems and make our lives better.” And a The Dispatch article argues that “A system with (far) less government involvement would have produced better results.” And it’s not just punditry; over half of states have allegedly rolled back some public health powers during the pandemic.
So, what should be the role of public health? Should we ask ourselves not only if public health has overstepped its boundaries but, more fundamentally, if public health has a place in a society that respects individual rights? After all, blunt mandates and restrictions imposed over the past couple of years have amounted to massive rights violations by restricting people’s movements, crushing “non-essential” businesses, and limiting school attendance. If the answer is “public health should be abolished to respect individual rights,” what would society look like if pandemic and other “public” health measures were the responsibility of individuals, businesses, and non-governmental organizations? What would society look like without the CDC, the FDA, the NIH, and state and local health departments, and without the president, regulators, governors, and county and city officials having the power to impose restrictions? Would a pandemic devastate society? Would we descend into chaos? Would the population be radically decimated by disease due to the lack of government force: no government testing and tracing guidelines, no public social distancing and mask mandates, and no officials handing down vaccine guidelines and directives? Or would voluntary networks and best practices emerge outside of government to address such threats? Networks manned by many of the same brilliant, passionate and dedicated individuals—scientists, M.D’s, nurses, administrators and former officials—that are currently involved in public health efforts.
Depending on where you stand, getting the “public” out of public health may seem like either wishful thinking, or the end of the world, so let’s paint a picture of how it may play out:
One day, politicians, regulators and public officials across the land collectively threw up their hands and with one voice declared “sorry folks, we completely messed up the response to this pandemic thing; you’re on your own when the next one hits.”
Health insurance and healthcare executives immediately threw a fit and sent their hordes of lobbyists into action, realizing that suddenly they had a threat to their reputation and bottom line on their hands; if the government wouldn’t be involved in pandemic preparedness, they would be on the hook. But after facing steely-eyed, principled politicians and government officials around the country they realized that lobbying was to no avail this time around.
Initially, some health insurance executives contemplated excluding pandemic coverage from their policies as an easy way out, leading others to immediately see inclusion as an opportunity to take market share. Pretty quickly, exclusion was deemed bad for business industrywide. The same discussion took place in healthcare company board rooms with the same result: turning away infectious disease patients would not look good in the eyes of the customers, a.k.a. the patients and their loved ones.
So they went to work. A marketplace quickly evolved with a variety of health insurance options. Some companies’ policies included testing, mask wearing, and vaccination clauses, while others saw an opportunity to grow their business by excluding—for a higher premium—some or all such restrictions. Legal professionals recommended including quarantine requirements in case of known serious of deadly infections; knowingly exposing your fellow men to such an infection is objectively punishable by law as it violates their individual rights.
As a result, consumers were able to find a policy with pandemic coverage that fitted their budget and preferences. Some adjusted their views on testing, mask wearing and vaccines when evaluating the cost/benefits of the different offers, not unlike the process for evaluating most other things in life.
Healthcare companies pondered how to address the challenge of managing surges in hospitalizations, and as a result decided to significantly improve their disaster preparedness. Working with medical device manufacturers and other suppliers, they increased emergency inventory levels to not run out in the initial stages of the next pandemic. Together they also put plans in place for quickly ramping up production, if needed. And cooperating with the diagnostics industry and independent test certification organizations, they made plans to quickly develop, manufacture and distribute tests.
The disaster plans also addressed the need to quickly increase hospital capacity by striking deals with the lodging and other industries that would have excess capacity due to lower demand at the height of the pandemic. And in order to ensure sufficient staffing levels, they created a reserve of trained hospital workers who could be called up when needed. (The same steely-eyed and principled politicians and government officials that threw up their hands also decided to revoke all government healthcare licensing requirements, leaving it to the healthcare companies and non-governmental medical organizations to develop adequate staffing standards for pandemic responsiveness).
The health insurance and healthcare industry participants quickly realized that regardless of how much they prepared, a pandemic would be expensive and hit the bottom line; most likely all the costs could not be passed on to the consumer in the form of health insurance payments, deductibles and co-pays. With the government no longer footing the bill, something had to be done but what? They asked themselves “What can we do to prevent a pandemic from happening in the first place?” This brought about domestic and international cooperation not only between health insurance and healthcare companies but involving pharmaceutical and biotech companies as well. Together they scoured the earth for potential hotspots to nip the next pandemic in the bud, they worked with local communities to influence cultural habits (“How can we help remove bat and pangolin from your diet?”) and they invested in R&D, manufacturing, distribution and safety preparedness to shorten the time to market for new vaccines and treatments.
They sometimes had problems getting access to potential hotspots due to foreign governments’ unwillingness to cooperate. This was one area where the federal government agreed to help out by using diplomacy to facilitate access to the countries and regions in question.
Taken together, a diverse, nimble approach emerged unlike the one-size-fits-all (or none) monopolistic approach when governments were in charge. Different groups of domestic and international health insurance, healthcare, diagnostic, pharmaceutical and medical device providers took slightly different paths as there was an obvious element of the unknown involved. But this was a feature of the system, not a bug, because once the next pandemic hit, the chances were greater that someone had come close to the right solution, which they then could profit from by selling to the others. And over time, thanks to the preventive advances, pandemics became a thing of the past that you read about in the history books.
There you have it; a high level outline of an individual rights-respecting pandemic approach without the need for public health. Obviously, there would be thousands of details to address, challenges to overcome, and disagreements to iron out, just like when governments are in charge. And the transition away from public health would certainly have bumps in the road. But in the end, we would be in a place where individual rights are respected and protected; we would be free to follow our conscience and convictions, adjusting our views and behavior as new facts emerge, and make our own cost/benefit calculations: Get the jab or not? Wear a mask or not? Travel or not? Work for an employer that requires vaccination or not? Enroll my kid in a school that requires masks or not? As a result, preparing for and responding to pandemics would lose much of its political contentiousness; just like most of us don’t get worked up about our neighbor’s behavior when he catches the common cold, others’ course of action in a pandemic would rarely be a threat to us.
Many would say that this is an exercise in futility; public health, however unhealthy, is so entrenched in our lives that discussing alternatives is a waste of time. But without establishing and concretizing a vision for tomorrow—a healthy, individual rights-respecting pandemic approach instead of unhealthy rights-violating public health—we have little to guide our actions today. And we’ll continue to forever be mired in interest group and political warfare in the public square.