Comment by todds_ratio | Hacker News Reader

Comment by todds_ratio | Hacker News Reader

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I'm an epidemiologist, though not an infectious disease (ID) epidemiologist. I'm nowhere near the top of my field, and still fairly young, but I have good credentials and some idea of what I'm talking about (everyone is trained in ID epi in graduate school, regardless of what you go on to specialize in).

I don't have much to contribute here except to say that where I was once very proud of my profession and American public health more generally, the pandemic has left me deeply embarrassed, so much so that I often wish these days I had something else to say when people ask me what I do for a living. The stuff Lewis (who I don't particularly love, by the way) talks about is barely scratching the surface on how bad things are behind the curtain in US public health.

There are huge structural factors that are "not our fault" (e.g. the 70-year project to gut "government" at all levels in this country), but there are others that very much are, from scientific rigor to public communication to what happens when normally pretty powerless people are suddenly given some power, and what they do with it.

HN readers will not like to read this, and I fully expect plenty of downvotes on this burner account, but the fact that a man like Anthony Fauci was (a) chosen to be our Covid guardian angel and intelligent-technocrat foil to Donald Trump at all after his abhorrent behavior during the AIDS crisis in the 80s [1], and (b) allowed to remain in this position throughout the past year, as hundreds and hundreds of thousands of Americans have died of Covid, is ghastly. Even if the deaths are "not his fault" somehow, or that he's been trying his best in a bad system -- I'm sorry, but the buck stops at the top. If you're presiding over a disaster of this scale, you need to be replaced.

That a country like Vietnam - poor and rural - could embarrass the US in handling this is deeply sad.

[1] https://www.huffpost.com/entry/whitewashing-aids-history_b_4...

> e.g. the 70-year project to gut "government" at all levels in this country

And yet the government continues to expand in money, scope, and power at an incredible rate.

When I put government in scare-quotes, I was alluding to - quoting! - what this country's hard-right has always actually meant when they've used the word for said 70 years: they mean services! Human services, social services, the safety net, welfare assistance, and above all any shred of help for the poor, the uneducated, or the disabled.

Every American knows what the word means in the context of the project I'm talking about.

The expansion you're talking about is true, of course. It's just true of, say, the Pentagon, or the "intelligence community", or subsidies to [insert rapacious economic interest groups], or bailing out Wall Street, or the airlines, or the car companies, etc.

Here's what the history looks like over 50 years from 1962 to 2011, so not quite 70 years and a little out of date, but today's numbers would hurt your case even more: https://www.npr.org/sections/money/2012/05/14/152671813/50-y...

In the early 60s military spending was half the federal budget, today it is around 16%.

Social security was 13% of the budget in 1962, today it is 23%. Medicare did't exist in 1962, today it is 17% of the budget. Medicaid didn't exist in 1962, today it is 9% of the budget. Other safety net programs that did not exist in 1962 include CHIP, the ACA, the Earned Income Tax Credit, and the Child Tax Credit.

If there is a 70-year project to gut government it has been a massive failure, government spending has grown at the same rate as the economy. 70 years ago, the majority of the federal budget was military spending. About half the budget today is Social Security, Medicare, and Medicaid, without taking into account the dozens of other social service programs.

> The expansion you're talking about is true, of course. It's just true of, say, ...

It's also true of the welfare state, contrary to what you're dishonestly insinuating.

> any shred of help for the poor, the uneducated, or the disabled

You're dishonestly implying that government programs are the only form of aid, whereas the empirical evidence shows that private charity is much more cost effective.

https://www.philanthropyroundtable.org/almanac/article/fixin...

https://www.theadvocates.org/2013/06/effective-government-we...

https://www.cato.org/blog/welfare-private-charity

Just to provide an alternate 100% contradictory source to your claims: https://www.cbpp.org/research/romneys-charge-that-most-feder...

A note that one of the cited papers is from the "The Journal of Libertarian Studies" and the third link is to a blog on the Cato Institute's website.

Can you explain why you think this is a "100% contradictory source to my claims"?

> A note that...

By that logic, I'll note that your link is to the CBPP, a left-wing think tank.

That's false, or at least a major distortion. Social Security is about $1T, Medicare+Medicaid is about $1T, Defense is about $0.7T. (FY 2019).

The money IS going toward health, services, etc. It's just not widely reported that way because talking about the cost of these things is not popular.

https://www.cbo.gov/publication/56324

I can't upvote this enough. We HAD a plan, both Bush and Obama put together pandemic response plans. We had serious issues in logistics and deployment for sure. We had some screw-ups in early testing for sure. Maybe we should grant some margin for error when there's a lot of uncertainty early on, but after about March or so, the errors are on pure government failure. The CDC isn't solely responsible here, but it has been an embarrassment given the skills it should have had and claimed to have.

Again, you're rewriting history. https://www.politico.com/news/2020/05/04/joe-biden-contain-h...

Can you be specific to what you are referring to? I’m not sure what’s the point?

“‘Listen, we need to be aggressive early on this,’” Biden announced, according to Brennan.

The next week, Biden made good on his pledge — and set off a deluge of criticism. In an interview on NBC’s “Today,” Biden said he wouldn’t advise his family to fly on planes or ride the subway.

I am specifically saying that the pandemic plan you say was in place prior to Trump would not have been effective with COVID, as evidenced by the statements of those who implemented that plan before.

"It is purely a fortuity that this isn’t one of the great mass casualty events in American history,” Ron Klain, who was Biden’s chief of staff at the time, said of H1N1 in 2019. “It had nothing to do with us doing anything right. It just had to do with luck."

A couple other perhaps more useful quotes from the same article:

“Despite Trump’s assertions, few close observers of Obama’s and Biden’s response to H1N1 consider it a “full scale disaster.” And Biden, despite his early messaging problems, played a role in mobilizing the administration and ensuring enough resources were devoted to defeating the pandemic.”

And just some of the “lessons learned” section:

“ To keep Ebola from spreading further beyond Africa, the administration, which already had dispatched 3,000 troops to West Africa to help contain the spread, had to send public health workers to the affected countries via commercial airlines. This would not be dangerous unless a person was exposed to the blood or other bodily fluids of an Ebola victim. But pilots, passengers, airport workers and others in American cities from which the workers came and went had to be put at ease about the possible spread of the contagion.”

“Fauci was dispatched to cable news shows. Employing another lesson of the H1N1 days, Klain recruited the CDC's Frieden to join him in briefings to add medical credibility to the administration’s assertions.”

2009 may have been luck. They learned things, put together a plan, that plan was trashed by the new administration.

Perhaps not. How many times must someone lie to you before you stop believing them? And worse, shilling for them?

That’s a pretty disingenuous link. The Bush administration did have a plan for Flu and was thinking about the issue. In 2015 (your article recounts stories of H1N1 in 2009) the Obama administration established NSC level officials responsible for pandemic work, Trump disbanded it in 2018. Nobody knows whether those plans would have worked, but A plan is better than NO plan every time. Even so, president “inject detergent”, “liberate America”or whatever, may have screwed it all up. But no, it is not rewriting history to say there were plans that might have helped if implemented. We’ll never know due to institutional failure in part encouraged by the last administration.

https://jamanetwork.com/channels/health-forum/fullarticle/27...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1283304/

> That a country like Vietnam - poor and rural - could embarrass the US

They do have experience.

They do, but they learned from it. What probability would you give to the US learning anything from this crisis? Personally I would say between zero and snowball's chance in hell.

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