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The Dismantled State Takes on a Pandemic

Conservatives won their war on Big Government. Their prize is a pandemic.

CDC Director Robert Redfield testifies before Congress on March 12. (Win McNamee/Getty Images)

Donald Trump’s televised address to the nation Wednesday night on the coronavirus pandemic failed just about every single test of political rhetoric. It neither reassured the American people nor did it inform them. The markets have continued their dismal tumble, and the White House took the extraordinary step of correcting (or, in Politico parlance, “walking back”) three separate untruths the president managed to deliver, despite seemingly sticking to his prepared remarks.

Not that anyone, at this stage, expected the president to rise to the occasion. It has become apparent that Trump and his staff view a pandemic as a messaging problem that threatens to become a liquidity crisis. The idea that they should have stepped in to contain the virus is as foreign to them as the idea that they now bear the primary responsibility for mitigating it.

Congressional testimony earlier this week featured an illuminating exchange between Representative Andy Harris, a Republican and medical doctor, and Robert Redfield, the director of the Centers for Disease Control and Prevention. Harris mainly wanted to use his time questioning the officials who were testifying before Congress to attack a Democratic proposal to lower drug costs for people on Medicare (Harris worries it would stifle “innovation” in the lucrative world of vaccine manufacturing) and to praise the superior ability of the private sector to handle such crises.

The problem, though, was that the private sector hasn’t yet done anything to slow down the virus. “Quest and LabCorp now are geared up to do [coronavirus tests],” Harris asked. “Could they have geared up sooner?”

“As a clinician like yourself,” Redfield said in his answer, “I guess I anticipated that the private sector would have engaged and helped develop it for the clinical side.” He finished his response with more bewilderment: “I can tell you, having lived through the last eight weeks, I would have loved the private sector to be fully engaged eight weeks ago.”

Here were two men wondering aloud why reality had failed to conform to their ideology. Where was the private sector, exactly, during these eight weeks? How odd that these companies, whose only responsibility is to their shareholders, had failed to make up for the incompetence of this administration.

Redfield seems to have been selected to run the CDC not only because he was a prominent virologist, which made him appear qualified for the job, but also because of his hard-line politics, which made him qualified to serve in this Republican administration. Even at the time of his appointment, a few experts tried to warn the administration that, as concerning as his dodgy politics were, his complete lack of experience in public health administration was even more disturbing. His politics, as it turns out, matter much more than his expertise when it comes to making a vital agency function.

Redfield wasn’t using his medical experience when he answered the question of whether the United States would be able to set up the sort of mass drive-through tests that South Korea has used to stem the spread of the virus; he was using his politics. “I think we’re trying to maintain the relationship between individuals and their health care providers,” he said.

It’s impossible to pin down precisely what led to that answer. Is it ignorance of most Americans’ relationship to the health care system? (A quarter of Americans have no primary care physician, and even among the insured, visits to primary care physicians have been declining for years, in large part due to costs.) Is it an ideological commitment to defending our for-profit health care system? Or is it merely the usual craven tendency of people in this administration to loudly assert into cameras that everything is fine? Soon, it won’t matter. The fantasy that everything is going to be fine is about to run up against an unavoidable reality. The only true answer to the question of when our government will be capable of responding to a pandemic with the vigor and efficiency of South Korea’s is “when we get around to building that government.”

Perhaps another Republican president would’ve handled this differently. President Marco Rubio likely wouldn’t have been so singularly focused on trying to make the TV say things are fine. But after two terms of George W. Bush and three years of President Trump, is there any reason for confidence that Rubio would’ve handled this significantly better?

This is how conservatives govern now, and even eight years of comparatively competent management by a liberal presidential administration was not enough to stem the larger trend of private negligence and public disinvestment. In its 2019 annual report on American public health funding, Trust for America’s Health calculated that “the CDC’s budget fell by 10 percent over the past decade (FY 2010–19), after adjusting for inflation.”

Many Americans seem to still believe we live in a country with functional institutions. Even as broadly defined “trust” in Congress and the government collapsed, this belief persisted: In 2017, with Trump in office, Pew still found that more than 60 percent of Americans believed the government did a good job “protecting the environment and responding to natural disasters.” Indeed, a lot of the conservative project of corrupting or starving government agencies depends on an almost touching belief in the resiliency of the institutions liberalism built in the twentieth century. Even the people dismantling the government probably believed, at some level, that the CDC could effectively address a massive public health crisis even though its new director was unqualified and its budget had declined for years. Despite its grip on power, the conservative movement cannot adapt to the circumstances created by its victory over the state. It didn’t occur to the right that a more terrifying series of words than “I’m from the government, and I’m here to help” would turn out to be “I’m from the government, and I guess I anticipated that the private sector would have engaged.”

There is perhaps only one competent and uncorrupted top-ranking official left in the federal government’s public health bureaucracy. The Department of Health and Human Services had its entire email system crash because the secretary is in a fight with the person who is ostensibly in charge of Medicare. The government added millions of masks and respirators to the Strategic National Stockpile in 2009, then forgot about them and forgot to buy more. Five million of the N95 respirators have expired.

In the absence of a functioning federal government, how the crisis plays out will depend in large part on whether you live in a well-managed state or a poorly managed one. In Minnesota, they are beginning curbside testing. California is dipping into its own emergency stockpile of surgical masks and respirators. The response may be less effective in, say, Texas, where, as Christopher Hooks writes in Texas Monthly, the state’s major public health agency worked out of an office full of rats and mold as recently as 2018.

These are all the predictable consequences of giving power to people whose only understanding of the role of government is to protect investment portfolios. A long boom market was seemingly enough to convince the people who check their 401(k) balances regularly that things were more or less fine; that, even if the guy in charge was a clown, the country was resilient and broadly functional. It turns out that, outside of its bloated military and management of the world’s reserve currency, the United States was barely a country at all.