Public Choice and the Pandemic
For better or worse, the people will ultimately decide how to strike the balance of public safety and convenience.
Shocked by the large numbers of people congregating on California beaches, Governor Gavin Newsom recently decided to shut some of them down altogether. Large numbers of people then congregated at the beaches in protest, and the beaches have since been reopened, for exercise at least. Earlier this week, a top public-health official in Los Angeles announced that stay-at-home orders might be extended through the summer. An uproar ensued, and Mayor Eric Garcetti almost immediately walked backed the announcement.
Similar “orders” across the country are now prompting reactions like this tweet, which captures the situation facing public officials:
COVID-19 is an extremely dangerous virus. It will almost certainly be one of the top five leading causes of death in the United States this year, and may remain in the top five for years to come. But people are reaching the ends of their tethers with lockdowns. Amid the most massive job losses since the Great Depression, people sense that some draconian health measures aren’t worth the squeeze. Mass protests and noncompliance may be rare for now, and the lockdowns continue to enjoy substantial support in principle. But opinion varies widely from region to region and between rural and urban areas. As Scott Rasmussen has pointed out, a large majority of people think that every business that establishes safe social distancing should be allowed to reopen. Public officials struggling to find the right balance of health measures need to realize that the public will soon start making those choices for them.
Dr. Anthony Fauci has said that the virus will determine the timetable for reopening, but that simply cannot be true. Rates of infection, mortality, and immunity are of course crucial factors in getting the policy right, but the most crucial factor of all is public choice. It is people who will decide when to reopen, what safety measures are reasonable, and what risks — to themselves and others — are worth taking. Government officials face a difficult set of incentives. They are held responsible for the impacts of both the virus and the measures taken in response to it. Their interest in political survival will make them increasingly sensitive to popular sentiment. It is worth asking whether public opinion should have such a decisive impact on health policy. But it does, whether we like it or not.
The reason that many states’ highway speed limit is 65 mph is not that some transportation expert decided that is the ideal speed limit from a risk–benefit point of view. People simply won’t accept a lower speed limit on the interstate, even if it would save 20,000 lives a year. On the other hand, most people agree that driving 100 mph is excessively dangerous. The moral of the story is that people need and want a lot of things; balancing those priorities is what sets the bounds of “reasonableness.” And as it turns out, people think it’s perfectly reasonable to do lots of things that put both themselves and others at risk.
That is true in virtually every major category of preventable death and serious injury, including those in which one person’s activity entails significant risk for others. According to the Centers for Disease Control and Prevention, in 2017, a typical year, the third-leading cause of death in the U.S., and by far the leading cause of death for people under the age of 55, was “accidents.” Among accidents, the leading killers were drug overdoses, motor vehicles, alcohol, and firearms. In each case, preventive policies have been set not by experts but by public choice, often driven by priorities other than safety.
Among drugs, the leading killer is heroin, possession of which is a criminal offense. Many policy experts think that the War on Drugs is a bad policy because it entails social costs that cannot be justified by its meager benefits. But people are not willing to accept the legalization and regulation of such drugs, even if legalization might reduce both the risks to drug users and related externalities (such as ruined families and rampant crime). So the policy endures despite not yielding the hoped-for benefits. As former secretary of defense Donald Rumsfeld likes to say, public policies are usually judged by their intentions, not their results.
The second-leading cause of accidental death in 2017 was motor-vehicle accidents. Speed limits were long a matter of state law, but in the 1970s Congress enacted a national speed limit of 55 mph. Noncompliance was rampant, particularly in rural areas. The limit was raised to 65 mph in 1987, and in 1995 the law was repealed, returning the setting of speed limits to the states. Local preferences, based on regional variations, won out over a single national speed limit. Public-choice theory holds that, whereas unanimity entails prohibitive decision costs, simple majority rule maximizes the externality of people’s being forced to accept outcomes they do not want. This negative effect increases disproportionately with scale — a considerable downside of national majority rule.
The third-leading cause of accidental death was alcohol. In the 1920s, the U.S. tried prohibition, and the chief result was a stupendous increase in organized and violent crime. Today, moderate social drinking is a highly prized pastime. Most people accept the necessity of laws against drunk driving, but they aren’t willing to accept excessive restrictions on their use of alcohol even to save tens of thousands of lives a year, to say nothing of the countless lives and families ruined by alcoholism.
Society accepts the risk of serious injury, from a variety of common activities, even more readily. Consider the sporting events you take your children to. Every year in American there are about three million emergency-room visits by children and young adults with serious injuries from sports and recreation. Football and basketball are the most dangerous of these, accounting for tens of thousands of emergency-room visits each year, followed by bicycling, soccer, skateboarding, and playing at playgrounds. But sports are important in child development, particularly nowadays, so good parents routinely rope their kids into activities that are considerably more dangerous than Instagram and Fortnite.
COVID-19 has already killed more people in two months than died from influenza and pneumonia in all of 2017, when those illnesses were the eighth-leading cause of death. Of course, to prevent the flu, many people don’t take even the most minimal precautions, such as washing hands, covering mouths when coughing, staying home when sick, or getting flu shots. People sick with flu routinely go to work or school knowing that they will infect others.
Where conditions and attitudes vary greatly from one region to another, local choice maximizes the number of people who will wind up with the outcome they prefer. Of course, in a pandemic the problem of local choice is obvious: Infection spreads quickly from one jurisdiction to another, so loose public-health measures in any jurisdiction can endanger people everywhere. And yet, if a virus is pervasive, and the goal of public policy is to reduce the local risk of infection, then local choice is likely still the most attractive option — even in a pandemic.
Take bars and restaurants. It may be years before we fully go back to normal in that sector. When we do, people will likely keep up preventive practices, such as wearing masks (when not actually eating or drinking) and gloves, and washing their hands often. But to require social distancing in restaurants will have hugely disparate impacts from region to region. Such measures will entail dramatically higher costs for businesses where commercial rents are high, such as in New York City and San Francisco, compared with rural areas where space is plentiful and warmer areas where restaurants can offer more seating outdoors.
In New York City and San Francisco, restaurants have to be great to survive at all; even operating at nearly full capacity, they still struggle. In Manhattan, apartment floor plans have long assumed that people are largely outsourcing their kitchens and living rooms. “Social distancing” used to mean that the music was set just loud enough so that you could hear the person you were eating with but not the person inches away at the next table. If social distancing is enforced for bars and restaurants in places like New York City, the only establishments that will survive are those than can charge prices two or three times higher than currently. That would make bars and restaurants a rare luxury for the very rich.
Given a choice, many people who live in New York City are likely to prefer taking their chances with the virus over giving up the things that make living in New York City worthwhile. In coming weeks, communities all over the country are likely to start making similar choices. Officials need to start thinking of public choice not as an obstacle to good policy, but as the central driver of it. That puts a special premium on their role in ensuring that the public is as informed as possible.
Striking the right balance of safety and the resumption of normal activity depends on how countless individuals will seek to balance their own priorities. The government simply doesn’t have that information — which was Friedrich Hayek’s central observation about why socialism can’t work no matter how good the government’s planners are. That is why, as Dr. Joel Zinberg and I argued back in March, universally available testing for both the virus and antibodies is the key. The best response to the virus is the one in which individuals are making the most informed choices.
As they consider when and how to lift the COVID-19 quarantine, public officials should start tracking public opinion. The ultimate arbiter of how to strike the balance will be the public itself.
© 2020 National Review