It’s not just health care that’s collapsing
The U.S. response to the Covid-19 pandemic shines a glaring light on the inadequacy of the U.S. health care system—so glaring that folks who have shrugged off the howls of critics for decades have been shocked to realize just how fragile it is. Bernie Sanders has been the highest-profile, most strident, and most consistent critic, but he has had a lot of company among progressives. and the pandemic is driving even some centrists into his “Medicare for All” camp.
The mounting crisis prompted David Himmelstein of the CUNY School of Public Health to observe, of a properly-run health care system’s response to a crisis, “You don’t see the results. It’s a dog that doesn’t bark.”*
What has saved the U.S. pandemic response from utter tragedy is the level of expertise and commitment among health professionals—doctors, nurses, nursing assistants, radiologists, lab technicians, and the like—highly educated and benefiting from leading edge research in medical science distributed among institutions throughout the country. Their sacrifices in battling Covid-19 have been heroic. But this cadre of health care professionals has to drag around the ball-and-chain of a system that is structured primarily not to promote health, but to make money for insurance companies who pry open every cranny in the structure to achieve private again. Many private hospitals and specialists also work hand-in-glove with insurance companies to drive up costs and fatten profits.
Of course this is not news. It entailed an extraordinary effort on the part of the Obama administration and Congress to correct some of the most flagrant abuses of the system and get us to within ten yards of the goal line of a properly run national health care system. The last ten yards call for yet more extraordinary efforts to obtain universal, unconditional, publicly financed health care similar to that of most of the most advanced nations on Earth—those who enjoy lower costs and better outcomes than the U.S. Most of all, it calls for the political will to prioritize public health over private interests. It needs to overcome entrenched forces who tout privatization as a blanket solution for social issues across the board—from health care to prisons to parks to schools.
How we fix health care is not the subject of this post. Health care is—well, you know, even beyond the comprehension of our Stable Genius of a President.
This post is to bring attention to other operations of government that quietly keep us safe from multiple threats to which we pay little, no, or only occasional attention—the things public guardians focus on as part of their everyday work lives, and for some keep them up at night. I am talking not just about terrorism or military attack. I’m talking about the threats and the programs to combat them that exist largely out of sight and out of mind. That’s until the dog barks—and in the case of Covid-19, barks furiously.
The “Fifth Risk” and our safety
The Fifth Risk is the title of a book by Michel Lewis which examines how government quietly maintains guardrails against dangers to the country in many forms.
What inspired Lewis’s book was his discovery that in the transition from the Obama to the Trump administration, the incoming bunch didn’t much care what the outgoing leaders and experts in their positions had to tell them. Trump appointees didn’t attend meetings, or bother to pay attention when they did attend. What’s more, many of the new officeholders—friends of the President, friends of friends of the President, relatives of friends of the President—were so inept that they wouldn’t know how to use what information they did get.
So Lewis got to work researching what the government does mainly behind the scenes crucial to the well-being of the public. (Think: pandemic preparedness group quietly waiting in the wings until it was axed by John Bolton).
As Lewis tells it, once you go behind the bland-seeming facade of bureaucracies that keep the most vital functions of government going, you are struck with appreciation for all those things it does to keep the dogs of calamity quiet. What the government constantly guards us from are, to name a few: accidents with nuclear weapons; crop losses from novel pathogens; attacks on the electrical grid; financial meltdowns; hurricanes and tsunamis; floods and droughts; collapsing bridges; collapsing dams; metastasizing internet worms; etc.
The term“Fifth Risk” is taken from an interview Lewis had with John MacWilliams, former Chief Risk Officer of the Department of Energy in the Obama administration. To summarize the risks recounted by MacWilliams under the watchful eye of the DOE, I quote from a review found on Amazon written by Mal Warwick:
Accidents with nuclear weapons and climate change top the list of five. They’re the first risk. The second and third are a potential attack by North Korea and the threat that Iran might develop a nuclear weapon now that Trump has pulled out of the Iran treaty. MacWilliams identifies the fourth as the fragility of our electrical grid. What, then, is the Fifth Risk? “Project management,'” MacWilliams says. To illustrate, he pointed Lewis to the decommissioned plutonium production facility at Hanford, Washington, which the author toured. There, a local official explained that “‘There are Fukushima-level events that could happen at any time.'”
Broadly, the “fifth risk” is the inability to manage a challenge that calls for experience in, and in-depth knowledge of, a field of expertise, as well as leadership skills. In the Obama administration, the outgoing DOE secretary was Ernest Moniz, a nuclear physicist who was head of the physics department at M.I.T., with a prior eight years as DOE undersecretary under Bill Clinton. To replace Moniz, Trump named Rick Perry, former governor of Texas with a degree in Animal Science from Texas A&M and no background in physics or nuclear weapons. Furthermore Perry, who happened also to be a Climate Change denier, had wanted to do away with the Department of Energy, then famously failed in a Presidential debate even to remember the name of the very department he wanted to eliminate (leading to the nationally-televised “oops” which dashed his Presidential aspirations**).
Rick Perry’s almost complete lack of credentials epitomizes the incompetence of officials named to key government positions in Trump’s administration. (Those who even get named as distinguished from just letting key positions go unfilled.) As with Perry, so with Trump hangers-on and campaign funders appointed to other departments, and so with active measures taken to hollow out the domains of government experts in, for example, the EPA and the Agriculture Department.
Trump the “trust-destroying machine”
In an interview with Roge Karma of Vox conducted this past April, Lewis characterized Trump as a “trust-destroying machine:”
He’s undermined trust in the media, in the electoral process, in the judiciary, in science. He undermines trust everywhere he turns.
So I’ve been asking myself: What critical trust that holds a society together is still more or less intact that he could undermine? And what comes to mind is the trust in the Federal Reserve and the Treasury — essentially the credit worthiness of the United States. Both in the financial crisis and now, the Fed is able to step in and act as the financial parent in the room when everything else is in doubt. The minute we lose that, the minute the world ceases to trust our government financial institutions, is the minute we lose our ability to touch bottom on any kind of crisis. I think Trump is perfectly capable of undermining that trust. And I can think of several ways in which he would do it.
That’s the thing I worry about with him most because I think it’s his instinct. He gropes for these trusted relationships and seeks to disrupt them. And he does so, I think, for a very simple reason: He knows that in a world with trust, he’s at a disadvantage because he’s not trustworthy. But if he manages to make everybody untrustworthy, he’s on a kind of level playing field. That’s the thing I worry about.
Trump’s trust-destroying proclivities dominated his response to Covid 19: spouting absurdities about cures and treatments (bringing light inside the body; injecting or swallowing bleach, etc.); encouraging staff to undermine Anthony Fauci; sidelining the CDC; forcing Deborah Birx to convey hollow optimism about bringing the virus under control without a nationally coordinated effort.
Distrust in the problem-solving capabilities of government, however, hardly began with Donald Trump. It has been a cornerstone of conservative ideology going back to the 19th Century, pithily expressed in Ronald Reagan’s 1980 inaugural pronouncement that “government is not the solution to our problem; government is the problem.”
If you are tired of my hammering repeatedly on this perverse maxim of the conservative creed in earlier posts, you have to concede that its poison still drips through the veins of today’s conservatives . . . not just among populists idolizing Trump, but also among self-righteous “never-Trumpers” who loathe the man personally and are sickened by his overt racism, xenophobia, autocratic leanings, crudity, ignorance, impulsiveness, and narcissism. They may not like Trump the man. What they have liked is his embrace of the plutocracy, and the wrecking ball he has taken to programs that elevate the common good. Such as: Programs to maintain the social safety net, to promote universal health care, to narrow the wealth gap, to protect the environment, to heal racial divisions, to treat immigrants with fairness and respect, to take in asylum seekers from other countries, to require a living minimum wage and recover worker protections that have eroded over the last 40 years, and to rein in the wealth and power of corporations and the military-industrial complex.
(It does say something about the extreme toxicity of Donald Trump that some prominent conservatives are working to prevent his reelection, even as it risks a potential Blue sweep of the national legislature which could lead to unwelcome liberal laws.)
Without Reaganism and its legacy carried on by Newt Gingrich, Paul Ryan, the Tea Party, Mitch McConnell, a panoply of libertarians, and so many others who have ridden the anti-government tide, you would not have the presidency of Donald Trump and its enablers. Trump’s predecessors sowed the seeds of a dehumanizing system that the coronavirus Sars-Cov-2 has gruesomely exploited.
Trump may be a “trust-destroying machine,” but the machine is merely the most flagrant manifestation of a trend that has been gathering momentum since 1980, paused briefly but not reversed in the Obama presidency.
Michael Lewis points out in the video below that the difference between Trump and other champions of the Reagan legacy is “the degree of malice and neglect” that has never been seen before.
FINAL WORDS: MICHAEL LEWIS ON TRUMP AND THE FIFTH RISK: A BRIEF INTERVIEW WITH JIM BRAUDE:
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* In Washington Post, July 19: “The Crisis that Shocked the World”
** To Perry’s credit, at least he boasted the experience of chief executive of a large state, in contrast to Trump’s serial bankruptcies in a relatively minor real-estate businesses. It’s virtually certain that Trump himself had little idea of what DOE did, except giving subsidies to fossil fuel companies, for which Perry was a very eager collaborator.