Rich Opportunities for Public Accountability

The COVID-19 crises provided valuable lessons in federalism. It is the division between the federal government’s power and that of the states. The majority of COVID-19 policies directly affecting Americans weren’t made or enforced by Washington. They were made and enforced by state and local authorities. Federalism allows citizens and local officials to be held directly accountable for the actions taken or not taken in response to the pandemic.

Liberal academics and policy analysts claimed that federalism was actually hindering an effective response. They claimed that it led to fragmented and inconsistent policiesNoncompliance, inefficient usage of resources, a worsening economic and social inequalities, as well as unequal medical outcomes, especially for minority groups.

The alternative to federalism is a concentration in Washington. Critics of the left claim that a single point would be able to develop and enforce a coherent national strategy that is applicable to all states and localities. However, such unitary governance would lead to failure on the ground. Deborah Birx, former White House advisor, says: warned last month, “One size never fits all, and generic communication and generic guidance didn’t fit at all.”

Some states were more successful then others. But one thing is indisputable: Washington failed. The biggest failures in America’s response to the pandemic, detailed by the Government Accountability Office and others, were the failures of federal officials.

This list includes: A failure to effectively coordinate full federal response to the pandemic using the powers legally available to the national government; the deadly delay in developing and deploying effective diagnostic testing; the inability to provide complete and consistent data to the states and the public; their neglect of the National Strategic Stockpile and the shortages of medical equipment and supplies; the confusing messaging on masks and mask mandates; the attempts to impose an unwise and illegal federal vaccine mandate on the private sector, while downplaying the vital role of natural immunity; The fumbled production distribution of anti-viral therapeutics; the insistence on recommending educationally and emotionally damaging lockdowns that created even more health problems; the anti-intellectual response to legitimate scientific dissent; and the continuing failure to identify the origin and development of the coronavirus. 

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President Joe Biden made it right in December 2021 when he said: “There is no federal solution. This gets solved at the state level.”  This is correct, both as a matter of Constitutional law and as a practical matter. Plenary police power can only be exercised by the state, and not by the feds. to protect public health and safety.

As North Carolina University Professor Thomas Birkland, and his colleagues observe, “The very foundation of federal emergency policy in general is the idea that state and local governments are best positioned to respond to emergencies.” As Heritage Foundation analysts predicted, success in combatting the coronavirus was determined by the effectiveness of public health measures on the ground—in states, counties, and localities. (The Heritage Foundation’s news outlet, The Daily Signal.)

The often starkly different state and local conditions would require policymakers to respond in a different way.

 In practiceDemocratic officials were more likely than Republicans to impose lockdowns or stay at home orders. Republicans, however, were more likely pursue public health initiatives that preserve personal freedom and allow normal economic activity to continue.

This diversity of policy, reflecting genuine philosophical differences and the democratic diversity of the nation, is a feature, not a flaw, of the Founders’ federalist design. His American Commonwealth (1888), British political scientist Lord James Bryce observed:

Federalism allows people to experiment with legislation and administration that cannot be safely tested in a large centralized country. A small commonwealth, such as an American State, can easily make and unmake its laws. Mistakes are not serious because they are quickly corrected. Other States benefit from the experience of a law or method that has worked well or poorly in the State that tried it.

The most important COVID-19 metrics were casesloads, hospitalizations, and deaths. In 2021, initial comparative mortality data did not show a clear “red” state versus “blue state” pattern.  

Unfortunately, the politicization caused by the pandemic mirrors the spread of the virus from politicians to academia. Writing in the British Medical Journal, for example, researchers published a methodologically flawed study that associated county mortality with Republican voting patterns. Although rural counties do tend to vote Republican, it is not uncommon for them to do so. Birx told Congress, rural America is older, with more comorbidities, and had higher death rates “long before” the COVID-19 pandemic.

Many factors affect the incidence of viral infections and mortality rates, which are not dependent on public health policies. Factors such as demographics, urbanization and population density vary greatly from region to region, state to state, and locality to locality—and they can make a huge difference. You can take, for example, the following: comprehensive report for the National Bureau of Economic Research (NBER) concluded that COVID-19 mortality risk is mostly age-related; for those aged 85 and over, the risk was nearly 9,000 times higher than those aged 5-17.

Or consider the experience of America’s four largest states. The NBER researchers adjusted for age found that California had a COVID-19 death rate of 256.1 per 100,000 and Florida’s rate was 265.1. New York’s and Texas’ mortality rates were significantly higher (346.3) than Texas (399.2). While California and Florida had similar mortality rates, despite having different policies, both New York (346.3) and Texas (399.2) had significantly higher mortality rates. However, both New York City and Texas experienced poor outcomes in terms of mortality. 

However, when accounting for pandemic-related mortality the impact of some government policy measures complicates matters.  A major NBER was also mentioned. research study shows that “shelter in place” policies generally increased “excess” mortality.

The impact of state policies on total death is a great way to evaluate the responses of local and state authorities.  It also accounts for the wider effects of pandemic lockdown policy on health and death, such as delayed routine medical care, suicide risk, and higher drug- or alcohol-related deaths.

Considering these crucial and competing needs, a prudential policy would seek to balance the protection of public health with the need to preserve personal freedom and individuals’ livelihoods. California, Texas and Florida are excellent examples of policy analysis because they have large and diverse populations. COVID-19 cases

How did the approach of a “balanced” policy fare? California and New York followed more closely the guidance of Washington, particularly the CDC guidance, while Florida and Texas took more independent actions since the outbreak of the pandemic. The economic impact of the pandemic was measured. Kerpen, Mulligan and Moore showed that these four states, with varying policies, secured very  different results.

Despite the high COVID-19 caseloads of Florida and Texas, both states did well in mitigating economic damage from the pandemic. Florida achieved an unemployment measure of 2.1%, in contrast to New York’s rate of 5.6%. California’s peak unemployment rate reached 10.2% while Texas capped unemployment at 7.7%. Texas and Florida took steps to stop the decline in their gross domestic products (GDP). New York had the highest unemployment rate and the steepest decline in its GDP, among the four largest US states.

Children were generally not at risk for severe illness, hospitalizations or death from COVID-19. Many states and municipalities closed schools for extended periods of times or imposed severe restrictions regarding in-person education. The multiple costs of learning loss are now well-documented and should be brought to the attention of public officials. Loss of in-person learning was significantly higher in California and New York, than in Texas or Florida, among the four largest US states.

Congress should hold serious oversight hearings to evaluate the performance of federal agencies such as the Centers for Disease Control and Prevention and National Institutes of Health. State lawmakers should also take a look at how their public health agencies performed.

Federalism expands democratic freedoms and accountability. Citizens should take advantage. The data is growing. Let’s use this information to learn from this experience and to hold elected officials—at all levels of government—accountable.

Original publication by RealClear Health.

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