How did we get here?

This is Joseph

From public comments by the president of the University of Washington:

As doctors, nurses, health professionals and researchers save lives threatened by the coronavirus, academic medical centers and their affiliated public hospitals and clinics on the front lines of this fight have been among the hardest hit financially. Unfortunately, UW Medicine is not immune. As you may have read, even as it has led our state and country in responding to the coronavirus – tracking its spread, treating those who fall ill and researching new treatments – UW Medicine is projecting a loss of more than $500 million by the end of this summer. While we continue to pursue federal and state emergency funding to support this critical work, without urgent mitigation efforts this shortfall jeopardizes our ongoing mission to improve the health of the public.

On Monday, UW Medicine CEO Dr. Paul Ramsey outlined the steps being taken to protect UW Medicine’s hospitals’ and clinics’ ability to care for patients. These will include temporary furloughs and reduced hours and compensation for staff, with the goal of minimizing the number of permanent layoffs that are needed. As a reminder, furloughs are temporary and allow employees to keep their benefits, including health insurance. Leaders at UW Medicine are voluntarily contributing part of their own salaries back to the University in light of these extraordinary circumstances, as are Provost Richards and I and many other UW leaders across our three campuses.

This is a consequence of ideology. Medical costs are not well aligned with free markets and, as a result, when there is an unexpected medical crisis it is actually causing the medical infrastructure to begin to fail. You will notice the exact opposite of "raise the line" to the point where using it in the US context seems disingenuous, as health system capacity is dropping and not rising.

I think this ideology is also showing up in the medical supply chain. The decision to off-shore the production of reagents for medical testing left the supply chain vulnerable when the primary exporter was the first country hit by the pandemic.   Similarly, fee trade with China ended up costing many jobs and is likely a source of discontent among those who suffered through this experience. It is fine to say that it is too late to get these jobs back now -- it likely is. Nah smith notes:

The authors suggest that real-world economies may simply be much worse at adjusting to big changes than most economic models assume. It is expensive and time-consuming for workers to train for new jobs and to move to new locations. It also takes time and money for businesses to figure out how to change their business models in response to the new landscape presented by a global economy with China in it. These adjustment costs might overwhelm the gains from trade.

In other words, it is probably a very good time to consider the costs of the economic choices that we are making. Now, please do not straw person this -- one can decide that the direction of change is misguided without calling for a socialist revolt.

But maybe the real lesson here is one of institutional strength and the building in of resilience. The love of silicon valley tech is  the love of the "fails easily but moves fast and reduces cost" model. It just happens to be a dangerous approach to pandemic mitigation.