When health bureaucrats take the wheel, other vital social goods get ignored, warns Carl Schramm—a specialist in the field, and former president of the Ewing Marion Kauffman Foundation.
Philanthropy: As an economist, how are you understanding this pandemic?
Schramm: In addition to being an economist I taught in the School of Public Health at Johns Hopkins University for 16 years. And I wrote an article for Foreign Affairs after we invaded Iraq laying out a framework on how to restart an economy after a war or disaster. So I’m interested in the intersection between epidemiology, crises, and economics.
The best work being done today on economics and epidemiology is by Jay Bhattacharya of Stanford. Note that he has made completely different forecasts for COVID cases than the public-health team at the University of Washington that has attracted so much media attention. I watched the leader from U.W. on TV last night. He’s purely a public-health guy. Bhattacharya has both a medical M.D. and a Ph.D. in economics, and he has a much more sober approach.
It annoys me to watch Dr. Fauci, whom for most of my life I have admired, announce from the President’s podium that the economy is not ready to open yet. Not until we have complete control of the virus. That’s a tradeoff he’s totally incapable of deciding—he’s likely spent little time thinking about opportunity costs or cost versus benefit.
I’m influenced by the scholarship of Henry Sigerist. He was a Hopkins professor in the World War II era, and he came to the view that if you want to improve the health of a population, the best thing you can do is increase personal disposable income. You don’t build hospitals. You don’t train more doctors. You don’t build public-health schools. You find ways to help people earn disposable personal income. He’s still absolutely right. Perhaps if Dr. Fauci had internalized Sigerist, he would be vastly more humble in his staccato declarations about the economy.
We’re going to have GDP declines and unemployment at Depression rates in another quarter. Capital investment is collapsing. Over time, the more subtle issue will be the decay of job skills. These developments will hurt America, including our health, in many, many ways.
Philanthropy: How could philanthropy improve our public-health infrastructure?
Schramm: Embedded in the U.S. Centers for Disease Control, the World Health Organization, and virtually every public-health school in the United States, is a political perspective, one that is sympathetic to ever larger government. And, the public-health establishment is deeply bureaucratic and very cosmopolitan. If you work in one of these bureaucracies, you go to lavish meetings to talk about things. It’s nice to get fly to Geneva and spend days hob-nobbing with your peers, all distinguished world leaders. And you come away thinking you’ve just dedicated five days of your life to the improvement of humanity.
But these kinds of meeting seldom really improve the world. We need a revolution in the public-health establishment. Let’s start with practical data. If you go to the WHO, or the CDC, and you try to get statistics comparing COVID to SARS, Ebola, Lyme disease, anything, there’s no uniform template. That’s shocking.
Economists struggle to create uniform data sets so we can make sense of the world. We need to understand this current virus in equivalent, long-term views: incidence levels, death rates, virulence, and so forth. The public-health people don’t have reliable templates for measuring those kinds of things. We need improvements like that.
The last thing I would counsel a wealthy person to do is give money to the local public-health school. All you’re doing is feeding the beast. There will be no reform. There will be nothing different.
If we quit the World Health Organization, there would be enormous pressure from the entire public-health establishment to re-join, to give it tons of money all over again. What’s really required is a different perspective. Perhaps a different discipline.
Let me acknowledge that economics is itself in trouble today as an academic discipline. On campuses there are dangerous strains in many intellectual fields. Yet compared to public health, economics has far more theoretical discipline.
There needs to be a marriage between public health and growth economics. Not “international development” economics (a field with many of the same problems as public health), but rather growth economics.
Somebody with half a billion dollars might consider funding a new, cold start, public-health school. And frame it as a school for maximizing public health and economic improvement married together. Because a society growing at 4 percent as opposed to 2 percent will ultimately become twice as wealthy—which, going back to Sigerist, we know will correlate with much more health and longer life. Economics ought to have much more influence over public-health issues.
Economic emphasis is also needed to understand sub-problems. The headlines in the New York Times and the Baltimore Sun from the last three days trumpet, “Blacks are hardest hit” by COVID. That’s the kind of alarmist story that media outlets have promulgated enthusiastically during this emergency. But it’s really not race. It’s income differentials and related co-morbidities that are relevant to coronavirus rates.
Public-health folks are happy to fan those kinds of worries, though, because they generate more money for health sociology.
Philanthropy: What are you noticing about hospitals?
Schramm: There’s a lot of hospital space we don’t need. People are not dying left and right from COVID. There are currently only 110 beds in the Johns Hopkins Hospital with COVID patients in them—in an 1,100-bed hospital. Responding to what the public-health bureaucrats told them, the city officials took over its vast convention center and converted it into a COVID hospital five weeks ago. Not a single soul has been admitted. Insanity. It all goes back to the issue of how horrible the estimates were out of the public-health establishment.
Philanthropy: Where are you during this lockdown?
Schramm: I’m at our farm, so any time my wife or I get antsy, we’ve got plenty of places to go walk. Which is healthy in an epidemic, something we need more of. Our country is doing some really dumb things in this lockdown, like keeping people out of parks. It’s ridiculous when cops are out arresting people sitting by themselves on a beach. It’s just plain nuts.