The United States now has the highest number of cases of covid-19 in the world, outstripping both China and Italy. The first line of defense against the disease is testing. On this key metric, the U.S. experience has been a fiasco: We started late, using a faulty test, and never quite recovered.
Trump’s claim that “anybody that wants a test can get a test” is a cruel hoax. Access to tests remains much worse than in most advanced countries. His assertion that the United States has tested more people than South Korea is nonsense because it doesn’t take into account that South Korea has less than one-sixth America’s population. Per capita, South Korea has done five times more testing than the United States, as of Wednesday. But forget about South Korea. Italy, a country not known for the smooth workings of its government, has tested four times as many per capita as the United States.
The United States has shortages of everything — ventilators, masks, gloves, gowns — and no national emergency system to provide new supplies fast. New York Gov. Andrew M. Cuomo (D) says his state will need 40,000 beds for critical care. It has only 3,000. That means many patients will die simply because they lack access to care that is available under normal circumstances. Not even three weeks into this pandemic, health-care workers are reusing masks, sewing their own and pleading for donations. In a searing essay in the Atlantic, Ed Yong writes, “Rudderless, blindsided, lethargic, and uncoordinated, America has mishandled the COVID-19 crisis to a substantially worse degree than what every health expert I’ve spoken with had feared.”
Why did this happen? It’s easy to blame Trump, and the president has been inept from the start. But there is a much larger story behind this fiasco. The United States is paying the price today for decades of defunding government, politicizing independent agencies, fetishizing local control, and demeaning and disparaging government workers and bureaucrats.
This was not always how it was. America has historically prized limited but effective government. In Federalist 70, Alexander Hamilton wrote, “A government ill executed, whatever it may be in theory, must be, in practice, a bad government.” President Franklin D. Roosevelt created the modern federal bureaucracy, which was strikingly lean and efficient. In recent decades, as the scope of government has increased, the bureaucracy has been starved and made increasingly dysfunctional. In the 1950s, the percentage of federal civilian employees compared with total employment was above 5 percent. It has dropped to under 2 percent today, despite a population that is twice as large and a gross domestic product that is seven times higher (adjusting for inflation).
Federal agencies are understaffed but overburdened with mountains of regulations and politicized mandates and rules, giving officials little power and discretion. The Food and Drug Administration’s cumbersome rules and bureaucracy — which have proved a huge problem in this case — are just one example among hundreds. The scholar who has long studied this topic, Paul Light, notes that under President John F. Kennedy, the Cabinet departments had 17 “layers” of hierarchy. By the time Trump took office, there were a staggering 71 layers. Both political parties have contributed to the problem, making the federal government a caricature of bureaucratic inefficiency.
Most of these dysfunctions are replicated at the state and local levels with their own smaller agencies. The challenge of creating a national strategy is complicated by the reality that the true power in public health lies with 2,684 state, local and tribal systems, each jealously guarding its independence. We like to celebrate American federalism as the flourishing of local democracy. But this crazy patchwork quilt of authority is proving a nightmare when tackling an epidemic that knows no borders, and where any locality with a weak response will allow the infection to keep spreading elsewhere. What happens on Florida’s beaches doesn’t stay on Florida’s beaches.
It’s an easy cop-out to say the United States can’t mirror China’s dictatorship. The governments that are handling this pandemic effectively include democracies such as South Korea, Taiwan and Germany. Many of the best practices employed in places such as Singapore and Hong Kong are not tyrannical but smart — testing, contact tracing and isolation. But all these places have governments that are well-funded, efficient and responsive. In today’s world, with problems that spill across borders at lightning speed, “well executed government” is what makes a country truly exceptional.