Now that widespread vaccinations have started to ease the terror of COVID-19, it is time to look back on what we learned. Under the headlines is an important question: Have Americans suffered more than necessary under the nation’s federal system?
Unfortunately, the answer is yes: the federalism practiced in the United States was unhealthy. The coronavirus death rate in the United States ranks fifth among the largest nations in the worldbehind Italy and the United Kingdom, but well ahead of France, Sweden, Chile, Austria, South Africa and Russia.
The US went into the pandemic with a public health system and national health authorities that much of the world envied. The virus hit the American coast with a fair warning so there was an opportunity to prepare. And as the pandemic progressed, many of the worst coronavirus variants hit this country later than other countries, giving us an opportunity to learn from the experiences of others. But the virus has ravaged the country and undermined the excellent reputation of the country’s public health system.
In March 2020, Dr. Anthony Fauci, he expected the pandemic could kill 100,000 to 200,000 AmericansNumbers that looked stunning at the time. More than a year later, the number is approaching 600,000. The Lancet, the British medical journal, has been published an analysis Last February it was concluded that 40 percent of deaths would be preventable if the US had followed the same course as other major industrialized nations. Andrew Atkeson, a UCLA economist, argued that with better testing, masking, and social distancing, American deaths could have been kept to less than 300,000. Even the Trump administration’s coronavirus coordinator, Dr. Deborah Birx, completed that hundreds of thousands of deaths could have been prevented.
So it’s impossible to avoid the conclusion that America could have done much better in the fight against COVID-19. A bigger debate is whether American-style federalism was particularly to blame.
Among the federal systems, similar to our own, where powers are divided among the levels of government, the death rate was higher in Brazil, but the US ranked second, higher than Mexico, Germany, Switzerland and Australia. The death rate in the US was almost three times higher than that in Canada.
It would be a reasonable guess that, due to shared authority, federal systems are more struggling with COVID-19 than unitary systems, where central governments make most of the decisions. But this assumption does not work. Uniform systems such as that of the United Kingdom, France, Israel and Denmark did not show any significant differences in the pandemic. Even more central federal systems like India and Brazil did not perform better than more decentralized systems like Switzerland and the US
Americans suffered more from COVID-19 because the decentralized system of federalism simply failed to meet the challenge. Instead of asserting Washington’s authority, President Donald Trump chose to divert measures against the states. Governance varied widely, from states like Florida and Texas, whose governors had to be dragged into masking and social distancing, and who fought local shutdowns, to states like Washington and Oregon, who became national leaders after the first few weeks of the virus Toll. A look around the globe shows that the most successful nations were those with strong national hand control policies, with an equally strong commitment of local governments in partnership to national policy.
COVID-19 affected every part of the United States, but not all parts equally. It has proven itself six times more deadly in New Jersey, New York and Massachusetts than in Alaska, Vermont and Hawaii. As with so many other political issues, the likelihood of Americans dying from COVID-19 depended heavily on where they lived. Rhode Island’s death rate is similar to that of Arizona, and that of Maryland is almost the same as that of Kentucky. In between, Delaware is almost identical to Kansas. The data does not contain a red / blue status pattern.
Death rate from COVID-19 per 100,000 people as of May 21, 2021
But the variations frame a great mystery. Has the Trump administration’s aggressive efforts to push big decisions to states made the crisis worse, forcing so many states to keep reinventing the wheel, wasting valuable time and making more Americans suffer? Or did it help the country’s overall response because at least some states were able to break away from the others and put in place more aggressive pandemic control policies that also helped protect them from the inaction of the national government?
There is no doubt that some states and municipalities have used this flexibility to tremendous advantage. One of the hardest hit cities, Seattle, became a national model over time. In fact, if every local government and state had followed their example, the death toll would have halved and 300,000 Americans would still be alive today.
This is a powerful argument in support of Justice Louis Brandeis’ argument that states are laboratories of democracy. But in general, states have not shown very good laboratories at dealing with the pandemic. Writing about his own government’s response in Switzerland, Danny Buerkli, co-founder of a government reform laboratory, made a strong point that is even more true of the US: he wrote, “Experiment a lot” but “learn very little”. In the US, there was simply no mechanism for collecting nationally what the states and their cities were learning, and this hampered the American response. In fact, one of the most profound breakdowns in the United States was not even realizing that this was an essential question in dire need of a solid answer. This, in turn, weakened the national hand on the COVID-19 steering wheel and the ability of states to function as real laboratories.
The same challenges are now flowing into the Campaign to Vaccinate Americans, where big differences emerge again. There are large differences in income, class, and race in who is vaccinated, but there are others major socio-economic drivers also: States with a higher percentage of uninsured residents have a lower vaccination rate. The higher the proportion of residents with good internet access, the higher the vaccination rate. Both indicators reflect problems with access to health care in general, the registration process for vaccinations in particular, and greater inequalities in health care across the country.
This is the most fundamental problem with the American response to COVID-19. The country has massive inequalities, which COVID-19 demonstrated and, in turn, accelerated the pandemic. Federalism has proven to be detrimental to health, largely because it has helped widen the gap between health and belongings in American society.
The only way to reduce this national divide is to act nationally in close partnership with states. We are further away from it now than ever before. Not only does this threaten broader efforts to reduce inequality in the US, but it also prepares us for another fall when the next pandemic inevitably occurs.
Governing’s columns of opinion reflect the views of their authors, and not necessarily those of the editors or management of Governing.
