Yglesias goes on one of his "I'm not an expert, but here's how I would completely change a field that I'm not an expert in" bits. It's not clear exactly how much merit there is in this because - wait for it - I'm not an expert.
However, there are undoubted problems with America's health care system. I don't think this is a surprise to anyone. We focus a LOT on access to health insurance, because that's Problem Number One, but there are a bunch of other issues. Massive disruptions tend to generate new policy ideas, however, and it doesn't look like we are "building back better" when it comes to our public health institutions. After 2008, we passed a number of important financial services reforms, because we had an administration who wanted to make government and the economy work. So far in 2021, Biden has focused - wisely - on getting the economy back on track, because that's a playbook that has been run before.
On public health there are a number of issues, some of which Yglesias mentions. Our public health institutions are sclerotic; the virus is agile. As a result, we had the mask fiasco in March and April of 2020. Currently, he points out that it really seems like we should have a longer gap between vaccines. However, the evidence from this comes from other countries like Canada, so we pretend it doesn't exist. The FDA is a MUCH stricter regulatory agency than those in Europe. My guess is that the origins of the FDA at a time of patent medicines, means that their desire to be stringent is rooted in past practices. However, we have to acknowledge that the lobbying power of drug companies makes the idea that Pfizer is just pursuing profits plausible. We live with a regulatory regimen that is paralyzed by the ghost of thalidomide.
The other issue that Yglesias notes is rapid testing. Speaking from experience, the ability to test frequently and easily has <knock wood> kept Covid from rampaging through our school - a school with both dormitories that function as petri dishes and teenagers who think masks are chin straps. Combined with mandatory vaccinations, when we find someone who's Covid positive, we can rapidly track and trace and alter our behavior until more testing puts us in the clear. Right now, flu is the big illness on campus precisely because we don't test for it.
That we have regulatory barriers to at-home testing because we worry about false results is both understandable and nuts. False negatives are no worse than operating in the dark, which is our current status. False positives would be caught by follow up testing. If we tested large swaths of the population at random, we would do a much better job of tamping down this pandemic. If David Leonhardt is right, the FDA is the reason we do not have widespread, cheap testing kits.
That's inexcusable.
The issue with treatments is a good one, too. When I was hospitalized with Covid pneumonia, they gave me a rheumatoid arthritis drug. That was "experimental" but it sure seemed to work. Yglesias notes the success of an SSRI drug. One of the knock on problems of the ivermectin bullshit is that alternate treatments are also dragged through the guilt-by-association issue.
However, we can go beyond what Yglesias notes to more general issues.
We have a patchwork of public health agencies that communicate poorly or not at all. We have political whackaloons running public health agencies who have become anti-vaxxers because that's what their Tangerine God told them to do.
We have no global network for vaccination, despite the very real need. In fact, globally, we are still just as unprepared as we were in 2018.
Dr. Fauci has become the default national face of the pandemic response, but he's very old. Who steps into his shoes for the next pandemic - and there will be a next pandemic.
When 1929 or 2008 broke the world economy, we got a robust response following the old New Deal form of Relief, Recovery and Reform. The reforms coming out of the New Deal and the Obama Administration are really important to prevent economic cataclysms from returning to their 19th century regularity.
It does not appear we have anything close to a reform movement to prevent a repeat of the Covid pandemic in 15 years.
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