David Cutler: evaluation

Transcript context

…What’s wrong with, say, the CDC? Their budget in real terms has gone up quite a bit. This morning — the day we’re recording — they issued a warning to Americans not to travel to Canada, which is literally insane. It’s the Biden administration now for some time. I’m broadly libertarian, skeptical about government — even I was shocked when that happened. What’s the model that explains how something like that can come about? There are two different types of things. Sometimes there’s just bad luck. For example, the CDC’s first tests for COVID got contaminated, and it took them a while to figure out what was the contamination, and stuff like that. There’s just bad luck. Then sometimes it’s systemic in that — an agency is falling apart, or it’s not sure about its mission or anything else, and then it’s a structural problem. One of the things — and I’m sure the libertarian in you wants to go there as well — is, I think, in general, it’s a bad idea where all of the public health of the country hangs on one agency so that if that agency has bad luck or bad leadership or just whatever happens, the power goes out, then nothing can happen. It’d be as if there were one hospital in Boston that could do cardiac surgery, and if the doctor was sick that day, “I’m sorry, we just can’t do cardiac surgery and emergencies that day.” I think in general, it’s just a bad idea when everything is stretched so thin that it’s hanging from a thread. I don’t know about how it’s functioning now. I haven’t done any looking or reading, but the agencies, all of the agencies of the public health system were so beaten down by the Trump administration that good people had left. It was difficult to do anything. They were just getting stigmatized, and they crawled into bunkers, and so on. It takes an enormous amount of time to recover from that sort of thing, so that there can be enormous lasting harm from even a few years or a few months of just completely awful policy. Take a given family — they’re thinking about the health tradeoff of moving to the suburbs. What would you advise them? What’s the main cost? What’s the main benefit?…

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