we're letting a man who works out in jeans wreak havoc on our public health
the american dream
I've decided to not make today about me, even though I will soon be taking a 16-hour trip back to the States without—still—a functional phone. Running on fumes and vibes. But I'm selfless like that. And few matters call for altruism more than the matter of public health. I mean, literally. It's a very easy altruism, to be fair, in the Mr. Rogers sense: it works best (and to our collective benefit) when we all care for each other.
I'm not an expert on public health, but I remember learning about risk pools my freshman (maybe sophomore?) year of college, back when the Affordable Care Act was in its infancy and detractors kept trying to argue the benefits of letting people opt out; that it was tyrannical, more or less, to make people have health care provided by the state. Much better, much more democratic, they posited, to allow those who wanted to fly solo to do so. Let them strike out on their own. The American way.
Of course, and this is not something I say gladly, but American individualism and public health are—alas!—frequently at odds with each other. You need other people. You can't simply pull a bootstrap and build a risk pool all on your own. One of those terms that we've probably always inherently understood but boy-is-it-helpful-to-put-a-name-to-it, risk pooling recognizes that calamities (personal, societal, national, etc.) do indeed happen but fortunately, they are (relatively) rare; as such, the more people participate in a pool (i.e. pay an insurance company to protect them in case of such calamities), the more affordable protection in the event of such calamities becomes. You are spreading out the risk among a large population, and the more varied and comprehensive the population the better, so as to avoid the concentration of risk factors.1
Spreading out risk of catastrophe within a more fulsome, comprehensive, and heterogenous population reduces the statistical likelihood of catastrophic events within the covered group, thus driving down the cost of insurance. It’s fairly basic math, if you can get over your fear of common sense and public goods.
The thing is: for risk pooling to work, to buy into it, we need to acknowledge that we live in a society. And that’s difficult for some people. See above, re individualism. Which is why the state is in charge of public health—it is both a benefit (e.g., with its tax-funded resources, the state finances research for the development of new treatments) and an obligation (e.g., some vaccines are mandatory). Personally, I would argue that most of the so-called obligations are benefits as well (specifically: my neighbors getting vaccinated means that I am at lower risk of illness myself; more generally: I prefer to live in a world where fewer people are sick because they can access preventative care, and in the event that people do become ill, they and their families are not financially ruined by said illness).
On the whole, I like knowing that fewer people are suffering.2
Depending on every individual to run through that cost-benefit analysis is not efficient, if we want to keep using economic/McKinseyan (not to be confused with Keynesian) terminology. Which is—not to belabor the point—why the state is usually in charge of utilities like water, electricity, infrastructure, education, defense, and, yes, public health.3 It is a recognition that a government is better positioned to regulate such things than individuals are—whether as chief negotiator with private companies, or as the provider itself.
People are self-interested, people are mis- or under-informed, and some people’s behavior is easily swayed by podcast hosts waxing poetically from their swivel chairs: should this have the power to significantly impact public health? Most of us, I think, would say no.
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(I will not get into the tragedy of the commons, but know that I am thinking about it.)
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We now find ourselves in the enviable position, though, of the nation’s health and human services being managed by a man whose facial topography alone is a public service announcement on the dangers of steroids. A man who is trying to gaslight us into changing the definition of a pull-up. A man who speaks with the easy elegance of an elderly pug struggling up a hill. A man intent on driving the athleisure industry out of business (or, possibly, into record-high profits) by donning jeans every time he engages in what passes for exercise in the worm-infested recesses of his brain.
This is what I wrote about RFK, Jr. last August:4
Forgive me for giving in to mild speculation, but do you understand how quiet I would be if God/Satan had seen fit to make me a Kennedy? You wouldn't hear a peep from me. Little Miss Does Her Job and Goes Home. And if I did, by some twist of poor judgment and a wide circle of frenemies, lean in to my genetic need for attention, I would go about it in much the same way Jack Schlossberg has — publicly deriding my unhinged cousin and using my ancestors' Wikipedia pages to become a sort of Internet court jester and fall into a Vogue byline (good for him btw, and I mean that).
It’s only gotten worse since then.
Last week, RFK fired/tried to fire CDC Director Susan Monarez, who, as a reminder, was nominated by President Trump earlier this year and confirmed by the Senate back in July.5 The Health Secretary’s reasons for her (attempted) ouster are unclear, other than not being “aligned with” Trump’s agenda and wanting to “change the institutional culture” at the CDC.
Sure! We can all agree: it was high time the CDC’s institutional culture became Joe Roganified. Enough with the disease control and prevention. I think this is really good news for all of us who’ve been wondering just how many new strains of chickenpox we can get going in the next couple years. Time to start mutating, babes!
Through her counsel, Monarez’s response:
When CDC Director Susan Monarez refused to rubber-stamp unscientific, reckless directives and fire dedicated public health experts she chose protecting the public over serving a political agenda. For that, she has been targeted. Dr. Monarez has neither resigned nor received notification from the White House that she has been fired, and as a person of integrity and devoted to science, she will not resign.
A few people who were none too pleased re Monarez’s [firing]? Her [former] colleagues. Resignations include: Dr. Debra Houry, the agency’s deputy director; Dr. Daniel Jernigan, head of the agency’s National Center for Emerging and Zoonotic Infectious Diseases; and Dr. Demetre Daskalakis, head of its National Center for Immunization and Respiratory Diseases.
In other words, it’s all looking up for the next pandemic. Things are looking stable.
And listen. Listen. I know we’re all looking at the Fed. The Jerome Powell and Lisa Cook of it all. The will they or won’t they [be fired]. I’m looking, too, having had ample time to read the news given the no phone/August depression of it all. The Fed is easy to pay attention to. Interest rates, as my econ professor was fond of insisting, are sexy. And I know we look at RFK in the sense of oh wow, car crash, I hope the brain worms are okay.
But man. This stuff—the firings, the loss of research grants, the funds, the protest resignations, the sheer amount of psychosis-inducing/induced doubt RFK and his buddies-in-denim are proffering regarding the safety of life-saving matters like vaccines … it’s causing irreversible damage, possibly more so than whatever will happen regarding monetary policy. Respectfully.
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Poverty, for instance, is a risk factor. When we allow folks to opt out of a public option health insurance, what ends up happening? Those with the capacity to pay for higher-quality insurance do so. When risk is pooled among an insured population whose health concerns are inherently and generally higher than the average population's (instead of being spread out), the insurance becomes more expensive as a result of the "catastrophic events" (e.g., cancer, diabetes, malnutrition) being more common within this more economically homogenous group. Tl;dr: The more large and varied a pool, the more spread out the risk.
There are exceptions, but honestly, with the fortnight I’ve had … I’m not risking it.
Arguably, the Internet should also be considered a public utility. Sorry to bring this up again, but as someone who’s been without a phone and as such without wifi/data for a week, I am ready to die on this hill.
Lest we forget, August is a diseased month that can only bring tragedy into our lives. The proof is in the headlines.
I say “tried” because Monarez is arguing that as an official whose role requires Senate confirmation—due to a legislative change in 2022, hers was the first confirmation vote in CDC history; they were previously appointed by the executive with no congressional voice—only the President, and not the Health Secretary, has the power to terminate her. This is not legal advice, literally do not sue me, I am already having a bad week and I will cry.
I’m Canadian I don’t even comprehend the difference between our (vs American) attitudes toward healthcare! Shouldn’t everyone have access to good affordable healthcare?
It finally hit me from the deep recesses of my brain- the line "He's Jersey. He skis in his jeans" from "Just Friends" which is a movie I do not recommend but for whatever reason that line has just stuck in my long term memory