The conservatives who would sacrifice the elderly to save the economy
The public health response to COVID-19 is accelerating. France and Spain have adopted aggressive new restrictions on recreation, retail, and travel, as have five U.S. states and a number of localities, including New York City. As a consequence, the world economy is visibly and sharply contracting, with no bottom yet in sight.
Is the effort worth it? That might seem like a crazy question given the number of lives on the line — and since the depth and duration of the slump are difficult to assess until we know a lot more about the virus and how successful our efforts have been to combat it. If asymptomatic carriers prove to be non-contagious, the virus retreats naturally when the weather warms, and an effective vaccine comes on line before next winter, the death toll might not be worse than a bad flu season, and the economy would be expected to rebound very sharply by the third quarter. But all of those assumptions could still prove false. It may be impossible to meaningfully slow the spread of the virus without bringing the world economy to a standstill, and preventing renewed outbreaks may require restrictions on travel and other activities that last far beyond the next few weeks. In that case, surely no one will be debating whether we did too much, but whether we could have done more, sooner, to prevent the worst.
And yet they might — they already are. There's a strain of argument being voiced in certain quarters — most famously from Rick Santelli, who has since apologized for suggesting we infect everybody and get it over with — that the whole world's approach to the virus is misguided. Rather than limit the virus's spread, we should effectively encourage it — at least among the young and healthy — and focus on isolating the most vulnerable. Once the disease has spread very widely, "herd immunity" will inhibit transmission and prevent future outbreaks. Meanwhile, we shouldn't shut down our economies, but focus on keeping them up and running as fully as possible. Some people may die, but lots of people die from car accidents, and we don't shut the roads — and lots of people will die from the costs of an economic contraction as well.
This is the philosophy that underpins the U.K.'s initial response to the crisis, and for which it has come in for an avalanche of criticism. The reason is that the risks of failure are enormous, a fact that the government is belatedly acknowledging. It is far from easy to comprehensively isolate the most vulnerable populations — which include everyone over 70 at a minimum — for the length of time it would take for the disease to pass through 60-70 percent of the population, at which point herd immunity would kick in. And if isolation fails, then the death rate could spike massively. Meanwhile, it's not even possible to identify perfectly who the most vulnerable are. In France, it was reported Saturday, 50 percent of the cases in ICUs were under 60 years old. Even if the prospects of recovery are much better for that group than for older patients, that prospect dims considerably if the medical system is overwhelmed and can no longer provide adequate respiratory care. And that is certain to happen if the virus is allowed to spread uncontrolled through the population.
On a coldly economic level, though, one might still ask: so what? Let’s take the U.K. as an example, since they are the most prominent proponents of the “herd immunity” strategy. Say that nothing is done to halt the spread and attempts to isolate vulnerable populations like the elderly fail. The over-70 crowd is literally decimated by the virus: One in ten of the infected die. Say that for adults under 70, by contrast, the death rate is half a percent. By the time 60 percent of the population is infected, that would mean approximately 600,000 deaths across the U.K. That sounds awful — but given the concentration of casualties among the elderly, the excess death rate would surely be lower, as over 450,000 Britons over the age of 70 already die annually, and those most-likely to be felled by the virus are also those most likely to die of other causes. And these are hardly the economy's most productive citizens; the economic impact of them dying earlier might even be positive. Moreover, if the elderly were simply denied medical intervention for any reason and limited to the simplest forms of palliative care during the duration of the crisis, we could probably keep the medical system from being overwhelmed and provide adequate care for those capable of returning to productive work.
I hope nobody would be comfortable making an argument like that explicitly. But it lurks in the background of the all-purpose dismissiveness voiced by the likes of Rush Limbaugh and Sean Hannity about the seriousness of the virus (who are following the President’s lead in doing so), or in pieces like this one by Heather Macdonald at the conservative cultural journal The New Criterion. It is implicit more generally in any purely economic read on the crisis. The fact is that only a portion of modern health care is aimed at enhancing productivity; much of it aims at improving and lengthening the lives of those whose most productive years are largely behind them. If you don't have any non-economic reason for valuing those lives — like the value of their presence in the world to children, grandchildren, neighbors, and friends, or simply the inherent dignity of being human — then it is hard to argue for spending scarce resources on them in normal times, much less in times of crisis.
Of course, there is a point where lifeboat ethics come into play. Where resources are acutely scarce, triage becomes necessary. You treat those who are in acute need and with good prospects for recovery first; those with less acute need have to wait, and those with poorer prospects likely die. That's the position that Italy's doctors are in right now.
But a big part of what makes us civilized is that we seek not to live that way. We don't want doctors to have to decide minute to minute who is worth saving based on their potential value, and we don't want to tell our parents and grandparents that their potential value is too low for them to be worth saving. In that sense, the escalating scale of restrictions isn't just about saving lives, but about trying to preserve that sense of civilization, to preserve our ability to look at ourselves and say: We don't just let people die by the tens of thousands because saving them would be too expensive and inconvenient.
Of course, not everyone on the right has been blithe; Tucker Carlson deserves particular credit for pushing back against the dismissiveness of his colleagues. And there's been plenty of clueless incompetence on the left, with New York City Mayor Bill De Blasio earning particular opprobrium. But there’s something particularly odious about supposed conservatives mocking authorities, public and private, that are taking prudent action against a novel threat.
Which is why I was so galled by the tone of Macdonald's conclusion:
It is hard to imagine that the panicked leaders and populace of today would have been able to triumph in the last century's World Wars. America's colleges sent off thousands of their young men to fight and die in those wars; those students went off with conviction and courage. Currently, colleges and universities are shutting down with no hint of the virus in their vicinity. Would today's panicked leaders and populace be able to triumph in the face of a World War, or some other legitimately comparable threat? Let's hope that we do not have to find out. [The New Criterion]
Quite apart from the fact that countries like China and Israel — hardly countries noted for coddling their youth — have been far more aggressive in responding to the virus than America has been, the comparison is preposterous on its face. The college students coming home aren't afraid of the virus, and neither are their school's administrators. Nor are the staff of hotels and restaurants and other businesses being shut, for who knows how long. Willingly or unwillingly, they are making a sacrifice to fight a disease that is mostly coming for others. Perhaps that is misguided, though I hardly think so, but it is absurd to call it cowardice.
The opposed spirit, meanwhile, is exemplified by those crowding the bars and restaurants on their unexpected days off. These are the heroes, I guess, of those who scoff and sneer at the entirely reasoned and evidence-based efforts to fight the virus with every tool at our disposal.
Far from the spirit that won the war, theirs is the spirit of Vichy, that sees resistance as futile, and coolly prepares a sacrifice to Moloch to preserve its comfortable ease.
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