Commonwealth Fund Prescription for Public Health: More Federal Control

Public health officials have not covered themselves in glory over the 127 weeks since the Trump administration announced “Fifteen Days to Slow the Spread” in response to the outbreak of COVID-19. Some signed a letter declaring Black Lives Matter protests “vital to the national public health” while condemning anti-lockdown demonstrations as “rooted in white nationalism and run contrary to respect for Black lives.” Others appeared to tell “noble lies” about the effectiveness of masks and whether vaccinated persons needed to keep wearing them. Others allegedly transgressed the lockdowns, travel restrictions, and masking regimes they prescribed to the public.

Objectionable acts by public health officials combined with the social and economic effects of restrictions on public life unprecedented in scope and temporal extent in the United States led some states to lift the restrictions before federal public health officials—or even the Trump administration—thought they should. This led the prestige metropolitan press to denounce the “experiment in human sacrifice” in Georgia or to write that “In Florida, we love our beaches. Thanks to our governor, now we can die for them.” More seriously, teachers unions exploited a climate of fear to keep schools locked down well into 2021 with mask mandates persisting to this very day.

But some in the world of left-of-center health care policy think that state-level opposition, not federal overreach, was the problem. In response to the state-level patchwork and increasing distrust in public health officialdom, an outfit called the Commonwealth Fund convened a Commission on a National Public Health System with a cast of former officials from liberal Democratic and establishment Republican federal and state administrations to address administrative reforms for the next pandemic.

The Commission’s Report

In June, the Commonwealth Fund announced its supposed solution. For a group that last came to prominence bragging that it laid the groundwork for Obamacare, the answer is predictable: more federal control, including “the power to set minimum health standards for the states.”

The full report is what one would expect from an organization that was deeply involved in developing and promoting Obamacare and a panel that included the former FDA commissioner and former acting Assistant Health Secretary in the Obama administration; the president of the Guttmacher Institute, a pro-abortion research outlet; and health officials in the administrations of Democratic governors and mayors. (It also included George W. Bush’s former CDC director and former Texas Gov. Rick Perry’s health commissioner.) The report calls for more funding for public health, centralizing public health efforts in the U.S. Department of Health and Human Services, and encouraging ongoing collaboration among local, state, and federal health bureaucrats, among other things.

A Misreading of Mistrust

The report’s Section D, entitled “Public Health Agencies Should Work to Earn the Public’s Trust,” is the most revealing. The Commonwealth Fund commission acknowledges that trust in public health has fallen over the period of public health’s greatest exercise of coercive power over the population but proceeds to adopt left-progressivism’s just-so-story of why that happened.

After throat-clearing paragraphs acknowledging the history of unethical medical experiments on Black Americans in the antebellum and Jim Crow eras and the consequences for residual mistrust in Black communities, it proceeds to examine the more recent mistrust of public health authorities from “rural and conservative areas.”

Does the commission report acknowledge the hypocrisy of prominent public health officers in breaking mandates? No. Does the report concede that even creating the appearance of “noble lies” was wrong? No. Does the report admit that a blatant act of political favoritism with respect to permissions for breaking unprecedented restrictions undermined fundamental trust? No.

Instead, the Commonwealth Fund commission argued that it was “a tsunami of misinformation and, when shared with bad intent, disinformation” that led to the increased distrust.

A Question of Values

While the report calls for “creating conditions for ethics and integrity in public health activities,” the specific recommendations appear to target publicly accountable elected officials’ input and to give preference to unaccountable bureaucrats.

Decisions by elected officials like Gov. Brian Kemp (R-“human sacrifice”) and Gov. Ron DeSantis (R-“die for the beaches”) to ease lockdowns early, limit mask mandates, and prohibit vaccination passports made politicians’ authority to decline to enforce public health officials’ desired policies an obvious target for restrictionist activists. Even one-time restrictionist Leana Wen (former head of Planned Parenthood and a television commentator) fell into the crosshairs of a hard-restrictionist faction of public health activists for conceding that the eradication of COVID-19 is effectively impossible and that restrictions should now be lifted.

Wen’s journey from hard restrictionist to apostate illustrates what the Commonwealth Fund commission most clearly missed, at least in its report. The values of the public health community and substantial swathes of rural and conservative America are in irreconcilable conflict. The public health profession as it exists has an implicit code of values that holds physical health constrained by left-progressive politics to be the Highest Good (“fatphobia,” one of Wen’s alleged transgressions, may be a particular sticking point here). But the public, who are the ultimate fount of sovereignty in the American republic, have different values. This does not mean they are doctrinaire libertarians—lockdowns were initially popular—but it does mean that they take notice when unaccountable bureaucrats issuing unprecedented edicts behave hypocritically or give special sufferance to their political allies, whether Black Lives Matter demonstrators gathering despite “social distancing” orders or teachers unions lobbying to keep school policies restrictive despite other countries not doing so. They see health officials appearing to grant more deference to sexual license than religious observance or even children’s schooling or endorsing “harm reduction” in intravenous drug use after having removed the rims from outdoor basketball hoops during the pandemic.

Americans place other values above physical health constrained by left-progressive politics all the time. It should not be surprising that after weeks, months, and years of the most onerous restrictions placed on the general population in at least a generation, those whose values were most ruthlessly suppressed look askance at those whom C.S. Lewis might call “omnipotent moral busybodies.”