The Power of Unexpected Events

Newsweek reminds us why Harold Macmillan was one of our favorite forgotten politicians - he summed up vast ideas in short, pithy sentences:

When Harold Macmillan became Britain's prime minister, he was asked what would determine his government's course. He replied with Edwardian languor: "Events, dear boy, events." As he well knew. An event--the 1956 Suez debacle--had catapulted him into 10 Downing Street. An event--the sex-and-spies Profumo scandal--would grease the skids under him in 1963.

He described a major part of any government's job - responding intelligently and effectively to unexpected events.

The new disease originally known as the "Wuhan virus", since re-branded as COVID-19 to enhance political correctness, is just such an "event."  As the virus spreads all over the world, it will act as a "stress test" of every health care system, every government agency, every leader possessed of a bully pulpit large or small, every supply chain, and just about everything else.  As the "Spanish Flu" epidemic of 1918 had different outcomes as communities handled it in different ways, this virus will generate a great deal of information about how different models of health care and governance perform under stress.

We've discussed health care from many different points of view.  Nobody knows how the numbers for COVID-19 will ultimately turn out because it's such a new virus and because different places handle it in different ways.  We can't confidently assert that one form of organizing national health systems will show itself to be better than all the others, but the data are suggestive enough that we can confidently state a preliminary conclusion: Democrats' "Medicare for all" is a bad idea and the virus proves it.

Britain, Brexit, and the National Health Service

The British ruling elites spent the last three years trying to frustrate the voters' desire that their nation leave the European Union.  Individual members of all our highly-mobile high-status global "one world" elites base their status on political power, wealth, ability, credentials, and connections.  They travel in private jets or in first-class commercial flights funded by taxpayers.  They stay in the same high-priced luxury hotels and hobnob with one another at exclusive watering holes such as Davos.

They have almost no connection to people anchored in one place, who don't travel as much, and who want to keep their home village culture as it is without being swamped by immigrants.  Of course, the only contact our elites have with immigrants of a lower class is as servants on their estates; their kids won't be sharing underfunded classrooms with disease-ridden illiterates.

In England as in America, the ordinary voter is not so lucky.  Brexit was about many things, but first and foremost it was a demand to slam the door on mass immigration from pretty much anywhere - the exact opposite of the desires of the elites, who want ever more minions to lord it over and to vote for more government power and spending.

After the Brexit vote, the British globalist elites did their very best to stay in Europe so they could keep playing on the wider European stage.  One of their most common claims was that Brexit would trash the British economy, just as American elites predicted economic disaster from a Trump administration.  Finally, Boris Johnson campaigned on "Get Brexit Done" despite the threats and warnings,  won a majority, and made it happen.

In the scant few months since Brexit became final, the British economy has not noticeably collapsed.  Not to worry: secure in the knowledge that no economy lasts forever, the elites simply bided their time, waiting for the inevitable downturn which they could blame on Brexit and those stupid rubes who voted for it.

Thus, the virus came along at a perfect time for Mr. Johnson: it brought enough economic disruption to swamp any Brexit effects.  Even the corrupt elites and media don't dare attempt to blame Mr. Johnson for the virus, so neither he nor Brexit are being blamed for economic problems.  By the time the virus has passed, the economy has recovered, and then it falters again - as it inevitably will - there will be far too much water under the bridge for any Brexit-related accusations to be remotely plausible.

COVID-19 is putting a great deal of strain on the National Health Service, however.  The high cost of private health services such as are enjoyed by British royals and high-end politicians serve so few people that one can regard the NHS as an implementation of the Democrat's beloved "Medicare for all" where the government funds and controls essentially all health services received by ordinary people.

Way back on Feb. 15, the Telegraph told us that British health officials expected to tell anyone with flu symptoms to "self isolate" instead of coming to a hospital if the virus got out into the general population.  This was because the NHS hadn't recovered from its annual flu collapse.  The Wall Street Journal notes that:

As of December, only 80% of emergency-room patients were treated within four hours of arrival, down from 84% in the depths of the previous two winters.

In other words, after centuries of experience with British winters, the British medical establishment still cannot really handle the flu patients that show up as regular as clockwork every year when it gets cold.  Adding a spike of COVID-19 patients would overwhelm the NHS that's already back on its heels, same as this time last year and the year before.  We expect Democrats to keep pushing for universal Medicare in spite of this dash of reality brought to us by the virus.

Italy

We know that the NHS could be overwhelmed by COVID-19 patients because that's already happened in Italy - a place which has rather milder winters than Old Blighty but seems just as unable to handle what it does get.  Although Italian doctors and other hospital workers know how to care for COVID-19 patients, they lack the resources to do what they've been trained to do.

The Organization for Economic Cooperation and Development gathers statistics on health care systems.  Italy had 2.62 acute-care hospital beds per 1,000 residents as of 2016. In Germany it's 6.06 and in France and the Netherlands it's 3.15 and 3 respectively.  That year, Italy devoted around $913 per capita to inpatient acute and rehabilitative care, compared with $1,338 in France, $1,506 in Germany, and $1,732 in the U.S.

Although economies grow and shrink over time, there are only so many resources available in any given year.  A dollar spent providing hospital beds that aren't always needed is a dollar not spent on old age pensions or education.  We see from the NHS' declining ability to treat normal flu patients that having hospital capacity sized to "normal" needs doesn't always work.  The Italian experience shows that sizing for "normal" can be catastrophic when a new disease causes a sudden surge in the need for acute care.

The New York Times told us that the Italian health care system, once ranked second-best health-care system in the world by the World Health Organization, is collapsing under the epidemic:

"The mayor of one town complained that doctors were forced to decide not to treat the very old, leaving them to die. In another town, patients with corona virus-caused pneumonia were being sent home. Elsewhere, a nurse collapsed with her mask on, her photograph becoming a symbol of overwhelmed medical staff."

Italian patients are being denied essential treatments.  The WSJ discussed Francesca Mangiatordi, a doctor in the Italian city of Cremona:

... as dozens of new cases poured in, the emergency-room doctor has been faced with heart-rending choices, such as how to allocate scarce oxygen supplies among critically ill patients.

"These are the choices I would have never wanted to make," she said. "It's somewhat like being in war."

The BBC reports that Italian patients are being housed in tents and warehouses.  Given their limitations on health care facilities - the WSJ notes that in Italy, "exhausted (and sometimes sick) doctors and nurses can't even muster the energy to throw up their hands in despair" - one can argue that the Italian's draconian quarantine is appropriate.

Quarantine won't keep the virus from spreading throughout the country, but Vox published a diagram which shows how quarantine will slow its spread.  This will both delay and reduce the peak strain on hospitals and doctors.  To the extent that spreading the peak means that more patients will receive life-saving treatment than could otherwise be treated, the quarantine will save lives.

The economic costs of the quarantine remain to be totaled.  Once numbers are available, the quarantine may or may not have been worth it, depending on the value one places on the extra lives saved among older people, most of whom no longer pay income taxes and would have died soon regardless of the virus.

Iran

Thus far, this virus seems to spare young people; most casualties are 60 and over.  Most of the Iranian leadership is the same age as Joe Biden or even older than his 77 years - prime targets for a death-dealing bout.  The Washington Post reported that as of March 4, more than two dozen members of parliament and at least 15 other current or former leaders had caught the virus; at least one MP has died.  Given the high death rate among this age group, it's not clear that the Iranian government can maintain continuity as the virus burns through it.  If they can't even cure a member of their own Parliament, what hope is there for ordinary people?

According to the Johns Hopkins University virus tracker as of March 13, at 11,364 cases, Iran ranks 3rd behind China and Italy in the number of cases.  The reported numbers are thought to be underestimated by at least a factor of 10 and perhaps 100 - give the mass graves visible from space, even these numbers may be underestimates.  Iranians are reluctant to go to any health care facility to be tested, rightly regarding them as the hottest of infection hot spots - but if vast numbers die alone at home untreated, there are many other plagues waiting in the wings to spread from rotting bodies.

Of even more concern to the leadership, the virus challenges the government's religious legitimacy.  First, religious centers such as Qom were major centers of the infection as people kissed the sacred shrines.  Second, the Washington Institute reminds us that the Ayatollahs are

"uncompromisingly rejecting modern medicine and promoting 'Islamic medicine' as the true science inspired by divine knowledge."

Imagine our CDC being staffed by uncompromising anti-vaxxers during a measles epidemic and you get the idea.  The more cynical among us might identify this as Darwin at work, whereas evangelicals would remind us that the Bible promises grief to any nation that gives Jews a hard time.

United States

Ever since the Carter administration, every American crisis of any sort is declared to be the Moral Equivalent of War (MEOW).  Winning any such "war," we're always told, means giving the Left everything it demands without discussion.  Anyone who opposes the slightest detail of any "woke" program is a hater, an XXphobe, or has blood on his (occasionally her) hands.  "Never let a good crisis go to waste," as Rahm Emmanuel famously put it, and turning everything into a political battle has become standard Democrat operating proceduree.

To no one's surprise, Ms. Pelosi immediately tried to attach federal abortion funding to emergency funds for battling COVID-19.  When Mr. Trump first restricted travel between the US and China, he was pilloried for "racism" in the same way he was criticized for limiting travel from Muslim countries.

Now that he's also stopped travel to traditionally-white Europe, they're accusing him of being too slow to respond, even though the British have sound reasons for not closing their schools:

Computer simulations indicate the UK is in the early stages of its epidemic which is expected to rise sharply in four weeks and peak in 10 and 14 weeks' time.

... computer models indicate this [suspension of mass gatherings] would be less effective and more disruptive than the measures they have recommended: hand washing and asking people to self-isolate if they show symptoms of the disease.

These measures, if correctly implemented, could cut the peak of cases by 20%.

Closing schools is effective for controlling serious flu epidemics, but Covid-19 seems to affect children less.

There are some who disagree with the British approach, but we welcome different countries trying different experiments.  In the US, The Atlantic accused Mr. Trump of botching our program to test for the virus.  Of course, racism charges are never out of style: he was called a racist again for referring to the "Wuhan virus" even though the Chinese had their first case on November 17, 2019, identified at least 266 people who were infected last year, recognized the virus by the end of December, but kept quiet about it, letting it spread everywhere.  In addition, that phrase had been used by many Democrats and MSM pundits for weeks.

On a different note, the virus has led to the New York Times printing words we thought we'd never see, "Mr. Trump has a point."

The 3.4 percent [fatality rate] refers to the rate of deaths among reported cases of corona virus, so Mr. Trump has a point that it may not include milder cases.  [emphasis added]

Based on data from the Diamond Princess, we believe the fatality rate will be even lower than Mr. Trump says.  Nobel laureate Michael Levitt pointed out, "Even on the Diamond Princess (the virus-stricken cruise ship), the infection rate did not top 20%."  9 people died out of 3,711 for a fatality rate of .2%, which is comparable to our annual flu. Any epidemic is a specific, focused problem and methods for dealing with epidemics are well established.  The difficulty with the universal Democrat response to all crises of "Do what I wanted before this problem came," is that they haven't thought about the specifics of the new crisis carefully if at all.  Mayor DeBlasio of New York has called for businesses to be nationalized to fight the virus.  Whenever there's a mass shooing by anyone who can be remotely connected with non-Democrats, they demand "common sense" gun control measures which would have had no effect whatsoever on the crisis du jour.

The Hazards of Global Manufacturing

When China imposed an extreme quarantine, the fact that China and only China supplies raw materials and finished medicines for most of our health care system suddenly became a problem.  Systems with only a few suppliers that rely on lean "just in time" inventories are the most efficient during normal times, but are the least resilient when a crisis arrives.  Moving all the Chinese production to other countries such as Vietnam or bangladesh won't help - we'll still depend on just one supplier.

Low cost brought about by efficiency isn't the only economic virtue.  There is also great value in the ability to respond to unexpected disruptions through redundancy.  One reason America was able to win WW II was because we had so many empty factories and trained workers lying around unused due to the Great Depression; we just needed a reason and funding to turn them all back on again.  Obviously the Depression was a Bad Thing, and empty factories are grossly inefficient, but in 1941, all that reserve industrial capacity turned out to be rather convenient for the entire Free World.

A Pentagon official called China's dominance of drug supply a national-security matter.  We're already complaining about the high cost of health care.  How will people feel if we start to manufacture more medical supplies and equipment in the US at higher cost than in China?  On the other hand, how would people feel if China's systems collapse under the viral onslaught and our source of medical supplies is entirely cut off along with our smart phones?

Assuming that we can test accurately for the virus and have enough bunny suits to protect medical staff, we don't need to put patients in isolation rooms.  Nobody who doesn't have the flu will be sent to isolation, so we can set up cots in gymnasiums and armories as we did during the Spanish Flu and as the Italians are doing now.  There may be a problem treating patients who need help breathing if there aren't enough respirators.  In addition, there are a great many type of flu that aren't caused by COVID-19, so we'd better hope that these rather tricky tests give very few false positives.

There are many diseases such as multiple sclerosis and pneumonia which cause breathing issues.  Fluid accumulates in the lungs and people "drown" when they're no longer able to transfer enough oxygen into their blood.  Medical respirators are standard items in most hospitals - they help people move air in and out of their lungs and add oxygen for extra boost.  They're so common that Ventilator-Assisted Pneumonia (VAP) has its own acronym.

But, as useful as they are, there is a limited, though large (for normal times) supply of such equipment.  If there is too great a spike in demand, hospitals could run out of ventilators as well as masks and other protective equipment.

"That is where we're concerned that U.S. manufacturing alone cannot sustain a true outbreak in the U.S.," she [Soumi Saha who works with an association of 4,000 member hospitals] said. A shortage of ventilators is also a concern, as the CDC has reported some patients require mechanical ventilation.

Suppose a hospital runs out of ventilators because too many dying COVID-19 sufferers arrive.  Will they take ventilators away from older patients who are close to death in favor of saving someone whose youth and overall health make it more likely that the new patient will live?  That's what the Italians are reportedly having to do.

Deciding whom to treat in an emergency is called "triage."  When resources are limited, ignore those who will stay alive without treatment and those who will probably die regardless of treatment and focus on cases where you might make a difference.

Our friends who are emergency responders do this all the time in mass automobile accidents, but never get used to watching people die whom they could save if only they had a bit more time.  How will nurses feel if they have to take life-giving respirators away from old people who're begging to be allowed to live in favor of younger patients?  For that matter, how will hospitals deal with taking away a costly, scare ventilator from an elderly patient with good insurance who is paying for it, to give to a young poor patient who doesn't have the money to pay?

We can be sure that our MSM will blame Mr. Trump for every such decision and every such death, regardless of which way the decision goes.  Perhaps this will finally be when majority America tunes them and their lies out entirely.

Events, Dear Boy, Events

The COVID-19 event has many noteworthy accomplishments with a profound effect on the ebb and flow of politics.

The Democrats' most vehement virus-enhanced demand is for "Medicare for all" or any other "universal" health-care system along lines generally described as "European."  They neglect the unarguable, but off-message, fact that effectiveness of European health care systems in handling this crisis is inversely proportional to the degree to which health care is funded by government payments like American Medicare and Medicaid.

The virus has shed an intense light on the limitations of government-supplied health care, as if issues at the VA hadn't already convinced us it's a bad idea.  Along with fewer hospital beds in Italy and Britain compared with France and Germany, the WSJ notes:

Government accounted for 79% of total health-care spending in the U.K. in 2017, according to Eurostat, and 74% in Italy. Germany and France both rely on compulsory insurance schemes with varying degrees of subsidy and government meddling, but outright government expenditure amounts to only 6% of total health spending in Germany and 5% in France. COVID-19 in this sense is a test of how much one trusts central health planners to make wise long-term decisions that boost resilience in the face of unusual dangers.  [emphasis added]

The greater the percentage of government spending and thus of government control, the less effective health care becomes.

The virus silenced criticism of Mr. Johnson's Brexit on economic grounds, but will ramp up criticism of his management of the health care system by supposedly starving it of money and by making it harder for health workers to migrate to Britain.  Alas, nobody in England is even bothering to make the argument that it should not be government's job to be managing health care in the first place.

The economic damage in Italy will hit the faltering Italian economy rather hard, particularly with all their tourist sites shut down.  Italian governments have been struggling with bankruptcy for some years; one wonders if the direct and indirect costs of COVID-19 will finally push their finances over the edge.

Mr. Trump's sanctions had caused a severe Iranian financial and political crisis even before they shot down a civilian airliner and lied about it.  The virus may kill enough aging leaders that the government loses coherence.  This could lead to a less theocratic, but more thuggish government which ramps up force to make up for loss of religious legitimacy - something vaguely along the lines of Iraq's Saddam Hussein.  It's hard to see how any form of democracy could emerge given that all civic institutions have been systematically destroyed.

In the US, Mr. Trump is no longer running against the Democratic presidential nominee, he's running against the virus.  His signature campaign rallies may become impossible or, if the virus burns through the population fast enough, he may spin his rallies as celebrations of his victory over it, particularly if he's able to highlight the "Bewildered Biden" meme along with "Sleepy, Creepy Joe."

Comparing the outcomes in single-payer health care countries with what happens in countries which are not as subject to government control won't stop Democrats from calling for more and more government control over over American health care, but may supply factual ways to push back against them.

Once again, we see the power of events.  As German cleric Thomas a Kempis put it in his 15th-century book, "Man proposes, but God disposes."