Why the U.S. failed to avert the pandemic (2)

Like Michael Lewis’s The Premonition, Andy Slavitt’s Preventable is a story of how people in authority disregarded warnings and allowed the COVID-19 virus to gain a foothold in the United States.

But while Lewis described the efforts of a number of far-sighted prophets, Slavitt concentrates on just one—himself.

Slavitt is an interesting figure—a political operator and member of the professional-managerial class, who influences policy, moves back and forth between government and the private sector, but would be unknown to the public except for this book.

He was an investment banker with Goldman Sachs, a consultant for McKinsey & Co., and founder of a company called HealthAllies, and then worked for United Health Group after it acquired HealthAllies. 

He served the Obama administration as head of the Center for Medicare and Medicaid Services from 2014, and was a medical adviser to the Biden administration during its first few months.

His power comes from being embedded in a network of politicians, corporate CEOs, wealthy philanthropists and academics, who all answer his phone calls and listen to what he has to say.

Preventable is about how he tried to alert the public to the danger, while also trying, from behind the scenes, to influence the Trump administration to take action before it was too late.

His book is a good overview of the Trump administration’s pandemic response and of the inadequacies of the American medical care system generally.

Much of the criticism of Trump is based on a knee-jerk response to his vulgar and offensive comments on Twitter and elsewhere, which don’t matter, and on a gullible acceptance of charges of collusion with Russian and Ukrainian leaders, which were either bogus or trivial.

Slavitt did a good job of showing the real problem with Trump, which was his inadequacy as an administrator and leader.  Trump refused to face unpleasant facts.  He thought of policy only in terms of public relations, not in terms of consequences, and he failed to think ahead even about public relations.

He calculated that closings are unpopular and openings are popular, so he shifted responsibilities for closings onto governors of states while positioning himself as the champion of openings.

As damning as Slavitt’s portrait of Trump is, it will not change the minds of Trump’s admirers because of Slavitt’s obvious bias and partisanship. 

The only named persons he holds accountable for the COVID-19 pandemic are Trump supporters, members of Trump’s administration and Donald Trump himself.  Democrats get a free pass.

Slavitt doesn’t mention any of the characters in Michael Lewis’s The Premonition, but Lewis’s book did mention Slavitt in passing. 

He got a copy of a pandemic-fighting plan from Charity Dean, deputy public health director of California, wrote the Centers for Disease Control into the plan over Dean’s objection, gave it a new title and other cosmetic changes and presented it to Jared Kushner as his own work.

Slavitt’s writing rubs me the wrong way for some reason, but I have to admit he deserves credit for seeing the danger and trying to do something about it.


With all its flaws and missteps, the U.S. response to the pandemic was not terrible compared to other rich majority-white countries. 

In objective measures, such as COVID-19 deaths per million population or excess deaths per million, the United States falls in the mid-range.  Graded on a curve, the USA deserves a B or a C, but not a D or an F.

We Americans should not take any consolation from this fact, however.  As W. Edwards Deming, the great statistician and management consultant pointed out, rank order is meaningless.  What matters is how far you are from where you need to be.

Deming pointed out that, if everybody fails to achieve a goal, there’s no point in analyzing what distinguishes the greater failures from the lesser failures.  What you look for is common factors that explain the failures.

The common factor that distinguishes the nations that allowed the virus to establish itself from the nations, mainly in eastern Asia, that stamped it out, is that the successful nations acted before the danger became evident to the public, and the other nations did not.

What explains this?  Michael Lewis thinks it is a question of incentives.

If you work for a for-profit company, your incentive is to concentrate on what contributes to the company’s profit, and ignore everything else.  If you are an academic. your incentive is to concentrate on research that results in publishable papers, and ignore everything else.

If you are embedded in a bureaucracy, your incentive is to concentrate of what’s in your job description and what pleases your immediate supervisor, and stay away from matters that are not your specific responsibility.

If you are an elected official or a political appointee, your incentive is to give the public what it wants, and stay away from things it doesn’t care about.

I don’t know of any system of rewards and punishments that will always push people to do what’s best, and I can’t think of any.

But Andy Slavitt, as well as Charity Dean, Carter Mecher and others profiled by Michael Lewis, tried to do the right thing without incentives, and, in some cases, in spite of risk to their careers.  Their rewards were personal satisfaction, and the respect of their peers.

There’s truth in the cynical saying, “No good deed goes unpunished.”  I think that, all other things being equal, most people want to do the right thing and they’d do it if they could do so safely.  But this requires a certain baseline level of morality and justified trust.


Transcript of Andy Slavitt interview for Washington Post Live.

Book review: Andy Slavitt’s Preventable by Alex Tabarrok for Marginal Revolution.

Delta variant is “COVID-19” on steroids, expert says, by Aya Elamroussi for CNN.

Comment by Brad DeLong for Grasping Reality.

Inside Operation Warp Speed: a New Model for Industrial Policy by David Adler for American Affairs.

Lockdown Effectiveness: Much More Than You Wanted to Know by Scott Suskind for Astral Codex Ten.

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