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Mind the Trust Gap – The American Prospect

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On the last day of February, U.S. Surgeon General Jerome M. Adams implored Americans to stop buying protective equipment in the midst of a contagious viral outbreak. “Seriously people—STOP BUYING MASKS!” Adams exclaimed. “They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!” It was a difficult two-step: Adams was trying to tell people that face masks are useless for disease prevention, but also vital for disease prevention—as long as you’re a medical professional.

There’s a kernel of science behind the argument. Face masks can prevent a coronavirus carrier from spreading germs to others. But non-carriers can receive transmission through any part of their body the face mask doesn’t cover. By contrast, medical professionals and caregivers operate in close proximity to patients, and need maximum protection when treating infectious diseases.

But telling Americans not to protect themselves because doctors and nurses take priority doesn’t sit well, and the empty shelves at stores provide testimony to that. It signifies a long-simmering feature of our politics, what University of North Carolina professor Zeynep Tufekci calls an “age of mistrust.” And a pandemic is the worst possible crisis to spring up in a country suffering from a collapse of institutional credibility.

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PUBLIC TRUST in government, according to the Pew Research Center’s historical data, reached its peak in 1964, with 77 percent favorability. It’s near historic lows of around 17 percent today. Discrete events, like the end of the first Iraq War, the booming economy of the late 1990s, and 9/11, have provided a temporary sugar high, but the trajectory for trust in government has mostly been straight downward for the last 55 years. This is also seen in Gallup polling regarding the presidency, Congress, the Supreme Court, churches, public schools, news media, and numerous other institutions.

People didn’t spontaneously come to a decision to distrust the government. They endured Vietnam, Watergate, Iran-Contra, the endless ginned-up scandals of the Gingrich era, Iraq, Katrina, the financial crisis, and finally the presidency of Donald Trump, with Citizens United, corporate concentration, and manipulation of government, and 40 years of stagnant wages and skyrocketing inequality hanging over everything. Moreover, American conservatives believe government cannot function well, and once in power they set about defunding and wrecking it to prove their point. It was a neat trick, and now a fateful one.

In a study with resonance in this moment, Harvard researchers found in 2006, after the SARS outbreak, that Americans were less likely to trust government information about public health than were people in Hong King, Singapore, or Taiwan. And that was well before the Baghdad Bob–style pronouncements about coronavirus from this president and his loyal disciples. Since January, Trump has attempted to downplay the threat for nakedly political reasons, rejecting recommendations that seniors be advised not to travel by air, and even going so far as to muse about blocking an infected cruise ship from coming back to port because “I like the [infection] numbers being where they are … I don’t need to have the numbers double because of one ship that wasn’t our fault.”

People tune out self-interested decision-making, and every one of Donald Trump’s decisions is based on his own self-interest. They decide that the man running the government, who told them the heat will kill the virus in April, is not equipped to protect them. They make the determination that they’re on their own. And then they storm Home Depot to buy face masks and hand sanitizer, and read articles like “What You Can Do Right Now About the Coronavirus.”

This can rapidly descend into panic, with real economic effects. The Centers for Disease Control and Prevention’s botched testing kits put the nation way behind in identifying exposure to the virus. When uncertainty rules and we don’t trust official sources, we must individually evaluate personal risk. It’s logical in that circumstance to cancel large gatherings and limit travel. But every concession worker at the shuttered South by Southwest festival, every baggage handler at United and Delta, every rental-car clerk and resort hotel concierge will feel the residual and possibly unnecessary pain. Panic and fear can induce irrationality into any calculus.

Public trust in government reached its peak in 1964, with 77 percent favorability. It’s near historic lows of around 17 percent today.

Maybe a government that inspires trust in its citizens could have allayed concerns. Maybe a government that operates with the intent of benefiting all people could have soberly explained the best means to keep safe, and received broad acceptance. But we live in a you’re-on-your-own society that glorifies the individual in a moment that requires collective action. And the trust gap only exacerbates this worldview.

It’s a source of difficulty for progressives, who know that ideas like paid sick leave and universal health coverage are precisely the kind of policies that can tamp down the virus’s spread. We should enshrine the principle that the lack of resources is not a barrier to personal health, rather than forcing the sick to maintain their daily schedule and reject medical assistance because they cannot afford to do otherwise. But in an age of mistrust, ideologues can scoff at a government that does nothing right, and often win that argument.

Usually at this point, some libertarian economist will suggest that private enterprise must be unshackled to perform the critical functions of government in a more efficient manner. Government must not be trusted to do any job that the private sector can do better; it needs to simply “get out of the way.” Of course, that has been the prime directive of government for the past several decades, ceding control to big business to run wild. How that’s worked out is clear if you follow the trajectory of the simple face mask.

THE WHOLE SPECTACLE of the surgeon general pleading with people to stop buying face masks should strike you as odd. Hospitals don’t typically rush to retail stores for Band-Aids and tongue depressors; they have dedicated wholesale medical suppliers, funneled through middlemen that contract with single sources. The contractors, known as group purchasing organizations (GPOs), are supposed to save hospitals money by buying in bulk. But in 1987, Congress enacted a “safe harbor” provision that transferred payment of GPOs from the hospitals to the medical-supply vendors. GPOs gradually consolidated, with no pushback from the antitrust authorities. And legalizing kickbacks totally changed the incentives; GPOs would sell contracts to the manufacturers offering them the highest payment, forcing those suppliers to cut costs elsewhere to eke out a profit.

This sent makers of supplies like face masks looking overseas for cheap labor, with little resistance from a government keen on abandoning its industrial base. The majority of all face masks are manufactured in China and Taiwan, and China spent the last month curtailing production in its factories, in a full-spectrum attempt to prevent coronavirus spread. The subsequent shortages have led China to declare masks a “strategic resource,” hoarding them for health professionals caring for their stricken population. America’s largest domestic manufacturer of simple surgical masks, Prestige Ameritech, simply can’t keep up with the demand. Honeywell and 3M, which make the more heavy-duty N95 respirators, have been racing to catch up to orders since January.

Even as Chinese factories get back up to speed, a peculiar problem has caused delays. Reduced sailings between China and ports in the U.S. and Europe have caused an imbalance of shipping containers. China can’t get ships out of its ports, and U.S. exporters have nothing in which to store their goods for transatlantic journeys. This has snarled global shipping and could take months to work through.

Follow that all the way down the supply chain, and it means that domestic hospitals cannot stock up on face masks to prepare for potentially thousands of new cases. Larger hospital chains have more resources to secure face masks and other supplies, while rural hospitals may lose routine shipments when shortages occur.

Some rural hospitals have already hit up hardware stores just to cover current needs like surgeries and other treatments. That puts them in the same aisle as ordinary people, trying to secure a face mask for themselves or a family member. None of that should ever happen, and GPO bulk-buying groups forcing outsourcing is a proximate cause.

The problem, in other words, is not a government that does too much; it’s one that does too little, and outsources its authority to the corporate boardroom.

When retailers see something in high demand, they do the all-American thing: shoot the price skyward. That’s not price-gouging, just supply and demand at work, say laissez-faire economists. But it’s undeniable that it leads to limiting protective equipment to the affluent, whether the rich individual or the rich hospital. Thirty-four states have laws against price-gouging, yet enforcement is weak enough that we continue to hear stories about exorbitant pricing on routine goods. Local officials even ask consumers to report the cases, lacking the manpower to engage in their own enforcement.

Our new platform-monopoly economy adds a wrinkle to price-gouging. Prices for items like face masks (as high as $195) and hand sanitizer ($350 for a two-pack) have surged on Amazon, and lawmakers have asked the company to crack down on excessive pricing. But Amazon cannot possibly police millions of items on its site in real time, and has no incentive to do so. Congress, in Section 230 of the Communications Decency Act of 1996, immunized platform companies from liability for the transgressions of their users, in this case the price-gouging sellers in Amazon’s virtual mall. Amazon also takes a cut out of every sale, and the higher the price, the higher the cut. That limits its desire to scour the marketplace for unfair pricing.

Liability concerns are also on the minds of the makers of the N95 respirators typically used in mining and construction. Manufacturers have expressed worry that someone wearing one of their masks might contract coronavirus and sue them for negligence, and have approached Congress for the same immunity from lawsuits that makers of hospital masks get. That would be a license to produce ineffective equipment without fear of reprisal.

LET’S PUT THIS all together. The global shortage of face masks and other protective equipment comes in large measure from corporate purchasing contracts forcing a centralized supply chain that increases fragility. This has pushed hospitals into retail markets to secure face masks, with the largest companies muscling out the little guy. Routine price-gouging is hard to arrest in largely unregulated e-commerce marketplaces. And face mask manufacturers want to be sure they aren’t held accountable for their products being defective.

Along the way, government has stood loyally by, providing the legal cover for monopolization, consumer abuse, and profiteering. In this sense, government deserves citizen mistrust, though not solely for the reason that it’s preternaturally incapable of executing policy or managing crisis. It deserves mistrust because it allowed corporations to rewrite the social contract, and the whims of the free market to overtake the public interest. The problem, in other words, is not a government that does too much; it’s one that does too little, and outsources its authority to the corporate boardroom.

Activist government, outside of a surveillance state autocracy like China, cannot work without public trust. Progressives generally pay too little attention to this problem, when they’re not explicitly stoking it. But the rebuilding of an activist government must begin by restoring democratic control to the institutions of our democracy. The cynicism that accompanies corporate collaboration with government feeds a loss of faith that becomes impossible to counteract. That’s bad enough on its own; it’s downright dangerous in a crisis, if the public feels it must rely on its own instincts instead of collective action and sound science.

The times call for a reformer who can make the case against private enterprise as the savior of society, and the case for democratic governance as the best means to solve big problems. But that requires a new level of education to demystify who has power in America and how they use it. Maybe it starts by telling the real story of the face mask.

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