A Hamiltonian View of Post-Pandemic America

By | July 13, 2021


“In countries where there is great private wealth much may be effected by the voluntary contributions of patriotic individuals, but in a community situated like that of the United States, the public purse must supply the deficiency of private resource. In what can it be so useful as in prompting and improving the efforts of industry?”

Those were the words of Alexander Hamilton published on December 5, 1791 in his “Report on the Subject of Manufactures.” He was making the case for an activist federal government with the capacity to support a fledgling nation and its leaders long enough to allow economic independence from foreign competitors.

Today’s “foreign force” of course is not any one nation but rather a microbe, gearing up for a fourth attack on our shores with Delta and Lambda variants. This invader has already wreaked havoc with our economy, knocking off nearly 2% of our GDP, as the nation and the majority of its workers experienced a period of voluntary lockdown.

Our leaders followed Hamilton’s advice and threw the full economic weight of our federal government into a dramatic and direct response. Seeing the threat as akin to a national disaster, money was placed expansively and directly into the waiting hands of our citizens, debtors were temporarily forgiven, foreclosures and evictions were halted, and all but the most essential workers sheltered in place.

Millions of citizens were asked to work remotely or differently (including school children and their teachers) or to not work at all – made possible by the government temporarily serving as their paymaster and keeping them afloat.

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As we awake from this economic coma, many of our citizens are reflecting on their previously out-of-balance lives, their hyper-competitiveness, their under-valued or dead-end jobs, and acknowledging their remarkable capacity to survive, and even thrive, in a very different social arrangement.

If our nation is experiencing a trauma-induced existential awakening, it is certainly understandable. America has lost over 600,000 of our own in the past 18 months, more people per capita than almost all comparator nations in Europe and Asia. This has included not just the frail elderly, but also those under 65. In the disastrous wake of this tragedy, 40% of our population reports new pandemic-related anxiety and depression.

A quarter of our citizens avoided needed medical care during this lockdown. For example, screening PAP smears dropped by 80%. And so, Americans’ chronic burden of disease, already twice that of most nations in the world, has expanded once again. There will be an additional price to be paid for that.

The Kaiser Family Foundation’s most recent Health System Dashboard lists COVID-19 as our third leading cause of death, inching out deaths from prescription opioid overdoses. Year-to-date spending on provider health services through 2020 dropped 2%, but pharmaceutical profits, driven by exorbitant pricing, actually increased, bringing health sector declines overall down by -.5% compared to overall GDP declines of -1.8%. The net effect? The percentage of our GDP devoted to health care in the U.S. actually grew during the pandemic – a startling fact since our citizens already pay roughly twice as much per capita as most comparator nations around the world for health care.

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In the “pause”, other nations have been soul-searching as well. A common theme has been work. Two of the most popular discussions include remote work from home and the four-day workweek. These discussions were already well underway pre-pandemic in Germany, Spain, New Zealand, Iceland and beyond. But now, they are cropping up in U.S. corporations like PepsiCo and Verizon as Human Resource departments grapple with scarce or reluctant employees, and consider paid time off, flexible work schedules, and remote work arrangements.

In some ways, we remain the nation that Hamilton described in 1791. We have been unable to come fully to grip with our racist past, and have used both our state and federal governments – not to provide economic room for our citizens to survive foreign competitors – but rather to maintain the status-quo advantages of home-grown “haves” over “have-nots.”

On the surface, Red vs. Blue America seems ill-prepared to start anew, to learn from and progress off the back-end of this historic pandemic.

Americans have had a year and a half to reflect and think about work and life, priorities and the future. Our discomfort with the current arrangement is palpable. Is this the America we want?

What if we managed to spread our nation’s resources more equitably? What if we eliminated “non-real work” and allowed remote work as the rule rather than the exception. What if health care and early childcare programs were universal, and not tied to one’s job? What if technologic innovation was employed to advance equity and justice? What if we decided that making our lives better was the goal instead of just maximizing our GDP.

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Wouldn’t that be a better way to live? A better America?

Mike Magee, MD is a Medical Historian and Health Economist and author of “Code Blue: Inside the Medical Industrial Complex.“

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