Debacle: Trump’s Response to the COVID-19 Emergency

Abstract

Why did the United States, ranked as the world's best prepared country, fail so dramatically in its response to the COVID-19 pandemic? Part of the reason is the backdrop of a fragmented and largely market-driven health care system, part of the reason is a society marked by dramatic racial and economic inequality, but a key part of the reason is the structure of the public health system. The United States approach, which reflects the politics of American federalism, involves underinvestment and underpreparedness at every level of government except the federal. Effective response has to be led by the federal government. The complexity of the federal government is such that any effective federal response must be led by the White House. If the White House fails to lead, the federal government will fail to lead and the system as a whole will not be capable of effective public health response. That is exactly what happened in 2020.