Some observers are blaming the lack of investment in public health infrastructure including the limited number of hospital beds, masks and medical devices. Further, the global health security team within the National Security Council was disbanded in 2018. However, this isn’t just a result of the Trump administration’s decisions. According to the Trust for America’s Health, the country’s lack of investment in public health stretches back long in history.
So why is the U.S. so poorly equipped for a mass pandemic? Much of the answer plausibly lies in democratic politicians’ incentives. Having the federal government prepare for crises may be incredibly good value for money. But politicians get few or no benefits from doing so, since voters don’t reward them for being ready. This is why.
Preventive spending is very effective
In 2009, Andrew Healy and I published a paper in the American Political Science Review analyzing how voters responded to federal spending on preparing for and responding to natural disasters such as hurricanes, tornadoes and earthquakes. We collected data on county-level presidential election results, disaster damage and spending.
We found that spending money on prevention is highly effective at mitigating future disasters. Benjamin Franklin famously said that “an ounce of prevention is worth a pound of cure” — suggesting a 16:1 relationship between the benefits of prevention and the costs of cure. That’s only a very slightly exaggeration. We estimate that $1 spent on preparedness is worth about $15 in terms of the future damage it mitigates. We also looked at response spending, which usually comes in the form of checks sent to disaster victims. Unsurprisingly, that does not reduce future disaster damage.
But prevention doesn’t benefit politicians
Despite the clear efficiency of investing in preparation rather than response, prevention spending has decreased over the decades — while response spending has increased. Why has the federal government spent its money so poorly?
The answer lies in electoral incentives. We find that presidents who deliver relief spending after a disaster get a larger share of the votes in the next election. Specifically, if the incumbent party increases relief expenditures in a county from $1 per person (the 66th percentile for spending in the data) to $10 per person (the 93rd percentile in the data), the incumbent party will gain about 0.77 percentage points more in the next presidential vote. But there is a flat relationship between prevention spending in a county and presidential vote share — in other words, there’s no increase at all. This creates a clear incentive for government to not invest much in prevention, and instead to send help when disaster strikes.
Why do voters behave like this? Although we don’t have direct evidence, we offer numerous theories in the paper. For instance, voters may not be aware of preparation spending, or may not think it should affect their votes. Voters might also be shortsighted and discount the future. Perhaps voters prefer to receive individual benefits like checks in the mail rather than collective, shared public goods like prevention. Or maybe the problem lies in who gets the credit. Why would a politician spend money on preparation today if a future politician will reap the electoral rewards later on when a disaster occurs and the media celebrates those preparations?
This has consequences for covid-19
Of course, there’s always an electoral risk of a massive failure such as Hurricane Katrina or a viral pandemic. But often, politicians’ most attractive strategy will be to kick the can down the road. That’s true not just for singular disaster events, but also for systemic problems such as climate change and underfunded pensions.
It is possible, at least in theory, that after horrific disasters, voters might start to reward politicians for investing in prevention. However, in the past, voters had notably short attention spans. Immediately after Hurricane Katrina in 2005, which devastated New Orleans, there were many proposals to shore up infrastructure and prepare for climate change. According a survey conducted by the Kaiser Family Foundation, in late 2006, 30 percent of New Orleans residents said that “repairing the levees, pumps, and flood walls” should be one of the top two priorities in the rebuilding efforts, ranking this item and crime control as their top two concerns. But once the event disappeared from the media cycle, the public’s desire for preparedness expenditure dissipated. The Kaiser Family Foundation surveyed New Orleans residents again in 2008. Only 2 percent of New Orleans residents ranked “hurricane protection/rebuilding flood walls, levees” as a top concern.
Neil Malhotra (@namalhotra) is the Edith M. Cornell Professor of Political Economy at the Stanford Graduate School of Business.
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