The ongoing debate over Covid-19 policies spawns many surprises. Among those that cause me to scratch my head most thoroughly is the claim that, for policymaking purposes, the steep age profile of Covid-19 fatalities ought to be ignored.
The age profile of these fatalities is indeed steep. According to the CDC, as of April 21st, 2021, 31 percent of all deaths in the U.S. “involving Covid-19” were of people 85 and older; 58 percent of these deaths were of people 75 and older; 80 percent of these deaths were of people 65 and older; and a whopping 96 percent of these deaths were of people 50 and older.
Roughly one-third (34%) of the U.S. population – the eldest third, those of us 50 and older – form the group that suffers nearly all, 96 percent, of Covid fatalities, with the bulk of these occurring among the very old and ill. How is this stark fact not relevant for the crafting of Covid policy?
In an earlier argument against the call to ignore this steep age profile of Covid fatalities, I used this hypothetical:
Consider three different novel diseases – A, B, and C – each of which results in a total of 500,000 deaths chalked up to it. But – disease A kills only people ages 2 through 50; disease B indiscriminately kills people of all ages; and disease C kills only people ages 80 and older.
No reasonable person would be indifferent between these diseases. While each disease (obviously) is unfortunate, disease B is clearly worse than is disease C, and disease A is clearly worse than is disease B – making, of course, disease A worse than disease C.
Any reasonable person given the power to choose which of these three diseases is to befall humanity – assuming no option exists for “none of the above” – would surely choose disease C. To my mind, this fact obviously implies that in our world of scarce resources, whatever are the agreed-upon appropriate responses for fighting disease A and disease B, the appropriate response for fighting disease C is less intense.
Yet recent email exchanges with some respected friends reveal that what to me seems obvious doesn’t seem obvious to everyone.
The most thoughtful justification that I’ve encountered for insisting that policymakers ignore the fact that Covid reserves the vast majority of its ravages for the elderly is that government should not discriminate – including, of course, not discriminate between young people (Y) and old people (O). Here’s a passage from an email sent by a libertarian economist friend whose intelligence and judgment I hold in very high regard:
So what’s wrong with the argument that less should be spent on preventing the death of O than on preventing the death of Y? What’s wrong, I believe, is the underlying assumption that the state should be allowed to make this balancing act, which is explicitly discriminatory, that is, about favoring a group of individuals at the detriment of another group.
While I’m sincere in describing this argument for ignoring the age profile of Covid’s victims as the most thoughtful one, I still remain wholly unconvinced. To explain why, I modify the above hypothetical just a bit.
Suppose that a society, identical to ours, will – with 100 percent certainty – be stricken with one of three deadly pathogens. But this society can choose which of the three to suffer. Each pathogen will kill the same number of persons, with this number being significant, potentially as high as 0.15 percent of the total population.
Pathogen A will kill only people 80 years old and older.
Pathogen B will kill only people 30 years old and younger.
Pathogen C will kill indiscriminately across all age groups.
The Fates give the society 24 hours to hold a plebiscite for choosing which of these three pathogens to endure.
There will probably be some very frightened people aged 80 and older who’ll selfishly vote for pathogen B. A few other elderly people, perhaps equally frightened but not as selfish, will vote for pathogen C. But I’m confident that the great majority of citizens – including, I suspect, most elderly citizens – would cast their ballots for pathogen A. (I, for one and regardless of my age, could not bear the mortification of knowing that I voted for an option that reduced my risk of dying at the price of increasing my son’s risk of dying. I don’t believe that in this matter I’m unusual.) At the very least, the claim that a majority of citizens would choose pathogen A is quite plausible.
And this choice is indeed discriminatory in a literal sense: The choice is to have the disease that kills only people 80 and older. The nondiscriminatory option (pathogen C) is rejected in favor of a discriminatory one (pathogen A). But should we therefore conclude that this collective choice is a kind of discrimination that the collective, whether by plebiscite or through elected representatives, should not engage in? I think not.
The principle that holds that government should not discriminate is a presumption – a very strong one, to be sure – that government should treat everyone identically. This presumption is meant to prevent the state for no good reason from bestowing favors on some people at the expense of other people, or from simply harming a subset of the population. Yet this presumption is rebuttable. No sensible person believes that the state engages in unjust discrimination by refusing to let ten-year old children drive automobiles on public roads or to enter into marriage contracts. Ditto for the state’s reservation of Social Security retirement benefits for retirees above a certain age. The fact that these, and many similar, instances of state discrimination are rooted in a utilitarian calculus doesn’t render them unjust.
At work in my disease hypothetical is a deeply rooted human understanding and sentiment about stages of life. We know that an 80-year old person likely has far fewer years left to live than does a 30-year old person. This fact is why when we learn of the death of an 80-year old we don’t experience the same sense of loss and of tragedy as when we learn of the death of a 30-year old. For government to ignore this understanding and sentiment is for government to ignore an almost-universally shared assessment about the value of life at different stages.
Importantly, to share this assessment is not to believe that some lives are more sacred and deserving of respect than other lives. It’s simply to recognize that all lives are finite, and that the older is someone, the closer is he or she to death. Therefore, in our world of scarce resources – in our world in which achieving more X means having less Z – it makes no sense for government to allocate whatever resources are legitimately at its disposal in ignorance of this widely shared recognition of life’s finiteness, and of the assessment of the meaning of this finiteness. (Note that this fact does not imply that government should coercively transfer resources from the old to the young simply because the young have more life remaining than do the old. In a liberal, free society, arbitrary government reallocation of privately owned resources is presumed to be illegitimate regardless of the owners’ age, health, sex, political affiliation, or whatever.)
Reality Isn’t Optional
Partly because I have little confidence that the state will act wisely and prudently, in my ideal world the state would play almost no role even in managing deadly pandemics. But the world is far from my ideal. The state is big, powerful, intrusive, and will without doubt play a role in managing pandemics. Given this given, libertarians such as myself are left to comment on options that, for us, are at best second-best. And so my plea is for the state to recognize the steep age-gradient of Covid’s victims and make policy accordingly.
Were the state to heed this plea, the result of course would be policies that differ from current policies which largely ignore Covid’s steep age gradient. In some ways, this difference in policies would be more favorable to the elderly. They would, for example, have priority over younger people for any vaccines the distribution of which is managed by government. But the biggest difference in policies is that they would be much less draconian, and they would reflect the Great Barrington Declaration’s advice to practice Focused Protection.
It is, I believe, deeply misguided to insist that the principle of government even-handedness requires that government ignore the age profile of a disease’s victims. It is misguided to demand – either on grounds of equity or by noting, correctly, that all lives are sacred – that the policy response to a disease that overwhelmingly kills old people must be just as vigorous and intense as would be the policy response to a disease that kills indiscriminately, or that kills overwhelmingly the young.
Such an indiscriminate policy response might be appropriate for a society that has escaped the bonds of scarcity or in which people can live forever. However, such an indiscriminate policy response to a highly discriminatory disease is utterly inappropriate for our society which remains firmly in the grip of both scarcity and mortality.