What does public choice theory say about responding to Ebola?
That is: What are the costs and benefits of various policies – not to the public – but to self-interested politicians? Public choice theory holds that politicians’ interests don’t always coincide with the public’s, and sometimes they diverge quite sharply. When interests diverge, politicians will often side with their own self-interest, even at the expense of the public.
So what do they want? Politicians want public esteem. They want above all to be seen as heroes. If that means sacrificing civil liberties - to little or no public benefit - then they will do so.
This remains true even if the “heroic” measures at hand amount to Ebola security theater. It would appear that's what we're getting - a set of state-level quarantines that are actually contrary to what doctors and epidemiologists recommend. (No, the public probably won’t care what the experts say. I mean, look – the public still buys antibacterial soaps, and public health experts don’t recommend those either.)
In general, then, we can expect politicians to be eager to quarantine. This eagerness will be completely independent of the specific facts of any particular disease. Recall that lots of politicians once wanted to be able to set up an HIV quarantine, too, even long after it was well known that HIV can’t be transmitted by hugging, kissing, sharing utensils, sharing toilet seats, non-euphemistic cuddling, or what have you. (Wasn’t that a loooong time ago? No: It was just last year. And they got what they wanted.)
In short, whether or not a quarantine is right in any particular case – and it might be right in some cases, though I wouldn’t know – public choice theory says that politicians will err on the side of quarantine.
If that seems cynical, consider the flip side: Politicians also don’t want to look like the ones who let Ebola into the country. Note that one might look like the person who brought Ebola into the country even when one’s policies are responsible for exactly zero additional Ebola risk. Life is unfair sometimes. Even to politicians.
To look like a screwup, all you have to do… is nothing. The public will be left to stew in its fears, and they hate it when that happens. So they will punish you, and your party, at the next possible opportunity. (When is that again?)
The costs of doing nothing here are especially high if your constituency happens to be made up of conservatives – in whom Jonathan Chait has pointed out a strong emotional preference for purity and cleanliness. We should thus expect to find fear of contamination at or near the top of the to-do list for conservatives, who will try, first, to intensify these fears, and second, to promote their own policies as the only ones capable of relieving them.
Much as I may hate to say it, this model explains very well the actions of New Jersey Governor Chris Christie, who enacted an Ebola quarantine against consensus medical opinion. Nurse Kaci Hickox, herself quarantined, has since delivered a harrowing account of her chaotic re-entry experience. Hardly the hero's welcome that she deserved.
Now, we might well expect Hickox to protest. After all, she was the one actually spending the days in isolation. We should consider then, the opinions of disinterested experts, who understand the risks but who did not have their personal liberty at stake. This letter in the New England Journal of Medicine seems especially on point:
[Quarantine for health workers] is not scientifically based, is unfair and unwise, and will impede essential efforts to stop these awful outbreaks of Ebola disease at their source, which is the only satisfactory goal. The governors' action is like driving a carpet tack with a sledgehammer: it gets the job done but overall is more destructive than beneficial.
When Christie appeared to abandon his quarantine policy – and let’s be honest about it, that’s basically what he did – he explained himself as follows:
We're trying to be careful here," Christie said on NBC's "Today," referring to his state's policy. "This is common sense, and ... the American public believes it is common sense. And we're not moving an inch. Our policy hasn't changed, and our policy will not change.
It’s common sense! And yet common sense isn’t necessarily what’s called for here. Common sense may win elections, but viruses are a lot more like chemistry than they are like common sense. Common sense doesn’t vary, but viruses’ properties do vary, often tremendously. The appropriate measures for containing each of them will likewise, and these measures will not always include quarantine. In a case like this, politicians, who must run on common sense, and on common fears, are unfortunately the last people we should be listening to. We know their biases too well.