Epistemic status: Not a medical doctor, But this seems correct.
Let’s say someone challenges you to a game of Russian roulette. But, he says, if you pay him a hundred dollars, he’ll let you play with just one bullet in the gun instead of two, doubling your chances to live.
The first thought through your head when you hear this offer is probably something like “a hundred bucks to double my chances to live? Sounds like a great deal!”. I’m guessing the second is “wait, I still don’t want a one in six chance of dying. Is there any way I can avoid playing Russian roulette in the first place?”
Let’s get back to The Virus. It’s hard to get exact estimates on Corona survival rates, because it’s new and research is ongoing and there’s like a million contradictory studies. But the rough estimate going around is that it has a 1% mortality with good healthcare and a 5% mortality rate without it. I’ve seen a lot of calls for more ICU beds and ventilators, so that we can avoid overwhelming the healthcare system – but it seems like only about half the people who go on ventilators survive. Assuming everyone who needs a ventilator would die without one and most people who dies (so far) get on a ventilator first, that (lower-confidence) estimate gives us that hospitals double survival rates. So overall, the healthcare system, using expensive equipment and highly-trained doctors and nurses, reduces the death rate between 50% and 80%.
Estimates for the total death rate (in the US) I’ve seen go from 30 thousand to 1-2 million Americans. This is a far larger difference – by orders of magnitude – and mostly depends on how well measures like quarantines and distancing work to stop the spread.
So in essence, healthcare lets you play Russian roulette with fewer bullets. Public health, if you do it right, lets you avoid playing it in the first place.
This isn’t limited to the Coronachan. Most of the increase in life expectancy over the last few centuries hasn’t been caused by healthcare, it’s been caused by removing Smallpox and Polio and helping people have enough to eat. Washing hands and sanitation has done more for longevity than cancer drugs.
Which brings us to the obvious question – what haven’t we done that we could still be doing? In a normal year, America spends about 18% of GDP – 3.5 trillion dollars – on healthcare. What are the public health interventions we can still do? Assuming they’re an order of magnitude more effective, they’d cost about 350 billion a year for the same effect as we get from healthcare, which would be totally worth it but still high enough to give us sticker shock. Where are the areas?
Globally the obvious answer is “Just contribute to Givewell, they already did the research (which mostly leads to third-world public health interventions).” If we’re thinking in terms of large-scale domestic spending projects instead of individual actions, the top priority is probably limiting or removing cars where possible – between crashes and pollution-caused illnesses, cars account for about a hundred thousand deaths a year, right up there with the lower-end estimates for Corona. If Corona is worth this kind of effort to address, we should probably be willing to spend a tenth of that to address car deaths. Try to imagine what spending a tenth the effort to limit cars every year as we are now to limit Corona (promoting alternative transport measures, congestion prices, gas taxes, red light cameras and intersection redesigns all have a history of working, for a start). It’d be an almost unimaginable amount, compared to what we do now – but if you assume our Corona measures now are reasonable, that would be worth it too. If you assume we’re overreacting to Corona by an order of magnitude, well, spending 1% of the effort on cars as we do on Corona would also be a lot more than what we do now.
The one other thing I can think of is food stamps – making them easily accessible enough that we remove all barriers to getting them (probably at the cost of giving them to a lot of people who don’t really need them) also seems like it would easily pay for itself.