Freedom Wins

ABOUT THE AUTHORS 

Joel M. Zinberg, M.D., J.D. is the Director the Public Health and American Well-Being Initiative at Paragon Health Institute, and a senior fellow with the Competitive Enterprise Institute. A native New Yorker, he served as General Counsel and Senior Economist at the Council of Economic Advisers in the Executive Office of the President at the White House from 2017– 2019. Dr. Zinberg practiced general and oncologic surgery in New York for nearly 30 years at the Mount Sinai Hospital and Icahn School of Medicine, where he is an Associate Clinical Professor of Surgery. He has been involved with health policy issues and the interaction between law and medicine for his entire career. He taught for 10 years at Columbia Law School where he created a course on legal and policy issues in organ transplantation and wrote two book chapters on the subject. He has published in varied outlets such as JAMA, The Wall Street Journal, National Review, New York Post, City Journal, and the Bulletin of the American College of Surgeons. 

Brian C. Blase, PhD, is the president of Paragon Health Institute and directs Paragon’s Private Health Reform Initiative. He is also a visiting fellow at the Foundation of Government Accountability and the CEO of Blase Policy Strategies. From 2017 through 2019, he was a special assistant to the president for economic policy at the White House’s National Economic Council. He has a PhD in economics from George Mason University and publishes regularly in outlets such as The Wall Street Journal, New York Post, The Hill, Health Affairs, and Forbes. He lives in northern Florida with his wife and five children. 

Eric Sun is a research fellow at Paragon Health Institute and an assistant professor and Associate Division Chief in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University. He served as a senior economist for the White House Council of Economic Advisers from 2019 to 2020. His research interests focus on the opioid epidemic and the economics of physician behavior. In addition, as a practicing anesthesiologist, he also provides care for patients undergoing surgery. 

Casey B. Mulligan, PhD, is a Professor in Economics at the University of Chicago. Previously, he served as Chief Economist of the White House Council of Economic Advisers and as a visiting professor teaching public economics at Harvard University, Clemson University, and the Irving B. Harris Graduate School of Public Policy Studies at the University of Chicago. His research covers capital and labor taxation, the gender wage gap, health economics, Social Security, voting and the economics of aging. 

EXECUTIVE SUMMARY 

The COVID-19 pandemic led to government interventions into the social and economic structures of our society that were unprecedented in their severity and duration. The fact that different states and localities took different approaches to imposing these measures created an opportunity to determine whether these interventions improved health outcomes, what economic and social side effects the interventions caused, and whether the interventions influenced people’s decisions about where to live. 

This paper compares a quantitative measure of government interventions from the Oxford COVID-19 Government Response Tracker—a systematic collection of information on policy measures that governments have taken to combat COVID-19—to health, economic, and educational outcome measures in all 50 states and the District of Columbia. We use the Government Response Index, which is the Oxford researchers’ most comprehensive index. 

Our results show that more severe government interventions, as measured by the Oxford index, did not significantly improve health outcomes (age-adjusted and pre-existing-condition adjusted COVID mortality and all-cause excess mortality) in states that imposed them relative to states that imposed less restrictive measures. But the severity of the government response was strongly correlated with worse economic (increased unemployment and decreased GDP) and educational (days of in-person schooling) outcomes and with a worse overall COVID outcomes score that equally weighted the health, economic, and educational outcomes. 

We also used Census data on domestic migration to examine whether government pandemic measures affected state-to-state migration decisions. We compared the net change in migration into or out of states in the pandemic period between July 1, 2020, and June 30, 2022, with the migration patterns over five pre-pandemic years. There was a substantial increase in domestic migration during the pandemic compared to pre-pandemic trends. There was also a significant negative correlation between states’ government response measures and states’ net pandemic migration, suggesting that people fled states with more severe lockdowns and moved to states with less severe measures. 

A comparison of two populous states that took divergent approaches to government pandemic measures—Florida and California—exemplifies the impact of government measures. Florida relaxed lockdowns after a short time, resulting in a low Oxford COVID-19 Government Response Index score, whereas California imposed strict and prolonged lockdowns and had one of the highest index scores in the nation. Yet the two states had roughly equal health outcomes scores, suggesting little, if any, health benefit from California’s severe approach. But California suffered far worse economic and education outcomes. And both states had substantial increases in their pre-existing domestic migration patterns. 

California’s severe lockdowns seemed to elicit a jump in its already high out-migration, while Florida experienced a significant in-migration increase during the pandemic as compared with pre-pandemic trends. Florida’s commitment to keeping schools open was likely a significant factor in attracting people from around the country. 

This study confirms what multiple other studies have documented: Severe government measures did little to lower COVID-19 deaths or excess mortality from all causes. Indeed, government measures appear to have increased excess mortality from non-COVID health conditions. Yet the severity of these measures negatively affected economic performance as measured by unemployment and GDP and education as measured by access to in-person schooling. States such as Florida and countries such as Sweden that took more restrained approaches and focused protection efforts on the most medically vulnerable populations had superior economic and educational outcomes at little or no health cost. The evidence suggests that in future pandemics policymakers should avoid severe, prolonged, and generalized restrictions and instead carefully tailor government responses to specific disease threats, encouraging state and local governments to balance the health benefits against the economic, educational, health, and social costsof specific response measures.