Fighting the Pandemic like South Korea

Korea rarely makes the headlines in the United States, and when it does it is usually on account of the threat posed by North Korea. COVID-19 has changed that. South Korea’s response to the pandemic and its success in “flattening the curve” received extensive media attention. I’m a Korean teaching American Politics in New York City—the current epicenter of COVID-19 in the US—and this perspective has made me realize just how much the US can learn from South Korea’s response.

A first lesson from South Korea is that access to healthcare is key. The Korean government introduced its social health insurance system in 1977 and achieved universal healthcare in 1989. This single-payer healthcare system financed through National Health Insurance covers the entire population of 50 million people. The government’s website indicates that the average Korean household paid $90 per month for healthcare in 2018. Nor does government pay exorbitantly for health care: per capita health expenditure by the Korean government is only one-third of that in the United States.

Lower costs do not mean worse care. There are few barriers to seeing a doctor in South Korea: any Korean can make an appointment quickly and visit any clinic or hospital. The universal healthcare system keeps health inequalities low, despite a sharp increase in income inequality since the Asian financial crisis of the late 1990s. The results speak for themselves: life expectancy in Korea is 5 years longer than in the United States.

Second, government structure matters. The United States has a federalist system, and South Korea has a powerful central government. Federalism is advantageous in the US given its size and heterogeneity across regions. But its structure creates cooperation problems when swift and coordinated actions across the states are required—such as when fighting COVID-19. States faced varying degrees of disease severity in the pandemic’s initial phases, causing starkly different actions by governors. The federal government’s response to urgent requests from the worst affected states—such as New York—has been criticized for being slow and inadequate, and states in need of medical equipment had to rely on donations from private companies and other states.

The situation is very different in South Korea.  There, the central government has strong power to allocate resources, and coordinated action between the central and provincial governments as well as hospitals and medical companies was swift. When Daegu and surrounding cities became the epicenter of the crisis, the government quickly declared the region a disaster area and channeled medical and government resources into the area to prevent the spread of the virus and minimize casualties. As a resident of New York, I wish the government had done the same here.

Third, government communication styles and the power of senior bureaucrats play important roles. Although a recent survey indicates that most Americans trust medical and health professionals, Democrats and Republicans sharply differ in what information about the pandemic they find trustworthy. In South Korea, trust in experts is generally high and the government communicates about the virus in ways that minimize potential damage from misinformation. Beginning in January, the senior bureaucrats overseeing the government responses have run daily briefings. Jung Eun-kyeong, director of the Center for Disease Control and Prevention, holds an MD and PhD in preventive medicine from Seoul National Medical School—the most prestigious institution in South Korea. Her briefings have provided accurate information regarding COVID-19 to the public, thereby preventing the misinformation that Koreans have received from other sources.

Fourth, bureaucratic quality matters, from top to bottom. In East Asian countries, working in civil services is one of the most respected career choices for ambitious young people. Bureaucrats are often graduates from top universities who survived highly competitive selection processes and fierce competition. In South Korea, the attractiveness of government employment has several roots: the culture is less hostile to experts than in the United States, after the Asian financial crisis government provided much-desired job security, and government has a lower gender wage gap than the private sector. These factors together lead to fierce competition: 30% of young Koreans who are looking for a job are preparing for a national civil service exam, with the lowest-ranked position drawing an astonishing 185,203 applicants for 4,985 slots in 2020. (Government jobs are so desirable that some worry that too few talented young people are entering the private sector.) The result of this intense competition for government jobs is that South Korea’s best and brightest are on the front lines of fighting the virus.

The United States is, of course, very different.  My undergraduate students at NYU do not aspire to become government bureaucrats. This is no surprise: government jobs pay far less than the private sector jobs that my students opt for instead, and there is widespread public mistrust—especially among those on the right—in those who devote their careers to government work.

These four differences between the United States and South Korea have high stakes. South Korea’s advantages are all on display in its massive testing programs and in its tracking the movements of infected individuals. This was possible thanks to a system of top-down control: lower-level bureaucrats in municipal governments capably implement policies formulated by experts in the national government. Citizens took seriously calls to self-quarantine, and trusted that municipal governments would provide food and other essential items to those who are self-quarantined—which is precisely what municipal governments did.

Adapting comparable massive testing and tracking procedures have been a challenge in the United States. Too few Americans—including, most significantly, the President—trust the experts who have the skills and knowledge to manage the crisis.  Even if the experts were fully empowered to fight the virus, they would be facing an uphill climb on account of Americans’  far spottier access to health care and the lack of coordination between federal, state, and local governments.

All this makes it odd—and profoundly sad—to be a Korean in New York City as the pandemic unfolds. South Korea and the US confirmed their first cases of COVID-19 on the same day: January 20. But while Seoul, the capital of South Korea, has witnessed only one death from COVID-19 (a man with a pre-existing condition), New York City has witnessed over three thousand deaths as of this writing. Seoul is larger than New York City by over a million people.

Americans have much to teach the rest of the world. After all, I first came to the United States as a student to take advantage of the world-class higher education available here. But as a political scientist, it is clear that America’s government structure and political culture are costing American lives. Those structures and cultures cannot and should not change overnight. But in fighting the virus, Americans would be wise to take a page from the South Korean playbook.

Hye Young You is an Assistant Professor in the Wilf Family Department of Politics at New York University.