Ezra Klein: belief

Transcript context

…Here’s a question from a reader, and I’m paraphrasing. “I can see why you would favor Obamacare and an abundance agenda because Obamacare throws a lot more resources at the healthcare sector in some ways. It did have Medicare cuts, but nonetheless, it’s not choking the sector. But if you favor an abundance agenda, can you then possibly favor single-payer health insurance through the government, which does tend to choke resources and stifle innovation?” I think it would depend on how you did the single-payer healthcare. Here, we should talk about — because it’s referenced glancingly in the book in a place where you and I differ — but the supervillain view that I hold and your view, which is that you should negotiate drug prices. I’ve always thought on that because I think in some ways, it’s a better toy example than single payer versus Obamacare. I think you want to take the amount of innovation you’re getting very, very, very seriously. I’ve written pieces about this, that I think if you’re going to do Medicare drug pricing at any kind of significant level, you want to be pairing that with a pretty significant agenda to make drug discovery much easier, to make testing much easier. A huge number of the choke points that make it hard to discover new pharmaceuticals — it’s not that if you could do it, you can’t make money off of it. It’s that it is very, very, very, very cumbersome to take flyers on these drugs. We could have had the GLP-1s decades ago, but there are a lot of reasons within the system that it would have been costly to try that out. Heidi Williams, who we both know, has some very, I think, good ideas for doing this. I think a huge failure of the way we talk about what we call healthcare reform, is, it’s always health insurance reform. We are extremely focused on the question, can somebody go in and afford the hospital bill — which is good, I want them to be able to afford the hospital bill — and not what is that hospital actually providing to them and what is it that we can put in place in the system at every level to make sure the pace of drug discovery and drug advancements is going really well. We spend some time in one of the chapters Derek wrote on the story of Operation Warp Speed. I always find two things really remarkable about that story. One is that they really did quite a bit under Donald Trump. It’s very unfortunate, I think, that both policy and structure of policy got disowned afterwards, but they did quite a bit to speed the ability to not just bring these things to research and to market, but the government was very active in there trying to figure out how to make sure supply constraints and secondary items like vials — because the vials need to be refrigerated and so on — that it wouldn’t retard the rollout. The government was acting in many ways in what Derek called a bottleneck detective. Months later, I was talking to some of the people who were working on trying to create pan-coronavirus vaccines. This doesn’t seem to have panned out, and I don’t know if it didn’t pan out exactly because they weren’t able to figure it out or because of what I’m about to say. This was still when COVID was very, very live in people’s minds. Here are these people working on a vaccine that could have genuinely ended the threat. gure it out or because of what I’m about to say. This was still when COVID was very, very live in people’s minds. Here are these people working on a vaccine that could have genuinely ended the threat. They described spending so much of their time, among other things, sourcing monkeys because they just could not find the monkeys they needed to test the vaccines on. That was one side of it. I thought the government was doing a good job on that with Operation Warp Speed. Then when it came out, because the government had done a lot for it, there was a very strong equity component in it. When that came out, it was not that the richest people were the only ones who could get COVID vaccines. If you were wealthy and connected, it was a bit easier for you, but the cost of that vaccine at the beginning was zero. It was zero for everybody in America. People could go, and they could get it in CVS. We really did pair an aggressive supply-side policy with an aggressive demand-side policy. I don’t think we do that enough. In my critique at least of my side of this, I think liberalism doesn’t do this enough. It will often ask, “How can we make it so people can afford something?” but not “How can we make sure there is enough of the thing? Also, “How can we make sure there is value in the thing that right now there isn’t because we haven’t done sufficient innovations?” The question of single payer and the system — it’s like, did you radically increase the number of medical residency slots? What kinds of things are you doing inside the innovation system and inside the way we bring devices and drugs to market? Then the point I think that you’re making, or that your reader is making, if you drive the price of things too far down, you are going to create shortages of them, and you are going to reduce the incentives to innovate in the future. You have to be very thoughtful and careful about that.…

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