MIT Technology Review has a fascinating, if depressing, article looking at the slow to non-existent progress that has been made on communication assistance technology, especially communication assistance technology apps for things like iPads and phones. Some parents had a great dela of hope that a portable computer would be a gateway to easy communications for their disabled children. It has turned out, unsurprisingly, not to be the case. And the why it has turned out not to be the case ties directly, I think, into the significant shortage in generic cancer drugs. We have turned every aspect of our lives over to the market, even when the market is a poor mechanism for the task at hand.
According to the article, when the iPhone and iPad first came out, the makers of communication assistance technology reacted in horror. They were terrified that their industry was about to be destroyed and their patients left high and dry. Now, some of this was obviously a fear for their own businesses. Businesspeople are going to businesspeople. But a lot of it was based on genuine concern for the viability of the market space. The state of the art was abysmal and apparently still is. Companies had to produce their own hardware in order to be viable and hope that they could be prescribed by doctors and sold at inflated prices. Why? There was no real market for these devices. If people thought an app could replace them, then the bottom would fall out and when people realized that apps were not a cure all, there would be no one left to pick up the pieces.
There is simply not a real market for these devices. Oh, there are plenty of people who need this assistance, but in terms of a market space, there are too few people who need this specific kind of assistance, and too much variation within the population that does need to help, to really drive a healthy marketplace. But since all of our medical decisions are driven by markets, the makers of these devices and applications are left scrambling, trying to fit the square peg of patient need into the round hole of capitalist determinism. And so people go without, leading lives that are more enclosed and cut off than they need to be.
The generic cancer drug shortage has a similar cause. One plant in India failed its inspection so hard it had to be shut down. Unfortunately, because generic drugs are such a low margin business, there are very few manufacturers (and those low margins may have contributed to the truly egregious violations discovered) of these drugs. The plant in questions was responsible for producing at least half the of the world-wide supply. And so now we have to ration lifesaving medicine and people will die who would have survived. Why? Because of we insisted that the market was the way to deliver lifesaving generic drugs.
It makes no sense. Generic drugs, as mentioned, are a low margin, low profit business with no real incentives to join. The US government is going to spend 1.8 billion dollars on Biden’s cancer moonshot. And that is good! Cancer is bad! And we should be spending money to cure it. But maybe, just maybe, we could have spent some of that to build some plants to manufacture the generic cancer fighting drugs and sell them to hospitals at cost? Or, hell, given them away. The government does not need to turn a profit.
The same could be done with communication assistance devices/applications. The market is clearly incapable of advancing that field and serving the needs of that population. Instead of paying inflated insurance and Medicare/Medicaid prices for substandard material in the vain hope that the market will help these people, hire the technicians and scientists and let them go to town. It would be cheaper in the long run and almost certainly produce better results for more people.
Government intervention is no panacea. Nothing ever is when you are talking about human institutions. But it is long time past to understand that the market is not the solution for all of life’s ills. It is not, in fact, both a dessert topping and a floor wax. A couple of weeks before I wrote this, a bridge in Philadelphia collapsed, severing I-95, the major motor vehicle artery on the east coast. Original estimates for fixing it ran about two to six months. The mayor of Philly and the Secretary of Transportation were having none of that — they demanded better results and the road was opened in less than two weeks. The governor of California, faced with skyrocketing insulin costs, has put in motion plans for California to produce its own insulin. Better things are possible. We just have to decide to take control of our collective destiny and not leave everything to the market.
It’s really not that hard. We just need to recognize that sometimes we need a dessert toping, and sometimes we need a floor wax. And that those two things never come out of the same bottle.