Brazil gets 40% cut on AIDS drugs

Brad DeLong jbdelong at uclink.berkeley.edu
Wed Sep 5 12:27:39 PDT 2001



>Brad, I think this is more a political problem than an economic one.
>
>If you gave NIH/NIM an extra $50 billion a year and told them to come up
>with some life-saving drugs, I suspect they'd do an excellent job. If they
>licensed private manufacturers to make the drugs near cost, they would end
>up extremely cheap. And health insurance companies would be more than happy
>to pay for these cheap drugs. All of this would be no problem.
>
>But if Prof. J. Bradford DeLong walked into the campaign policy-development
>meeting of the next Democratic presidential nominee and pitched this idea, I
>think he would be met with embarrassed silence if not derisive jeers.
>
>Seth

Nonsense! There would not be silence at all.

Tom Kalil would point out that the only times when the DARPA made significant progress was when it was too small to be of interest to the High Bureaucrats of the Pentagon, and that something with $50 billion a year is much too politically salient to be an effective research organization. He would ask why I was taking Pentagon weapons development as a model for biomedical research.

Andrei Shleifer would not be there, but if he were he would point out that the Soviet Union poured a huge amount into research and development and got very little out of it, largely because of bureaucratic meddling. He would say that the only area in which Soviet science lived up to its potential was higher math and mathematical physics--and that only because none of the bureaucrats could understand anything other than that doing it was internationally prestigious.

Charles Schultze would point out that the U.S. political system simply cannot handle directing large amounts of money at product development of any kind--that East Asian and western European bureaucracies can semi-successfully run industrial policies but that we cannot--and that such a tremendous boost in NIH spending would mean that the direction of research would be decided not by the (imperfect) consumer market demand for drugs but by the (even more imperfect) negotiating skills of political and policy entrepreneurs like Ira Magaziner.

Robert Reich would argue that we need post-modern entrepreneurial forms of organization--that the NIH should be split into ten and set to work competing against itself for public funding--but that it was important that the incentive mechanisms set up to award funding to the post-modern post-big government entities avoid the flaws of bureaucratic groupthink and of market distortions.

Larry Summers would say that he has heard me say many things that have not been thought through, but that this is perhaps the champ: that we have run this social experiment three times over the past half century--U.S. science vs. Soviet science, the U.S. computer industry vs. NASA, and the U.S. pharmaceutical industry vs. Pentagon weapons development--all three times the flaws in the more market-oriented forms of organization have been dwarfed by the flaws in the more centrally-planned forms of organization, and that this three-fold failure of centralization should tell us something.

Central planning is good if you have one overarching clear goal--to build an A-bomb, to send Neil Armstrong to the moon, to electrify the Ukraine's cities, to build as many T-34c tanks as possible, even to harvest as much sugar as possible in a single year. Central planning is much less good if you have a number of goals, or if you are not clear on exactly what your goals are.

Lenin had no view of what a proper socio-economic organization would be other than to try to copy Ludendorff's war economy. But Lenin's ignorance is no excuse for keeping today's discussion of forms of organization on his--low--level.

Brad DeLong



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