I'm back

And better than ever?

This newsletter has been dormant for a few years while I took what I was calling a “sabbatical” at a large VC. It was fancy, but understandably a bit limiting for my writing — compliance rules exist for a reason. 

If you’ve been a long-term follower of this newsletter, you know that I started when I worked in healthcare policy in DC, continued while I worked at Thirty Madison, and largely ceased while at Andreessen Horowitz. All of these employers were gracious with letting me write, but it wasn’t the same as being independent. I’m excited to be able to write freely about anything, and I hope you’ll see that reflected in the quality of my posts.

I’m also turning on paid subscriptions because I put a lot of effort into these posts, and because I’d like to engage with this audience more. To that end, expect recurring paid posts (in addition to ongoing free content), and add-ons for paid subscribers.

Next up

Before I stopped writing, my topics had started to trend very logistics-heavy. That’s because I’m convinced at least 60% of current issues in healthcare trace back to a lack of state capacity. Poor access to care in rural areas? State capacity challenge. Not enough innovation in antibiotics? State capacity challenge. Pharmaceutical shortages? State capacity challenge.

I’ve been working on these topics, but in more staid venues than this newsletter.

If you haven’t already, check out my article on the national security implications of our pharma supply chains in American Affairs (excerpt below):

 By offshoring the majority of medications, including key antibiotics and cardiovascular drugs, U.S. policy has unintentionally created a major national security risk for civilians and servicemembers alike. As the United States and China increasingly define the other as an adversary, the creation of a resilient and transparent drug supply chain can no longer be an afterthought.

Much as the Strategic National Stockpile grew out of a worst-case scenario in the counterterrorism era, policymakers and regulators must reflect on the current worst-case scenario and act accordingly. If the United States and China were to enter a hot conflict, China could shut off the supply to a wide swath of critical medicines, making it impossible for American hospitals to continue functioning as normal.

I’m also in the early stages of leading a big project on supply chains — more to come there — and writing on the policies that might help us overcome these logistics challenges. If you’ve been a long-term follower of this newsletter, you might know that I spent a few years writing about healthcare at the American Economic Liberties Project, and I strongly believe there’s some combination of antitrust and abundance policies that are the key to American state capacity in healthcare and pharma.

All of that to say…I’m back! Expect more writing from me here. Let me know if you have any ideas for how I should spend my time. And in the meantime, here are a few articles from my archives that I’m particularly proud of:

State capacity

• A Shot in the Arm (American Prospect) — on government success in Covid vaccine development…and failure in distribution

• Dry ice and millions of secret chickens — on production of complex medications (like the then-new Covid vaccine) and when government should be involved

• The vaccine software is one giant 404 error — on the lack of user friendliness of software developed by government (read: consultants) and how the breakdown affected vaccine distribution

Supply chains

• A National Defense Strategy for Generic Drugs (American Affairs) — on our reliance on China for the vast majority of pharmaceutical precursor materials

• Advanced manufacturing in drug supply chains — on potential tech solutions to the ongoing disaster that is the U.S.’s pharma supply chain

• The weird world of pet meds — on how veterinary medications are artificially expensive and why it’s near-impossible to buy them outside of your vet’s office

Corporate power

• PSAOs, a middleman to handle middlemen — on the multi-layered world of pharmacy, and how independent pharmacies are always getting the short end of the stick (relatedly, my former colleague Matt Stoller wrote a good piece about corporate power and rural pharmacies in 2022)

• Private Equity Chases Ambulances (American Prospect) — on how ambulance services are frequently owned by PE, driving up prices

• The sun never sets on the UnitedHealth empire — outdated but still relevant, on how UHG is rolling up all aspects of healthcare with harm to patients