"Green New Deal backers say they want more high-speed trains to make airline travel less necessary, and more electric cars and charging stations. But experts warn that changing the existing fleet of cars in the U.S. would be an extraordinary effort." -- NPR tweet, February 9, 2019
"Colonists say they want to throw off the yoke of royal tyranny and form a new nation founded on the principles of self-evident truths about equality and liberty. But experts warn that winning a revolution against England would be an extraordinary effort." -- 1776
"Abolitionists say they want to end slavery, America's original sin and an atrocity of untold depths and darkness. But experts warn that changing the economic model of southern agriculture would be an extraordinary effort." -- 1852
"New Deal backers say they want to rescue the nation from economic catastrophe and take steps to both prevent another one and mitigate the effects of another one should it occur. But experts warn that doing literally anything would be an extraordinary effort." -- 1932
"World War II backers say they want to stop the march of fascist tyranny that promises untold death and destruction and imperils the very notion of freedom and democracy. But experts warn that defeating Germany and Japan would be an extraordinary effort." -- 1941
"Civil Rights activists say they want to end a century of Jim Crow laws and extend Constitutional protections to everyone, not just whites. But experts warn that asking people not to discriminate and actually abide by the law would be an extraordinary effort." -- 1954
"President Kennedy says he wants to put a man on the moon in an effort to inspire a nation, prove its superiority to communist dictatorships and to open up a new frontier of scientific discovery and human imagination. But experts warn that landing a man on the moon would be an extraordinary effort." -- 1961
Doing anything that truly matters takes extraordinary effort. Aid in that effort. Help direct that effort if you genuinely feel that it is misguided in some important way. But don't sit the hell back and whine about doing something simply because it takes effort.
I am just as intrigued by autonomous vehicles as the next guy. Everything I've read about them suggests that they'll relieve congestion and improve safety, and I both hope and believe that to be true. Our roads are clogged and anything to unclog them -- and to improve efficiency, confer environmental benefits and cost savings compared to the current shape of our car-obsessed culture -- would be a good thing.
But while it's one thing to view autonomous vehicles as replacements for non-autonomous vehicles on existing roadways, it's another thing altogether to say that we should literally rip up existing mass transit tracks and fill the tunnels with them.
Oh yes, someone is saying that. Peter Wayner in The Atlantic, writing about how, rather than fix New York's aging, overtaxed and increasingly unreliable subway system, we replace it with autonomous vehicles:
The New York City subway is a miracle, especially at 3 a.m. on a Friday night. But the system is also falling apart, and it’s going to cost billions to keep the old trains running: $19 billion, at least according to one estimate from city planners. The time has come to give up on the 19th-century idea of public transportation, and leap for the autonomous future . . .
I'm less interested in the specific pros and cons of such a plan -- hey, we put a man on the moon, so why not a driverless Uber underneath Sixth Avenue? -- than I am in the assumptions and preferences which underlie it.
The premise of this idea -- one which has been astoundingly popular across the political spectrum over the past several decades -- is that it's simply unreasonable to expect our society to build and maintain great public works. That taxes are inherently bad and that raising them to provide goods and services for the well being of people is simply out of the question. It assumes, more specifically, that we simply cannot or should not fix New York's subway system because it's too hard. Too expensive. Not sexy. "Yes, the subway has been one of the marvels of the industrialized world for over a century," the article basically argues, "but it'll cost money and require work to maintain it so let's go with Project: Jetsons."
It's so very sad to see such a mindset. One which doesn't even attempt to push back, not even a little, against the mindless "government bad, taxes bad, private sector good" dogma which has permeated public discourse since the 1980s. One that completely ignores not just the immediate and obvious benefits of public transit, but which doesn't even begin to comprehend the second, third and fourth-order impacts public transit has had, particularly in New York. The city, as we know it, would not exist without the subway system. One would think that grappling with that fact would be required before one talks about replacing it with a bunch of Teslas in a tube.
It's also worth noting that this cars-on-the-7-line idea is intended to be operated by private companies on a for-profit basis. The article talks about how such an idea would take New York back to its roots, noting that the subway system was once a patchwork of private companies (the IRT and BMT, etc.) and public entities (the city-run IND) running competing lines. It might be useful for the author to note, however, that that system ended in the 1940s, with the city taking over and eventually creating a public transit authority to run it all, because the private companies had little interest in cooperating or serving the public effectively. Put simply: private ownership of public transit simply didn't work.
Any transit idea, however fun and futuristic it sounds, that does not appreciate the shortcomings private sector solutions have historically had when attempting to confront large scale public needs is fatally flawed. Any plan which does not appreciate the negative social, economic and even democratic impacts of a private, profit-driven system organized around individually-tailored and custom-priced trips, as opposed to moving masses of people along common corridors, is either hopelessly naive or intentionally tailored to sew inequality.
Most countries treat mass transit systems as national assets. They openly acknowledge the fact that public works require public investment in the form of tax dollars in order to deliver goods people want and need. They do not apologize for it, fetishize private investment or bend over backwards to invent crazy new systems from whole cloth when a near-perfect model -- time-tested and, however worse for wear these days, historically reliable -- is already in place. They do not act like it is a bad thing for people, through governmental authority, to build things via collective action. They recognize that public works are not, first and foremost, aimed at profit-generation, and for that reason they cannot, by definition, be the responsibility of those in the business, first and foremost, of profit-creation. For that reason, their transit systems tend to be far more useful and far better run than ours do.
We should fix the existing subways and build new ones where they are needed. We should build on what has worked in the past and fix that which is not working now. We must dispense with the idea that we can somehow disrupt our way out of having to pay for, build and maintain the sorts of large-scale public works which benefit society via public means.
We must, above all else, acknowledge that when it comes to building a civilization, there are no shortcuts.
Once when I was a little boy, a lightbulb burned out in a lamp in our house. As my dad changed the lightbulb I asked him why they don't make lightbulbs that last forever. He said, "if they did that, the people who make lightbulbs wouldn't make any money."
I didn't think too hard about that answer at the time, but I thought about it right after I read this story from Tae Kim at CNBC, about something a Goldman Sachs analyst wrote in a report to biotech company executives last week.
The report, entitled "The Genome Revolution," asks, "is curing patients a sustainable business model?" The answer is no, at least not in the long run:
"The potential to deliver 'one shot cures' is one of the most attractive aspects of gene therapy, genetically-engineered cell therapy and gene editing. However, such treatments offer a very different outlook with regard to recurring revenue versus chronic therapies. While this proposition carries tremendous value for patients and society, it could represent a challenge for genome medicine developers looking for sustained cash flow."
"People would love a lightbulb that lasts forever," the report basically says, "and it would be great for society. But you would make less money if you made one of those." Except, instead of lightbulbs, it's cures for hepatitis of diabetes or what have you. The report goes on to outline ways these companies could make more money if they focus on chronic therapies rather then cures, not because it's better for the world, but because it's better for the bottom line.
The report hit the news the other day and since then I've seen a good amount of outrage about it on Twitter. It seems perverse to many that an analyst from an investment bank would tell biotech company executives that curing diseases is not as good for "sustained cash flow" as treating a recurring stream of customers who never are cured but always need expensive medical products.
Such outrage is misplaced. Or at least not sufficiently placed. We should not merely or even primarily be outraged at the Goldman Sachs analyst. What he said is completely true. That doesn't get him off the hook, of course, as "I was just doing what I was asked to do" is not, last I checked, a "get out of morality free" card, but that's not the end of the discussion. What's outrageous is that we willingly accept a medical system in which what he wrote in that report can be completely true. One in which "cash flow" rather than "tremendous value for patients and society" is the priority and in which those two things are at odds.
The medical establishment -- including providers, the pharmaceutical industry and biotech firms -- has long been caught in a fundamental dilemma between the need to cure and treat the sick and the pursuit of market-based wealth. These actors have improved and extended the life for millions of people through their products and services, yet the need to make entrepreneurial decisions is frequently at odds with the advancement of public health, particularly the health of the poor. Striking a balance between those allegedly equal imperatives is why biotech firms do things like hire Goldman Sachs analysts to tell them what to do. Well, that and putting the hard, moral and ethical calculations inherent in this dilemma in someone else's hands.
Motives aside, the lines of debate on this tend to break down between (a) pro-market actors arguing that, if not for the profit motive, biotech firms and pharmaceutical companies would not research and develop lifesaving cures and drugs; and (b) those who find profiting off of the lives and health of others to be immoral on the other. The former group tends to believe in the market like the devout believe in a god, believing that it will provide all that we need if we merely have sufficient faith. The latter group is often naive about what, exactly, motivates human beings to do anything.
The market is not just, of course. It creates "winners" and for there to be "winners" there must be "losers." In the context of people's lives and health, the existence of "losers" is obscene. Likewise, most people are not inherently altruistic. Depending on people to simply do the right thing, however noble, is misguided.
Typically at this point in the discussion someone will bring up Jonas Salk, who famously eschewed patenting the polio vaccine despite the fact he could have made billions of dollars if he had. When asked why he did this, Salk famously said that "the people" owned the patent and asked, rhetorically, "would you patent the sun?” Salk truly believed that, by the way. He considered his work to be a "moral commitment" -- his words -- and devoted the rest of his life to trying to make the world a better and healthier place when he could've spent it sitting on boards, hitting the lecture circuit and raking in boatloads of cash. I tend to think he's the exception, not the rule, when it comes to this sort of thinking.
Either way, it did not require someone as altruistic as Salk was for the polio vaccine to be developed. Salk's research, after all, was not free. It was funded by donations from The National Foundation for Infantile Paralysis -- the March of Dimes -- which represented a massive mobilization of the public, spurred on strongly by FDR and the federal government. Rather than R&D losses willingly taken in the hopes of future profits to help recoup those costs, the polio vaccine was financed on the front end by hundreds of millions of donations. As I said, Salk truly was an altruist, but it's also the case that if he had patented the vaccine, he'd be double-dipping in a sense. The public, in large part, had already paid for it, the work was done and then society benefitted, massively.
I will not pretend to have all of the answers about how to best structure our medical and public health system. I appreciate that innovators require incentives and funding to innovate and that depending on altruism to solve society's problems is unrealistic. I do not believe, however, that Goldman Sachs analysts are privy to the only means by which innovators can innovate and I do not believe that the market is as omnipotent as Goldman Sachs analysts believe, especially when it comes to public health, where the ultimate rewards are not and should not be financial ones.
Don't believe people when they tell you that taking the profit motive away from science that science will cease to exist. Don't believe them when they tell you that the market will provide optimal outcomes. We have plenty of counterexamples to both of these spurious assertions and we can do better than we are doing to deliver the goods which benefit humanity.