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Illegal Immigrants Didn’t Break the Housing Market; Bad Policy Did

2025-11-17 20:19:06

In an interview, JD Vance claimed:

[H]ousing is way too expensive….because we flooded the country with 30 million illegal immigrants who were taking houses that ought by right go to American citizens.

I noted on Twitter that this framing reeks of socialist thinking, national socialist to be precise. A demand for the state to designate a privileged class that get special rights to scarce goods. Treating housing as a fixed stock to be allocated to a favored in-group while blaming an out-group for shortages is collectivist politics driven by grievance, not market reasoning. In short, grievance and entitlement, zero-sum thinking and central planning wrapped into one ugly bundle.

That criticism set people off. The first rebuttal was predictable “Ha ha, the economist forgot about supply and demand!”—a miss, because my point wasn’t about the mechanics of house-price growth but about Vance’s rhetoric: the collectivism and the cheap politics of blaming outsiders. The second rebuttal was that “America belongs to Americans” so of course illegal immigrants shouldn’t be allowed to buy homes.

The second objection is amusing because who is harmed most when a government bans immigrants from buying homes or deports a chunk of potential buyers? American home sellers. The way such bans “work” is by preventing sellers from accepting the highest bid. In effect, these policies are a tax on sellers combined with a subsidy to a subset of buyers.

So bans on foreign buyers are really about taxing some Americans and subsidizing others. Moreover, although the economic logic of illegals pushing up demand is sound, the numbers don’t add up to much. First, there aren’t 30 million illegals; the best estimates are roughly 14 million. And second illegals are obviously not the reason homes blow past a million dollars in places like San Francisco, San Jose, Washington, or New York! The effect of illegal immigrant on house prices exists but is small—the bigger factors are native population growth, rising incomes, zoning rules, and strict limits on new construction. Block illegal immigrants from buying homes and you will get a pause in price growth, but once demand from natives keeps rising against a capped supply, prices will climb back to where they were.

That gets to the deeper problem with Vance’s style of thinking. If “fixing” housing scarcity means blaming whichever group is politically convenient, you end up cycling through targets: illegal immigrants first, then legal immigrants (as Canada has done), then the children of immigrants, then wealthy buyers, then racial or religious minorities. Indeed, one wonders if the blame is the goal.

If you actually want to solve the problem of housing scarcity, stop the scapegoating and start supporting the disliked people who are actually working to reduce scarcity: the developers. Loosen zoning and cut the rules that choke what can be built. Redirect political energy away from trying to demolish imagined enemies and instead build, baby, build.

Wise Words Addendum (hat tip G. Scott Shand):

There is a cultural movement in the white working class to blame problems on society or the government, and that movement gains adherents by the day….We’ll get fired for tardiness, or for stealing merchandise and selling it on eBay, or for having a customer complain about the smell of alcohol on our breath, or for taking five thirty-minute restroom breaks per shift. We talk about the value of hard work but tell ourselves that the reason we’re not working is some perceived unfairness: Obama shut down the coal mines, or all the jobs went to the Chinese. These are the lies we tell ourselves to solve the cognitive dissonance—the broken connection between the world we see and the values we preach.

The post Illegal Immigrants Didn’t Break the Housing Market; Bad Policy Did appeared first on Marginal REVOLUTION.

Why are US Clinical Trials so Expensive?

2025-11-16 20:16:42

Dave Ricks, CEO of Eli Lilly, speaking on the excellent Cheeky Pint Podcast (hosted by John Collison, sometimes joined by Patrick as in this episode) had the clearest discussion of why US clinical trial costs are so expensive that I have read.

One point is obvious once you hear it: Sponsors must provide high-end care to trial participants–thus because U.S. health care is expensive, US clinical trials are expensive. Clinical trial costs are lower in other countries because health care costs are lower in other countries but a surprising consequence is that it’s also easier to recruit patients in other countries because sponsors can offer them care that’s clearly better than what they normally receive. In the US, baseline care is already so good, at least at major hospital centers where you want to run clinical trials, that it’s more difficult to recruit patients. Add in IRB friction and other recruitment problems, and U.S. trial costs climb fast.

Patrick
I looked at the numbers. So, apparently the median clinical trial enrollee now costs $40,000. The median US wage is $60,000, so we’re talking two thirds. Why and why couldn’t it be a 10th or a hundredth of what it is?

David (00:10:50):
Yeah, brilliant question and one we’ve spent a lot of time working on…“Why does a trial cost so much?” Well, we’re taking the sickest slice of the healthcare system that are costing the most. And we’re ingesting them. We’re taking them out of the healthcare system and putting them in a clinical trial. Typically we pay for all care. So we are literally running the healthcare system for those individuals and that is in some ways for control, because you want to have the best standard of care so your experiment is properly conducted and it’s not just left to the whims of hundreds of individual doctors and people in Ireland versus the US getting different background therapies. So you standardize that, that costs money because sort of leveling up a lot of things, but then also in some ways you’re paying a premium to both get the treating physicians and have great care to get the patient. We don’t offer them remuneration, but they get great care and inducement to be in the study because you’re subjecting yourself quite often, not all the case, but to something other than the standard of care, either placebo or this. Or, in more specialized care, often it’s standard care plus X where X could actually be doing harm, not good. So people have to go into that in a blinded way and I guess the consideration is you’ll get the best care.

Patrick (00:12:51):
Of the $40,000. How much of that should I look at as inducement and encouragement for the patient and how much should I look at it as the cost of doing things given the regulatory apparatus that exists?

David (00:13:02):
The patient part is the level up part and I would say 20, 30% of the cost of studies typically would be this. So you’re buying the best standard of care, you’re not getting something less. That’s medicine costs, you’re getting more testing, you’re getting more visits, and then there is a premium that goes to institutions, not usually to the physician, the institution to pay for the time of everybody involved in it plus something. We read a lot about it in the NIH cuts, the 60% Harvard markup or whatever. There’s something like that in all clinical trials too. Overhead coverage, whatnot. But it’s paying for things that aren’t in the trial.

Patrick (00:13:40):
US healthcare is famously the most expensive in the world. Yes. Do you run trials outside the US?

David (00:13:44):
Yeah, actually most. I mean we want to actually do more in the US. This is a problem I think for our country. Take cancer care where you think, okay, what’s the one thing the US system’s really good at? If I had cancer, I’d come to the US, that’s definitely true. But only 4% of patients who have cancer in the US are in clinical trials. Whereas in Spain and Australia it’s over 25%.

And some of that is because they’ve optimized the system so it’s easier to run and then enroll, which I’d like to get to, people in the trials. But some of it is also that the background of care isn’t as good. So that level up inducement is better for the patient and the physician. Here, the standard’s pretty good, so people are like, “Do I want to do something where there’s extra visits and travel time?” There’s another problem in the US which is, we have really good standards of care but also quite different performing systems and we often want to place our trials in the best performing systems that are famous, like MD Anderson or the Brigham. And those are the most congested with trials and therefore they’re the slowest and most expensive. So there’s a bit of a competition for place that goes on as well.

But overall, I would say in our diabetes and cardiovascular trials, many, many more patients are in our trials outside the US than in and that really shouldn’t be other than cost of the system. And to some degree the tuning of the system, like I mentioned with Spain and Australia toward doing more clinical trials. For instance, here in the US, everywhere you get ethics clearance, we call it IRB. The US has a decentralized system, so you have to go to every system you’re doing a study in. Some countries like Australia have a single system, so you just have one stop and then the whole country is available to recruit those types of things.

Patrick (00:15:31):
You said you want to talk about enrollment?

David (00:15:32):
Yeah, yeah. It’s fascinating. So drug development time in the industry is about 10 years in the clinic, a little less right now. We’re running a little less than seven at Lilly, so that’s the optimization I spoke about. But actually, half of that seven is we have a protocol open, that means it’s an experiment we want to run. We have sites trained, they’re waiting for patients to walk in their door and to propose, “Would you like to be in the study?” But we don’t have enough people in the study. So you’re in the serial process, diffuse serial process, waiting for people to show up. You think, “Wow, that seems like we could do better than that. If Taylor Swift can sell at a concert in a few seconds, why can’t I fill an Alzheimer’s study? There seem to be lots of patients.” But that’s healthcare. It’s very tough. We’ve done some interesting things recently to work around that. One thing that’s an idea that partially works now is culling existing databases and contacting patients.

Patrick (00:16:27):
Proactive outreach.

See also Chertman and Teslo at IFP who have a lot of excellent material on clinical trial abundance.

Lots of other interesting material in this episode including how Eli Lilly Direct—driven largely by Zepbound—has quickly become a huge pharmacy. The direct-to-consumer model it represents could be highly productive as more drugs for preventing disease are developed. I am not as anti-PBM as Ricks and almost everyone in the industry are but I will leave that for another day.

Here is the Cheeky Pint Podcast main page.

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