“She’s not decent,” the Chief of Staff said at one point, almost rhetorically. The Chief of Staff was always more grounded than the others in the room, going home every night to a husband and two teenagers who had homework, acne, boyfriends. More important, she had a heartfelt desire to make the world better. Politics was a way of doing that, but not an end in itself. The Chief of Staff used the word “decent” in a way I had never heard it used before. To her, it was a binary measure of whether one was using government for good or for ill, regardless of ideology or intelligence or political circumstances. The Chief of Staff might meet with a right-wing legislator whose views were completely out of sync with her own, particularly on social issues, but she would return to the White House and say, “He’s decent.” She did not mean it in a begrudging or half-hearted way; it was a serious compliment. What she meant was that this person was intellectually honest and committed to making the world better, even if his or her definition of “better” was not one she shared.
Conversely, she might walk out of a meeting with a lawmaker or lobbyist—even those ostensibly “on her side”—and declare, “He’s not decent,” which meant this guy could not be trusted, or his motives were impure, or for some other reason this person had not come to Washington with the intention of making Americans better off.
The Speaker of the House was not “decent” in the eyes of the Chief of Staff, but come Monday she would be sitting in the Oval Office with us.
22.
MONDAY FELT LIKE SOMEONE TURNED UP ALL THE DIALS. Everything was going faster, bordering on panic for the first time. Because of time zone issues, the President had been up much of the night speaking on the phone with Asian and European leaders. At a “meeting before the meeting,” set up primarily so we could speak among ourselves before the Speaker arrived, the Chief of Staff briefed us on the calls. “It’s not good,” she said. “Most of the countries with meaningful stocks of Dormigen have some Capellaviridae issues of their own, or they’re convinced they might. They’re not going to ship Dormigen out of the country until they have a better sense of what’s going on. Honestly, I don’t blame them. The only countries with enough stock to close our gap are India and China.”
“It’s a shit show,” the President said. He looked paler than normal, with dark circles under his eyes. His body language suggested he really needed a nap. India and China, with over a billion people each, had enormous stocks of Dormigen. Meanwhile, neither country was seeing the same Capellaviridae trends that we were. Either one of them might be able to cover our shortfall.
But, as the Strategist cleverly put it, “India and China are the opposite of Latvia.” What he meant was that Latvia had offered up a paltry quantity of Dormigen as a gesture of solidarity and goodwill. The country was too small to do anything more. On the other hand, India and China were big enough to make all the difference, but the Dormigen donation would not be about solidarity or goodwill. Each was looking to exact a pound of flesh, or, more accurately, a metric ton. Our initial concern about India was that their Parliament would have to ratify the deal, making everything public. We had now reached a point where we could deal with the publicity if it would solve our shortage; our concern about bad publicity felt quaint. The problem was that India’s populist Prime Minister had thrown down a new roadblock. “He wants $100.4 billion,” the President explained wearily.
“My goodness,” the Secretary of Defense said, with a little whistle afterward.
“That’s an oddly precise number,” the Strategist said.
“The licensing deal,” the President said. His comment meant nothing to me, but the Chief of Staff and the Strategist both nodded in recognition. The Chief of Staff explained to the rest of us. Dormigen was still governed by a patent held by an American firm. The drug itself is strikingly cheap to produce. A lifesaving dose of Dormigen can be manufactured for less than the cost of a large cup of coffee. But that is not what the pills cost to buy—not even close. A full dosage was typically priced between five thousand and seven thousand dollars. The economists had no problem with such an extraordinary markup. The pills may cost just a few dollars to produce, but the intellectual property—the research and development that made this medical miracle possible—cost billions. Somehow the pharmaceutical company had to earn back that overhead. If we deprive them of huge profits now, we will not have blockbuster drugs in the future, the economists explained.
But a 250,000 percent markup? The ethicists were not so sure. Politicians in developing countries like India were apoplectic. Here was a drug that could transform their public health systems, potentially wiping out diseases ranging from tuberculosis to malaria for just a few dollars a pill. The U.S. patent holder had denied these poor countries the right to produce the drug without paying a hefty licensing fee. When the Indian Prime Minister had declared several years earlier that India would violate the patent and produce the drug without paying the licensing fee, the U.S. government had threatened to levy huge economic sanctions. The Indian Prime Minister accused the U.S. government of “going to bat for big pharma” (true). The President, who was in the Senate then, justified the huge licensing fee as “necessary to protect intellectual property and future innovation” (also true). In the end, the Indian government was granted a steeply discounted licensing fee to produce Dormigen, but the dispute obviously still rankled. The Congressional Budget Office had estimated that the economic sanctions threatened against India (but never implemented) would have cost the country $50.2 billion—exactly half what the Indian Prime Minister now was asking for the Dormigen doses.
“What a prick,” the President said.
“He’s got a point,” the Strategist said. “If you look at it from his perspective—”
“Yeah, I get it,” the President snapped. The Indian Prime Minister had been swept into power atop his party as a populist, railing against elites within the country and the perfidy of the “club of rich countries” beyond the borders. He had been a pain in the President’s side ever since. He backed out of several treaties, expelled a handful of U.S. diplomats, and even canceled the license that had allowed the U.S. Embassy to import liquor duty-free. The last one had delighted the Indian press because the U.S. Embassy was subsequently required to document all of its liquor imports in customs—right down to the vermouth—for public scrutiny. “Americans Drink Martinis as Indian Economy Stumbles,” one headline screamed.
“What about China?” the Secretary of Defense asked. His tone suggested he knew the answer would not be any better.
“Do you want the good news or the bad news?” the Chief of Staff asked.
“It’s all bad,” the President interjected.
“They’ll give us two million doses free,” the Chief of Staff explained.
“Nothing with the Chinese is ever free,” the Defense Secretary said.
“Of course not,” the Chief of Staff replied. “They will ship the doses tomorrow if the President cancels his trip to Australia.”
“That can’t happen, sir,” the Defense Secretary said quickly.
“I know that,” the President snapped. He was as ornery as I had seen him. Several of us looked to the Chief of Staff, who explained the geopolitics of what was going on. The administration had been working for months to reinvigorate an alliance of Pacific nations—Australia, Vietnam, the Philippines, South Korea, and a host of small countries—to push back against Chinese encroachment in the region. The President was scheduled to fly to Australia later in the week to sign the agreement. But it would not be just any flight. The U.S. Navy would be sailing the Sixth Fleet through international waters into the South China Sea—an area illegally claimed by China, according to the U.S. and its allies—where the President was going to land on an aircraft carrier. The leaders of the other nations would join him on the carrier, at which point they would all sign the agreement. It would be the clearest, boldest, and broadest effort to push back against China’s persistent encroachment in the region. “Am I even going to be able to make that trip?” the President asked.