Evolution Keeps Inventing Crabs (And So Does Medical Industrial Policy) : Operation Warp Speed & Japan's "Wasteful" MRIs

Like how everyone evolve into crabs, medical industrial policy ends up gaining similar set of traits

Evolution keeps inventing crabs.

Biologists call this carcinization: the tendency of crustaceans to independently evolve crab-like forms. King crabs aren’t true crabs. Neither are hermit crabs or porcelain crabs. They evolved from different ancestors at different times in different oceans, yet converged on the same body plan: claws, a hard shell (homegrown or secondhand), flattened carapace, reduced tail, legs optimized for walking.

Nature finds the crab shape over and over because it solves fundamental problems about living on the ocean floor. The form isn’t copied. It’s rediscovered.

Healthcare policy just did the same thing.

In 1961, Japan implemented universal health insurance with government-set prices and unrestricted equipment deployment. Goal: make healthcare affordable and accessible. Side effect: Now MRI scans cost $160-200 (with some hospitals even lower!), life expectancy reached 84.5 years, and a domestic medical imaging industry emerged.

In 2020, Operation Warp Speed guaranteed vaccine purchases before products existed, negotiated prices during development, and streamlined deployment. Goal: end the pandemic fast. Side effect: vaccines in under one year, domestic mRNA manufacturing capacity, proof that coordinated procurement works.

American health economists call Japan’s system “overutilization” and “supplier-induced demand.” They celebrate Operation Warp Speed as innovative emergency response.

They’re looking at the same organism and seeing different species.

Both systems converged on identical principles: guaranteed demand + price discipline + minimal barriers to deployment. Different origins, different goals, same solution. Like crabs, this policy form keeps getting rediscovered because it solves fundamental problems about translating medical innovation into population health.

Why do Americans abandon proven principles the moment COVID becomes endemic? And can we spot the same convergent evolution in policy failures, where different systems independently discover the same dysfunctions?

The Cancer Detection Paradox

Start with numbers that make no sense.

Japan has 57 MRI scanners per million people. America has 28 per million. Between 2005 and 2011, CT scanners increased 47% and MRI scanners 19% in Japan with no government restrictions. Small clinics compete by buying imaging equipment.

Every healthcare economics textbook says this should be catastrophic. Fee-for-service payment plus equipment proliferation equals spiraling costs, wasteful testing, worse outcomes. Certificate of Need laws exist in 35 U.S. statesspecifically to prevent this “overcapacity,” requiring government permission before hospitals can buy expensive equipment or add beds.

But Japan’s “wasteful” system produces MRI costs one-fifth of America’s ($160-200 vs $1,100-1,700), healthcare spending half of America’s (8.5% of GDP vs 17.6%), life expectancy 84.5 years versus 78.8, and the second-highest cancer survival rates globally.

This shouldn’t work. It does.

Cancer statistics reveal why. The 10-year survival rate for stage 1 stomach cancer in Japan is 80.4%. For stage 4: 6.0%. That 74-point gap isn’t about treatment quality. It’s about timing. Among Japanese lung cancer patients diagnosed in 2013, 38.6% were stage I at diagnosis. Their 3-year survival: 89%. Stage IV survival: 12.3%.

Small lung cancers under 2 cm increased from 23.4% of cases in 1994 to 39.0% in 2010, driven by widespread CT use.

The tradeoffs exist. Japanese physicians acknowledge that “clinicians have become indifferent to indications of imaging modalities and tend to rely on CT or MRI.” Japan’s estimated annual collective radiation dose from CT is 277,400 person-Sieverts, driven by physician workload, malpractice fears, and patient expectations. Defensive medicine is real. Some scans are unnecessary.

But the “wasteful” imaging catches cancer when surgery still works. Combined MRI and mammography screening in high-risk women produced cancer detection rates of 1.4% versus 0.5% for mammography alone. The MRI group had zero interval cancers (cancers appearing between screenings). The mammography-only group had nine.

MRI screening for hereditary breast cancer detected tumors significantly smaller and less likely to be node-positive than control groups. Most screening studies without MRI showed 30-45% positive nodes in high-risk women. With MRI: 21%.

Population-scale imaging access enables early detection. Early detection transforms survivability. The “overcapacity” is a cancer surveillance network operating at scale.

Which raises the real question: Why does this cost less rather than more?

When America Rediscovered the Crab

Operation Warp Speed did something American healthcare almost never does: eliminated market uncertainty through guaranteed demand.

OWS invested over $18 billion starting May 2020. Pfizer received a $2 billion order for 100 million doses before FDA authorization. Moderna got direct development funding. The government paid for factory expansion during clinical trials. Unprecedented financial risk that private capital wouldn’t take.

Companies built manufacturing capacity not knowing if their vaccines would work. Why? Guaranteed procurement eliminated downside risk.

Two vaccines received FDA emergency authorization in December 2020: Pfizer-BioNTech on December 11, Moderna on December 18. From virus sequencing to deployment: under one year.

The European contrast clarifies the mechanism. The European Commission spent months negotiating prices, achieved 24-45% lower costs than the U.S., but received almost no initial supply. Manufacturers prioritized countries guaranteeing payment. Price negotiation without procurement guarantees produced notional savings but actual shortages.

Critics argue this only works for emergencies because normal quality standards don’t apply. Wrong. FDA maintained safety standards throughout OWS. Emergency authorization compressed timelines by running trial phases in parallel and processing applications faster. Not lowering safety bars. The emergency revealed that standard timelines included significant slack.

The portfolio approach funded six vaccine candidates across three platform technologies: mRNA, viral vectors, protein subunits. Not picking one winner but de-risking multiple approaches simultaneously. Two became primary vaccines. The “waste” of funding four others bought speed insurance. When facing exponential pandemic growth, parallel development beats sequential optimization.

Guaranteed demand plus negotiated pricing plus parallel deployment plus portfolio risk management. Japan’s healthcare system uses the same structure, implemented continuously since 1961.

The Formula Both Systems Discovered

Both systems guarantee demand. Every Japanese resident must have health insurance by law since 1961. Patients don’t skip MRIs because of cost. Doctors don’t hesitate to order scans. Equipment runs at high utilization. OWS worked the same way. Government contracts guaranteed purchase of 100 million doses before vaccines existed. Make something that works and sales are certain.

When buyers commit to purchasing successful products, suppliers can invest in capacity without market risk. Private capital flows when government eliminates demand uncertainty.

This isn’t market distortion. It’s correcting for fragmentation that prevents coordination. Healthcare systematically violates conditions for efficient markets: multiple buyers can’t coordinate, information asymmetry is extreme, entry barriers are enormous, externalities are massive. The “natural” market delivers local monopolies with asymmetric information. Guaranteed universal coverage doesn’t distort. It enables coordination buyers couldn’t achieve individually.

Both systems enforce price discipline. The Ministry of Health, Labour and Welfare sets a nationwide fee schedule negotiated every two years. For diagnostic imaging, a fixed amount is paid per scan as technical fee, currently around $160 for an MRI. That’s not suggested pricing. That’s the only price. OWS negotiated prices during development, paying for both R&D and manufacturing scale-up. Moderna: $15-25 per dose. Pfizer: $19.50 initially. Clear pricing before deployment.

Single-payer or coordinated buying power prevents monopoly pricing. Manufacturers compete on efficiency and innovation, not price exploitation.

Some argue OWS paid premium prices compared to other countries. True. And America got supply when others didn’t. The “premium” bought domestic manufacturing capacity and priority delivery. Other countries negotiated lower prices but got rationed supply. The choice wasn’t between high and low prices. It was between paying enough to guarantee supply or saving money but getting vaccines months later during exponential pandemic growth.

Japan makes the opposite calculation: accept lower margins but guarantee massive volume. The tension is real. Japan’s aggressive price cuts over 20 consecutive years have contributed to drug shortages and “drug lag.” Only 40% of new molecular entities launched between 2010-2015 are available in Japan, versus 61% in the US. Japan’s share of the global pharmaceutical market declined from 12% in 2003 to 5.1% in 2022. Both approaches work better than fragmented American healthcare, where dispersed buyers have no negotiating power and no guaranteed volume, producing high prices AND supply uncertainty.

Both systems remove barriers to rapid deployment. Japan has no Certificate of Need laws restricting equipment acquisition. Any hospital or clinic can buy imaging equipment if they can fill appointment slots at $160 per scan. OWS used Emergency Use Authorizations to compress approval timelines while maintaining safety standards. Other Transaction Agreements replaced standard federal procurement contracts that normally take six months, closing deals in three weeks.

Regulatory barriers that protect incumbents prevent competition and innovation. Removing unnecessary restrictions while maintaining safety standards allows rapid scaling.

Certificate of Need laws emerged from legitimate concerns about healthcare arms races and duplicated services in the 1970s. The worry: competing hospitals would overbuild, duplicate expensive equipment, then spread fixed costs across fewer patients by increasing utilization. Some early evidence suggested this was happening.

But research consistently shows CON laws increase costs 10-15% while reducing access, especially in rural areas. One study found CON laws resulted in 50% fewer hospitals per 100,000 persons and 12% fewer beds. The concerns were real. The solution failed. Scarcity-driven pricing overwhelmed any efficiency gains from avoiding duplication. Japan and Singapore don’t use CON laws. Neither do most peer nations. Congress eliminated the federal CON mandate in 1986; fifteen states have since eliminated CONs entirely.

High guaranteed demand plus negotiated pricing plus minimal barriers equals manufacturers investing in capacity and competing on efficiency rather than rent-seeking.

The Valley of Death and How Guaranteed Procurement Bridges It

Medical innovation typically dies between lab proof-of-concept and commercial manufacturing. Biotech calls this the valley of death. New technology requires massive capital investment with uncertain returns. Private capital won’t fund risky scale-up. Technologies languish despite being transformative.

DARPA funded Moderna’s mRNA platform research since 2013 with $25 million. Moderna designed its COVID vaccine in two days after China published the virus sequence. But proven technology doesn’t automatically scale.

Dr. Dan Wattendorf, who led DARPA’s biotech office: “DARPA’s early investments de-risked the technical problem. But they didn’t solve the fundamental capital shift we needed.” The technology worked in the lab. No one would fund billion-dollar manufacturing facilities with uncertain demand.

OWS changed the calculation: guarantee purchase if the product works, and private capital flows. Manufacturers built factories during clinical trials because downside risk was eliminated.

Japan solves this continuously for medical equipment. When buying MRI machines from Siemens or GE, Americans pay about twice as much as Japanese for the exact same machine. Japan sets low prices; manufacturers lower their prices to access the Japanese market. They charge Americans more because American hospitals will pay more.

Manufacturers face a choice: miss the Japanese market entirely, or engineer machines profitable at Japanese price points. The guaranteed volume makes lower margins viable.

Toshiba (now Canon Medical) developed Japan’s first MRI system in 1982. Japanese manufacturers specialized in cost-effective, high-reliability scanners for high-volume use. Hitachi sold over 7,000 permanent magnet MRI systems globally, with operating costs about one-third of superconducting systems. Fujifilm acquired Hitachi’s imaging business for $1.6 billion in 2021.

Japanese companies don’t dominate globally. Siemens, GE, and Philips still command roughly 65% of MRI market share. But Japan created a domestic manufacturing base in affordable, efficient imaging equipment through market conditions where only cost-effective designs survive.

Similarly, SiO2 Materials Science received a $143 million OWS contract to produce advanced vials domestically. The company spent a decade developing glass-plastic hybrid vials that could handle ultracold mRNA storage. VCs typically don’t invest in manufacturing startups. Guaranteed procurement changed that. President Laurence Ganti: “Before Warp Speed I thought the government would only slow things down. I am shocked at speed of government.” The jobs pay $80,000 annually in rural Alabama.

Guaranteed procurement converts research breakthroughs into scaled manufacturing. Both systems independently evolved this mechanism.

Why The “Overutilization” Diagnosis Fails

American health economists look at Japan’s scanner density and diagnose waste. They miss that high volume enables low unit costs.

Imagine you’re a Japanese hospital administrator. An MRI machine costs $1.5 million. You can charge $160 per scan. That’s not negotiable. It’s the only price the government will pay. The math only works if you’re running dozens of scans daily. What kind of machine do you buy?

Private hospitals in Japan wholly depend on reimbursement revenue, so they must adopt cost-effective (low-field) machines. Hospitals with high-field machines can’t escape deficits in MRI operation. When reimbursement is capped at $160 per scan, the premium 3-Tesla systems American hospitals prefer make no economic sense.

Japanese hospitals need machines that are cheap to purchase, cheap to operate, reliable enough for high-volume use, and adequate for routine diagnostics. Market selection pressures manufacturers toward cost-effectiveness rather than premium features.

Equipment pays for itself through volume. Finding stage 1 cancer instead of stage 4 means 80% survival instead of 6%. For stage 4 stomach cancer, 10-year survival is 6.0%. If detected at stage 1 it rises to 80.4%. Downstream savings dwarf imaging costs.

Paying billions for vaccine development before knowing if products would work looked wasteful. Until vaccines arrived in under one year instead of 5-10 years. The “waste” was optimization under conditions of exponential threat growth.

Critics measure equipment per capita and procedure volumes. They should measure productive years of life saved. By that metric, Japan’s “overcapacity” is optimization and America’s “efficiency” is waste.

The Accidental Industrial Policy in Both Cases

Neither system was designed as industrial policy. Japan’s goal: healthcare access through universal coverage, cost control, and early disease detection. OWS goal: end pandemic fast through rapid vaccine development.

But both created conditions for domestic manufacturing. Universal coverage guarantees demand in Japan; purchase commitments before product approval did the same for OWS. Unrestricted equipment deployment in Japan generates volume; building multiple factories simultaneously did the same for vaccines. Fee schedules negotiated every two years force cost innovation in Japan; negotiated pricing during development did the same for OWS. High utilization generates population-scale data in Japan; monitoring vaccine effectiveness across millions of doses served the same function for OWS.

Japan established the Japan Medical Image Database (J-MID) in 2018, containing CT and MRI scans from major university hospitals. Transformed to cloud infrastructure in 2023, J-MID now contains approximately 500 million images. Population-scale data enables AI-driven diagnostic improvements. Small-sample experiments can’t generate this.

OWS demonstrated the same principle. Continuous monitoring of vaccine effectiveness across millions of doses enabled rapid detection of rare side effects and optimization of dosing strategies.

The manufacturing base emerged as side effect. When hundreds of hospitals need profitable operation at $160 per scan, manufacturers meet that price point or lose the market. When government guarantees vaccine purchases, manufacturers build domestic capacity or miss the opportunity.

Convergent evolution doesn’t require conscious design. Selective pressures produce similar forms independently.

Convergent Evolution Also Produces Dysfunction

The same forces that independently produce successful policy forms also produce failed ones. America and Japan haven’t just converged on what works. They’ve converged on predictable failures.

83% of public hospitals in Japan operated at a deficit in fiscal 2024, with combined losses of ¥395.2 billion. This isn’t unique to Japan. Healthcare expenditures are projected to reach ¥89 trillion by 2040, 1.6 times current levels, creating a ¥27 trillion funding gap without tax increases. American hospitals face the same dynamic through different mechanisms: Certificate of Need laws create artificial scarcity, allowing incumbents to maintain monopolies while extracting rents. High prices, poor access, and hospitals that still go bankrupt when pandemics hit or populations shift.

Different causes. Same outcome. Convergent evolution toward financial instability.

Japanese physicians work 66.4 hours per week on average. A 2020 nationwide survey found 67.9% of resident physicians work over 60 hours/week, and 26.5% exceed 80 hours, the threshold for “karoshi” (death from overwork). American physicians face different pressures: administrative burden consumes 19% of hospital revenue navigating multiple payers, and physicians spend twice as much time on electronic health records as with patients. Japan extracts value from physician time through overwork. America extracts it through administrative complexity. Both systems independently discovered how to burn out their medical workforce.

Japan’s aggressive price cuts discourage drug development. America’s fragmented system produces monopoly pricing. Japan’s share of the global pharmaceutical market declined from 12% in 2003 to 5.1% in 2022. America’s prices are roughly double Japan’s for the same drugs, yet Americans contribute an estimated 78% of OECD profits from pharmaceuticals, essentially financing drug development for the world through monopoly rents. Neither system effectively translates high investment into accessible innovation. Both converged on extractive models that fail patients.

Policy convergence isn’t just about successes. Different political economies, constrained by similar pressures, independently evolve toward similar dysfunctions. Japan’s fiscal discipline produces hospital deficits and physician exhaustion. America’s market fragmentation produces administrative waste and monopoly pricing. The mechanisms differ. The failure modes converge.

Japan’s Response: Facing the Hidden Costs

Japan recognizes the stress points. Since April 2024, the country has implemented comprehensive physician work hour reforms capping annual overtime at 960 hours for most physicians, with special circumstances allowing up to 1,860 hours. Still far above the “karoshi line” of 80 hours monthly, but progress. Early data shows results: among pediatricians, those working ≥60 hours/week dropped from 51.7% in 2020 to 31.0% in 2024, and those exceeding 80 hours/week fell from 14.4% to 4.9%.

The pharmaceutical challenge presents a more interesting puzzle. Japan’s response, the 2024 drug pricing reforms, follows conventional wisdom: create new premiums for “early introduction” of innovative drugs, expand “usefulness premiums,” abolish company criteria that disadvantaged biotech firms, and provide stronger price protection for pediatric drugs. The goal: eliminate drug lag by making Japan more financially attractive to pharmaceutical companies.

This misses the lesson from Japan’s own success, especially as the fact that China is taking a more “industrial policy” approach.

Japan doesn’t need American drug prices. It needs the MRI approach applied to pharmaceuticals.

Consider the contradiction: Japan solved imaging equipment costs through guaranteed demand plus price discipline plus unrestricted deployment. This created a domestic manufacturing base in cost-effective imaging. The system works because manufacturers compete on efficiency rather than monopoly rents.

But for pharmaceuticals, Japan is moving away from this model. Trying to raise prices through premiums and protections rather than applying guaranteed procurement logic. The pharmaceutical industry explicitly demands this: “exclude innovative medicines from actual market price-based revisions during the patent period.”

This is backwards.

Apply Operation Warp Speed logic to pharmaceutical innovation instead. Guarantee procurement of domestically-developed pharmaceuticals that meet efficacy thresholds. Fund parallel development of multiple approaches to the same disease target. Create committed purchase agreements for biotech startups developing innovative therapies. Maintain price discipline while eliminating market uncertainty.

The guaranteed demand would solve the drug lag. Not by matching American prices, but by de-risking investment the way OWS did. Japanese biotech firms would know: develop an effective therapy and the domestic market is guaranteed. Foreign firms would include Japan in early trials not because prices are high, but because guaranteed procurement at reasonable prices beats the uncertainty of American fragmentation.

Hospital financial deficits and physician burnout are being addressed through direct interventions: work hour caps, staffing requirements, financial reforms. These are tractable problems with known solutions.

But pharmaceutical policy represents a fork in the road: Japan can either abandon its successful model by raising prices toward American levels, or it can double down on guaranteed procurement plus price discipline as the solution to drug lag. The MRI approach worked. The OWS approach worked. The question is whether Japan recognizes its own success.

The American Political Paradox: Both Parties Abandon OWS

America, meanwhile, has orphaned its own proof of concept.

Operation Warp Speed produced vaccines in under one year. Trump once called it “one of the greatest achievements ever.” But during the 2024 campaign, he barely mentioned it. In a June 2023 Fox News interview, Trump explained: “I really don’t want to talk about it because, as a Republican, it’s not a great thing to talk about, because for some reason it’s just not.” Governor DeSantis distinguished himself as a vaccine skeptic. Trump was reduced to defensively noting DeSantis had initially supported vaccines.

Democrats haven’t championed OWS either. Despite “progressive enthusiasm for Covid vaccines, there’s been no effort to systematize or institutionalize the successes of Operation Warp Speed,” writes Noah Smith. Vaccine development for new COVID variants remains slow. Next-generation coronavirus vaccines get no fast-track funding. The organizational capabilities that produced vaccines in under a year have dissolved.

The most successful American industrial policy intervention in decades has no political constituency.

Simultaneously, Trump’s administration is allowing the enhanced Affordable Care Act subsidies to expire at the end of 2025. These subsidies (passed during COVID and extended in 2022) cover 22 million Americans. Without them, average premiums will rise from $888 to $1,904 annually. About 80% of subsidy beneficiaries live in states Trump won. The Congressional Budget Office estimates 4 million people will become uninsured.

Yet Republicans largely oppose extending the subsidies, with conservative groups arguing they “exacerbate rising health care costs.” Polls show 78% of Americans, including majorities of Republicans and MAGA supporters, support extending them. The political response is a shutdown that ended for a promise for a vote on subsides (no guarantees). If the vote happens, it will fail. The policy is popular, except with political leadership apparently. The beneficiaries are mostly Trump voters. The subsidies are ending anyway.

Proven interventions that work become politically radioactive. OWS demonstrated guaranteed procurement works. Both parties ignore it. Enhanced ACA subsidies expanded coverage to 24 million people. They’re expiring. The principles that Japan applies continuously, America abandons the moment emergencies end.

Concentrated interests benefit from fragmentation. Insurance companies, hospital systems, pharmaceutical manufacturers, and device makers extract rents from dysfunction. Insurers consume $16 of every $100 in administrative overhead, but under medical-loss-ratio rules, higher provider costs mean higher allowable insurer profits. They don’t want to control costs. They want costs to rise while they capture their percentage. Certificate of Need laws increase costs 10-15%, but incumbent hospitals defend their monopolies. Diffuse costs, concentrated benefits.

OWS succeeded partly because pandemic urgency overwhelmed these barriers. The organizational structure resembled a pharmaceutical company without shareholders demanding short-term profits. Emergency enabled coordination that normal politics prevents.

But when COVID stopped being a declared emergency, proven principles became politically toxic. Republicans can’t champion vaccines without alienating the base. Democrats won’t systematize OWS’s industrial policy, preferring the old ineffective system that came before. Both parties would rather Americans pay double and die younger than acknowledge the other side proved guaranteed procurement works.

This too is convergent evolution, toward political dysfunction. Different constraints, same failure mode. Japan’s challenge is applying its successful model to pharmaceuticals. America’s challenge is applying any model continuously rather than only during declared emergencies.

What the Crab Form Tells Us About Policy

Healthcare policy keeps discovering guaranteed procurement plus price discipline plus deployment freedom. The pattern holds across successes and failures.

Successes converge on guaranteed demand eliminating market uncertainty, price discipline preventing monopoly rents, minimal deployment barriers enabling rapid scaling, and portfolio approaches managing risk. Failures converge on hospital financial instability through different mechanisms, physician burnout through different extraction methods, pharmaceutical dysfunction through opposite pricing errors, and political economy favoring concentrated interests over diffuse benefits.

Japan produces 5-6 extra years of life at half America’s healthcare costs, with second-highest cancer survival rates globally. But it also struggles with hospital deficits, physician burnout at the “karoshi” threshold, and pharmaceutical drug lag. Japan is responding: work hour reforms cut extreme physician overwork, and 2024 pharmaceutical pricing reforms target the drug lag.

But Japan’s pharmaceutical solution moves away from guaranteed procurement toward matching American prices. This abandons the very principles that made MRIs affordable. Japan should apply OWS logic to pharmaceuticals: guarantee procurement of effective therapies at disciplined prices rather than raising prices to American levels. The guaranteed demand would solve drug lag through de-risked investment, not monopoly rents.

America proved these principles work in 2020. Then both parties abandoned them. Trump barely mentions OWS during campaigns because “as a Republican, it’s not a great thing to talk about.” Democrats haven’t systematized its lessons. Enhanced ACA subsidies covering 22 million Americans are expiring despite 78% public support including Republican majorities.

The most successful American industrial policy intervention in decades has no political constituency. Concentrated interests benefit from fragmentation. Insurers extract $16 of every $100 while being financially incentivized not to control costs. CON laws increase costs 10-15%, but incumbent hospitals defend their monopolies. Americans pay double for worse outcomes because political economy rewards dysfunction.

The convergent form works. The evidence is clear. Japan’s healthcare spending as GDP percentage has remained relatively stable while costs rise in absolute terms. America’s 17.6% and rising. That’s the crisis.

Different selective pressures produce the same solution when it’s optimal. The question is whether either country can learn from its own successes. Japan must recognize that MRI logic solves pharmaceutical lag, not American price levels. America must acknowledge that OWS principles work continuously, not just during declared emergencies.

Evolution doesn’t care about intentions. It selects for what works. The question is whether political systems can sustain proven solutions once the immediate crisis passes, or whether it will take another emergency to force another temporary convergence.

Americans face ongoing emergencies: life expectancy 4 years shorter than peer nations, $1,145 average per MRI in 2018 versus $~160 in Japan, cancer survival rates lagging, healthcare consuming 17.6% of GDP heading toward 20%.

These kill more Americans annually than COVID-19 did in 2020. Somehow only COVID merited the efficiency of guaranteed procurement and coordinated action. The crab form works. We keep abandoning it. That’s the real convergent evolution, toward political systems that can’t sustain what works.