It is unnerving to know you are living in history. In the past decade, as words I’d first encountered in books erupted into my daily lexicon—words like fascism, global pandemic, and ecological disaster—then settled, with alarming speed, into the static of how things are, I have often felt dizzy and uncertain of how to live. I have felt, as the writer Eileen Chang once wrote, like my everyday life “is a little out of order, out of order to a terrifying degree.”

Sometimes I have consoled myself with what feels like the exceptionalism of our present instability. Has the pace of change—social, political, ecological, technological—ever moved with such hallucinatory, destructive intensity? But this consolation doesn’t reach the more urgent question: While I am being hurled into the scary future, what am I supposed to do about breakfast, and vacuuming, and laundry? When I feel caught like this, between the tidal tug of the times and the calls of my small but pressing life, reading a writer like Chang is what brings me true comfort.

Zhang Ailing, also known as Eileen Chang, became a literary wunderkind in her native Shanghai for her stylish and slyly observant stories of city love affairs and romances—“some of the trivial things that happen between men and women,” as she put it, with characteristic understatement—before falling into obscurity after the 1949 Revolution, when she and her work were no longer welcome in mainland China. She was later rediscovered by Taiwanese and Hong Kong readers.

The facts of her historical era serve a healthy dose of humility to my own sense of contemporary tumult: As Chang was coming of age, competing warlords were still trampling the grave of the Qing dynasty. China was fighting the invading Japanese while also embroiled in a civil war. Mao’s Communist rebels were marching steadily in the provinces, preparing to overturn everything. Elsewhere, World War II was raging. All of this historical noise flickers in the background of Chang’s writing—and if you look closely, informs its very core—but somehow, her eye remains determinedly trained on the individual human life, catching and examining those fluttering bits of reality that the tides of history threaten to wash away. A new edition of her early essays, Written on Water, translated by Andrew F. Jones (and edited by Jones and Nicole Huang), captures Chang’s irreverent voice and her stubborn everyday sensibility. This sensibility, powered by a modest humanism and formed by a subtle and heartbreaking discipline, has become my manual for surviving history.

In 1944, when Written on Water was first published, Shanghai was a city of commerce and fashion and unwilling political entanglement. China’s most cosmopolitan city because it was chopped up for foreign concessions after the first Opium War, Shanghai to this day has a reputation for “mean” and savvy people who know “how to fish in troubled waters,” as Chang wrote. Like many Shanghainese, Chang herself was a “traditional Chinese [person] tempered by the high pressure of modern life,” one of many “misshapen products” of a place where so many ideologies, cultures, and trends met and clashed and melded.

Her life, too, was misshapen by the wild instability of her time. In “Whispers,” Chang divulges that her father, once a favored aristocrat in the Qing dynasty court, was an opium addict who ruled dictatorially over his wife, concubines, and children. Once, he punished Chang by locking her in a room for months, refusing her medical treatment even when she got dysentery; only with the help of a servant did she escape that room, and that household, one “cold bitter” night. Her mother, a bourgeois woman who preferred all things European, left Chang with her father for years at a time while she traveled. Later, when Chang was a student at the University of Hong Kong, the arrival of Japanese bombers cut her studies short, forcing her to return to Shanghai. She was only in Hong Kong at all because the world war had made university in London an impossibility.

But what is captured in these essays is not Chang’s life so much as her way of living and seeing. These are dashes of vivid observation, sketches of whatever Chang happens to want to write about: movies, money, her friends’ favorite sayings. Take “On Carrots,” a two-paragraph transcription of a memory her aunt once recounted over a meal of turnip soup, about Granny feeding carrots to the pet cricket, which Chang thought a “stylish little essay.” Or “Under an Umbrella,” a bite-size riff on a rainy day that doubles as a parable about class. “Those who don’t have an umbrella press against those who do, squeezing beneath the edges of passing umbrellas to avoid the rain,” she writes. “But the water cascading from the umbrellas turns out to be worse than the rain itself and the people squeezed between umbrellas are soaked to the skin.” Her crisp moral? “When poor folks associate with the rich, they usually get soaked.”

Then there is the structurally fascinating “Epilogue: Days and Nights of China,” which follows the writer step by step on a walk to the vegetable market. Chang describes in fastidious detail the interesting people she passes on her way, as if transcribing one of the lively character drawings interspersed throughout the book (“a tangerine seller,” “a Taoist monk,” “a servant woman”). Then she goes home, writes a poem, and the essay—and the book—ends.

Written on Water evokes a lyric Chinese conception of ephemerality while also alluding to Keats (his gravestone reads “Whose name was writ in water”). As Huang writes in an afterword, the title came to Chang in English first. But for me, it can’t capture the barbed playfulness of the Chinese, 流言 (Liu Yan), which translates to “flowing words” but also means “gossip.” Indeed, Chang relished any occasion to take a “stealthy glance at one another’s private lives.” She declared, “The secrets of everyday life must be made public at least once a year.” She thought literature should “plainly sing in praise of the placid.” She preferred the “noise and clatter” of city streets to “rousing” symphonies. She wished historians would write more about “irrelevant trivialities.”

With this assertion, she opens “From the Ashes,” her account of the Battle of Hong Kong, Japan’s December 1941 attack on the then–British colony. In the essay, Chang recalls surviving weeks of shelling and unhappily volunteering as a makeshift nurse. But what she foregrounds is a string of almost devastatingly flippant observations: the “wealthy overseas Chinese” dorm mate who’d packed clothes for dances and dinner parties but didn’t know what to wear for a war; “hardy” Evelyn who stuffed herself with more rice than ever while rations ran out, and then got constipated; defiant Yanying—“the only one of my classmates who had any guts”—who left the basement to take a bath, singing even as a stray bullet shattered the window. These anecdotes are told with amusement and some gentle mocking, but also with admiration: Here are people who, in a literal war zone, insisted on the small pleasures of living.

Chang defended her trivial stories against those who might wish them more heroic. Ordinary people going about their lives, falling in love, and acting on petty fancies might not make a “monument to an era,” but, she wrote, “people are more straightforward and unguarded in love than they are in war or revolution.” Chang had no desire to write about “supermen,” who “are born of specific epochs.” Why, when the “eternal”—the grist of daily life that is the only true stability—was right there? She understood the contradiction in her belief: that although everyday life is fundamentally “precarious,” “subject at regular intervals to destruction,” it is also the material from which springs the truly human, and the divine. (Also: “Chest-pounding, wildly gesticulating heroes are annoying.”)

[Read: Great sex in the time of war]

I read in Chang’s determined apolitical gaze a transgressive, feminine ethos. For a great deal of history—and still, amazingly, today—men have shaped epochs, with their empires and conquests. Meanwhile, women have sustained the reality that is accrued in days: going to the market, mending garments, cooking and cleaning, carrying and caring for the people who are coming next. In “A Chronicle of Changing Clothes,” Chang documents the passing fashion fads—collars rising then disappearing, necklines going from square to round to heart-shaped—as “warlords came and went.” Chang loved clothes and designed many of her own. Fashion is decidedly trivial, and Chang’s interest in it is a powerful aspect of her “misshapen” morality, one way of insisting on something minorly meaningful in a world of constantly shifting values. Buffeted from place to place by war, Chang could control little of her external circumstances, but she could decide, every day, what to wear.

“Each of us lives inside our own clothes,” she writes. We live inside our clothes; we live inside our days. Imagined as a container for life itself, the vanities of fashion gain urgent moral significance. In this light, the dullness of menswear can be seen as a form of depravity: “If men were more interested in clothing,” Chang writes, they might be “a bit less inclined to use various schemes and stratagems to attract the attention and admiration of society and sacrifice the well-being of the nation and the people in the process of securing their own prestige.” Think of the uniforms of men like Steve Jobs or Mao Zedong, who preferred to preserve the energy it took to dress for accomplishing what Chang called “earth-shattering deeds.” Chang was already famous when she published this book, but she distances her writing from this epic realm, comparing herself instead to a child running home from school, eager to gab about everything she’s seen to any available adult.

Can seeing be an ethic, a way we choose to live? For Chang, it was also a way to continue living. To fix a gaze is also to find something—anything—to hold on to amid terror and chaos. In “Seeing With the Streets,” Chang teaches us how to see the reality that can be irrevocably disrupted by history. She walks through the city, observing the displays of shop windows, passing through the smoke and scents of street vendors, and noticing the usual people and things, before a military blockade brings her walk and day to a halt. Everyday life is eternal; in war, the eternal is in grave danger.

Behind Chang’s knowing irony, I hear a desperate urgency. I hear the rapt attention of someone who loves her world and sees that it is disappearing. I hear: What you treasure, however silly, might not be here tomorrow. Chang wrote like the devil was chasing her. It is as if she knew that when the era she lived in reached its culmination, there might no longer be a place for someone like her—a writer between nations, epochs, and ideologies—“in the barren wastes of the future.” “Hurry! Hurry!” she wrote. Hurry to capture reality, as closely as possible; hurry, hold on to it and keep it. Then you might have it for tomorrow, to turn over in your hand, for just a little pleasure, a little amusement, a little laugh, even after it is no longer real.

A preliminary analysis of the balloon by U.S. authorities showed that it included a combination of U.S.-made off-the-shelf equipment as well as sophisticated Chinese gear.

The balloon floated across the US early this year before being shot down off the South Carolina coast.

On the first day of class in the fall of 1924, Martha Lum walked into the Rosedale Consolidated School. The mission-style building had been built three years earlier for white students in Rosedale, Mississippi.

Martha was not a new student. This 9-year-old had attended the public school the previous year. But that was before Congress passed the Immigration Act of 1924, banning immigrants from Asia and inciting ever more anti-Asian racism inside the United States.

At the time, African Americans were fleeing the virulent racism of the Mississippi Delta in the Great Migration north and west. To replace them, white landowners were recruiting Chinese immigrants like Martha’s father, Gong Lum. But instead of picking cotton, many Chinese immigrants, like Gong and his wife, Katherine, opened up grocery stores, usually in Black neighborhoods, after being shut out of white neighborhoods.

At noon recess, Martha had a visitor. The school superintendent notified her that she had to leave the public school her family’s tax dollars supported, because “she was of Chinese descent, and not a member of the white or Caucasian race.” Martha was told she had to go to the district’s all-Black public school, which had older infrastructure and textbooks, comparatively overcrowded classrooms, and lower-paid teachers.

Gong Lum sued, appealing to the Fourteenth Amendment’s equal-protection clause. The case went all the way to the U.S. Supreme Court. All nine justices ruled in favor of school segregation, citing the “separate but equal” doctrine from 1896’s Plessy v. Ferguson decision.

[Imani Perry: Lessons from Black and Chinese relations in the Deep South]

“A child of Chinese blood, born in and a citizen of the United States, is not denied the equal protection of the law by being classed by the state among the colored races who are assigned to public schools separate from those provided for the whites when equal facilities for education are afforded to both classes,” the Court summarized in Gong Lum v. Rice on November 21, 1927.

A century from now, scholars of racism will look back at today’s Supreme Court decision on affirmative action the way we now look back at Gong Lum v. Rice—as a judicial decision based in legal fantasy. Then, the fantasy was that separate facilities for education afforded to the races were equal and that actions to desegregate them were unnecessary, if not harmful. Today, the fantasy is that regular college-admissions metrics are race-neutral and that affirmative action is unnecessary, if not harmful.

The Supreme Court has effectively outlawed affirmative action using two court cases brought on by Students for Fair Admissions (SFFA) against Harvard University and the University of North Carolina at Chapel Hill. Organized by a legal strategist named Edward Blum, SFFA filed suit on behalf of Asian American applicants to Harvard as well as white and Asian applicants to UNC to claim that their equal-protection rights were violated by affirmative action. Asian and white Americans are overrepresented in the student body at selective private and public colleges and universities that are well funded and have high graduation rates, but they are the victims?

This is indicative of a larger fantasy percolating throughout society: that white Americans, who, on average, stand at the more advantageous end of nearly every racial inequity, are the primary victims of racism. This fantasy is fueling the grievance campaigns of Donald Trump and Ron DeSantis. Americans who oppose affirmative action have been misled into believing that the regular admissions metrics are fair for everyone—and that affirmative action is unfair for white and Asian American applicants.

It is a fantasy that race is considered as an admissions factor only through affirmative action. But the Court endorsed SFFA’s call for “race neutral” admissions in higher education—effectively prohibiting a minor admissions metric such as affirmative action, which closes racial inequities in college admissions, while effectively permitting the major admissions metrics that have long led to racial inequities in college admissions. Against all evidence to the contrary, the Court claimed: “Race-neutral policies may thus achieve the same benefits of racial harmony and equality without … affirmative action policies.” The result of the Court’s decision: a normality of racial inequity. Again.

This is what the Court considers to be fair admissions for students, because the judges consider the major admissions metrics to be “race-neutral”—just as a century ago, the Court considered Mississippi public schools to be “separate but equal.”

Chief Justice John Roberts, in his majority opinion, recognized “the inherent folly of that approach” but doesn’t recognize the inherent folly of his “race neutral” approach.

History repeats sometimes without rhyming. “Race neutral” is the new “separate but equal.”

The Court today claimed, “Twenty years have passed since Grutter, with no end to race- based college admissions in sight.” In actuality, twenty years have passed, with no end to racial inequity in sight.

Black, Latino, and Indigenous students continue to be underrepresented at the top 100 selective public universities. After affirmative action was outlawed at public universities in California and Michigan in the 1990s, Black enrollment at the most selective schools dropped roughly 50 percent, in some years approaching early-1970s numbers. This lack of diversity harms both students of color and white students.

In its reply brief in the UNC case, SFFA argued that the University of California system enrolls “more underrepresented minorities today than they did under racial preferences,”  referencing the increase of Latino students at UC campuses from 1997 to 2019. But accounting for the increase in Latino students graduating from high school, those gains should be even larger. There’s a 23-point difference between the percentage of high-school graduates in California who are Latino and the percentage of those enrolled in the UC system.

Declines in racial representation and associated harms extend to graduate and professional programs. The UC system produced more Black and Latino medical doctors than the national average in the two decades before affirmative action was banned, and dropped well below the national average in the two decades after.

[Bertrand Cooper: The failure of affirmative action]

Underrepresentation of Black, Latino, and Indigenous students at the most coveted universities isn’t a new phenomenon, it isn’t a coincidence, and it isn’t because there is something deficient about those students or their parents or their cultures. Admissions metrics both historically and currently value qualities that say more about access to inherited resources and wealth— computers and counselors, coaches and tutors, college preparatory courses and test prep—than they do about students’ potential. And gaping racial inequities persist in access to each of those elements—as gaping as funding for those so-called equal schools in the segregated Mississippi Delta a century ago.

So what about class? Class-based or income-based interventions disproportionately help white students too, because their family’s low income is least likely to extend to their community and schools. Which is to say that low-income white Americans are far and away less likely than low-income Black and Latino Americans to live in densely impoverished neighborhoods and send their kids to poorly resourced public schools. Researchers find that 80 percent of low-income Black people and 75 percent of low-income Latino people reside in low-income communities, which tend to have lesser-resourced schools, compared with less than 50 percent of low-income white people. (Some Asian American ethnic groups are likely to be concentrated in low-income communities, while others are not; the data are not disaggregated to explore this.) Predominately white school districts, on average, receive $23 billion more than those serving the same number of students of color.

When admissions metrics value SAT, ACT, or other standardized-test scores, they predict not success in college or graduate school, but the wealth or income of the parents of the test takers. This affects applicants along racial lines, but in complex ways. Asian Americans, for example, have higher incomes than African Americans on average, but Asian Americans as a group have the highest income inequality of any racial group. So standardized tests advantage more affluent white Americans and Asian ethnic groups such as Chinese and Indian Americans while disadvantaging Black Americans, Latino Americans, Native Americans, and poorer Asian ethnic groups such as Burmese and Hmong Americans. But standardized tests, like these other admissions metrics, are “race neutral”?

Standardized tests mostly favor students with access to score-boosting test prep. A multibillion-dollar test-prep and tutoring industry was built on this widespread understanding. Companies that openly sell their ability to boost students’ scores are concentrated in immigrant and Asian American communities. But some Asian American ethnic groups, having lower incomes, have less access to high-priced test-prep courses.

Besides all of this, the tests themselves have racist origins. Eugenicists introduced standardized tests a century ago in the United States to prove the genetic intellectual superiority of wealthy white Anglo-Saxon men. These “experimental” tests would show “enormously significant racial differences in general intelligence, differences which cannot be wiped out by any scheme of mental culture,” the Stanford University psychologist and eugenicist Lewis Terman wrote in his 1916 book, The Measurement of Intelligence. Another eugenicist, the Princeton University psychologist Carl C. Brigham, created the SAT test in 1926. SAT originally stood for “Scholastic Aptitude Test,” aptitude meaning “natural ability to do something.”

Why are advocates spending millions to expand access to test prep when a more effective and just move is to ban the use of standardized tests in admissions? Such a ban would help not only Black, Native, and Latino students but also low-income white and Asian American students.

Some selective colleges that went test-optional during the pandemic welcomed some of their most racially and economically diverse classes, after receiving more applications than normal from students of color. For many students of color, standardized tests have been a barrier to applying, even before being a barrier to acceptance. Then again, even where colleges and universities, especially post-pandemic, have gone test-optional, we can reasonably assume or suspect that students who submit their scores are viewed more favorably.

When admissions committees at selective institutions value students whose parents and grandparents attended that institution, this legacy metric ends up giving preferential treatment to white applicants. Almost 70 percent of all legacy applicants for the classes of 2014–19 at Harvard were white.

College athletes are mostly white and wealthy—because most collegiate sports require resources to play at a high level. White college athletes make up 70 to 85 percent of athletes in most non-revenue-generating sports (with the only revenue-generating sports usually being men’s basketball and football). And student athletes, even ones who are not gaming the system, receive immense advantages in the admissions process, thus giving white applicants yet another metric by which they are the most likely to receive preferential treatment. Even Harvard explained as part of its defense that athletes had an advantage in admissions over nonathletes, which conferred a much greater advantage to white students over Asian American students than any supposed disadvantage that affirmative action might create. And white students benefit from their relatives being more likely to have the wealth to make major donations to highly selective institutions. And white students benefit from their parents being overrepresented on the faculty and staff at colleges and universities. Relatives of donors and children of college employees normally receive an admissions boost.

Putting this all together, one study found that 43 percent of white students admitted to Harvard were recruited athletes, legacy students, the children of faculty and staff, or on the dean’s interest list (as relatives of donors)—compared with only 16 percent of Black, Latino, and Asian American students. About 75 percent of white admitted students “would have been rejected” if they hadn’t been in those four categories, the study, published by the National Bureau of Economic Research, found.

While private and public universities tout “diversity” recruitment efforts, their standard recruitment strategies concentrate on high-income students who are predominantly white and Asian, at highly resourced schools, positioned to have higher grade point averages and test scores that raise college rankings. Public colleges and universities facing declines in state and federal funding actively recruit white and wealthy out-of-state students who pay higher fees. At many institutions, including a UC campus, “admission by exception,” a practice originally promoted as a means of expanding opportunities for disadvantaged groups, has been used to enroll international students with the resources to pay U.S. tuition fees.

Targeting international students of color to achieve greater diversity on campus disadvantages American students of color. Targeting students from families who can pay exorbitant out-of-state fees benefits white families, who have, on average, 10 times the household net worth of Black families.

Affirmative action attempted to compensate not just for these metrics that give preferential treatment to white students, but also for the legacy of racism in society. This legacy is so deep and wide that affirmative action has rightly been criticized as a superficial, Band-Aid solution. Still, it has been the only admissions policy that pushes against the deep advantages that white Americans receive in the other admissions metrics under the cover of “race neutral.”

[Issa Kohler-Hausmann: No one knows what ‘race neutral’ admissions looks like]

If anti-affirmative-action litigants and judges were really supportive of “race neutrality”—if they were really against “racial preferences”—then they would be going after regular admissions practices. But they are not, because the regular admissions metrics benefit white and wealthy students.

Litigants and judges continue to use Asian Americans as political footballs to maintain these racial preferences for white and wealthy students. Particularly in the Harvard case, SFFA’s Edward Blum used Asian plaintiffs to argue that affirmative action harms Asian American applicants. No evidence of such racist discrimination was found in the lower courts. According to an amicus brief filed by 1,241 social scientists, the so-called race-neutral admissions policy SFFA advocated for (which was just adopted by the highest Court) would actually harm Asian American applicants. It denies Asian American students the ability to express their full self in their applications, including experiences with racism, which can contextualize their academic achievements or struggles and counter racist ideas. This is especially the case with Hmong and Cambodian Americans, who have rates of poverty similar to or higher than those of Black Americans. Pacific Islander Americans have a higher rate of poverty than the average American.

Pitting Asian and Black Americans against each other is an age-old tactic. Martha Lum’s parents didn’t want to send their daughter to a “colored” school, because they knew that more resources could be found in the segregated white schools. Jim Crow in the Mississippi Delta a century ago motivated the Lums to reinforce anti-Black racism—just as some wealthy Asian American families bought into Blum’s argument for “race neutral” admissions to protect their own status. Yet “separate but equal” closed the school door on the Lums. “Race neutral” is doing the same. Which is why 38 Asian American organizations jointly filed an amicus brief to the Supreme Court in support of affirmative action at Harvard and UNC.

A century ago, around the time the Court stated that equal facilities for education were being afforded to both races, Mississippi spent $57.95 per white student compared with $8.86 per Black student in its segregated schools. This racial inequity in funding existed in states across the South: Alabama ($47.28 and $13.32), Florida ($61.29 and $18.58), Georgia ($42.12 and $9.95), North Carolina ($50.26 and $22.34), and South Carolina ($68.76 and $11.27). “Separate but equal” was a legal fantasy, meant to uphold racist efforts to maintain these racial inequities and strike down anti-racist efforts to close them.

Homer Plessy had sued for being kicked off the “whites only” train car in New Orleans in 1892. About four years later, the Court deployed the “separate but equal” doctrine to work around the Fourteenth Amendment’s equal-protection clause to defend the clearly unequal train cars and the exclusion of Black Americans like Plessy from better-equipped “whites only” cars. Later, the Court used the same doctrine to exclude Asian Americans like Martha Lum from better-equipped “whites only” schools.

The “separate but equal” doctrine was the Court’s stamp to defend the structure of racism. Just as Plessy v. Ferguson’s influence reached far beyond the railway industry more than a century ago, the fantasy of “race neutral” alternatives to affirmative action defends racism well beyond higher education. Evoking “race neutrality,” Justice Clarence Thomas recently dissented from the Supreme Court decision upholding a provision in the Voting Rights Act of 1965 that prohibits racist gerrymandering.  

Now that “racial neutrality” is the doctrine of the land, as “separate but equal” was a century ago, we need a new legal movement to expose its fantastical nature. It was nearly a century ago that civil-rights activists in the NAACP and other organizations were gearing up for a legal movement to expose the fantasy of “separate but equal.” In this new legal movement, defenders of affirmative action can no longer use the false framing of affirmative action as “race conscious” and the regular admissions metrics as “race neutral”—a framing that has been used at least since the Regents of the University of California v. Bakke decision in 1978, which limited the use of affirmative action. Racist and anti-racist is a more accurate framing than “race neutral” and “race conscious.”  

[From the September 2021 issue: This is the end of affirmative action]

Affirmative-action policies are anti-racist because they have been proved to reduce racial inequities, while many of the regular admissions metrics are racist because they maintain racial inequities. To frame policies as “race neutral” or “not racist” or “race blind” because they don’t have racial language—or because the policy makers deny a racist intent—is akin to framing Jim Crow’s grandfather clauses and poll taxes and literacy tests as “race neutral” and “not racist,” even as these policies systematically disenfranchised southern Black voters. Then again, the Supreme Court allowed these Jim Crow policies for decades on the basis that they were, to use today’s term, “race neutral.” Then again, voter-suppression policies today that target Black, Latino, and Indigenous voters have been allowed by a Supreme Court that deems them “race neutral.” Jim Crow lives in the guise of “racial neutrality.”

Everyone should know that the regular admission metrics are the racial problem, not affirmative action. Everyone knew that racial separation in New Orleans and later Rosedale, Mississippi, was not merely separation; it was segregation. And segregation, by definition, cannot be equal. Segregationist policies are racist policies. Racial inequities proved that then.

The Court stated in today’s ruling, “By 1950, the inevitable truth of the Fourteenth Amendment had thus begun to reemerge: Separate cannot be equal.” But it still does not want to acknowledge another inevitable truth of the Fourteenth Amendment that has emerged today: Race cannot be neutral.

Today, racial inequities prove that policies proclaimed to be “race neutral” are hardly neutral. Race, by definition, has never been neutral. In a multiracial United States with widespread racial inequities in wealth, health, and higher education, policies are not “race neutral.” Policies either expand or close existing racial inequities in college admissions and employment. The “race neutral” doctrine is upholding racist efforts to maintain racial inequities and striking down anti-racist efforts to close racial inequities.

Race, by definition, has never been blind. Even Justice John Harlan, who proclaimed, “Our Constitution is color-blind” in his dissent of Plessy v. Ferguson, prefaced that with this declaration: “The white race deems itself to be the dominant race in this country” and “it will continue to be for all time, if it remains true to its great heritage.”

In the actual world, the “color-blind” often see their color as superior, as Harlan did. In the actual world, an equal-protection clause in a constitution can be transfigured by legal fantasy yet again to protect racial inequity.

“Separate but equal” then. “Race neutral” now.

In 1919, Lu Xun, one of modern China’s most influential writers, wrote a short story about a down-on-his-luck Confucian scholar named Kong Yiji. Having failed to pass the imperial civil-service exams, Kong is unwilling to keep a regular job and sinks into poverty. The other villagers show no sympathy for his plight or respect for his learning: “His speech,” recounts the tale’s narrator, the wine-warmer at a tavern Kong frequents, “was so dusty with classical constructions you could hardly understand him.” The villagers taunt and abuse him until, at the story’s close, his legs having been broken in a beating he takes for stealing, Kong drags himself out of the tavern with his hands, never to be seen again.

More than a century later, China’s educated young people have found a special affinity for the unfortunate Kong Yiji. By the official count, one in five Chinese aged 16 to 24 is unemployed, the highest level on record. Their hard-earned college degrees have diminished in value as a result of both the economy’s halting recovery from strict COVID lockdowns and an ideologically driven crackdown on private enterprise. Many educated young people face a choice similar to Kong’s: take a job beneath their credentials or fail to pay the bills.

[Read: The moral hazard of dealing with China]

One commentator on social media compared his college education to “a pedestal I can’t get down from, much like Kong Yiji couldn’t get out of his ‘scholar’s robes.’” An essayist went so far as to blame China’s leader, Xi Jinping, for the distress of today’s Kong Yijis, dropping a reference to another famous fable: “The economy is in the toilet, and unemployment is severe,” the essay read. “Rather than make Kong Yiji take off his scholar’s gown, how about stripping the Emperor of his new clothes?”

Censors scrubbed that essay from the Chinese internet. But the proliferating expressions of empathy with Kong Yiji suggest a mood of disenchantment that is notable in contemporary China. One of the hallmarks of the reform era had been a boundless optimism: Tomorrow would always be better than today. And for the most part, it was. With the economy in hyperdrive, the opportunities ahead seemed limitless, while the emergence of new technologies and easier access to international travel and better education made life feel freer, even under an oppressive Communist security state. The Communist Party was able to capitalize on these good feelings to solidify its grip on the country and build a degree of local support.

But recent years have brought reasons for pessimism. The go-go years of China’s economic growth have come to an end, and with them, the easy gains in welfare and free-flowing jobs. Three years of Xi’s unforgiving “zero COVID” pandemic controls, which locked hundreds of millions into their homes or placed them under other restrictions, exposed the regime’s capacity for irrationality and brutality. Xi is sealing off any remaining crevices for free thought with a campaign to reassert ideological and social conformity with the party line—more accurately, his own line, known as Xi Jinping Thought. That effort has brought greater censorship, the suppression of private education, and even limits on playing video games.

How the Chinese people truly feel about Xi and his agenda is almost impossible to determine in the absence of a free press or freedom of speech. Yet some statistics offer clues. Take, for instance, interest in entrepreneurship. The greater confidence a person has in the future, the more likely he or she will probably be to embark on the risky venture of starting a business. Only a few years ago, young Chinese were eager to try their luck in this regard. Incubators popped up across the country to accommodate a wave of start-ups. Now that enthusiasm has waned. According to reports from Global Entrepreneurship Monitor, which tracks trends in start-ups worldwide, the proportion of adults engaged in starting new companies has fallen dramatically in China recently, from 15.5 percent in 2014 to only 6 percent last year.

The Chinese aren’t starting families either. By the government’s own tally, the number of babies born in China dropped by almost half from 2016 to 2022, to a mere 9.6 million among a populace of more than 1.4 billion. Interestingly, the dramatic decline began immediately after the government finally lifted its draconian population-control policy, which permitted most urban couples only one child. Nicholas Eberstadt, a demographics specialist at the American Enterprise Institute, writes that the nosedive in childbearing “signals deep disaffection with the bleak future the regime is engineering for its subjects” and “can be read as a landslide vote of no confidence in President Xi Jinping’s rule.”

Of course, Chinese birth rates have been meager for years, which is why the country’s population is shrinking. The demographic trend is common across East Asia, including in Japan and South Korea. But Eberstadt maintains that the scale and speed of China’s plunge are extraordinary in times of peace and relative stability.

[Read: China isn’t that strategic]

“These are developments that take a generation. These aren’t things that happen in six years,” he told me. In fact, Eberstadt struggled to find a period and place that has experienced an equivalent decline in modern times. The fall in births wasn’t as steep during the famine of China’s Great Leap Forward (1958–61), nor after the collapse of the Soviet Union. At the same time, the rate of first marriages in China has plummeted by more than half since 2013, the year Xi consolidated his power.

“I think it’s got to be a big shift in mentality,” Eberstadt said. “It’s a shift towards pessimism” and “not having confidence that it is a good time to get married and bring children into the world.”

Rising pessimism may also account for the number of Chinese fleeing their country. According to the United Nations Refugee Agency, more than 116,000 Chinese nationals were seeking asylum around the world at the end of 2022, a tenfold increase over the preceding decade.

Taken together, the statistics paint a picture of a society that is reluctant to invest in an uncertain future—one where many Chinese appear to be protesting with their wallets, wombs, and feet, and where the best and brightest see themselves in a literary character meant to symbolize irrelevancy.

Xi and his team haven’t shown much more concern than the hard-hearted villagers of Lu Xun’s story. An online post by the Communist Party Youth League and state broadcaster CCTV used the fate of Kong Yiji to scold the young and jobless as arrogant and lazy. Kong failed “because he couldn’t let go of the airs of a scholar and was unwilling to change his situation through labor,” the post lectured. Xi—who has said he opposes the “idleness-breeding trap of welfarism”—has told his nation’s struggling youth to learn to “eat bitterness.”

[Read: China’s big new idea]

If the public mood continues to sour, the Communist Party will likely resort to greater repression to assert its will and enforce its unpopular policies. Xi could also continue to turn to nationalist causes, such as unification with Taiwan or control of the South China Sea, to rally the public behind him, potentially making his regime a greater danger to regional stability.

The official reading of the story of Kong Yiji as a parable about the scholar’s arrogance is telling. In fact, Lu Xun wrote the story to critique Chinese society: The old traditions were fading into an unknown future, but, by Lu’s reckoning, neither China’s self-serving leaders nor its heartless villagers seemed to care. In the end, the people at the tavern forgot about Kong Yiji and just presumed he had died. Will Xi Jinping do the same?

The recent mutiny in Russia could make Chinese leader Xi Jinping think twice about launching a war in the Taiwan Strait or elsewhere.

On an empty patch of land in my hometown, a new economic order may be taking shape.

Growing up around Syracuse, New York, at the turn of this century had its share of joys: post-blizzard sledding, minor-league baseball games, chance sightings of Syracuse University basketball players at Wegmans. But the area’s best days seemed to be slipping ever further into the past. One major employer after another abandoned the area for leaner workforces and cheaper pastures abroad. To those of us coming of age then, the blaring signal was that if we wanted opportunity and security, we’d better get out. So many of us did—leaving home, and our families, for the “superstar” cities (in my case, New York) where the good-paying jobs were.

That story of decline and exodus was repeated in any number of cities and towns around the country during those years. It was driven in no small part by place-agnostic policy choices that let the “invisible hand” of the market pick where jobs would go. This led to concentrated growth in a few big cities, while regions like Central New York and much of the Midwest were relegated to stagnation or worse. It fostered animosity among the people who had been sold out, forging a ready-made constituency for Donald Trump and the politics of resentment.

[Ronald Brownstein: Bidenomics really is something new]

But perhaps that story is changing. In October, the semiconductor manufacturer Micron Technology announced that it will spend as much as $100 billion over the next 20 years to build a plant outside Syracuse. It’s an unheard-of amount of money for Central New York. The deal was sealed by last summer’s CHIPS and Science Act, a bipartisan $50 billion investment in American-made semiconductor chips. It is, to date, the biggest example of—and the biggest bet on—the Biden administration’s rediscovery of an old idea about the economy: that geography matters. This approach recognizes that when it comes to growth and opportunity, the question is not just how much, but where and for whom. If it succeeds in places like Syracuse, it could transform the American economic and political landscape.

An earlier era of government policy put Syracuse on the map. Nineteenth-century nation-builders such as Henry Clay pushed for an “American System” to support domestic industry and build connective infrastructure. The shining success was the Erie Canal, running from Albany to Buffalo, as upstate–New York schoolchildren still learn through field trips and song. Syracuse sat at its center and was soon transformed from empty swampland into a boomtown. The city grew into a full-fledged manufacturing hub by the 1900s, producing everything from automotive gears to steel to typewriters. The name of my hometown and Micron’s new base just north of Syracuse memorializes the area’s American System heritage: Clay, New York.

During the Great Depression, Syracuse was among the earliest beneficiaries of place-conscious New Deal policy. Then-Governor Franklin D. Roosevelt’s 1931 regional-relief legislation put hundreds of residents to work building a park and parkway along Onondaga Lake, on the city’s northwestern edge. (He would nationalize this type of initiative as president to support hard-hit places through programs such as the Works Progress Administration and the Tennessee Valley Authority.) In the 1940s, the parkway was essential for transporting workers to a massive new General Electric campus north of the city known as Electronics Park. GE joined the air-conditioner producer Carrier and other manufacturers to form the area’s economic backbone during the postwar boom.

That golden age came under strain in the 1970s. After decades of American industrial dominance, competitors in Europe and Japan began catching up. At the same time, Milton Friedman–style laissez-faire economics was on the rise. So was inflation. Policy makers prioritized national growth and low prices for consumer goods above all else and believed that the best way to achieve them was to get government out of the way. Where that growth took place and those consumer goods were produced was mostly irrelevant. The proceeds, it was claimed, would trickle down to everyone.

This combination of macroeconomic forces and policy choices bludgeoned industry in Syracuse. The GE plant started shifting jobs—including in semiconductor production—overseas during the ’70s. About 20 years after Ronald Reagan visited the Syracuse plant as a GE spokesman, the company closed operations there entirely during his presidency. Other companies followed suit, shedding thousands of jobs in the ’80s and ’90s. Then, after China was admitted into the World Trade Organization in 2001, with the United States’ support, a flood of cheap Chinese imports further undercut the local manufacturing base. In the biggest blow, Carrier moved production overseas in 2003, explaining that it could make air conditioners “three times cheaper in Asia.”

Deindustrialization left a void that Syracuse has struggled to fill. There are fewer private-sector jobs in the area today than there were in 2001. The city’s population fell for decades. It has one of the highest child-poverty rates in the nation. GE’s old Electronics Park campus, where 17,000 people once worked, is surrounded by a sprawl of mostly empty parking lots; its current tenants employ fewer than 3,000 people. Until last year, Carrier’s name still graced the university’s famed sports dome, two decades after the company last produced an air conditioner in Syracuse.

The dramatic rise in economic inequality in the U.S. since the 1980s is usually pictured in vertical terms, as a pulling-away of the top earners from everyone below. But the shift toward market fundamentalism also had drastic horizontal effects, creating a map of winners and losers. Merger-friendly regulators waved through corporate acquisitions that saw regional businesses gobbled up by large multinationals headquartered in coastal hubs. The Midwest was already seven years into a recession before the 2008 financial crisis. The few elite cities where job growth clustered, meanwhile, became crushingly expensive to live in. And a pandemic exposed the downsides of place-agnostic economics: Crises anywhere could snap supply chains and throttle economies everywhere.

In response, President Joe Biden’s administration has embraced industrial policy—that is, direct government support for particular domestic industries—through legislation investing in semiconductors, clean energy, and infrastructure. Crucially, but with less fanfare, the administration has also been designing these efforts to reverse decades of geographic redistribution. It aims to invest “in places and communities that risk being left behind,” as the White House economic adviser Heather Boushey said in a recent speech. Brookings Institution researchers identified $80 billion worth of place-based programs in Biden’s laws, with the CHIPS Act leading the pack.

[Read: Why the economic fates of America’s cities diverged]

“There is no doubt that without the CHIPS Act, we would not be here today,” Micron’s chief executive said upon announcing its Syracuse investment. Micron stands to reap billions from the act’s pot of money for new semiconductor plants and could collect even more from a separate investment tax credit. In exchange, the 20-year project is forecasted to directly create 9,000 good-paying jobs, generate another 40,000 jobs at local companies, and raise $17 billion in state tax revenue. Micron has also pledged to fund local child care, achieve net-zero emissions by 2050, and spend millions on other community investments. (New York mandated some of these commitments to unlock state subsidies, in part to avoid the kind of blowback that killed the Amazon HQ2 deal in Queens.)

Having been burned before by big promises of new industry that never materialized, many in Syracuse are taking a believe-it-when-we-see-it caution with Micron. But the economics of hope are already gaining visible momentum. Even before Micron breaks ground, the county is preparing for a house-building spree. Underused spaces are being targeted for residential and commercial development. Public transit is being expanded to get workers to and from Micron. Colleges are adding degrees and training programs to seed a semiconductor workforce. Local breweries are crafting semiconductor-inspired lagers.

Biden, who attended Syracuse University for law school, has been a vocal booster of the Micron project. Effective place-based economics may prove politically beneficial for him and the Democratic Party. In 2020, Biden drew support overwhelmingly from the most economically vibrant parts of the country. As opportunity has concentrated in fewer places, so too have the college-educated voters whom Democrats rely on. If more areas grow, the party’s electoral map may too.

Ultimately, Bidenomics will be judged by whether it actually delivers for the people and places that lost out under the old economic-policy consensus. From my adopted home 250 miles away, I’m watching Micron’s arrival with cautious optimism. Americans have long been lauded for our willingness to pick up and move, to “go west” toward new frontiers and opportunities. But maybe we shouldn’t have to. And maybe, in a few decades, we won’t. A generation from now, Syracuse may be churning out semiconductors like it once did televisions and air conditioners. Maybe more children will be able to envision a good middle-class life where their roots are—not just in Syracuse, but in places like Detroit, Columbus, northwestern Indiana, and more. The old order had too little use for too many places. We may be witnessing the birth of a new one that spreads possibility and meaning across more of America.

Alpine nation's main intelligence agency says at least a third of Russia's 220 accredited officials are probably spies.

This weekend’s tumultuous events showed just how big a gamble the Chinese leader Xi Jinping took by partnering with Moscow.

Russian President Vladimir Putin survived the rebellion that Yevgeny Prigozhin and his private army unleashed on Saturday. Perhaps Putin’s hold on power was never in great peril. Yet whether the incident is perceived as a mark of Putin’s weakness or of his resilience, it painted a picture of a Russia in deep decline, where a warlord can march on Moscow practically unchallenged, and where political fortunes can be unpredictable and even volatile.

Such is the country on which Xi has pinned many of his foreign-policy ambitions. Xi seems to have embraced Putin as an invaluable partner in his quest to push back American global power and reshape the world order in Beijing’s favor. That choice was always a risky one. By sticking with Putin when he invaded Ukraine last year, Xi was effectively trading ties to Europe for a closer bond to Russia, as his stance galvanized the allied democracies against him. Xi made his decision in the service of grander plans: The two dictators would make history. “Change is coming that hasn’t happened in 100 years. And we’re driving this change together,” Xi told Putin during their summit in Moscow in March.

Watching the rebellion unfold in Russia, one might imagine that Xi now feels that he bet on the wrong guy. Putin looks like a leader with a fair share of problems at home that will limit his ability to project significant influence abroad, and the drawn-out conflict in Ukraine has exposed the weaknesses of the Russian military.

[Read: How China is using Vladimir Putin]

But Xi has remained unmoved. The war, the reaction of the West—nothing so far has dissuaded him from tightening his ties to Putin. And though it is not easy to know the true thinking in China’s opaque halls of power, the rebellion doesn’t appear likely to change his mind either. If anything, it may further convince Xi of Putin’s importance as a bulwark against a destabilized Russia on his northern border. In a statement, China’s Foreign Ministry noted that “as Russia’s friendly neighbor and comprehensive strategic partner of coordination for the new era, China supports Russia in maintaining national stability.” A headline in the Global Times, a news outlet run by the Chinese Communist Party, called the notion that Putin has been weakened “‘wishful thinking’ of the West.”

At the same time, if in fact Putin has been weakened, Xi could stand to gain. Certainly, Xi has benefited already from the leverage Putin’s isolation affords China over Russia: Having torched his ties to the West, Putin has little choice but to deepen Russia’s reliance on China’s diplomatic support and trade—even its currency. That arrangement suits Xi just fine. And if the Wagner coup has weakened Putin still further, Xi can exert yet more influence over Russia’s economy and policy. Xi could use this authority to secure sources of energy and other raw materials from American interference and press Moscow to align its policies with Chinese interests.

Xi’s next moves regarding Russia will say a lot about the trajectory of China’s foreign policy. Continuing to stand by Putin will signal that Xi’s desire to undermine the power of the West remains paramount in his approach to the world and overrides even some pressing concerns at home. With China’s economy staggering and in need of Western investment and technology, Beijing has theoretically been seeking to repair its relations with Europe. But doing so will not be possible unless Xi ditches or at least greatly alters his relationship with Putin. Last week, Chinese Premier Li Qiang toured Europe, talking up the importance of continued engagement, but the European Commission, rather than embracing this outreach, released an economic-security strategy that aims to protect Europe’s interests against threats posed by China. In throwing his weight behind Putin, Xi will continue to damage relations with countries that have the wealth and influence to bolster China’s economic development and global stature in favor of advancing a partnership with a man and a nation that may no longer possess the power to help Xi achieve his goals.  

[Read: Taiwan prepares to be invaded]

The emphasis placed on partnership with Russia indicates just how dramatically Xi has reoriented the priorities of the Chinese government. Development was the prime concern for four decades, which meant that ties to the wealthy West had to take precedence. Now Xi is fixated on security, and he apparently believes—evidence aside—that Putin can help provide that security. The choice is a fateful one, with potentially severe consequences for China. But the Chinese political system has transformed into a one-man dictatorship that will stay on the course Xi sets, come rebellions, disastrous wars, or who knows what else.  

Lessons remain for Xi to learn from Putin’s weekend travails. The rebellion reflected the strain placed on an authoritarian regime by an unpopular and protracted war. If Xi is watching closely, he might see in this episode a warning of the domestic political vulnerabilities that could arise from a military grab for Taiwan. A war for Taiwan, like Russia’s invasion of Ukraine, could fail or prove long and costly—tempting rebellion, and making it another gamble for Xi to lose.

Last November, FDA inspectors found almost farcical conditions when they inspected an Indian manufacturing plant that supplies medical drugs to the United States. The plant, owned by Intas Pharmaceuticals, had hardly any working systems for ensuring the purity or sterility of its products. And its employees were trying to conceal evidence of these problems by shredding and hiding documents or, as one quality-control officer admitted, dousing them in acid.

Intas provided America with a lot of frontline chemotherapy drugs—half of the country’s supply in some cases—that are used to treat more than a dozen types of cancer. When the disastrous inspection led the company to halt production, other manufacturers couldn’t make up the difference. Hospitals are now reeling: In a recent survey, 93 percent of U.S. cancer centers said they were experiencing a shortage of the drug carboplatin, while 70 percent were low on another, cisplatin.

Even short delays in cancer treatment can increase a patient’s odds of death, and substitute medications may be less effective or more toxic, if they exist at all. Chemo drugs often run dry—“I can’t think of a year in the past 10 or 12 where we didn’t face some kind of shortage,” Yoram Unguru, a pediatric oncologist at the Herman & Walter Samuelson Children’s Hospital at Sinai, told me—but the current crisis is unprecedented in scale, for reasons that go beyond Intas’s woes. Fourteen cancer drugs are currently scarce, jeopardizing the care of hundreds of thousands of Americans. “I’ve been doing this forever, and this is absolute lunacy,” Patrick Timmins III, a gynecologic oncologist at Women’s Cancer Care Associates, told me.

By delivering drugs at lower doses or over longer intervals, most oncologists are still managing to treat most of their patients—but barely. “Patients often say to us, I just need a plan,” Eleonora Teplinsky, an oncologist at Valley Health System, told me, and the shortages riddle every plan with question marks. Some institutes have already been forced to ration care. Timmins no longer has enough cisplatin and carboplatin to treat patients with recurrent tumors, even though those drugs can improve one’s quality of life or offer decent odds of another remission. “A lot of people are going to be hurt,” he told me. “Lives will be shortened.” Such tragedies are especially galling because the drugs in shortage aren’t expensive, state-of-the-art treatments that patients might struggle to access anyway, but cheap ones that have existed for decades. “It’s just unfathomable that a patient wouldn’t be able to receive them,” Amanda Fader, a gynecologic oncologist at Johns Hopkins, told me.

Intas screwed up, but how could one manufacturer’s downfall trigger such widespread problems? The coronavirus pandemic made plain how reliant the U.S. is on brittle international supply chains, but this much-discussed fragility doesn’t explain the current shortages: Cancer drugs are not scarce for the same reasons that yeast, toilet paper, or couches were. They’re scarce because the market for some of our most important medicines—the ones that should be most accessible—is utterly dysfunctional, in a way that is both very hard to fix but also entirely fixable.

Many recent supply-chain problems were caused by an external force—a pandemic, a hurricane, a stuck ship—that throttled a product’s availability, leading to surging demand and dwindling stocks. But most cancer-drug shortages are caused by internally generated problems, created within the market because of its structure. In other words, “they’re self-inflicted wounds,” Marta Wosińska, a health-care economist at the Brookings Institution, told me.

Generic drugs such as cisplatin are sold at extremely low prices, which overall have fallen by more than 50 percent since 2016. These ever-tightening margins have forced many manufacturers to tap out of the market; for example, the U.S. gets all its vincristine, an anti-leukemia drug, from just one company.

Such drugs are also hard to make. Because they’re injected into the bloodstream, often of severely ill people, they must be manufactured to the highest possible standards, free of microbes and other contaminants. But quality costs money, and generic drugs are so unprofitable that manufacturers can rarely afford to upgrade machinery or train employees. If anything, they’re compelled to cut corners, which makes them vulnerable to spontaneous manufacturing problems or disastrous inspections. And because they usually run at full capacity, any disruption to production has severe consequences. The affected manufacturer might fail to financially recover and leave the market too. Its competitors might struggle to ramp up production without triggering their own cascading shortages. And the drugs, which were never profitable enough to manufacture in surplus, quickly run out.

These principles apply not only to cancer drugs but to generics as a whole, dozens or hundreds of which have been in shortage at any given time for the past decade. The markets that produce them are frail and shrinking. And even when a drug is manufactured by many companies, they might all rely on the same few suppliers for their active pharmaceutical ingredients (APIs)—the chemicals at the core of their medicines. Mariana Socal, a pharmaceutical-market expert at Johns Hopkins, has shown that a third of the APIs in America’s generic-drug supply are made in just two or three (mostly overseas) facilities, and another third are made in just one.

The supply chains that link these chemicals to finished drugs are also frustratingly opaque. Consider fludarabine, one of the cancer drugs that’s currently in shortage. The FDA has approved 12 companies to make it, but only five actually market it; only because of a Senate-committee inquiry is it publically known that of those five, only one makes the drug itself; two others get theirs from Europe, and one of those used to supply the final two. Meanwhile, six facilities are registered to make fludarabine’s API, but it’s again unclear which ones really do, or which manufacturers they supply, or even, for one of them, which country it is in. The fludarabine market is clearly weaker than it first appears, but how weak is hard to gauge. The same goes for cisplatin and carboplatin, Socal told me: She and other experts thought their markets looked resilient, until the Intas shutdown dispelled the illusion.

This opacity masks not only the market’s weaknesses but also its strengths. Erin Fox, a drug-shortage expert at the University of Utah Health, oversees a drug budget of more than $500 million, and would love to spend it on manufacturers that make the most reliable medicines, even if their products cost a little more. But “we just don’t know which products are higher-quality than others,” she told me. The FDA has an internal scoring system that it uses to decide which facilities to inspect, Fox said, but because those data aren’t publicly available, manufacturers can distinguish themselves only through price. “We get a race to the bottom where companies undercut each other to get the lowest price, and then quit either because their manufacturing is so poor, or they can’t afford to make medicines anymore,” Fox said. As Wosińska and Janet Woodcock of the FDA identified in 2013, “The fundamental problem … is the inability of the market to observe and reward quality.”

The average generic-drug shortage lasts for about a year and a half. Many people I spoke with hoped that the current wave could abate more quickly if other manufacturers slowly ramp up. The FDA is also looking to import scarce drugs from international suppliers, and has temporarily allowed a Chinese company to sell its cisplatin in the U.S. But ultimately, “it’s very hard to solve a shortage after it started,” Allen Coukell, of the nonprofit Civica Rx, told me. They need to be prevented from happening at all.

Some commonly suggested preventive measures might not work very well, because they misdiagnose the problem. Politicians often focus on bolstering domestic manufacturing, but Wosińska, Fox, and others told me that many drug shortages have been caused by manufacturing problems in American facilities. Because American drugmakers are subject to the same flawed markets as foreign ones, moving the problem inshore doesn’t actually solve it. Nor does stockpiling generic drugs, though a worthwhile idea. These strategies work well against an external shock like a pandemic, Wosińska said: When faced with unpredictable external forces, it pays to build a large buffer. But because the shocks that cause drug shortages arise from predictable forces inherent to the market, the best bet is to reimagine the market itself—a “very difficult problem but a solvable one,” Stephen Colvill, the executive director and a co-founder of the nonprofit RISCS, told me.

A few new initiatives show how this could be done. Civica Rx, which was launched in 2018, sources generic drugs from manufacturers that it vets for quality; it then builds up rolling six-month inventories of those drugs, which it supplies to hospitals through long-term contracts. (Civica is also building its own generics-manufacturing facility in Virginia.) RISCS, founded in 2019, uses confidential data from manufacturers to rate generic-drug products according to the robustness of their supply chains. The FDA has also been developing its own rating system—the “quality management maturity” (QMM) program—that assesses a manufacturer’s quality-control practices; the program successfully completed two pilots but is still being developed and has no firm launch date, an FDA spokesperson said.

In theory, these initiatives should allow hospitals to make better purchasing decisions, and shift the market toward drug companies that are least likely to be responsible for shortages. In practice, Wosińska thinks that hospitals need to be pulled into such a culture shift. For example, she and her colleague Richard G. Frank argue that Medicare could reward hospitals for proactively choosing reliable vendors or participating in programs like Civica. The FDA could support such a scheme by finally launching its QMM program. Congress could require manufacturers to disclose more details about their products and suppliers, so that supply chains can be fully mapped. HHS could offer loans to generic-drug manufacturers for upgrading or expanding their facilities. The point, Wosińska told me, is to do all of this at once, and shift the market into a new stable state. The solution, she said, needs to be comprehensive.

It also needs to be coordinated. The drug-shortage problem lingers partly because “it’s not obvious who’s responsible for solving it,” Joshua Sharfstein, a health-policy expert at Johns Hopkins, told me. The FDA is a candidate, but economic matters sit outside its wheelhouse. Instead, Sharfstein and others suggest that the drug-shortage problem could be owned by the Administration for Strategic Preparedness and Response. It already works to shore up medical supplies in the event of emergencies such as pandemics or natural disasters, and ongoing shortages of generic drugs are effectively a perpetual state of emergency that we’re trapped in.

Meanwhile, the exact consequences of the shortages are hard to measure. Some of today’s cancer patients will suffer, or even die, because they couldn’t get treated in time, or were given lower doses, or were given more toxic drugs as substitutes. But it’s almost impossible to know if any individual person would have fared better in a world where shortages never happened: If they died, was it because of a few weeks’ delay or because their tumor was always going to be hard to treat? The impact of the shortages can only really be assessed at a population level, and that evidence takes a long time to collect. “I don’t think we’ll see the full downside for many years,” Yoram Unguru told me.

The measures needed to prevent such shortages will also take years to implement—if they ever are. The coronavirus pandemic revealed just how frail our supply chains and health-care system are, but it also showed how quickly attention and resources can disappear once a problem is thought to abate. But the drug problem isn’t abating, and is actually compounding the problems the pandemic created. When health-care workers can’t help their patients, whether because their hospitals are inundated by COVID or because their drugs have run out, the resulting moral distress can be unbearable. Such conditions during the pandemic drove so many health-care workers to quit that “you can feel the system shaking,” Patrick Timmins III said. He worries that this exodus followed by the current drug shortages are “a one-two punch” that will be visible to outsiders only when they have neither the drugs to cure them nor the health-care workers to treat them.