Elad Gil, writing in a blog post: In most industries, regulation prevents competition. This famous chart of prices over time reflects how highly regulated industries (healthcare, education, energy) have their costs driven up over time, while less regulated industries (clothing, software, toys) drop costs dramatically over time. (Please note I do not believe these are inflation adjusted – so 60-70% may be “break even” pricing inflation adjusted.)
Regulation favors incumbents in two ways. First, it increase the cost of entering a market, in some cases dramatically. The high cost of clinical trials and the extra hurdles put in place to launch a drug are good examples of this. A must-watch video is this one with Paul Janssen, one of the giants of pharma, in which he states that the vast majority of drug development budgets are wasted on tests imposed by regulators which “has little to do with actual research or actual development.” This is a partial explanation for why (outside of Moderna, an accident of COVID), no $40B+ market cap new biopharma company has been launched in almost 40 years (despite healthcare being 20% of US GDP).
Secondly, regulation favors incumbents via something known as “regulatory capture.” In regulatory capture, the regulators become beholden to a specific industry lobby or group — for example by receiving jobs in the industry after working as a regulator, or via specific forms of lobbying. There becomes a strong incentive to “play nice” with the incumbents by regulators and to bias regulations their way, in order to get favors later in life. Additional resource: All-In Summit: Bill Gurley Presents 2,851 Miles.
