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Insulin prices have increased dramatically over the past decade in the United States. In this report, the authors compare international prices for insulins using a price index approach. They describe the shares of volume and sales for all insulins and different categories of insulin (including insulin type and timing characteristics) in the United States and 32 comparison Organisation for Economic Co-operation and Development (OECD) countries in 2018. For the market basket of insulins sold in both the United States and comparison countries, the authors report ratios of U.S. insulin prices to insulin prices in other countries. They found that manufacturer prices in the United States were considerably higher (often five to ten times higher) than those in other OECD countries for all insulins combined and for different types of insulin. Although the authors focused their analysis on manufacturer prices rather than on net prices after potential rebates, the analysis suggests that U.S. insulin prices would still have been considerably higher — about four times higher — than those in other countries even when accounting for potential rebates.

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Naval surface fire support (NSFS) has been a traditional mission of U.S. Navy surface combatants. Although naval guns have been viewed as a major instrument of sea control, they have also been seen, and widely used, as ways to directly influence the battle ashore by providing the equivalent of artillery support for U.S. Marine Corps (USMC) forces operating ashore. Although there is no denying that the Navy and the USMC have viewed NSFS as important, the actual requirements are sometimes vague. For that reason, RAND researchers conducted an assessment of the formal requirements and programs for NSFS. The researchers examined existing requirements documents and refined those requirements by applying battalion-level scenarios. They also applied a formal model to address volume of fire and required magazine size and considered possible technological and platform solutions. By comparing actual and potential requirements, the researchers were able to then make recommendations for capability development and for changes to existing requirements.

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Economic shocks are unanticipated changes in the conditions upon which resource allocation decisions are based. Economic shocks include a wide range of events, from typhoons to trade policy changes to mergers and acquisitions-any event that causes a decisionmaker to reconsider such choices as what to buy or sell, how much work to do, what production technology to use, or what price to pay or charge. The concern underlying this report is the possibility that economic shocks could induce the same effects as classic kinetic supply interdiction efforts: the degradation of reliable military capability, diversion of resources from high-priority military initiatives, and imposition of costs. The purpose of this report is to assist Department of Defense (DoD) decisionmakers called upon to respond to adverse economic shocks by identifying opportunities for improving analysis of shocks and their effects on U.S. defense postures. The authors examined historical and hypothetical instances in which shocks threatened or would threaten defense postures to identify questions that an analytic capability might be able to answer. They also reviewed data analysis methods used in the economics literature on shocks. Research findings suggest that DoD might benefit from improving its capability to analyze shocks. Moreover, although existing methods from economics provide insights necessary for achieving the desired analytic capability, they are not sufficient for fully providing that capability. Novel techniques employing multidisciplinary approaches appear best suited to help close gaps between existing and desired analytic capability, but additional research is needed to develop and refine such techniques.

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Since 2016, Plan Blue wargames have explored scenarios that depict large-scale war fights against state adversaries in order to help U.S. Department of the Air Force (DAF) leaders better understand the demands of these potential war fights, evaluate the capabilities and limitations of programmed forces to meet those demands, and test new approaches to projecting power. The 2021 iteration of the game (Plan Blue 21) was set in the Arctic, in keeping with the Department of Defense's 2019 Arctic strategy, which calls for enhancing capabilities for operations in the region and strengthening the rules-based order there. The purpose of the game was to increase the DAF's understanding of the capabilities, posture, allied command, control, and communication relationships that may be called for to support future Arctic operations. Focusing on competition with Russia in the year 2030, game play took place in the context of steady-state competition and crisis operations rather than large-scale combat, and it explored the intersection of two key trends: (1) changing environmental conditions and (2) the completion of current Russian investments in new military capabilities and infrastructure in the Arctic. Plan Blue 21 was also specifically designed to test the extent to which capabilities for persistent and visible intelligence, surveillance, and reconnaissance can provide real-time situational awareness and potentially contribute to “deterrence by detection.” U.S. players in Plan Blue 21 benefitted greatly from the participation of officers from key allied and partner countries that have important interests in and capabilities for operations in the Arctic region.