There is a drawer in your house.
Maybe it is a nightstand. Maybe it is the kitchen counter, next to the coffee maker, where you can see it and remember. Inside is a plastic organizer with seven compartments and small raised letters on the lids. Beside it, something with a battery. A meter. A pump. A monitor that beeps when it should.
You built that drawer over years. Every item in it was a decision, or a diagnosis, or a bad afternoon in a doctor’s office that you have since stopped talking about.
Two of those things do not come from here.
One of them depends on an island roughly the size of Maryland, a hundred miles off the Chinese coast. The other depends on the country that has spent the last decade rehearsing how to strangle it.
Nobody has ever told you this. Not your doctor, who does not know. Not your pharmacist, who is not asked. Not the news, which has covered the Taiwan question as a story about warships and aircraft carriers and men in suits, and never once as a story about your drawer.
So let me tell you.
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Start with what would actually happen, because it is not the thing you have been shown on television.
An invasion is loud. Landing craft, missiles, a date that goes in the history books. It is also expensive, uncertain, and would almost certainly bring the American navy into the fight.
A blockade is quiet.
Ships get stopped for inspection. Inspections take a long time. Insurance rates climb until no shipping company will sail. There is no invasion date, no declaration, no single moment anyone can point to and call the beginning. Just a slow tightening, deniable at every step, and by the time the world agrees on what it is watching, it has already been going on for months.
China has practiced this in the open. Taiwan practices against it. Their annual Han Kuang exercises now include training to break a naval blockade of the island’s supply routes, which tells you something plain. Both militaries think this is the likely shape of it.
And a blockade would work, because of a number almost nobody outside Taipei has heard.
On the twenty-eighth of February this year, the Strait of Hormuz closed.
Not partially. Not for a week. Iran shut the waterway after American and Israeli strikes, and it has stayed effectively shut ever since. Hundreds of ships sat trapped. Traffic collapsed to a handful of vessels a day against a normal count near seventy.
That was five thousand miles from Taipei. It was also a live experiment nobody designed.
Taiwan imports 97 percent of its energy. Roughly a third of its natural gas comes through that exact strait. When the water closed, the island got to find out how much cushion it actually had.
Eleven days.
That is the legally mandated reserve of liquefied natural gas. Eleven days, for the fuel that generates more than forty percent of the island’s electricity. The coal pile buys perhaps six weeks after that. Then the lights that run the most advanced factories on earth start going out.
The strait reopened briefly in June and shut again. Taiwan scrambled, found alternative cargoes, and got through it. Everybody exhaled.
Almost no American outlet connected those two facts. The strait and the island. The rehearsal and the thing being rehearsed.
Beijing connected them. You can be certain of that.
Taiwan makes the chips.
Not some of them. More than sixty percent of the world’s advanced semiconductors come off that island, and for the most sophisticated ones the share climbs higher still.
Here is the part that will make you angry, and you should let it.
About half of all medical devices contain semiconductors. Pacemakers. Insulin pumps. Glucose monitors. Ventilators. The defibrillator on the wall at your church.
And medical devices account for roughly one percent of the semiconductor market.
One percent.
So when supply tightens, and the chip factories decide who eats first, the medical device industry is standing at the back of a very long line. Behind the automakers. Behind the phone companies. Behind the data centers now consuming chips at a rate nobody projected five years ago.
Your pacemaker loses that fight. It is not close.
We already watched a smaller version of this. During the last chip shortage, device manufacturers halted production lines and hospitals started rationing equipment. And the workaround everyone assumes exists, swapping in a different chip, does not really exist. Change a component in a regulated medical device and you can trigger a fresh approval process. Months. Sometimes longer.
That was a shortage caused by a pandemic and a few factory fires.
Now imagine the island itself is dark.
That is the first thing to go.
You may be thinking you are safe on the pills. Pills are chemistry, not electronics. Nothing in your amoxicillin needs a microchip.
I thought that too, before I looked.
Generic drugs account for about 91 percent of every prescription filled in America. Your prescriptions. Almost certainly all of them.
The United States manufactures 12 percent of its own active pharmaceutical ingredients.
Twelve.
Of the hundred generic drugs Americans take most, 83 percent contain no American-made active ingredient at all. More than forty percent of generic drugs have a single manufacturer on the entire planet. If that one plant floods, or burns, or gets caught on the wrong side of a trade war, there is no second source. There is nothing.
Most of what is left runs through India, which sounds reassuring until you learn that India imports around eighty percent of its active ingredients from China.
And then the number that stopped me cold. A standards body called the United States Pharmacopeia found that China is the only supplier on earth of at least one key starting material for six hundred and seventy-nine different pharmaceutical ingredients.
Six hundred and seventy-nine.
Now hold both hands open. In one, an island that makes the chip in your device and has eleven days of fuel. In the other, a country that makes the molecule in your pill and is currently practicing how to squeeze that island.
A blockade does not create either of those problems.
It collects on both. The same week.
Here is the part I keep coming back to.
Those pharmaceutical numbers are not secret. They were not leaked. They were delivered as sworn testimony this past March, in a hearing room in Washington, to the Senate Special Committee on Aging.
The committee whose entire reason for existing is you.
Somebody stood up in that room and said that eighty-three percent of the top generics older Americans depend on contain no American-made ingredient. That more than forty percent have one factory. That six hundred and seventy-nine ingredients trace back to a single country.
And then everyone went home.
No emergency broadcast. No letter from your insurer. No pharmacist calling to say, we should talk about your metformin. It went into the record, and the record went onto a shelf, and you spent that week worrying about your knee.
That is not a conspiracy. It is worse than a conspiracy, in a way. It is nobody’s job.
I want to be careful here, because it would be easy and dishonest to hand you a villain.
There isn’t one.
No party voted for this. No president signed it. It accumulated across roughly thirty years, one procurement decision at a time, each of them defensible on its own morning. A cheaper supplier. A leaner inventory. A plant that closed because the numbers said close it.
Efficiency, everyone called it. Both parties said the word. Both meant it.
The trouble with efficiency is that it eats slack, and slack is the only thing that saves you when something goes wrong five thousand miles away. We spent thirty years converting our margin for error into savings, and we handed the savings to shareholders, and now the margin is gone and the bill is sitting in a drawer in your house.
You did not vote for that. You were never asked.
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None of this is worth reading if it leaves you sitting there afraid. So here is the part that matters, and every item is a question you can ask before the end of the month. Free. No appointment required for most of them.
Ask your pharmacist to check whether any of your regular medications are currently on the FDA’s drug shortage list. It is a public database. She can look while you wait. Almost no patient ever asks, which is exactly why you should.
Ask her which of your prescriptions have only one manufacturer. That is the real fragility marker, and it is not the same as the drug being rare. Some of the most common medicines in America come from a single plant.
Ask your prescriber to name a therapeutic alternative for each of your critical medications now, while there is time to check whether your plan covers it. Finding out at an empty counter is the worst possible moment to start that conversation.
Ask whether a ninety-day fill is appropriate and permitted for your specific medications. This is a question for your prescriber, not a decision to make alone, and it does not apply to everything. But where it is allowed, it turns a two-week scare into a non-event.
If cost is the thing standing between you and a longer fill, ask about Extra Help through Social Security, and ask your pharmacist about the manufacturer’s patient assistance program for your specific drug. Most people who qualify for these never apply, because nobody tells them they exist.
If you have an implanted or battery-powered device, find out the manufacturer, the model, and the replacement window. Then put the appointment on the calendar instead of pushing it another year. A battery you replace on schedule is a battery you never have to source during a crisis.
And write one page. Drug name, dose, manufacturer, pharmacy. Keep a copy in the drawer and one in your wallet. If a substitution ever has to happen fast, that page turns a week of phone calls into a ten-minute conversation.
Seven questions. That is the whole list.
I am not going to tell you a blockade is coming. Nobody knows that, and anyone who says otherwise is selling something.
What I will tell you is that the vulnerability is not pending. It is already built. It was built while you were raising children and paying a mortgage and trusting that somebody whose job it was had this handled.
That trust was reasonable. It was also misplaced, and finding that out at seventy is a particular kind of insult.
But look at what you actually have.
You have a pharmacist who can answer six of those seven questions in a single visit. You have a prescriber who will take the call. You have a month, and possibly years, and a list on a piece of paper that costs nothing.
The people who built this system are not going to fix it in time. That is simply true. What they cannot do is stop you from knowing which of your medicines has one factory, and having a backup named before you need it.
Go open the drawer.
Then go ask.
Congressional Research Service, The Strait of Hormuz: Security Developments and Impacts on Oil, Gas, and Other Commodities — https://www.congress.gov/crs-product/R45281
Atlantic Council, The Iran war tests Taiwan’s energy resilience, March 2026 — https://www.atlanticcouncil.org/blogs/energysource/the-iran-war-tests-taiwans-energy-resilience/
Testimony before the U.S. Senate Special Committee on Aging, March 2026 — https://www.aging.senate.gov/download/testimony_chang-031126pdf?download=1
The changing landscape of semiconductor manufacturing: why the health sector should care, National Library of Medicine — https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10292744/
Taiwan Climate Action Network, Navigating Geopolitical Turbulence with Taiwan’s Energy Transition Policy — https://tcan2050.org.tw/en/navigating-geopolitical-turbulence-with-taiwans-energy-transition-policy/
Australian Strategic Policy Institute, Taiwan worsens its vulnerability to a Chinese energy blockade — https://www.aspistrategist.org.au/taiwan-lacks-clarity-on-energy-security/
Bloomberg Economics, Xi, Biden and the $10 Trillion Cost of War Over Taiwan — https://www.bloomberg.com/news/features/2024-01-09/if-china-invades-taiwan-it-would-cost-world-economy-10-trillion
The Unseen Ripple: How Semiconductor Shortages Sent Shockwaves Beyond Automotive — https://markets.financialcontent.com/wral/article/tokenring-2025-11-3-the-unseen-ripple-how-semiconductor-shortages-sent-shockwaves-beyond-automotive
Taiwan Ministry of National Defense, Han Kuang exercise anti-blockade training — https://newsinfo.inquirer.net/1761638/taiwan-preparing-for-chinese-blockade-in-annual-war-drills/amp
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