Hard to believe it has been more than a decade since Chechen rebels took hundreds of Russians hostage in a Moscow theater. Displaying their legendary penchant for tact and patience, Russian special forces pumped the theater full of a gas, the contents of which remain mysterious to this day, developed by the FSB as a "knockout gas.
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" It allowed Russian police to storm the theater and, uh, eliminate the terrorists with traditional Russian ruthlessness, but it happened to kill more than 130 hostages as well. Whoops.
What nobody knew that day – because Russian officials refused to offer any description of the contents of the secret gas for years – was that a major ingredient was fentanyl, a powerful synthetic opiate. High inhaled doses of such a strong drug were fatal for about 15% of the hostages. This was important because if medics and doctors had been told that the hostages had been incapacitated by an opiate drug, they could have saved lives by injecting them with something called an opioid antagonist. When this was finally reported it was the first time I heard of Naloxone.
Apparently Naloxone has become considerably more well known in the intervening years because many states have passed laws recently to relax rules about its administration. This is a result of increased pressure from the public, police, activists, and medical professionals to make Naloxone available for response to opioid overdoses. Briefly leaving aside the inconvenient reality that nobody cared about heroin addicts but now that white kids (and their parents) in the suburbs are ODing on prescription painkillers, it's hard to argue that this is not a good idea.
The problem, as usual, stems from the many glories of the free market and its infinite justice. The sole company in the United States that makes Naloxone noticed around 2008 that demand, driven by government purchases, was starting to soar. So of course they…oh, come on. Do I even need to finish the sentence? Suffice it to say that the drug, the price of which hovered around $3 per dose, became more expensive. By several hundred dollars.
As a generic, technically any manufacturer can start producing it.
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The problem is that every other drug company knows that at the drug's true price – somewhere closer to $5 per dose – it isn't worth it to invest in starting production. And they are unwilling to take the risk based on the hope that the current attempt at price gouging is sustainable. So the current company, Amphaster Pharmaceuticals, has a de facto monopoly. And oh boy, do they intend to milk it.
The idea of a single payer sends the average American into paroxysms of stroke-inducing rage. The idea of a single supplier, oddly enough, doesn't do the same even when accompanied by a healthy dose of price gouging. With state and local governments essentially at the mercy of the demands of one company for a drug it could hardly give away ten years ago, you'd think someone would be pointing out that the free market is not working as intended. Then you realize that this is in fact exactly how it is intended to work and any confusion disappears.
Andrew says:
Free markets are intended to balance supply and demand by allowing prices to fluctuate until supply equals demand. Under current conditions, it should be a great time for a new maker to enter the market, since no legal monopoly exists. This would drive down the price, but only somewhat, which would encourage further entrants, which would drive the price down more, and at some point some number of producers would be willing to produce exactly the amount the market desires.
Rich says:
Andrew, I'm trying to understand your response. Did you read the part of the post that says, "As a generic, technically any manufacturer can start producing it. The problem is that every other drug company knows that at the drug's true price – somewhere closer to $5 per dose – it isn't worth it to invest in starting production. And they are unwilling to take the risk based on the hope that the current attempt at price gouging is sustainable?"
Seems to me that the current conditions you describe don't exist.
Alex SL says:
Andrew has accurately described what the ideology based expectation is, conditional mood and all. He still misses what appears to be the point of the post:
When faced with a malfunctioning market, the majority of people will still be unable to believe that it could have failed in any way because The Market (PBUH) Is Always Right; and when faced with a problem that has a very clear regulatory solution, the majority of people will still be against it because Everything The Government Touches Goes Bad. Actual evidence or past experience doesn't enter into the equation at any point.
US in the UK says:
Andrew, you might want to pull back on the stick a bit. There's a crash headed your way.
Xynzee says:
Hmmm… If I was both extremely cynical and open to conspiracies it almost sounds like there's some kind of collusion happening here.
We promise not to manufacture generics of your flagship product, you let us gouge the market with ours. Win!
As for your comment about the lack of uproar over the near monopolistic nature of the pharmaceutical industry I believe there are 2 1/2 primary reasons:
1a) a general lack of knowledge about the industry and how it operates. Unless it's on the 6 o'clock news, and there's significant uproar on the Beck(er)head's rant line the average person is in the dark on this.
2) because of the social Darwin nature of how healthcare is administered in the States many would just put it as part of the reason why healthcare is so unaffordable. Thereby making it just another cog of the machinery designed to crush people. Is this part of the reason why pseudo medicines are so popular?
2 1/2) never gave it much thought. I'm guilty of this, but went, "Hey yeah, you're right!", as soon as you pointed it out.
Luckily having government administered healthcare, it's in the government's best interest to have the cheaper alternatives made available. What retailed for ~$28/box of 24, only cost me $6 dollars for the econo-size of 48.
Major Kong says:
A "free market" is like a "frictionless surface" in physics. An abstraction that's useful teaching a theory but doesn't exist in the real world.
RosiesDad says:
There are similar circumstances in generic markets for manner of pharmaceuticals. Doxycycline, a common antibiotic used to treat, among other things, Lyme disease, used to be available as a very inexpensive generic (15 cents a pill) until about 18 months ago. Then supplies dried up and it was only available as a brand name drug ($4 a pill). Some generics have returned but they are still much more expensive than previously.
There is currently a global (we are led to believe it's global, anyway) shortage of fluids for intravenous injection. Lactated Ringers, Plasmalyte, 0.9% Saline. These used to be available for about $2 per bag until a year or so ago when supplies vanished and then when they trickle back, cases of fluids that used to be $25 are now $60. Or $80. Or $120. Of note, in the US, the majority of fluids are produced by only 2 companies, Baxter (a division of Hospira) and Abbot.
It's very frustrating, it adds unnecessary cost to patient care and it is going to shorten the length of my career as it takes away from the joy of practice.
Tim H. says:
I chalk it up partly to the nonexistence of that best of bad examples, the USSR. without the continuous reminder of the stupidity of single sources of critical items Wall $treet has rapidly moved to eliminate as much profit-sapping market competition as possible. Next step, we'll be one more bad example in econ 101.
c u n d gulag says:
"Free Markets" often devolve into monopolies, as one company gobbles-up its competitors, or, other companies refuse to take on the company which has a stranglehold on the market, it leave one company to set-up its own price structure for the commodity/commodities, it provides – for a price.
Single Payer = Bad.
Single Provider = Good.
And so, we pay far more for the same drugs here, that are sold for pennies on the dollar in countries which look out for its citizens, and its health care/pharmaceutical budgets.
We are one fucked-up country.
Anubis Bard says:
One of the last middle class jobs in existence in much of the gutted economy of rural America are in the medical field. Fortunately, since obesity, diabetes and the other debilitations of poverty are rampant, it's a growth industry. In fact, getting on disability is one of the better checks you can get. If that has the side-effect of flooding the area with prescription medications that not everyone on SSDI really needs, well that gives the cops something to do with their federal grant monies, gives the hospital room to expand, and ensures a steady stream of new fodder for the system.
Go to one of these places where the factories and mines are shut – I've been in central Appalachia all week – and you'll see that government assistance and medical insurance payments are one of the main sources of cash flow into the area. So the drug companies and every other supplier do their gouging, the insurance companies and the government pay up or balk, and in the churn of it all, enough of the crumbs settle into the counties of third world America to suit the local powers that be.
It's some kind of system, but free market capitalism it ain't.
Totoro says:
I'm with RosiesDad. These shortages are widespread. Each insurance network negotiates prices for drugs (and fluids) and depending on the effectiveness of their negotiations the price you pay can vary widely. The "Free Market" is incredibly effective for many things but health care is not one of them. When you are intubated you are at a disadvantage for negotiating amongst various health-care providers for the best combination of price and quality.
sluggo says:
@ rosies dad
Add colchicine to that list. Doctors have been using it for nearly a thousand years and now that is been relabeled as Colcrys(TM) it went from a nickel a pill to five bucks a pill because the manufacturer knows that in the middle of a gout attack, you will pay anything to make the pain stop. It is BLOOD MONEY, plain and simple.
Is anyone taught about the consequence and dangers of monopolies anymore. I was taught about the Sherman AntiTrust Act in HIGH SCHOOL and more in depth while getting my bachelors in economics in the eighties.
@kong
When I was a kid, the phrase was 'free enterprise system' that described American Economics, and it implied that everyone would get piece of the pie. After Milton Friedman won the Nobel prize, the phrase became 'free market' and the and pedatory economics became the law of the land.
Emerson Dameron says:
@Major Kong:
Yep. The proper place for free-market libertarianism has always been college campuses. It's a great toy for smart, spoiled rich kids utterly sheltered from reality.
If the world could run on an algorithm, I would have voted for Deep Blue.
Dial Tone says:
While we're at it we should probably mention that many of the patent medicines we eventually pay through the nose for came from a massive public investment in medical research. We socialize the R&D costs and privatize the profits. In other words, capitalism at its finest.
Mike D. says:
Classic game theory example.
The moral of the story is that monopoly rents are a natural and rational result of the presence of fixed costs. And the more technical the product, typically the higher the fixed/up-front costs. And so monopoly rents soar.
Misterben says:
Dial Tone, above, makes an argument that I've heard many times before in regards to pharma:
"We socialize the R&D costs and privatize the profits. In other words, capitalism at its finest."
I've been looking for evidence of this for a while, with little success. If anyone knows of any articles, books, documentaries, or anything, substantiating this assertion, please post about them here.
I'm sorry if I'm missing something obvious. But this is definitely an argument I'd like to be able to make and back up with facts.
Thanks!
MS says:
The unfortunate truth of markets settling is that they can settle at many different prices, and as long as there's some sort of barrier to entry, it's often possible to make more money by selling less product. For instance, electricity producers in California discovered that if they turned off their power plants, the spot price of power would increase by more than they lost from not producing and selling that power. Power demand is inelastic, so a small reduction in supply causes a near-infinite increase in price. If the market demands 1000 Gigawatts, providing 950 makes you a lot more money than providing 1000.
Same with drugs, and many other things. If 1000 people need a life-saving medication, make sure to provide no more than 900 doses, and price it at whatever the market will bear. If you don't like the price, you can always be one of the 100 that die. It's your choice!(TM)
One of the big ways that single-payer healthcare wins is that the government buys many drugs in bulk. They're a monopsony buyer, having the power to negotiate on behalf of millions of customers. So much of this jerking around by drug companies doesn't happen.
Khaled says:
@Misterben- this is a different area, but most of the research done into parallel processors and what eventually Intel was able to patent was done at college campuses. That you know, our tax dollars paid for. Ditto with cellular technology. The government developed it and sold the patents off for pennies on the dollar to what they eventually would be worth.
I'm betting Xynzee's explanation of collusion is most probable. Most of the time, when a drug comes off patent, a number of companies produce the drug and see what kind of market penetration they can achieve. After about 6 months or so, it is usually reduced to one or two companies. The pharmacy benefit managers (PBMs) and pharmacy distributors will usually approve and pick the ones that they like / got paid the most to cover or carry, and those are the ones that get sold to pharmacies.
The free market would work if another company started producing the drug and selling it, but as Ed has said, once that happened, the company would lower the cost to drive the competitor out of the business. What the government should do is give a tax break or a subsidy to a competitor to produce the drug to lower the cost. Of course, that's socialism or something. And rewarding drug addicts.
Heath Care is not something that is a free market, since in a free market you always have the power to walk away or find a substitute good. If you are in an ER with a heart attack, you have no power to do either.
Often the best example of the law of supply and demand is tickets to sporting events. IE the market for hockey tickets in Toronto is better than the market in say, Miami, so the pricing structure is very different. And since the supply is fixed, the price must go up or down based on the demand. Time is also a factor. For example, what happened when the price of gasoline went through the roof? People found ways to buy less gasoline by buying more fuel efficient cars, reducing demand. I have faith in free markets, but I also understand when they get off the rails, they REALLY get off the rails, which is why we have anti-trust legislation. Which is now being ignored, and has been for years in many different industries. Monopolies are good for lazy companies and CEOs interested in making a quick buck, but in the long run they usually get munched by the competition because they refuse to innovate to keep up with customer demand. Blockbuster is a great example of this principle in action. Cable TV is another good example. I have a feeling that internet access will follow this model. Of course, the same people who preach the bible of the free market will happily pass laws banning cities from building their own fiber-optic network because government will be cheaper because they don't have a profit motive. I guess schools don't have that problem.
Skippper says:
Big Pharma is, at its core, a massive criminal enterprise.
Dookie says:
A monopoly is the opposite of a market. Condemning free markets based on a monopolistic anecdote is sophistry of high order.
And of course, we have the usual, almost unimaginable, suggestion that because the physical ingredients of a product cost $3 or $5 or whatever, then it's price should, for some reason I can't comprehend, be somewhere close to that $3. Oh but to live in such a simple, child-like world.
Mo says:
Alex!
When faced with a malfunctioning market, the majority of people will still be unable to believe that it could have failed in any way because The Market (PBUH) Is Always Right; and when faced with a problem that has a very clear regulatory solution, the majority of people will still be against it because Everything The Government Touches Goes Bad. Actual evidence or past experience doesn't enter into the equation at any point.
Beauty, dude.
NonyNony says:
A monopoly is the opposite of a market. Condemning free markets based on a monopolistic anecdote is sophistry of high order.
The natural order of an economy is a bunch of different monopolies/oligopolies enforcing their own turf. Read your Adam Smith, he knew the score on this one. It takes massive government intervention to get anything approaching a true free market because of a variety of barriers to entry that established players can put into place, collusion among the players to maintain their monopoly/oligopoly, and the ability of the oligarchs to hide information from their customers (free markets can only exist in environments where no information is hidden from any of the players in the game – if one player has knowledge others don't, then you don't have a free market anymore.)
Chicagojon says:
One comment that I'm not seeing above is that we're talking about "Free Markets" within the confines of a very regulated industry with a small number of major payers.
There is a vested interest for Pharma X to not go after Pharma Y's quasi-monopoly drug not just because of upfront costs but because it may lead to Pharma Y looking at Pharma X's drugs and markets to try to get a piece of their pie.
Now I know what you're thinking, what if a smaller Pharma Z recognized this problem and specifically sought to correct these issues by entering into profitable generics against both X and Y? I'm sure this happens all the time, but as soon as Z comes up with their own penis stiffener where a monopoly will help them they join the group of big companies with an interest to not get in each others way. More likely X or Y will just buy up Z as soon as they come up with something and Z's lower cost generics will fade away.
cackalacka says:
Does our resident Duke graduate ever wade in here and manage to NOT step on a rake?
Michael says:
"A monopoly is the opposite of a market."
Uh . . . no. That is not I taught in Intro Micro for five years. A monopoly (one seller, many buyers) is a type of market which we can point to many examples of in the real world.
Skippper says:
For those who are old enough to remember, AT&T was a monopoly, a well-regulated monopoly. Phone rates — given the available technology — were very good for the consumer. Businesses paid more, but the goal of AT&T and the government regulators was to get a twisted pair of wires into every home — rich or poor — in the country. And it pretty much worked. Service, despite the whiners, was excellent. If you had a problem with your phone, their goal was to repair it within four hours of its being reported.
Then, we broke up AT&T — and not for the reasons everyone thinks, but that's another story. At that point, it became a "market" and everything went to shit. Just like the banks, the airlines, Big Pharma, the gas and oil industry, etc., — and lest we forget, cable.
mothra says:
Had no idea Naloxone's price shot up; they just allowed paramedics and cops to carry it in our town. Or maybe it was just cops. Whatever, maybe the government should get in the business of manufacturing drugs. Talk about creating some jobs…
Skippper says:
I've administered naloxone (Narcan) in the field. It's a tricky business. One thing you need to be cautious about is that it can and has caused the person to become violent due to the sudden reversal of sedation. My concern with cops — untrained in other aspects of pre-hospital medical care — administering it is that they would use this violence as an excuse to shoot the patient 12 or a 100 times. Cops don't seem to need much of an excuse these days to do that.
John Danley says:
Free markets are like free will; there's always a hidden fee behind the illusory curtain of latitude.
Dial Tone says:
@MisterBen
I should've provided a source. I used Dean Baker's "The Conservative Nanny State" for numbers which can be found here for free:
http://deanbaker.net:8080/books/the-conservative-nanny-state.htm
From page #50:
The pharmaceutical industry justifies the vast economic waste associated with patent protection for prescription drugs by claiming that patents are necessary to finance research. According to the pharmaceutical industry, it spent $41.1 billion on research in the United States in 2004.
From page #53:
The federal government already spends more than $30 billion a year supporting bio-medical research, primarily through the National Institutes of Health (NIH). This spending has enjoyed widespread political support, especially from the pharmaceutical industry, which has vigorously pushed for increased spending over the last two decades. (Under the current system, NIH research is effectively a subsidy to the pharmaceutical industry.)
So the American public is already spending 75% as much as the entire pharmaceutical industry on research.
Dial Tone says:
And I should've said "75% as much as the entire pharmaceutical industry spends **in the United States** on research".
Not chump change by any measure.
Skepticalist says:
It never ends. Now I understand why cops and medics in my little upstate NY town, suddenly began using Nalaxone. The level of greedy behavior by drug companies is stunning.
Evil drug companies never consider doing the right thing. Some years ago, drug companies talked Border Patrol agents into harassing buses with seniors drug shopping in Canada. The idea was simply to make it not so nice a trip.
Of course we all know that Canadian towns are littered with bodies of people not able to buy "real drugs" across the border. Drugs don't "expire" either but drug company liability insurance is iffy after a time. Fear works.
Keeping customers off balance works and they have drugs for that too.
Anonymouse says:
@Rosie'sDad; you're a vet, right? I worked for a vet, years ago, when I was a poor college student with no health insurance. One benefit of working for the vet was that the workers were allowed to fill doctor prescriptions for ourselves at the cheaper, veterinary price. For example, a prescription for antibiotics for a sinus infection that would have cost me $25 at the pharmacy cost me just $4 through my job. I had heard that prescription meds costs are going up for vets, too. Can you confirm?
JPL says:
I am currently taking a pill called Harvoni for HepC. The cost is $1,125 per pill. That is our free market in action.
RosiesDad says:
@Anonymouse: Many if not most of the generics we use are drugs labeled for humans but yes, prescription med costs for some items are increasing astronomically.
One racket that I didn't mention is that there are a bunch of drugs–old school drugs–that were not subjected to the same scrutiny as newer drugs are now. So the FDA made a deal that if the drug manufacturers pay a fee to the FDA, they will allow the drugs to be grandfathered in and remain approved. The alternative would be to pull the drugs ad subject them to an approval process from step one. Drugs treated this way include metronidazole (flagyl), an antibiotic that has been around forever for treating Giardi and clostridial diarrhea; and phenobarbital (modern medicine's oldest drug for treating seizure disorders).
The other completely ridiculous thing is the cost of a DEA certificate–what a doctor needs to prescribe scheduled drugs. A DEA certificate used to cost about $50 for 3 years. At my last renewal, it was over $700. (They are issued by the DEA.)
Robert says:
JPL – I am taking a combination pill for HIV. The retail amount per month is more than my mortgage – my copay with insurance is US$35.00.
My HMO wishes that I would die, and soon.
Khaled says:
@Robert, JPL
I worked in a drug store for about 15 years. I remember one of the drugs in the fridge (that we couldn't send back without Car… er pharmacy distributor claiming that it wasn't labeled correctly or out of temp) costing us about $30,000 for a 30 day supply. I wanted to go to whatever doctor prescribed the medicine and kick them in the nuts. There was no way that ANY insurance company would cover it, and even if they did, it would be so expensive even with insurance that there was no way anyone would ever actually pick it up once we filled it. And of course, it was a special order and no one ever used the drug, so we pretty much had to let it outdate and get salvage credit for it (for about 25% credit or something stupid low like that).
Was there a similar drug that the Dr could have prescribed that was cheaper? Of course there was. The only time those expensive drugs actually got paid for by people if insurance didn't cover it was for opiates (oh, hey, you want 30 day supply of Oxy? Cash price $3,000 no problem? I bet your back hurts really bad, asshole) or fertility drugs. Depending on the shitiness of the insurance company, people could have to pay cash for those, and those could run as much as $1,000 per dose.
Before my wife got pregnant, we chose the "cadillac" insurance plan. The fertility drugs were all covered (woo!) and our twins ended up costing $100k each. And I think we paid a total of like $5000 out of pocket that year for health care costs. I'm surprised we didn't get hate mail or severed rat heads in the mail from them, especially since I think we changed companies the next year.
VCB says:
Hey! Something I know something about! Anyway — the issue in new entrants to Naloxone is not manufacturing setup or scale up, which are not particularly difficult. It's time lag. You need to get the line and the formulation and everything else approved by the FDA. Which can take anywhere from months to years, depending on a variety of factors. And there is a need to license in the IP in the original formulation, usually — or you can reverse engineer it, but again, time. So by the time we get a 2nd or 3rd manufacturer, who knows what the market will be like? Hard to invest in that scenario. I guess you could argue that regulation is changing the flow of the free market in this scenario, and I would argue "as it should be to ensure public safety."
Tim H. says:
Sure regulation can ensure safety, but if structured just so, does a bang up job of keeping out the rif-raf.
Anonymous says:
My job just switched us all to Cigna for our health insurance. Naturally, it pays for nothing.
I confronted a Cigna rep about this. I said, "My old insurance actually paid for stuff. Now I have to pay hundreds of dollars a month for things like insulin."
She replied, "All you people complain about the insurance, but how much are you saving on your monthly premiums?"
"Maybe $10-$20?"
"EXACTLY! And if you were a wise consumer and *saved* that money instead of spending it on frivolous things, you'd have plenty of money to pay for insulin."
"But I'd save at most $20/month, and I'm having to pay at least $300/month out of pocket that my old insurance covered."
(Exasperated) "Well, why do you need all those expensive medicines anyway?!?"
"I don't have to justify myself to you." (shithead.)
(Smirking and nodding) "Well, let me tell you- you guys complain about the cost of insurance, but you all need to get a lot healthier. A lot."
Note that Cigna's key raison d'etre at this point is "use the money you would have spent on premiums, and save it up for unexpected medical expenses instead." Why the hell are we giving Cigna any money at all? Why not save *all* the money we would have spent on premiums?
Cigna's health plan is "consumer based." This quite literally means you are expected to shop for the cheapest care possible- even in an emergency. If, for example, your kid has an asthma attack and needs to be hospitalized, you're expected to go to MyCigna.com and shop for the hospital with the cheapest rates for asthma, AND every time the doctor tries to give your kid medicine, you go to MyCigna.com to search for a generic or an alternative drug or a Cigna-preferred provider.
I do not exaggerate when I say that I'm now living in that Ayn Rand parody in which the detective has to put a quarter in the coin slot of his gun before he can fire it. It's like the libertarian argument that we don't need the FDA because it's your responsibility to test your own groceries for salmonella every week. This is Milton Friedman's wet dream, down to the last detail: everyone pays money to a big corporation, and in return is expected to work a second, unpaid job in which you hustle on the free healthcare market, learning the ins and outs of the pharmaceutical industry so you can spot a good deal. And here's the inevitable Andrew/Dookie/libdouche/Asperger's icing on the cake: if you complain that it's the insurance company's job to do all that for you, then the Cigna rep tells you that you're a lazy whiner who doesn't understand the value of jut-jawed John Galt-style individualism.
Of course, it's only a matter of time before some fucking libsquatch says, "If you don't like your insurance, you're free to quit your job and pick a new one with a better insurance plan. In fact, clearly Cigna must be satisfying the majority of your co-workers, or your employer would not continue to use Cigna, because they know that all their employees are free agents on a free market who can seek employment elsewhere. If you feel trapped in bad health insurance, then clearly the fault can only lie with OBAMACARE."
Andrew says:
I find it telling that those who disagree with me and Dookie here are stopping just short of ad hominem attacks but not explaining why we're wrong. Because we're not.
Mo says:
Do your own damn homework, Andrew.
mothra says:
(Smirking and nodding) "Well, let me tell you- you guys complain about the cost of insurance, but you all need to get a lot healthier. A lot."
Generally, I don't like to wish ill health or tragedy to visit people because I worry about the karmic effects, but I am thinking a nice bout with some kind of chronic, horrible genetic illness might right this lady's thinking. Or how about a debilitating accident (not her fault) which involves not only a lengthy hospital stay, but rehab and maybe permanent injury for which she must have treatment and care for the rest of her life. Cow.
Arslan says:
Andrew, history and the present explain why you are wrong. That's the cool thing about history- it is the killer of bad economic theory. When someone says that markets and monopolies are polar opposites, or that government intervention is bad for development, we can check the historical record and see what happened when people actually believed in this lassaiz-faire bullshit. Oh, crap, it was really, really, bad. I guess that means your theory is debunked.
There has never been such a thing as a "free market." Like one other poster said, it would be a useful abstract concept for a model, but it has never existed in real life.
Anonymous says:
Andrew is, of course, a very perfect sea lion:
http://wondermark.com/1k62/
Of course nobody actually argues with him. As Arslan and others have pointed out, it would be like trying to argue with an ostensibly polite but doggedly persistent flat earther. If your beliefs are obvious bullshit, then that advertises to everyone that you're too stupid to be worth having a conversation with.
Once I heard a creationist say, "Well, if there's so much proof for evolution, then where is it?"
Evolutionist: "It has been cleverly hidden in books, where you will never see it."
After years of arguing with these people, I finally realized that it's pointless. Creationists and libertarians aren't interested in the truth. Their two defining features are that they like to argue, and want to be stupid. Think of it this way: can you really believe that a creationist can go for years picking fights on the internet, and NOT ONCE did someone bring up, say, retrogenes? It's trivially easy for me to come up with arguments that reduce creationists to saying, "your fancy arguments won't do you any good in hell." That means someone else has already presented the creationists with those arguments, over and over again. The creationists have heard it all, they know the evidence, and they know they can't rebut it. They just like being fuckwits.
Do you really think nobody has pointed out to these libertarians that, say, racism in hiring actually exists? That once upon a time Jim Crow actually existed? That slavery existed? I am getting tired of libertarians telling me that racism can't exist for long because the free market (PBUH) will make it instantly disappear.
Xynzee says:
A monopoly "isn't a market"? Qué?
Uh Econ 101: a market is where buyers and sellers meet.
Pretty straight forward.
Remove the buyer. No market. Remove the seller. No market.
Whether you have 1 buyer or 1000s is irrelevant. And vice versa. As long as you have 1 of each you've got a market.
Now a true free market can never exist. Bare bones description you can do your own freaking work after this.
Firstly, all parties must be purely equal. Same mental capacity, physical ability, financial, the list goes on and on. Basically a clone of yourself. As soon as one thing is different, you lose the perfect equality. Ergo no perfect free market.
Secondly, all parties must have perfect knowledge. Maybe not a God level of omniscience, but certainly closer to chess with all pieces on the table. Do markets work like chess, or more like poker? Ergo, no perfect free market.
Third, misfortune, good/bad luck, happenstance, etc. cannot exist. All events must be under the total control of all parties. Doesn't sound like this universe/reality.
Finally, and I'm surprised Smith left this one out, there's a piece of human nature that Judeo-Christians call "sin". In this case it means: the ability and desire to fuck you over to advance one's agenda. Hell some people do this just because they enjoy doing it—which I guess means they're advancing their agenda.
And by the way, economics is NOT a hard science. It's a social science.
There's more, but you can now go learn how the real world works.
Anonymouse says:
@Anonymous (not Anonymouse, which is me): I recently quit one job and took another in part because of the horrible insurance my old company was forcing on us. We had to take part in a program where we "consulted" with a health insurance official and then were penalized for not "taking charge of our own health". For example, I have a genetic anomaly I was born with. Properly medicated, it doesn't impact my life at all. I was being penalized (by having to pay more money) for being born with a genetic condition. Punished for being born, in other words.
On top of that, we had a third party called Connect-your-care "managing" our $5k deductible. Here's how it works; a half-baked company from Floriduh (first warning sign) that's not medical in any way, holds onto $5k of the employees' money. Any time the employee has a medical event (doctor's visit, pharmacy visit, physical therapy, etc. etc.), the employee pays out of pocket and then must spend dozens of hours on the phone and the fax machine (because you can't email anything to them) sending them multiple copies of very-personal medical information with all kinds of personal identification numbers on it, in the hopes that maybe–just MAYBE, if all the stars align–Connect-your-care deigns to reimburse *some of the employee's own money* to pay for this expense. This on top of the regular insurance premium of $1200/month for family coverage.
Anonymous says:
Ouch :( One would hope that with ACA they couldn't penalize you for a pre-existing condition.
Also, one wonders what their excuse for connect-your-care is. It seems inevitable, given the profusion of Health Savings Accounts and suchlike now: set up some sleazy investment firm to sit on people's money and put it into credit default swaps or some such bullshit until they need to pay for something. I wonder if there isn't some weird law which makes/enables insurance companies to manage HSA money differently than premiums.
moderateindy says:
Dial Tone….One thing youmissed about Pharma R&D is that the majority of spending, some estimates say 75%, done by corporations is not actually done developing new drugs, but instead on developing "delivery systems" This is done to extend the patented life of blockbuster drugs. A drug is about to come off patent, so you develop the exact same drug that is noe time released, or only has to be taken once a week, instead of daily. Now you have a new patented drug that you can continue to sell at an inflated cost, as long as you get the doctors to prescribe that instead of the old drug that went generic.
Skipper….. your concerns about cops administering the drug is about as silly a reason I have ever heard. Your position is; don't save the persons life, because there is an off chance that they might become violent, and then a cop will shoot them, and they could end up dead. Yes, I'm certain if the cop just allows them to die of the OD there is little chance of that person being shot and killed by that cop, but If I'm ODing I think I'll take that risk.
Robert says:
Some of the stories being told here are horrifying to me. As a civil servant, I had an HMO; now that I'm retired, I have the same one. I've had the same primary physician (what we use to call a 'doctor') since 1987. At this point, it's a toss-up whether I die before he retires, or vice versa. The only problem I ever had was them not wanting to cover an ER visit; I pointed out (repeatedly) that the EMTs who responded to the accident didn't even ASK me if I wanted an ER visit, they just picked me up off the street and took me. I was on the street because a driver hit my scooter with his van, which also wasn't my idea. After six to eight months of desultory bickering, they eventually paid. Working at the VA was a good practical education in dealing with health care bureaucracies.
Seriously, though, that Cigna rep has a noticeable empathy deficit.
Michael says:
"oh, hey, you want 30 day supply of Oxy? Cash price $3,000 no problem? "
Ok, when I was Doing Without Decent Insurance, Oxy was $1 a pill…? And the pharmacy always had the discretion to decline to fill any prescription, a whip the occasional pharmacist used to override my doctor's prescription a couple of times. Ah, America. Don't get sick, and if you do, die quickly.
Michael says:
"I find it telling that those who disagree with me and Dookie" I don't "disagree" with you. I believe you to be mentally ill and don't have the power to prescribe appropriate medication. So once you've been established to be a libertarian (a particular flavor of BPD, as far as I can tell), I'm done.
You get your kicks off of hurting people. No reason for me to get in line on that one.
Kaleberg says:
The Russian government claimed the gas was fentanyl, but the evidence is that it was halothane, a popular general anesthetic in Russia, or etorphine which is a very powerful veterinary tranquliizer, the drug of choice for knocking out elephants or rhinos very quickly. Etorphine is maybe 1,000 times more powerful than morphine, so it could knock a person out very quickly, but it could also cause a coma or respiratory collapse.
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