Pills and Profits

One of the many aspects of America’s mess of a healthcare landscape–a mess that the Senate GOP is trying to make much worse– is the issue of drug prices. Pharmaceutical companies defend that pricing by pointing to the significant costs of research and development.

That argument seems persuasive–if we ignore the inconvenient fact that taxpayers fund a considerable amount of that research. As Fran Quigley recently wrote in the New York Times, 

How’s this for a great deal? The United States government funded research and development of a new vaccine against Zika. But the Army, which paid a French pharmaceutical manufacturer for its development, is planning to grant exclusive rights to the vaccine to the manufacturer, Sanofi Pasteur, along with paying Sanofi up to $173 million.

Sanofi will be free to charge the United States American health care providers and patients any price it wishes. Although American tax dollars funded the vaccine, and the United States took the economic risks, history suggests that many Americans would not be able to afford it.

This is a negotiating strategy of unconditional surrender. Although President Trump said before taking office that drug companies were “getting away with murder” and had campaigned on lowering drug prices, his administration is doing the opposite. A draft order on drug pricing that became public in June would grant pharmaceutical companies even more power to charge exorbitantly. For example, it could shrink a federal program that requires companies to sell at a discount to clinics and hospitals serving low-income patients.

Another major problem is the fact that for-profit drug manufacturers have little incentive to produce medications for which there are no markets, so diseases that are widespread in poorer countries get little attention. Quigley notes that, of the 756 new drugs approved between 2001 and 2011, fewer than 4 percent targeted so-called “neglected” diseases, despite the fact that those diseases afflict one out of every six people in the world.

A new drug company intends to change that reality.

Pécoul and Doctors Without Borders decided to tackle the diseases that were killing the global poor. Doctors Without Borders dedicated its 1999 Nobel Peace Prize award money to providing seed funding for the Drugs for Neglected Disease Initiative, known as D.N.D.I. The aim was to see what could be accomplished when research priorities ignore questions of profitability, and the price of medicines is “delinked” from research costs, which are instead shouldered by public financing or philanthropy.

An immediate challenge was that D.N.D.I. possessed none of the required hardware for the expensive drug research and development process: It had no labs, no manufacturing facilities, and no distribution process. It fell to Pécoul to recruit partners, including private pharmaceutical companies he persuaded to share drug compounds that had been uncovered but abandoned because of lack of profitability…

D.N.D.I. has already delivered seven new patent-free, low-cost treatments for neglected diseases.

Interestingly, D.N.D.I. has created these seven drugs, with 30 more in testing, at a cost of $290 million to date. For-profit pharmaceutical manufacturers have long claimed that it costs them $2.5 billion to develop a single drug, although critics insist that the figure is an exaggeration intended to justify higher-than-necessary prices.

D.N.D.I. conducts “open source” research, and does not patent its drugs.

Pécoul and his D.N.D.I. colleagues say their biggest challenge now is securing sustainable funding for research — another illustration of the limits of a model with no profits to invest in research. But the government funds research all the time — it’s just often turned over to for-profit companies. The Zika vaccine is one example. The prostate cancer drug pacilataxel, the leukemia medicine imatinib and many mental health and H.I.V. medicines and vaccines can all trace their origins to government-funded research — only to be handed over to industry to charge what they want.

As the article makes clear, this model cannot replace for-profit drug manufacture. But if governments provide more resources to nonprofit companies modeled after D.N.D.I, their products, at least, would be available and affordable to everyone.

Some economists have argued that since Medicare and Medicaid are the leading purchasers of drugs (and Medicare is forbidden by law from negotiating on price), the money saved by buying from nonprofit drugmakers could easily replace all privately funded research and development. The increased public research dollars could then be applied, D.N.D.I.-like, to develop the medicines that would have the most significant public health impact.

Focusing tax dollars on the public good…what a concept!

The Party As Cult

Evidently, McConnell and the Senate GOP are still intent upon taking healthcare away from millions of Americans–despite the overwhelming unpopularity and utter immorality of that effort. If this current vote fails, they’ll fall back on their determined sabotage of the ACA and continue their refusal to work with Democrats to tweak and fix that measure’s flaws.

All because their “base” can’t abide the fact that a black President passed it.

On several occasions, I’ve remarked that today’s GOP bears less and less resemblance to the party I once worked for, and more and more resemblance to a cult. I used the term in its broadest and least precise sense–to indicate a walled-off reality–but I recently came across the following description of cult behavior, and it made me think that, at least for the so-called “base,” the comparison may have been more apt than I realized.

There seems to be a typical mindset within most destructive cults. This is often characterized by black and white thinking, a low tolerance of ambiguity and a relentlessly judgementa1 attitude. Members of such a group often think in “we, they” opposing terms regarding those outside their group. This mindset frequently produces feelings of superiority and/or spiritual elitism, claims of supposed “persecution” and unreasonable fears.

The description sent me on a Google search for information about the characteristics of cults. The so-called “unsafe” groups evidently share certain behaviors: affinity for authoritarianism, a lack of tolerance for critical inquiry and analysis (any criticism is labeled “persecution”), isolation and fear of the outside world, and loss of a sense of humor.

To be fair, any group of zealots–left or right–exhibits these characteristics. But the degree to which the Republican base falls within this description is striking. The penchant for authoritarian leadership, wholesale rejection of science and scholarship, isolation within an information “bubble,” excessive fear of terrorism, and the utter lack of a sense of humor (which requires a sense of proportion), are hard to miss.

We live in a time when the increasing complexity of the world around us requires a tolerance for ambiguity, a willingness to consider contending and unfamiliar perspectives and an ability to recognize the common humanity of people who do not look like us. Those are responses that many people simply cannot manage.

Political scientists analyzing the motivations of Trump voters in the wake of the 2016 election have identified “resentment”–especially but not exclusively racial resentment– as a primary characteristic.

That finding brings us back to the description of cult behaviors: black and white thinking (no pun intended), rejection of ambiguity and uncertainty, tribalism and claims of persecution (War on Christmas, anyone?).

The 64 Thousand Dollar question is: will this pass? Are these fearful and self-defeating attitudes mostly confined to older Americans who will die out, leaving the social and political landscape to a less panicked, less tribal and more intellectually nimble younger generation?

We can only hope.

Democracy Vouchers

The outrage that followed the Supreme Court’s decision in Citizens United focused national attention on a problem that has long preceded that unfortunate ruling: the influence of money on democratic deliberation.

Even if we ignore the armies of lobbyists and the corrupting influence of “big money” campaign donations in Washington and our state capitals, anyone who is at all familiar with the way in which policy is made understands that our elected representatives respond to the constituents from whom they hear, and those constituents are highly unlikely to be poor people.

People who are struggling to make ends meet rarely have time or energy to visit legislative bodies, testify in hearings or participate in grass-roots lobbying efforts. And it goes without saying that they are not numbered among the donors to legislative campaigns. As a result, even the most conscientious lawmakers (and they do exist) simply do not hear the voices and perspectives of working class Americans.

Seattle has recently embarked upon an effort to change that dynamic, at least to a degree.

If money amplifies the voices of wealthy Americans in politics, Seattle is trying something that aims to give low-income and middle-class voters a signal boost.

The city’s new “Democracy Voucher” program, the first of its kind in the US, provides every eligible Seattle resident with $100 in taxpayer-funded vouchers to donate to the candidates of their choice. The goal is to incentivize candidates to take heed of a broad range of residents – homeless people, minimum-wage workers, seniors on fixed incomes – as well as the big-dollar donors who often dictate the political conversation.

This August’s primary is the trial run for the program. But before Seattle can crow about having re-enfranchised long-overlooked voters, it must contend with conservative opposition.

A Libertarian law firm has sued the city to stop the program, alleging that democracy vouchers violate the first amendment rights of homeowners because their taxes are funding vouchers that will be contributed to candidates they oppose. That case is pending, but constitutional lawyers consider its prospects dubious.

The program opponents appear to be in the minority; the voucher program and its funding mechanism (a 10-year, $30m property tax levy) were approved by voters in a ballot measure in November 2015. All registered voters are sent the vouchers automatically. Residents who are not registered or who lack a permanent address – such as homeless people – can apply by mail or in person.

Seattle’s proposal joins other efforts that have emerged in the wake of the Obama and Sanders campaigns, both of which demonstrated that significant funds could be raised through appeals to small donors–no one of whom, presumably, would have the same ability to influence policy as individuals contributing large sums.

Last fall, South Dakota voters approved a program similar to Seattle’s, joining more than a dozen other states with some form of public financing, usually a matching fund for small campaign donations. Cities such as Portland, Oregon, and Berkeley, California, also followed the public-financing trend last year.

Democracy Vouchers are unlikely to make much of a dent in current levels of inequality of political influence, but the effort is encouraging. It represents an acknowledgment of the disparity in political influence between the rich and the rest, and to the extent it encourages candidates to focus  fundraising strategies on vouchers/small donors, it should add a (currently absent) perspective to the political conversation.

Just The Facts, Ma’am…

Shades of Joe Friday!

There really are incredible resources on the Internet. Granted, it can be hard to locate them  in that ever-burgeoning sea of spin, propaganda and conspiracy theories, but they exist. Last week, I blogged about “ProCon,” a site that presents the arguments made by contending sides on so-called “hot button” issues.

Today, I want to highlight USA FACTS, a site devoted to presenting a data-driven portrait of the American population, our government’s finances, and government’s impact on society.

We are a non-partisan, not-for-profit civic initiative and have no political agenda or commercial motive. We provide this information as a free public service and are committed to maintaining and expanding it in the future.

We rely exclusively on publicly available government data sources. We don’t make judgments or prescribe specific policies. Whether government money is spent wisely or not, whether our quality of life is improving or getting worse – that’s for you to decide. We hope to spur serious, reasoned, and informed debate on the purpose and functions of government. Such debate is vital to our democracy. We hope that USAFacts will make a modest contribution toward building consensus and finding solutions.

The site offers a brief description of its genesis:

USAFacts was inspired by a conversation Steve Ballmer had with his wife, Connie. She wanted him to get more involved in philanthropic work. He thought it made sense to first find out what government does with the money it raises. Where does the money come from and where is it spent? Whom does it serve? And most importantly, what are the outcomes?

With his business background, Steve searched for solid, reliable, impartial numbers to tell the story… but eventually realized he wasn’t going to find them. He put together a small team of people – economists, writers, researchers – and got to work.

Ultimately, Ballmer partnered in this effort with Stanford’s Institute for Economic Policy Research (SIEPR), the Penn Wharton Budget Model, and Lynchburg College.

The site does something I have long advocated–it collects numerical data about America’s state and federal governments that has previously been available only through a patchwork of reports and agency sites, and assembles it in a usable, comprehensible (and comprehensive) format. Want to know how much government took in in taxes last year and the year before? Where those dollars came from? What was spent? What a “trust fund” is and what its assets are? How many people work for government? What governments owe?

It’s all there, along with population demographics.

The charts are simple, the text understandable.

The next time one of the talking heads on cable makes an assertion about job creation under President X, or deficits amassed under President Y, his numbers can be checked in real time. (Like the t-shirt says, “Trust Data, Not Lore.”) (Star Trek fans will get that…)

These days, it sometimes seems as if partisans are uninterested in those pesky things we call facts; indeed, they seem to resent those of us who prefer to deal with accurate data. This site isn’t for them–but it is definitely a great resource for the rest of us!

Elevating Ignorance

By now, most people have heard about the twitter storm in the aftermath of NPR’s 4th of July tweeting of the Declaration of Independence. A number of Trump supporters responded angrily to the descriptions of King George as a tyrant; unfamiliar with one of this nation’s founding documents, these “patriots” assumed that the tyrant in question was Trump and unleashed their ire accordingly.

Pretty much everything to be said about that episode has been said, and I don’t intend to belabor yet another example of the lack of basic civic knowledge. (I’ll  even resist the temptation to say “See, I told you so.”)

What is worth thinking about, however, is what has been termed “America’s Cult of Ignorance.” An article addressing that issue began with my favorite Isaac Asimov quote:

There is a cult of ignorance in the United States, and there always has been. The strain of anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that ‘my ignorance is just as good as your knowledge.’”

The linked article is an excerpt from a book the author has written on the subject. He gives several examples of the harms done by widespread ignorance, then gets to the point:

These are dangerous times. Never have so many people had so much access to so much knowledge and yet have been so resistant to learning anything. In the United States and other developed nations, otherwise intelligent people denigrate intellectual achievement and reject the advice of experts. Not only do increasing numbers of lay people lack basic knowledge, they reject fundamental rules of evidence and refuse to learn how to make a logical argument. In doing so, they risk throwing away centuries of accumulated knowledge and undermining the practices and habits that allow us to develop new knowledge.

The author grapples with the phenomenon of “stubborn ignorance”in the midst of the information age, and concludes that “hilarious” as examples may be (see the NPR episode, for example) it is ultimately no laughing matter.

Late-night comedians have made a cottage industry of asking people questions that reveal their ignorance about their own strongly held ideas, their attachment to fads, and their unwillingness to admit their own cluelessness about current events. It’s mostly harmless when people emphatically say, for example, that they’re avoiding gluten and then have to admit that they have no idea what gluten is. And let’s face it: watching people confidently improvise opinions about ludicrous scenarios like whether “Margaret Thatcher’s absence at Coachella is beneficial in terms of North Korea’s decision to launch a nuclear weapon” never gets old.

The problem, as he readily admits, is not that we do not have experts. We do. The problem, he says, is that we use them as technicians, as conveniences. We don’t engage with them.

It is not a dialogue between experts and the larger community, but the use of established knowledge as an off-the-shelf convenience as needed and only so far as desired. Stitch this cut in my leg, but don’t lecture me about my diet. (More than two-thirds of Americans are overweight.) Help me beat this tax problem, but don’t remind me that I should have a will. (Roughly half of Americans with children haven’t bothered to write one.) Keep my country safe, but don’t confuse me with the costs and calculations of national security. (Most U.S. citizens do not have even a remote idea of how much the United States spends on its armed forces.)…

Any assertion of expertise from an actual expert, meanwhile, produces an explosion of anger from certain quarters of the American public, who immediately complain that such claims are nothing more than fallacious “appeals to authority,” sure signs of dreadful “elitism,” and an obvious effort to use credentials to stifle the dialogue required by a “real” democracy. Americans now believe that having equal rights in a political system also means that each person’s opinion about anything must be accepted as equal to anyone else’s.

A society that knows nothing, elects a know-nothing.