Sarah Kliff, Promoter Of Democratic Healthcare Fantasies

Vox's Sarah Kliff, last seen before 2016 election whistling past the Obamacare graveyard, now chirps about the number of Democratic health care proposals! Yay, team!

It’s notable to me that Democrats seem really keen on having another health care debate. They’re preparing for it by putting all these different options on the table, to sort through where a consensus might exist.

And the "options" really boil down to a Hobson's choice: how do you want your government-controlled health care delivered? All from the government right now (single-payer, a consistent loser at the polls)? Pretending that single-payer isn't the endgame right away (Medicare/Medicaid buy-in, i.e. the public option)? However you cut it, the belief in magical government intervention as an elixir is central to all of them. None of these will fix the physician shortage, nor will it fix the patent system, nor the regulatory moats around pharmaceuticals. Kliff doesn't concern herself with those kinds of details; her job is that of cheerleader. We know this because the second half of her article goes on to explain the wonders of the Murphy-Merkley plan, during which she writes the following:

The Choose Medicare Act envisions that individuals and companies would cover their costs for buying into Medicare, meaning actuaries would need to determine what those premiums would look like. There is some reason to expect these premiums would be lower than premiums for private insurance, because Medicare typically pays lower prices.

There are a lot of things to say about that, not least the shifting terrain that a large influx of new "insureds" would look like; recall that the Obamacare cohort was sicker than the general population, i.e. the incentives are for such people to seek out such care. There's hardly a reason to think a "public option" would save material costs, and considerable reasons to think it would do worse (i.e. the Democrats would be sure to goose the actuarial realities by way of further subsidies).

Another problem is the quip sometimes attributed to Stalin, that quantity has a quality all its own. Kliff is right that private payers pay more for their services than Medicare. But assuming Medicare expansion will fix costs also assumes that physicians will continue to accept Medicare patients. While data is hard to come by, Texas Medical Association figures showed a dramatic drop in the acceptance of new Medicare patients from 2000 (when 67% of physicians accepted all comers) to 2010 (only 31%). Moreover, given that Medicare represents a relatively small fraction of physician income (as of 2011, around 40% in Texas, see PDF page 5), expanding it would demand physicians take a substantial pay cut. That they might opt out of accepting new patients or stop seeing Medicare patients altogether. Second-order effects: we can haz them!

Contra Randall Munroe On Free Speech

Bar none, the best explainer of why that XKCD comic on free speech is both correct and woefully inadequate: while it is true that advertiser boycotts are a legitimate means to get TV programs one dislikes off the air, it also gives air to the deplatforming assholes who also are wont to exercise the heckler's veto.

How An Idiotic Patent Turned $20 Worth Of Generic Drugs Into $5,430

So I went to see the surgeon today for a followup appointment following my knee surgery, a routine arthroscopy. He recommended I take an anti-inflammatory, 800 mg of ibuprofen, three times a day. Doses that large are not always well-tolerated; they have been known to cause gastric upset. Consequently, we get this:

Meet Duexis, a product of Horizon Pharma. Duexis consists of 800 mg of ibuprofen, and 26.6 mg of famotidine. Ibuprofen was patented in the UK in 1961, and expired in 1984; the US patent (3769425A) was granted in 1970, and would have expired in 1987. Originally sold under the trade name of Pepcid, famotidine has been off patent for 20 years, with generics appearing in 2001.

I checked at Sam's Club, and 200 count 20mg famotidine is currently $8.76, and 1,200 200 mg ibuprofen is available for $10.88. Assuming I take three 800 mg ibuprofen doses daily and three of the 20 mg famotidine, that would mean the latter is the limiting factor, and I could go about two months (66 days, plus two doses the next) on that. (The 1,200 ibuprofen would take me 100 days, a little over three months.)

A one month prescription of Duexis (30 days @ 3x/day) is $2,715 (per the Sam's Club pharmacy). Two months is $5,430.

Duexis is covered by US patent 8,501,228, which I assume is the reason for this insane pricing. (Horizon also granted Par Pharmaceutical a license to make a generic starting in 2023 as a result of a patent suit settlement.) This kind of apparently frivolous patent grant is disturbingly common:

When the patent reaches its expiry date, the comfortable monopoly evaporates, replaced by cut-throat competition. Incumbents have three ways of defending themselves. Marketing can create brand-specific demand, dulling the temptation to switch to low-price products. Ibuprofen illustrates this. Developed by the chemists at Boots itself in the 1960s, the patent expired in 1984. But a year earlier Boots had created Nurofen, branded ibuprofen. The clever mix of packaging and advertising protected its profits. The lucrative Nurofen brand was sold in 2006; Boots still stocks the product, which costs five times more than its generic equivalent.

A second strategy nudges customers towards newer drugs that are still protected by patent. Omeprazole, a drug to reduce stomach acid developed by AstraZeneca in the 1980s, shows how it works. Branded as Losec in Britain and Prilosec in America, it became one of the world’s bestselling drugs in the mid-1990s. With the patent set to expire in 2001 AstraZeneca faced a drop in profits. So the company took its drug and adapted it, creating a closely related compound, esomeprazole, which it sold as Nexium. Though a clear offshoot of the original medicine, this counted as a new drug and was given a patent. A big marketing campaign and attractive pricing helped shift demand away from Losec and towards Nexium. With the help of this strategy, sales between 2006 and 2013 amounted to almost $40 billion.

A third approach is to "pay the makers of generics not to compete". None of these are in the customer's interest.

Ironically, the surgeon pointed me at a manufacturer program that was going to cut me a break if I used their particular pharmacy — oh, joy! — I only have to pay a $10 copay! But this made me wonder if my insurance was going to pay it or some part of it. In which case, am I not indirectly paying for this usuriousness?

Jill Filipovic, Political Medium, Speaks To Conservative Ghosts

Jill Filipovic once described herself as a "recovering attorney", which is about right, because she doesn't actually do a terribly good job of encapsulating the arguments of her opponents. I came across an essay of hers in NBC News' Think blog, in which she attempts to extirpate the stain of Chappaquiddick from the Democratic brand while bagging on conservatives for their support of someone as vile as Donald Trump. Leaving that aside for the moment (and she does have a valid point that support for Trump precludes conservative moral dudgeon on a vast array of Democratic transgressions), she seriously stumbles at her misapprehension of what the conservative argument actually might be:

The conservative worldview has always been animated by the idea of men as sexual predators who need reining-in by the morally temperate, sexually mild and inherently alluring female of the species. Women, in this view, are a family’s moral beacon, while men are its public face. That ideology conveniently requires women to stay behind the scenes; if women do subvert their traditional roles, it removes responsibility from men to still behave well.

 This is a curious charge to level at Republicans, who offered up a famously incompetent but still female vice presidential candidate in 2008. Republican women form a majority of women governors and lieutenant governors, as well as notching 706 elected state-level representatives. Not only does Filipovic's explanation appear not to come from someone within the movement, it doesn't even square with known facts. It's like she's having a conversation with the ghost of Phyllis Schlafly.

Second Amendment For All, Shot And Chaser Edition

Shot:

"I have a dream that enough is enough." -Yolanda Renee King, granddaughter of Martin Luther King Jr. #MarchForOurLives pic.twitter.com/gD5V8bQl1I

— March For Our Lives (@AMarch4OurLives) March 24, 2018

Chaser:

Martin Luther King Jr. carried guns for self-protection, applied for a conceal-carry permit (denied by racist white authorities), and once declared, "the principle of self-defense, even involving weapons and bloodshed, has never been condemned, even by Gandhi."

The War On Objective Competence

Campus Reform brings to us a masterpiece of feminist criticism of engineering and the hard sciences. And by "masterpiece", I mean a perfect example:

The professors are especially concerned with how engineering courses tend to be “depoliticized” compared to classes in other fields, which they contend is due in part to engineering culture’s emphasis on meritocracy and individualism.

“Socialization into the ideologies of meritocracy and individualism, coupled with a valorization of ‘technical’ prowess at the expense of ‘socially focused’ work processes, depoliticizes the gendered structure of the profession,” they write.

The professors add that this can be problematic because “students learn that raising concerns about marginalization—of themselves or others—is tangential or even distracting to what counts as the ‘real’ practical and objective work of engineering.”

The authors' credentials are all impeccable: none of them teach engineering classes, and only one drifted away from that discipline:

• Carroll Seron has a post at the Criminology, Law and Society department of UC Irvine's School of Social Ecology.
• Susan S. Silbey works at MIT's Sloan School of Management as a Professor of Behavioral and Policy Sciences.
• Erin A. Cech is an assistant professor in the sociology department at U. Michigan after obtaining an engineering degree at Montana State.
• Brian Rubineau teaches at McGill University as an Associate Professor of Organizational Behaviour.

As usual, none of these people have anything directly to do with their institutions' engineering or science schools. But it does qualify as yet another salvo in the ongoing war by idiot mandarins who do nothing upon objective measures of competence in fields where its exercise is of obvious import to society.

Matt Yglesias, Picker Of Free Speech Cherries

Time was, Vox published some decent defenses of free speech, even vile speech, and particularly, its constraint on campus in recent years. Matt Yglesias' recent effort, "Everything We Think About The Political Correctness Debate Is Wrong", is not one of them. He makes a number of claims regarding free speech, young people, and colleges, which rest on cherry-picked data, a stubborn refusal to engage with the more serious arguments of his adversaries, and studied ignorance of current events. He starts by tut-tutting David Brooks' review of events at Lewis & Clark Law School in Portland, Oregon, caricaturing his argument as

... broad generalizations about ... “basic understanding of how citizenship is supposed to work” versus “today’s students” for whom “reason, apparently, ceased to matter” and instead “see public life as an inevitable war of tribe versus tribe.”

He smirks at Reason's Eric Boehm's survey article and its characterization of "authoritarian political correctness" as so much bombast. He flippantly dismisses Bari Weiss' essay in the New York Times about Christina Hoff Sommers' premature ejection from a lectern at Lewis & Clark Law School by its dean of diversity and inclusion by noting Weiss got taken in by one — one! — tweet from a fake Twitter account that she subsequently removed from the piece. Ah, well, no need to deal with the rest of it, then!

Yglesias starts his counterattack with a disingenuous tweetstorm by Jeffrey Sachs, who cites a 2016 Gallup/Knight poll (PDF) as proof that students really do support free speech, despite all the anecdotal deplatforming. While they answer the question, "Should universities be open environments that permit offensive speech, or safe ones that forbid it?" in the affirmative, he conveniently ignores all the other polling data that shows how thin this commitment really is. As FIRE observes with a more recent (and more expansive) version of the same Gallup/Knight poll (emboldening mine):

• In the new survey, conducted in November and December of 2017, students said they preferred an “open learning environment” that allows offensive speech (70 percent) to a “positive environment” that prohibits certain speech (29 percent). However, students’ attitudes have become more speech restrictive since 2016, when the percentage point difference was 78 percent to 22 percent.
• More students today than in 2016 believe campuses should restrict slurs or “language that is intentionally offensive to certain groups” (73 versus 69 percent) and “political viewpoints that are upsetting or offensive to certain groups” (30 versus 27 percent). ....
• More students today than in 2016 think their campus “prevents some people from saying things they believe because others might find them offensive” (61 versus 54 percent).
• Students also think that First Amendment rights are less secure today than they were in 2016: freedom of speech (64 versus 73 percent), freedom of religion (64 versus 68 percent), freedom of press (60 versus 81 percent), freedom of assembly (57 versus 66 percent), the right to petition the government (67 versus 76 percent).

In other words, students

• are getting more, not less, censorious (with a significant minority advocating censorship)
• like censorship when it serves a politically useful purpose
• unsurprisingly believe that colleges are stifling offensive speech
• also believe that First Amendment rights (consequently?) are under attack.

Among the newer survey's findings:

• ... Forty-nine percent of students favor “instituting speech codes, or codes of conduct that restrict offensive or biased speech on campus that would be permitted in society more generally.” However, 83 percent of students favor “establishing a free speech zone, a designated area of campus in which protesting or distributing literature is permitted, usually with pre-approval.” It’s possible most students don’t know that inaptly named “free speech zones” are a type of restriction on speech – or speech code – which might explain the disparity with students’ mixed support for speech codes.
• Students narrowly prefer “diversity and inclusion” as a more important value when pitted against free speech (53 versus 46 percent).
• Students perceive that political conservatives are the least free to express their views on campus by a pretty wide margin, though most students (69 percent) believe political conservatives are free to express their views. Ninety-two percent of college students think that political liberals are free to express their views on campus.
• A majority of students (69 percent) are in favor of canceling planned speeches because of concerns about the possibility of violence. Most students, however, (72 percent) oppose disinviting a speaker because some students are opposed to the invitation. That said, FIRE’s “Speaking Freely” survey found that when students are presented with the actual names of speakers or ideologies represented by those speakers, most students (56 percent) support disinviting some guest speakers.
• [A] minority of students — 10 percent —  report that it is sometimes acceptable to use violence to silence a speaker. The survey also found that 37 percent of students think it is sometimes acceptable to shout down speakers.

Given prior fatuous conflations of disagreeable speech and violence, let alone spurious historical claims of "racist" speech or "sexist" speech (ahem, Laura Kipnis), one can't condemn this sort of censorship advocacy by other means too strongly. Yet Yglesias ignores it all, just as he doesn't mention the FIRE disinvitation database, cataloguing hundreds of such events — and most of them at the hands of supposed liberals. If he thinks this is even remotely convincing outside the universe of pro-censorship-under-another-name types in colleges, he is deeply mistaken.