B. Generics are bid out like DFAR DoD contracts. Either cost-plus or FFP (Firm Fixed Price).
B.1 because companies like Teva Pharmaceutical have bought up many generic competitors making a monopoly of generics.
C. New brand drugs are also purchased. They can bid by US march in rights on Patents if a reasonable cost-plus price is not acceptable to the manufacturer.
D. The US NIH etc already funds billions for drug research. Like Defense companies, DoD now HHS can fund 2 or more Pharmaceutical companies to do targeted research. Also if Pharmaceutical co like Defense co, use internal funding (IRAD), that guarantees the Pharmaceutical company some share of sales participation and ROI
Totally agree on A-C. Regarding D, however, NIH research funding (that's around $10bn/year) is largely in the hands of Big Pharma, who generally determine grant recipients. And except in cases of national emergency--e.g., Aids epidemic, COVID--focus on developing new drugs with high profit potential; instead of broader public benefit. Ending Big Pharma's regulatory capture of NIH--or at least moderating it--would be better for consumers.
How about a Netflix model? Everyone pays the $X each year ($2000 if you want to use the proposed maximum). If it is on the market and your doctor prescribes it, you get it. Any money left over goes to the NIH for funding R&D. This forces negotiations between public and private insurers and the pharmaceutical companies and makes life a whole lot simpler for the consumers. Companies and the ACA can subsidize the payment if they want.
The infamous $600 toilet seat was an artifact of military accounting, since it also included all the overhead costs associated with buying a batch of toilet seats (such as paying the wages of the people who have to implement the purchase), not just how much money the manufacturer was paid per seat.
Why is it that when it comes to energy or housing traditional economics like increasing the supply is considered the right policy but when it comes to controlling costs in the healthcare system, the same strategy cannot be pursued? I know the answer to that - every part of the healthcare delivery system has a lot of lobbying power and there are a lot of sacred cows who cannot be harmed by either party. Just expected more honesty on this instead of BS like negotiating drug prices is the best way to lower costs.
Congress first needs to modify, repeal or replace the GOP's Medicare Part D law, passed under the GW Bush Admin, that expressly FORBIDS the federal government from collectively negotiating drug prices with Big Pharma. Which is the reason why Americans still pay 200-1000% more than consumers in countries like Canada for identical meds; and are banned by law from importing Rx's of these much cheaper meds from Canada.
Housing is in principle a pretty competitive market that is mostly constrained by local regulations that prevent more building. So reducing the level of regulation to increase supply seems like a no-brainer.
I agree with your sacred cows point. I think if we want to increase supply in healthcare it will be a more complex process than just putting it in a candidate's platform and running straight at it. Maybe more fiddling with medical school and residency caps? Creating more retail healthcare areas similar to Lasik? Finding more ways to put remote or automated options into the loop? AI-based systems seem like they will soon start making a big difference here, regulation permitting.
Apart from the presence of lots of interested buyers, housing is in fact not a very competitive market. The barrier to entry is high because it’s costly to acquire land and obtain permits to build a home, construction costs are high. It’s bought and sold infrequently so the kind of advantage that consumers have when they purchase frequently purchased items is missing. There’s a lot of information asymmetry because the bids are not open. The transaction costs are high because of agent fees and other costs associated with buying/selling a house.
And what about the idea of preventing “price gouging”? It’s dumb AF. First off, market prices are a signal. If you want to fill a tank of gas where no gas is available, guess what? To induce a supplier to take the risk and drive into a hurricane’s zone of destruction, he will need to be compensated! Otherwise… no gas for you! Price caps or restrictions during emergencies distort these signals, discouraging suppliers from entering high-risk areas because they can’t charge what the market demands. This leads to shortages and leaves consumers worse off. High prices, while painful, encourage supply to flow to where it’s most needed, incentivizing producers to take risks or ramp up production. Interfering with this natural market process prevents resources from reaching critical areas and prolongs the crisis.
I always see this as a reference to banks, but has any one seen the rediculous markup fees on something like a late EZPASS ticket? Whether it be real or a misread its well over whatever the bank overdraft markups are and I have never seen it referenced anywhere with regards to fees. Something the vast majority of at least the east coast deals with, has an absolutely absurd markup, and is never discussed.
I do not see much of Harris's economic policy becoming law. Both Harris and the insurrectionist will be greatly constrained by Congress in economic policy, but the insurrectionist will try much harder to evade that constraint. Harris will be willing to compromise on economic issues with Congress, but the insurrectionist will simply demand that the Republican Party do what he tells them to.
What is your name for the guy who tried through violence and fraudulent electoral certificates to retain power after an electoral defeat? I'd probably be happy to use it.
The perfect place for it. Dead and buried. Chernobyl and Fukushima Daichi and Ten Mile Island are proof that, despite strong industry assurances to the contrary, nuclear plants aren't worth the extreme downside risks. Y'know, like the irradiation of major metropolitan areas? On top of that there's no viable--much less cost effective--way for industry to dispose of nuclear waste, unless it dumps cleanup on the taxpayer.
A 10,000 year guarantee of safe storage, with the assumption that no one will pay any attention to it for the entire duration, is a requirement designed to block nuclear by eliminating any sane, cost-effective means of disposal.
"Harris’ plan is to continue ... allowing fossil fuel drilling."
What are you basing that on? There is not one word in her 82-page economic policy platform that says she will work to continue to allow fossil fuel drilling. She celebrates that oil and gas output has been at all-time highs the last few years, but that is mostly in spite of the Biden-Harris administration, not because of it. Expect even more stifling of oil and gas in a Harris-Walz administration.
It's true that Noah Smith's favored candidate is less erratic and corrupt, but in endorsing her program (Clinton 5.0) he seems not to attend to several elephants in the room, all relating to presidential powers: Who is going to pay for these programs? Which legislators are going to vote for them? What if anything would Harris do to the almost one trillion dollar "defence" budget (other than increase it), for example funding the 50K troops in Japan and 30K troops in Germany? Attend to the Russian and Chinese threats, no doubt? Here are some pretty well known facts Mr Smith does not seem to attend to: //
As of September 2022, there are 171,736 active-duty military troops across 178 countries, with the most in Japan (53,973), Germany (35,781), and South Korea (25,372). These three countries also have the most U.S. military bases – 120, 119, and 73, respectively. Oct 25, 2023
Noah, calling a policy for the poor welfare, even "new welfare," is the absolute kiss of death. I haven't heard the word welfare in many a day—people manage to pronounce TANF. You might as well call it the “Dolled-up Dole."
I disagree with your dislike of taxing unrealized capital gains.
Because we already do that for homeowners (property taxes* are based on current appraised value), we should also do it for the rich who hold most of their net worth in stocks/bonds. For lots of homeowners, their house represents most of their net worth. I call this as massively unfair.
*: My father was paying more _every year_ in property taxes the last few years of his life than he paid for his house when he bought it.
If the value of the property had skyrocked while father's income was still at 1955 or so levels, he'd have had to sell the house, pay his capital gains taxes (20% or so, not a big deal if you've just made, say, a factor of 10 or more on a loan you could barely afford), and move to a location more commensurate with his income. That's what happened in Tokyo during the bubble: people sold their near-center-city land, paid their taxes, and lived happily ever after in the suburbs in nicer digs and with gobs of money in their pockets. Folks who refused to move, lost big.
(In real life, the locality we lived in is willing to accept the property in lieu of taxes, so the elderly poor can remain in their homes. (Father retired at 75 or so with decent retirement income, so it wasn't property taxes, but mother's medical care costs that threatened to take the house.))
Obviously one has to be careful about the fine print, but taxing stock market gains might mean a tendency for insane bubbles (WeWork, Theranos) to fizzle out before they got out of hand. Besides, a 20% tax on unrealized gains would, unlike real estate taxes, only occur once: if the stocks go up again, you already paid the first part of the rise, you should only be liable for the untaxed unrealized gains (depending on the fine print, of course).
But thanks! Your note made me realize the above point: unrealized capital gains would only get taxed the year they occur, but property taxes apply to all the gains over all the years you owned the property, every year, year in, year out. Someone has to pay for police, fire, and schools, so I'm not advocating abolishing property taxes. But it makes my argument for taxing unrealized capital gains stonger.
The primary rationale for property tax is that it discourages people from hoarding real estate, which is bad because the supply is inherently limited. This argument would be a bit clearer if we taxed only land, not improvements, but regardless it's still the foundational reason that property tax is near-universally accepted as a good thing, even though taxing wealth is generally problematic.
To put other sorts of wealth taxes on an equal footing, you'd need to find a similar rationale, I think, and the only one I see on offer is the notion that inequality is inherently bad, which is debatable at best.
The fact that she is not a rapist or a fascist fuck is all I need to know.
You left out an important piece: Is there any weird capitalization in the document??
I was Relieved not to Find any.
NOt wEird EnOuGH
Great stuff. My small step proposal is:
Buy Pills like Bullets.
A. CMS/HHS is the sole buyer of all drugs
B. Generics are bid out like DFAR DoD contracts. Either cost-plus or FFP (Firm Fixed Price).
B.1 because companies like Teva Pharmaceutical have bought up many generic competitors making a monopoly of generics.
C. New brand drugs are also purchased. They can bid by US march in rights on Patents if a reasonable cost-plus price is not acceptable to the manufacturer.
D. The US NIH etc already funds billions for drug research. Like Defense companies, DoD now HHS can fund 2 or more Pharmaceutical companies to do targeted research. Also if Pharmaceutical co like Defense co, use internal funding (IRAD), that guarantees the Pharmaceutical company some share of sales participation and ROI
Totally agree on A-C. Regarding D, however, NIH research funding (that's around $10bn/year) is largely in the hands of Big Pharma, who generally determine grant recipients. And except in cases of national emergency--e.g., Aids epidemic, COVID--focus on developing new drugs with high profit potential; instead of broader public benefit. Ending Big Pharma's regulatory capture of NIH--or at least moderating it--would be better for consumers.
How about a Netflix model? Everyone pays the $X each year ($2000 if you want to use the proposed maximum). If it is on the market and your doctor prescribes it, you get it. Any money left over goes to the NIH for funding R&D. This forces negotiations between public and private insurers and the pharmaceutical companies and makes life a whole lot simpler for the consumers. Companies and the ACA can subsidize the payment if they want.
The infamous $600 toilet seat was an artifact of military accounting, since it also included all the overhead costs associated with buying a batch of toilet seats (such as paying the wages of the people who have to implement the purchase), not just how much money the manufacturer was paid per seat.
It’s very good policy across the board. Why she needs to win.
Why is it that when it comes to energy or housing traditional economics like increasing the supply is considered the right policy but when it comes to controlling costs in the healthcare system, the same strategy cannot be pursued? I know the answer to that - every part of the healthcare delivery system has a lot of lobbying power and there are a lot of sacred cows who cannot be harmed by either party. Just expected more honesty on this instead of BS like negotiating drug prices is the best way to lower costs.
Well, that's one reason. There are others. But supply and demand definitely do operate in the health care system.
Good to see that others are also talking about the lack of conversation around the abundance agenda in healthcare.
https://x.com/pahlkadot/status/1844885634831327569
Congress first needs to modify, repeal or replace the GOP's Medicare Part D law, passed under the GW Bush Admin, that expressly FORBIDS the federal government from collectively negotiating drug prices with Big Pharma. Which is the reason why Americans still pay 200-1000% more than consumers in countries like Canada for identical meds; and are banned by law from importing Rx's of these much cheaper meds from Canada.
The IRA has removed the ban I believe, which is why the Biden administration was able to negotiate the prices of 10 drugs.
Housing is in principle a pretty competitive market that is mostly constrained by local regulations that prevent more building. So reducing the level of regulation to increase supply seems like a no-brainer.
I agree with your sacred cows point. I think if we want to increase supply in healthcare it will be a more complex process than just putting it in a candidate's platform and running straight at it. Maybe more fiddling with medical school and residency caps? Creating more retail healthcare areas similar to Lasik? Finding more ways to put remote or automated options into the loop? AI-based systems seem like they will soon start making a big difference here, regulation permitting.
Apart from the presence of lots of interested buyers, housing is in fact not a very competitive market. The barrier to entry is high because it’s costly to acquire land and obtain permits to build a home, construction costs are high. It’s bought and sold infrequently so the kind of advantage that consumers have when they purchase frequently purchased items is missing. There’s a lot of information asymmetry because the bids are not open. The transaction costs are high because of agent fees and other costs associated with buying/selling a house.
The product is not homogeneous or fungible.
Of course she can promise a lot, but so much of this would be funded by tax increases such that it wouldn’t survive congress.
You like her housing ideas? Giving $25k to new home buyers will cause home prices to go up by $25k.
Probably not the full $25k, because not everyone would qualify.
Ok. It’s still an awful idea. Helps no one except maybe the politician who gets a few votes.
And what about the idea of preventing “price gouging”? It’s dumb AF. First off, market prices are a signal. If you want to fill a tank of gas where no gas is available, guess what? To induce a supplier to take the risk and drive into a hurricane’s zone of destruction, he will need to be compensated! Otherwise… no gas for you! Price caps or restrictions during emergencies distort these signals, discouraging suppliers from entering high-risk areas because they can’t charge what the market demands. This leads to shortages and leaves consumers worse off. High prices, while painful, encourage supply to flow to where it’s most needed, incentivizing producers to take risks or ramp up production. Interfering with this natural market process prevents resources from reaching critical areas and prolongs the crisis.
Her ideas suck and are based on fantasy.
> Part 6: Measures to lower financial fees
I always see this as a reference to banks, but has any one seen the rediculous markup fees on something like a late EZPASS ticket? Whether it be real or a misread its well over whatever the bank overdraft markups are and I have never seen it referenced anywhere with regards to fees. Something the vast majority of at least the east coast deals with, has an absolutely absurd markup, and is never discussed.
Have you checked out the most recent single from the New Welfarists?
I do not see much of Harris's economic policy becoming law. Both Harris and the insurrectionist will be greatly constrained by Congress in economic policy, but the insurrectionist will try much harder to evade that constraint. Harris will be willing to compromise on economic issues with Congress, but the insurrectionist will simply demand that the Republican Party do what he tells them to.
Who was charged with insurrection? Anyone? If you are going to make accusations be accurate, not just spout a narrative.
What is your name for the guy who tried through violence and fraudulent electoral certificates to retain power after an electoral defeat? I'd probably be happy to use it.
Energy "perfect" as nuclear remains moribund?
Joe Biden has been the most pro-nuclear President of my lifetime, BY FAR.
https://x.com/Blake_Allen13/status/1840763288373576157?t=43Ipb9a89DF9z9HD6R37AA&s=19
Just because he is anti fossil fuels doesn't make him pro nuke (except for Iran) . How many nuclear plants were built under Biden/harris?
And why did he appoint a commissioner who favors the present red tape mess? Talk’s cheap.
My thought exactly
The perfect place for it. Dead and buried. Chernobyl and Fukushima Daichi and Ten Mile Island are proof that, despite strong industry assurances to the contrary, nuclear plants aren't worth the extreme downside risks. Y'know, like the irradiation of major metropolitan areas? On top of that there's no viable--much less cost effective--way for industry to dispose of nuclear waste, unless it dumps cleanup on the taxpayer.
Yes, let's just breathe that coal dust nice and deep
A 10,000 year guarantee of safe storage, with the assumption that no one will pay any attention to it for the entire duration, is a requirement designed to block nuclear by eliminating any sane, cost-effective means of disposal.
"Harris’ plan is to continue ... allowing fossil fuel drilling."
What are you basing that on? There is not one word in her 82-page economic policy platform that says she will work to continue to allow fossil fuel drilling. She celebrates that oil and gas output has been at all-time highs the last few years, but that is mostly in spite of the Biden-Harris administration, not because of it. Expect even more stifling of oil and gas in a Harris-Walz administration.
It's true that Noah Smith's favored candidate is less erratic and corrupt, but in endorsing her program (Clinton 5.0) he seems not to attend to several elephants in the room, all relating to presidential powers: Who is going to pay for these programs? Which legislators are going to vote for them? What if anything would Harris do to the almost one trillion dollar "defence" budget (other than increase it), for example funding the 50K troops in Japan and 30K troops in Germany? Attend to the Russian and Chinese threats, no doubt? Here are some pretty well known facts Mr Smith does not seem to attend to: //
As of September 2022, there are 171,736 active-duty military troops across 178 countries, with the most in Japan (53,973), Germany (35,781), and South Korea (25,372). These three countries also have the most U.S. military bases – 120, 119, and 73, respectively. Oct 25, 2023
Where in the world are US military deployed?
Chicago Council on Global Affairs //
https://globalaffairs.org/bluemarble/us-sending-more-troops-middle-east-where-world-are-us-military-deployed#:~:text=As%20of%20September%202022%2C%20there,119%2C%20and%2073%2C%20respectively.
Noah, calling a policy for the poor welfare, even "new welfare," is the absolute kiss of death. I haven't heard the word welfare in many a day—people manage to pronounce TANF. You might as well call it the “Dolled-up Dole."
I disagree with your dislike of taxing unrealized capital gains.
Because we already do that for homeowners (property taxes* are based on current appraised value), we should also do it for the rich who hold most of their net worth in stocks/bonds. For lots of homeowners, their house represents most of their net worth. I call this as massively unfair.
*: My father was paying more _every year_ in property taxes the last few years of his life than he paid for his house when he bought it.
If the value of the property had skyrocked while father's income was still at 1955 or so levels, he'd have had to sell the house, pay his capital gains taxes (20% or so, not a big deal if you've just made, say, a factor of 10 or more on a loan you could barely afford), and move to a location more commensurate with his income. That's what happened in Tokyo during the bubble: people sold their near-center-city land, paid their taxes, and lived happily ever after in the suburbs in nicer digs and with gobs of money in their pockets. Folks who refused to move, lost big.
(In real life, the locality we lived in is willing to accept the property in lieu of taxes, so the elderly poor can remain in their homes. (Father retired at 75 or so with decent retirement income, so it wasn't property taxes, but mother's medical care costs that threatened to take the house.))
Obviously one has to be careful about the fine print, but taxing stock market gains might mean a tendency for insane bubbles (WeWork, Theranos) to fizzle out before they got out of hand. Besides, a 20% tax on unrealized gains would, unlike real estate taxes, only occur once: if the stocks go up again, you already paid the first part of the rise, you should only be liable for the untaxed unrealized gains (depending on the fine print, of course).
But thanks! Your note made me realize the above point: unrealized capital gains would only get taxed the year they occur, but property taxes apply to all the gains over all the years you owned the property, every year, year in, year out. Someone has to pay for police, fire, and schools, so I'm not advocating abolishing property taxes. But it makes my argument for taxing unrealized capital gains stonger.
The primary rationale for property tax is that it discourages people from hoarding real estate, which is bad because the supply is inherently limited. This argument would be a bit clearer if we taxed only land, not improvements, but regardless it's still the foundational reason that property tax is near-universally accepted as a good thing, even though taxing wealth is generally problematic.
To put other sorts of wealth taxes on an equal footing, you'd need to find a similar rationale, I think, and the only one I see on offer is the notion that inequality is inherently bad, which is debatable at best.
So Harris will repeal the SALT deduction limitation, the one truly effective progressive tax reform in decades?
No. Just the corporate tax cut and pass-through tax cut.