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As the Marxist agitator Adam Smith once said, âPeople of the same trade seldom meet together, even for merriment and diversion, but the conversation ends in a conspiracy against the public, or in some contrivance to raise prices.â
Smith understood that capitalists hate capitalism. They donât want to compete with one another, because that would interfere with their ability to raise the prices their customers pay and reduce the wages they pay their workers. Thus Peter Thielâs anticapitalist rallying cry, âcompetition is for losers,â or Warren Buffettâs extreme horniness for businesses with âwide, sustainable moats.â
These anti-capitalist capitalists love big government. They love no-bid military contracts, they love ACA subsidies for health insurance companies, they love Farm Bill cash for Cargill and Monsanto. What they donât love is markets.
Case in point: pharma giant Merck. The Inflation Reduction Act (IRA) includes a provision that allows Medicare to (finally) start (weakly) negotiating the prices it pays for (a tiny handful of) drugs. If youâre scratching your head and wondering if you understood that correctly, let me assure you, you did: the US government is currently prohibited from negotiating drug prices when it bargains with pharma companies.
In other words: Medicare simply pays a pharma companiesâââwhose products build on billions in publicly funded basic research, whose taxes are reduced by billions in research credits, whose patents are backstopped by billions in enforcementâââwhatever it demands.
To do otherwise, you see, would be socialism. Markets are âefficientâ because they âdiscover pricesâ through bidding and selling. In the case of publicly purchased drugs, the price that Uncle Sucker âdiscoversâ is inevitably âa titanic sumâ or possibly âadd a couple more zeroes, wouldya?â
Enter the IRA. Starting in 2026, Medicare will be permitted to negotiate the price of ten (10) drugs. The negotiations will use the prices of other drugs from the dysfunctional, monopolized market as a starting point and go up from there. The negotiations go on for three years, and there are multiple stages where pharma companies can hit pause with court challenges:
The system will not consider the prices that Medicaid or the VA (which are allowed to bargain on prices) pay. Nor will it consider the prices that other governments payâââthe US is alone in the wealthy world in offering the anticapitalist price-taking posture when dickering with the pharma companies.
But this isnât enough for Merck. They are suing the Biden administration over the IRAâs drug pricing plan, arguing that it is an unconstitutional taking under the Fifth Amendment:
Merck is represented by Big Law firm Jones Day, who made their bones by representing the RJ Reynolds from smokers with lung-cancer, arguing that the smoking/cancer link wasnât scientifically sound. Thatâs not the only fanciful argument they put before a judge: Jones Day also represented Trump in his attempts to overturn the 2020 election (they also hired Trumpâs counsel Don McGahn as he exited the White Houseâs revolving door).
As Ryan Cooper writes for The American Prospect, Merckâs argument is that the âfair marketâ value of its drugs can only be discovered if its single largest customerâââMedicareâââsimply pays whatever Merck demands of it:
They explicitly denounce the idea that a powerful buyer should use its market power to extract price concessions from sellers like Merck: âleveraging all federal insurance benefits (amounting to over half of the prescription drug market) to coerce companies to abandon their First and Fifth Amendment rights is a quintessential unconstitutional condition.â
Rebutting this argument, Health Secretary Xavier Becerra said, ânegotiating for the best price is as American as apple pie. Since when is competition in this American system a bad thing? Why should we be the patsies around the world and pay the highest prices for medicines?â
The irony here is that Merck itself is a very powerful buyer. Whether negotiating commercial leases, raw materials or wages, Merck is ruthless in extracting the lowest prices it can from its suppliers. The company attained its massive scale the old fashioned way: buying it. By drawing on its nearly limitless access to the capital markets, Merck bought out dozens of its competitors:
https://mergr.com/merck-acquisitions
Anticapitalist investors funded these acquisitions in the expectation that Merck would be able to use its market dominance to pay suppliers less, charge customers more, and use some of the resulting windfall to corrupt and bully its regulators so that it could buy still more companies, charge still higher prices, and impose crushingly low prices on still more suppliers.
The IRAâs drug-bargaining provisions are extraordinarily weak. When they were first mooted in 2021, I talked about how Democrats were caving on muscular drug price controls that would benefit every American (except a handful of pharma shareholders):
They did so despite wild, bipartisan support for imposing price discipline on Big Pharma, and ending the 300% premium Americans pay for their drugs relative to their cousins abroad. 95% of Democrats support strong price controls; so do 82% of independentsâââand 71% of Republicans:
No one believes Big Pharmaâs scare stories about how this would kill R&D: 93% of Americans reject this idea, including 90% of Republicans. Theyâre rightââânearly all US basic pharma R&D is directly funded by the federal government, with pharma companies privatizing the gains:
Despite the fact that really whipping the shit out of Big Pharma would be both popular and good for America, the Demsâ final version of pharma bargaining is a barely-there nothingburger where ten drugs will become slightly cheaper, after the next federal election. This is called âpolitical realismâ and itâs a fantasy.
The idea that limiting drug controls to the faintest, most modest measures would make them easier to attain was obvious nonsense from the start, and Merckâs anticapitalist lawsuit proves it. Merck will settle for nothing less than total central planningâââby Merck. For Merck, the role of the federal government is to wave through a stream of mergers culminating in Merckâs ownership of every major drug; patent extensions for these drugs to carry them into the 25th century and beyond, and unlimited sums paid for these drugs on Medicare.
Given all that, there would have been no downside to the Dems passing an IRA that subjected the drug companies the same modest, commensense, market-based discipline we see in Canada, or the UK, or France, or Germany, or Switzerland.
But thatâs not the IRA we got. Instead of defending a big, visionary program in court, the Biden admin is facing down Jones Day and Merck to defend the most yawn-inducing, incrementalist half-measure. What a wasted opportunity.
If youâd like an essay-formatted version of this post to read or share, hereâs a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:
[Image ID: A caricature of a businessman with a money-bag for a head and a stickpin bearing the Merck logo, standing atop a pile of bundled $100 bills. At the bottom of the pile, a frowning, disheveled Uncle Sam offers up a $100 bill.]
U.S. sales of the 20 top-selling drugs totaled $101.1 billion in 2020, while sales of these drugs to the rest of the world totaled only $57 billion, highlighting how Americans massively overpay for drugs, a new Public Citizen report found.
Some drugs saw greater disparities than others. For example, AbbVie earned $16,112,000,000 from U.S. sales of the autoimmune drug Humira, compared to $3,720,000,000 from international sales, or more than four times as much. For 17 of the 20 top-selling drugs worldwide, Big Pharma made more from U.S. sales than from sales to all other countries combined, and for 11 of the 20, U.S. sales revenue was double that of the rest of the world or more, the report found.
Additionally, 11 of the 13 pharmaceutical companies selling these top drugs made more money in the U.S. from these drugs than they did in the rest of the world combined.
The analysis offers a glimpse of how much these businesses benefit from the American health care system overpaying for drugs. The U.S. is one of the only high-income countries not to negotiate the price of drugs. Granting Medicare the authority to push back against pharmaceutical company profiteering would mean an end to decades of overpaying for medicines and would save the U.S. billions of dollars.
âThis eye-popping rip off Big Pharma is getting away with is an insult to the American people,â said Rick Claypool, a Public Citizen research director and co-author of the report. âEmpowering Medicare to push back against inflated drug prices is the responsible and commonsense way to stand up to the industryâs greed â which, certain members of Congress should be reminded, lawmakers in both parties have been promising to do for years.â
Last week, we learned that Merck is planning to charge Americans 40 times its cost for a COVID drug whose development was subsidized by the American government. The situation spotlights two sets of facts that have also gone largely unmentioned in the legislative debate over whether to let Medicare negotiate for lower drug prices.
Fact one: Americans are facing not merely expensive drugs, but prices that are examples of outright profiteering.
Fact two: In many cases, the medicines we are being gouged on are those that we the public already paid for.
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Molti di voi sono comprensibilmente indignati per la recente decisione unanime del CDC di aggiungere il vaccino COVID-19 al calendario pediatrico.
Source: Oct 21, 2022; by A Midwestern Doctor on The Forgotten Side of Medicine
(moreâŚ) ââ
Cory Doctorow: We paid to develop Merckâs covid pill
Taxpayers paid for the Covid pill, but Merck is pocketing a 4,000% profit. The pill costs $17.74 to produce, but Medicaire and US insurers will pay $712 to receive it.
If government should be run like a businessâa typical slogan repeated by naive neoliberals who rip off taxpayers and enrich billionairesâthen the American public are the angel investors, and we should get paid first.
But thatâs not what people who say âwe should run the government like a businessâ mean. The business in question isnât a startup with shrewd investors.
Rather, itâs more like a schlock Hollywood film, the kind thatâs funded by star-struck midwestern dentists who are stupid enough to agree to a share of the ânet profitsâ and get nothing, not even a free ticket to the premiere.
If the US government is a business, then American public are the suckers at the table, the marks who get hustled into paying for everything in exchange for nothing, not even the bragging rights. Our contribution is treated as both beneath mention and literally unmentionable.
