>Supreme Court might be sympathetic to some of the industry’s arguments
No surprise here, the US Supreme Court is now just like the rest of the US Gov, they are very happy to take bribes. And due to how the US Gov is structured, no way to stop them from holding out their hand. So getting appointed to that Court is a great gig, you do not even have to care about the law these days.
“Now”? Seems like this has been going on for a very long time.
We started paying attention now.
As for the US gov and institutionalized corruption I highly recommend Lester Lessig’s work around political donations reform as the first step to democracy in the US.
How about something far simpler - reduce to the us government to only enumerated powers. If they want to do something not enumerated pass an amendment.
That would just end in a situation even worse than now - such a policy requires a government in the continental European parliamentary form to make sure the government always has a parliamentary backing.
No, actually it would be far superior. We should strictly limit the power of the Federal government to what was actually intended by the Founders instead of using the Commerce Clause as a loophole. Devolve everything else to the several states.
We tried that. It was called the Articles of Confederation[0]. It was an unmitigated disaster, and the reason we have our current Constitution with power actually consolidated under a Federal government.
> Justice Thomas said (in 2001) that for the pay they receive no one would take the job if not for the gifts^H^H^H^H^H bribes.
FTFY.
As of 2022, the salary of a US Supreme Court Justice is $274,200 per year. The Chief Justice of the United States, who is the head of the Supreme Court, receives a slightly higher salary of $286,700 per year.
Of course no one will take that job. How much does a banana cost again? $10?
Yeah, how many millions of government employees and contractors who have to be under very strict gift policies and much lower salaries. Somehow they stay in their jobs without taking bribes.
I agree it’s unreasonable that avowed socialists should maintain multiple homes as well, but here we are. How do freshman Congress people suddenly have millions in assets to their names?
How much could a good lawyer with a long and distinguished career make in the private market? That's how much we should be paying our judges. If you want the best you have to at least be moderately competitive with what's on offer. I have a similar opinion about legislators -- we probably want top tier doctors and executives and lawyers as our legislators. Being elected to office should not be a step down in their lifestyle.
I see private compensation for elite talent being completely out of whack -- the prices the public service must compete with -- as basically a separate issue.
Historically, a generous salary for legislators and various other high offices was part of the progressive/left platform in both the UK and France. They weren't paid before the 19th century, ensuring only the independently wealthy could hold those offices.
It may be idealistic, but I think that those elected to office or appointed to influential positions such as judges should do so largely out of a sense of public service instead of personal enrichment. For people who are motivated by greed or power, no amount of compensation will be enough, they will always be tempted to to increase their power and wealth by taking bribes or political favors.
Pay them a respectable salary but you do not and should not try to match what the private sector pays. It not the same playing field and should not attempt to be.
I don’t understand this position. It feels to me like you’re proposing we financially exploit those who are magnanimous and duty-driven enough to tolerate public service. Do you have the same opinion regarding other organizations operating for public good, rather than financial self interest?
For instance, what you’re saying feels logically equivalent to me to saying we should tax charities more heavily since they aren’t driven by greed, or that we should underpay active duty military personnel since they’re driven more by love for their country than by self interest. It seems to me that it should be the exact opposite, and we should incentivize people to make sacrifices for the greater good.
Underpaying people who choose to enter a certain sector because of a personally held belief that they ought to be financially unmotivated, then ceding massive power to those people and allowing them to take bribes, seems to miss the forest for the trees.
EDIT: I’m also curious how you rectify your position with the empirical evidence that our current system, wherein public service is financially discouraged, has led to direct and indirect bribery and corruption in the legislative, executive, and judicial branches. It seems to me that the current system isn’t working, and leaning further into the aspect that makes it not work is not a good idea. Maybe a more fruitful route would be reducing the power of individual representatives so that there is less incentive to bribe them, or outright banning the quid-pro-quo agreements that run rampant in our country currently, like prohibiting regulators from working for companies in the industry they regulated after their time in office.
This. You cannot simply normalize graft on the grounds that somebody might exist who can out-bribe a government. Any more than you normalize murder because everybody eventually dies some way or other.
Having it act like the same playing field got us in this mess. I'll note there are some supreme court justices who apparently don't take bribes or suggest their power should be supplemented by enough bribery to equal that of the best private sector lawyers and/or the best mob bosses…
1. Supreme Court justices historically haven’t been the best, just the most cozy with politicians
2. Even if Justices were paid $10M, the corruption wouldn’t go away, because greed never goes away
Instead of focusing on the fact that justices are taking bribes because their salary is modest, therefore we need to pay them more, we should focus on nominating justices who don’t have such weak morals and ethics.
> How much could a good lawyer with a long and distinguished career make in the private market? That's how much we should be paying our judges.
That would maybe make sense if we were able to reign in their conflicts of interest. The private market would set a fiduciary duty on many lawyers in a number of capacities, but nothing like that exists for the SCOTUS.
As it stands now, there is no way to hold the justices (or really any elected or appointed official) accountable.
I don't disagree with you, but at some point the number stops mattering. What's the difference in lifestyle between 300K and 500K? 500K and 1M?
And even if there is a difference, is that worth the opportunity cost of paying everyone else a little bit better?
It's not a very popular opinion, but there should be a maximum salary imo. Beyond a certain number money is a means of acquiring power and influence, and it feels wrong to reward people with that. Set a maximum to give people something to work harder for, but without inadvertently giving individuals the power to subvert democracy through money.
$300k - after taxes - is not buying you a lavish lifestyle of in most major cities.
It's probably not even getting you comfortably into one of the better neighborhoods, unless your partner is the bread winner.
Chicago is one of the most affordable major cities in the US - and $300k isn't gonna do more than have you comfortably living in a small condo in the better neighborhoods.
> What's the difference in lifestyle between 300K and 500K? 500K and 1M?
Pretty massive, particularly when it comes to taking vacations and bringing friends who can’t afford them with you. $300k barely permits that domestically. $1 or 2mm lets you do that comfortably all over the world. Or, alternatively, single handedly saving restaurants you love or a buddy’s small business.
I imagine by the time a lawyer is experienced enough to be given a seat at the Supreme Court that they’re well past the point of needing an income.
With that being said, I’m not surprised in the slightest someone as corrupt as Thomas would have this opinion. Ginni Thomas and Clarence’s defense of her has forever tarnished the reputation of the Supreme Court and I don’t want to hear another word from his office. His replacement honestly cannot come soon enough.
The gov should do what Singapore does: pay senior officials well but exterminate any sort of non monetary perquisites and impeach or fire violators. Also ban any gov person from trading on insider info.
Also, if I had it my way, no government person while in the employ of the gov, should be able to vote at the level they represent or work in. If they’re fed employees no voting in fed elections and so on. Yes, I know under our constitution this would violate their rights. But you know, one can wish. I see it as a conflict of interest.
For a long time, basic pride by Supreme Court justices kept this in check.
But now it's time for external enforcement. There are too many justices who think that they embody law and order in themselves, and therefore no matter what they do they are obeying the law, since they are the law. Similar to most police forces these days.
Oh, they are, in theory and in practice. Their literal job is embodying law and order and they make up the rules, and everyone else is stuck with what they decree, handing down final decisions like legal Gods.
I do not get how they then turn around and insist on also having uncountable wealth. Surely there are a lot of people who would be content with just having unaccountable power? Maybe they should make minimum wage, while also having final say over what law is.
For a long time, basic pride by Supreme Court justices kept this in check.
That's incredibly naive.
If anything politics and was dirtier in the past than the present. The media in the past did a great job of covering up things since they were so cozy with politicians.
Read about some of the politics of the 1800's in the US and it's far worse than today.
The Supreme court is/will be bounded by the fact the inflation reduction act is law. This isn't like abortion where there is no federal law passed by congress and signed by the president.
I'm very happy to see this. And surely pricing transparency is good: we're gonna see just how this works.
Further I'm glad the US government is challenging corporate America. Corporations implicitly threaten the US public saying if minimum wage goes up they'll be forced to cut jobs. They implicitly threaten a leaner pipeline of drug advances if prices are negioated down.
Let's see how this cookie crumbles.
The US congress is explicitly tasked with the federal checkbook. Negotiating prices down is clearly in their purview and is consistent with agency they've always had. Has congress ever negotiated a price with defense, office supply chains? Has the congress solicited competitive bids on work? Then why not meds?
The Supreme Court has the authority to strike down any law it finds unconstitutional. It may have to work slightly harder, but I have no doubt that they can find grounds on which the Inflation Reduction Act is unconstitutional.
In fact, googling those last five words turns up an industry lawsuit alleging precisely that:
I am certain that some members of the Court will agree, and others will not. It will come down to a count of votes. And I strongly doubt that I will agree with the reasoning that justifies those votes, either way.
An industry that heavily lobbied for a law which heavily boosts their profits wants to heavily lobby against the destruction of such a law? Shocked. /s
Honestly I see no theoretical benefit to not allowing the government to negotiate. Maybe there is a practical one?
I don't think they're fighting to keep the price on rare lifesaving drugs. They are fighting to keep the price of insulin, cholesterol medication, blood pressure medication, and various other "public good medications" commonly used by medicare recipients as high as possible.
Its the same tactic doctors use when dealing with medicare. I've been to several doctors that won't take it. The reasoning is obvious: your insurance company will just deny you and medicare will fight them to the bitter end on pricing.
Can you name a single large biotech firm that is going to produce a negative yearly profit because insulin is affordable? I sure can't.
Not true: insulin is not a drug whose price is being negotiated here (https://www.jmcp.org/doi/full/10.18553/jmcp.2023.29.3.229). The drugs whose prices are being negotiated are the brand new ones, the ones that took billions of dollars to develop. Without the promise of a payoff, future R&D will be halted, and humanity won't get benefit from the new medicines.
Yet many other comparable countries pay substantially lower prices, and presumably the drug companies are still making a profit of that.
"If you don't pay us through the nose with billions we'll stop developing drugs" seems like a rather odd argument; disallowing the government from engaging in the free market on price in pretty much any area it would set of all sorts of corruption red flags. This is why all sorts of regulation around public procurements exist in almost any jurisdiction.
If you need money to develop new drugs: fine, this is why things like grants exist. Right now the drug companies want to have the best of all worlds with none of the obligations and downsides: inflated prices from Medicare are just tax subsidies but without any controls or checks or anything.
Exactly. It’s not like we’re saying people in medicine shouldn’t make good money. I’m glad doctors are paid well for example. What we don’t like is lack of price transparency and needlessly expensive medications. We allow drug companies to patent drugs, creating an inherent monopoly on that drug, then allow them to decide on an arbitrary price, usually a massive mark up over a reasonable profit margin. This has to stop and I love that there has been progress on this recently. But we need much much more
You’re assuming that the return pharma companies get is the absolute minimum they would be prepared to accept in order to do R&D, but I suspect there’s quite a lot of slack that the regulator could take in. The FCC fixed the price that AT&T could charge back in the monopoly days yet Bell Labs continued to churn out research for the benefit of humanity.
My understanding (and I don't have the time to look this up) is that insulin is complicated. It's not a single thing - and variations are currently being developed.
>Its the same tactic doctors use when dealing with medicare. I've been to several doctors that won't take it. The reasoning is obvious: your insurance company will just deny you and medicare will fight them to the bitter end on pricing.
I don’t think it’s a “tactic”, at least in that it’s not a maneuver meant to get the other party to do something differently or win a battle or something, it’s just frequently not worth it for the doctor to bother with insurance, in many cases. The insurance companies can make it arbitrarily hard to get paid, and they’ve gotten so far up there on that abusiveness scale that in many cases, it’s better for sanity, business, focus, etc to just lose those patients that have that insurance.
Source: I’ve worked on billing for a small doctor’s office that eventually decided to drop insurance altogether for life enjoyment rather than monetary reasons. It was incredibly painful working with eg some of the Blue Crosses. It made us want to just not deal with them, regardless of the amount of money, and we eventually did, almost purely for happiness reasons. Not dealing with insurance anymore was a big quality of life improvement. The patients could still file claims themselves, which let the insurance purchaser experience the product, and we always steered people towards Aetna when they asked about less horrible insurance companies, away from Blue Cross and UnitedHealthcare.
1) Explicitly fund research with public dollars, then, not make people who need drugs that aren't even very new fund it.
2) Stop paying to fund everyone else's research (I think this is about 90% bullshit, seeing as other developed countries have strong drug research sectors and I doubt that's solely because of their sales in the US, but even if it's not bullshit—why the hell would we do that?)
Every time someone tries to defend the status quo, they seem not to notice that they're defending a very shitty version of what they're advocating for, even if all their claims are true.
Most of the basic research is already publicly funded. Where pharmaceutical companies have huge expenses is in running large scale clinical trials necessary to bring drugs to market. In theory that work could be nationalized but in practice I doubt that government bureaucrats without a profit motive would make good choices. More likely they would operate based on political pressure and focus on whichever diseases have the loudest advocates.
People innovate because the want to, not because they can use that innovation to price gauge sick and dying people.
The only people you are protecting with this idea are the top 1% of the top 1%. We will always value medicine, but we don’t have to line the pockets of billionaires with our cash so they will bestow upon us cures from the ether.
The NYT keeps getting worse. The article goes on and on and doesn't say anything (in the first ~75% or so that I muddled through) about how the proposed negotiations are different than the status quo.
Medicare dictating a price sounds fine. Gravy train is ending (pharma dictating the price) and pharma is in shambles.
I’d like the Times and the media in general to start reporting the names of the individuals participating in these efforts, instead of faceless corporations.
Agreed. Recently we’ve seen some multi-million/billionaires called out specifically for saying horrific things about their workers striking and it’s great. When you hoard so much wealth I honestly don’t know how it could be argued you should have privacy. We should have public accounting of their goings on, they’re sometimes more influential than our presidents.
How about we dictate a price on whatever industry you happen to be in? Maybe your product cost billions of dollars to develop, but how about we force you to sell it to everyone for peanuts?
There is no logical reason that pharma should be on the receiving end of all this hate. Especially considering that their job is literally to save lives.
> How about we dictate a price on whatever industry you happen to be in? Maybe your product cost billions of dollars to develop, but how about we force you to sell it to everyone for peanuts?
If I work in an industry where human life depends on it, yes! I entirely agree. This is not a market to corner, regardless of your innovation and how clever you are.
> Especially considering that their job is literally to save lives.
Positive contributions must not lead to “these people can hold those who have medical needs economically hostage.” Don’t like the deal, get out of pharma and let other people (operating under a different ideology on the topic) build.
> Today, 1 in 4 Americans cannot afford to take their medications as prescribed. Too many seniors are having to ration their treatments to get by until their next social security check arrives. And contrary to what industry lobbyists argue, soaring drug prices are not the inevitable result of research and development costs to bring breakthrough drugs to market. It’s time to put this widely debunked excuse to bed.
Roads are profitable? Non profits are profitable? There is an enormous amount of valuable work done in aggregate, every day, funded without the intent to profit and with work performed by people not maximizing for comp.
DARPA's mRNA research that directly led to rapid COVID vaccine development comes to mind. Cut out the middleman. Fund the research directly. We're paying for the end result one way or another (if not with direct government payment, with government payment to companies who are then taking profit, spending marketing/admin expenses, etc).
You make it sound as if nothing will get done if poor corporations can't lock medical tech up behind economic gates. We can always go back to ruthless capitalism if pharma price controls don’t work.
There are any number of industries that people need to live. You really want Donald Trump (or someone just as crazy) dictating what the prices are for those industries?
Every other developed country imposes price controls on at least parts of the healthcare industry. Drugs are just about always on the list. Either directly, or through monopsony power.
Sure maybe they have to say “yes” to the price, but I’m asking if they have to actually provide the drugs. Could they just decide not to sell them at that price or to just sell less?
My post was ambiguous, sorry. I am saying my understanding is the drug companies are arguing that they literally do not have the ability to not provide the drugs. So no - they cannot decide not to sell the drugs to the govt. They cannot "walk away" no matter the price the govt names.
They can walk away, but the government can levy additional tax if they do.
But realistically, from a moral point of view, they can't really walk away in the first place unless the government demands are ridiculously unreasonable (e.g. demanding a price lower than production). The only drugs subject to negotiation are those without generic alternatives (i.e. where a free market doesn't really exist), so stopping supply would quite literally kill people. This gives drug companies an enormous advantage in negotiations in the first place, so this kind of compensates for that.
Selling at an artificially low price will result in shortages. Always does. Short of nationalizing these companies, there is no way to "force" them to produce anything.
We are talking about prescription drugs here right? This isn't about something people want it's about something doctors are prescribing individuals for their health or survival. Regular supply and demand should not apply here. If it does this is an indication of another pharma industry issue -- creating consumer demand for drugs through advertising.
Using goodRX has really opened my eyes to the shady practices of drug pricing. The same drug with or without insurance at different pharmacies can range in price by 80+% (often with the higher rate "discounted" for insurance). The drug companies are willing to be this flexible with the prices when dealing with retailers. In the case of a Wal-Mart or Costco the negotiations don't sound so different. So what's the difference with what's happening with the government? It's on public record not in a private corporate meeting room. The business side of Healthcare in this country follows protection racket economics and it doesn't look like this is going to change any time soon.
I never argued otherwise. I was simply pointing out that unless drug companies are actually being forced to priced the drugs (which I don’t think they are), they always have the option to direct more of their sales to a higher bidder.
Seen a different way, we pay for goods with two currencies: money and time. If the dollar price is artificially low, the time to acquire the good increases to compensate.
No surprise here, the US Supreme Court is now just like the rest of the US Gov, they are very happy to take bribes. And due to how the US Gov is structured, no way to stop them from holding out their hand. So getting appointed to that Court is a great gig, you do not even have to care about the law these days.