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August 29, 2023 Heather Cox Richardson

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“For far too long, Americans have paid more for prescription drugs than any major economy. And while the pharmaceutical industry makes record profits, millions of Americans are forced to choose between paying for medications they need to live or paying for food, rent, and other basic necessities. Those days are ending,” President Joe Biden declared today.

The government announced the first ten drugs whose prices it will negotiate with pharmaceutical companies for about 65 million Medicare recipients. Until now, the United States has been virtually alone as the only country in which the government did not negotiate or regulate medicine prices, instead allowing companies to set whatever prices they believe the market will bear. Since their products often are the difference between life and death, it turns out the market will bear quite high prices, but—as Biden observed—those prices often force consumers to sacrifice in other ways to afford them.

A 2021 study by the RAND corporation found that drug prices average 2.56 times higher in the U.S. than in 32 other countries. For name brand drugs, U.S. prices were 3.44 times those in comparable nations. 

As Amy Goldstein and Daniel Gilbert explained today in the Washington Post, when Congress created Medicare and Medicaid in 1965 as part of President Lyndon B. Johnson’s Great Society program, it covered drugs administered in a health care setting but excluded those a patient took at home. In 2003, after almost 40 years of medical innovation had significantly changed our management of chronic illnesses, Congress included those drugs under a separate Medicare plan—Part D—or as part of managed-care plans, but to get Republicans behind the bill, Congress explicitly prohibited the government from negotiating the prices of medications. 

In 2021 a nearly three-year investigation by the House Committee on Oversight and Reform, then overseen by Democrats as they held the majority in the House of Representatives, concluded that “[d]rug companies have raised prices relentlessly for decades while manipulating the patent system and other laws to delay competition from lower-priced generics. These companies have specifically targeted the U.S. market for higher prices, even while cutting prices in other countries, because weaknesses in our health care system have allowed them to get away with outrageous prices and anticompetitive conduct.”

Republicans sided with the drug company executives who insisted that high prices were necessary to create an incentive for drug companies to innovate, as their investment in research and development depends on the revenue they expect from new drugs. But the committee’s report said their investigation concluded that “sky-high drug prices are not justified by the need to innovate. The largest drug companies spend more on payouts for investors and executives than on research and development. And many blockbuster drugs rely on scientific discoveries from research funded by taxpayers, while drug companies’ R&D spending often focuses on minor changes to extend patent protection and block lower-priced competitors.”

In 2022, Democrats passed the Inflation Reduction Act without a single Republican vote. That law permits the government to negotiate with pharmaceutical companies over drug prices the government will pay. 

The ten drugs listed in today’s announcement are among those with the highest total spending in Medicare Part D, and today the Department of Health and Human Services released a report that 9 million seniors paid a total of $3.4 billion for these drugs in 2022. The Congressional Budget Office, the nonpartisan agency that provides budget and economic information to Congress, estimates that government negotiation over these drugs will save taxpayers about $98.5 billion over ten years. If a drug maker refuses to negotiate, it either will face a significant tax or must withdraw from Medicare and Medicaid.

This measure is extraordinarily popular. More than eighty percent of Americans want the government to be able to negotiate drug costs. 

The new negotiated prices are scheduled to go into effect in 2026. Pharmaceutical companies are suing to stop the law, claiming it is unconstitutional, although when asked by reporters today about the lawsuits, domestic policy advisor Neera Tanden pointed out that the government “negotiates prices for every other element” Medicare covers of the health care system,, including rates for doctors, other providers, and hospitals. “The only reason why Medicare has not been negotiating drug prices is because Pharma got a sweetheart deal decades ago to basically prohibit negotiations,” she said. “Negotiations are part of [a] market system. It’s very normal for that to happen.”

“This plan is a key part of Bidenomics, my economic vision for growing the economy from the middle out and the bottom up—not the top down,” Biden said. “And it’s working.” 

Notes:

https://www.cbo.gov/publication/57126

https://www.kff.org/health-costs/poll-finding/public-weighs-in-on-medicare-drug-negotiations/

https://www.rand.org/news/press/2021/01/28.html

https://www.bloomberg.com/news/articles/2022-07-19/why-prescription-drug-prices-in-the-us-are-so-high-quicktake

https://oversightdemocrats.house.gov/sites/democrats.oversight.house.gov/files/DRUG%20PRICING%20REPORT%20WITH%20APPENDIX%20v3.pdf

https://www.washingtonpost.com/health/2023/08/29/medicare-drug-price-negotiations/

https://www.pharmexec.com/view/astrazeneca-joins-legal-battle-against-ira

https://www.whitehouse.gov/briefing-room/press-briefings/2023/08/29/press-briefing-by-press-secretary-karine-jean-pierre-domestic-policy-advisor-neera-tanden-and-fema-administrator-deanne-criswell/

https://www.politico.com/news/2023/08/29/biden-drug-prices-gop-00113404

https://www.whitehouse.gov/briefing-room/statements-releases/2023/08/29/statement-from-president-joe-biden-on-historic-action-to-lower-prescription-drug-costs/

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Your Constitutional Right To Zyn Kiran Sampath

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Photo illustration by The Free Press

According to Senate Majority Leader Chuck Schumer, they are a “sinister new threat to the health of young Americans.” Vox says they explain “the new ethos of conservative young men.” Business Insider frets that its users belong to “a subculture on the right that doesn’t just tolerate nicotine use, but venerates it.” 

A new front has opened up in the culture war, and the fight is over inch-long nicotine pouches called Zyns. The product was developed as a cleaner, healthier alternative to “Snus”—moist tobacco pouches tucked inside the gums. Zyn pouches offer all the nicotine without the sticky mess. In other words, Zyns are to Snus what Juuls are to cigarettes—and the latest wave in the push for ever more refined, automatic, and hassle-free nicotine delivery.

And they are popular. Nicotine pouches debuted in the U.S. in 2016 and sales grew by over 540 percent between August 2019 to March 2022. Brands like On! and Velo have played their part, but Zyn, the brand born in Sweden in 2014 and acquired by the tobacco behemoth Philip Morris in 2022, commands 75 percent of the market share as of 2023.

“Part of the appeal is the name.” says Wilson Nesbit, an economics student at Yale University. “It’s short. It’s sweet. And you can put it in a lot of words.” 

In other words, it’s memeable. “Monica Lezynsky,” Nesbit offers. “Zyn-Manuel Miranda. Qui-Gon Zyn.”

Nesbit lives on Lynwood Place, a small street just off Yale’s campus in New Haven, Connecticut. Lynwood is home to two churches, three fraternities, two secret societies, one Chabad house, and a boatload of nicotine. Hence the block’s new nickname, Zynwood. 

“It’s been known as Zynwood for two years,” says Nesbit, who lives with six boys in a house on the street. “The guys who lived here before us had a tent with the Zyn brand stamped across it.” More recently, he underwent an artistic project to solidify the community’s identity, collecting the empty Zyn tins from throughout the neighborhood—277 of them—and spelling out ZYNWOOD on the wall of their living room. 

The Zynwood sign. (Photo courtesy of Wilson Nesbit)

But Zyns aren’t just for college kids. Twentysomethings in corporate jobs now see them as a sophisticated way to get a nicotine hit.

“Vapes are unprofessional,” Andrew Schuler, a consultant at PricewaterhouseCoopers, former vaper, and Zyn user, tells me. “We need nicotine to cope with our jobs because they are extremely stressful,” says Schuler, who goes through three to four pouches a day. “But you’re not going to rip a clunky-looking, purple-colored vape at your desk.”

It’s also about optimization, he said. “Smoking a cigarette requires a break.”

“The guy who used to work at the desk next to me used to take meetings with a Zyn in his cheek,” says one friend, a former Goldman Sachs banker. 

For some, nicotine delivered via Zyns isn’t a nasty addiction, but something of a macho life hack. Arch-techbro Peter Thiel claims nicotine raises your IQ 10 points, while Tucker Carlson (Carlzyn?) proclaimed on Theo Von’s podcast, “Zyn is a powerful work enhancer” as well as “a man enhancer.” (Last December, the Nelk Boys podcasters gifted Carlson the world’s largest Zyn, delivered via helicopter.) But it isn’t neccessarily just right-wingers who use Zyn: a recent picture of Squad member Alexandria Ocasio-Cortez showed a Zyn pack-shaped bulge in her white jeans. 

Tucker Carl-zyn with the world’s largest Zyn, and a regular-sized packet for scale. (Image via X)

In January, Chuck Schumer called for a crackdown on Zyns. “Amid federal action against e-cigs and their grip on young people, a quiet and dangerous alternative has emerged and it is called Zyn,” Schumer said, warning that Zyns “lock their sights on teens and use social media to hook them.”

As part of his crackdown, Schumer wants to investigate how Phillip Morris has marketed Zyn, and whether the firm has targeted minors. In 2023, Juul agreed to pay $462 million to settle lawsuits into the marketing of vaping products to children. But, rather than investing in social media influencers or extensive advertising campaigns, Zyn has relied on organic viral traction in the U.S. 

A spokesman for Zyn says the company’s marketing practices “are focused on preventing underage access and set the benchmark for the industry.” 

But even Nesbit says Schumer is right to worry about young people getting hooked on the pouch. “It’s an easy introduction for youths that haven’t used nicotine,” he told me over the phone from Zynwood. “Mitigating youth usage should be a top priority, but finding the right approach is another story.” 

Others see ingesting Zyns as a constitutional right, and Schumer as an enemy of freedom. As Rep. Marjorie Taylor Greene recently exclaimed on X about his crackdown : “This calls for a Zynsurrection!”

Kiran Sampath is a researcher and reporter. Read her last piece about the temple in New Jersey that took 12 years and $96 million to build.

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South Korea Is Running Out of Kids. Is This America’s Future? Anna Louie Sussman

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In January, more than 150 schools in South Korea had no new first graders. (Photo by Busà Photography via Getty Images)

If you’ve been on TikTok in the last few weeks, you might have seen that American women are talking about 4B. The South Korean feminist movement gets its name from the “Four Nos” its adherents commit to: no dating, no sex, no marriage, no childbirth. In short, 4B, which began around 2019, encourages women to actively avoid men as much as possible. That it’s now trending in the U.S. raises an uncomfortable question: Are our gender politics starting to look like Korea’s? And if so, will the demographic consequences be as extreme?

Right now, South Korea is running out of kids. Last week, it was reported that the Education Ministry plans to reduce the number of teacher training places, citing the precipitous decline in students, which is so extreme that in January of this year more than 150 schools across the nation had no new first graders. Six years ago, the average number of children a South Korean woman had in her lifetime was 0.92, a figure rarely seen outside wartime; since then, it’s fallen all the way to 0.78, with a projection of 0.65 in 2025. In Seoul, the capital, it’s already at 0.59

When I visited Seoul in 2022 to report on why Koreans aren’t having babies, I often found myself wondering: Could this happen in America? Our nation’s fertility, though significantly below the replacement rate of 2.1, is currently higher, at 1.8. But, in the course of dozens of conversations with Koreans of reproductive age, I heard more extreme versions of sentiments I’d started to observe at home. 

Today, Americans who want a good old-fashioned heterosexual relationship struggle to find someone who shares their values. Analysis has shown a gigantic mismatch in the nation’s dating pool: for each single liberal woman, there exist 0.6 single liberal young men. Conservative young men have it even worse, with just 0.5 single conservative young women available to choose from. At the end of last year, the pollster Dan Cox found that this divide is particularly intense among American members of Gen Z, whose oldest members are now 27, the average age of a first-time mother in 2022. 

In Gen Z, Cox showed, women and men are much further apart on fundamental questions of gender equality than the generation before them: whereas 52 percent of millennial men say they’re feminists, compared to 54 percent of women, the equivalent figures for Gen Z are 43 percent and 61 percent. In 2019, a third of adult men under 30 said they face discrimination based on their sex; only five years later, that number has increased to almost half.

Recent data suggest this gender divide is global—and growing. In January, a Financial Times report showed the wide, and widening, divergence in political values between young women and men. This is true in South Korea and the U.S. but also in China, Germany, and the UK.

Americans haven’t given up on having a family to the extent that South Koreans have. In 2023, about 35 percent of Koreans said they don’t think having children after marriage is necessary, a figure that rose to more than 57 percent among 19- to 24-year-olds. By contrast, a recent Gallup poll found that the vast majority of Americans under 30 “either already have children (21 percent) or hope to someday (63 percent).” 

But young American women haven’t just been making TikToks about 4B out of curiosity—an increasing number are genuinely swearing off male partners, with the hashtag #celibacyjourney racking up tens of millions of views. A New York Times op-ed published in February described going “boysober” as “this year’s hottest mental health craze.” Meanwhile, men who identify as “involuntarily celibate” are retreating to online echo chambers that, one 2022 study suggested, now harbor eight times as many instances of degrading language toward women than they did in 2016. In the twelve months after December 2022, self-described misogynist Andrew Tate’s following on X increased from 3 million to 8.5 million.

Conservative politicians across the globe are capitalizing on these divides. Not long before I arrived in Korea, the president Yoon Suk-yeol had coasted into office in May 2022 on a wave of anti-feminist campaign promises, in what multiple observers described as an “incel election.” For the first time, young men describing themselves as anti-feminist were seen as an influential voting bloc, with Yoon promising to abolish the nation’s Ministry of Gender Equality and Family. (He has not yet succeeded.)

In the U.S., the Republicans also appear to be aggressively courting the male vote. Since the fall of Roe, the Republican Party has become actively hostile to women’s reproductive rights, pushing female voters left. And some of the party’s most influential members are now stoking a war between men and women.

In a breathtakingly offensive comment last January, Florida congressman Matt Gaetz called for the Republican Party to all but forget about female voters, saying that “For every Karen we lose, there’s a Julio and a Jamal ready to sign up for the MAGA movement.” Fox News host Jesse Watters has been even more explicit in singling out liberal single women as the GOP’s nemesis, alighting, somehow, on matrimony as an electoral strategy. 

“Single women are breaking for Democrats by 30 points,” he said after the 2022 midterms. “We need these ladies to get married,” he warned, following up with an order: “Guys, go put a ring on it.” 

And yet a recent poll found that 40 percent of Republicans said they don’t believe marital rape should definitely or probably be prosecuted, suggesting the party’s not overflowing with eligible bachelors. 

All signs point to an ever-widening rift between the sexes. And if women and men become sworn enemies, America is going to start running out of kids, too.

Anna Louie Sussman is a journalist covering gender, economics, and reproduction. She is a 2024 Alicia Patterson Fellow

For more on America’s gender divide, read Rikki Schlott’s piece, “When It Comes to Sex, My Generation Is Screwed,” and become a Free Press subscriber today:

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April 15, 2024 Garamond

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