People are free to vote how they want. I just don't agree with third party voters that it is the choice with more integrity. Voting for someone who makes you feel good for voting for them even though they have no chance of winning is, to me, an easy choice. We all like to do things that make us feel good and virtuous. And I think that there's probably an argument that one individual vote is so inconsequential to the outcome that the psychic goodness you get from casting it in a way that makes you feel good is a rational choice. And, if you are voting for a particular 3rd party because you are playing a longer game you want their numbers to improve, that's another rational choice.

But if someone votes for a candidate that they think is below average in order to do everything they can to stop a candidate that they think is horrible, how does that choice lack integrity? Someone made the small sacrifice of foregoing the opportunity to cast a protest vote in order to try and prevent a horrible person from winning an election. That's not a bad thing.

tl;dr : "Third-party voters are throwing away their vote" and "voting for the lesser of two evils is wrong" are both lazy takes.

Yes to all of this. Our voting system is very flawed and lends itself to a "lesser of two evils" situation the vast majority of the time. Without massive reform, which will never happen because the politicians who would have to pass it would be putting themselves at risk by doing so, this is inevitable.

There are voting systems used in other countries that allow for you to pick the candidate that aligns with your beliefs and have it be a more meaningful choice even if that candidate has no chance at winning a majority of votes. We do not have that sadly.

There's always this assumption that 3rd party voters should "count" in some theoretical election for someone else, usually the Democratic candidate. I never bought it. The whole point of voting for Nader was that people thought there was no real difference between Gore and Bush. We shouldn't just automatically award those Nader votes to Gore then "blame" the Nader voters for the election result. They DIDN'T WANT GORE, otherwise they would have voted for him in an election everyone know would be close. Same with third party candidates in any presidential election. We shouldn't just assume that those are virtual votes for Clinton or Trump. Those voters DIDN'T WANT CLINTON, otherwise they would have voted for her. Hell, I remember salty Sanders voters declaring they'd vote for Trump because it was closer to their preferred goal of burning everything down. If they couldn't get there through active reform, some were OK with disaster possibly sparking reform for next time. They were actively voting against the status quo and a Clinton vote would have been the exact opposite of that. They didn't cost Clinton the election, they exercised their right to vote or not to keep her out of the white house.

If a main party doesn't nominate a candidate that inspires the votes they need, that's on them, not the voters who don't want that candidate to be president. Clinton's loss was a huge blow to her era/style of Democrat and that will probably influence voters and the party in subsequent elections. That's a feature, not a bug, for some of the people who chose to stay home, vote third party, or chaos vote for Trump.

This also makes me think of a strategy that I've considered for third parties.

Under current law, a party that receives between 5-25% of the vote in a presidental election gets partial matching funds in the next election.

And, if you are the Libertarians, or the Modern Whigs, or another party that has ideas and isn't just a vanity project for a particular candidate, I've wondered why you don't explicitly shoot for that.

Avoid the battleground states. Go to New York and California and Texas and Georgia. Run on the platform of "Hey, candidate [X] is going to win this state, but do you still want your vote to matter? Vote for us and help us get to 5%, so we can start building something. This is why we are awesome[list reasons], and your vote this November can help make it so that we are a real choice for your children and grandchildren."

dola

and yes, I know that the Dems always say that Texas is purple and the GOP always says that it can make a play in California, but they don't ever actually spend money there, so they aren't really swing states and you are not competing with them for airtime.

I would have been funny to see the libertarian party take a big check from the federal government if Johnson reached 5%.

Do we know how much money we're talking if Johnson pulled that off? He ended up at 3.2%. I guess it's possible that a better run campaign, fewer campaign gaffes, etc, could have gotten there, but how much a game changer would that have been?

Y’all please tell me I’m not the only one who read this in a Howard Dean voice.

HA! I hadn't even considered that angle.

Most people consider libertarians worse than the other 2 parties. The Green Party has also been a joke for decades. If there was a legit 3rd or 4th party candidate running, I think they might get some votes.

James Weeks' Libertarian Strip Show - YouTube

What's the point of a third party President? Congress will still be either D or R and getting anything done will require the President to largely fall in line with one of the two parties. There may be some movement of one party, but neither the Dems or Reps were ever going to pass a libertarian platform.

And the idea that some Dems and some Reps would come together to form a majority, in that case, is a fantasy.

I don't have any problem with voting affirmatively for any candidate, but I still think the most likely way to achieve whatever change you want is by changing the platform of an established party.

Its because its run for profit and shouldn't be - certain things are not sensible to have as profit based industries because they're items which aren't optional to people.

The myth that people can 'shop around' when they need medical care is something the Republicans tout repeatedly - yet if you've ever tried to ask about the cost for a procedure best of luck getting a straight answer, what I hear is generally is 'well it depends' ...

I'm probably going to pick up US citizenship just so I can vote next election, my vote will go to anyone supporting medicare for all.

If you include Pharma/Biomedical as part of "healthcare", I do think there should be large "profit" motive otherwise you are not going to get a lot of innovation.

For Payers & Providers, there should be some "for profit" but there should be a baseline of services (e.g. safety net) that is essentially non-profit.


Absolutely agree with you, see my above post on my experience. It's BS, sure we need to control "costs" but without transparency, good luck.

For those Drs. out there, lots of cheaper and almost as well qualified labor from India for most of you.

For those Medical schools charging students outrageous amounts, you need more competition also.


Hey congrats! Unlike some some naysayers, still one of the top countries in the world in aggregate (Trump or not!) ... and although I do not like it, it is legal so keeping your orig passport works to your advantage.

This is a capitalist view of an industry that long shed it's free market cloak.

Consumers can't shop around and buy their prescriptions from other countries. Competitors can't encroach on patents to make competing products at a lower cost. And the pharmaceutical industry doesn't have to pay for the billions in research the government gives out in grants for their field.

I'm all for companies competing and having motive to innovate. But there has to be a free market for that to work which pharmaceutical companies don't want.

Re: consumers that is true for the most part and many drugs will have outrageous prices initially. However, in 12 years (20 yrs patent - 8 yrs avg of development), patents will expire and they will be able to buy generics. Will people be hurt during the 12 years, sure but I think its a fair tradeoff for the innovation.

Re: competitors some developing countries can create some generics for before patents expire so that is definitely a good thing. I think China also has something that allows them to break drug patents (who's going to stop them ... maybe Trump!).

So yeah, the US & western competitors are screwed for 12 years but again, the US leads the world in drug innovation (even after factoring the M&A activities with big Pharma), and its important they have incentive to continue innovating.

Re: subsidizing big Pharma, true but its dropped quite a bit. If big Pharma doesn't do it, who will?

Data check: U.S. government share of basic research funding falls below 50% | Science | AAAS


I'm thinking of free markets re: other countries cheating (e.g. I'm pretty sure viagra generics were out there long before patent expiration; if we can't stop China in technology reverse engineering and copying, can we do that for drugs?).

So ultimately the US & other western pharma subsidizes the rest of the world. Not perfect and I agree with you that maybe big Pharma makes too much profit and we can probably create more transparency & competition etc.

... but let's not mess it up because drug innovation is key.

Having attended a research institution known for its biomedical program...yeah, I don't think profit is what motivates all those doctors/engineers.

That's still a lot of money. Put it this way, that's more money than the entire R&D spending of Pfizer, GSK, Merck, Roche, Astra, Lilly, Abbvie, Sanofi, Novartis, and J&J COMBINED.


I wouldn't say "not perfect". I'd say terrible. Most of these pharmaceutical companies are multinational. Why are we the one's that have to subsidize it? Why does our tax dollars need to subsidize a company headquartered in England?


What innovation are you seeing? There haven't been any blockbuster drugs in the past decade. There doesn't appear to be much in the pipeline either.

11% of revenue last year came from drugs that were developed in the past 5 years. And a big chunk of that comes from just Gilead.

And Gilead is an example of one of the huge flaws in the industry. Take their Hepatitis C drug that was terrific. Since it's a specialty drug that's only used by a small percent of the population, they have to price it extraordinarily high to keep shareholders happy. This means it costs nearly $100,000 for a treatment course.

On top of that, it's something that cures. That means it's not something you need to take for decades on end. This has caused their revenue to drop this year. It's why pharmaceutical companies don't want to innovate cures, they want to innovate ways to make chronic conditions more livable. It's why so much has gone into arthritis or statins (which is a whole other pharmaceutical disaster story).

Take a look at the top selling drugs last year. Arthritis drugs such as Humira and Enbrel are rooted in government financed research. Herceptin was more or less discovered in a university lab thanks to government grants. I can go on and on. You'd be surprised how many of these top-selling drugs are just polished up breakthroughs made by government-financed research.

That's not saying the industry is all bad. There is money put into polishing up prior research and getting it to an end consumer product. But you're still talking about an industry that is taking taxpayer funded research and using it to create drugs for themselves to make money. And when we in return ask them to share clinical trials for the advancement of science, they scoff.

I can't think of a better industry to be in "for profit" than what you just described.

Hell, isn't that an ultimate goal of most for-profit enterprises? To be / become "indispensible"?

{fist bump}

And to avoid a silly dollar after so few characters, I'll just toss this in here

Therein lies the huge rub: that'd generally be a damned short list, among the very valid reasons that 3rd (4th, 5th, 18th, etc) parties are the inconsequential entities that they are.

If they had much to hang their hats on, they'd have already seized control of one of the big two. (regardless of labeling, the ideas still have ample opportunity to take hold ... they don't, because the sizable majority rejects those things as being of enough significance to fight for)

You should get in on this:

https://mashable.com/2016/05/12/chin.../#7sNTNDgRhGqW

You have a better way of making sure innovation continues at same pace or better, let's implement it. Until then, there's plenty to fix in Payer, Provider and Pharma "as a whole" to reduce costs and inefficiencies but let's try not to adversely impact drug research & innovation.

I did read a while ago that big Pharma spends more on marketing than on research. I would agree they can cut down on that and redirect the savings.


The past 5-10 years includes the Great Recession to be fair. Let's go back 20 years.

In the below link, second table, it has revenue per quarter and when first brought into market. To keep it simple, let's say the first 24 are "blockbuster" as quarterly revenue x 4 > $1B. The majority of the 24 are since 1998.

List of largest selling pharmaceutical products - Wikipedia

These pipeline drugs seem pretty significant, lots of cancer ones.

As far as Pharma's not wanting to innovate cures, interesting thought. My gut tells me not true but let me do some more research.

10 Blockbuster Drugs of the Future for Big Pharma Stocks


And so? Are you saying the government could have pushed these drugs out by themselves without help from big Pharma? They didn't which tells you something.

How about the other blockbuster drugs, do you think government can do as good or better job with our current for-profit big Pharma? The answer is a most definite no.


It boils down to - has big Pharma and the drugs they brought out done more good vs. the inefficiencies, subsidies, screwing us for profits and all the other legit complaints about them? I don't know how to quantify this but taken worldwide as an aggregate and all the drugs & generics that are now doing good globally, I say the answer is "yes".

(but let's cut down on the marketing costs)

My comment was to Pharma and Biomedical companies. You don't think they are motivated by profit?

Yaawwwhhhh

It's bad enough when I try to play Mario Tennis Aces, I'm subjected to knowing about the Luigi penis meme. But now I got that Toad thingy to contend with.

I'm in favor of negotiating like some businesses do, we get your lowest price. Even if that was altered to we get the average price of industrialized nations, there would still be a big cost reduction. If that meant other countries had higher prices, so be it. Why are we subsidizing all the research?

Yes, they are. But the implication seemed to be that there wouldn't be pharmacological or biomedical innovations if profit wasn't the goal. I don't believe that's true.

Newer drugs are higher because prescription drug prices have skyrocketed over the years. These drugs are also under patent. And companies have gotten much better at gaming the system in regards to this. For instance one of those drugs on the list Retasis had it's patent expire in 2014 and the company shifted it to an Indian Tribe that had sovereign immunity to stop legal fights to overturn it.

I'd also add that these companies didn't do all the legwork on these drugs. Sovaldi which was one of the biggest selling drugs last year was developed by a company called Pharmasset. Their research was funded in large part by the NIH and Department of Veterans Affairs. So taxpayers funded the research for the drug and the company turned around and sold it back to taxpayers for $100,000 per treatment.

And like I said, you can go through almost every single one of these big drugs on that list and find the roots of their research comes from the government. Whether that's a breakthrough at a University lab or in the case of Pharmasset, just a handout to research something the government wanted a cure for.


It's not a thought. They discuss which drugs to target with shareholders all the time. Of course they don't explicitly come out and say "we want to focus on drugs that help, not cure". But the value of a drug that treats a chronic condition for a long time is seen as much more valuable than a drug that provides a cure. It's why a drug such as Humira is more valuable than Sovaldi. Would you rather sell a drug and cure it over 6 months or have a patient on your drug for 30 years?


This is a site focusing on how new drugs impact companies financially. They are "blockbusters" from a financial standpoint, not as medical breakthroughs.

The cancer ones you mentioned look promising but it isn't a breakthrough. They are just variations of enzyme inhibitors which have been around for a long time.


What you're not getting is that the research for most of these drugs is paid by you and me. Breakthroughs don't happen in a laboratory at Abbott. They happen in a University laboratory over the course of years. They happen at small biotech companies that are funded almost entirely by large government grants.

We have socialized the most expensive and riskiest part of their business model. They are profiting off the research your tax dollars paid for and in return are going to gouge you for as much as they can.

Let's assume from 1-10 that current state is a 10.

Where do you think pharma or biomedical innovations that come to the market would be without the profit motive? I would personally say maybe up to 3 if we are lucky and you are including government.

Because it's privatize the profits and socialize the losses. If the government is funding the riskiest part of your business and then paying top dollar for your product in return, you can't lose.

There's a reason that these big pharmaceutical companies NEVER LOSE MONEY.

And so why weren't they non-profits able to bring them to market? What was missing and why was big Pharma needed?

You make it sound as if all these drugs were almost to completion and big Pharma took it over the line (8/10). Is it more likely these drugs you referenced were in (3/10) and big Pharma took them over?


I honestly don't know and this sounds very interesting. Do you have a reference on this?



I guess you can nuance between financial vs medical breakthrough. If a drug is a financial breakthrough, it means it has high demand from consumers and therefore, for all practical purposes, is a medical breakthrough.

Not to say cheaper drugs can't be a breakthrough but financial success is a pretty good indicator.


I think I get that our tax-funded subsidy is very important for big Pharma. On the breakthrough aspect, see my question in the first quote.

Because we're funding the research part, not the development part. I'm sure we could fund development too but this would not make the pharmaceutical happy as they lose their pay pig.

I'm not making it sound like they were ready for primetime. I'm just saying the most expensive part of bringing a breakthrough drug to market is the research. It is also the area that has the most risk as a lot of research does not result in any kind of breakthrough.


I don't have minutes on shareholder meetings. I do know the small biotech labs that sell to the big dogs for the most have the kind of long term drugs. Just take a look at where a lot of their money is being pumped into. Arthritis, cardiovascular (statins), gastrointestinal, depression, asthma, diabetes.


I don't think that's always the case. Take statins for instance. It was #4 on that list of top selling drugs (also something discovered in a government funded lab!). We still don't know if they help much of the people that are prescribed them. The pharmaceutical industry has done a masterful job of marketing them to the public. They've even convinced the federal government to lower the danger level of cholesterol which just so happen to put a bunch more people on their product.

So sometimes it's not about a medical breakthrough that saves lives to make money. Sometimes it's just about convincing the right people that you're "better safe than sorry" in prescribing your product.

One way to lower the drug cost is to lower the need for the drugs, namely preventive medicine. However, Americans seem especially enthusiastic about living recklessly and banking on a magic pill to fix them.

It gets complicated when deciding which institution can best do preventive medicine. The hmo that sees preventive as long term cost savings, but also a temptation to put profits over people or the public medical where lack of incentive has lead to a near total reliance on pills (mental health being the worst).

From one of my lecturers, it’s from 2016, not sure numbers are still same:
Assuming modest improvements in preventing and treating disease, we could avoid 40 million cases of chronic disease annually and reduce the economic impact of disease by 27% by 2023

If you want to get pissed off at our healthcare system and understand how we're all being fucked over, particularly by Big Pharma, read this book:

An American Sickness: How Health Care Became Big Business And How You Can Take It Back

I found the below study which attempts to quantify public vs private research.

THE IMPACT OF PUBLICLY FUNDED BIOMEDICAL AND HEALTH RESEARCH: A REVIEW - Measuring the Impacts of Federal Investments in Research - NCBI Bookshelf

From the Introduction

From the conclusion. Probably a fair summation to our discussion.


How I read it is public sector has contributed greatly to R&D to a "smaller share of but more important" drugs and Pharma leverages the research. Although not explicitly stated, the statement implies there are a large share of drugs that public sector does not contribute significantly to. Introduction also says Pharma 58% vs 33% in $.

On my attempt to define where Public vs Pharma plays a role on a 1-10 measurement, I'm still thinking its at (3/10) or (4/10) and Pharma finishes drives to touchdown/field goal/punt. However, there are a large share of drugs (albeit lesser importance) that public doesn't seem to play a role in.


I can see where Pharma prioritizes and allocates R&D to what they think will make them the most money (vs risk of failure or vs ROI) regardless if it is a "cure" or "treatment". Unfortunately, this leaves out many less popular diseases.

We have all this going on with the flooding in Horry County right now, but events in DC never go away it seems. Horry County School Board member asked to step down after posting this about the Kavanaugh accuser:


404 - StoryLine

Bullshit.

Because the same people who are "concerned" about how we're going to pay for things like health care have *zero* concern about how we're going to pay for things like trillion dollar tax cuts for corporations.

Or, to the extent they care, their solution is to cut the social safety net, because we can pay for tax cuts by weeding out what the government spends on "moochers."

It has zero to do with fiscal conservatism. It has everything to do with "my money," which is darkly hilarious coming from a voting bloc that identifies so strongly with Jesus (and completely misses the dichotomy between "my money" and the things Jesus actually said).

Doesn't this (falsely) assume that all republican voters are fully supporting everything the republican platform stands for?

I wonder if it's ok for the most powerful man in the US, to go on about how women handle being sexually assaulted, and how that might be unfair to him, as a man?

Look, don't get me wrong. There have been plenty of times where the accuser was wrong. That is however, a minority of events, compared to the number of times that a woman was assaulted or raped and didn't tell anyone about it. That ends up hurting the woman far more than any accusation against the man. Look at all the women who came out against trump and he's still the president. Did you expect any other response from him?

I've about had it with certain FB friends and their 'funny' jokes about how the normalization and minimizing of this. If Ford testifies, and she will, the R's are going to come out of it with a lot of heat. They're either setting themselves up to fail in November if the all male committee doubts her account and pushes Kav through, or buckle and see Kav rejected and feel the wrath of the baby in chief.

Then, there's this whole exchange about Rosenstien and supposedly asking about recording the president and the 25th amendment. You've got 4 people with different recollections of that meeting and one who said it was said in sarcasm as a response to another. 3 say the 25th thing never came up. I wonder how fast trump is going to run and say it's the long suspected proof he's needed to fire him, or how long until Fox decides that's a step too far for the FBI? Never mind that Fox has nearly bent over backward multiple times, as have trump supporters to say 'Trump never really meant that about whatever he said about some awful thing, instead he was joking, or kidding, and you just can't take a joke when he says these things!"

At this point I wouldn't be the least bit surprised if Republicans submitted Shaggy's It Wasn't Me as evidence of Kavenaugh's innocence.

I don't think it's all that false, really. "Everything" the Republican platform stands for? No, maybe not. There may be Republicans who want to see honest criminal justice reform or the rescheduling of marijuana or whatever.

But the key tenets of Republicanism are "immigrants are bad, tax cuts are good, and people who use the social safety net are moochers."

If you're a Republican voter (as opposed to a voter who casts a ballot for a Republican) I'm pretty confident in saying that you support at least two of those three pillars, and almost certainly all three. Disagreement with the platform for Republican Voters is at the margins, not the core.

Maybe also throw in "I don't understand nuance so anything that isn't a bear hug for the military and USA! USA! USA! when the flag makes an appearance is commie bullshit," I dunno.

No bueno.
Walmart warns Trump tariffs may force price hikes: letter

I don't 100% agree with any of those pillars and I am a Republican voter. So you're 0 for 1, Sack.

So what're you doin' voting for the party that wants to "Build that wall" and that wants to pay for tax cuts by eviscerating the social safety net?

Because, frankly, if you don't agree with any of those three pillars and you're voting for Republicans, you are one seriously confused puppy.

Probably because you are over generalizing and there are nuances? Not sure if you are talking about GOP Trump vs traditional GOP. I do agree there is a lot of coalescing towards Trump but prob still a lot of traditionalists who don't like Trump and just biding their time.

Here's how I would re-word them for me at least ...

For sure "illegal immigrants & ME refugees/asylum seekers are bad" but the war isn't against legal immigration overall. I do know Trump/Miller wants to limit legal citizenship against any green card holders that uses social services etc. but for your statement to be true, it would be stop immigration which is not what has been proposed.

Agree with "tax cuts are good" but would add for context "tax cuts are good because it helps grow the economy and helps stock market" (and both are going pretty good so far)

Third could be changed to "many people who use the social safety net for too long are moochers, let's get the non-legit off the programs"


I would also toss these in:

1) Gun ownership
2) Many countries are screwing us economically, lets stop that (more Trumpism vs traditional)
3) Fiscal responsibility. Now I know this is not true obviously but at least the GOP parrot it more than the Dems

I didn't say I voted Republican everywhere, just that I am a Republican and I have beliefs that can be classified as somewhat Rwpublican.

My point is that you should stop generalizing all Republicans with your broad strokes. I realize it makes it easier for you to hate on all Republicans if you dehumanize them in your mind, but do us a favor and keep that in your head. Not every Republican likes Trump nor the uber-conservative side either.

lolololol

But the Dems do it more.

edit: I should add to this. The thinkers behind GOP legislation aren't looking at fiscal responsibility at all. The goal is to cause a crisis by relentlessly cutting taxes so that they can gut entitlements and have a government small enough to, "drown in a bathtub." Over the years a number of them have been very honest about this plan.

Really?


I agree with second sentence but let's be fair. Were the Dems thinking about it during the Obama 8 years?

Don't think I believe in the conspiracy theory but it sounds interesting, do you have a source(s) so I can read more?

Thinking about what exactly? Cutting taxes? Fiscal conservatism? Pulling the economy out of the shitter?

Reagen went from 74 to 155 billion in eight years.

Bush1 went from 153 to 290 billion in four years.

Clinton went from 255 to a surplus of 236 billion in eight years.

Bush2 went from a surplus of 128 to a deficit of 459 billion in eight years.

Obama went from a 1413 to 585 in eight years.

Trump has gone from 665 to an estimated 1000 or more billion in two years.

I'll admit it isn't as simple as just who is the President, but the trends are pretty clear.


Google starve the beast. The idea goes back to at least Reagan and David Stockman. It isn't a conspiracy theory, people have been pretty open about the idea.

Presidents have to play the hand they are dealt. I would define fiscal responsibility as having 1) reducing deficit spending 2) reducing the total deficit and 3) at the very least, a balanced budget.

I think you've listed starting deficit spending to ending deficit spending by president (lots of years inbetween)?

Lets try this chart for gross federal debt by presidential term (approx in the middle of page).

History of the United States public debt - Wikipedia

Plenty of blame to go around for sure which is my point. And the total actual deficit hasn't decreased.

re: Starve the beast, my problem with your statement is in highlights.

Look at how wiki defines it

Starve the beast - Wikipedia

Let's not make it sound as if its just all entitlement spending (medicaid, medicare, social security). "Crisis" over dramatizes it, its basically hey we are running a deficit, let's cut spending.

If you argument is that it hasn't worked, I wouldn't disagree with you.