TCS Daily


Unsafe at Any Price

By Gilbert Ross - July 29, 2009 12:00 AM

Sen. David Vitter (R-LA) is on a quixotic quest to allow foreign drugs into our pharmacies and clinics. However, anyone familiar with the issue is well aware that so-called "Canadian" drugs allowed under the "Vitter Amendment" can come from almost anywhere on the globe -- an easy path for substandard and toxic drugs to enter our supply. Despite this, Vitter demanded and got his drug importation amendment tacked onto the funding bill for the Department of Homeland Security, which has been passed by the Senate and goes now to be massaged in Senate-House conference.

How ironic that this is being done under the umbrella of homeland security: short of terrorism and contagion, there are few things that would more undermine the safety of the homeland than allowing drugs of uncertain provenance to mingle with home-grown, safe, and effective FDA-approved pharmaceuticals.

Vitter has tried this trick before, but wiser heads have thus far prevailed by excising his ill-advised amendments from other bills. His colleagues in the Republican Party generally oppose eliminating the longstanding barrier against foreign drug imports, but they have been unable to throttle his populist posturing (drugs from other countries seem to promise lower prices, due more to foreign price controls than market competition, even if many of those drugs are in fact adulterated or otherwise worthless). The Democratic majority, knowing full well that his amendment has almost zero chance of being preserved in the final bill and does not deserve to be, is nonetheless happy to let him take temporary "credit" for the amendment, since criticizing it on the merits might antagonize their anti-pharma base.

Vitter ignores three key facts in his ongoing crusade:

  • First, the FDA has long held the authority to permit foreign drug imports. All that is required is that the FDA Commissioner be able to certify that such drugs are safe. No FDA boss has believed that, though, and with good reason.

  • The presence of "cheap" foreign drugs would have little impact on the cost of pharmaceuticals for the overwhelming majority of our population. Sacrificing our safety and health would be a large price to pay for a very small return.

  • Most importantly, importing cheaper foreign drugs en masse would by definition mean importing foreign price controls. And where government-imposed price controls are in place on drugs--including Europe, Japan, and Canada--innovative drug research and development withers as the profit motive is removed from the drug business. How many innovative new drugs have been developed over the past fifteen years by European pharmaceutical companies, as compared to American blockbusters?

Fifteen years is the period during which price controls have been imposed over there, leading to a flight of intellectual resources westward across the Atlantic. Imposing such controls here--which is what importation, in effect, does--will lead to stagnation in our own drug R&D process, and our children and grandchildren will have to accept 2009 formularies into the foreseeable future.

Let's hope that Vitter's anti-business, anti-consumer amendment is once again stricken from the legislation. That way we will be protected from an onslaught of less-expensive but potentially more-toxic foreign drugs, and more importantly, we will avoid a future in which fewer lifesaving drugs are discovered and made available to us and our progeny.


Gilbert Ross, M.D., is Medical Director of the American Council on Science and Health (ACSH.org)
Categories:

66 Comments

Danger is not the issue
Canadian drugs are unsafe! This is why Canadians are dieing in droves. (not)

The real issue here is price controls. The Canadian price controls "work" only because the US doesn't have them. The marginal cost of producing additional drugs for foreign markets is very low -- AFTER recouping the R&D cost in the unregulated US market. If US customers can get price controlled product from Canada, the drug companies will react... probably by refusing to sell the drugs abroad until far later than availability in the US.

It will hurt the drug companies some, but it will hurt Canada much more. Let's do it and watch the socialists squirm!

Socialism is great until you run out of OPM.


We import all sorts of goods...no magic here...
The problem with importing pharmaceuticals is not that we cannot know where they come from or that they have been carefully made. We can do site audits and have factories ISO certified...we do that all the time.

The problem is with individuals filling presciptions outside the United States. It is not that we might get counterfeit drugs etc. It is that the US companies sell overseas at reduced prices or give drugs to third world countries at cost or below and those goods are diverted in the gray market or the black market and are then sold to Americans...especially through Canada. All companies sell into channels with specific target markets. Diversions violate their distributor agreements and compromise traceability when a questionable batch must be recalled. These are drugs, they have active ingredients and they must be carefully controlled or people will get hurt.

The larger problem is one of competition. The American market is regulated in such a manner that pharmaceutical houses are able to extract larger premiums than should be available in such a mature, consolidated industry. Lots of highly technical products cost a lot to develop, qualify and manufacture in clean room facilities...yet they are sold into global market with razor thin margins and those companies do just fine. We get computers, televisions and cell phones with ever more features at ever cheaper prices.

Drug doses are astoundingly cheap to manufacture and don't tell me about all those R&D and FDA costs. Everything we own is difficult to develop. If the FDA is making these particular things too expensive then it seems like the FDA is part of a government that is attempting to solve precisely that problem.

We live in a dangerous world. We let people below median intelligence drive automobiles, while they are punching numbers into cell phones, after they just bought very small bags of very powerful dope. Not to mention all the handguns out there. Let the physicians safeguard their patients by writing responsible prescriptions. And let the people take responsibility for this part of their lives. Health care is not a natural monopoly that the government should take over as a public utility.

There is nothing sacred here. Bio-med is a technology, it is a business, there are customers, medical professionals need to behave or be prosecuted just like anyone else and there are risks. We need to do the best we can, we want to live longer than nature intended and we will do the best we can. And then we will die anyway...in the end, perhaps, of nothing particular.

ISO certified is no guarantee of quality.
"In China, milk producers often buy raw milk from dealers and mom-and-pop operations that receive little oversight. Four milk dealers have been arrested for adding melamine to their milk to defraud quality tests before reselling it to companies such as Sanlu. One man allegedly purchased 200 kilograms of melamine last November."
http://online.wsj.com/article/SB122158011929343485.html

"The Chinese firms — Xuzhou Anying Biologic Technology Development and Suzhou Textiles — supplied wheat flour that was sold as wheat gluten and had been tainted with melamine, an industrial chemical not allowed in food. Melamine made the gluten appear more protein rich and was cheaper than increasing the actual protein content, the indictments say."

http://www.usatoday.com/money/industries/manufacturing/2008-02-06-pet-food-deaths_N.htm


Quality cannot be inspected into the product.

Would you rather buy your life saving drug from Singapore or Switzerland or from Manila or China?

won't work
If the drug companies refuse to sell the drugs, foreign govts will react by voiding the patents and permitting local companies to make the drug directly.

The only available reaction to such a bill would be for drug companies to stop making new drugs.

Where do you get your misinformation?
Yes, many products are difficult to develop, but few are as expensive and as risky to develop as new drugs.
How many software projects are abandoned after they are 90% complete? Many drug development projects are.

I don't know where you get the crazy notion that high tech products are being sold with razor thin margins. Nothing could be further from the truth. If Microsoft were to follow your logic, MsOffice would be sold for the price of 10 CD's and the cost of the packaging. Last time I checked, it goes for several hundred dollars. That's hardly "razor thin margins".

I believe you are confusing the companies overall profitability, which takes into count the cost of development, with the profit margins on individual products.

"Study finds patent systems may discourage innovation"
"(PhysOrg.com) -- A new study challenges the traditional view that patents foster innovation, suggesting instead that they may hinder technological progress, economic activity and societal wealth. These results could have important policy implications, because many countries count on patent systems to spur new technology and promote economic growth."

http://www.physorg.com/news167929968.html

Here we go. 'Studies' to prove protecting private property rights stifles growth.

Glad you asked...
I was a senior manager at Abbott Labs for 8 years...recruited directly out of my MBA program in 1975. Started as an Isotope Chemist, was a Manufacturing Manager and my last job there was Senior Project Leader in Diagnostics R&D. I directed the launch of the first TDx product line. After that I was with Deloitte for a while and then I was an executive manager at a number of high tech manufacturing companies here in Silicon Valley for more than 10 years...with R&D under my direction most of the time.

Pharmaceutical R&D is not very different from many other technical disciplines. Those companies like to complain that they need to eat their investments too often when programs don't work out...but such losses mostly result from speculating on blue sky product opportunities, hoping to get lucky and with the knowledge that selling such a discovery into the US market could be worth 10 fortunes. However, many a such project is basic research posing as development, more appropriate inside a University, a poorly managed waste of money for a corporation, predictably must come to nothing useful, should have never been undertaken in the first place, and were partially funded by the government with a "what the heck" attitude about the spending. If there was not such an astounding payday at the end then those projects would be more carefullly vetted in the beginning and losers would be closed down quickly when it became clear that nothing was happening.

With CPU's, memory chips, ICs and hard drives the R&D technical demands are equally daunting and the clean room manufacturing facilities are incredibly expensive. Nevertheless, those goods are carefully produced, with high quality yields and are sold with very tight margins into competitive global markets.

Software and players like Microsoft who enjoy a monopoly position...and who get sued for precisely that all the time...are a somewhat different case. In spite of their healthy margins we do not seem to be crushed under the weight of the Microsoft price points and none of us would die if we needed to buy an Apple instead of a PC. Or a Lenovo running Linux.

But back to Bio-tech. We know that these products can be inexpensive when we look at the Veterinary industry serving the agricultural community. Farmers can't afford to be beaten up by prices for such medications. They are producing commodities. And they are quick to cut their losses. Rich guys won't even fix a racehorse with a broken leg. Nevertheless, there is a very large market for animal vaccines and antibiotics. Furthermore, the reproductive medicine applied to large animals is far more sophisticated and advanced...and far less expensive...then those same techinques for humans. We understand all this stuff really well with cattle because there was always a lot of money to be made getting milk cow genetics fine tuned.

Artificial insemination is done inexpensively by technicians with very high success rates. Embryo transfers are common. Genetic engineering has been productized for industrial applications and cloning is easy...especially with plants.

We make pharmaceuticals in the same sort of tanks used to brew beer and if you were standing in the mixing room of either such facility it would be hard for you to tell if they were making medicines or food there.

By the way, lots of software never makes it. That's why there are so many software start-ups looking to hit the bigtime. Same thing with biotech, actually. There are lots of nimble little companies actually better than in-house R&D teams with all their politics.

Remember, 95% of the world's population is outside our borders, they are rapidly getting wealthy enough to demand state-of-the-art healthcare goods and services in immense volumes, it will be quite some time before they can afford to be pillaged by their physicians and their pharmacists like we are and as they develop their own societies you can be very sure they won't make the same mistakes we have with this business. By the time they catch up to us in wealth and lifestyle their health care services will be as effective, more efficient and much cheaper than ours. Bet on it.

Fifty years from now? Certainly. Maybe sooner than that. How long did it take Detroit to kill itself with stupidity? Thirty years? Something like that.

So that is where you got stupid, being a manager?
Why do so many like you don't respect free markets and prefer fascism?

Nearly all CEOs and corporate execs donate big time to democrats and like government control.

Microsoft was never a monopoly, and Gates didn't grease the right palms so he was sued.

Those that built their companies from nothing, like Gates, are the ones who appreciate liberty and free markets.

I guess that answers my question. You can't compete in a free market and want the government to run interference for you.

I'm a Republican...
Although the Libertarians are morons they mean well and probably also believe in Santa Claus...bless their hearts.

Microsoft wholesale copied the Apple user interface and Bing looks exactly like Google.

Their 90% of the US desktop market is a de facto monopoly and Microsoft is ruthless regarding competitors...just as our practice of capitalism assumes we should be and just as I am with the businesses I manage. That's the way the game is played.

But that does not mean that maximizing the agenda of each party results in the best outcome for all stakeholders. This is just the way we have our own economy structured. In other societies a personal agenda might extend to the best outcome for a family or a clan rather than an individual. Here in America, however, a man will lie to his boss regarding a mistake he made that will hurt the company, lie to his investors about how well their business is doing and cheat on his wife with her sister if he imagines he won't get caught.

I can compete in the business arena with any man alive and I stay completely away from the government and all their special agents. I have never donated one dollar to any politician ever.

American Blockbusters
Since when do conservatives demand the status quo?

I thought the movement was about rebelling, shaking things up, doing it the right way, with principle.

This article cheerleads for Big Pharma and FDA like its coming from the marketing dept. To believe this carp trap is to think stupidly. ho..

Does Canada have an overwhelming problem of counterfeit pharmaceutical drugs?

"Microsoft wholesale copied the Apple user interface "
If true, then they cold not have been a monopoly. Apple is a competitor.

"I have never donated one dollar to any politician ever."

So? You don't support limited government and free markets.

A Palin Republican or...
a Jindal or Perry or Rush Republican or a McCain or a Snowe RINO?

"maximizing the agenda "

Billions of free and voluntary trades between individuals does not maximize the outcome for all 'stakeholders'?

" Here in America, however, a man will lie to his boss regarding a mistake he made that will hurt the company, lie to his investors about how well their business is doing and cheat on his wife with her sister if he imagines he won't get caught. "

This happens all over the world and is especially prominent in the Philippines. Maybe that is why their business climate is so poor.

Once again, a little bit of knowledge, and a lot of ideology
one,

Microsoft is not a monopoly, never has been never will be.
This goes double for it's applications, such as Office, for which there are a dozen, very viable competitors.

The fact that you reference Microsoft as being a monopoly completely discredits anything else you might say.

Then you admit that many pharmecutical development products never reach market, but then you turn around and blame management. Rather than the reality that you never know how a drug will work on humans, until it is tried on humans.

You have let your hatred of big corporations cloud your judgement and blind you to reality.

a lot of Republicans are proto-fascists, so are most Democrats
So what if MS copied the look and feel of Apple.
Apple in turn copied it from another, yet smaller company.

It wasn't patented, so they had every right to copy a good idea.

As to Bing looking like Google. Just how many different ways are there to put a text box and an activation button?

Microsoft is not a monopoly, it has many, very viable competitors.

The fact that you cling so eagerly to a lie, says that, like the AGW crowd, you would rather believe a warm lie, than the cold hard truth.

Apple's 'monopoly'
" Microsoft Corp.'s quarterly earnings report last week featured a number of grim statistics, including a relatively overlooked, albeit steep decline related to its Zune portable media player_potentially adding more uncertainty to the embattled product's future.

Designed to rival Apple Inc.'s iPod, Microsoft's Zune first appeared in late 2006, but has struggled to chip away at the iPod's dominance. While Apple has morphed the iPod since its 2001 debut into a range of models including the iPod touch and iPhone, Microsoft has so far limited the Zune to a few different devices distinguished only by size and storage capacity."

http://www.physorg.com/news168198505.html

By your logic, Apple now has the monopoly on Ipods and Iphones. Time to file a lawsuit.

Roy, NearNoad and Forest all intersect here.
They all want to have control of the government so they can have their way.

Merely ASSERTING won't make it so Marjon. On the other hand, you've assiduously promoted "anarchy"
so that, you can PERSONALLY inflict deadly force whenever you “feel” like it, on whoever you “feel” has “Wronged” you, with a Clean Conscience.

Marjon doesn’t want ANY “Government” as he wants his way in PERSONALLY using deadly force whenever
he “feels” like it, on whoever he “feels” “Wronged” him, with a Clean Conscience.

Xerox was a smaller company?
"Apple in turn copied it from another, yet smaller company."

They stole it from XEROX. The 'iconic user interface' (including the mouse) was developed at XEROX PARC.

Rent "The Pirates of Silicon Valley" to see the scenes where Steve Jobs just walked in there, checked it out and then just plain stole it because XEROX execs didn't know what they had. They showed one gray-haired XEROX exec holding up a mouse and asking the project manager, "What is this again? A rat?"

It is nice to know...
...that with catastrophic declines of liberal trolling on non-liberal forums due to wide-spread disenchantment with the Messiah, Bob Jones still takes the time to 'shake things up' here while not making a whole lot of sense in the process.

Reminds me of the 'clunker for cars' program. It doesn't make sense that people want to hand over control of their health care to morons who can't even administer a simple $1 billion remittance program for crappy cars.

But there will always be at least a few Bob Jones who claim that they do support said morons.

You have proven you like the state. No assertion required.

Big governments, big companies....
are not very nimble.

Unless they create very small, nearly autonomous units like a Skunk Works.

To do so requires the big bosses must sacrifice control. That is too much for some to achieve results.

Quote me if you can. But YOU continuously promote "anarchy" so you can PERSONALLY use pre-meditated
deadly force whenever you feel like it, on whoever you “feel” “Wronged” you.

Merely using words like “state” without defining what it means and without showing – by quoting my posts - how it converges with what I have been advocating, you think you can get away with it?

What I hate is poor management...
Some businesses are natural monopolies. Desktop software that allows personal computers to communicate across LANs, WANs and the internet is a great example. There should only be a few such options, the various flavors need to interact seamlessly and one such alternative will probably come to dominate the market. Microsoft seems to be in that position. Great. But they cannot be allowed to engage that reality to exploit our reliance on personal computers. They worked hard, they got lucky, perhaps, but they find themselves in the position of controlling a public utility now and they must behave or that franchise will be taken away from them. Otherwise, with our practice of capitalism we should reasonably expect them to maximize their earnings at our expense...because "greed is good".

Arrogance on the part of our leaders in government, industry and banking brought this economy to an event horizon threshold of total collapse last Fall. We were doing stupid things...we knew that...we were allowing certain entities to misbehave egregiously and we dumbly believed that the invisible hand of the market would nevertheless correct any imbalances created without anarachy because the global system was so large and our financial instruments were so buffered, collateralized and insured that nothing could cause them to unwind on their own or our economy to deleverage.

But we were reckless to allow stupidity and egregious behavior. We were foolish to watch all the money being paid to Wall Street technicians and not to tease apart the underlying processes. Something was wrong and we did not bother to find out what. In the end it was our old friends "lie, cheat and steal".

When we see stupidity then we must simply put a stop to it in order to reduce the unknown variables we manage in our work and the unpredictable impact hidden mistakes might have during a crisis. Everything seems wonderful during periods of rapid growth because screw-ups can be buried into the flow. When things slow down, however, those festering items are still on the books and they suddenly come alive to demand resolution.

The morons who allowed this to happen politely excuse themselves and retire. Those of us who knew how to do the work right all along, but were ignored, underpaid and unappreciated must remain to pick up the pieces. Actually, we need the work.

Industry standards
" Desktop software that allows personal computers to communicate across LANs, WANs and the internet is a great example. "

Poor example of a 'monopoly'. Great example of industry collaboration to agree upon standards like VHS or BluRay or 120VAC or......

"the invisible hand of the market would nevertheless correct any imbalances"

The market has responded to the stupidity of government controls. If the results are not what you expected, don't blame the market, blame the government coercion that forced the market response and advocate for limited government market coercion.

Then you must support decentralized management and control?
Management as described in "It's Your Ship" or "The Ice Cream Maker"?

"He learns to empower his workers, listen to customers and obsessively measure every detail of production processes with an eye to continuous improvement. Soon lumpy texture and leaky cartons are a thing of the past, profits soar, Pete is promoted to company president and he even applies Mike's teachings to enhance the quality of his marriage and parenting."

http://www.amazon.com/Ice-Cream-Maker-Ingredient-Everything/dp/0385514786

You never say much of anything,
but you do oppose free market solutions to state coercion.

What "free market" solutions? "Anarchy", where YOU can PERSONALLY use pre-meditated deadly force
whenever you “feel” like it, on whoever you “feel” “Wronged” you?

All you want is to INDULGE in your EVERY emotion, including using pre-meditated deadly force whenever you “feel” like it, on whoever you “feel” “Wronged” you, with a Clean Conscience.

That’s why you promote “anarchy”.

What “free market solutions”, where you hand over the murder of an innocent girl to “God”?
Remember the unfortunate case of the University of North Carolina student?

Good one...
Large centralized organizations create efficiencies when they decentralize. Large decentralized organizations create efficiencies when they centralize. I know this seems counter intuitive. But here is why.

Centralized teams accumulate the baggage of any large bureaucracy with some strong people doing most of the work and many others simply playing politics. The operating units out in the field are not able to make many decisions and they spend most of their time competing with each other trying to get posted to corporate where the action is. So you decentralize, put your best people in the field, shake things up out there and cut your corporate deadwood ruthlessly. Everything gets better in a hurry.

Decentralized teams are continually trying to manipulate their measurements, sandbag their annual plans and maximize their local agendas without any regard for the rest of the corporation. They make mistakes and they hide them. They do all the simple stuff at the beginning of the month, ignore the important jobs until the end of the month and then spend a lot of overtime trying to catch up. Local general managers accumulate fiefdoms of worthless, overpaid drinking buddy cronies. So we centralize decision making by cherry-picking the talent out there, bringing them up to corporate and executing the rest of those morons in senior staff positions out at the plants. Everything gets better in a hurry.

We do this back and forth, centralize and decentralize on something like seven year cycles because that is about how long it takes to build up the benefits of such transitions before everyone gets lazy, too clever about how to manage their numbers and then just plain corrupt.

This is really hard to do with the Federal Government because the same people stay in their GS organizations for their entire careers regardless of who is elected and regardless of which Secretaries are appointed by the politicians. Nothing changes very much because no one makes enough decisions to make enough mistakes to get sacked. The people who rise to the top are those who play that game best, work straight by the book, spend a lot of time revising policies and procedures and are terrific at finding someone to blame.

Proving need for real competition of free markets
"We do this back and forth, centralize and decentralize on something like seven year cycles because that is about how long it takes to build up the benefits of such transitions before everyone gets lazy, too clever about how to manage their numbers and then just plain corrupt."

In real free market competition, those who practice what you suggest will soon be out of business, unless protected by politicians.

So why don't you support free markets?

Blame the media
" Venezuela's top prosecutor insisted Thursday that freedom of expression in Venezuela "must be limited" and proposed legislation that would slap additional restrictions on the country's news media. "

The new law would punish the owners of radio stations, television channels and newspapers that have attempted to "cause panic" and "disturb social peace," Attorney General Luisa Ortega said. "
http://www.breitbart.com/article.php?id=D99P3IKO0&show_article=1

"Reid said reporters created a fictitious deadline of a successful vote by the August recess, and downplayed the fact that the chamber won’t meet that mark."

http://thehill.com/leading-the-news/senate-dems-blame-media-for-august-health-deadline-2009-07-30.html

"Franken, who was seated talking to someone else, did not stand when Pickens said hello. Instead, Franken began to berate him about the billionaire’s financing of the Swift Boat ads in 2004.

Read more: http://www.politico.com/news/stories/0709/25667.html#ixzz0MtjXFZP9
"

"“I personally encourage the president to establish a White House commission on public media,” the legendary newsman said.

Such a commission on media reform, Rather said, ought to make recommendations on saving journalism jobs and creating new business models to keep news organizations alive.

At stake, he argued, is the very survival of American democracy."

http://www.aspendailynews.com/section/home/135834

Yes, at stake is the liberty of US citizens if the government has more control of the media.

natural monopolies
OS's are no more a natural monopoly than are automobiles.
After all all automobiles need to use the same roads, etc. etc.

Your example of LAN's and WAN's shows just how little you know of software and monopolies.
The internet is a standard. One that is not maintained by a govt agency I must add. Any company can build a device that talks on the network, so long as they follow the standard. Which is why there are dozens of companies marketing devices for communicating on the internet.

And what's this cr@p about it being a public utility.
Do you bother to do any research before you mouth off?

As to stopping stupidity, who gets to define what is stupid, vs what is revolutionary? The government?
Every revolutionary development in the history of the world, was originally labeled "stupid" by those in power at the time.

optimum size
Every organization has an optimum size, when they are bigger or smaller than that optimum size, they loose efficiancy.

The optimum size for a company is not a static number. As technology changes, as the skill sets of those who run the company change, so does the optimum size.

It is up to the market to determine what the optimum size for a company is, not the govt, not any outside agency.

Good post...
Unfortunately, a number of industries are very much inclined to consolidation...and much of this is implied by the structure of society itself...and how it fits into the global arena.

For example, in the United States we became very mobile following World War II in order to continue developing our economy in all parts of the nation by relocating available workers to the jobs rather than to locate factories close to labor resources. To fight the Cold War. For this we needed lots of automobiles, the car companies grew very large, we allowed foreign corporations into our markets, unit margins dropped and the balance sheets of such entities required massive debt instruments.

We laid-out our cities and towns during the last 60 years with the assumption that everyone would have a car. So here we are. Automobiles are public utilities. Car companies are part of a structure much larger than our practice of capitalism implied and the industry is irreversibly consolidated. To make more money there should be myriad car companies, all very profitable, cars should be extraordinarily safe, the government should restrict new models to make certain they are as free of flaws as any medical device and some people should simply not have a car. If there were not so many cars and they really cost a lot then 17 year old kids would not be driving at all. Older cars would be retired as soon as better brakes etc were introduced. It would be like private planes. Everyone like them. Almost no one has one.

You said "As technology changes, as the skill sets of those who run the company change, so does the optimum size."

Not all there is to it. If we each needed an airplane to get around every day, you could get a good used one for $1500 and if everyone who could sit up straight had a pilot's licence then aircraft companies would be pumping them out as fast as car companies. Airplane technology is as solid as for automobiles and the management skills are similar. There would only be a handfull of multinational players.

Never mind that lots of people would die every day in plane crashes. Lots of people die every day in car crashes and that doesn't slow us down...or even make us stop texting while we drive...one little bit.


Keep right on accelerating until we hit the wall...
We really shouldn't be encouraging the gray market diversion of prescription medicines through Canada or anywhere else. The article urges that it is dangerous for the wrong reasons, of course. Not that we would get real drugs at lower prices but that we have no way to know what we would be buying up there.

Of course, the industry and their friends in the government have not shut down the characters trying to sell genuine fake drugs over the WEB or magic potions to make our various pieces-parts larger than nature intended so one must question their sincerity.

We have still not addressed the underlying reality that the government makes drugs too expensive to develop and restricts competition to such a degree in the health care industry generally. The problem is the price. And the price keeps rising. There is no magic here. There is a lot of money to be made, there should be more capitalists out there going after that money, most of the health care industry's goods and services are mature and prices should be dropping like they always do for almost everything else we consume.

If the government will not let capitalism operate then the government has declared a natural monopoly and must socialize medicine as a public utility. We don't have any third choice. We're not going to let ourselves die without medicine and health care spending is not going to take over our entire economy. Can't actually happen. This business is about life and death. So it will get resolved. That's why God made the word "unsustainable".

inclination vs. profitability
All companies are "inclined towards consolidation". It's basic human nature to want to be bigger.

The role of management is to try and determine what the optimimum size for a company is, and keep it there. Some managers recognize this, some don't. Regardless, when a company grows past it's optimum size, it starts getting beaten by smaller companies that are closer to the optimum size.

"by relocating available workers to the jobs rather than to locate factories close to labor resources."

You really do go out of your way to make yourself sound paranoid.
Nobody relocated workers. They chose to move where the work was. In an era where lots of workers were needed to make big plants more efficient, these plants were built where the workers were. Big cities. As the plants grow, the job opportunities lured people from smaller cities.

This had nothing to do with the cold war, I have no idea why you decided to try and introduce that shiboleth.

Car companies grew large, because lots of people wanted cars. It had nothing to do with any kind of govt conspiracy.

As to letting foreign companies into our market, why do you consider that a bad thing? Don't you believe that consumers should be allowed maximum choice?

As to unit margins, in those situations where the govt is not restricting the supply, unit margins will always drop to the point where a product the profitability of investment approaches that of investing in T-Bills.

Of course we laid out our cities with the assumption that everybody would have a car. By that time, everybody did have a car. Shouldn't city planners deal with reality?

Automobiles are a public utility?????
Once again, you use a word while having absolutely no idea what the word means.

Nothing is irreversibly consolodated. Ever.

You assume that having more car companies would be better? Why? What's your evidence that car companies are larger than optimal?

Cars will never be extraordinarily safe. Not so long as they are being driven by humans.

There are three reasons why few people own private planes.
1) They are more expensive than cars.
2) It takes time and money to get a pilots license.
3) They are more dangerous than cars.

Do you really believe that if demand were greater, that planes would be $1500????
Based on what evidence?
There is a great deal of demand for cars, cars are easier to build, and cars are much more expensive than that.

Please, please, please. Take the time to learn what the words you use mean.

so the solution to govt interference is total govt control
that's a really dumb position to take.

Flying cars
The only thing holding back 'flying cars' is the government switching over to a GPS based ATC.

"Raytheon will build the ground stations for the GPS-Aided Geosynchronous Augmented Navigation System, and the Indian Space Research Organization will provide the space segment and additional ground equipment. The system will provide satellite-based navigation for civil aviation over Indian airspace and adjoining areas in South and Southeast Asia."

http://www.upi.com/Security_Industry/2009/07/21/Raytheon-to-install-GPS-aided-air-navigation-in-India/UPI-58791248190800/


India will have a better ATC than the USA soon.


"Every pilot faces uncertain weather, rising costs, and ground transportation hassles on each end of the flight. The Transition® combines the unique convenience of being able to fold its wings with the ability to drive on any surface road in a modern personal airplane platform. Stowing the wings for road use and deploying them for flight at the airport is activated from inside the cockpit. This unique functionality addresses head-on the issues faced by today’s Private and Sport Pilots.'

http://www.terrafugia.com/aircraft.html

The next step is to have an automated ATC for such vehicles.

Whats nice about it?
You know everything Zyndryl, doesn't that take the nicety out of such a mundane thing as you opening your mouth?

You didn't refer to my point about conservatism, so you must have no defense for yourself. As I said, you clearly support the status quo. Good doggey.

And you didn't answer my question about counterfeit drugs in Canada either, so you must agree the author is just another conservative shill for Big Pharma and FDA. Common ground.


I'm curious how you think 'clunker for cars' isn't administered well when its such a popular program it ran out of money waaaaaay ahead of the expected timeframe. Seems the administration of it is just fine, the feds just didn't realize how crazy popular it would be. Its hard to understand how it can't be called a success. Can you explain how its not? Please try to use real evidence or examples instead of your usual ideology-driven theories.

what say you mark?
Lets assume a free market solution is impossible, hypothetically speaking. As such, in your opinion, is the sytem better 'as is' - government interference, or is total government control better? I know, thats two bad options, but which is better? We make this judgement every four years in Presidential elections, surely your capable for this hypothetical. Thanks.

Slowly getting the idea of a monopoly.
It requires government coercion to create and maintain a monopoly.
FDA rules do make drugs expensive.
Drug prices are also high because US consumers subsidize drug sales to countries with socialized medicine.
How will more government coercion make anything better?

Bad assumption.
"government interference, or is total government control"

What is the difference?

let's start by assuming that hot is cold
when you start with an absurd assumption, it's hardly surprising that you end up with absurd conclusions.

Total govt control is never a good solution.

Thats nice, but you need a third variable
Otherwise what you say in the header is nonsense.

Very well. You want the status quo. You want health insurance corporations to continue with ridiculous profits at the expense of people and business, and then people again because any business expense is really an expense to its customers. Clearly, you're also happy with the even more insane profits for pharmaceutical companies, again at our expense. All so a small minority of corporate executives can live like kings and face no accountability for the job they do. As long as the shareholders and executives share the wealth with each other.

You're sick MarkTheVader. You are a bacteria in the body that is our human condition.

What ridiculous profits?
What I have seen is their profit margins are on par or lower than other FOR profit companies.

Profits are NOT at our expense. They are for out benefit, unless you want companies to go out of business and provide no products and services you need.

How much is too much
"Profits are NOT at our expense. They are for out benefit, unless you want companies to go out of business and provide no products and services you need."

Where is the line marjon? Is there one? If health insurance premiums doubled next year, insurance company profits and stock price would go up, would it be to our benefit? Would it be worth the price?

At what point do you start to think you pay too much for something? Has that ever happened to you?

Profits ARE at our expense, because every expense a company pays is at it's customers' expense.

What ridiculous profit?
In a free market, competition will drive down the costs and therefore, the profit.
Now, government regulations limit competition in the insurance industry.


What ARE the 'ridiculous profits' of the insurance companies and how do they compare to any industry average?

$100/enrollee per year IS a ridiculously low profit.
"In no case is the company making more than $100 per enrollee per year in profits. Given that most insurance plans cost a good $4000-$6000 per year, the amount of what we pay for insurance that goes to “lining insurance companies’ pockets” would seem to be fairly small."

http://the-american-catholic.com/2009/08/03/excessive-health-care-profits/

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