“There are few better emblems of the failures of the US system of medical care than its inability to consistently provide insulin to Americans who need it.
The drug was discovered 100 years ago, and it provides essential and ongoing treatment for millions of people living with diabetes, one of the most common chronic diseases in the country. And yet one in six Americans with diabetes who use insulin say they ration their supply because of the cost. Some people end up spending nearly half of their disposable income on a medicine they must take to stay alive.
Though insulin generally costs less than $10 per dose to produce, some versions of the drug have a list price above $200. This is in part because, in the US, a warped market has allowed three companies to dominate the insulin business.”
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“With California leading the way, a handful of states are considering trying to disrupt the market for essential medications, starting with insulin. The plan would be to manufacture and sell insulin themselves for a price that is roughly equivalent to the cost of production.”
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“Medicare, the federal health insurance program for seniors, is about to institute a $35 per month cap on insulin costs for its beneficiaries, a provision of the Inflation Reduction Act that Democrats passed last year. But, because of the Senate’s arcane rules, they could not establish the same cap for private insurance, which covers more than half of Americans.”
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“The main mechanism the US has for bringing down prescription drug prices is allowing generic drugs to compete with brand-name versions. When a company develops a new drug, it gets a period of exclusivity, 10 years or more, in which it is the only one able to make or sell that drug. But after that exclusivity period has passed, other companies can make a carbon copy and sell it at a lower price. Studies find that once several generic competitors come on the market, prices drop significantly.
But pharma companies are savvy about finding ways to extend their monopolies, with insulin and other drugs, by making minor tweaks to the chemical compound and asking for a patent extension. In the case of insulin, the companies can also modify the delivery device to protect their market share. Each product is meant to be used with specific, company-designed injectors. Though the patents on the artificial insulin developed in the 1990s have started expiring, these companies continue to hold and extend monopolies on either their devices or other chemical compounds, making it harder for generic competitors to enter the market.
Other federal regulations have added to the challenge. The FDA began to treat insulin as a biologic drug in 2020 — meaning it is made with living materials instead of combining chemicals like conventional pharmaceuticals — which comes with a different set of standards for generic versions, which are known as biosimilars, as well as manufacturing challenges given the precise conditions these products must be made in. Biosimilars can cost up to $250 million to produce and take up to eight years to bring to the market, versus a one-year investment of as little as $1 million for conventional generics. And unless the FDA recognizes a new generic insulin as interchangeable with the products already on the market, health insurers might not want to cover it and doctors may not be willing to prescribe it.
To add one more layer of difficulty, the current manufacturers can always decide to drop their prices to crowd out new generic competitors, given the gap between the retail price and the $10 cost of production. The first biosimilar drugs have come onto the market in the past few years, but only one of them has been deemed interchangeable with the brand-name version; ultimately, in late 2021, it was priced at only $20 less than the brand-name insulin it was competing with. More competition is needed to meaningfully depress prices.”
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“If manufacturing a cheap generic insulin proves viable for California, the consequences could be enormous and stretch far beyond insulin. California would provide proof of concept, and a fledging public marketplace for public pharmaceutical production could potentially emerge.”
“A 2014 survey of economists found that nearly 20 percent of workers have noncompete clauses in their contracts. That number is more likely 50 percent for people in high-skilled and high-tech jobs”
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“Marx added that these agreements don’t just specify that you can’t share a specific company’s secrets, but are often interpreted more broadly so that a person can’t use skills they had prior to working at that company — something he said can be debilitating to high-skilled workers and entrepreneurs.”
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“Detractors of noncompete clauses say the agreements prohibit workers from getting jobs with competitors or even within the same industry. In doing so, they restrict job mobility and prevent workers from being able to push for higher wages, since changing jobs is often how workers get higher pay. These clauses can send them on lengthy job searches or even “career detours.””
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“Pro-employer groups like the US Chamber of Commerce have argued that noncompete clauses can actually be pro-competitive because they protect an “employer’s special investment in, training of, and disclosure of sensitive business information to its employees.” In a statement released shortly after the FTC’s announcement, the organization called the rulemaking “blatantly unlawful” since it says the FTC doesn’t have the authority to promote the rule. “When appropriately used, noncompete agreements are an important tool in fostering innovation and preserving competition,” the Chamber said in an emailed statement.”
“Perhaps the greatest success of the American health care system these last few benighted years is this surprising fact: The uninsured rate has reached a historic low of about 8 percent.
That’s thanks in part to the pandemic — or, more precisely, the slew of emergency provisions that the government enacted in response to the Covid crisis.
One policy was likely the single largest factor. Over the past three years, under an emergency pandemic measure, states have stopped double-checking if people who are enrolled in Medicaid are still eligible for its coverage. If you were enrolled in Medicaid in March 2020, or if you became eligible at any point during the pandemic, you have remained eligible the entire time no matter what, even if your income later went up.
But in April, that will end — states will be re-checking every Medicaid enrollee’s eligibility, an enormous administrative undertaking that will put health insurance coverage for millions of Americans at risk.
The Biden administration estimates upward of 15 million people — one-sixth of the roughly 90 million Americans currently receiving Medicaid benefits — could lose coverage, a finding that independent analysts pretty much agree with. Those are coverage losses tantamount to a major economic downturn: By comparison, from 2007 to 2009, amid the worst economic downturn of most Americans’ lifetimes, an estimated 9 million Americans lost their insurance.”
“Balloons, it turns out, are already part of that US arsenal, with the Pentagon spending $3.8 billion over the past two years on them, according to Politico. As industry expert George Howell posted on LinkedIn, “High Altitude Balloons are actually a pretty smart thing to invest in, they’re cheap, easy to transport, can be fielded in large numbers and are payload agnostic,” meaning that while they’re most likely to be carrying cameras or radar, in certain situations balloons could field a weapon.”
“In Turkey and Syria, the high concentration of old, inflexible, concrete buildings, the lack of construction oversight, the Syrian civil war, and an ongoing cholera outbreak have left the region vulnerable to devastation. “You already had areas where people were displaced and living in temporary shelters,” said Traub. “In many ways, they’re already really compromised going into the disaster, and now they’re doubly displaced, and don’t have their support mechanisms.”
This is what happens when you end up on the wrong side of the disaster divide, which explains how unequal losses experienced by certain communities and countries following a natural disaster are chiefly due to the discrepancy of wealth and resources, limiting the ability to invest in the very things — strong buildings, weather prediction, rapid humanitarian response — that would prevent deaths. There’s a reason that 90 percent of disaster deaths between 1996 and 2015 occurred in low and middle-income nations, the United Nations Office for Disaster Risk Reduction found. It’s not that rich countries are somehow exempt from extreme weather and geological events. It’s that the lack of wealth, and everything it can buy, is what makes a quake or a hurricane or a tornado disastrous, more than the sheer strength of a storm or how high a quake scores on the Richter scale.”
“Turkey sits along two major fault lines, and after a deadly 1999 earthquake, the country passed stricter building codes, but they were not consistently enforced. And that goes beyond builders and contractors cutting corners or using inferior materials. There are also likely inspectors and municipal and state officials who issued permits when they shouldn’t have, or who looked the other way. There are those who lobbied for (and the politicians who backed) amnesty laws for buildings, essentially overriding ordinances in the name of quick construction and profit.
“Earthquakes are a natural phenomenon. Yes, it happens. But the consequences of the earthquake are quite, I would say, governmental and political and administrative,” said Hişyar Özsoy, a deputy chair of the Peoples’ Democratic Party and an opposition member of Parliament representing Diyarbakır, a city near the quake’s devastation.
All of this happened under the rule of President Recep Tayyip Erdoğan, who, along with his Justice and Development Party (AKP), has been in power for about two decades. Erdoğan made a construction boom the centerpiece of Turkey’s economic growth. At the same time, he has consolidated his power over institutions, the press, and the judiciary. This rapid economic growth, happening alongside democratic erosion, created layers of corruption and government mismanagement that allowed contractors to construct the buildings the way that they did.
“This is very much about the entire system that Erdoğan built — not just the politics of it, but also the economies behind it,” said Sebnem Gumuscu, a professor of political science at Middlebury College who has studied democracy and authoritarianism in Turkey. “The entire system is built around these corrupt networks, crony networks, and it is all levels: local level, national level, local branches of the party, local construction, developers — they’re all in this together.””
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“Construction was also a source of political power for Erdoğan and the AKP, as major Turkish construction companies enriched themselves with government contracts and cozied up to the regime. That construction boom, which fueled other sectors of the economy, helped make Erdoğan and the AKP popular; that in turn allowed him to bolster his own authority, and helped put AKP into power at all levels of government, including state and municipal offices — often the ones tasked with overseeing permits or enforcing construction codes.
Politicians had incentives to approve things like amnesty laws. People enriched themselves through this ecosystem of cronyism, so there was no incentive to make sure earthquake-safe standards were applied. And the institutions that might hold these players and politicians accountable — the press, the civil service, the courts — were being hollowed out and eroded by Erdoğan’s increasingly authoritarian bent.
So, yes, developers and contractors likely were negligent, constructing buildings with cheap materials or designs that could not withstand a 7.8-magnitude quake. But these shortcuts couldn’t happen without the complicity or encouragement of government institutions, all of which knew the country’s vulnerabilities and pushed ahead anyway.”
“Does the media’s Trump-Russia coverage hold up? It depends on what coverage you’re talking about. The “Trump as Manchurian candidate” theories, the frenzied hunt to unearth any suspicious-sounding “contacts” with any Russians, and anything based on the Steele dossier — the explosive document that purported to have the goods on Trump but very much didn’t — have not aged well.
But the coverage and scandal were about more than that. Though it’s inconvenient for the revisionists’ narrative, the Russian government really did intervene in the 2016 election by hacking leading Democrats’ emails and having them leaked. Much of the coverage of the scandal now derided as “Russiagate” was about the investigation into whether anyone associated with Trump was involved in that Russian effort, treating this as an open question to which we simply didn’t yet know the answer.
Much of what the critics are arguing here is less about the facts of the scandal and more about the larger narrative around it. Should the media have treated Trump-Russia as the biggest political story in the country? Did the overall amount and tone of the coverage leave a false impression of his guilt? How does it compare to scandal coverage of other politicians, like Hillary Clinton?
And was the media and liberal establishment too suspicious of Trump in treating him like an unprecedented threat to the nation or have his subsequent actions proven they were right all along? The revisionists, in arguing that Trump got a raw deal, want to focus more attention on the overreaching of his liberal and establishment critics, but their one-sided account distorts the full picture of what happened, and reveals their own blind spots about the former president as he runs for office again.”
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“A fuller recap of what the scandal was all about would go something like this: What became the FBI’s investigation into Trump-Russia was opened in the summer of 2016 for reasons having nothing to do with Steele, Fusion, or Alfa Bank.
That year, leading Democrats had seen their emails and documents stolen in hacks, later to surface on mysterious websites or to be published by WikiLeaks. Initial assessments blamed the Russian government for the hack (and Mueller’s team later confirmed those assessments, fleshing them out with much more detail).
Trump viewed these leaks as highly beneficial to him, touting them constantly on the campaign trail, and even publicly calling on “Russia, if you’re listening” to find more Clinton emails. (He then claimed this was a joke, but in private, he urged his campaign advisers to try and get ahold of more Clinton emails.)
While this was unfolding, the FBI received a tip that a little-known Trump foreign policy aide, George Papadopoulos, had been saying he knew Russia had damaging emails related to Clinton before any hack news was public. So the bureau opened a counterintelligence investigation originally focused on a discrete question: Had the Russian government conveyed information about their plans to interfere in the 2016 election to someone on Trump’s team?
This was, I would argue, an entirely reasonable question. And with hindsight, due to this investigation and reporting, we know that many shenanigans were indeed afoot.
Trump’s longtime adviser Roger Stone was trying to get hacked Democratic emails from WikiLeaks in advance, while apparently informing Trump about his efforts.
Trump campaign chair Paul Manafort was sharing the campaign’s polling data and strategy with an associate the FBI claims is tied to Russian intelligence.
Trump’s personal attorney, Michael Cohen, had reached out to the Russian government to try to get a Trump Tower Moscow project going, though it didn’t end up happening.
Donald Trump Jr. even welcomed an emailed offer of dirt on Hillary Clinton that was said to be “part of Russia and its government’s support for Mr. Trump,” setting up a meeting with Manafort and Jared Kushner to discuss it. (They didn’t find the information useful.)
Additionally, Trump later tried to get a different foreign government to help him win the 2020 election, in his effort to strong-arm Ukrainian president Volodymr Zelenskyy into investigating the Biden family — so it’s not like he’s ethically opposed to colluding with a foreign government to help him win the presidency.”
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“the revisionists too rarely acknowledge that many other media outlets, including the New York Times and the Washington Post, were more cautious about Steele’s claims, and about theories of Trump being Putin’s puppet. Much of their coverage of the Trump-Russia investigation and the topic generally was newsworthy and stuck to the facts, making clear that it wasn’t known whether Trump conspired with the Kremlin.”
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“recall that Trump fired the FBI director and then quickly contradicted his own aides’ explanation for why he did so, saying it was because of “the Russia thing.” Should the assumption have been that Trump had nothing to hide? (Gerth puts great weight on Trump also saying that he thought the firing actually might prolong the Russia investigation, ignoring the false explanation Trump’s team initially offered for Comey’s firing and sounding rather too credulous about whether Trump truly would have let such an investigation proceed.)”
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“How should the media cover these unfolding investigations when information about them is incomplete and imperfect and the full story really isn’t initially clear? How much coverage is too much and how much is not enough? Can the press really know in advance which investigation is a nothingburger and which isn’t? These are tough questions with no easy answers.”
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“To be clear, there was too much hysterical and flawed reporting in Trump-Russia coverage, and that shouldn’t be defended. But a great deal of thoughtful, rigorous, and newsworthy work took place on that beat too. Journalists did not in the end find that Trump cut a deal with the Kremlin in 2016, but they unearthed a great deal about Trump and his allies in the process.
Dismissing the whole thing as a hoax or debacle — as the revisionists are doing — is too pat a dismissal. It was a complicated, messy endeavor”
“A Florida law signed by DeSantis last March requires that all books available to children be “reviewed by a district employee holding a valid educational media specialist certificate,” such as the school librarian, since the state says teachers cannot be trusted to select appropriate texts for their students. This means that classroom libraries assembled by teachers violate the law, and parts of the state — up to one-third of the state’s counties, according to reporting from the New Yorker — have restricted access to all books until they could be reviewed.”
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“DeSantis announced..that the state is blocking AP African American studies, a new class developed by the College Board, on the grounds that it is “a political agenda” and an example of “woke indoctrination.” The administration objected to certain topics contained in a draft framework for the course: queer theory, intersectionality, Black Lives Matter, reparations, prison abolition, and more.
At a press conference in January, DeSantis said the course is on “the wrong side of the line for Florida standards.” He added, “We believe in teaching kids facts and how to think, but we don’t believe they should have an agenda imposed on them. When you try to use Black history to shoehorn in queer theory, you are clearly trying to use that for political purposes.”
Florida rejected the course under its Stop WOKE Act (Stop the Wrongs to Our Kids and Employees Act), which took effect in July 2022 and bans schools and businesses from teaching anything that could make anyone feel “guilt, anguish or any form of psychological distress” because of their race, gender, sex, or national origin. Though a judge ordered a temporary injunction against parts of the law that limit conversations about race in public colleges and universities, the law remains mostly intact.”
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“At the start of the year, DeSantis called for the elimination of diversity, equity, and inclusion programs. The programs became required in 2020, ordered by a largely Republican-appointed board, while he was already in his second year as governor. A January 31 order from DeSantis prohibits higher education institutions from using any funding, no matter the source, to support DEI or critical race theory — the besieged academic framework that says racism is systemic — and anything else the administration considers “discriminatory initiatives.””
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“DeSantis wants school leaders to review course material. On January 31, he announced that the State University System Board of Governors and the State Board of Education must review general education core courses to make sure that they are historically accurate, “foundational,” and “career relevant.” The administration has not publicly explained what “foundational” or “career relevant” means. The boards must also ensure that core classes don’t “suppress or distort” historical events or include “identity politics” in their curriculum.
The governor also wants to require schools to give priority to “graduating students with degrees that lead to high-wage jobs, not degrees designed to further a political agenda,” but hasn’t specified which degrees they are referring to. His proposed overhaul would also mandate courses in Western civilization.”
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“DeSantis urged schools to bypass their tenure systems to conduct post-tenure reviews of faculty members “at any time with cause.” “They can be let go if they’re not performing to expectations,” he observed, adding that “the most significant dead-weight cost to a university is unproductive tenured faculty.” He also empowered school presidents and boards to “take ownership” of their hiring and retention decisions without interference from unions or faculty committees.”
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“DeSantis is staging what’s being called a “hostile takeover” of the New College of Florida, a small school in Sarasota. As part of his 2023-2024 budget recommendations, DeSantis wants to spend $100 million to recruit and retain faculty members at Florida’s state universities, and in addition, he wants to allocate another $15 million to “overhaul and restructure” the New College of Florida.”
“Nineteen states and Washington, DC, currently have red flag laws, otherwise known as extreme risk protection laws. It’s a form of gun control that even Republicans have endorsed, including some red-state governors, former President Donald Trump, and South Carolina Sen. Lindsey Graham. Connecticut was the first to enact such a law two decades ago, but the rest were passed in the last six years.
The more modern laws follow a similar formula, modeled after domestic violence protection orders. Certain people can petition for an extreme risk protection order from a court — a civil, not criminal mechanism that would prevent an individual from legally possessing or purchasing a gun for up to one year and allow police to seize their firearms for that period.
In most cases, it’s the police who initiate the petition against individuals who have a criminal history, who have made threats of violence, or who present other behavioral risk factors. But in some states, family members of the individual, health professionals, and school administrators can also do so. Should the individual continue to present an immediate danger to themselves or others, the petitioner can go back to the court after the year is up and seek another order.
The intention of these laws isn’t to criminalize people; it’s to stop guns from falling into the hands of those who have exhibited heightened risk of violent behavior and who don’t otherwise meet the threshold to be charged with a crime or involuntarily committed.”
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“There have been some jurisdictions — including in San Diego; King County, Washington; and Broward County, Florida — that have put resources toward creating dedicated law enforcement units that petition for such orders, but they are the exceptions. King County, for example, used a protection order to seize firearms from the alleged leader of a neo-Nazi group in 2019.
“What we’re seeing is that where you have that robust training, you have people who are dedicated to this, this is their job or a good part of their job, we see better success,” Horwitz said. “The laws don’t self-execute. These are very new laws. We need to make sure that we support them.””