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It seems rather simple to me....

For the better part of a year, the worlds of health-care finance and health-care politics have been scandalized by the specialty drug called Sovaldi. The $84,000 cost for a course of treatment of this hepatitis-C cure was said to reveal that pharmaceutical prices were irrational or abusive; that markets were helpless to respond; and that, absent government intercession, this new wave of complex biological therapies would bankrupt the nation.

Then, this winter, all of a sudden, discipline and competition arrived. The response has largely come in the form of new hep-C medicines and pharmacy-benefit managers, or PBMs, a kind of quasi-insurance company that purchases medications in bulk from drug makers, negotiates prices and oversees patient drug plans.

Really?

Gee, that seems to me to be market power.  And while you can argue from one side that this improves competition there's an equally-powerful argument that it destroys an inherent part of competition -- choice.

After all, closed formularies and similar things are all about destroying choice and playing favorites.

The real question is why we have this debate at all -- and the answer to that question is that we have allowed pharmaceutical companies to practice disparate pricing and control of redistribution by people who bought said drugs.  That is, restraint of trade.

See, that's supposed to be illegal.  The "trump" that is played by these firms is that counterfeit drugs would be bad (dangerous), and that's true.  But that simply militates that counterfeits should not be allowed; it says exactly nothing about you buying something (legitimate) and then reselling it.

Never mind CVS itself, which claims to fill one in five prescriptions nationwide. That, it would seem to me, pretty-much defines "market power."

And this is where the problem comes in. I've got personal experience with an early version of this when an employee of mine a couple of decades ago had our health insurer yank a drug she had been on for a good long time out of their formulary without notice to her -- or me.  This was discovered when she was met with a demand for several hundred dollars to refill a script without any foregoing notice -- in other words, without the opportunity for her to talk to her physician first and find out if there was an equal or better alternative, and if not for her (or I) to petition for a waiver.

I managed to resolve the problem but not without a lot of yelling, most of it centered on the outrageously unfair failure to provide reasonable notice to anyone that this was about to take place.

Then there's this problem:

In January, CVS turned around and made Harvoni and Sovaldi the preferred hep-C treatments on its own PBM formularies. Both PBMs almost certainly received concessions on list prices in return for offering one therapy in lieu of competitors, though details haven’t been disclosed.

And therein lies the problem -- are these therapies equivalent in performance and, may I ask, who decides?

This isn't really competition, in my opinion.  Competition happens when individual consumers make choices and by doing so provide incentives for better outcomes all around -- including financial outcomes for everyone.

Being forced under pain of not being "covered" isn't choice, it's use of force and while it might provide a cost benefit that benefit may come with material (and undisclosed!) costs to the user, in this case effectiveness.  After all, isn't the question who decides effectiveness, and isn't divorcing that decision from the person who takes the medication inherently dishonest?

I think so.

Next, shouldn't we be talking about the root of this, rather than simply pumping drugs?

About half of all Americans suffer from one or more chronic conditions such as high cholesterol, diabetes or asthma.

Half?!

Yeaaaah.  Some of that is self-inflicted -- and forcing society (however you define that) to pay for it is obscene.  But the other question becomes this -- how much of that is "generated illness" predicated on a disproved hypothesis?

I speak specifically of the "high cholesterol" meme -- when we now know that the lipid hypothesis has been disproved?

How many billions are siphoned off from you and to these companies, now with the urging and "management" of companies like CVS/Carmark, predicated on disproved theorems?

Now that's an inconvenient question.

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The usual list of pundits are coming out with their various nostrums about the Greek elections going on right now, and they all focus on one thing -- a debt is a debt, and must be paid (somehow.)

Wrong.

Lending prudence only occurs when the risk of default is present should you extend credit foolishly!

It is beyond question that Greece was extended credit by various members of the EU (and the ECB itself) when it was incapable of paying as agreed under the current economic paradigm in place at the time.

This didn't happen only when Greece "got in trouble", it happened for well over a decade prior; indeed, it can be argued that it occurred on the first first day Greece was part of the Eurozone!

Erecting the middle finger was the right thing to do when Greece first got in trouble and it still is.  Let's remember that the Euro treaties provide no means of forced exit; that is, the members of the Eurozone can refuse to extend further credit to Greece but they can neither force the nation off the Euro nor can they abrogate the duty-free trade access!

When you're spending more than you take in the only sane thing to do is to stop that.  But nothing says you have to pay what you allegedly owe and recourse is strictly defined by the agreement in question.  Virtually all lending to a government is inherently unsecured because there is no property deed given to be held in escrow, as is sometimes the case with private lending arrangements.

In other words you simply take the debtor government's word they will pay.

But nothing binds them to pay.

Even if their Constitution allegedly binds them, Constitutions can be changed through entirely lawful process.

What Greece should do is repudiate the debt.  All of it.  If they need to vote through a change to their Constitution to do that, then do so.  This will immediately cut off their access to further credit but that's good, not bad.

You cannot get out of debt by borrowing more money.  The two options to get out of debt are to pay it down and erect the middle finger toward the creditors.  In the case of a sovereign nation that cannot pay the correct choice is often to erect the middle finger; after all, the other alternative, to run said "primary surplus", requires cutting spending at least as much and nearly always more than does repudiation!

Give the Eurozone and ECB this Greece -- they have it coming:

smiley

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If only, the lament goes:

In predominantly African-American neighborhoods of U.S. cities, far too many killers have gotten away with far too many crimes for far too long, fueling a disastrous murder epidemic. Solving these murders and other serious crimes of violence in black communities should be a top goal for law enforcement—and it deserves to take priority over much more widely discussed issues such as racial profiling and the excessive use of force by police in black neighborhoods, from Ferguson to Staten Island.

Ah, but you see choking and shooting unarmed men is easy.  It requires no courage, no thought and certainly no "policing."  It's simple -- choke him or shoot him.  The End.

Now take a person wanted for murder.  That's a different matter.  Now there's risk -- the suspect might shoot back! So what do we do then?  Why, we throw a bomb wherever the suspect might be (note, not "is known to be") or, if that's inconvenient then you burn the place to the ground (Waco anyone?)

Consider this -- nearly every time someone is wanted, even for murder, they can be easily captured without violence.

Why?  Because damn few people can remain "switched on" forever and most thugs aren't "switched on" at all.  The suspect comes out, goes to the store for a six pack of beer, and oops -- he leaves his rear unguarded.  Cop steps out from behind him, with another cop at an elevated location with a bead on him and the cop behind him says in a nice loud voice: "Put up your hands, you're under arrest -- and oh by the way, a police sniper has a nice red dot on your chest!"

If the suspect turns or tries to go for a gun, he gets shot -- and that's perfectly justified.  Such a capture scenario also has a near-zero chance of harming anyone else -- like innocent people in the vicinity.

But that takes time.  You have to think out the scenario, figure out where to put the officers, stake the place out and generally use your head.  You have to do police work, in short, with the key word being work.

So instead you throw bombs.  You shoot people "preemptively."  You charge in with 20 officers in a "breach", all in body armor with guns at-the-ready and if anything moves, you shoot it whether it's the suspect going for a weapon or it's a grandmother who has absolutely nothing to do with the raid -- in what might be the wrong house.

See, the real problem with inner-city policing is that handing out tickets by the tens of thousands for having an open beer in the street is trivially easy while running down murderers, assault perpetrators and rapists is hard.

You also don't make any money for the city running down murderers and rapists while writing bull**** tickets by the tens of thousands makes the city millions of dollars -- and of course, we know all about those cop pensions and the need to fund them, right?

Yeah.

Impunity for murder,******and serious assault exists because the cops have demonstrated that they are fundamentally lazy and a bunch of cowards, and are either mentally incapable or unwilling to expend the effort to run down, stake out and peacefully arrest these predators.

They all deserve to be fired -- but until the public as a whole stands up and demands their firing I'll settle for shunning any that have not individually and personally demonstrated that they do not fit that general mold.

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Would someone mind telling me what purpose being anything other a maximally-exploitive ******* is given the following sort of story -- and the lack of immediate judicial reaction to it?

Here, an 18-year-old woman from the Great Lakes region describes her romantic relationship of almost two years with the biological father she met after 12 years of estrangement.

This is filed under The Science of Us.  Uh huh.

It tells a tale of a girl abandoned by her biological father, and with a seriously-unstable mother; she not only emotionally blew up immediately following the girl's birth but remained that way throughout her childhood.

This is a young woman with serious abandonment issues and more than a bit of magical thinking thrown in.  Among other things she claims all the potential suitors during her teen years were "heroin abusers."  I doubt it; while it may be true that all of the people she associated with had serious drug problems that certainly wasn't the entire count of male associates available to her -- just the ones she decided were "good enough" (or, more to the point, the converse.)

Here's just a small example from the article:

Near the end of the time my parents had joint custody of me I had a stepdad. He took good care of my mom but she went through one of her stages again, so it ended. She had another husband who went crazy and tried to kill her. He was schizophrenic. Then she got with my brother’s dad and they dated for a while but when my brother was born the dad didn’t want anything to do with him, so I helped my mom raise him. Once he was about 3 she got together with my current stepdad and had my baby sister. My brother and I are 9 years apart and my sister is 12 years younger than me. I think of them as my brother and sister, and I also think of them as my babies because I helped raise them.

There's much more but I strongly recommend not reading this article unless you have a monstrously-strong stomach.

Look, at 18 you're free to do pretty much whatever you want; I understand that.  But there are still limits, and irrespective of that this article documents an incestuous and blatantly sexual father-daughter relationship when the girl was 16.  That's a crime (and a serious one) everywhere in the United States, with good reason: There is inherently a serious power imbalance in such a relationship, never mind the potential genetic problems raised.

The writer at this paper speaks of Genetic Sexual Attraction as if there's something "scientific" about that.

Well, duh -- you have the same genes!

See, here's the thing -- what usually happens is that about 10 seconds after birth you see and hold that child and everything changes.  I don't know why it changes, but I do know (as a man) that it does.  I suspect in people with normal emotional responses it changes if you're a woman too, and probably before birth (for the same sort of reason.)

This is probably why true sexual assault between biological fathers and their kids, even among those who assault adult women, is extremely rare.  That natural inhibitory response turns "hmmm" into "oh yuck" instantly.  There's a very good evolutionary reason for this from a genetic perspective; you want the physically stronger gender to be naturally protective of his offspring, not exploiting them for sexual pleasure.

The concept of "consensual incest" is raised in this article and paraded around in this respect.  I ain't buying it.  Consent may be legally possible at 18 unless you're clinically insane but it is psychologically impossible if you're chasing demons of the sort that this gal volunteers throughout the article.

Further, there are other problems with the story -- this gal claims to recall in detail events that happened when she was 2 to 4.  I ain't buying that either.  Traumatic events at 4 or 5, sure.  Vague recollections of bad things (or really good things)?  Yes.  But fine details at that age?  I ain't buying that and you shouldn't either; she was told certain things happened and instead of relating them as "I was told that..." she has internalized those alleged events as her own.  That's bad; separation of what you are told and choose to believe is true from what you actually recall as having happened is one very, very important mental development that must occur before you can make logical and reasonable decisions.

In the end this is a young woman who was missing something very important -- love -- when she was growing up.  The sperm donor who assisted in manufacturing her slept with her while in his girlfriend's house.  It sounds to me like nothing has materially changed for him in the intervening years and he knew exactly which buttons to push to get what he wants.

Do I believe the story?  Maybe.  It's credible in a number of ways, and in others my "BS" alarm is going off.  So I'll reserve judgement on the possibility that this is all made up in an attempt to press a political agenda of attempting to get people to see the outrageous and destructive as "normal" (gee, we haven't seen that before with other various "lifestyle choices", have we?)

But there is one impossible-to-avoid aspect of this if the story is in fact real, and that is the admission of a serious felony (on the father's part) when the girl was 16, no matter where they were in the United States.  I do not believe there is any state where such an act is legal.  And while you're entitled to do all the dumb things you want due your lack of insight when you're of age, and suffer the consequences of doing so, this is not true when you're a minor.

So where are, may I ask, the cops?

Whether you think it should be so or not, it isn't -- and frankly, while I abhor "intervention" by the authorities in the consensual affairs of adults I draw the line when consent is not freely given, and while being ****ed in the head as an adult is your own problem until and unless it reaches a very serious degree (at which point you're adjudicated incompetent by a court) this is not true for someone under the age of 18 as she was when this "relationship" began.

Societies are defined in many ways by whether they protect those who are unable to protect themselves.

Think about it.

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Uh huh....

DAVOS, Switzerland (AP) — Violent extremists who are killing children and others in Iraq, Syria, Nigeria and other parts of the world may cite Islam as a justification, but the West should be careful about calling them Islamic radicals, Secretary of State John Kerry told an audience of opinion leaders Friday at the World Economic Forum.

Utter nonsense.

I challenge sKerry to categorize terrorism over the last 20 years into two buckets: Islamic and not-Islamic.

Oh by the way, screaming "Allah Akhbar!" as you murder people defines your act as Islamic terrorism.

 

Our biggest challenge in this country and indeed worldwide is our refusal to call things what they are.

You cannot confront a challenge in your life or in your society until you name it what it is.

"We will certainly not defeat our foes by vilifying potential partners," the top U.S. diplomat said. "We may very well fuel the very fires that we want to put out."

We have no partner in any nation or group that refuses to confront the truth.  Indeed, what we're likely doing is contributing assistance to the very people who want to kill us simply because we refuse to submit to their twisted, sick view in which absolute adherence to their "belief system" is the only means by which you are allowed to live.

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