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Culture War Roundup for the week of March 25, 2024

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Conversation has been slow here. I feel like the standards have increased to the point where people are afraid to post (except of course for bad faith posters who don't care).

So, let me try a post that's more of a conversation starter and less of a PhD thesis.

According to Bernie Sanders, it costs about $5 to make a monthly dose of Ozempic, the blockbuster-weight loss drug. Americans pay about $1000/month. Canadians pay $155. Germans pay $59.

The stock of the company which makes the drug, Novo Nordisk, has doubled since the beginning of 2023. (I considered buying in 2022 but didn't because I thought I was already too late đź’€) It now has a market cap of nearly $600 billion, making it the most valuable company in Europe.

I assume that if companies were forced to charge the same price in U.S. as they do in Europe, the global pharma industry would become insolvent.

So why is the United States paying for > 100% of global pharma research? And how can we fix the glitch?

The entire US medical system is fucked. Higher drug costs are a substantial input cost, but another huge one is the AMA.

The steps for fixing US healthcare are actually pretty simple:

  1. Smash the AMA cartel by allowing unlimited immigration of doctors trained in Canada, UK, Australia, NZ and Ireland without any licensing requirements, re-doing residency etc. Allow doctors from other Northern European (not southern) countries if they pass a tough English written and oral exam that requires fluency. This will lower US doctors’ salaries (currently 300% or more of what they are in Europe) by half, to a more reasonable rate where surgeons are respectable PMC but not making a million dollars a year solely because the AMA lobbies to restrict residency places. Doctors should be paid $120-300k a year at the cap, with the high figure for the most elite surgeons in tough specialties. Why is the American middle class paying for anesthesiologists to make $700k a year when their equivalents in European countries that are almost as rich are paid like $150k? There are almost a million doctors in America, this overpaying adds up.

  2. Handle drug pricing centrally. Insurers pay a price negotiated by a trade association chartered for that purpose and which represents all US insurers (including the state for the VA etc), exempt from the usual rules around cartels. The trade association negotiates as a bloc and can therefore refuse to accept pricing that is any more than a basket of comparable countries (eg rest of Anglosphere) + 20% (at most). Pharma companies will essentially be forced to comply, since there is no other major wealthy market that would possibly pay more than the US. The reason manufacturers can charge so much is that (much as with doctor pay) so much of the cost is offloaded onto third parties (eg employers for most health insurance) in a way that causes huge economic drag but which is often not immediately visible.

Yes, please do. My job as a quant is sort of like software engineering (in some aspects) and I wouldn't give a single shit if every country on earth could send over quants to the developed world. In fact that's basically what the situation is like now where companies will bend over backwards to arrange your visa and everything if you can convince them you'll be a positive addition to the team.

Competent quants who really understand what they are doing are quite rare, it's already basically a global market for us and we're doing more than fine regardless. Why can't other jobs also handle the heat? Are you scared that you'll be outdone by third worlders who had and have none of the advantage you were handed on a silver platter by being born in a first world country?

Trying to protect your job by limiting freedom of movement is a system of economic rent extraction and nothing more. Westerners who were born in high wage countries use their borders to prevent firms from getting their labour from the most efficient source possible. This imposes a (very large, when you integrate over the whole world) deadweight loss upon humanity as a whole. I am in favour of smashing them down just like how I am always in favour of smashing down rent seeking.

Not too long ago you boasted how you and yours exploit Western weaknesses and do it with no remorse because you do not respect the way the West does things. I consider that a data point in favor of protectionism.

Sure, that's a good argument for protectionism from a western prespective (much as I would dislike it). However just because one argument for something is good doesn't mean all arguments for it are good, and we can still tell a lot about people from the types of bad arguments they make.

The "they take all our jerbs!" refrain against immigration is fundamentally selfish and rent seeking. It needs to be called out and ruthlessly mocked whenever it shows up.

do it with no remorse

No remorse? I do it with glee. See my latest dramapost about the Scottish First Minister hosting an Iftar event at his official government residence.

And why shouldn't I be happy like this? We're slowly winning over the west in a completely peaceful and bloodless manner and that is a cause for celebration because I genuinely believe our system is better than the western system. Funnily enough I think the western system is better for someone like me than our system but for society as a whole and those lower down on the human hierarchy it's the opposite. Instead of being selfish and promoting the western way I look at the bigger picture and support what I think is best for society instead of me personally.

Normally transitions between systems are times of upheaval and suffering but the transformation we are slowly effecting is one of the most peaceful ones of this scale that has ever happened in human history. This is a good thing.

To quote a Magic the Gathering card: "On the day of victory, no one is tired".

I think I will graciously refuse your offer for cultural uplifting and selflessly suggest that you stay home and build up your own country.

Well, hypothetically, that is, since I'm not a Westerner. In my country, the best Muslims seem to be able to do is shoot up a concert hall. I don't think excessive Islamophilia is going to be in vogue in the near future, here.

The "they take all our jerbs!" refrain against immigration is fundamentally selfish and rent seeking.

I'm beginning to see why Ayn Rand got a following. The world runs around people acting selfishly. EAs may claim they should give as much of their income as they can for malaria nets. Non-EAs earn money for themselves and their families. Yes, not wanting competition from immigrants is selfish. So is saying "you should hire me for this job over the other applicant" whether immigrant or not. So is spending money to buy yourself ice cream instead of donating it. So is saying "I really would like to keep my kidney even though someone else can use it more than me."

Maybe your parents told you "don't be selfish" growing up, but kids are told simplified versions of things. Look out for your own interests.

Maybe your parents told you "don't be selfish" growing up, but kids are told simplied versions of things.

"A moderate degree of sharing will result in positive goodwill which will in the medium and long run be considerably greater than the loss from deviating from pure selfishness" -- Adam Smith to his kids, probably.