#bargaining power

[mostlysignssomeportents]

Capitalists hate capitalism

As the Marxist agitator Adam Smith once said, “People of the same trade seldom meet together, even for merriment and diversion, but the conversation ends in a conspiracy against the public, or in some contrivance to raise prices.”

Smith understood that capitalists hate capitalism. They don’t want to compete with one another, because that would interfere with their ability to raise the prices their customers pay and reduce the wages they pay their workers. Thus Peter Thiel’s anticapitalist rallying cry, “competition is for losers,” or Warren Buffett’s extreme horniness for businesses with “wide, sustainable moats.”

These anti-capitalist capitalists love big government. They love no-bid military contracts, they love ACA subsidies for health insurance companies, they love Farm Bill cash for Cargill and Monsanto. What they don’t love is markets.

Case in point: pharma giant Merck. The Inflation Reduction Act (IRA) includes a provision that allows Medicare to (finally) start (weakly) negotiating the prices it pays for (a tiny handful of) drugs. If you’re scratching your head and wondering if you understood that correctly, let me assure you, you did: the US government is currently prohibited from negotiating drug prices when it bargains with pharma companies.

In other words: Medicare simply pays a pharma companies — whose products build on billions in publicly funded basic research, whose taxes are reduced by billions in research credits, whose patents are backstopped by billions in enforcement — whatever it demands.

To do otherwise, you see, would be socialism. Markets are “efficient” because they “discover prices” through bidding and selling. In the case of publicly purchased drugs, the price that Uncle Sucker “discovers” is inevitably “a titanic sum” or possibly “add a couple more zeroes, wouldya?”

Enter the IRA. Starting in 2026, Medicare will be permitted to negotiate the price of ten (10) drugs. The negotiations will use the prices of other drugs from the dysfunctional, monopolized market as a starting point and go up from there. The negotiations go on for three years, and there are multiple stages where pharma companies can hit pause with court challenges:

https://prospect.org/health/2023-05-11-regulators-bungling-drug-price-reform/

The system will not consider the prices that Medicaid or the VA (which are allowed to bargain on prices) pay. Nor will it consider the prices that other governments pay — the US is alone in the wealthy world in offering the anticapitalist price-taking posture when dickering with the pharma companies.

But this isn’t enough for Merck. They are suing the Biden administration over the IRA’s drug pricing plan, arguing that it is an unconstitutional taking under the Fifth Amendment:

https://www.cnbc.com/2023/06/06/merck-sues-biden-administration-over-medicare-drug-price-negotiations.html

Merck is represented by Big Law firm Jones Day, who made their bones by representing the RJ Reynolds from smokers with lung-cancer, arguing that the smoking/cancer link wasn’t scientifically sound. That’s not the only fanciful argument they put before a judge: Jones Day also represented Trump in his attempts to overturn the 2020 election (they also hired Trump’s counsel Don McGahn as he exited the White House’s revolving door).

As Ryan Cooper writes for The American Prospect, Merck’s argument is that the “fair market” value of its drugs can only be discovered if its single largest customer — Medicare — simply pays whatever Merck demands of it:

https://prospect.org/health/2023-06-08-merck-negotiating-drug-prices-unconstitutional/

They explicitly denounce the idea that a powerful buyer should use its market power to extract price concessions from sellers like Merck: “leveraging all federal insurance benefits (amounting to over half of the prescription drug market) to coerce companies to abandon their First and Fifth Amendment rights is a quintessential unconstitutional condition.”

Rebutting this argument, Health Secretary Xavier Becerra said, “negotiating for the best price is as American as apple pie. Since when is competition in this American system a bad thing? Why should we be the patsies around the world and pay the highest prices for medicines?”

The irony here is that Merck itself is a very powerful buyer. Whether negotiating commercial leases, raw materials or wages, Merck is ruthless in extracting the lowest prices it can from its suppliers. The company attained its massive scale the old fashioned way: buying it. By drawing on its nearly limitless access to the capital markets, Merck bought out dozens of its competitors:

https://mergr.com/merck-acquisitions

Anticapitalist investors funded these acquisitions in the expectation that Merck would be able to use its market dominance to pay suppliers less, charge customers more, and use some of the resulting windfall to corrupt and bully its regulators so that it could buy still more companies, charge still higher prices, and impose crushingly low prices on still more suppliers.

The IRA’s drug-bargaining provisions are extraordinarily weak. When they were first mooted in 2021, I talked about how Democrats were caving on muscular drug price controls that would benefit every American (except a handful of pharma shareholders):

https://pluralistic.net/2021/11/18/bipartisan-consensus/#corruption

They did so despite wild, bipartisan support for imposing price discipline on Big Pharma, and ending the 300% premium Americans pay for their drugs relative to their cousins abroad. 95% of Democrats support strong price controls; so do 82% of independents — and 71% of Republicans:

https://www.rwjf.org/en/library/research/2021/11/healthcare-affordability--majority-of-adults-support-significant-changes-to-the-health-system.html

No one believes Big Pharma’s scare stories about how this would kill R&D: 93% of Americans reject this idea, including 90% of Republicans. They’re right — nearly all US basic pharma R&D is directly funded by the federal government, with pharma companies privatizing the gains:

https://khn.org/news/article/public-opinion-prescription-drug-prices-democratic-plan/

Despite the fact that really whipping the shit out of Big Pharma would be both popular and good for America, the Dems’ final version of pharma bargaining is a barely-there nothingburger where ten drugs will become slightly cheaper, after the next federal election. This is called “political realism” and it’s a fantasy.

The idea that limiting drug controls to the faintest, most modest measures would make them easier to attain was obvious nonsense from the start, and Merck’s anticapitalist lawsuit proves it. Merck will settle for nothing less than total central planning — by Merck. For Merck, the role of the federal government is to wave through a stream of mergers culminating in Merck’s ownership of every major drug; patent extensions for these drugs to carry them into the 25th century and beyond, and unlimited sums paid for these drugs on Medicare.

Given all that, there would have been no downside to the Dems passing an IRA that subjected the drug companies the same modest, commensense, market-based discipline we see in Canada, or the UK, or France, or Germany, or Switzerland.

But that’s not the IRA we got. Instead of defending a big, visionary program in court, the Biden admin is facing down Jones Day and Merck to defend the most yawn-inducing, incrementalist half-measure. What a wasted opportunity.

If you’d like an essay-formatted version of this post to read or share, here’s a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:

https://pluralistic.net/2023/06/09/commissar-merck#price-giver

[Image ID: A caricature of a businessman with a money-bag for a head and a stickpin bearing the Merck logo, standing atop a pile of bundled $100 bills. At the bottom of the pile, a frowning, disheveled Uncle Sam offers up a $100 bill.]

Image: Flying Logos (modified) https://commons.wikimedia.org/wiki/File:Over_$1,000,000_dollars_in_USD_$100_bill_stacks.png

CC BY-SA 4.0 https://creativecommons.org/licenses/by-sa/4.0/deed.en

[theoldkyokodied]

The Allegiance of the Ascended Vampire and the New God of Magic

[alliswyattonthewesternfront]

i don't have positive or negative feelings about NYC, but in Alan Wiesman's book The World Without Us he has a chapter on the sewer system there and how high maintenance it is, how without humans there to keep it running NYC would get entirely reclaimed by water in a matter of days, and how on 9/11 the entire city was one mistake away from being completely submerged Atlantis-style under millions of gallons of sewage. so now that's the only thing i can think about when i think about new york.

[syndrossi]

Writing some absolute fluff as a palate cleanser after finishing chapter twenty-eight, in the little what if Resonant!Daemon woke up a few months before the twins' birth AU concept.

“No,” his son said, his first word and his favorite since. His grey eyes were fixed on the spoon and its cargo of cooked peas in Daemon’s right hand. With his left, Daemon brought the other spoon to Rhaegar’s mouth, and his other son opened his mouth dutifully for a bite. Daemon moved the full spoon back and forth, mimicking a roaring dragon descending, and brought it right up to Jon’s closed lips. His son’s stare found Daemon’s, deeply unimpressed. “There are foods other than carrot,” Daemon informed him with a sigh.

[blakbonnet]

when things ended with former shows and interests (either cause of shit writing or cancellation), I always found it hard to go back to rewatches because it kinda felt like pressing down on a wound yknow? Happy to report that this is not true of ofmd and I experienced the same queer joy when I rewatched my favourite bits today and went down the rabbit hole of my gifsets and art that the fandom has created, weirdly healing actually ❤️

[squirrelstone]

me watching the Spider-Man franchise become a metaphor for determinism in direct conversation with the original concept

[the-lonelybarricade]

You did not just casually, sneakily dropped in the tags that Feysand will bone in the next chapter of QoT.

BRB need to go do my happy dance real quick.

Daddy made himself very clear last time!

[pratchettquotes]

LORD, WE KNOW THERE IS NO GOOD ORDER EXCEPT THAT WHICH WE CREATE...

Azrael's expression did not change.

THERE IS NO HOPE BUT US. THERE IS NO MERCY BUT US. THERE IS NO JUSTICE. THERE IS JUST US.

The dark, sad face filled the sky.

ALL THINGS THAT ARE, ARE OURS. BUT WE MUST CARE. FOR IF WE DO NOT CARE, WE DO NOT EXIST. IF WE DO NOT EXIST, THEN THERE IS NOTHING BUT BLIND OBLIVION.

AND EVEN OBLIVION MUST END SOME DAY. LORD, WILL YOU GRANT ME JUST A LITTLE TIME? FOR THE PROPER BALANCE OF THINGS. TO RETURN WHAT WAS GIVEN. FOR THE SAKE OF PRISONERS AND THE FLIGHT OF THE BIRDS.

Death took a step backward.

It was impossible to read expression in Azrael's features.

Death glanced sideways at the servants.

LORD, WHAT CAN THE HARVEST HOPE FOR, IF NOT FOR THE CARE OF THE REAPER MAN?

Terry Pratchett, Reaper Man

[scriberated]

Necessity's Bargain Chapter 8 [COMPLETE]

Chapter 8: betrayal [NSFW] || Ao3

Chapter Summary:

We are dying by the thousands, starving and being hunted, and he’s here with you, playing house. And breaking the rules, no less. How long did you actually remain blindfolded?” he asked, lip curling.

“What are you talking about?” Galadriel asked, more angry than she was frightened.

He considered her for a long moment before carefully making his way to the table and pouring out two glasses of wine, sliding one across the table towards her. Stepping back, he took a long drink from his glass, unperturbed by the threat she posed. “Your presence here,” he began, speaking slowly, “was part of a larger bargain with our master, and it had rules that were to be obeyed. He has broken them.”

“Your master?” Galadriel asked, feeling the bite of the cold air more acutely.

“Take the wine,” the Elf said pityingly, looking at her with gentle scorn.

Work Summary: 1st Age Cupid & Psyche inspired AU. The crossing of the Helcaraxë is harsh and terrible. Wounded, weary, and running out of supplies, Galadriel ventures alone into the dark forest to gather supplies and meets a benevolent spirit, one who offers much needed aid to her people in exchange for three favors. The catch? She must agree before knowing what those favors are.

For her people, there is nothing she would not do. Rating: Explicit Warnings: Creator Chose Not to Use Archive Warnings Ships: Galadriel | Artanis/Sauron | Mairon Tags: Alternate Universe - Canon Divergence, 1st Age AU,Helcaraxë, First Kiss, First Time, Faustian Bargain, Desperation, Mildly Dubious Consent, Other Additional Tags to Be Added, Sensory Deprivation, Disrespected boundaries, Seduction, Accidental Plot, Non-Consensual Voyeurism, Voyeurism, Hair-pulling, Blindfolds, Masturbation, Vaginal Fingering, Cunnilungus, Deconstruction of Elven Purity Culture, Light Dom/Sub, First Time Blow Jobs, Dry Humping, Vaginal Sex, Loss of Virginity, Hurt No Comfort, Angst

[girl4music]

I love how Hannigan plays that sacrificing the deer scene. Apprehensive but determined. Very much a “I don’t want to do this but I’m doing it for her” vibe. Of course she lies. Tells the Gang she got the deer blood at the black market. Never tells them that she killed the poor thing with her own two hands and drained the blood from its corpse herself. I suppose in a way it is safer than going to the market. But still, the fact of the matter is SHE FUCKING KILLED BAMBI! And you’re meant to view it as a very disturbing moment.

WILLOW: “All I know is that we have to have it to finish the spell so it’s good stuff in my book.”

It’s the whole methodically planned out deception to make sure Tara doesn’t know just how dangerous it actually is because she knows she’d never go along with it if she actually knew what the resurrection spell required. And Xander pretty much confirms that when he asks Tara in the next episode whether she knew about it and she immediately says “No”. So as far as she’s aware, Willow never knew about the risks or consequences either. It was a surprise to the both of them. Except that’s not quite true. Of course Willow didn’t know what was going to happen with the chaos of the Buffybot and biker gang breaking the urn of Osiris and disrupting the whole ritual. But she did know how dangerous it was. She did know of the risks and consequences. She just didn’t care about them because desperate times call for desperate measures.

Spike - when he found out - he immediately knew Red was the one behind Buffy’s sudden appearance and to blame for the absolute traumatised state she was in. That the rest of the Gang were merely just coerced and while knowing the goal, had no real idea of what Willow was doing and how far she was going to meet that goal. And the dishonesty of it all is telling of that.

SPIKE: “Listen, I’ve figured it out. Maybe you haven’t but I have. Willow knew there was a chance that she’d come back wrong. So wrong that you would ha- that she would have to get rid of what came back and I wouldn’t let her. If any part of that was Buffy, I wouldn’t let her. And that’s why she shut me out.”

XANDER: “What are you talking about? Willow wouldn’t do that.”

SPIKE: “Oh, is that right?”

Spike seems to be the only character that can see darkness in Willow this early because he deals with it in himself. Spike is scared of Willow because he recognises in her that hunger for power and a willingness to inflict pain and cruelty to get it that he constantly fights in himself as an evil demon. He sees right through her lying and manipulative tactics. He notices that she’s playing them all for fools because that’s what he has done and it’s what he can still do if he lets the darkness within him win the battle. He is afraid of what he sees in her because it’s something that he is afraid of in himself. Her energy is very frightening for him. And I’ve always said how I wish there was an interaction between Spike and Dark Willow but I’ve just realized something just now in writing this. He already was interacting with her the whole time. Dark Willow is already there right from the first episode of Season 6. There’s just no “makeover of the damned” because she’s not fully embracing the darkness yet. She doesn’t do that until Tara dies because that was the catalyst to push her over the precipice and fall. She doesn’t embrace the darkness because she’s convincing herself she was doing good.

It’s very clever what they do with Willow this season in that nobody even realizes that the Big Bad is right there with them. Hidden within the ranks of the good guys. Like a viper hidden in harmless vegetation. Something that’s purpose is to nourish and sustain you. Not bite and poison you. The only character that seems to realize this sudden change in Willow is Spike and that really is so interesting to me narratively and thematically because there’s layers upon layers of complexity with Willow that the only character that sees that in her is just as complex himself and I can’t imagine it’s very fun to see his reflection so he spends practically the whole season avoiding her because he can’t stand it. He can’t stand looking at himself. What he used to be. How he used to behave. How he still can if the dark side takes over and drives him over.

And you would think it’s because they’re just characters that wouldn’t interact because there’s no reason for them to why they don’t. I mean they don’t inform each other as characters usually. But rather - at least in Season 6 - I think that it is purposeful. It’s the point. He doesn’t want to interact with her because she scares him. She scares him because she reflects what he doesn’t want to see in himself because despite everyone still treating him as if he is (including the narrative), he isn’t evil anymore. He can still do evil things but his nature has changed because of his love for Buffy and Dawn. Because he cares for them and wants to protect them. I just think it’s so interesting that what was once the purest member of the Scooby Gang is the one member that Spike actively avoids now because he doesn’t want to deal with darkness anymore. He is looking towards the light. At least that was the plan. To change. But it doesn’t work out that way precisely because Buffy is brought back to life by Willow. So in a way she foils his plans by giving him exactly what it is he wanted. Which probably just made him even more scared of her come to think of it.

I really do think it’s interesting how Spike is with Willow in Season 6. To me they are the paralleled characters of the season. Even if not intentionally. It just makes sense to me given how I interpret them and their arcs. How they both struggle to hold on to who they believe they are and should be. And Spike’s had much more experience with darkness than Willow. He knows well what can happen if all control is lost when his anger flares up and he lets his dark side win.

[vanhelsingapologist]

Strahdposting (with possible spoilers so tread lightly)

One of the worst things about Strahd in our campaign is that he's not overtly forced anyone to do anything. His underlings have, sure, but never him. He just waits for us to eliminate our options all on our own, and then presents us with his way. And of course, his way is the easiest. He'll even make it easier. We keep falling into the pit because he ensures we dig it ourselves.

We're almost past the point where he wants to bargain with us and I'm nervous about what happens when he stops being the devil we know and becomes something else altogether.

The recent reveal that there were other parties before ours has been so shattering for us, I think, because it made us all realize that our party is an amusement until it is an inconvenience, and then we'll be insects in the garden that have overstayed our welcome. And then he'll start with the force.

[princesssarcastia]

*banging pots and pans together* ILSA FAUST DIDN'T REALLY WANT TO QUIT INTELLIGENCE WORK SHE JUST NEEDED A WORKERS UNION

[monsterbisexual]

the silt verses: chapter 34

chapter 38

[somecunttookmyurl]

my laptop (finally) died the other day and must say design/print jobs from a phone are not the easiest but we soldier on 💪🏻

[soubidou]

Okay okay but WHAT IF to help Ashton beyond just health points, Laudna had remembered/thought of Delilah's demand for "MORE" and had just...gone up to Ashton to suck in the shard's power like she did the stone??