Jeff Faux, my former boss at the Economic Policy Institute, tells a story from his days as a foot soldier in President Johnson’s War on Poverty. Johnson was asked by a delegation from Alaska if he had an anti-poverty program for their state. Johnson assured the delegation that he had a "great big program" for Alaska. As soon as the delegation left, Johnson rushed into Jeff’s office and told them that they needed to come up with a program for Alaska.
Unfortunately, many liberals have not moved beyond Lyndon Johnson’s thinking on the role of the government in the economy. They still tie progressive outcomes – the guarantee of good quality health care, education, childcare, housing and a secure retirement – directly to big government. While the government must play a role in ensuring these outcomes, the point should be to have good government, not big government, as we usually conceive it.
There is a long list of ways in which the rules set by the government determine economic outcomes. While these rules have an enormous impact on the economy, they do not amount to "big government" in the sense of a large amount of taxes and spending.
Perhaps the most obvious example along these lines is patent protection for prescription drugs. The Centers for Medicare and Medicaid Services projects that the country will spend more than $330 billion in 2012 for prescription drugs. These same drugs would cost roughly $30 billion in the absence of patent protection. This means that the government’s patent monopolies will be redistributing roughly $300 billion in 2012 from patients to the drug companies. (There are alternatives to patent monopolies for financing the research and development of prescription drugs.)
To put this sum into perspective, after-tax corporate profits are projected to be less than $1,400 billion in 2012, so the amount at stake in preserving patent protection for prescription drugs will be more than 20 percent of all corporate profits. Alternatively, imagine getting Congress to appropriate $300 billion a year, or $3 trillion over a 10-year budget window, for our favorite government program(s).
However, in spite of the enormous amount of money at stake, this issue has received almost no attention from the vast majority of progressives. In fact, most progressives have probably never even given the issue of patent protection for prescription drugs a moment’s consideration.
It is easy to find other examples of ways in which government rules determine who gets the money. Along the same lines as patent protection, the entertainment industry and software industry survive in their current form because of the government’s copyright protection. This form of government intervention has made thousands of people, from Rupert Murdoch to Bill Gates, very rich at the expense of the rest of us.
The trade agreements over the last three decades have been deliberately designed to put manufacturing workers, and noncollege educated workers more generally, directly in competition with low-paid workers in the developing world. The predicted and actual result of this policy is to lower the wages of noncollege educated workers in the United States.
Do we want to rebalance the field? Why not set trade rules that put highly paid medical specialists and other big "winners" in direct competition with their low-paid counterparts in the developing world. We can debate whether this is good policy, but there is no dispute that we can use this "market" outcome to bring down the wages of those at the top.
And speaking of wages of those at the top, we can also rewrite the rules of corporate governance so that CEOs and other top executives don’t get to write their own paychecks. The compensation packages of the top five paid executives could be subject to regular approval by shareholders in a vote where unreturned proxies do not count. My guess is that with these rules much less money would go to those at the top.
There are many other ways in which we can change the rules so that less money flows to those on top, leaving more for the rest of us. Changing the rules does not require big government in the sense of large portions of GDP being collected in tax revenue.
It does require that government take an active role in the economy, but it is already taking an active role in the economy in these areas. The difference is that, currently, the conservatives have been setting these rules, while progressives have been polite enough not to pay attention. Instead, they have mostly focused their energy on matters that will have far less impact.
The economic crisis brought on by the collapse of the housing bubble offers progressives unprecedented opportunities. But we have to be prepared to actually think big, and not just think about big programs.



48 Comments







If we have the political will.
here’s what’s been the “government rules” in the near past;
“if you voted republican you get more dollars back then you give in taxes, if you voted democratic you pay that welfare bill”
Wow. Those figures for patent-protected drugs are staggering.
Coming from the movie business, ever-extending copyright protection means that our cultural history never falls into the public domain and thus can never be freely commented upon and “digested” by documentary filmmakers because nobody can use, say, Mickey Mouse’s image without paying Disney for it. (Warner Brothers owns “Happy Birthday,” and the valuable documentary “Eyes on the Prize” — with rare footage of Martin Luther King — could not be legally shown for a long time because the copyright agreement on the song had expired.)
It’s just one of many ways this “corporations first” way of passing legislation is stifling.
The universal health care seems to be riding to doom. I read two governors of conservative states are in line to be the new HHS secretary. What a waste. We have competent doctors in line for this position that know of the fraud that is medicaid and medicare. Why would they consider someone from a state that doesn’t even offer health care to children as a mandate?
this is disgusting, and a sign that no change is about to come. The economy collapses if the people aren’t given at least free health care amidst the ruin of our nation, and world, and planet.
How much are you going to put up with? How much non change can we stand?
You can be sure with Daschle at HHS that drug patents would not be dicussed, much less any impetus to change the free lunch of Big Pharma.
Whoever Obama selects will not offer much in “real change” either.
This is the area where lobbyists make a huge impact.
For example there was the business of whether or not the Government was allowed to shop around for the lowest prices for prescription drugs, including Canada, and whether the Gov’t could bargain for lower prices. The Republican Congress prevented the Government from bargaining, to the delight of the Pharmaceutical companies, who were actively lobbying.
Health care in general is a big issue: The health care insurance industry has a huge stake in the outcome, and has been a pivotal issue in cost containment.
One could go on and on. So thanks for bringing the issue up in this way. We need to be smart about this.
Bob in HI
Thanks Dean.
digg is open.
You have forgotten the golden rule. He who has the gold, makes the rules.
however right now it’s “who used to have the gold continue making the rules”
and that has to stop
The money drug companies spend on research is a pittance compared to what they spend on advertising. It is no coincidence that drug prices skyrocketed after the government started allowing Big Pharma to advertise on television.
And remember this: in their advertising on television, driving consumer demand is an only incidental benefit. Their “advertising” dollars are really going to pay off media — is MSNBC going to do any negative reporting on the drug companies when their budget is Cialis-dependent?
Citizen ratfood:
Yes and the drug comanies profit from the tax subsidized research in the major land grant universities.
And don’t forget the enormous sums they spend on new and better ways of poisoning us.
Thanks, Dean. What a refreshing insight!
But what is this obsession Obama has with computerizing medical records?
mccain was talking about that, too.
I know, but where is the push coming from? Maybe it’s the conspiracy theorist in me, but it just seems like another way to control people — having a big database on their medical records.
It could be pretty scary for that kind of information to fall into the hands of our future planetary overlords.
Computerizing medical records actually does improve care. My mother had a 40-year history at the local clinic. Whenever she went to an appointment, the staff had to lug around a huge paper file that probably weighed about 15 lbs. It contained hundreds, maybe thousands of pieces of paper, so finding a specific piece of info quickly was impossible. After the records were computerized, her doctor could quickly locate any pertinent data.
I think it is the difference between say an ebook and its dead tree version. If you are looking for a single specific piece of information an electronic version will take you to it (although you may have to navigate through a lot of screens and time to get there). A paper record you can thumb through and get a better global idea in a shorter period of time. Also paper records are not amorphous. They are broken down into sections and again these can be scanned quickly. The visit notes are probably the longest part and again scanning and going through the most recent doesn’t take long.
This of course assumes that a physician hasn’t seen the patient before. But if the record is really long the odds are that he/she has and so they only have to refresh their memory on the patient, if that.
In an electronic record, it takes time to type or dictate a note. There are probably a lot of companies in India or somewhere that make a living out of transcribing these dictations. If it is the phsycian doing it, it is a terrific waste of their time since they are probably doing it off a note they already wrote.
Currently, both electronic and paper records face HIPAA privacy restrictions. So say if a patient sees a physcian and later goes to a hospital on their own, the hospital can’t gain access to those records until the patient or family signs a release and then it has to go all be processed. While a hospital physician may want to see some of this older information, it is very likely that the hospital will do most of its own testing and assessment anywhere for what are laughingly called “medico-legal” reasons. Even where some medical systems, like the VA, have electronic records, there is no unified record. Each VA institution has its own and while all are accessible, it is very difficult to assemble them all in any coherent fashion.
I am throwing all this out here just to give an idea of how the reality is more complicated than the concept.
My guess is that it’s one of the least controversial ways to cut costs AND improve outcomes.
interesting. informative.
AND THE KILLIN’ GOEZ ON AND ON AND…
Citizen DeanBaker and the Firepup Freedom Fighters:
“There is a long list of ways in which the rules set by the government determine economic outcomes.”
And new rules that would free up opportunity for competition, limit profits and redistribute economic surplus back toward the “means of production” are all part of democratic socialism and, at this point, the fascists have enough private capital and control more private military than the federal government so that implementing such rule changes will take a VERY bloody revolution. Oh and did I mention “rule of law” and the justice system…shit, we’re jest rearrangin the shuffleboard cues on the deck of this sinkin barge.
KEEP THE FAITH AND PASS THE FUCKIN AMMUNITION, THE STRUGGLE GOEZ ON AND ON AND…
Obama just now:
“It is the right size; it has the right scope.”
WTF?
The Mafia has their version of patent protection…much like the conservatives.
Thanks for this post Dean. The other day I attended a conference where a panelist declared that “capitalism has failed”. I respectfully disagree. The failure has been one of rigging the system, of keeping the playing field as lopsided as possible. There are many ways to reconfigure our system, it’s high time we start to consider them…
Dean,
These rules are the ones that the industries lobby for. Of course it should be different, but never will be under current campaign financing.
BTW, did you know that presciption drug prices rose less rapidly than inflation until Waxman’s generic drug legislation was passed? Then big pharma woke up to the fact that they’d have to up-front their profits, discovered in the process that their product was price inelastic and the rest is history.
not price inelastic in much of the rest of the world. people just end up dead.
Just wanted to mention that Dean Baker had a great interview yesterday here:
http://will.illinois.edu/media…..ry-8-2009/
And selise transcribed the best quote from it here in a previous thread:
http://firedoglake.com/2009/02…..nt-1825065
Good opening discussion on how the “free” market isn’t free, but operates through channels defined by government. Booststraps and entrepreneurship have less to do with CEO pay and company profits than influencing those channels.
Liability protection, as expressed through the legal system, is an example. If FDA approval for a drug generates an “all clear” from the economic risks of selling a flawed drug, a consequence promoted by Bush, it will lead to the sale of more flawed drugs. That would divert resources away from making more efficacious, but nominally “less profitable” drugs. Moreover, those flawed drugs generate profits, in part, by passing on losses to others, in the form of their lower efficacy and greater side effects, and more pain and suffering and consequentially fewer work days and higher stress at home. Similar effects can be traced in the sale of cars, concrete, other building materials, and even services, like “tax planning” advice.
Liability protection is the pebble thrown into the pond, which produces ripples, profits and peril in unequal measure. That’s one reason the Bush administration devoted enormous resources to unregulating drugs, financial services and other industries, and to making sure that its sort of judges acted as the mortar in walls of profit.
Obama can plant ivy to hide those walls, or put up chairs and enjoy the view. But that won’t “tear down that wall” or even put a door in it. That requires heavy tools and heavier lifting, and an ear turned deaf toward the unearned privileges enjoyed by those in their secret gardens.
Yep. We ain’t seen nothing yet of the consequences of removing all liability from mfgrs. And all that just to eliminate lawyers as funders for Ds.
98 dollars for an MRI Scan in Japan’s universal health care system. Close to a thousand dollars in America’s for profit health care system. Pure profit. Whether it is for profit health insurers, or for profit drug makers, or for profit health care services providers, it is all about profit, not people,
on the contrary – TRIPS and the race to the bottom in workers’ rights and wages (see the prisoner’s dilemma in game theory) has been at the forefront of the arguments my friends in the global justice movement have been making for years.
and just to be clear – i’m pretty sure that workers and people who need access to patent protected drugs outside the usa have suffered even more from our fucked up trade policies than americans have. it’s government welfare for favored corporations – at the expense of many people all over the world.
The threat from computerizing medical records is the misuse of the information, like not giving care to people with pre-existing conditions. This problem would go away if the system was either financially sane or universal health care was applied.
Okay, as long as they’re not used to determine whether I’ve had my GPS chip implanted yet.
Good points, but the potential to misuse information remains. The US, unlike the EU, Japan, Canada and Australia has very few rules regulating the compilation, storage, analysis and use of personal information.
A petty example, but one collectively worth billions, is that your personalized cable viewing habits are your cable company’s, or so it claims, not yours. The magic is aggregating that data with others, from other viewers in your neighborhood or income bracket, or with other facts about YOU from private and government databases.
The freedom our mythology prizes so highly is in serious jeopardy unless we adopt greater protection for our personal information. EU rules, for example, limit the amount of what can be collected, limit the time it can be retained and the purposes it can be used for. They provide a mechanism for individuals to see and correct that information and a workable means, including penalties, to enforce the rules.
There are exceptions to these rules and some governments, such as the UK, are driving lorries through them. But it’s an active fight, unlike here. Imagine trying to get your name, Jane Smith, off Bush’s (now Obama’s) “no fly” list, or seeking damages from a data aggregator who “somehow” obtained access to your credit, medical, payment, academic and job histories. You’re more likely to get Grover Norquist to promote raising taxes on the top 1% of income earners.
If we insist on capitalism without real and effective anti monopoly rules, we have to realize that, like monopoly, it reaches the point where most people are broke and/or really want to end the misery. So can’t we just say that the billionaires definitely won? We give up. The game is over. And it’s time for a new game.
Here is a wiki on clinical trials, especially the part about Phase I-IV trials.
Basically, it runs something like this:
Phase I: Is it safe?
Phase II: Does it do what it is supposed to do?
Phase III: How does it measure up against current treatment?
Phase IV: When it goes into mass production and usage, was something overlooked crop up?
Each of these steps can take considerable time, money, and resources. The process for each new drug can take years and cost hundreds of millions. Besides moving to more deregulation, drug companies have gotten around this in three important ways.
First, they come out with a drug that is closely related to one that is already out. This explains why there are so many SSRIs, PPIs, and cephalosporins out there.
Second, they reformulate a current drug about to lose its patent. So for example if drug X needed to be taken 3 times a day, the drug company comes out with a new improved version that only needs to be taken once a day. Tey then use their marketing pull in media advertizing and through their drug reps to push the new version.
Third, they increase market share throuh off label uses. Anti-convulsants (anti-epilepsy) drugs are sort of famous for this. Some of them started out as anti-convulsants but weren’t all that good for seizure disorders but moved out into other areas. Neurontin used in treatment of chronic pain for example started out as an anti-convulsant.
Oh that wiki link:
http://en.wikipedia.org/wiki/Clinical_trial
This sounds like a clever way of not having to create anything new or useful. And, on top of that, it’s cheap.
Oh Big Pharma – if only you would use your powers for good instead of for evil.
DEMOCRATS NEED TO ATTACK REPUBLICANS TO DIVERT THEIR ATTACKS ON AMERICA……………………
Republicans are practicing forms of demagoguery and guerrilla obstructionism that are intended to destabilize our economy for purposes of political exploitation. Republicans AREN’T making a sincere effort to stop the bleeding their incompetent leadership and failed policies created. Instead, they are using conflicting economic theories as a smokescreen to conceal their real agenda, which is to undermine President Obama and cause him to fail. Republicans are professing their disgraceful political whoring had nothing to do with the banking, real estate, stock market and employment failures that resulted. Republicans are shamelessly trying to block the success of Democratic governance, which is a concerted effort to further damage America, rather than undo or fix its problems. Republicans are offering up subjective controversial arguments they know no one can agree on in order to disrupt and deny constructive change. They want political gridlock for strictly PARTISAN POLITICAL purposes. That’s how they gained power and that’s how they’re trying to retain it. I don’t see them as being the loyal opposition. I see them as an ENEMY WITHIN whose political ambitions have distorted their moral and ethical standards to the point that treachery and betrayal are their preferred weapons of choice. It’s one thing for Republicans to stand up for their conservative beliefs; it’s another thing entirely to deliberately sabotage our government because a successful America would not be vulnerable to the fears and hatreds that created and sustained Republican extremism.
Patents are among the few economic activities expressly mentioned in the Constitution. Regulating them is the exclusive preserve of the federal government. The issue is balance: Encourage innovation by granting a temporary monopoly to the inventor to commercialize his or her products. Spread the benefits from innovation by encouraging their adoption.
Under Bush and compliant Democrats, that balance has been tilted heavily toward overextended protection for inventors, at the cost of curtailing the benefits from their wider use.
One of the fudges that extends wider use but protects profits is making inventors free from liability from the use or expected misuse of their products. When the only interest government protects is profits, imbalance and widespread pain are inevitable consequences.
What bothers me is the move to patent plants and genomes or parts of genomes like genes.
In practice, I don’t think individuals own their own genomes. Call me Luddite but I find this disturbing.
Patents would seem to be a good thing in general. They allow a person or company to profit from a legitimate innovation. Patents have limits. I would not approve of dropping patent protection, but it may be worth thinking about adjusting the limits.
Patent protection alone does not provide sufficient motivation to get drug companies to work on treatments for diseases that are not widespread. They love “blood pressure” and “chlorsteral” cause so many people need it- but ignore “less popular” diseases.
people profit from legitimate innovation all the time without patents (trade secrets or sometimes just being the first to market a product for a couple of examples).
patents in the pharmaceutical industry are about creating a private property out of a public good – in this case scientific knowledge. a patent creates a temporary monopoly – something that makes markets inefficient, but might be justified in the long run if it provides incentives for more research and innovation.
but that’s just not the case – big pharma puts more money goes into marketing than “research” even into copycat follow on drugs.
and beyond the market inefficiencies – the way patents are used today in our so-called free trade regime (patents are the opposite of free trade if everyone is not already clear on that) have killed thousands, probably hundreds of thousands maybe even millions of people.
in addition to being a multi hundred billion dollar rip off of americans.
this has got to end.
excellent point and even more the incentives currently favor treatments for chronic conditions rather than cures.
Behind the rule-setting struggle is the general struggle now going on between Republican disciples of Milton Friedman’s laissez-faire monetarist policies, and Democrats, who generally (and especially in the current situation) are Keynesians. The whole rule book (i.e., the Code of Federal Regulations [CFR]) needs to be re-written.
Laws are just laws. The CFR is where the rubber meets the road.
Bob in HI
“The economic crisis brought on by the collapse of the housing bubble offers progressives unprecedented opportunities. But we have to be prepared to actually think big, and not just think about big programs.”
Think big and think out of the box. Think Henry George. (His Progress and Poverty is free on the Web.) No patents. Very narrow, limited copyrights.
The biggest problem progressives have is the absence of a political economics worthy of the name. They have the right sentiments. They don’t have a sane, simple, actually workable system of economics that allows their sentiments to be realised.
Henry George outlined just such a system over a hundred years ago. Why do so few progressives know little, or more likely nothing, about him?