top | item 27803314

Biden launches action on "Big Tech, Big Pharma, and Big Ag" – can it be real?

470 points| horseradish | 4 years ago |mattstoller.substack.com

563 comments

order
[+] Sophistifunk|4 years ago|reply
"Big Pharma" in the eyes of the public is two related but separate issues; 1) the weird employment-insurance-hospital loop that has developed in the US, and the terrible second-order-consequences of all the open-high/settle-low insurer<->carer system it led to, and 2) the medicine advertisements, and all the terrible consequences thereof.

The second one seems like a much easier thing to get rid of using hard government power, and should be the low-hanging fruit.

The first will require a decade of masterful leadership, co-operation from competing interests, and delicate undoing over time that I don't think any country in the west has right now.

[+] hyperhopper|4 years ago|reply
There is also a third issue:

The high cost of medicines that are low cost to produce, and are sold at low cost elsewhere

[+] ampdepolymerase|4 years ago|reply
And the Congress mandated monopoly on residency positions and building new hospitals. We would have a lot more advances in medical science if MD positions were not gate kept by the artificially limited residency positions.
[+] WalterBright|4 years ago|reply
Ironically, it's the governments attempts to lower health care costs that produced this mess of high prices.
[+] o8r3oFTZPE|4 years ago|reply
""Big Pharma" in the eyes of the public..."

What the public does not see is how the patent system is gamed by generic sellers. How this works is not something that can be easily explained in a single paragraph.

The problem is specifically mentioned in the Fact Sheet/Order. This is a legitimate antitrust issue but it is exceedingly difficult to succeed in the courts.

[+] Lutger|4 years ago|reply
These are all mostly non-issues outside of the US where virtually all countries have implemented some form of universal healthcare. The US is really unique in this respect, being so affluent and having an almost unbridled capitalism with a huge influence on politics.

It's always strange to me to read discussions about healthcare on somewhat 'global' forums like this, because this is a US specific issue. It's healthcare system is such a deviation from what is the norm globally.

https://en.wikipedia.org/wiki/Health_care_systems_by_country...

There is, of course, 'Big Pharma' everywhere. However I think in the eyes of non-US public it's rather about large corporations wielding a disproportionate power. A power that is incentivized by profit motivates which don't necessarily align with the public health interest.

[+] ixacto|4 years ago|reply
Why not just decouple health insurance from employment?
[+] deregulateMed|4 years ago|reply
Big pharma is significantly less of a problem than the physician and hospital cartels.

I have no idea why these groups have survived scrutiny for their literal multi-hundred million dollar lobbying/bribery of politicians.

My closest guess is that we all know "My" physician or a well paid nurse that benefits from the bribery.

[+] fallingknife|4 years ago|reply
I have a medical condition with no cure, yet I still have to pay a doctor every 6 months to keep my prescription with no changes. Total racket.
[+] giantg2|4 years ago|reply
I don't see most physicians being an issue. Many of them are fed up with the insurance, pharma, and regulations. Most are forced to work for large providers instead of being independent just due to the overhead of dealing with digital record systems, legal, insurance billing, etc.
[+] mpmpmpmp|4 years ago|reply
"Well paid nurse"... Now thats a funny one.
[+] spaetzleesser|4 years ago|reply
I think pretty much all players in the US health system are a problem. They all benefit to some degree from this corruption. If I had to pick the worst I would name hospitals. But everybody else profits handsomely too.
[+] Andy_G11|4 years ago|reply
I would think tech is now at the point to undermine micro-exploiters who extract punitive payments from people who feel that there is no viable alternative provider (e.g. a specialist who requires completely unnecessary monthly visits, gives a cursory glance, keeps treatment unchanged and charges hundreds in the process).

What do you think? - Is this something tech CAN do today, with an open source application and publicly available data?

[+] wormslayer666|4 years ago|reply
Direct link to the executive order (it's in the article, but might as well put here):

https://www.whitehouse.gov/briefing-room/presidential-action...

[+] sb057|4 years ago|reply
I found this fact sheet more useful than the order itself or articles about it:

https://www.whitehouse.gov/briefing-room/statements-releases...

In the Order, the President:

* Encourages the FTC to ban or limit non-compete agreements.

* Encourages the FTC to ban unnecessary occupational licensing restrictions that impede economic mobility.

* Encourages the FTC and DOJ to strengthen antitrust guidance to prevent employers from collaborating to suppress wages or reduce benefits by sharing wage and benefit information with one another.

* Directs the Food and Drug Administration to work with states and tribes to safely import prescription drugs from Canada, pursuant to the Medicare Modernization Act of 2003.

* Directs the Health and Human Services Administration (HHS) to increase support for generic and biosimilar drugs, which provide low-cost options for patients.

* Directs HHS to issue a comprehensive plan within 45 days to combat high prescription drug prices and price gouging.

* Encourages the FTC to ban “pay for delay” and similar agreements by rule.

* Directs HHS to consider issuing proposed rules within 120 days for allowing hearing aids to be sold over the counter.

* Underscores that hospital mergers can be harmful to patients and encourages the Justice Department and FTC to review and revise their merger guidelines to ensure patients are not harmed by such mergers.

* Directs HHS to support existing hospital price transparency rules and to finish implementing bipartisan federal legislation to address surprise hospital billing.

* Directs HHS to standardize plan options in the National Health Insurance Marketplace so people can comparison shop more easily.

* Directs the DOT to consider issuing clear rules requiring the refund of fees when baggage is delayed or when service isn’t actually provided—like when the plane’s WiFi or in-flight entertainment system is broken.

* Directs the DOT to consider issuing rules that require baggage, change, and cancellation fees to be clearly disclosed to the customer.

* Encourages the Surface Transportation Board to require railroad track owners to provide rights of way to passenger rail and to strengthen their obligations to treat other freight companies fairly.

* Encourages the Federal Maritime Commission to ensure vigorous enforcement against shippers charging American exporters exorbitant charges.

* Directs USDA to consider issuing new rules under the Packers and Stockyards Act making it easier for farmers to bring and win claims, stopping chicken processors from exploiting and underpaying chicken farmers, and adopting anti-retaliation protections for farmers who speak out about bad practices.

* Directs USDA to consider issuing new rules defining when meat can bear “Product of USA” labels, so that consumers have accurate, transparent labels that enable them to choose products made here.

* Directs USDA to develop a plan to increase opportunities for farmers to access markets and receive a fair return, including supporting alternative food distribution systems like farmers markets and developing standards and labels so that consumers can choose to buy products that treat farmers fairly.

* Encourages the FTC to limit powerful equipment manufacturers from restricting people’s ability to use independent repair shops or do DIY repairs—such as when tractor companies block farmers from repairing their own tractors.

* Encourages the FTC to prevent ISPs from making deals with landlords that limit tenants’ choices.

* Encourages the FTC to revive the “Broadband Nutrition Label” and require providers to report prices and subscription rates to the FCC.

* Encourages the FTC to limit excessive early termination fees.

* Encourages the FTC to restore Net Neutrality rules undone by the prior administration.

* Announces an Administration policy of greater scrutiny of mergers, especially by dominant internet platforms, with particular attention to the acquisition of nascent competitors, serial mergers, the accumulation of data, competition by “free” products, and the effect on user privacy.

* Encourages the FTC to establish rules on surveillance and the accumulation of data.

* Encourages the FTC to establish rules barring unfair methods of competition on internet marketplaces.

* Encourages the FTC to issue rules against anticompetitive restrictions on using independent repair shops or doing DIY repairs of your own devices and equipment.

* Encourages DOJ and the agencies responsible for banking (the Federal Reserve, the Federal Deposit Insurance Corporation, and the Office of the Comptroller of the Currency) to update guidelines on banking mergers to provide more robust scrutiny of mergers.

* Encourages the Consumer Financial Protection Bureau (CFPB) to issue rules allowing customers to download their banking data and take it with them.

[+] the-dude|4 years ago|reply
> hospital price transparency,

Wasn't this already put in place by the previous administration?

[+] sethammons|4 years ago|reply
A couple years past, def under Obama, I went in for a retina exam. They absolutely could not tell me the price for the appointment. "It depends on services rendered" - "what if it is a standard appointment with no extra services, how much (ball park) should I expect? $50? $500? $5k?" - "I couldn't tell you, I can't imagine that high."

There is no price transparency. Sure would like it since I have a high deductible plan.

[+] ryanSrich|4 years ago|reply
Of course it was, also see “value based care”. It’s all bullshit.

Hospitals have zero incentive to be transparent, and all the incentives to be opaque. So long as you’re a non-Medicare/Medicaid patient you’ll continue to suffer.

The American healthcare system is completely fucked (there’s no better word).

[+] giantg2|4 years ago|reply
Only for billing cost of procedures. It's still a mess.

Did you know that hospitals make money by using name brand medications? They will get a contract with a brand, like Motrin, and charge you full price at $8 a pill. Then Motrin will will evaluate how much the hospital used and give them a big rebate to bring the hospital's cost down under $1 per pill. You can literally buy a bottle of ibuprofen for what they charge for a single pill, but of course in the name of safety (and really kickbacks too) they won't allow the cheaper outside medication. It's effectively an internal monopoly.

[+] Black101|4 years ago|reply
yes... One of the good things Trump did
[+] DoreenMichele|4 years ago|reply
Well, I hope this does some good, but I'm a bit skeptical. I think we need more focus on how to help freelancers, gig workers and microbusiness actually succeed as a counterpart to preventing big business from preying upon small business.

It's something I personally try to promote but I feel I have little in the way of success. I still struggle to make it through the month myself and my various projects intended to help others seem to mostly kind of languish, with one exception and I have no hard data on how much good that is doing.

I think my efforts aren't pointless or fruitless, but it never seems to be enough to actually resolve my chronic poverty and I don't get enough feedback affirming that the lives of others suck less thanks to me.

That kind of thing is maybe part of what helps drive a concentration of money and power.

I think we overregulate small business. You need to know a lot of laws and regulations to operate at all and if you are one or a few people, that's a big burden. It's less of a burden for big business to play that game because they make enough money and have enough people that it's a relatively small part of what they do and I think that regulatory burden is one of the things hampering small business, just like it tends to impede the development of affordable housing.

I don't know the answers. I just am skeptical that focusing exclusively on breaking up monopolies and putting a break on big business actually breathes life into small business. It's perhaps a necessary but insufficient precondition.

[+] nr3msd|4 years ago|reply
> I don't get enough feedback affirming that the lives of others suck less thanks to me.

I have always liked your posts a lot over the years here.

I'm in the same boat, I have created a few things that are used by actual people but I have not yet thought about trying to make a living that way. Ideally I would open source everything and go the Patreon / donation route, but I want to get some of my work in order and nail at least one of my bigger ideas... then it might be feasible, but for now money is absolutely the limiting factor and I don't even need much relative to some :(

[+] giantg2|4 years ago|reply
Sort of good, but we'll see how it plays out without other policies supporting it. Frankly, many consolidations are not malicious but necessary for survival. Economies of scale and verticle integration are required to complete with foreign companies with lower costs. Look at domestic steel production. No way the market can support numerous domestic options that can compete with the low cost of foreign imports.

Then there's vertical integration. I don't know if this will effect vertical integration. If it does, I wonder how domestic companies will compete without it.

As a beekeeper, it's vastly cheaper foreign imports (some of it fake) that are more damaging than large domestic producers (although there's a healthy variety). The low prices have been forcing consolidation, or for some people to switch from producing domestically to packing imported honey. It's tough to market local honey for even $12/lb when walmart sells honey for less than $5/lb.

[+] tayo42|4 years ago|reply
What are some uses for honey by the pound? Off topic but curious, I only ever put it in tea rarely or simmiliarly rarely use it as a sugar alternative when cooking.
[+] ampdepolymerase|4 years ago|reply
How about Big Telecom and Big Fintech and Banking? Or is it simply because the rest did not pay enough to the lobbyists?
[+] rayiner|4 years ago|reply
Worth noting that the Pharma industry, as well as Big Tech and Wall Street, supported Biden. As a Biden supporter I’d like to believe that this is because he’s an old school Democrat and not afraid of biting the hand that feeds him. More cynically, this could be seen as posturing to keep together what is a very weird coalition (Occupy Wall Street and Wall Street under the same tent).

Also maybe relevant: https://ksr.hkspublications.org/2021/05/18/can-conservatism-...

> The best answer, in my view, is that the Republican Party’s remaining connection to the dominant sectors of the American economy occurs through its usefulness as a tool to selectively balance and discipline the members of the Democratic coalition. Big Pharma, for instance, will throw money at the Heritage Foundation to rant against “socialized medicine” whenever talk of the government negotiating drug prices surfaces, but pharma is hardly interested in repealing Obamacare, much less dismantling Medicare. Financial lobbies will rent the Republican Party to ward off troublesome regulations or taxes, but are hardly interested in “sound money” policies or big spending cuts that would derail financial markets, never mind social conservatism. Big Tech will team up with Americans for Prosperity to oppose legislation limiting app store developer fees, all while more aggressively controlling conservative speech online, and so on.

[+] throwawayboise|4 years ago|reply
"Hearing aids cost thousands of dollars apiece, for no other reason than there is a cartel established by government that prevents firms from selling hearing aids without a prescription."

An example of how many (most?) monopolies are able to exist because of some sort of legal authorization or protection. Regulatory capture.

There are dozens of companies who would no doubt start making inexpensive hearing aids tomorrow. Absent government regulation, they already would be.

[+] throwawayswede|4 years ago|reply
No it can't.

Top 10 spenders on lobbying in 2021:

    "Lobbying Client","Total Spent"
    "US Chamber of Commerce","$17590000"
    "Pharmaceutical Research & Manufacturers of America","$8664000"
    "National Assn of Realtors","$7985521"
    "American Medical Assn","$6520000"
    "American Hospital Assn","$5852623"
    "Blue Cross/Blue Shield","$5774300"
    "Raytheon Technologies","$5360000"
    "Amazon.com","$5060000"
    "Facebook Inc","$4790000"
    "Northrop Grumman","$4610000"
Look up more stuff: https://www.opensecrets.org/federal-lobbying/top-spenders

Plus, Biden is the last person to be trusted with this. The overall lockdowns in the US are basically a joke. Your government let big pharma abuse the entire society for more than a year and people are still so discombobulated by what happened that they've started to develop a stockholm syndrome.

[+] phendrenad2|4 years ago|reply
If the whole country gets a California-style ban on noncompetes, will Silicon Valley start to lose it's hold on tech?
[+] xenihn|4 years ago|reply
imo: yes, absolutely
[+] LatteLazy|4 years ago|reply
A lot more people support action than support any given outcome. I worry that the majority will be disappointed by the outcome because of this.

Take the big tech action: some people support it because they want less censorship (that's me), others because they want more. The same applies in other aspects of peoples' issues with big tech (fake news, hate groups, grooming and CP, privacy, foreign election meddling etc). We can't all be happy with whatever the FTC does to social media sites can we, given we mostly want different things.

[+] 1vuio0pswjnm7|4 years ago|reply
"The most interesting pushback was by Google, Facebook, and Amazon, as well as Chinese giants DJI and Alibaba. All of these firms speak though the trade association Netchoice, which has them as key members. Netchoice didn't bother to try and convince Democrats. Instead, the big tech trade association used the order to lobby Republicans, making the case that Biden's actions against monopoly are opening the door to a larger more powerful government. Here's the key part of Netchoice's statement:

"Sen. Lee and Rep. Jordan's warnings were right - when Republicans back progressive antitrust proposals because of concerns about tech, they open the door to progressive antitrust activism... By backing hard-left proposals, like nominating Lina Khan to the FTC and Rep. Cicilline's antitrust legislation, anti-tech Republicans bear responsibility for the damage that will result from importing a European-style antitrust framework to all sections of the American economy."

Netchoice represents mostly American giants, but also Chinese dominant players. So it's interesting is to see the Chinese tech giants through their lobbying proxy coming out against Biden's anti-monopoly actions, and praising conservative Republicans Jim Jordan and Mike Lee in the process. It's clear that both big tech, and China's own tech giants, do not want to see anti-monopolists like Lina Khan succeed. But conservative Trump-supportive ranchers, by contrast, do."

It is almost as if these "tech" companies are trying to sow divisiveness. Divide and conquer.

[+] apercu|4 years ago|reply
So why do we a accept that VC's invest in software tech but we don't expect them to do the same in biotech (obviously some do I am generalizing) but instead expect Americans (mostly, I live in Canada though) to subsidize Big Pharma through taxes and, in many many many cases outrageous costs for decades old drugs?
[+] jfengel|4 years ago|reply
Apparently, because Americans tolerate it. A bunch of factors lead to higher drug prices here and an almost complete inability to agree on a way to fix it.

A lot of it comes down to tribalism: "I'd rather pay higher drug prices than lower drug prices your way."

[+] SV_BubbleTime|4 years ago|reply
Perhaps we would look at the donations to see if this is likely or not?
[+] ratsmack|4 years ago|reply
I can understand them going after Ag and Pharma in a big way, but I'm skeptical about the Tech part. There is just too much to lose in political support from that industry for any politician to attack them too aggressively.
[+] ohashi|4 years ago|reply
I hope they take a look at VeriSign's monopoly power over .com/.net. We saw how dangerously close .ORG got to being turned into a rent seeking tax on non profits. .COM/.NET are a licensed rent seeking monopoly with increasing prices and decreasing costs to serve and no contract competition. Those contracts need to be made competitive, there are plenty of registry providers who can do it cheaper and VeriSign as a company exists because of those no-compete contracts.
[+] Hani1337|4 years ago|reply
The reason we can afford universal health care in my country is because there are hard caps to the prices health professionals can legally ask, be it for fees or medication prices. If the prices are kept closer to their real value, and not inflated prices, then it's already much more affordable to consider paying for universal health care.
[+] CountDrewku|4 years ago|reply
Yes there's a good argument that insurance in the US has artificially increased prices. College loans have done similar. This is why the ACA (obamacare) kinda failed to fix most of the issues. Care is much too expensive.
[+] Bancakes|4 years ago|reply
Cut sugar industry subsidies and promote real food. Covid pandemic is nothing to the obesity one.
[+] stjohnswarts|4 years ago|reply
Why don't they allow insurance companies to operate in all states so people can shop around more? Currently they have regional rackets.