Dear SCORAI’ers,
Some of you may find the attached document about the public alternative to Big Pharma interesting. It is a fine report issued by the Next System Project in the US. The proposal in it focuses on the US but it can be just as well applied in other advanced economies with a strong research sector.
https://thenextsystem.org/medicineforall?mc_cid=9bc87732e4&mc_eid=e81c2d3d7d
I find this proposal to be an important alternative to guaranteed basic income proposals. I have always been uncomfortable with the idea of guaranteed basic income because I see it as a massive indirect subsidy for the private sector that wants people to spend money on more and bigger stuff. This sector will surely devise the cleverest of ways to extract that extra income from citizens.
At the risk of sounding awfully patronizing, I believe that many people will spend that extra income not on better housing, live necessities, education for their children or other such “wise” choices, but on other things.
A better solution, other than distributing cash, is to create access to affordable high-quality housing, high quality free education, low cost or free healthcare, and low cost or free medicines, etc. This is why I find this report interesting.
Halina S. Brown
Professor Emerita of Environmental Science and Policy
Clark University
Worcester, MA 01610
http://halinasbrown.com
Associate Fellow
Tellus Institute
2 Garden Street, Cambridge MA 02438
Co-founder and Member of Executive Committee
Sustainable Consumption Research and Action Initiative, SCORAI
www.scorai.org
Halina,
Yours is an interesting line of thought.
Do you (or does anyone) know of formal work that sets out, thinks through and compares/contrasts the two approaches? I do not. I know of work that argues for/assesses each line of thought separately, both not together.
Ruben
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Dear Joe, and all,
With the danger of being labeled as a retro 60s or 70s adept, I’d like to discuss the drive for more and more innovation. First, I think that it would be useful to consider public-private partnerships with strong and clear rules as to profits and ethical research. Next, biomedical research takes us with the speed of light towards cloning humans and gene-editing and whatever these new technologies are being called, without a viable discussion about the desirability of that all, and about possible negative side effects. That takes me straight to Joe’s point about innovation. While I see the benefits of biomedical innovation and we all benefit from it in our personal lives, I would like to propose that we do not take “more innovation is better” for granted; just like we are questioning economic growth and unbridled consumerism. Innovation should be led by social consensus, not by profit making.
I agree that most innovation comes from smalls start-ups; and it is not easy to regulate that; but the implementation comes through buying up of small start-ups by large corporations; and there is the possibility for public intervention and regulation.
Warm regards,
Philip
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Michael,
Reducing my reflections to this single question: “do you really want to address the climate crisis by keeping people in poverty?” misses the point of my reflections or, worse, is disingenuous. And comparing the idea of public ownership of the pharmaceutical industry to providing slabs of third grade cheese is ridiculous.
My point is that right now poor people (and not only the poor) in this country spend a large proportion of their income on corporatized healthcare, including medications as well as other basic amenities such as housing, etc. Giving them cash does nothing to change the system that produces these exorbitant prices and transfers wealth from the poor to the well-to-do and the rich. To the contrary: it indirectly subsidizes that system and keeps it more stable. It treats the symptoms, not the cause. And it is the system that needs to be fundamentally changed.
This is why (among other reasons I articulated earlier) I do not think that basic income is a good idea.
If these basic amenities become easily affordable (or perhaps free for the poor of this country) will allow these people to buy whatever they wish with the meager income they have and thus regain some dignity of which poverty strips them.
Halina
Thank you Philip, for these comments. I would go a step further with my critique of innovation in the pharmaceutical industry. We all take the concept of innovation as an absolute good. But is it really an absolute good if it bankrupts the economy? Do we really have enough money as a society to pay a million or two dollars per person for the future yet unknown cures to some yet unidentified diseases? This is not a new question among moral philosophers but I do not hear it being discussed at all in the public forum. There is a reason why most of the costs of bringing new pharmaceuticals to the market is covered by venture capital: the expectation of quick and huge returns to the investors and shareholders.
Halina
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Dear Joe, and all,
With the danger of being labeled as a retro 60s or 70s adept, I’d like to discuss the drive for more and more innovation. First, I think that it would be useful to consider public-private partnerships with strong and clear rules as to profits and ethical research. Next, biomedical research takes us with the speed of light towards cloning humans and gene-editing and whatever these new technologies are being called, without a viable discussion about the desirability of that all, and about possible negative side effects. That takes me straight to Joe’s point about innovation. While I see the benefits of biomedical innovation and we all benefit from it in our personal lives, I would like to propose that we do not take “more innovation is better” for granted; just like we are questioning economic growth and unbridled consumerism. Innovation should be led by social consensus, not by profit making.
I agree that most innovation comes from smalls start-ups; and it is not easy to regulate that; but the implementation comes through buying up of small start-ups by large corporations; and there is the possibility for public intervention and regulation.
Warm regards,
Philip
From: 'Joe Zammit-Lucia' via SCORAI [mailto:sco...@googlegroups.com]
Sent: Friday, September 13, 2019 12:45 PM
To: Halina Szejnwald Brown
Cc: sco...@googlegroups.com
Subject: Re: [SCORAI] public amenities instead of basic income
Dear Halina,
With respect, I find the paper circulated to be well off base.
Public ownership of pharmaceutical research and development was tried in the 60s and 70s in some countries. It was an absolute disaster. Innovation stalled amid the public bureaucracy and lack of real incentives to innovate. Bureaucracies don’t innovate, they mainly spend their time justifying why they should get bigger budgets.
The authors clearly have no idea of the dynamics of pharmaceutical innovation most of which now comes from agile startups funded by the financial markets rather than big pharma. This is emerging as the only way in which the high risk nature of pharmaceutical research and the need for global availability of innovation can be sustained. The idea that government monopoly (with all the inevitable political shenanigans that it involves) can carry this sort of risk profile is laughable.
I also personally find the retrograde discussion of pitting private vs public a tiresome throwback to the 1970s. I thought we were done with all that and that most people had moved on to an understanding that a mixed economy works best provided we keep working towards refining the incentive structures - which are currently out of whack - and can get better but will never be perfect.
The issue of healthcare funding and access is a very valid one but one that is proving to be highly intractable in most countries. Would be great if there were some magic bullet but there isn’t.
And it’s not just the difficulty of trying to work out appropriate pricing for drugs (an impossibility) but also gets one into what should doctors, nurses and everyone else get paid? What is the right price for an MRI scanner? Should governments be building those too? And everything else?
I have no easy answers I’m afraid. And, sadly, neither does anyone else.
Beware those selling snake oil.
Best
Joe
Dr Joe Zammit-Lucia
Dr Joe Zammit-Lucia
Dr Joe Zammit-Lucia
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Hi JoeI think that the balance between public and private sector is far more complex than dealing with the pharma and health issues. We see this in the idea of "Moral Capitalism" or what some call democratic socialism in which the pharma issue is only one small subset. We see it in dealing with the SDG's and the balance between the developed and developing countries to use old terminology.tom
On Sat, Sep 14, 2019 at 6:25 PM 'Joe Zammit-Lucia' via SCORAI <sco...@googlegroups.com> wrote:
Dear Jean,
Thanks.What I meant is that in the 1970s and later many engaged in an endless battle. One side believed that everything that was public was good and everything private was bad. Then we went through a period where the fashion was exactly the opposite: private is good public is bad.I thought we had got past all of that and had reached an understanding that each had its strengths and weaknesses and that what we needed was to keep looking for the appropriate balance and work our what was most appropriate for what.What I find tiresome is re-hashing the same discussions we had decades ago as though we’ve learned nothing.Of course there are people on both sides of this discussion who remain wedded to their own ideological convictions from which they won’t shift irrespective of any previous experience.But I believe that most mainstream discussion has now moved on to people trying to work out the best balance between private sector and public sector both of which are necessary. The discussion is now how to create synergy and effective collaboration between the two rather that the unproductive putting of one against the other.Don’t know if that makes sense.Best
Joe
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Joe
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Hi Tom, Philip and all at SCORAI
If I may add something here, I think we need to take care with innovation.
I see many state and corporate interests evoke innovation in an undifferentiated way, which creates all sorts of problems, including those mentioned in this thread. Scepticism and critique are important here. However, I think that to do so in a similarly indiscriminatory way will be just as problematic. It is more a matter of what kinds of knowledge, ideas and novelties societies wish to cultivate and how: the directions of innovation to be taken. Clearly, the implications for consumption should be one guide. I like the way my colleague Andy Stirling put it recently:
“Innovation is about more than technological invention. It involves change of many kinds: cultural, organisational and behavioural as well as technological. So, in a world crying out for social justice and ecological care, innovation holds enormous progressive potential. Yet there are no guarantees that any particular realised innovation will necessarily be positive. Indeed, powerful forces 'closedown' innovation in the directions favoured by the most privileged interests. So harnessing the positive transformative potential for innovation in any given area, is not about optimizing some single self-evidently progressive trajectory in a 'race to the future'. Instead, it is about collaboratively exploring diverse and uncertain pathways – in ways that deliberately balance the spurious effects of incumbent power. In other words, what are needed are more realistic, rational and vibrant 'innovation democracies'.
Yet conventional innovation policy and regulation tend simply to assume that whatever products or technologies are most energetically advanced, are in some way self-evidently beneficial. Scrutiny tends to be through narrow forms of quantitative 'risk assessment', focusing only on particular direct risks and asking merely whether they are 'tolerable' –often at a time too late for significant change. Technologies are typically privileged over other innovations. Attention is directed only in circumscribed ways at the pace of innovation The result is a serious neglect for the crucial issue of the direction of innovation in any given area–and increased vulnerability to various kinds of 'lock in'
… Together, qualities of participation, responsibility and precaution help ‘open up’ scrutiny and accountability beyond anticipated consequences alone, to also interrogate the driving purposes of innovation.They allow societies to exercise agency not only over the rate and riskiness of innovation, but also over its direction. And they offer means to enable hitherto more distributed and marginal forms of innovation –which presently manage only rarely (like renewable energy or ecological farming) to struggle to major global scale. Together, these qualities celebrate that innovation is not a matter for fear-driven technical imperatives, but requires a democraticpolitics of contending hopes.”
https://steps-centre.org/wp-content/uploads/Innovation-Democracy.pdf
Of course, disagreeing with this argument, and seeing innovation as something to be resisted per se rather than its directions, is to contribute to the kind of democratic deliberations being encouraged here …
All the best
Adrian
Professor of Technology & Society
Science Policy Research Unit, University of Sussex
@smithadrianpaul
Joe
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While I see the benefits of biomedical innovation and we all benefit from it in our personal lives, I would like to propose that we do not take “more innovation is better” for granted; just like we are questioning economic growth and unbridled consumerism. Innovation should be led by social consensus, not by profit making.
Between a 'dangerous present' and a 'seemingly impossible future' lie many possible unequal paths for human wellbeing... Ian Gough suggests human needs provide the best framework to reconcile these dilemmas. Ecological Economics
An impressive piece of work, rich and dense (in a good, difficult way), touching on an extraordinary range of issues and scholarship, and packed with detail and data. Political Quarterly
A state of the art review about how social inequalities are linked to climate change. Swiss Political Science Review
Bit by bit this interesting tour leads us to some sacred cows - including the assumption that there is no alternative to continuous economic growth … Engaging in a clear eyed way with these issues requires both hard-headedness and Utopianism. Journal of Social Policy
A well-researched, well-argued, well-written, timely, and important book ... not just an academic book (but) a manual for policy makers. Citizens Basic Income Trust
In this wonderful book, Ian Gough shows how we can deal with climate change sensibly, by developing eco-social policy that promotes human wellbeing. The result is a tour de force. International Dialogue, A Multidisciplinary Journal of World Affairs
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Unless we can be clear about what UBI actually entails, confusion will reign.
There are indeed many different versions, as Lanchester concedes.
But there is also a core idea: UBI is a programme to give every citizen or resident a regular income for life with no strings attached which is enough to live on and provide ‘security’. It is not Brazil’s Bolsa Familia programme. It is not even Alaska’s
Permanent Fund, since $1400 a year is not enough to starve on, let alone enjoy security. Nor is it any of the various plans, from the UK Royal Society of Arts scheme or Andy Stern’s US plan or van Parijs’ start-low-and-see-how-it goes €200 idea.
All extant pilots, experiments and plans are partial.
They give money to selected groups of people or they give a little bit of money to everyone and usually payments cease after a limited period.
Insofar as there is evidence that any of these ‘work’, it is only on their own, limited terms. So what is all the fuss about? The key is that they are all promoted as way stations to a Big Idea that will transform our lives and politics. But then we
encounter two fundamental issues: cost and the very desirability of this as the end-goal of progressive politics.
Lanchester’s arguments around cost are specious. He concludes that ‘many forms of UBI are more affordable than you might think.’ But the most affordable are those he correctly labels as ‘dystopian Mad Max’. It is not ‘odd’ that the origins of UBI lie with Hayek and Friedman, quite the opposite. Eliminating all collective infrastructure and services whilst giving the poor just enough money to survive and expecting them to purchase all life’s necessities in the market is a perfectly rational neo-liberal project.
Interestingly Lanchester provides no estimates of the costs and benefits of the ‘full fat’ welfare state plus UBI option.
Yet they exist. The 2016 Compass scheme for the UK is admirably honest here: despite raising income tax rates by 5p, abolishing personal tax allowances and extending NICs to all employees, the BI achieves tiny falls in pensioner and working age adult
poverty and reduces the numbers reliant on means-testing by only one fifth. Luke Martinelli after exhaustive modelling concludes:
“an affordable UBI is inadequate and an adequate UBI is unaffordable.”
So in truth we cannot have a full UBI and at the same time safeguard and build the social infrastructure of a generous welfare state. This crucial insight has led some of us to argue for universal basic services (UBS), a collective programme for meeting needs we all share. This offers a radical alternative that is far more affordable and effective.
Most serious is the political vacuity of UBI as a progressive slogan for greens and the left. The overriding tasks today are keeping within planetary limits – addressing climate breakdown, species extinction and other existential challenges, whilst at the same time shifting from a greed-driven to a need-driven economic system. The central slogan should be a ‘just transition’ from the present to a future green, equitable and sustainable world. There are other movements and programmes out there to help realise this vision, such as a Green New Deal. To spend all our political and fiscal capital on a dream that cannot be realised is irrational and perilous.