"This proposal will use $50 million in funding to enter into a partnership with a contract manufacturer to develop and bring to market interchangeable biosimilar insulin products in both vial and pen form."
"This proposal also includes an additional $50 million for the construction of an insulin manufacturing facility based in California. CalHHS will partner with the Governor’s Office of Business and Economic Development (GO-Biz), leveraging its expertise in business investment services such as site review, permit assistance, and other related activities. CalHHS will lean on GO-Biz’s expertise to mitigate risk and properly execute the proposed manufacturing facility, if
CalRx proceeds with this component of the project."
Sometimes I feel like this is the endgame where the US overall kind of declines but California starts managing itself better and operates almost like an independent country.
I can’t relate at all to that sentiment. California has got to be one of the most bloated and wasteful state governments in the entire US. High taxes and nothing to show for it. The entrenched far left seems bent on destroying the middle class, driving out business, regulating everything to death and displacing merit as a selection factor.
Whatever glory Cali has— tech, entertainment, farming, weather, natural beauty— is in spite of govt rather than because of it.
California's government is center-right. There is no far left party in US politics. That's why you don't have affordable higher education or healthcare, why your infrastructure is decaying, why you don't have nice public transit, etc.
It's also why your taxes are so high with nothing to show for them. Turns out austerity is expensive for most people. Canada and Mexico have cheap insulin because their governments are only willing to put up with so much profiteering in medicine. One has to ask why the US government is. Is that because of the far left, too?
I don’t think that’a entirely fair. California is the product of good governance during the 1950s-1980s. There is public infrastructure, like good schools and universities, that needs to be laid to attract industry in the first place. California probably wouldn’t the what it is without the UC system, for example. Of course that was a very different California.
I can't claim you are wrong. But I do question when the evidence is so murky. A lot of what folks think they want in efficient systems are systems that would fail because of how efficient they were run.
That is, what evidence do you have that the success is in spite of government? Is there a comparable government or system that is doing better? Why? Or why not?
It's a mix. California has at least some reasons for why it is a tech haven: non-competes unenforceable; well-supported state university system
California also gets a lot wrong that interferes with tech: prop 13 and friends, housing policy, incredible corruption, massive local conservatism
But California is most like America as a microcosm: horrifically corrupt but such a powerhouse that it resembles a leviathan that charges despite the parasites on its back and belly.
I chuckle whenever I read someone referring to any US political view as "Far Left" ... the most leftist leftist in the US would be considered center-right in most parts of the world
While I respect where you are coming from, the data doesn't match your perceptions. California's governance is exceptional despite the corruption. Here's some data,
- One of the best ways to match models to reality is to see if they have predictive power, for some time now people have predicted that California is doomed, see, “California doom: Staggering $54 billion deficit looms,” https://apnews.com/article/48a9ce5ad7494d22ec0c42ac46ae9baf , but the surplus that year was a $75 B.
- Since 2006, California has cut the rate maternal mortality and women dying in childbirth by 65%, the national maternal mortality rate has increased by 50% to 70%. The impact this one data point has on people's lives cannot be overstated. More women are dying in the States at a rate 6x that of Nordic states and 3x that of Canada, and it's a trend that's increasing for most of the US. Except California. This data is from 2018, but the graph is simply staggering, https://www.npr.org/news/graphics/2017/05/propublica-mortali... and https://cdn.cnn.com/cnnnext/dam/assets/220510134152-hponly20...
- Despite the reduction due to the pandemic, California has the longest lifespan in the US for men. If you are born in California, as a man, you will live to 78.4 years on average as compared to 71.7 years (and falling) in West Virginia, 76 years in Texas, 72.6 years in Kentucky, and 75.7 years in Texas.
- California has the highest rate of income growth in all of the US. Even when compared to Texas. Here's a comparison of the two states,
Despite a slight decline in population, California's per capita income grew at a significantly greater rate than Texas,
"Between 2000 and 2020, California’s PCI was significantly greater than both Texas and the U.S. as a whole (BEA, 2021). Both disparities grew substantially from 2015 to 2020. For example, while California’s per capita income was 20 percent higher than Texas’ in 2015, this gap surged to 30 percent just 5 years later. And this was not simply a COVID-induced phenomenon, as the rising disparity was apparent in 2019 even before the pandemic."
Between the two states, the government invests substantially more on the public in California, even when adjusting for state revenue,
"A large part of this difference between California and Texas, however, is driven by differences between the two states in GDP per capita, which is 22 percent higher in California ($79,405) than in Texas ($65,077) (BEA, 2020). Even adjusting for this, state and local governments loom much larger in California, with their spending representing 20.3 percent of the state’s GDP versus just 15.4 percent in Texas. By this metric California’s public sector is about one-third larger than in Texas, implying that the greater per capita GDP in California explains almost half of its higher state and local spending."
From the data the study concludes that this spending leads to, "it appears higher government spending in California leads to stronger student performance, better environmental and health outcomes, and safer neighborhoods than in a small government state such as Texas"
- We can contrast California against states like Kansas, where they've implemented low taxes and cut public spending as a part of the "Kansas Experiment", the state has gone almost bankrupt and there has been no subsequent increase in GDP growth. The experiment is widely regarded as a failure. https://en.wikipedia.org/wiki/Kansas_experiment
There are areas where California doesn't do well, such as homelessness, but by every conceivably metric, California has exceeded other US states. Surely some of this has to do with governance.
If I was to sum up my position here, it's this. You get what you pay for.
I agree, current management is pretty bad. I can easily envision a world where it is well-run and with less grift where your California ID essentially unlocks a slew of services like healthcare and university access.
Like i said before, this is wishful thinking, but it’s not for lack of resources.
As opposed to Republican states, which are utopias of innovation, culture, and industry, and totally not leeching on the merit of the blue states who keep transferring wealth to them via the Federal government.
Nancy Pelosi has been CA rep for decades and she is worth over $100M, meanwhile California education system is shit, the prison system is shit, taxes are among the highest in the US, income inequality is fucked, water is fucked, electricity is fucked. Same goes for all those politicians like Diane Feinstein, etc.
The last time a Republican had any presence in California was 30 years ago and the Dems have driven this state off a cliff. Why do Californians still keep falling for the same grift election after election? It doesn't matter who you vote for, all they do is steal from the people for their own gain and we keep voting for them because they give us lip service on particular causes.
Pretty wishful thinking indeed. It's already losing population (down two years running), probably due to a bunch of factors. My guess it's being driven by the obscene cost of living (housing, taxation, energy) and the declining quality of life (worsening air quality, growing petty crime and homelessness, creaky infrastructure).
Most of these are uncomplicated policy problems, yet solutions seem out of reach. Do you think CA would establish property rights to get housing? Or repeal prop 13 to reduce penalties for the young in favor of the old? Or get rid of CEQA to let folks build infrastructure? Or reform the CPUC so that energy markets are more competitive and reliable? Not going to happen.
The last time we "reformed" CPUC so that energy markets could be more competitive and reliable, we essentially rendered the whole thing subject to the free markets. Immediately, both PG&E and SoCalEd teetered on the edge of bankruptcy due to corrupt energy traders (e.g., ENRON, but not just them) manipulating the markets. Sometimes, regulation is a good thing.
Yeh that was sweet when we tried to build a high speed rail or when we spent billions to fix homelessness. We are extremely efficient and effective with the ridiculous amount of cash we lucked into.
The irony is that California was a model for the country decades ago. Now it’s coasting on the inertia of that period. On its current trajectory it’s headed the way of New York, if it’s lucky, and Illinois, if it’s not.
Any state in the US has a lot of autonomy, not just California. California has many issues though, as an aggregate indicator look at underfunded pension liability per capita or per household. It wasn’t looking good, then it got better in 2021 because investment performed well, but as we in a recession I think next numbers aren’t gonna look good. CalPERS have made some very questionable investment choice, which caused removal of the previous CIO. What is more concerning is that they tried to sponsor the bill that would allow them to keep secret due diligence information of certain private investments. They basically wanted to venture into lending business but keep the lid closes. This seems to me a disastrously risky.
California has a high poverty rate as measured by local cost of living (but very low using the standard federal methodology) 8j no small part because federal funding formulas funnel money out of California because of its aggregate economic success, limiting it's ability to effect distribution.
Poverty is a definitional thing, it does not refer to actual living conditions. Poverty in California and poverty in, say, your average red state are very different. Our people in poverty have access to a wide range of public benefits. Our poverty line is quite high which means people qualify for public benefits at higher levels of income. Living in California in poverty is far more tolerable than living elsewhere in poverty. Likewise how being in poverty in the USA is nothing like being in poverty in India or even China.
This action might be rational actually given lack of federal regulation on healthcare, but they could just as well handle it another way, and more comprehensively (i.e. price controls, pricing transparency - yes, it's hard).
There is no obvious path forward.
I kind of think Vermont has a lot of it sorted but that's also a cultural issue, I mean, Los Angeles and Vermont might as well be on different continents.
Healthcare is the most heavily regulated industry in the US. Many of those regulations were written specifically to minimize or eliminate the influence of market forces. You can't reasonably say the market has failed when it has been so tightly constrained by regulation.
interesting contrast vs the us congress, which is trying a price cap
as with every build-vs-buy problem, you don't know if you'll actually be able to do it until you do it. I'm wondering what a state government has ever done that is as complex as manufacturing a medicine -- maybe road building / big water projects?
if they succeed it would be a new chapter in state capacity + really exciting, especially if they are transparent about accounting and show that they're not warping the market
I think biohacker group open insulin https://openinsulin.org/ was founded in oakland -- they're working on lispro, the fast-acting kind in humalog
the humalog plant in puerto rico cost 200-500 million dollars in the early 2000s [1]. there are 3+ million californians w/ diabetes (per diabetes.org), and it costs north of $5k per year per person, so that's like 15 billion. you don't have to dent that # much to get ROI on this.
"Picking the winner" would imply the state forcing market participants to buy the state's insulin.
As long as they're not forcing people to buy their insulin then what they're doing is more akin to setting a price floor (assuming they are selling at cost rather than subsidizing a loss).
But hey if it's going to be a boondoggle then the private sector should have nothing to fear from competition here, right?
>> October 12, 2020 - Insulin prices are more than eight times higher in the US than in 32 comparable, high-income nations combined, according to a new RAND Corporation study.
>> In 2018, the average insulin prices in the US was $98.70, compared to $6.94 in Australia, $12.00 in Canada, and $7.52 in the UK.
Thanks, that is a great analysis, especially the details on modern insulin.
What would be even better to know is what people are paying. It is well known that the AWP or average retail price in this case is not close to average price paid.
This is a pretty interesting public-private partnership proposal that Newsom seems to have been working on for a while.
Budget Request Summary
HCAI requests one-time $100 million General Fund, available until 2025-26, for the CalRx Biosimilar Insulin initiative. Through a contract partnership, the State would invest $50 million towards the development of low-cost biosimilar insulin products, an additional $50 million towards a California-based insulin manufacturing facility. HCAI also requests $2.8 million General Fund, over four years, for state operations to fulfill requirements of the partnership, including monitoring, oversight, and legal compliance. The insulin products are expected to be widely available to Californians, through a variety of outlets.
They'd have exactly the same incentives, because they'd be bound in exactly the same regulatory environment. the F in FDA is for food. the other F in FDA is the silent (Federal) in front of it. its the US FDA. Its federal.
Drug safety regulation is federal. It's a federal agency of the Department of Health and Human Services.
The California facility would still be bound by the same standards (if anything, California is more not less stringent on things like that) and the risks are still the same.
Readit News
https://esd.dof.ca.gov/Documents/bcp/2223/FY2223_ORG4140_BCP...
"This proposal will use $50 million in funding to enter into a partnership with a contract manufacturer to develop and bring to market interchangeable biosimilar insulin products in both vial and pen form."
"This proposal also includes an additional $50 million for the construction of an insulin manufacturing facility based in California. CalHHS will partner with the Governor’s Office of Business and Economic Development (GO-Biz), leveraging its expertise in business investment services such as site review, permit assistance, and other related activities. CalHHS will lean on GO-Biz’s expertise to mitigate risk and properly execute the proposed manufacturing facility, if CalRx proceeds with this component of the project."
California can't even build high speed rail with a budget in 10s of billions of dollars and more than a decade of time.
Probably wishful thinking but would be great.
Whatever glory Cali has— tech, entertainment, farming, weather, natural beauty— is in spite of govt rather than because of it.
It's also why your taxes are so high with nothing to show for them. Turns out austerity is expensive for most people. Canada and Mexico have cheap insulin because their governments are only willing to put up with so much profiteering in medicine. One has to ask why the US government is. Is that because of the far left, too?
That is, what evidence do you have that the success is in spite of government? Is there a comparable government or system that is doing better? Why? Or why not?
California also gets a lot wrong that interferes with tech: prop 13 and friends, housing policy, incredible corruption, massive local conservatism
But California is most like America as a microcosm: horrifically corrupt but such a powerhouse that it resembles a leviathan that charges despite the parasites on its back and belly.
- One of the best ways to match models to reality is to see if they have predictive power, for some time now people have predicted that California is doomed, see, “California doom: Staggering $54 billion deficit looms,” https://apnews.com/article/48a9ce5ad7494d22ec0c42ac46ae9baf , but the surplus that year was a $75 B.
- Since 2006, California has cut the rate maternal mortality and women dying in childbirth by 65%, the national maternal mortality rate has increased by 50% to 70%. The impact this one data point has on people's lives cannot be overstated. More women are dying in the States at a rate 6x that of Nordic states and 3x that of Canada, and it's a trend that's increasing for most of the US. Except California. This data is from 2018, but the graph is simply staggering, https://www.npr.org/news/graphics/2017/05/propublica-mortali... and https://cdn.cnn.com/cnnnext/dam/assets/220510134152-hponly20...
- Despite the reduction due to the pandemic, California has the longest lifespan in the US for men. If you are born in California, as a man, you will live to 78.4 years on average as compared to 71.7 years (and falling) in West Virginia, 76 years in Texas, 72.6 years in Kentucky, and 75.7 years in Texas.
On average, you will live 6+ to 3+ years longer than most US States if you're born in California. The same is true for women. Data, https://www.cdc.gov/nchs/data/nvsr/nvsr70/nvsr70-1-508.pdf
This is roughly the same amount you would get from an intervention such as lifelong/prolonged caloric restriction, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3014770/
- Between 2015 and 2019, California's economy grew at a rate of 22%. For comparison, China was 26%. Germany, 15%. Japan, 16%. In December of 2021, California added 42% of all jobs in the US. Nearly half of all new jobs in the country for that month were created in California. Alone. https://mehabe.com/2021/06/14/among-the-five-largest-economi... | https://www.gov.ca.gov/2022/03/11/californias-economic-recov...
- California has the highest rate of income growth in all of the US. Even when compared to Texas. Here's a comparison of the two states,
Despite a slight decline in population, California's per capita income grew at a significantly greater rate than Texas,
"Between 2000 and 2020, California’s PCI was significantly greater than both Texas and the U.S. as a whole (BEA, 2021). Both disparities grew substantially from 2015 to 2020. For example, while California’s per capita income was 20 percent higher than Texas’ in 2015, this gap surged to 30 percent just 5 years later. And this was not simply a COVID-induced phenomenon, as the rising disparity was apparent in 2019 even before the pandemic."
Between the two states, the government invests substantially more on the public in California, even when adjusting for state revenue,
"A large part of this difference between California and Texas, however, is driven by differences between the two states in GDP per capita, which is 22 percent higher in California ($79,405) than in Texas ($65,077) (BEA, 2020). Even adjusting for this, state and local governments loom much larger in California, with their spending representing 20.3 percent of the state’s GDP versus just 15.4 percent in Texas. By this metric California’s public sector is about one-third larger than in Texas, implying that the greater per capita GDP in California explains almost half of its higher state and local spending."
From the data the study concludes that this spending leads to, "it appears higher government spending in California leads to stronger student performance, better environmental and health outcomes, and safer neighborhoods than in a small government state such as Texas"
Full study, https://siepr.stanford.edu/publications/policy-brief/tale-tw...
- We can contrast California against states like Kansas, where they've implemented low taxes and cut public spending as a part of the "Kansas Experiment", the state has gone almost bankrupt and there has been no subsequent increase in GDP growth. The experiment is widely regarded as a failure. https://en.wikipedia.org/wiki/Kansas_experiment
There are areas where California doesn't do well, such as homelessness, but by every conceivably metric, California has exceeded other US states. Surely some of this has to do with governance.
If I was to sum up my position here, it's this. You get what you pay for.
Like i said before, this is wishful thinking, but it’s not for lack of resources.
Alexander Hamilton. On california of course
That's why almost 12% of the US population chooses to live in California right?
The last time a Republican had any presence in California was 30 years ago and the Dems have driven this state off a cliff. Why do Californians still keep falling for the same grift election after election? It doesn't matter who you vote for, all they do is steal from the people for their own gain and we keep voting for them because they give us lip service on particular causes.
Most of these are uncomplicated policy problems, yet solutions seem out of reach. Do you think CA would establish property rights to get housing? Or repeal prop 13 to reduce penalties for the young in favor of the old? Or get rid of CEQA to let folks build infrastructure? Or reform the CPUC so that energy markets are more competitive and reliable? Not going to happen.
i don't suppose you're familiar with what a dystopian nightmare the housing market is?
This action might be rational actually given lack of federal regulation on healthcare, but they could just as well handle it another way, and more comprehensively (i.e. price controls, pricing transparency - yes, it's hard).
There is no obvious path forward.
I kind of think Vermont has a lot of it sorted but that's also a cultural issue, I mean, Los Angeles and Vermont might as well be on different continents.
Dead Comment
Dead Comment
And I say that as someone who left California for the northeast.
Somehow they've figured it out.
I can provide no insight as to 'how' but I suggest some reasonable regulation has something to do with it.
https://mattstoller.substack.com/p/buckraking-did-a-medical-...
https://www.accessdata.fda.gov/scripts/drugshortages/default...
Dead Comment
as with every build-vs-buy problem, you don't know if you'll actually be able to do it until you do it. I'm wondering what a state government has ever done that is as complex as manufacturing a medicine -- maybe road building / big water projects?
if they succeed it would be a new chapter in state capacity + really exciting, especially if they are transparent about accounting and show that they're not warping the market
I think biohacker group open insulin https://openinsulin.org/ was founded in oakland -- they're working on lispro, the fast-acting kind in humalog
the humalog plant in puerto rico cost 200-500 million dollars in the early 2000s [1]. there are 3+ million californians w/ diabetes (per diabetes.org), and it costs north of $5k per year per person, so that's like 15 billion. you don't have to dent that # much to get ROI on this.
1. https://www.pharmaceutical-technology.com/projects/eli_lilly...
Arguably the whole point of this is to warp the market by picking the winner and giving them all the business in the state.
Though, chances are this will just turn into a taxpayer subsidized boondoggle like every other time the politicians pick the winner.
As long as they're not forcing people to buy their insulin then what they're doing is more akin to setting a price floor (assuming they are selling at cost rather than subsidizing a loss).
But hey if it's going to be a boondoggle then the private sector should have nothing to fear from competition here, right?
>> October 12, 2020 - Insulin prices are more than eight times higher in the US than in 32 comparable, high-income nations combined, according to a new RAND Corporation study.
>> In 2018, the average insulin prices in the US was $98.70, compared to $6.94 in Australia, $12.00 in Canada, and $7.52 in the UK.
US Compared to Similar Nations: https://pharmanewsintel.com/news/insulin-prices-8x-higher-in...
What would be even better to know is what people are paying. It is well known that the AWP or average retail price in this case is not close to average price paid.
Budget Request Summary
HCAI requests one-time $100 million General Fund, available until 2025-26, for the CalRx Biosimilar Insulin initiative. Through a contract partnership, the State would invest $50 million towards the development of low-cost biosimilar insulin products, an additional $50 million towards a California-based insulin manufacturing facility. HCAI also requests $2.8 million General Fund, over four years, for state operations to fulfill requirements of the partnership, including monitoring, oversight, and legal compliance. The insulin products are expected to be widely available to Californians, through a variety of outlets.
https://esd.dof.ca.gov/Documents/bcp/2223/FY2223_ORG4140_BCP...
My understanding (maybe wrong) is that for private drug manufacturers, the risk of lawsuits provides a strong incentive for safe, effective products.
Would a California-run facility have similar incentives?
Drug safety regulation is federal. It's a federal agency of the Department of Health and Human Services.
It's not an area I know well, but I am not aware of a similar grant if immunity for medication in general.