INK DOES NOT WORK AND TASTES AWFUL. TERRIBLE PEN 1/10 WOULD NOT BUY AGAIN.

Mylan Pharmaceuticals has altered its price schedule for epinephrine auto-injector EpiPenⓇ. The wholesale price is now $365.16, up from around $50 this time last year. Naturally, this price change, unconnected as it is to the unit costs of production, has prompted a bit of moral outrage.

viz:

There's no reason an EpiPen, which costs Mylan just a few dollars to make, should cost families more than $600. https://t.co/rVWUlMxD0Q

— Bernie Sanders (@SenSanders) August 18, 2016

Quite true. Anaphylactic shock is as terrifying as it is swift. In cases of severe allergy, the windpipe clamps shut and if you're alone, you have to hope that your vision doesn't fade before you can reach your dose. I have been assured by competent, trustworthy health care professionals that lethal suffocation can be somewhat uncomfortable. One shot of epinephrine can relieve the worst of the symptoms almost immediately, and another administered 30 minutes later can relieve lingering issues. Consult a physician before use, and seek medical attention if an attack occurs.

Point is, for some folks, a single bee sting or a couple of peanuts is all that's required for permanent residence with John Cleese's infamous Norwegian Blue, but for the EpiPenⓇ. And it would indeed be a travesty if families had to pay up to a grand for the mistake of a kid accidentally getting a mouthful of Uncle Mike's pad thai. So is this the case? Is Mylan CEO Heather Bresch actually asking bog-standard customers to pony up a car payment per dose?

The short answer: yes, if.

The long answer: no, but.

The MY EPIPEN SAVINGS CARD™ is available to customers under the following restrictions (from the link; emphasis mine):

This SAVINGS card can be redeemed only by patients or patient guardians who are 18 years of age or older who are a resident of the United States and its territories. Not valid for cash paying patients (except for commercially insured patients without coverage for EpiPen® Auto-Injector) and patients who are covered by any state or federally funded healthcare program, including but not limited to any state pharmaceutical assistance program, Medicare (Part D or otherwise), Medicaid, Medigap, VA or DOD, or TriCare. This SAVINGS card is not health insurance. The SAVINGS card is not transferable and the amount of the benefit cannot exceed the patient’s out-of-pocket expenses. Cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription. Program expires 12/31/2016. Program managed by McKesson Corporation on behalf of Mylan Specialty L.P. Product dispensed pursuant to program rules and federal and state laws. Void where prohibited. The parties reserve the right to amend or end this program at any time without notice.

So if your insurance company covers EpiPen, your insurance company picks up the tab. If you pay by cash, you pick up the tab—unless your shiftless commercial insurer doesn't cover it, in which case Mylan has your back. It's a bit confusing, isn't it? Perhaps the wording is too difficult for journalists and politicians to parse, leading to all the pitchforks and the torches. I understand.

At any rate, it seems to me that what we have here is classic price discrimination. The savings cards means that insured patients who are still unable to pay can get their life-saving emergency epinephrine injections at (roughly) zero price, with institutional payers (insurance companies, states, the federal government, &c) absorbing the residual production costs. Put another way, it's precisely the same approach taken by the PPACA: end customers pay next to nothing, and the costs of care are socialized. Only now it's a hated pharmaceutical firm doing it, so we make all suitable preparations to punish the wicked heretic.

Then again, auto-injectors are not strictly bound by patent law, and epinephrine is a generic drug, so you can always just go shopping for alternatives. There's no law that says you have to buy the name-brand product.

Yet.

Greed and Shortages

Remarkably, the shortage of milk that is shutting down Venezuela's famed ice cream shop is caused by greed.  And price-gouging.  And hoarding.  Hmmmm.....there is no international milk shortage.  And people have been greedy since...well, forever.  Something new must be at work.

Gosh, Pres. Maduro, you keep saying "greed causes shortages."  I don't think "cause" means what you think it means.  Self-interest is what supplied Coromoto with milk for all those years.  What causes shortages?  Socialism.

Tomáš Sedláček on Self-Interest

Interesting Spiegel interview with Tomáš Sedláček, philosopher / economist and adviser to the Czech Republic.

I don't think he's talking about "greed," exactly. I'd call it purposive human action.

Excerpt:
SPIEGEL: Mr. Sedláček, in Oliver Stone's 1987 film "Wall Street," the fictional tycoon Gordon Gekko, played by Michael Douglas, pronounces the provocative motto of neoliberalism: "Greed is Good." Has the crisis in financial capitalism reduced greed to what it was once before, one of the seven deadly sins?

Sedláček: Gekko succeeds with his greed, but then he falls victim to it. Mankind's oldest stories tell us that greed is always Janus-faced. It is an engine of progress, but it's also the cause of our collapse. Being constantly dissatisfied and always wanting more seems to be an innate natural phenomenon, forming the heart of our civilization. The original sin of the first human couple in the Garden of Eden was the result of greed.

SPIEGEL: Not of temptation and curiosity?

Sedláček: Desire and curiosity are sisters. The snake merely awakened a desire in Eve that was already dormant inside of her. According to Genesis, the forbidden tree was a feast for the eyes.

SPIEGEL: Just like the suggestive images of modern advertising.

Sedláček: Eve and Adam grab the opportunity and eat the fruit. The original sin has the character of excessive, unnecessary consumption. It is not of a sexual nature. A desire for something she doesn't need is awakened in Eve. The living conditions in paradise were complete, and yet everything God had given the two wasn't enough. In this sense, greed isn't just at the birthplace of theoretical economics, but also at the beginning of our history. Greed is the beginning of everything.

In Sedlacek's writing, he is a bit more nuanced. There are two things going on here: 1. Greed is good, or 2. Greed is.

Compare it to gravity. Gravity is a fact. We build things that help us manage it. Without gravity, we have real problems with...well, everything we know. Life in the forms we know it is pretty much inconceivable without gravity.

But would you say, "Gravity is good!"? Probably not.

I think of greed the same way. Social scientists, or idiots like Che Guevara, who try to think of how to get rid of greed make no more sense than telling physicists that their job is to change the physical properties of gravity.