Price doesn't even have to be fixed for it to be depraved!

Good time to remind everyone that Shkreli is in prison for financial crimes largely unrelated to the pharma side of his businesses, the rest of the pharma industry continued doing the same things as him as usual.

That was kinda the point, no? Shkreli was made into a bogeyman, but he was just doing in the open what every other pharma was smart enough to keep secret (pricing things higher than necessary). He also did it an excessively bombastic way.

Don't hate the player, hate the game.

Fix the root causes, not the symptoms.

"Don't hate the player" is the kind of thing you say about people scraping by at a day job, who hold no real power over the business practices. He wouldn't have gone hungry if he'd behaved acceptably, so he had a choice free of influence by the immediate need to survive. I wouldn't characterize Shkreli's moral failure as a symptom of "the game," but rather one of several root causes of its perpetuation to begin with. In my view, fixing the problem includes denouncing powerful people who fail to abide by the ethical standards that we want them to hold.

Morality is not objective.

If you want people to stop doing something, make it illegal.

If you can't muster the political will to do so, clearly not enough people agree with your view of morality (assuming a functional democracy).

I made no statement about "objective" morality. I explained my own morals, and why I'm comfortable encouraging people to blame the wealthy for the harms they perpetuate. Could you please elaborate on how you think this reply is relevant to that?

As slow as it seems to be, my perception is that societal attitudes towards wealth have been shifting over the past few decades. I'm hopeful that one day, the tolerance for their misdeeds continue to dropbenough to inspire progressively more social and legal change, as you suggested.

Innocent until proven guilty, etc. etc.

Public witch hunts are called "witch hunts" for a reason, and it's not a pretty one. It's also known as "mob justice", which despite the name is generally considered to be not justice at all.

It seems poorly considered to characterize social pressure as a witch hunt. It is acceptable to encourage others to share your moral convictions, there is a vast gulf between that and a pitchfork mob.

You would characterize the response to Shkreli as more "societal pressure" than "pitchfork mob"?

That... doesn't seem true to reality. Maybe I'm remembering it incorrectly.

I definitely would, since the response to Shkreli has been primarily online ranting. He's never been at significant risk for physical harm as a result of the public discourse as far as I can see. I don't consider negative public opinion and castigation for unethical behaviour to be unwarranted or undesirable, so I can't see that rising to the level of vigilantism either.

In my view, society would become severely dysfunctional if we are expected to withhold our negative views of someone's choices, from fear that too many people will share those views.

This is something people often forget, nothing is objectively good or bad as they are social/individual constructs. Even things like killing or theft could be seen as good looking through the right lens.

I find fault in your reasoning. Let me explain.

This is a game theory problem with perverse incentives where regulation and law enforcement are needed. If CEO A (in this case Martin Shkreli) were to take the "moral high ground" and behave acceptably, the board of directors would look at similar companies performing 10x better, fire him and replace him with someone less moral.

If the board were to take the "moral high ground" the shareholders would value the company many times lower, and they'd be bought out for pennies by an acquirer willing to take the low road because that would be a super profitable move.

If moral shareholders refuse to buy the shares of low-road companies, the value of the shares fall, but the profits don't, and suddenly being "amoral" is super profitable for stock investors, and there are always some, and they will be richer than moral shareholders. As amoral investors amass riches, they will deploy greater amounts of capital using amoral valuations, which will then dominate.

So the whole system is broken, and personal ethics does nothing to fix the game. In a nutshell, this is also why libertarianism is broken.

I see what you're saying from a business perspective. From a social perspective though, I don't consider that a reason to withhold my ire towards people like Shkreli. Choosing to be a bad person because someone else might be worse is still a choice to be a bad person, so while your pragmatic reasoning might work well when it comes time to determine a legal response, I don't feel that encouraging people not to hate Shkreli is helpful in encouraging good social norms.

Your ire is not necessarily directed at a personal preference to be a bad person, though. Attributing it to him "wanting to be evil" is easy, especially because he is abrasive.

Due to the incentives above, it might be said we are annoyed by their lack of willingness to be fired in a futile effort to obstruct a system which will carry on regardless--we are annoyed they won't do something pointless.

I have a feeling most people would have trouble taking food out of their family's mouth and literally becoming unemployed in order to tilt at a windmill where your effort cannot win. That's a pretty impossible standard to expect. If Shkreli found morals and got fired, Shkreli2 would take over.

So instead, I say, the problem is the system. Pretending it is about moral failing enables the system to go on by wasting time blaming moral failings instead of fixing it. The system produces bad behavior. We can tut tut each individual person it produces, or we can change the incentives and fix the system.

I really appreciate your reply, you've definitely got the gears turning in my head.

Something to clarify, I'm not really trying to say that people like that want to be evil. People like Shkreli make bad choices not because they like to be bad, but because they're indifferent to the indirect consequences of their choices. I'm extremely skeptical that someone in a position like Shkreli was would be in any serious risk of losing access to essentials like food and shelter if they were to behave more ethically, so I think it's important to set the standard that choosing a job like that when you have alternatives is wrong.

All that being said, I do agree with you that the primary problem by far is the exploitative structure that enables these people to exist in these positions, in the first place. If someone's analysis of the situation ended at Shkreli, I'd encourage them to think deeper. However, I do strongly believe that we don't have to choose between one or the other -- encouraging others to look down on those who choose to be a part of this system can have a significant influence by discouraging others from entering it, themselves. The more voices we have saying "this is not something to aspire to," the more pressure we can build to effect meaningful systemic change.

I appreciate your open-minded approach. In terms of turning gears, I find that a surprising amount of the time, the evil people (greedy bankers, landlords, unions, execs, VCs police) are caricatures held by outsiders who don't see the full set of incentive structures driving their behavior.

Instead, from afar, they become cartoon bad-guys. When this happens, most people take the easy route and decide they are all "evil" rather than looking at the incentive structure of the system, and the behavior it encourages.

Next time you see one of these, see if you can instead see it as a bunch of people in roles mostly acting in their own self interest, and think on whether policy, institutional organization, or law could alter the incentives and change what is in their self-interest in a better way.

There are many root causes, one of them being execs with decision making abilities, like Shkreli, making greedy decisions at the cost of people's health. It's ok to hold them accountable.

The root cause, in that, medicine is a for-profit endeavor and people are not only profiting, but seeking to maximize their profits on other people's basic needs?

Pretty much. Other things that don't help (somewhat US specific):

1. Layer of indirection created by the entire insurance system, which at this point is clearly not a good model for healthcare. Everyone needs/should have some amount of healthcare, so a system built entirely around the idea that only a minority of people should need to take advantage of the system is silly.

2. The half-assed government intervention of Medicare/Medicaid/ACA/etc – worst of both worlds in that when a government just injects shittons of money into the private sector (without very strong controls on price and behavior), what you end up with is ballooning costs... and that's about it. See also the govt. guaranteeing student loans for another example of the same. Or the Military Industrial Complex. And so on.

It's a bit more complicated than that. Health care costs have skyrocketed in the US. One of the big contributors to that has been the explosion in testing, both routine and diagnostic. These large costs aren't always shared to the same degree with other countries that have socialized medicine.

One example is with MRI scans. MRI machines, and the technicians and doctors who work with them, are insanely expensive. The US is, of course, not the only country with MRI machines. However, in countries with socialized medicine there may be a much longer wait for people to get an MRI scan for a non-critical issue. What about in the US? If you've got the money, you can get one right away. As a Canadian, I've seen tons of advertisements over the years targeting Canadians for MRIs as a cross-border service.

So the question is: is getting an MRI now instead of waiting 6 months a basic need? Private MRI clinics are definitely profiting from it. It definitely seems frustrating for people on the waiting list who can't afford to cross the border and pay out of pocket. However, it doesn't seem nearly as bad as a company price-gouging people on life-saving insulin, for example.

Too much of that is markup. The cost of MRI machines is down, and the cost of CT scanners is way down. But charges for those services have not dropped to match.

You could say the same about bakeries ("seeking to maximize their profits on other people's basic needs").

IMO the problem is more about (very) imperfect competition. Also medicine is very special in many ways (desperate buyers, doctors making decisions for them, moral and emotional weight, etc.), so it's hard to have incentives aligned.

The entire food pipeline is heavily subsidized by the government, from advantageous loans to crop price insurance to direct cash subsidies to a sales tax exemption, to SNAP to people who can't afford food. I agree wholeheartedly with the bakery comment, that they try to maximize profits, but, bread is less than a dollar a loaf and significant expense and effort is taken to ensure everyone is fed. There seems to be no will to do the same for healthcare.

Maybe people would have less problems with "corporations are just groups of people working together" if the people of a corporation were ever held accountable.

Sell your shares before it's getting caught and you won't even be affected by the heaviest fines. Absence of information asymmetry is a fiction.

In evolution adaptation prevails over customary behaviors thought of as morals. The question is why have the generic makers continued to cooperate instead of defect? How is the cartel protected?

In this thought I am reminded of the Econtalk podcast’s discussion of Martin Shkreli in the interview about the High Cost of Cancer Drugs with Vincent Rajkumar.

http://www.econtalk.org/vincent-rajkumar-on-the-high-price-o...

http://www.econtalk.org/extra/the-high-cost-of-cancer/

One tactic pharma companies use is playing games so generic makers can't get samples of the medication. These samples are required for making a generic version.

I read this somewhere but don't have a link.

That seems like evolutionarily adaptive and expectable behavior for a corporate collective in that context, yes.

> least consider the fact that it is proven that poverty is correlated with human trafficking (due to desperation and vulnerability) and illegally high medical bills force people into poverty.

This is pretty tenuous and would implicate a lot of other behaviors. You know what else causes poverty?

- the ability to hire based on skill and lay off people when you don’t need them

- alcohol

- charging for housing

- charging for food

- charging for utilities

- property taxes

- charging for transportation

If, “does something that could cause poverty” is the bar, then a huge chunk of market exchange of goods and services needs to stop.

You’re comparing the basics of a capitalism based society to a large company actively breaking the law (price fixing) on products that affect people’s lives and health directly.

I agree - let's.

Someone should make a list of the companies and executives implicated in generic drug price fixing. Shame is a very powerful tool...

We detached this subthread from https://news.ycombinator.com/item?id=25932516.

> Can we just appreciate the level of moral depravity needed to price fix medication?

First thing I thought of:

Valeant Pharmaceuticals

Please don't take HN threads into ideological flamewar or nationalistic flamewar (this is a bit of both). Those paths just lead to internet hell, and we're clinging to little clumps of grass and the occasional rock trying to stave off the downward slide into that abyss.

https://news.ycombinator.com/newsguidelines.html

https://hn.algolia.com/?dateRange=all&page=0&prefix=false&so...

Part of it may be lack of compassion but that it certainly not all. Part of it is that Americans have been led to believe that government can do nothing right and that the free market is all that is needed to solve the problem. Which is incorrect, but here we are.

Certainly government is competent in many places, but the performance of the American national and many state governments throughout the pandemic hasn't exactly been confidence inspiring. I don't think Americans who believe that their government isn't capable of many simple tasks are delusional.

They aren't delusional about the government. But there is some delusion that private business or the "free market" can necessarily handle all these same problems entirely better.