18 Comments
Jan 27, 2021Liked by Matt Stoller

Question -- re "The contact tracing apps turned out to be irrelevant or useless, Amazon has continued to grab market share, and Cuomo’s reputation as a Covid hero has unraveled."

(1) thoughts on why tracing apps are/were irrelevant or useless?

(2) three 'events' are listed together in one sentence -- apps, Amazon, Cuomo -- are you implying just an association by the grouping, or...?

Many thanks

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Jan 27, 2021Liked by Matt Stoller

"Meanwhile, the Chicago School thinkers have been almost entirely silent on the problem of big tech censorship and market power. They can’t say they think private corporations to run the world as they normally would, because they are Republicans and realize that Facebook censorship Trump will get them tossed from their position of social influence."

Typos in this chunk, maybe - could we have some errata?

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Jan 27, 2021Liked by Matt Stoller

Excellent section on Big Pharmacies. You could make the same argument for hospitals: A big part of the reason Germany's response to COVID is so much better than the US is their public hospitals keep a much larger reserve of higher-cost ICU beds than private US hospitals.

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

especially true for private equity-owned hospitals.

https://www.nbcnews.com/health/health-care/private-equity-firms-now-control-many-hospitals-ers-nursing-homes-n1203161

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Jan 27, 2021Liked by Matt Stoller

Thanks for doing this work. It is appreciated.

Concentrated systems are fragile and you highlight this constantly. Not that you need additional support, but as with vaccinations and PPP loans, community based businesses succeeded and big businesses failed.

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Government's original function was to organize masses of people for irrigation projects. There really is no reason the federal and / or state governments could not have rounded up a fraction of the people out of work right now and trained them to administer the vaccine

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Ah yes, those hospital beds. Drove my gf nuts and ws ready to move to the recliner. Finally the medical supply replaced it with one that used a gel-filled mattress w/o all the pumps and bells and whistles. Had a devil of a time with a shower bench too which I suspect is also monopolistic.

As I send this via a bad internet provider but what alternative is there? Recently upgraded tv service, added 34$ to my bill but still can't afford the next pkg up, the only one that has MSNBC.

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Further update on UK vaccine rollout.

Per BBC news this am (Radio 4 Today programme).

Of the groups called so far to attend mass stations, doctors offices, and some at home: high 90's takeup, some groups near 100%. This is amongst elderly, vulnerable, and some key frontline workers.

Certain demographics at 50% or lower; mostly poor (convenient hours and locations an issue), some cultural issues (e.g. creating a dislike of mass vaccination which is not very private) starting to be addressed by recruiting more appropriate venues to offer vaccine.

Both also being addressed by engaging local pharmacies in areas of lower uptake (such locations have previously offered vaccination and other private consultations) but the pharmacies usually have to be able to perform 1000 per week to not disrupt the supply chain wastefully (and presumable won't be allocated Pfizer as this needs special handling which is challenging in such environments).

Some of these local pharmacies will be owned by chains like Boots (I.e. WBA), or Lloyd's (McKesson I believe), others will be smaller local chains or independents

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Update on vaccine rollout in the UK. The National Health Service has now contracted some pharmacies to increase dispense points beyond large temporary vacc stations (e.g. the Excel Conference centre in London which also hosts a C19 "Nightingale" field hospital), home dispense and some doctor's office based dispensing.

Amongst the locations are some owned by the Boots chain (a division of WBA Walgreens Boots Alliance). They have decluttered parts of the shops removing part of their range to set up booths. Wait line presumably partially in the street outside the shop.

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Great read, thanks! (Guess I have to burn my CVS discount card now...)

I forwarded this to my medical colleagues and asked them to replace the words "independent pharmacies" with "independent medical practices". Can't wait for the replies! As to having pharmacists own pharmacies that would be helpful, but PE uses the MSO to effectively skirt the CPOM(corporate practice of medicine) laws. What we really need in all of these areas are state and federal attorneys general with the guts to pull back the curtain and expose the wizard(s).

Keep writing.

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More UK comparison.

Vaccine sourcing..UK also contracted several different suppliers potentially significantly over purchasing, very early (much to the chagrin of the EU which had mostly orchestrated a joint multinational purchase but was much later in committing and is now further behind in getting deliveries).

In the UK, the National Health Service acts as a monopoly PBM for almost all prescriptions, linked to government body National Institute for Health Care Excellence (NICE) who approves drugs for NHS use based on value for money. That said, the NHS-BA unit that runs the PBM function has been squeezing pharmacy dispense fees. This is in a context where most people have to pay a $15 copay per item direct to pharmacy (set fee, covers 2 month supply if relevant) although this can be capped at about $50 a quarter or $150 per year prepaid, with an ability to pay the quarterly/annual fee backdated and reclaim the recent copays. Children, seniors, disabled and unemployed don't pay the copay.

I am not sure how the very few private prescriptions dispensed by pharmacies (rather than in hospital) that are covered by insurance are handled financially. The one time I went private (for something not covered by NHS or by private insurance) I "self funded" and paid pharmacy the full amount direct. As it happens the pharmacy was run by Asda division of Wall*Mart, and was for a condition where for PR reasons ASDA choose to sell the medicine at cost price (special order and quote needed, so not particularly convenient but acceptable for a planned treatment).

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Exception that tests the rule...the fast rollut of the vaccines in the UK is being done by a monopoly: the National Health Service. In strict priority order of risk (focusing on reducing hospitalisations in the first instance, and also some care providing staff e.g. care homes, hospitals).

Some home dispensing is happening for housebound and care homes.

No private option available to jump the line.

UK government still working out if/when to expand provision via local pharmacies (including big chains like Boots owned by WBA of the US, and smaller chains/independents), while maintaining enforcement of priority order.

One of the challenges is some vaccines need very high spec cold chain (Pfizer -80 degree C freezers, max 4 hours out), others less so (Oxford AstraZeneca, just needs normal fridges)

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Would that be the same Richard Epstein who predicted that the death total from Covid would be only 500 ? (He then said he made a calculation error, and that he meant to write 5000). Why anybody listens to this man is beyond me.

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I don't think you've got it quite right on the Gamestop phenomenon.

A vulnerability was exposed via social media (reddit) and consequently exploited. The person who discovered and published the opportunity turned $53k into (as of close on 1/27/2021) $44mil. I agree with you that social media leverage played a big role in disseminating the opportunity. I disagree with the role of leverage available to the retail investor.

It wasn't leverage available to the retail investor that made this possible. That gives too much power to the retail investor. The opportunity was recognized by the retail investor, publicized, and then taken advantage of by retail investors and other firms on wall street. The natural trap set by shorting a stock to 140% of it float makes it an enticing and almost sure bet. It was a solid hypothesis that paid off. Not enough stock to buy back... naturally that'll lead to massive prices should the stock encounter sufficient demand. The attribution of 'gamer' to the people/persons involved in discovering is diminutive. Don't sell this person short. He (or she) could easily work on wall street given his understanding of the markets.

Within the communities that the opportunity was presented, leverage was discouraged as equity bought via leveraged or margin could be used/borrowed by the same firms that placed the short positions in the first place. Leverage has caused some of the inflation (due to 'gamma squeeze/risk mitigation), but the underlying hypothesis doesn't depend on it. Rather than leverage, the bigger story is how the monopoly on information doesn't exist like it did 20 years ago.

You no longer need access to a bloomberg terminal for up-to-date info. You don't need to spend $60 per trade (thanks to the competition from Robinhood) to be a market participant. The options market allows leverage and exploitation in underlying valuation issues problems. Forums like wallstreetbets is a sharing of knowledge/hypotheses that has never been available to the 'retail' investor. There's some lessons here about the power of decreasing monopolization of power in regards to information (thanks to the internet) and even trading (lowering the cost of entry).

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Yes, hire Lina Khan.

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I just did a search of independent pharmacies in my area, Asheville N.C. and most of them are out of business. Now I understand the local as well as the international problem with finding a covid vaccine. I am 72 and I'm on a LIST. Thank you BIG time.

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