I have a friend who voted yes and he lives outside of Basel because he thinks the city is too crowded. If you've been there you might find that amusing. His most vocal complaint is about too many people on Swiss hiking trails and difficulty in Booking huts.

More recently, he was laid off by a multinational pharma company where most of the Swiss office is now German immigrants.

That's not to say culture isn't a factor, but it would be a mistake to apply American ideas of racism to it

Governmental policy is the appropriate place to focus attention - not Twitter outrage campaigns about random companies following the laws that were democratically put in place

Now you add the word "complete". Anthropic IS arguing _complete_ circumventing is NOT possible.

It is hard to see being a new benefit for anthropic.

If I have 5% of a company, I dont care if I traded services or cash for it.

Factors that would make it more attractive our lower interest rates, higher returns, or faster development.

All of these are theoretically possible to adjust, but the last is most feasible to do in a tailor-made way through FDA review and approval reform. An ambitious example would be allowing conditional Market approval after Phase 2 and treating phase 3 deliverables as post-market commitments.

Advancing the revenue curve two to three years while maintaining the same patent expiration dates can dramatically change the ROI of a pharmaceutical development program.

Beyond this, even conditional Market allowance allows firms to better gauge Market interest and validate Financial investment models sooner.

Similarly, there's also some really low hanging fruit in this area to help manufacturers get to Market faster. For example, the FDA approval of trade names and label content is one of the last steps in Market authorization. Moving this earlier in the process would help products itself sooner and start producing Revenue sooner. Imagine having your billion dollar annual revenue shift out a quarter because the FDA wanted some last minute change to how a cartoon belly button looks in the instructions for use.

I do think a lot of the rot is in the PBM layer, and the country would benefit from an attempt to eliminate it, reduce their influence, and move away from the formulary.

Insurance should dictate what is covered, NDC exclusions should be banned, and rebates should be discouraged.

Ideally manufacturers sell for a list price, and insurance decides what is an acceptable balance of cost to subscriber satisfaction.

PBMs would go back to handling the papwerwork, or better yet be replaced by an open standard protocol

A more moderate response would be for government programs like medicare and medicaid to simply refuse buy products with such a high markup. This is called purchasing controls and practiced by many European countries.

You can take $5 of labor, $5 of capital, and make something people will pay $20 for

If you are doing vertical integration, there are lots of common technologies and skills.

Increasingly, we just stopped inviting them to select activities. It is like inviting the gluten free vegan to dinner parties.

If I am hosting an event, I'm not interested is spending a disproportionate ammount of time or effort to accommodate one person.

Having spend decades work with pharma companies, I agree that one of the main issues is missaligned incentives between patients and PBMs/health plans.

Bad patents are hard to quantify but a big part of picture. Should the patent office rejected Flovent + HFA as obvious? Another example would be Novarits patents on VEGF in silicone syringes. Litigating a global patent fight with Pharma companies with billions at stake is a huge barrier. The best way to prevent this IMO is more disgression in initial patent issue.