"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."
And what exactly is the proper amount of time and money for California high speed rail? I doubt you can give an answer that isn't practically bullshit.
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?
Left and right aren't objective measurements, they are relative ones. Relative to US politics generally California's government is left. If you're in some even more left European country that doesn't mean anything - Europe is not the objective standard by which everyone measures politics.
While it's true that the terms are relative, there are countries in Europe and South America that have literal communist, socialist or anarchist parties.
Hearing people describe Democrats as far left makes them sound like clowns spouting canned propaganda. It's not conducive to conversation as you know you aren't talking to a rational person who can argue in good faith.
For most Americans, exposure to outside cultures will happen much more through reading about them or interacting with, say, foreign exchange students and foreign cultural social groups, than visiting the places. Americans who grow up with the money to travel abroad a lot often come from general wealth, which also lets them afford to spend more time doing things like grad school. This affects the liberal causes well-traveled American liberals might support; they may care less about economic fairness than gender/racial equality for instance.
This is just the opinion of some fool on the internet, but I personally think that interacting with people from other cultures is far more important than just reading about them. Not saying I disagree with you, I definitely had social studies in school in the US but that didn't impact me nearly as much as interacting with other fellow fools on the internet. We can learn a lot more about each others perspectives and cultures by interacting.
I completely agree. I live in Canada, and run a weekly Zoom call on startups etc. We have quite a few members from India, Latin America and elsewhere and I find it useful to get their perspectives. I even have callers from China (you need to change the Zoom data center config to permit this). These are people that I met on WeChat groups (unfortunately not a realistic option outside China for most right now), and some former students. We try to stay away from politics, but interestingly there is a wide range of points of view from Chinese callers.
Agreed. Though the things I learnt in social studies like history, geography, and civics helped me in finding a common ground with people of other cultures. Given my introverted nature I imagine I would have had a much harder time if I did not have this foundation.
Some countries are further left and some are further right. To add even more complexity some countries, all of them really, are just different in ways that a one dimensional scale doesn't really capture that well. This is both true and a trivial observation. It is a banality that doesn't really mean anything but is often offered as if it did.
On this note, most of California's problems come from a populace that apes left wing ideology while acting right wing when the rubber hits the road.
"Black Lives Matter but not if they have to build housing next to me" is a California meme.
See also Prop 13, a tax revolt, being the crux of a lot of California issues.
While government services can certainly be more efficient and cost disease is rampant, we first have to agree that the government should be providing the service in the first place (which we don't, countrywide)
I’d argue there is a difference between what side of the political spectrum California is on and whether or not they are good at governing. You mention that we don’t have good public transit but California is famous for massively expensive infrastructure projects. It seems it’s less of a ideological issue and more of a competency one.
SF spends more on homelessness than any other municipality, but still has rampant homelessness.
SF’s muni is one of the worst in the country in terms of reliability and speed but we have a muni budget that is equal to London per capita.
Most complaints in California isn’t on its ideology, but rather its incompetence at executing its ideology
Compared to the most populous countries, China and India, would you put the US and California to the left or the right? How about compared to other major world powers like Japan?
It seems to me that California does both more economic redistribution via higher taxes and is more open in terms of accepting a wide variety of foreign immigrants, cultures and religions.
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.
In the last 30-40 years the cost to attend UC has gone up significantly (when I attended in the 90s tuition went down to $3,600/yr, it’s 5X that now), but the top schools are still world renown and the next tier have arguably moved up (UCSD and UCSB in particular).
I believe the greatest risk to California’s continued prosperity is the lack of affordable housing (which I would associate partly with Prop 13, but also just general NIMBYism). There have been a lot of efforts in the past few years to move towards higher density but I think we’ll need to wait until the next administration to see if this pro-housing approach is going to stick.
Like FLA and GA? California has higher taxes, california also has internationally ranked economies at the city level.
Of course things could be better, and like a previous commenter mentioned, there are missing investments in housing, transportation and more. That is however, because of the continuous specter of the right winning state offices and the "left" party basically being centerist.
FLA/GA are not major ports. They also do not have the farm land. Prosperity is not entirely location dependent, but it is one of the largest factors. CA has the climate (at least during that period) and natural resources very few places in the world do.
People will say anything to avoid admitting that a higher tax, slightly center right state is doing well because of those policies and politics
Cognitive dissonance, just like the fact that all of the red states have way higher gun deaths per capita than any blue state yet they'll scream about Chicago without looking at the actual numbers
> Cognitive dissonance, just like the fact that all of the red states have way higher gun deaths per capita than any blue state yet they'll scream about Chicago without looking at the actual numbers
Some of the states with the highest levels of gun ownership, like Oregon, Idaho, Utah, Minnesota, and Maine, have the lowest levels of homicides. Rhode Island has far fewer guns than Maine and New Hampshire, but all three have similar homicide rates.
Living in California for four decades I have definitely heard people living here call it Cali. California is large and diverse, not everyone speaks like you do.
Some of the best public elementary, middle/junior, and high schools in the country are in California. Some of the worst are as well. California as a whole has a pretty good public school system. There are certainly issues. But many of them are really just debatable trade offs. For example, the whole San Francisco ed board recall. The main issue (aside from the renaming, which really was a side show to the main event) was the proposal to eliminate merit based entry to the premier high schools. The scientific data is pretty clear that if you want to benefit the most, you should not track students based on ability (i.e., put the "gifted and talented" into special advanced programs) but rather spend your limited resources on bringing the bottom half up. However, this is "unfair" to those who could benefit from development of their above average intellectual talents. In any way you proceed, there will be winners and losers. If you have an opinion on this: vote!
The rankings beg to disagree - https://www.niche.com/k12/search/best-public-high-schools/. Even the best schools in California are not as good as the other state's top schools. It doesn't help that 18%!!! of students in California's public education system are ESL. That's not due to Visa & green-card immigrants.
> Some of the best public elementary, middle/junior, and high schools in the country are in California. Some of the worst are as well.
...
> but rather spend your limited resources on bringing the bottom half up.
Ok, so right here is the issue. It's like saying that US has no poverty issue, because some of the richest people live here. You yourself mentioned, that it is important to improve the bottom percentiles. And the bottom percentiles in California are not good. Some of the exceptional schools in CA are private, some of them are public, but most likely located in expensive areas. You gonna have to pay for a good school either directly or via insane home prices. Yes, you can find decent schools in less-crowded-but-not-very-rural areas with more reasonable cost of living, sort of a sweet spot. And the majority of those schools aren't gonna be exceptional, the will be fine, just fine. Not better than any other state. But the lowest percentile in the worst area is still gonna drag the whole chart down. Everyone I know in CA who cares about school for their kids either lives in a pricy area or pays for a private school.
What the hell do you mean not track students based on ability? How else could you track them?
It's not unfair really. If you let the smart fall to the level of the average, you end up with board and angry smart kids. They will not pull up the middle, they'll check out. The end results will be outsourcing. Based on the skilled worker shortage in Cali, I'd say bringing up the bottom isn't doing much for the top.
My main issue with the BoE was competence. There was a lack of competence across the board, but If I had to give a more specific reason to recall them, it was their incompetence with respect to re-opening schools. Their incompetence around the re-naming showed how bad they were.
As for Lowell, I think that was a big issue for many, but not amongst the 100+ parents that I’ve spoken to on the issue.
My experience with elementary school in California vs. Florida as a kid had such a disparity in quality in favor of California that I was able to notice it even at that young of an age. I came to figure out why much later in life, but I'll never forget that feeling like I'd taken a huge step back.
According to most charts, numerous Universities in California are generally high ranking (the UC system, USC, Pepperdine, Stanford among them) but within numerous specialties it's indisputable: UCSD for biotech, UC Davis for Ag-tech/veterinary science, Berkeley/Stanford for CS, Boalt/Hastings/King for Law, etc. The specialization matters here significantly.
The US weirdly in general has a lot of high ranking universities, but its elementary and secondary schools are very very uneven, at any level.
California has plenty of amazing public schools. But California is also highly segregated by both income and ethnicity. Fremont High School, for example, rivals some of the most expensive private schools nationally in terms of achievement, but it's a majority Asian school, especially South Asian, many of whom are middle- and upper middle-class (notwithstanding that by Bay Area standards the Fremont area is considered "working" class. You can find schools like Fremont all over California, but especially in the Bay Area, coastal Central California, and many places in Southern California.
OTOH, just a few miles from some of the best public schools in the country you can also find some of the worst. While California is segregated, most Californians nonetheless live in relative close proximity to people living in vastly different circumstances, so disparities are very evident.
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?
Bullet train: despite earthquakes and mountains, Japan runs a pretty decent network of high speed trains. Politics, well documented by the papers, show how a high speed train had repeated stops added to it, and was slowed down in California to the speed of a regular train while costing much more.
Despite adding an additional 1.0% tax to fund mental health, homelessness has only increased in California. Efforts to reduce prop 13 inflated property values are feeble at best. Senior and junior water rights, where senior land holders can extract as much water as they want over juniors, based on an arbitrary date chosen in law, have not been reformed. CalPers is very poorly funded compared to other states.
Don't get me wrong, a lot of California's success is due to government. Banning non-competes and funding a strong system of community colleges and state universities for example. But other states are 'kinda' adopting non-compete bans and the state has cut funding years ago to those institutions, which makes me question the value of my tax dollars when a house built just after WW2 costs over a million dollars, K-12 is below the national average, and the public universities here cost much more than well regarded ones in other states. The state is not dealing with it's problems.
Another good point of comparison for the bullet train system is Spain. California is currently projecting to spend $105 billion for 520 miles of track. By contrast Spain built over 2000 miles of track for $72 billion.
I'm not sure this fully tracks. A type of public transit failed in California that succeeded elsewhere. If that is the reference, why can't I point to the tech industry and use it as positive evidence?
And, most of the bad things you are bringing up are happening all throughout the US. Just feels too convenient to say that the tech industry is in spite of the government, but the failures are because of it.
> I'm not sure this fully tracks. A type of public transit failed in California that succeeded elsewhere. If that is the reference, why can't I point to the tech industry and use it as positive evidence?
You asked for an example of another government doing better. I gave you a recent one by California's government. Japan is perhaps the best one, but many other countries do trains a lot better than California despite all the hype and money they put in it's mediocre result. It was a very open question that your follow up questions are trying to pivot to something else.
> And, most of the bad things you are bringing up are happening all throughout the US.
Please read my post again. Being below average in K-12 among the states, despite the high taxes and land values, is not happening all throughout the US.
> Just feels too convenient to say that the tech industry is in spite of the government, but the failures are because of it.
Please read what I wrote carefully above, I did not agree with that fully. My argument was more of the recent CA govt has not been addressing it's problems and the tech industry's success was due to good decisions in the past (and the weather). The recent CA govt actions has been poor. Calling the recent tech boom in spite of government policies is something I can somewhat agree with.
Ah, apologies. This will be a goal post shift, from the question I asked. What I meant was specifically one that does better at the things California is good at.
Think of it as me asking if a tennis player is training well. You want to compare to other tennis players, not cyclists.
You may be able to get some cross learning, of course. But I'm specifically questioning if California's successes are in spite of government. Not if their failures are because of it. These are two questions and it is not clear to me that they would have the same answer.
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.
> California also gets a lot wrong that interferes with tech: … incredible corruption…
Indeed, it is literally “incredible”. What passes for corruption in California wouldn’t even be worth noticing on the older states of the east coast, especially the north east. I’ve lived in both.
I've lived in a few countries, but when I was on the East Coast I wasn't anywhere near noticing this. Happy to grant the point that it's better than the older economies of the East.
Non-competes is an interesting point, I always wonder how much it impacts innovation. Probably very hard to measure and isolate this impact. Current tech scene seems to be a combination of few things: remnants of semiconductor industry, great climate and beautiful outdoors. College system obviously is a factor as well.
non-competes is huge. I've personally been involved in a couple of startups in another country that got hammered by non-compete issues (once even just an implied non-compete). The fact that smart motivated folks can just up and leave a sinking ship and start a debt-free competitor next door relatively easily is a gigantic advantage that is absent is most jurisdictions.
California income tax has no carve outs for capital gains so I don’t know where you got that idea. Rich people specifically don’t like California because of the taxes (as compared to other No or low income tax states).
I assume you are referring to property taxes, but undoubtedly any “dynastic” family is going to have more tax liability from income than from property value.
yes but the point is that they love CA DESPITE the tax burden. In other words, tax them. They will come anyway because it is great there. And the taxes will pay for ever more lovely things like nature preserves and clean air and water and decent schools (yes they are pretty dang good in CA) and art, museums, science, tech, etc. And this will be a virtuous cycle (as it already has been).
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
> the most leftist leftist `that you see on TV` in the US would be considered center-right
ftfy
There is some leftists in the US, i found them. Old hippies or young actives doing a lot of hiking/rock climbing/kayaking and playing music. They mostly don't engage in the two-party politics.
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.
Swinging from a 54B deficit to a 75B surplus then holding that surplus
during a period of record inflation is the absolute definition of
inefficient and wasteful.
A single doctor at a single hospital developed this theory and then tested
it. There is a foundation which is partly funded by the state, but they
just promulgate the ideas... it's up to the hospitals to do the mortality
review and apply what they've learned there. There's really no fingerprint
of recent government efficiency to be found here.
What connection is there between government efficiency and life span of
citizens? This is a minefield of variables.
Aren't minimum wages significantly different between California and Texas?
Wasn't this phased in around that time? How much of this increase is due
to this?
We can contrast California to states like Idaho, which spend 2/3 of what
California spends per student and yet gets far better outcomes than
California does. California has the lowest rate of education attainment
out of any state in the country.
The infrastructure is crumbling. New projects are consumed by consultant
driven graft. Sacramento is generally paralyzed by special interests. The
complete lack of action on homelessness is tragic for the absolute volume
of human life just discarded on the side of the road. Gas prices are absolutely
ridiculous and the state is hoarding tax dollars during grotesque inflation.
8 years ago.. I would have agreed, California may have been a little shabby, but
it was still on a great track. Today I have far less faith in the state, particularly
considering the Governor appears to be desirous of a presidential campaign and
the state is about to be used as a prop in his endeavors.
I am unsure if you've read my comment carefully, but the expectation was a $54B deficit. What they got was a $72B surplus.
> A single doctor at a single hospital developed this theory and then tested it. There is a foundation which is partly funded by the state, but they just promulgate the ideas... it's up to the hospitals to do the mortality review and apply what they've learned there. There's really no fingerprint of recent government efficiency to be found here.
I don't understand. Can you please provide citations for what you're trying to say?
> CMQCC was founded in 2006 at Stanford University School of Medicine together with the State of California in response to rising maternal mortality and morbidity rates. Since CMQCC’s inception, California has seen maternal mortality decline by 65 percent between 2006 to 2016, while the national maternal mortality rate continued to rise.
If you read through the links, you'll see that the Californian Government has made substantial investments in maternal mortality and perinatal care which has resulted in this staggering decline. The resources of the state were mobilized with the help of the best evidence backed medicine to save lives. That's a great outcome!
> What connection is there between government efficiency and life span of citizens? This is a minefield of variables.
It's not about efficiency as much as it is about policy. No large organization is efficient; rather they ought to be measured by their effectiveness.
Investment in hospitals, clinics and public health. Reductions in environmental emissions (air pollution dramatically reduces lifespans). Expansion of coverage programs like medicaid via systems like medi-cal; https://www.medi-cal.ca.gov/ Ensuring access to clean drinking water, adequate sanitation - https://www.npr.org/sections/health-shots/2020/11/23/9379451... . Preventing dumping of toxic waste. Public vaccination programs. And the many, many other levers governments can pull to ensure that people live longer and are healthier.
> Aren't minimum wages significantly different between California and Texas? Wasn't this phased in around that time? How much of this increase is due to this?
In the comment, the study compares California and Texas between 2000 to 2020.
I am not a specialist on the rest, and do not have the data on hand, but just a note, American infrastructure is crumbling in general due to a receding of the state from infrastructure investments.
Could you please provide a citation and explanation for your Idaho comment?
> 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 lived in California for years before I moved to London 3 years ago. I agree that California does a lot of things better than some states and there's an element of "you get what you pay for." But I think that doesn't let California off the hook for the value they return on the money they collect.
Between federal tax, state tax, social security and all the zany other taxes (CA SDI, etc), the tax rate you pay in California is very close to what you pay in the UK or a lot of other European countries. If you own a home, add in yearly property tax which is similar to what you'd pay in UK council tax.
But in London, you get 100% free healthcare (including all medications at a nominal fee), fantastic public transit, weekly trash/recycling pick-up from your local council, extensive council housing to actually house low-income people, etc. The same money is getting more done. I'm not claiming it's perfect or can't be improved, but the services you get for paying roughly the same tax rate are significantly higher (and the same applies in many other cities in Europe).
I think a lot of people in the US don't realize that CA taxes are essentially at the same level as many countries in Europe. So I have at least a little sympathy for people who throw their hands up and move to a low tax, low service state like Texas when they feel like they aren't getting a European level of services for a European level of taxes.
I think some of the inefficiency in California stems from the proposition system where large pots of money are allocated to seemingly good causes but it ties the hands of government who are trying to manage the overall budget efficiently. The amount of propositions included in every voting cycle is comical and in my opinion it is just shifting the work of detailed governance onto the general public who has neither the time nor the expertise to decide on a lot of the issues presented at the level of detail required.
This should be higher up. California’s policies have shown incredible public benefit. As much of the USA has been sliding back on important metrics, California’s progressive politics have pulled it forward. This makes conservatives very mad and they will do everything to discredit it, including trying to spin the budget surplus as a terrible thing, despite them not long ago (15 years ago?) spinning our budget deficit as precisely the same sign of bloated and wasteful mismanagement. This shows they aren’t arguing in good faith.
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.
You could imagine that in quite a few states. California isn’t even on top in terms of GDP per capita (DC, MA, NY, AK, ND all rank higher, CT, WA, WY slightly below).
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.
Republicans have a hammerlock over California to this day, thanks to Prop 13, Prop 218, and the Gann Limit, all of which starve our public resources and prevent duly-elected Democrats from enacting the overwhelming will of the people.
These talking points are all lies, especially Prop 13. Look at the home prices and the home sales, all of which are getting sold at ridiculously high prices. The turnover is huge across the state. Demand for housing is still strong despite the interest rates, despite your Prop 13 BS.
What Prop 13 does is stop retired families from being forced to move out. The retired families in my neighborhood would have to pay $4000+/month in property tax. What will it be in 2030 or 2040? The only thing keeping things sane are things like Prop 13.
And don't forget, Pelosi, in all her glory, was trying to add back in the SALT tax exceptions to the Biden bills earlier this year. Why would she do that except to reward all her rich donors in CA?
Without Prop 13, homeowners would support the construction of multifamily housing in their communities, and that would keep property taxes low for everybody (not just dynastic families) and home prices affordable. Just like things were before Prop 13.
NIMBYs would all of a sudden want more housing to be built? 100% delusional.
Nothing would change except homeowners would get crushed by property taxes and especially given the horrific income inequality in California, all the middle and lower income families would get destroyed.
Thank God for Prop 13, it's the last vestige of income equality for Californians.
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.
Reform is not as simple as 'more' or 'less' regulation. A web of rules and processes can be quite permissive yet so complicated as to cause gridlock. Or they can mess up markets, create perverse incentives, or drive up (or down!) costs.
Regardless of what you think about how to manage going forward, it's hard to argue that current policies are working well. PG&E sells electricity to residential customers in Northern California at approximately 3x the national average price. By comparison, if you're in Oregon (right next door with similar climate, resources, and topography) your power is typically right around (or even slightly cheaper) than the national average. And it's less likely to go out in windy weather. As far as I can tell, PG&E is precisely the company you would expect to get out of the regulatory environment in which it operates (e.g., you guarantee fixed margin on opex and a larger fixed margin on capex, obviously the power company is driven to maximize costs and minimize maintenance). So I blame the regulators more than PG&E.
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.
The fact that the federal government has used the income tax to centralize power, taking money from the citizens of the states and sending (some of) it back with strings attached, is a different issue.
Regardless, the cost of living is the cost of living.
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.
Perhaps is some instances. But there are greatly diminishing returns on cost and regulations in terms of life expectancy. A lot of basic care can go a long way for a low cost with no 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?
There is a product that can be made for $1 that is being sold for $100. They are going to make it and sell it for $2 and you can chose to buy it from their "startup" calinsulin inc for $2 or pay megacorp inc $100 for their one.
Shockingly megacrop inc. are crying that it is socialism to make only $1 and that noble capitalists like them are doing it right and making $99.
>> 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.
They will probably end up failing at this because of politics and waste enormous amounts of money, give up and instead import insulin from China or India and resell it, which would actually work.
How hard would it be to found an insulin startup? This seems like the kind of problem designed to be intractable, the "busy work" of bureaucratic private health care systems.
Depends on the type of insulin you want to make, but if you want to be at the cutting edge it would likely cost around a billion dollars.
You have to avoid the intellectual property minefield on the manufacturing side. The production of insulin and its delivery mechanisms are heavily patented and the big pharma companies will shut you down if you infringe on anything. If you want a reference for this happening you can google 'lusduna'.
Plus you have to make it through the FDA, which is its own can of worms. The 505(b)(2) is still not a cakewalk but at least it will give you 3-5 years of market exclusivity so you can recoup your costs. (Wait you can get market exclusivity for a biosimilar with an expired patent? That should sound insane to anyone not in healthcare.)
Then you have to actually manufacture and distribute your product. There are extremely high capital costs to get set up. For reference, Novo Nordisk's insulin manufacturing facility in North Carolina is 328,000 sqft and staffed by ~500 people 24/7. Just to get a comparable facility up and running you're talking about 400-500 million dollars in capital cost. Sanofi, Eli Lily, and Novo Nordisk have spent billions over the last decade upgrading and maintaining their facilities.
I would suspect it's about the hardest project you could tackle if you were a startup.
No one in their right mind would build manufacturing from scratch. Contract manufacturers exist to do relatively cheap design work in exchange for access to their expensive-to-build (but cheap to use by comparison) manufacturing facilities.
I can't speak to drug manufacturing, but I know from experience that when it comes to medical devices, you save almost 10x in up front fixed cost by outsourcing, like California is doing. You spend more per unit, but still profit, so you can build a healthy warchest while you accumulate experienced personnel to build out a more vertically integrated manufacturing process.
With regard to insulin 3 companies control 90% of worldwide production. I'm not aware of a third party manufacturer that can actually produce modern insulins at scale. Even if they existed, they still have to work around the issues previously stated. It is unlikely that you would be able to partner with the big players as they have no incentive to help a competitor and they are already running at full capacity. You probably don't have any other option than to build it yourself.
Medical devices are frankly a lot simpler than making new drugs. (I know they are still exceptionally challenging)
There are many many very difficult parts to novel drug developments, and I'm not saying they will have success finding something that doesn't infringe and also scales. What I'm saying is that the strategy of doing everything yourself with startup level funding and experience is not optimal, and you can save money and time by outsourcing at the beginning.
There's already a insulin project where they're trying to open source (or something like that) insulin. They just made headway this year or the year before, but it seems like they're a long way from having any kind of effect.
It sounds to me like the modern process is just working up GMO yeast matabolites. I feel like the main issue is probably going to be patents and not something technical.
Yes, state governments have to respect patents. So does the federal government.
However, many patents that are issued in association with a research grant include a clause that allows the government to use the patent without charge. I have no idea if any/many insulin patents are included in such clauses.
Most older expired IP insulin just isn't very convenient to use for most people; it requires more intense participation from the people using it, so you tend to get worse results (imagine if you had to actively think about breathing in enough oxygen every single waking hour of your life -- it's exhausting). The longer acting, more specialized insulins are still heavily patented. When insulin takes longer to work, the person using it has to think less about the insulin and actually gets to live their life rather than think about blood sugar all day.
Now, if you closed the loop and used older insulins, you'd have good control and less issues since a computer would bear the cognitive load, but glucose control, especially in the outpatient setting, is ridiculously hard. If you think you can solve it though, give it a shot. It's a multi billion dollar market and a lot of lives you can improve.
I'm quite liberal on most topics, but I dreaded expecting to read that California state government was going to spin up some office of pharma manufacturing with all the state employees that entails.
Thank god it's only talking about hiring a contract manufacturer to do this.
Next, the question is, will it institute enough protections that someone doesn't take advantage of the cheap prices and sell them for profit elsewhere...
It solves a specific and practical need without being too grandiose.
In the long term, an independent, non-profit, social enterprise, government-sponsored entity would be a better vehicle for this because whichever states, federal (Medicare, Medicaid, VA), pension funds, AARP, and/or insurance companies could back it in order to reduce their costs. It's far better to pool the risks, minimize duplicated effort, and reap the rewards using scale.
This is how pharmaceuticals and healthcare should be delivered for nonelective care.
The leading US industry lobby, PhRMA, will do everything in its power to kill it in some manner whether through the legal system, traditional advertising, and/or social media.
I suspect they're not actually as good as the newer insulins.
"I am an endocrinologist working in the biopharmaceutical industry, and it surprises me that we still need to scapegoat drugs like insulin for high drug prices (“Injecting Some Insulin Reality,” Review & Outlook, April 6). Absent from the discussion is the dramatic improvements in marketed insulins over the past 25 years.
When we talk about modern insulin therapy, we aren’t talking about the old insulins. These agents required patients to carefully plan what they ate well before they did—they should rightly be cheap. Modern insulins allow patients better control of blood sugar and more flexibility. It takes large investments to develop medications. How much is it worth to not have to determine what you will put in your mouth 30 minutes prior to doing so? It is good those days are over."
— Coleman Gross, M.D. Letter to the Wall Street Journal, published there 14 April 2022.
That doesn't seem to answer the question? It lists a bunch of biosimilar insulin analogues but doesn't say why California wouldn't buy them instead of manufacturing their own molecule.
Sure, but why? Why manufacturer another biosimilar, with all the costs and regulatory requirements for manufacturing a new drug (the FDA regards biosimilars as "new drugs")?
They could just have someone who is currently manufacturing the drug sell them at a discount (CA has immense buying power)? If it's not cheap enough, then further subsidize the cost.
Which is why Blue Shield of California, as a major health care payer (which the State of California also is), has invested in doing the same thing (with the same nonprofit that has been discussed as the most likely contractor for the California state effort.)
Because pharmaceutical research is hitting a wall in many areas, and companies are “catching and killing” generic manufacturers specifically to extract more revenue from long invented products.
Government should absolutely play in this space. Hell, one of the primary anti-fungal creams (NYStatin) was developed by a female researcher and state employee in the 1960s.
But it’s not a new insulin, it’s just some manufacturer. Plenty of generic insulin’s exist already. Why build a new plant just to make something that’s already sold?
Government has no profit motive and the existing sellers are not competing on price efficiently. The CA Government can sell at cost plus and force the other players to lower their price.
You can lock in the costs. Drug prices are increasing faster than inflation. We’ll have a republican congress in the the new year that won’t be lowering drug prices via policy.
California has enough diabetics on Medicaid, etc that they can make a capital investment and lock in a less steep cost curve. They don’t need to pay taxes, can borrow at lower rates, and don’t need to make money.
Big players always do stuff like this when constraints exist. Walmart, Apple, Amazon are buying up ocean and air freight assets to skip the lines, for example.
Because California wants to drive the price down. With this system there will both be more supply in the California market and as an investor and part owner, the state can influence the price much more directly.
Whether or not it works remains to be seen. But driving down the price, both for the end consumers and California state insurance providers is the goal.
hiddencost said something very stupid and kcplate mocked him for saying something that stupid. The specific stupid thing hiddencost said was that capitalism was inefficient.
Mocked is probably a bit strong,. I was definitely pointing out the irony a bit sarcastically that virtually everything (excepting healthcare) in Canada is more expensive than the US. Right now, at least 31% more expensive.
> Outsourcing would be financially expedient, but that would be the end of executive aspirations.
Suspicions regarding Newsom's motive notwithstanding, outsourcing production to foreign countries is in fact a more difficult endeavor due to strict controls on pharmaceutical imports by the FDA.
Government manufacturing consumer goods is by definition Communism. Communism has been tried before in many places, and it never worked out well.
This manufacturing plan may bring some short-term results, but long-term cheap tax-payer funded insulin will destroy competition and ultimately make insulin more expensive. There might also start a black market smuggling cheap CA-produced insulin outside CA.
I don't know why the CA politicians could not decide to investigate what trends caused insulin to get so expensive, and to introduce programs to make it easier for existing manufacturers to produce cheaper and for new manufacturers to enter the market.
Your comment does not specify which part of my previous comment is "delusional". The notion that Communism never worked out well is a historical fact.
Looking at the mess that the healthcare sector has become presents yet another example that Communist-style policies do not work well.
Regarding the corrupt and inefficient healthcare system, the solution I would have preferred would be if the government had an unlimited low-interest credit line for each citizen specifically for medical expenses. This would allow anybody to get medical treatment regardless of their financial situation, but still keep the prices low by encouraging bargain-shopping as the credit line would still have to be repaid. Payments could be deducted from paychecks depending on income just like regular taxes.
The most expensive medical treatments don't allow you the luxury of shopping around. And how is the average American going to pay back a millions of dollars loan?
That is a far stretch when a few items are produced by the state to call the society/state a communistic construct. Especially when California hosts so many very capitalistic companies.
They intervened in a disfunctional market and take care of their citizens. That is what a state has to do for their citizens.
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."