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Unfortunately, epinephrine is inherently unstable. Research shows that it degrades pretty quickly over time, and it’s recommended that EpiPens be replaced every year.

Mylan stopped selling individual EpiPens and began to sell only twin-packs.It also raised the price.

Kids need them in many places. They need them at home. They need them at school. They need them at camp. They may even want to stash one at Grandma’s house. So people often need to buy quite a few.More revenue for Mylan. And it raised the price.

Then in 2010, federal guidelines changed to recommend that two EpiPens be sold in a package instead of one

People in anaphylaxis need a full dose every time. They therefore need to replace all their EpiPens every year, again and again.

In 2013, the government went further. It passed a law that gave funding preferences for asthma treatment grants to states that maintained an emergency supply of EpiPens. As the near sole supplier of the devices, Mylan stood to make even more money. Advertisement Continue reading the main story That year, Mylan raised the price again.

Of course, competition would bring the price down. But it’s very hard to bring such a device to market.

setbacks, all in the last year, have once again left Mylan with a veritable run of the market. It raised the price of EpiPens again. As of this May, they cost more than $600 a pack. Since 2004, after adjusting for inflation, the price of EpiPens has risen more than 450 percent.

An alternative still exists. The Adrenaclick, while still not cheap, is back and less expensive than the EpiPen. Some think it’s harder to use, though. It’s not on the accepted list for many health insurance plans. More important, few physicians think of it. Because of that, they write prescriptions for EpiPens. Since the Adrenaclick is not a generic version of the EpiPen, pharmacists can’t substitute one for the other. A prescription for an EpiPen must be filled with an EpiPen, regardless of what consumers might want.

you could argue that they’re an alternative when the “Cadillac” EpiPens are financially out of reach. Write A Comment But those are unsatisfactory arguments. Epinephrine isn’t an elective medication. It doesn’t last, so people need to purchase the drug repeatedly. There’s little competition, but there are huge hurdles to enter the market, so a company can raise the price again and again with little pushback. The government encourages the product’s use, but makes no effort to control its cost. Insurance coverage shields some from the expense, allowing higher prices, but leaves those most at-risk most exposed to extreme out-of-pocket outlays. The poor are the most likely to consider going without because they can’t afford it.

EpiPens are a perfect example of a health care nightmare. They’re also just a typical example of the dysfunction of the American health care system.

There is, instead, a practiced authenticity. The biggest stars — even Kylie Jenner — get ahead by giving you deep access to their real lives. As a result, much of what you see on Snapchat feels less like a performance than on other networks. People aren’t fishing for likes and follows and reshares. For better or worse, they’re trying to be real.

The diminution of personalization algorithms and virality also plays into how Snapchat treats news. Snapchat’s primary format is called a Story, a slide show of a user’s video clips that are played in chronological order. This, too, is an innovation; before Snapchat, much online content, from blogs to tweets, was consumed in reverse chronological order, from the most recent to the oldest. Snapchat’s Stories, which have since been widely copied, ushered in a more natural order — start at the beginning and go from there.

insiders at Snapchat noticed that Stories were an ideal vehicle for relaying news. They could be crowdsourced: If a lot of people were at a concert or sporting event or somewhere that breaking news was occurring, a lot of them were likely to be snapping what was happening. If Snapchat offered them a way to submit their clips, it could spot the best ones and add them to a narrative compilation of the event.

Snapchat began hiring producers and reporters to assemble clips into in-depth pieces.

Every day, Snapchat offers one or several stories about big and small events happening in the world, including football games, awards shows and serious news.

Snapchat has said that it thinks of itself as a camera company rather than a social network. This sounds like marketing puffery (after all, it only just started making its first actual camera, Spectacles), but I think its determination to set itself apart from the rest of the tech industry is important to note. Advertisement Continue reading the main story

“However important it was for an individual to win fame and add to his and his family’s reputation, this should always be subordinated to the good of the Republic … no disappointed Roman politician sought the aid of a foreign power.”

now we have a president-elect who openly asked Russia to help smear his opponent, and all indications are that the bulk of his party was and is just fine with that. (A new poll shows that Republican approval of Vladimir Putin has surged even though — or, more likely, precisely because — it has become clear that Russian intervention played an important role in the U.S. election.) Winning domestic political struggles is all that matters, the good of the republic be damned.

Famously, on paper the transformation of Rome from republic to empire never happened. Officially, imperial Rome was still ruled by a Senate that just happened to defer to the emperor, whose title originally just meant “commander,” on everything that mattered.

For such people, toeing the party line and defending the party’s rule are all that matters. And if they sometimes seem consumed with rage at anyone who challenges their actions, well, that’s how hacks always respond when called on their hackery.

Consider what just happened in North Carolina.

Combine this sort of thing with continuing efforts to disenfranchise or at least discourage voting by minority groups, and you have the potential making of a de facto one-party state: one that maintains the fiction of democracy, but has rigged the game so that the other side can never win.

My question, instead, is why one party’s politicians and officials no longer seem to care about what we used to think were essential American values. And let’s be clear: This is a Republican story, not a case of “both sides do it.”

what directly drives the attack on democracy, I’d argue, is simple careerism on the part of people who are apparatchiks within a system insulated from outside pressures by gerrymandered districts, unshakable partisan loyalty, and lots and lots of plutocratic financial support.

the process of destroying democratic substance while preserving forms is already underway.

One thing all of this makes clear is that the sickness of American politics didn’t begin with Donald Trump, any more than the sickness of the Roman Republic began with Caesar. The erosion of democratic foundations has been underway for decades, and there’s no guarantee that we will ever be able to recover.

But if there is any hope of redemption, it will have to begin with a clear recognition of how bad things are. American democracy is very much on the edge.

If you look at exit polls of white voters only, Bump writes, Trump was clearly “earning more support from lower-income whites than wealthier ones.” Others have noted that exit polls diverged more sharply on racial lines than by income, and that Trump played on racial fears openly in his campaign. They argue that what triumphed on Tuesday was white racism.

That strikes me as true. And it also strikes me as true that white workers were acting out of a deep economic grievance on Tuesday. Argument A doesn’t falsify Argument B, in this case

In the nineteen-thirties, Germans suffered terrible economic pain—and many turned openly and violently anti-Semitic. It has been suggested that people find it easier to sustain moral virtues like racial tolerance, fairness, and open-mindedness when they’re prospering. The idea is a little discomfiting to conventional understandings of moral autonomy and personal responsibility. It suggests that it is impossible to provide ethical leadership for people without also attending to their material welfare—and that it is dangerous morally as well as materially for a demagogue to promise to solve an economic problem that he cannot.

Anger over the jobs lost to free trade was a hallmark of Trump’s campaign, and as it happens, in Brennan’s “Against Democracy”—as well as in books by Bryan Caplan and Ilya Somin that Brennan drew on to support his case—voters’ mistrust of free trade is commonly cited as an example of their ignorance.

According to Brennan and his allies, economists agree almost unanimously that free trade boosts a nation’s overall welfare. In March, 2012, when the University of Chicago Booth School of Business polled a panel of economic experts, fifty-six per cent agreed and another twenty-nine per cent strongly agreed that “Freer trade improves productive efficiency and offers consumers better choices, and in the long run these gains are much larger than any effects on employment.

In June, 2012, half of the same panel of experts agreed and another thirty-three percent strongly agreed that “Some Americans who work in the production of competing goods, such as clothing and furniture, are made worse off by trade with China.”

The professional consensus among economists, in other words, isn’t that free trade helps everyone; it’s that free trade so benefits the country as a whole that the government should find it easy to compensate the subset of citizens hurt by it—those who lose their jobs because workers abroad displace them.

In practice, such citizens are rarely given adequate compensation.

A disturbance in a remote corner of the world market leads to chaos and panic at the very center of the system (and these symptoms are given a multiplier effect when the pangs begin at the center itself), and John Micklethwait and Adrian Wooldridge, doughty champions of capitalism at The Economist, admit straightforwardly in their book on the advantages of globalization that Marx, “as a prophet of the ‘universal interdependence of nations,’ as he called globalization … can still seem startlingly relevant … His description of globalization remains as sharp today as it was 150 years ago.

The falling rate of profit, the tendency to monopoly … how wrong could that old reading-room attendant have been?

Marx is so embedded in our Western cast of thought that few people are even aware of their debt to him. Everybody I know now believes that their attitudes are to an extent a creation of their material circumstances … “that, on the contrary, their social being determines their consciousness”, as Marx wrote—and that changes in the way things are produced profoundly affect the affairs of humanity even outside the workshop or factory.

“It’s the economy, stupid.”

What he postulated, and what made him different from any previous theorist of materialism whether historical or dialectical, was a sharp distinction between the forces and the relations of production. Within the integument of one system of exploitation, in other words, was contained a systemic conflict that, if not resolved, would lead to stagnation and decline but, if properly confronted, might lead to a higher synthesis of abundance and equality.

(War between competitive capitalist states, for example, would be an instance of the negative. Seizure of power by an educated working class that understood and could transcend the logic of private ownership would be an example of human progress.

In my opinion, therefore, the most powerful Marxist book of the past four decades was Rudolf Bahro’s The Alternative, which showed how and why the East German state and economy were certain to implode. Communism, said Bahro—one of its former functionaries—was compelled to educate and train people up to a certain level. But beyond that level, it forbade them to think, or to inquire, or to use their initiative. Thus, while it created a vast amount of “surplus consciousness,” it could find no way of employing this energy except by squandering and dissipating and ultimately repressing it. The conflict between the forces and relations of production in the eastern part of the homeland of Karl Marx thus became a locus classicus of the sort of contradiction he had originally identified.

Marx was a keen admirer of that other great Victorian Charles Darwin, and according to Engels he wanted to do for the economic system what the author of The Origin of Species had done for the natural order: lay bare its objective laws of motion and thus make it possible at last to dispense with subjective and idealist interpretations.

The term exploitation, for example, should be not a moralizing one but a cold measure of the difference between use value and exchange value, or between the wages earned at the coal face and the real worth of that labor to the mine owner

there was an underlying love-hate relationship between Marx and capitalism. As early as the Manifesto, he had written of capitalism’s operations with a sort of awe, describing how the bourgeoisie had revolutionized all human and social and economic relations, and had released productive capacities of a sort undreamed-of in feudal times.

it does not quite explain Marx’s later failure, in Capital, to grasp quite how revolutionary capitalist innovation really was. (The chapter on new industrial machinery opens with a snobbish quotation from John Stuart Mill’s Principles of Political Economy: “It is questionable if all the mechanical inventions yet made have lightened the day’s toil of any human being.” This must have seemed absurd even at the time, and it appears preposterous after the third wave of technological revolution and rationalization that modern capitalism has brought in its train.

There’s also the not-inconsiderable question of capitalism’s ability to decide, if not on the value of a commodity, at least on some sort of price for the damn thing. Eugen von Böhm-Bawerk and the other members of the Austrian school were able to point out this critical shortcoming of Capital—no pricing policy—during Marx’s lifetime

John Cassidy wrote of Marx, “His books will be worth reading as long as capitalism endures.” That would appear to mean that Marxism and capitalism are symbiotic, and that neither can expect to outlive the other,

Dean’s own forecast for the next four years is arguably much grimmer. He is not only convinced that Trump will be worse than Nixon in virtually every way—he thinks he’ll probably get away with it.

In Trump, Dean says he has observed many of his former boss’s most dangerous traits—obsessive vengefulness, reflexive dishonesty, all-consuming ambition—but none of Nixon’s redeeming qualities.

Unchecked, Dean worries, these neo-Nixonian instincts will only grow stronger once Trump enters the Oval Office—a place where every occupant since Nixon has found new ways to expand his authority and further his reach.

Hang on when Trump and his crew fully appreciate the extraordinary powers they will have—it is not only going to be thrilling, but dangerous.”

“I don’t think Richard Nixon even comes close to the level of corruption we already know about Trump.”

Yet, he’s profoundly pessimistic about the prospect of Trump facing any true accountability while in office. In the four decades since Nixon resigned, Dean says, the institutions that are meant to keep a president’s power in check—the press, Congress, even the courts—have been rendered increasingly weak and ineffectual by a sort of creeping partisan paralysis.

Dean believes the American electorate has become desensitized to political scandal. In the years immediately following Watergate, he said,  politicians were on high alert, and so was the public. But since then, that culture of vigilance has so eroded that it’s nearly impossible now to envision a sin so grave, or a revelation so explosive, that it would lead to the ouster of a sitting president.

“The Trump campaign is an interesting measure of how high the tolerance has gotten for a public figure’s misbehavior,” he said, citing the candidate’s now-infamous comments on the leaked Access Hollywood tape as just one example.

Dean says Trump will almost certainly weather whatever storms he faces during his presidency. “Unless Trump is a such a disaster that the public rises up and changes control of Congress in the mid-term elections, he is very safe.”

“By nature, I am an optimist,” he told me. “But Trump as president is going to be about surviving disaster.”

they believe it even though there is no clear example of a modern health care system built along the lines that they desire.

The dominant systems in the developed world, whether government-run or single-payer or Obamacare-esque, are generally statist to degrees that conservatives deplore.

As the conservative policy thinker Yuval Levin wrote late last year, the striking thing about Obamacare to date is how much smaller than expected its effect on the overall health care system has been. Fewer people are being insured on the exchanges than liberals hoped, fewer employers are dumping high-cost employees onto the exchanges than conservatives feared

mostly they tend to be much more heavily regulated and subsidized than the system that conservative health policy wonks and policy-literate Republicans would like to see take over from Obamacare.

embracing even the smartest conservative Obamacare alternative requires a not-precisely-Burkean leap of faith.

this is the advantage of Cassidy-Collins: It encourages governors and legislators to actually put the conservative theory of health care to the test without simply reversing the ideological colors of the great Obamacare experiment and immediately turning the entire United States health care system over to the right’s technocratic vision.

There is compelling evidence that markets in health care can do more to lower costs and prices than liberals allow, and good reasons to think that free-market competition produces more medical innovation than more socialized systems.

he writes:The extremely serious problems we are seeing now are within the one system that Obamacare created from scratch, the exchange system. That system may not survive, and its condition has a lot to teach us about the problems with liberal health economics. But it is a much smaller system than anyone thought it would be at this point, about half the size that C.B.O. projected, so that the effects of any failure it suffers are likely to be more contained than anyone might have expected.

If the Obamacare exchanges aren’t ultimately going to work out, then allowing them to persist in liberal states while an alternative system gets set up in red states is a reasonable way to gradually transition from the liberal model toward the conservative one. If the right’s wonks are right about health policy, the Cassidy-Collins approach should — gradually — enable conservatives to prove it.

if the right is wrong, if its model doesn’t match reality, if people are simply miserable as health care consumers because the system has too much of Friedman and not enough of Burke — well, in that case both the country and conservatism will be better off if we learn that via a voter rebellion in 10 right-leaning states, rather than through a much more widespread backlash against a nationwide health-insurance failure

Surely Trump and his advisers know it, too. Blustering his way through rallies and interviews with his mix of insult comedy and unrestrained id has earned Trump plenty of media attention and helped him solidify his reputation as the guy who bucks the establishment and doesn’t worry about policy specifics. He obviously believes that approach will appeal to voters who, as TV viewers, have long been energized by outspoken truth-tellers. So far, he’s been absolutely right.

Which all may explain why many people have been observing Trump, and the election in general, with an LOL sort of detachment. The primaries and caucuses notwithstanding, it’s still early, and many of us have engaged with the political theater the same way we engage with reality TV.

This is how we tend to process most things as a culture these days.

So having a reality-TV celebrity running for commander in chief may subconsciously signal our brains to participate in this election the same way we’ve grown accustomed to consuming reality shows: not as if they’re real, as Omarosa suggests,but instead believing that none of it is genuine, that none of it has any actual consequences.

defend two of their own seats

$10 million in air time to target the state's open Senate seat in Florida

$10 million in Ohio

$8 million in the race to unseat GOP Sen. Kelly Ayotte.

$5 million to defend two seats -- Colorado

$4 million in the race for the Nevada seat

air time will be reserved later in other states where there are major Senate races, like Illinois, but unlikely to be contested in a presidential race.

declined to comment.

10 seats to defend compared to 24 for the Republicans.

Democrats believe that swing voters in purple states will end up voting for their candidates down-the-ticket and help them take back the Senate

Katie McGinty, has benefited from $1.1 million in advertising by the committee

Trump’s monumental ego would be blown up even more by a presidential victory, and his modus operandi in business and the nominating process—telling his subordinates to act with no questions asked, using bluster and intimidation to force others to bend to his will—would be reinforced.

whatever the circumstances, if Trump does capture the Republican nomination and there is no significant third party or independent effort, he has a chance, however remote it looks now, to win. With America’s tribal politics, any nominee probably starts with a floor of 45 percent of the votes. What if there is serious economic turbulence or a Paris-style attack in the fall? Could enough voters in key states like Ohio and Michigan go to the strong man? It’s possible.

Donald Trump’s emergence as the GOP frontrunner and likely nominee creates an existential crisis for the Republican Party, as the angry populism exploited and incited by Republican leaders in Congress to regain majority control turns inward to consume its host. The potential outcomes are bad for the party and its adherents—but even worse for the rest of America.

Many mainstream Republicans have comforted themselves by noting that Trump has no strong or fixed ideology, and as a lifelong dealmaker, is used to some give-and-take. Maybe they are right. But given that he has no understanding of policy or how policy is made, no ties at all to veterans of politics and government, and disdain for all those who have been inside and made those terrible deals, it would be a long, long time before he would or could recognize the reality of governing in a democracy.

If Republicans in Congress can’t help themselves from giving a collective middle finger to the outgoing president, how will they treat a new Democratic president? If Hillary Clinton wins—after the vast majority of Republicans in Congress endorse their presidential candidate by demonizing the alternative, and given the long history of contentiousness between the Clintons and Republicans in Congress—is there any way it can be better?

The near-term future of politics and policy in America is a pretty grim one. Intimidated by the nihilist, nativist pressure from talk radio hosts and bloggers, Republican leaders in Congress are not all that likely to ignore their desires.

A Trump loss—which he would surely blame on the enemy within—would not mean the demise of a Trump movement or the angry populism behind it, and the driving need by Republicans to recapture their party’s mojo in the midterm would probably have them fall back on the populist approach that worked in 2010 and 2014. So brace yourselves for a rocky road ahead, not just in 2016 but in 2017 and beyond. 

It’s also a culture that values physical toughness. It’s a culture that celebrates people who are willing to fight to defend their honor.

It’s also a culture with a lot of collective pride.

Sports has become the binding religion, offering identity, value, and solidarity.

From 1945 to 1995, conservative and liberal elites shared variations of the same vision of the future. Liberals emphasized multilateral institutions and conservatives emphasized free trade. Either way, the future would be global, integrated and multiethnic.

This honor code has been decimated lately. Conservatives argue that it has been decimated by cosmopolitan cultural elite

Much of this pride is nationalistic.

Most of all, it has been undermined by rampant consumerism, by celebrity culture, by reality-TV fantasies that tell people success comes in a quick flash of publicity, not through steady work. The sociologist Daniel Bell once argued that capitalism would undermine itself because it encouraged hedonistic short-term values for consumers while requiring self-disciplined long-term values in its workers. At least in one segment of society, Bell was absolutely correct

There’s now a rift within the working class between mostly older people who are self disciplined, respectable and, often, bigoted, and parts of a younger cohort that are more disordered, less industrious, more celebrity-obsessed, but also more tolerant and open to the world.

But the honor code has also been decimated by the culture of the modern meritocracy, which awards status to the individual who works with his mind, and devalues the class of people who work with their hands.

But the elites pushed too hard, and now history is moving in the opposite direction. The less-educated masses have a different conception of the future, a vision that is more closed, collective, protective and segmented.

When people feel their world is vanishing, they are easy prey for fact-free magical thinking and demagogues who blame immigrants.

We need a better form of nationalism, a vision of patriotism that gives dignity to those who have been disrespected, emphasizes that we are one nation and is confident and open to the world.

Anybody who spends time in the working-class parts of America (and, one presumes, Britain) notices the contagions of drug addiction and suicide, and the feelings of anomie, cynicism, pessimism and resentment.

The conclusion one is drawn to over and over is that Bannon and Trump are living out a cultural revenge fantasy. Bannon-Trump remain bonded to their base not because of ideology or agenda, but because they desire the downfall of coastal and urban elites (personified by the media), detest the ethnic and racial demographic trends that continue to make the country more diverse and hold fast to various myths and an exaggerated sense of victimhood (e.g. climate change is a hoax, minorities all live in violent and poverty-stricken cities, Christians are “persecuted”).

When Trump cannot achieve his aims (e.g. replacing Obamacare with a nonexistent superior system that costs less) or when his rhetoric embroils the country in political and economic conflict, members of his base may notice that their lives are not improving one iota. Perhaps some will stick to him until the bitter end

In the meantime, an impressive coalition of rationalists from right and left is developing. From both sides of the political perspective we see Americans amassing who understand that globalism is both desirable and irreversible and that democratic norms are worth preserving. They’ve decided that what Trump wants to destroy — not just Obamacare but also international liberal structures and democracy itself — is worth preserving.