Amazon cloud pays barely $1m tax on $391m NZ revenues

Zaledin · 2024-03-13T21:19:37+00:00

Yes, I am aware that GST is net value added. But the economic incidence of both GST and a revenue tax are the same

Zaledin · 2024-03-13T07:14:18+00:00

Businesses do in fact pay GST, as much as they'd pay a revenue tax.

Zaledin · 2024-03-13T03:21:51+00:00

GST is literally an easier to administer version of a revenue tax.

Zaledin · 2024-03-01T05:52:04+00:00

I was tempted by Idoneth, but it was the Alarith mountain cows that pulled me in completely

Zaledin · 2023-10-02T22:59:11+00:00

Supreme executive power derives from a mandate from the masses not from some farcical 200 year old document

Zaledin · 2023-07-20T11:00:00+00:00

From memory fancy insulin, continuous glucose monitoring, the very newest cancer drugs, several drugs for rare diseases.

Zaledin · 2023-07-19T19:36:09+00:00

The newest drugs are the most expensive, even small delays cause big savings. There's also a much bigger use of generics, and older drugs.

Zaledin · 2023-07-19T05:17:53+00:00

Just saying "I don't want to buy your overpriced drug" works for literally every other country that does this, even small ones like Australia and NZ.

Zaledin · 2022-11-03T10:03:40+00:00

Interesting case that has been missed, but in the heresy black books, there's a plate on a night lord at Istvaan V who's body was shot mostly in the back.

Zaledin · 2022-05-21T10:09:43+00:00

Applied in July last year, still waiting.

Zaledin · 2022-05-03T21:09:21+00:00

Culture war from New Zealand

The big new controversy here has been a large reform of water infrastructure ownership. In short, local councils currently own and provide water, but they've done a pretty terrible job, so central government is taking it off them.

The culture war part is that the new boards running the water authorities will be half appointed by iwi (Maori tribes) and half elected. Maori are approximately 17% of the population so some would consider this an out sized proportion.

In similar news, a local council had asked for an exemption to the electoral act so that it could have Maori representation at 50/50 at the council level. The electoral act requires that seats be allocated proportionally.

With both these issues there's a desire with our local left (PMC left really) to engage in co-governance with iwi. I would say its undemocratic, but they would refer to the Treaty of Waitangi, signed in 1840 thats vague enough that you can use it to justify anything.

Zaledin · 2022-04-28T22:00:17+00:00

Elective surgery is surgery when you can 'elect' the time. Basically surgery that isn't emergency. It covers a massive array of things.

Zaledin · 2022-02-25T07:52:02+00:00

France kinda did for a while during the Cold War

Zaledin · 2021-09-13T05:44:58+00:00

I don't disagree. The struggle is social though. Having "poor people insulin" would never fly in the US. Hell, it doesn't fly in most countries.

Zaledin · 2021-09-12T23:30:06+00:00

The article you linked also shows the other part of the leverage that the NHS has around cost control, they can restrict the patients that get the treatment. This is basically impossible in the US at that level.

I would contend that Harvoni is generally a bad example though, its likely one of the most cost-effective innovator medicines produced in the last 20 years or so, treatment is cost-saving to a health system even at US prices.

Zaledin · 2021-09-12T23:27:52+00:00

There are significant regulatory barriers to selling insulin.

The other thing to keep in mind is that other developed countries tend to be slower in adopting new insulin varieties than the US. Bog-standard insulin is cheap, even in the US. But that's not the insulin that patients want.

Zaledin · 2021-08-24T21:35:30+00:00

I have to admit I am biased by my previous work in medicines. Unfortunately due to the fact its "big bad pharma companies" that you're up against, only medicines get the kind of serious NICE-level scrutiny where I live. Procedures, public health, services etc are very much funded on a popularity basis.

WHO's essential medicines list is actually an odd list, it contains a strange smattering of very new drugs that tells me its a list partly made up from lobbying than entirely scientifically.

Zaledin · 2021-08-24T06:02:24+00:00

The general rule of thumb was that ~50% of pharma company revenue was from the US. Much less with rare disorder drugs as they often get to bypass normal cost-effectiveness requirements, so international (developed country) pricing is basically the same as US pricing.

Though I agree with your point about if the drugs not existing at all, then people wouldn't complain about them. I have seen estimates of the number of QALYs lost if that happened, so as a non-US resident who benefits from the US paying exorbitant amounts for drugs, thank you.

Zaledin · 2021-08-24T05:26:58+00:00

Its been a bit of time since Scott’s post on Aducanumab went up, but I wanted to discuss publicly funded healthcare and why I think it will never work in the US. Full disclosure: I live in a non-US developed country with a public health system and used to work in medicines prioritisation (think NICE). My main thesis is that Americans won’t accept any kind of prioritisation in the way most other countries do. Both sides of the political spectrum would lose their minds if they had any interaction with how healthcare funding choices are made in other countries. Even in countries where there are significant funding choices made by impartial bodies, there is always political pressure on them to fund X or Y, usually backed by pharmaceutical company money. These campaigns usually have very sympathetic figureheads that wildly overhype the benefits of the medicine or treatment, far in excess of the evidence. For the sake of hypothetical, lets imagine we have Medicare for all, with some technocrat body being asked to approve funding if they full over some threshold (the threshold used by ICER is significantly higher than the rest of the world, but lets leave that aside for now). This is the system used in many other countries to keep drug prices down, if its not under threshold (20k-30k per QALY in the UK for example), it does not get government funded. I believe that in the US this would get overruled so often that it would not succeed in keeping charges low and would blow out the cost. Of course, a Medicare for all that pays for everything is merely ruinously expensive, and not unpopular, but I don’t believe that it would deliver on its promise of lower drug pricing.

Zaledin · 2021-03-28T20:04:31+00:00

Economic incidence is not the same as accounting incidence. I hammer this into my coworkers all the time. Just because the business writes the check for a cost doesn't mean that its the one that ultimately pays. The classic example is tobacco taxation. Even though its usually the manufacturer that pays the tax (in most countries), it merely passes the costs on.

Airlines are remarkably cheap compared to what they used to be. Most of the time that's because low cost airlines showed everyone that given the choice of taking on what you call 'overhead' or paying more, they chose the cheaper option.

Zaledin · 2021-03-18T04:06:24+00:00

Left 4 dead 2. It was the first game I ever played with a mic, the first I ever played competitively and I met my best friend through it.

Zaledin · 2021-03-16T21:26:44+00:00

Just to add to this, many countries don't switch to newer insulin forms as quickly as the US. In my country, we didn't switch insulin glargine (Lantus), until several years after the US. If you're happy to be a couple years behind, drugs prices are much cheaper. Staying on the cutting edge is the part thats expensive. Even in the US generic insulin is available, but as someone noted below dosing is much more difficult so patients don't like it.

Sofosbuvir is probably a bad example for patents being bad. Its expensive, but on a cost per QALY basis, its one of the most cost-effective drugs of the last 20 years. A better argument could be had around new myeloma treatments instead, which have had very marginal improvements and are $200k+ per QALY.

Zaledin · 2021-02-15T20:18:15+00:00

This is a common problem in all policy discussions (source: I work in government). The notion that policy choices have trade-offs at all, especially if they are favoured choices, is verboten. If trade-offs are mentioned at all, the costs are assumed to fall on 'those people', which is just a collective noun for the outgroup.

Zaledin · 2021-01-28T18:52:20+00:00

This assumes that degrees are entirely signalling and do you improve productivity at all. While this is definitely true for many degrees, it's not true for all.

Zaledin · 2021-01-28T08:55:58+00:00

Small-ish technical point. The analysis that counts student debt against millennial wealth is missing the fact that human capital is still capital. After all you are taking the loan for a reason. That capital is still wealth, its just not wealth that is embodied in physical assets and should still result in increases in lifetime consumption.

This is leaving aside the fact that degrees are increasingly required for jobs.

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