Business Ideas V: BestUse

Idea: BestUse – analyze real estate through the lens of local zoning and code to determine best use, and identify underused properties

MVP: The process of identifying promising opportunities in real estate is largely a manual one today. Real estate investors and agents scour listings and property records to determine where opportunities to convert an old office into multifamily housing might exist, for example. BestUse would automate this process by using machine learning to compare zoning laws and potential uses to identify underutilized properties. A minimum viable product would involve targeting a particular metro area to analyze local zoning and building rules there in detail.

Market: BestUse has a likely path to market very similar to HiddenLevers (my current concern). The advantage of selling high value software in a niche market is that initial clients can be acquired very quickly after alpha release – the moment HiddenLevers portfolio stress testing worked in a minimal way for a professional audience, client acquisition amongst investment advisors began. With BestUse, real estate investors might quickly embrace a technology that enables them to identify “diamonds-in-the-rough”, properties currently languishing in a sub-optimal use.

The downside with this approach – the total addressable market tends to be limited: if real estate investors are willing to spend four to five figures per year for this capability, the total addressable market might be in the billion dollar range – enough to build a viable business, but not enough for a highly scalable growth path.

Idea Score (0-10 scale, up to 2 points per question): 6 points

Feasibility of MVP / Market Entry: 2

An MVP for BestUse would require a non-trivial initial effort to acquire needed real estate data and to plug in the appropriate analytics on local real estate codes. Actual market entry would likely follow a pattern similar to that for other niche analytics products – get in the hands of paying beta customers and iterate. This is a proven model with much lower risk than launching b2c oriented products.

Revenue Market Size or Eyeballs: 1

If the market is confined to analytics tools used by the commercial real estate industry, then the total addressable market is likely to be subscale (no unicorns here). A high margin $10M revenue business is possible, but getting past this to the next level is a key concern. Since the same sort of analytics is used in commercial real estate appraisal (an $8 billion market), adding this and related capabilities might push the scale a bit – but it’s not clear how to get to a $10B addressable market.

In a Growing Market? 0.5

The real industry is very mature, with growth rates unlikely to exceed the overall economy.

Difficulty, Barriers to Entry, and Competition 1.5

BestUse requires a combination of knowledge of real estate investing with technical modeling capabilities, providing a modest barrier to entry. The need to analyze zoning rules further raises the bar here.

Startups have started to appear in this space – Skyline is using similar analytics to partner invest in properties, an approach which might lead to greater overall market potential. Bowery Valuation is focused on automating real estate appraisals, a naturally related market.

Riding Hype or a Trend? 1

Applying advanced analytics and machine learning to any niche generates interest at the moment – but this is not a particularly innovative or new use case.

Business Ideas IV: Follow My Diet

Idea: Follow My Diet – Help users follow their diet’s guidelines when eating out

MVP: Eating within a diet’s guidelines is challenging for most, and is further complicated when eating out at restaurants. FMD solves this problem by detecting when a user is in a recognized restaurant, and showing only those menu options that meet their diet’s rules (the app would also show how to custom order at restaurants to stay within the diet). At launch the top 100 restaurant chains in America would be supported, representing the majority of all American restaurants – crowdsourcing additional restaurants and menu items should enable coverage to expand quickly from there. FMD will also enable the tracking and optimization of a user’s diet over the course of time – fall off track and the app will let you know what sorts of food choices would put you back on track for the rest of the day or week.

Market:

Roughly 15% of all Americans (45m people) are trying to follow a particular diet at any given time, with total spending in the diet and weight-loss industry exceeding
$33B last year. FMD could market the app toward existing diet providers in the space, as a management tool for their clients. FMD could also find a market in the management
of diabetes and other diseases where diet is an integral part of managing a long-term chronic disease.

With a large potential user b2c user base, freemium or advertising-based business models might make the most sense for FMD – but the possibility of a disease-management oriented approach remains open as well.

 

Idea Score (0-10 scale, up to 2 points per question): 4.5 points

(Overall this idea scored relatively poorly – I think pivoting it toward the health management space, perhaps diabetes or other food-related disease management, could strengthen the business case substantially)

Feasibility of MVP / Market Entry: 1

A substantial amount of restaurant menu data needs to be gathered and maintained in order to enable the app to function – but most of this is readily available and can be parsed online. With major restaurant chains commanding a huge market share in the restaurant industry, it should be possible to gather this data pre-launch in order to enable a functional product at launch.

Revenue Market Size or Eyeballs: 1

While the market size is large (as discussed above), advertising-supported products need to gain substantial scale in order to support a meaningful revenue stream. Since FMD is initially focused on helping dieters eat out, restaurants may be interested in sponsoring the app in order to drive traffic.

In a Growing Market? 1

The market for weight-loss and diet solutions is well established, and on the whole can no longer grow faster than single-digit growth rates. But the market for apps
that help manage diet-related diseases continues to grow rapidly, providing a strong potential growth niche.

Difficult, Barriers to Entry, and Competition 0.5

Numerous competitors exist in the diet app space, and apps even exist to find healthy restaurant options – but none attempt to analyze the mass market restaurant space. This is the opportunity for FMD – fast casual and similar restaurants can be hard to navigate for dieters, but it seems that there are no apps that attempt to solve this menu navigation process in a comprehensive way.

Riding Hype or a Trend? 1

Digital health apps, fitness trackers, and similar are a fast growing space. While diet-related apps operate at the edge of this space, the relationship may provide some halo for a business like FMD.

Business Ideas III: HalfTimer

Idea: HalfTimer – Link employed developers with spare capacity to half-time positions

The economy is going full steam. The number of job openings is at an all time high [1]. Technology positions are particularly in demand, with hundreds of thousands of developer positions unfilled nationwide.

MVP: Halftimer.com places developers interested in long-term part time employment with companies looking for experienced development talent. We have found that experienced developers are willing to lower their hourly rates by up to 40% in order to secure a long term contract that is in addition to their full time job. This differential enables savings for companies that work with HalfTimer – a substantial competitive advantage in the staffing business. The initial MVP need not involve more than outreach to employers and developers via LinkedIn, to staff the first several candidates and prove the model.

Market: 5M full time technology professionals

Halftimer.com builds on a concept successfully used by my other ventures to tap an underutilized resource: experienced, full-time employed developers. Many developers, particularly at large corporations, are not fully utilized whether in terms of mental capacity or even time (this documentary details the situation at length). There are almost 5m individuals employed in development-related positions in the US today – if even 10% have excess capacity, this represents a pool of 500,000 potential resources.

Scoring (0-10 scale, up to 2 points per question): 6 points

1. Feasibility of MVP / Market Entry: 1.5 points

The HalfTimer concept exploits an inefficiency: most employers historically won’t buy limited hours for professional work. On the developer side, developers looking for additional freelance work find it difficult to consistently find small projects that fit around their day jobs. HalfTimer attempts to solve this problem, and market entry is straightforward as this is just a new spin on existing staffing concepts.

2. Revenue Market Size or Eyeballs: 1.5 points

500,000 potential HalfTimers, with net revenue per resource at $15,000 = $7.5B/yr total addressable market. Put another way, staffing ~100 HalfTimers would generate 1.5M in net revenue (against roughly $6.5M in gross revenue), enough to run a profitable small startup. The crucial question: cost of acquisition of both employers and employees.

3. In a Growing Market? 2 points

The technology employment market continues rapid growth, and the core constraint remains supply – which is precisely the problem HalfTimer seems to resolve.

4. Difficulty, Barriers to Entry, and Competition: 1 point

Many existing players in the staffing space could potentially attack this idea, and technically there are no real barriers to entry. Gigster, Gun.io, TopTal, and FlexTeam are startups attempting to ease companies’ ability to find freelance talent – these are similar but not identical to the HalfTimer concept (startup competition bolsters the strength of the idea, as it confirms an idea is worth exploring).

5. Riding Hype or a Trend? 0 points

The gig economy has grown substantially, and HalfTimer represents an evolution halfway between freelance and traditional full time employment. But it’s not clear that concepts in this space have much mind-share at the moment.

[1] The JOLTS survey shows the number of openings to be at an all time high, even when compared to 2000 and 2007 on a relative basis.

Note: I changed the first scoring question to address feasibility rather than whether the idea is “transformative”, which seems to be an imprecise concept at best.

Business Ideas I: Juggler, Never Let A Message Drop

Over the years I have kept a running spreadsheet of business ideas – my current business, HiddenLevers, was once a denizen of the same spreadsheet. But ideas have expiration dates [1], and my idea list has grown while my available time has shrunk. Over the next few months I will be sharing my ideas – I’d love to hear feedback and to inspire others to take the next step or gain inspiration. To provide structure, for each idea I’ll share my thoughts on what I thought the MVP might be, and a scoring of the idea using my own 10 point scale. Here goes!

Idea: Juggler – Never Let a Message Drop

Juggler would watch your firm’s emails, LinkedIn, and other messaging platforms to ensure that every inbound request is tracked and gets a response. The challenge today is that inbound business communication arrives across channels, and often comes in to many different personnel at your firm. Using AI, Juggler would determine which messages actually require response, and monitor these across all firm users, alerting managing when prospects and clients are awaiting response.

There are a ton of AI-based email solutions and also support email solutions from firms like Zendesk – but none of these seem to focus on this specific use case – firm-wide monitoring and taking a global look at all communications to a particular client.

MVP:

The MVP is simple – do the machine learning work to simply determine whether a particular email requires response. Emails asking questions clearly come to mind – but taking a true machine-learning approach, can we approach 99% accuracy here? This can then be married to a simple UI showing individuals (not messages) requiring attention – this sort of dashboard data could ideally then be integrated into Salesforce or other CRM platforms.

Scoring (0-10 scale): 6 points

1. Is it Transformative? 1 point

This is a fairly standard use of machine learning in 2018 – but the accuracy level required to make this viable is not. Also, many businesses still don’t take real advantage of CRM systems, and this idea automates some of the key value concepts from CRM for a small business (ie don’t let any leads slip through the cracks – I’m looking at you, contractors).

2. Revenue Market Size or Eyeballs: 1 point

This is a broad market – virtually every business could use this capability, so volume pricing of even a few dollars a month in a SaaS solution could scale quickly. Presuming that this capability is worth $5/user/month – the US market alone is greater than a billion per year.

3. In a Growing Market? 1 point

While email utilization is stable, multi-channel communication is growing – think chat, social media, VOIP (phone) – in theory the same approach could be applied to all of these.

4. Difficulty, Barriers to Entry, and Competition: 1 point

It may prove difficult to achieve the level of accuracy with machine-learning to inspire user confidence. If businesses suspect that even a few important messages might be slipping through, they will lose confidence and not use the product. Ideally the system ought to learn based on each user and firm’s data – posing a bit more complexity.

5. Riding Hype or a Trend? 2 points

AI and machine-learning are arguably THE trend of the moment, and while arguable overhyped – the Juggler idea definitely is riding this trend.

 

[1] James Watt’s steam engine was an excellent invention, and applying it to pumping water out of mines an excellent business idea – for the 1770s. The concept of hailing a car via smartphone was likewise a great idea – in 2009. It’s also possible to be too early – Yahoo Briefcase shutdown the same year DropBox was founded (although the latter was also a vastly superior implementation).

 

P.S. Investors out there, feel free to reach out if any ideas in this series are of interest – while my core business continues to grow rapidly, I’m open to discussions on how to seed fund and launch against many of these ideas.

TrumpCare (AHCA) – Welcome to Universal Catastrophic Health Insurance

The AHCA would move the USA toward universal catastrophic healthcare coverage, by enabling insurance companies to sign up individuals to $0 monthly premium plans with high deductibles and limited coverage.

While healthcare analysts have been in overdrive commenting on the new GOP health plan, it appears that some key points have been lost in the noise. Whether on Medicaid, total enrollment, or tax credits, it seems that many analysts fail to understand the large-scale implications of the bill. As written, the AHCA has the potential to be transformative – it would retain the goal of universal coverage, while shifting tax credits toward universal high deductible insurance. If fully implemented, the AHCA could actually lead to gains in coverage – but the US healthcare market would be transformed by a move toward high deductible catastrophic coverage.

AHCA Key Changes:

  • Covered Benefits: The AHCA does not change the essential benefits list, but Secretary Price is interested in reducing essential benefits to lower costs.
  • Tax Credits: Tax credits will be less generous, but will cover more of the population, potentially leading to a shift toward catastrophic plans.
  • Medicaid: The Medicaid expansion ends after 2019, but tax credits will be available to all lower and middle-income Americans.
  • Employer Coverage: AHCA creates a strong incentive for employers to drop coverage, since most American workers will receive tax credits.
  • Universality: AHCA provides tax credits to virtually all Americans without other coverage, cementing the goal of universal health care in the USA.
Detailed Findings:

Covered Benefits:
With the exception of abortion coverage, the AHCA does not change the essential benefits under the ACA. HHS Secretary Tom Price has indicated that he will reduce regulations that increase costs – he can do this by limiting the definition of essential benefits.

Tom Price has indicated on multiple occasions that HHS will seek to reduce regulations on health insurance markets, and recently both he and President Trump indicated that these changes would be part of “phase 2 & 3” of their healthcare overhaul. In the past Secretary Price has indicated that he will seek to specifically limit the essential benefits requirement while at HHS.

The AHCA is particularly punitive towards abortion, barring the use of tax credits for any plan that covers abortion services (page 72 of bill pdf).

Tax Credits:
The AHCA offers up to $14k in tax credits per family, at 2k-4k per person depending on age (pages 90-92 of pdf). It also enables insurance companies to claim tax credits on behalf of enrollees, enabling them to offer cheap or free plans to the public.

Much has been written on winners and losers with the proposed tax credit changes. Analysts both left and right fear many will lose insurance. But look at page 106 of the bill: “Not later than January 1, 2020, the Secretary … shall establish a program … for making payments to providers of eligible health insurance on behalf of tax payers eligible for the credit under section 36C.”

Consider what this means – insurance companies will be paid between $2000 and $14,000 per year for each enrollment. In a similar situation in the for-profit university industry, tuition essentially matched federal loan programs, creating a no-money-down product for students. With the AHCA, insurers will be strongly incentivized by the market to offer $0 premium plans in order to maximize their signups of younger individuals in particular.

With the change of young-old ratio to 5:1 (page 66), and Tom Price’s expected reduction of essential benefits, new catastrophic plans will likely flood the market, providing a no cost option for many. See Appendix I for specific examples using 2017 exchange pricing.

Medicaid:
The AHCA ends the Medicaid expansion in 2019, but states may have some incentivize to jump in now, because the future funding they receive is based on the number of enrollees at the end of 2019. Beginning in 2020 the Medicaid expansion will be repealed, and only those enrolled under pre-ACA rules (with stricter income and asset tests) can be newly enrolled into Medicaid.

The AHCA does close a gap caused in non-Medicaid expansion states, where many workers make too much to qualify for traditional Medicaid, but too little to qualify for ACA subsidies. These individuals will qualify for the new AHCA tax credits.

Employer Coverage:
The AHCA removes penalties for not providing insurance (page 84 of bill pdf), and could encourage employers to drop coverage as it provides tax credits to a much larger range of working age Americans.

Per the Kaiser Foundation, the average employer contribution to individual employee healthcare is around $4800, with the employee contributing around $1200. At a 25% federal tax rate, this leads to a tax deduction value of $1500, versus a tax credit of $3000 for the median-age American worker. For family coverage, a tax deduction value (25% tax bracket) of roughly $4500 compares to a tax credit of $9000 for a family of four with adults in their 30s. In both cases, both the employer and employee would benefit if the employer dropped coverage, raised wages, and let the employee take advantage of the tax credit.

Appendix II presents a fully worked example for a family of four making $100k per year, and shows that the family would likely benefit under AHCA changes.

Universality:

The AHCA offers tax credits to all Americans without employer-based healthcare (except those with higher incomes), and as a result the AHCA accepts the ACA’s premise of universal health insurance.

The only Americans excluded from the new AHCA tax credits are those already receiving healthcare from a government program (Medicare, Medicaid, VA, etc) or from employer-based coverage (page 97 of bill pdf).

The GOP has produced a plan that implicitly accepts that universal healthcare is here to stay. The end game (relative to the ACA) will look very different, however, with large swaths of the population covered by high-deductible catastrophic plans.

Appendix I: Are $0 premiums for catastrophic plans really possible?

Is $2000 ($166/month) sufficient to offer a “free” plan to a young adult, or $10,000 ($833/month) sufficient to offer a “free” plan to a family of 4?

Using Healthcare.gov, in the Atlanta area the current cheapest plan for age 21 is exactly 1/3 of the $597 charged to a 64 year old, as a result of the ACA 3:1 limit on costs for older Americans. A bronze plan for age 20 is only $126/month in Atlanta, since the 3:1 limit doesn’t apply below age 21 (even in New York City, individual catastrophic plans are available from around $165/month). Since the AHCA raises the ratio limit to 5:1, this shows how $0 plans will fit within the $2000 tax credit.

How about for a family of four ages 31, 31, 4, and 2? This priced out at $713/month in Atlanta, below the $10k AHCA annual tax credit. Since the AHCA allows excess tax credits to be placed into an HSA, the family could bank around $1500 per year toward future medical expenses while paying $0 in premiums. In New York City, the family premium would be around $1050/month, leaving the family bearing around $200/month in premiums – but this is before accounting for the impact of the new 5:1 ratio and curtailment of essential benefits, which would likely bring net costs to $0 even in NYC.

What about older Americans? A $4000 ($333/month) tax credit will not cover a single 64 year-old’s $600/month premium in Atlanta. If HHS substantially reduces essential benefits, that may close the gap, but with a corresponding loss of benefits. Pre-Medicare age older Americans are clearly the biggest losers under the AHCA reform. But if the AHCA is able to substantially increase enrollment by the young and healthy due to $0 premiums, this may enable more affordable plans further up the age spectrum.

Appendix II: Why Employers May Drop Coverage – A Specific Example

Let’s consider again a family of four, ages 31, 31, 4, and 2. Using Kaiser numbers, on average the family and their employer spent a total around $18,000 on health insurance premiums, with the employer contributing roughly $13,000 of that amount. In the 25% tax bracket, the family is receiving $4500 in value from the existing tax deduction. In total, the family is spending about $500 out of pocket on health insurance when employer assistance and tax deductions are considered.

What if the employer were to drop coverage, enabling the family to receive a $9k AHCA tax credit, and to raise the employee’s salary by $13,000 instead? The employee would receive $9750 in new after-tax income (considering only a 25% federal rate) plus $9000 in tax credits, or $18,750 total. Assuming similar premiums, the family would then spend $18,000 on health insurance, leaving $750 unspent. In total the family might come out $1250 ahead versus the existing system, and the employer would be able to offload the risk and expense of managing benefits.

Why Today is not Brexit USA

Update: Well I get to eat crow on this one! While demographic shifts did aid Clinton, it looks like she may win the popular vote but lose the electoral college, as Al Gore did in 2000. But while I (and many) were surprised by this result, at HiddenLevers we made sure to prepare our audience for the possibilites by looking at the election through the lens of risk parity. Whatever you were hoping for in Election 2016, it helps to be prepared for all the contingencies! Watch our pre-election webinar and scenario forecasts here.

Original Post Below:

It’s become fashionable in the media to compare today’s election to Brexit, and to forecast that the result may play out similarly. Markets and the mainstream will be shocked when the silent majority rises up and defies the global elites! But is this analogy really apt for the US? What’s surprising is the lack of demographic comparisons – the simple fact is that the US looks nothing like the UK, and voter demographics matter even more in an election like 2016.

The UK’s population was 87% white at the 2011 census, and its voting population is whiter and older since many minorities are relatively recent immigrants. The US, by way of contrast, is 61% white, with the voting population estimated to be roughly 69% white in the 2016 election. A 26 percentage point difference between the US and UK mean that the two are worlds apart – the Brexit comparison simply falls down in this light. Mr. Trump may be losing minorities by as many as 50 percentage points, helping to explain the early voting results in places like Nevada. Demographics pose another challenge for Mr. Trump – his voters are on average already more likely than minority voters to turn out, and so the surge he may have whipped up could hurt him as much as it helps him.

While a Clinton victory today isn’t guaranteed, those making simplistic comparisons to Brexit are ignoring the world of difference between the population voting today, and the population in the UK that voted back in June.

What Can Be Done About Skyrocketing Drug Prices?

The American government and even major insurers actually have a lot of levers they can pull to lower drug costs – but do politicians, insurers, and employers have the courage to try?

The drumbeat of overpriced-drug stories has been continuous in America of late, from Martin Shkreli’s 5400% price hike last year, to the recent price hike and subsequent backpedaling of Mylan with respect to the EpiPen. With growing outrage over skyrocketing drug prices, it’s worth asking – what can be done about it? Drug pricing is not subject to typical market forces since a new drug often has exactly 0 direct competitors – enabling a drug company to set virtually any price. New cancer drugs often start list pricing at $300,000 per year, while groundbreaking new Hepatitis-C treatments like Gilead’s Sovaldi started out at $84,000 for a short term (curative) course of treatment. Insurance companies (and major employers) have been unwilling to say no, swallowing each hike and passing it on in higher premiums. Medicare, Medicaid, the VA, and other public entities have been banned from negotiating prices, leaving them powerless to get a better deal for those receiving care through their programs. Here are a few ideas on how to break the logjam, in order of increasing potential savings:

1. The Anti-Monopoly Approach

Making drugs, and in particular so-called small molecule drugs, is actually both inexpensive and easy. The primary protection that drug makers use to enforce their monopoly position on new drugs is the patent system. While this arguably makes sense for new drugs, what about long-generic drugs? In recent years certain drug companies (e.g. Valeant) began specializing in buying up the manufacturers of old drugs and immediately hiking prices. After gaining a monopoly position it became easy to hike prices by 50-100% per year and extract huge profits, while new entrants were stymied by
the FDA approval process required to certify the efficacy of their drug version. Why not streamline the FDA approval rules for generic drug manufacture? If a drug is tested and shown to be chemically identical, how much further testing is really necessary?

Alternately, the Department of Justice or FTC could bring suit to halt acquisitions which would leave zero competitors in the market for a generic drug. Special pharmacies called compounding pharmacies are also capable of making many drug compounds. Why not
allow compounding pharmacies to compete across all generic drugs, or specifically contract with them to make generic equivalents for the VA system or Medicaid system?

2. The “Title IX” Approach

Private American colleges and universities are not actually required by law to provide equity in women’s sports, or to follow any of a wide range of Department of Education edicts. The catch? In order to receive federal funding, institutions of higher education must comply with these rules. Since virtually all colleges make use of varying forms of federal assistance, they fall into line.

The American pharmaceutical industry does very little original research – most innovations originate in the university system, and most of the research funding (over $21B per year) comes from the National Institutes of Health [1]. The American government could utilize this lever to strongly influence drug pricing. Pharmaceutical companies might be required to adhere to certain pricing guidelines if they wished to license research originating from NIH funding.

Those guidelines might require drug makers to release drugs into the generic market on an accelerated timeline, for instance. Or the rules might require that drug makers adhere to a value-based pricing approach, as described further below. Drug makers could be required to pay a tiered tax on drug sales to fund NIH research – a tax of 25% on prices above $1000/patient/month and 50% above $4000/patient/month could simultaneously fund future research and encourage drug makers to keep pricing down. The advantage of the “Title IX” approach is that it preserves the liberty of drug companies – if they don’t want to conform with the rules, they can simply do their own basic research. Fiscal conservatives might find this approach palatable as it directly charges users (drug companies) for the government programs they use, and lowers the deficit in the process.

3. The Value-Based Approach

If insurers and government buyers (Medicare/Medicaid/VA) all insisted on paying for value, pharmaceutical companies might be compelled to go along. How do you define value? The UK’s NICE measures the efficacy of medical treatments by attempting to measure the number of “quality-adjusted life years” provided by that treatment. If a cancer drug postpones death by 2 years on average, and has mild side effects, then it can be said to provide 2 years of QALY. The NIH takes this a step further by quantifying how much it will pay per QALY (currently around 25,000 pounds per year), and it sets prices
on drugs using this approach.

American buyers could emulate this approach by offering to pay for measured improvements in outcomes. If a new cancer drug extends life by 2 years, but existing cancer drugs extend life by 1.5 years, then the value of the new drug is an additional half-year of life. Drug buyers could offer to pay a premium for the new drug based on this degree of improvement, and no more. Buyers could also use this as a way to foster competition between older and newer generations of drugs. The older drug is 75% as effective, so it can be placed into competition with the new drug, but at a discount. Express Scripts took this approach in the Hepatitis-C market and was among the first buyers to find a way to push back against Gilead’s $1000 per-pill asking price for Sovaldi.

Conclusion

As long insurers are happy to pass rising costs along in the form of higher premiums, and American politicians remain beholden to the pharmaceutical lobby, nothing will change. But the ideas outlined above show that America doesn’t need European style price controls to break the drug price spiral – a combination of relatively small policy changes and insurers’ willingness to negotiate are all that is required.

 

[1] This article investigates the breakdown of basic pharmaceutical research in detail, and concludes that big pharma companies contribute less than 25% of research dollars in the US, with most of the balance coming from the NIH.