Biden’s Inflation Reduction Act may seem to have reduced the cost of insulin for those on Medicare to $35 a month… but it turns out only for some. If the type of diabetes requires a mix beyond basic insulin, sorry old person, you still lose. Being the only developed country on earth without universal health including prescriptions (and often including vision and hearing care as well), we still lumber under the Republican mantra that we cannot afford to provide this basic program to all Americans or interfere with the research-driven pharmas who make those drugs. By calling it an “entitlement,” they look at this as an optional gift. But a corporate income tax rate reduction from 35% to 21%, which despite assurances to the contrary produced virtually no new jobs but raised and will continue raise our deficit by trillions of dollars, was an essential pro-business move. That is a perfect description of an “entitlement.” Yet, we pay more per capita, by far, for healthcare than any other country.
Republicans derisively call these healthcare programs “creeping socialism,” conflating socialism with social programs (like public schools), just because of a similar root word. Funny how major capitalist nations like Japan, South Korea, UK and Germany have provided universal healthcare for a very long time… and are profoundly globally competitive. We also lumber as a nation run by the 1% that owns well over half of American wealth, where special interests continue to make massive campaign contributions (thank you Citizens United vs FEC for making this so much worse) to ensure that federal and state legislation do not infringe on their profits. Do you know why we have these staggering deficits when we are not at war or in crisis? Because we tax the very wealthiest in our land at rates far below any other major developed economy!
The staggering cost of meds plus lack of universal healthcare only compounds the other shortages as in medical staffing, from nurses and techs to doctors. As costs escalate, essential personnel are let go; existing staff are further overburdened with patient loads that could impact patients’ lives. It’s not just small, isolated hospitals. It’s everywhere. In Los Angeles, giant Kaiser Permanente faces the same cost-staffing gap as the prestigious Los Angeles Cedars-Sinai Medical Center. Cedars just announced senior staff “including pharmacy technicians, administrative support staff, patient service representatives and management employees, in a move that the hospital said was needed to reduce costs as it faces ‘a challenging financial environment.’” LA Times, May 6th. The system is breaking down. Good healthcare cannot be relegated to the rich.
Back in 2010, when the Affordable Care Act (ACA) was passed with a Democratic Congress and President, the bill was “special interested” with an insurance mandate to placate big insurers and requirement that the resulting healthcare exchange would be forbidden to use their sizeable bargaining power to reduce Big Pharma’s unilaterally determined prescription drug prices. Courts and Congress chipped away at the ACA, but pandemic added new coverage for all Americans that is now expiring. Although the Inflation Reduction Act was a micro-tiny effort at bringing the cost of one drug (insulin), we are still at the mercy of Big Pharma pricing. Americans are footing the bill for Big Pharma’s massive advertising campaigns and lost profits in nations with universal healthcare. US private equity firms have also taken to buying out small pharmas with specialized medicine only to jack up the price a thousand percent to make a financial killing… as many sick Americans can no longer afford their necessary treatments. The above chart, provided by the July 22, 2022, Forbes.com, is clear as a bell.
To illustrate how prescription drug pricing works, Kaisa Lipska, an MD/MHS and associate endocrinology professor at the Yale School of Medicine, took her experience with diabetes treatment into an interview with Yale’s Internal Medicine journal (April 27th). Here are some key excerpts: “Diabetes is a disease that’s diagnosed when blood sugars are too high. In people with type 1 diabetes, the pancreas is no longer able to produce insulin. Blood sugar levels are high in the blood stream, but the blood sugar is not getting into the cells, where it can be used as energy. This results in weight loss, profound fatigue, thirst, and other serious symptoms. Without insulin, people with type 1 diabetes cannot survive.
“In type 2 diabetes, people have some insulin but not enough to drive sugar into their cells, a state that is called insulin resistance. Some people with type 2 diabetes can be treated with pills or tablets, but others require insulin so that they have enough of the hormone to overcome insulin resistance and bring their blood sugar levels down. Over the long term, high blood sugars can lead to complications such as heart attacks, kidney failure, blindness, and amputations. Insulin is vital to the health of people with type 2 diabetes… Insulin is seven to 10 times more expensive in the U.S. compared with other countries around the world. The same vial of insulin that cost $21 in the U.S. in 1996 now costs upward of $250. But it takes only an estimated $2 to $4 to produce a vial of insulin.
“From when insulin is produced by the drug manufacturer to when it goes to a pharmacy, profit is extracted at every step of the way. The insulin market is dominated by three large drug manufacturers—Eli Lilly, Sanofi, and Novo Nordisk—that, with little competition, have raised their list prices in lockstep. But there are other players besides the Big Three that are contributing to the problem. Pharmacy benefit managers, or PBMs, contract with insurance carriers and act on behalf of the insurer to negotiate the price of insulin with the drug manufacturers. In negotiating the price, PBMs place a drug higher or lower on their tier of preferred drugs and receive rebates based on a percentage of the list price. This kind of system incentivizes high list prices, which determine the amount of co-insurance patients pay. And if patients have a high deductible or are uninsured, they might pay the entire list price…
“To see how widespread the issue of insulin unaffordability is at the Yale Diabetes Center, we conducted a study that included 199 people who were prescribed insulin. In the survey, we asked them if they rationed insulin, meaning they stretched their prescription, didn’t fill it, or used less than prescribed because of cost. One in four patients told us they rationed insulin. That was one of the first studies that highlighted how much of a problem this was… In another study, we found that more than 1.1 million Americans, or 14 percent of those who filled insulin prescriptions, reached catastrophic spending, defined as spending 40 percent of their post-subsistence income on insulin alone…
“Recently the Inflation Reduction Act was passed with a provision that caps insulin co-payments for Medicare beneficiaries at $35 a month. But I just saw a patient, a Medicare beneficiary, who paid $140 for insulin because of the types of insulin he is on and the way the insulin is packaged. And when that insulin runs out in 40 days, he's going to have to pay that again. Other patients at the Diabetes Center have had similar experiences.” We are a cruel country, it seems. We will twist and squirm to ensure the richest in the land pay relatively the lowest taxes in the developed world… and the rest of us have to make up the difference… sometimes with our lives.
I’m Peter Dekom, and every time some rightwing politico tells the US cannot afford programs that make medical care reasonable to all, they’re telling that America cannot do what every other developed country on earth already does!
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