Saturday, April 02, 2022

One Small Step

Leave it to Republicans to confront a flawed, albeit useful, bill and miss the point entirely, probably intentionally.

The problem is diabetes treatment, and it won't go away by wishing it away when

More than 37 million Americans live with either type one (produce no insulin at all) or type two (do not use insulin properly) diabetes and a quarter of them rely on insulin to stay alive.

But with the price of insulin skyrocketing in recent years (for instance, a vial of insulin made by Eli Lilly cost just $21 in 1999, but by 2019 prices had shot up by 1,000 per cent to $332 a vial), it’s now become the most expensive chronic disease to treat in the country.

That would be 37 million+ Americans diagnosed with diabetes and many others living with it, undiagnosed. The problem, then, is twofold- millions of patients can't afford insulin and pharmaceutical companies are price-gouging.  An effort is being made to address the first problem because the House of Representatives

passed legislation Thursday that would cap the monthly cost of insulin at $35 for the millions of diabetic Americans who rely on the drug.

Lawmakers approved the measure in a 232-193 vote, with just a dozen Republicans joining Democrats in support. It now heads to the Senate.

The Affordable Insulin Now Act, which would take effect in 2023, would limit cost-sharing under private health insurance for a month’s supply of certain insulin products at $35, or 25 percent of a plan’s negotiated price, whichever is less.

The legislation is necessary, though not sufficient because it

doesn’t address the major issue of the US pharmaceutical companies price gouging the overall price of the lifesaving drug, and instead shifts that burden onto a person’s insurers and employers.

For comparison, a study conducted by the RAND Corporation, an American nonprofit global policy think tank, found that drug companies in the US charge more than in nearly three dozen other countries surveyed, while the same study found that the average price in the US was more than ten times higher than the average for all of the other countries combined.

The American average list price for a vial of insulin was $98.70. The closest any other country came to that was Chile where the same amount of the lifesaving drug, on average, costs $21.48.

But leave it to Republicans (only twelve of whom supported the bill in the House) to confront a flawed, albeit useful, bill and miss the point entirely, probably intentionally.  Thus Representative Virginia Foxx of North Carolina called the legislation "a massive power grab that will lead our country one step closer to socialized medicine" as Democrats "want the government to control our lives in every way they possibly can," Similarly, Washington State's Cathy McMorris Rodgers whined "Today, it's the government fixing the price on insulin. What's next? Gas? Food? History tells us that price fixing doesn't work."

If only it were so, the legislation would be even better.  The cost of insulin often wipes out a family's financial security assuming, of course, that an individual or said family doesn't forego the drug in favor of, for example, extravagances such as food, shelter, or transportation.

The cost of insulin should be borne by the public at large, not only by individuals unfortunate enough through lifestyle, diet, heredity, or serendipity to suffer this common ailment. The ideal source should be general revenues, raised through the broad-based income tax, largely progressive notwithstanding unfortunate loopholes utilized by some of the very wealthy. If that's unacceptable, we could  try an excise tax, perhaps on an industry such as sugar or alcohol, without which the incidence of diabetes would be a small fraction of what it is.

Passage in the Senate is doubtful because Republicans will do what Republicans do.  But supporters of health care must press on because, in this case at least, the perfect must not become the enemy of the good.



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