After Never-Trump Republicans trendily lament exploitation of
immigrant children at President Trump's detention centers, contemptuously
dismiss GOP opposition to same-sex marriage, and cheer the nation's women's
soccer team for winning the World Cup, they still exhibit a conservative blind spot on
several enduring, less sexy issues. One of these is health care.
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Criticizing Kamala Harris' rhetoric on school busing and
elimination of health insurance companies, George Will argues "One cannot
unring a bell and Harris cannot erase the fact that she has repeatedly said she
wants to take from 217 million Americans -- 80 million more than voted in 2016
-- something most of them like."
This is questionable. A Real Clear Opinion research poll
conducted a couple of months ago found that when people were asked about
support for health insurance obtained "through the government’s Medicare
system," respondents were overwhelmingly in favor. More importantly in
light of Will's allegation, they were asked
“Do you support or oppose Medicare for All, which is a
system that will eliminate all private health insurance companies, and where
all Americans, not just older ones, get health insurance through the
government’s Medicare system?” Even with that caveat, 55% were in support, with
34% opposed.
Very likely, Americans suggested opposition to eliminating
health insurance companies when the question did not suggest an alternative. If
an individual were asked whether she wants those companies to go away, and not
given an alternative, she might believe they would be replaced by
nothing. Given a person a choice of the current system and the current system
with no health insurance, it's likely they'd be far more enthusiastic than Will
suggests.
But of course there is an alternative, the benefits of which
are highlighted by the pharmaceutical market, and especially in the case of
insulin. Natalie Shure writes in The American Prospect
On June 22, 2017, Alec Raeshawn Smith, a recently promoted
restaurant manager with Type 1 diabetes, left his local pharmacy empty-handed.
He’d gone in to pick up a month’s worth of insulin supplies, which he assumed
would set him back around $1000—the amount he and his mother Nicole Smith-Holt
had budgeted the month before when he turned 26 and, under Obamacare rules, had
to drop off her insurance coverage.
For Alec, that price was already steep: Even with his
promotion, he was making $35,000 a year with no benefits. He and Smith-Holt had
combed through Minnesota’s Obamacare marketplace for months in search of a
decent plan, but the affordable ones all had sky-high deductibles. That meant
that he’d be paying full price for his insulin for months before his junk
insurance kicked in, on top of hundreds of dollars in monthly premiums—sucking
up some 80 percent of his take-home pay once he paid the rent. So he made a
rational decision: He’d go uninsured, save the cost of the premium, and just
pay for his meds out of pocket, while racking up work experience that could
serve as a springboard to a better position with health insurance.
As it turned out, it wouldn’t have made a difference if Alec
had been insured or not: The price of his insulin had apparently gone up again
to $1300, which was more than he had in his bank account. Perhaps he felt
embarrassed, too proud to borrow money so soon after finally moving out of his
parents’ place. Perhaps he didn’t want anyone to worry about him, and figured
he could keep his blood sugar down until payday.
So he left. He never told his mother and he never told his
girlfriend. Five days later, he was dead.
The autopsy later determined the cause of death to be
ketoacidosis, a complication of diabetes typically brought about by not taking
insulin.
Shure recounts the history of the "insulin racket" and notes a
recent, published study which determined "one in four diabetes
patients reports rationing their insulin due to costs." She quotes the
lead author, a clinician who has found "that one-in-four number only
reflects people who actually used less insulin because of costs, but other
people make trade-offs. They may be spending less on food or other necessary
items, even on other medications." Shure explains
U.S. drug-pricing negotiations are the responsibility of
individual insurance plans, of which there are thousands. Each of them has
relatively little leverage against price hikes, which drug manufacturers have
every reason to push as high as possible to pay off shareholders, whose
investments were predicated on the promise of some of the highest returns in
the stock market. If you’re a pharma exec whose goal is to maximize short-term
profits, then jacking up prices on a drug like insulin—whose millions of
patients are practically captive—is a sensible strategy.
The result has been predictable and
Average deductibles have quadrupled in the past decade, nearly
half of all people with employer-based insurance have high-deductible plans,
and co-pays have risen or been replaced with coinsurance, a frequently higher
percentage of the overall price. Taken altogether, the deterioration of
insurance quality and rising list prices mean that individual patients are
bearing more and more of the brunt of high drug costs.
Drug prices are too important to be left to the private
market. Shure understands
Removing all financial barriers to insulin to ensure that all
patients have an uninterrupted supply of it would require governmental
intervention, not just relying on multinational companies to devise better
deals. It might even demand making moves that end our reliance on those firms
to make the drugs we need most.
Bernie Sanders' Medicare for All proposal, a single payer system more generous than existing Medicare, would guarantee that patients would
get the prescription drugs they need. (He also has proposed a measure
encouraging development of generic drugs.) However, there is a long way to go
to enacting that and some patients, such as the tragic Alec Smith, have a very
short time to get there. Meanwhile, the prescription drug problem persists- and
you won't be surprised to learn that someone has A Plan For That:
Elizabeth Warren has written legislation providing for the
public manufacturing of generic drugs, and explicitly stated in the bill that
generic insulin would have to be produced within a year of passage.
George Will may not like it- he definitely does not like it-
but two Democratic senators, Warren and Sanders, running for President would
like private insurance to vanish. (Depending on the day of the week, Kamala Harris would agree.) People need access both to the care they
require and to preventive care before they fall victim to diabetes or another
chronic disease. And if the plan is properly framed,
voters would agree.
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