Dustin Weber '20L in a black suit and red tie
Closing Arguments

Rising Insulin Costs: We’re Just Living to Die

By Dustin Weber ’20L

It feels like the U.S. health-care industry is conspiring to kill us. Numerous reports are finally breaking into the mainstream discussion that detail how young adults are dying from being unable to afford insulin. These stories, both heartbreaking and infuriating, have illuminated the moral bankruptcy of our health care system. With a supposed bounty of wealth and resources, the U.S. nonetheless remains the only country in the post-industrialized world with a for-profit health-care system. Without legislation that caps costs, fully funded regulators and limitations on the ability to continually patent life-saving medications, the pharmaceutical industry, and its federal accomplices will be culpable in the deaths of thousands more diabetics.

I am afflicted with Type-1 diabetes. Access to insulin is very literally a life and death issue for me. The unnecessarily convoluted U.S. health-care system has long made access to insulin expensive and frustrating. The Health Care Cost Institute estimates that the average Type-1 diabetic spent approximately $5,700 on insulin in 2016. According to the Journal of the American Medical Association, out of pocket costs for insulin’s consumers, who are helplessly and permanently captured, have more than doubled in the past decade.

I have been insured every year of my life with diabetes, however, my total out-of-pocket costs for diabetes-related health care from my eighteenth birthday through this year exceeds $100,000.Currently, while a full-time student in law school, I spend a significant number of hours working for my father throughout the year so I am able to comfortably afford the $250-$300 I spend monthly on life-sustaining medication.

The fear and anxiety wrapped around unceasing thoughts of a relatively sudden death force us to endure the myriad burdens associated with this inhumane system. The disease, itself, is unrelenting and punishing. Bouts of hyperglycemia are exhausting. Without proper treatment and management, one becomes lethargic, dehydrated, subject to mood swings and declining mental acuity. As the body uses toxic acids for energy, the person is left slowly suffocating before going into a coma. Absent emergency treatment, these comas are fatal.

The causes undergirding this crisis are layered and systemic. One solution is allowing more generic medications to hit the market, but since it is no requirement that manufacturers of generic drugs competitively price its products the prices for generic drugs have crept closer to the prices set by the patent-holding manufacturers. Every insulin manufacturer this decade has dramatically and simultaneously increased its prices. This is not evidence of a healthy and competitive free market. This is collusion.

Yet, even suggesting the pharmaceutical industry actually is subject to market pressure ranks as so laughably absurd one would be forgiven for thinking the assertion came from the president’s Twitter account. By law, Medicare cannot negotiate lower drug prices with pharmaceutical companies. This was a gift given by Congress to Big Pharma, which spends more on lobbying Congress than any other industry, during the controversial passage of the MedicareModernization Act in 2003.

Furthermore, the industry does not set prices based on traditional market factors. Gilead, a pharmaceutical company, recently developed heatmaps and statistical models to determine the probability of public outcry at different price points for a new drug. Once the model determined the highest price it could charge without a strong likelihood of public outcry, Gilead set the drug at that price.

Industry arguments for these killer cost increases are as devoid of empirical support as they are of humanity. Another industry gem is that products get better, so the costs of developing the supposedly more efficacious insulins are built-in to the price increases. Yet, as Dr. Jing Luo, a professor at Harvard Medical School, noted in a study published in The Lancet, “the cost of innovation” argument does not explain why the costs of older insulins are rising at a significantly higher rate than inflation.

Another argument suggests that high prices are needed to fund research and development. The nonsensical idea advanced here is that if the U.S.puts more regulatory controls on the pharmaceutical industry, it will do less research and thus fewer lifesaving drugs will make it to market. Again, the emptiness of this claim, one cleverly designed by the industry’s public relations professionals, is belied by empirical data.

Peter Bach, a researcher at Memorial Sloan-Kettering, which is the world’s largest private cancer center, recently found that the difference between U.S. and global prices of the pharmaceutical industry’s top twenty selling drugs worldwide pays for all of the industry’s research and development costs, with billions to spare. Thus, every sale of every other drug goes to profit and an industry favorite pastime — marketing its wares. These nauseating advertisements really should conclude by stating to ask your doctor if bankruptcy is right for you.

The perverse incentive structure of the U.S.health-care system produces cruel and demeaning outcomes. Money is not made by curing diseases. Rather, month after grueling month for insulin’s consumers, profits are maximized by extracting the most money from patients, while minimizing the amount of medication provided. Unsurprisingly, this approach contributes to further health issues.

Type-1 diabetics are four times more likely to experience depression and more than twice as likely to experience anxiety relative to the general population. I experience some of the former but thankfully less of the latter. A Type-1 diabetic born between the ages of 0-10, the age range in which I was diagnosed, will have fourteen years cut off his or her life expectancy. Evidence not only buttresses the assertion that the U.S. health-care industry is trying to kill us but rather supports a far more alarming conclusion — it is succeeding.

Reprinted with permission by the Advocate. Learn more about advertising and sponsorship opportunities with the Advocate by emailing Ardalan Raghian at araghian@scu.edu for details.