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Insulin: A Prime Example Of The Good And The Bad Of American Healthcare

The evolution of the prescription drug Insulin is living proof of how American healthcare can both save life and end life. Like most prescription drugs the American healthcare industry played a major role in its invention. Unlike most prescription drugs it defies the laws of gravity, the longer Insulin stays around the cost goes up, it doesn’t come down. This life saving prescription drug is a prime example of how good American healthcare is at preserving life, and how greed makes American healthcare bad at providing healthcare to all Americans.

Insulin first became available for sale to the general public in 1922. It is a prescription drug used to treat Diabetes, a disease that is a serious, usually life-long condition and the sixth leading cause of death in the United States. Diabetes is a disorder of one’s metabolism, which regulates the way the human body digest food and converts it into energy. There are three forms of diabetes. Type 1 diabetes is an autoimmune disease that accounts for five- to 10-percent of all diagnosed cases of diabetes. Type 2 diabetes accounts for 90- to 95-percent of all diagnosed cases. The third type of diabetes occurs in pregnancy and is referred to as gestational diabetes. Left untreated, gestational diabetes can cause health issues for pregnant women and their babies.

Because of the high cost of prescription drugs the only way a lot of Americans can afford them is if they are lucky enough to come across discount coupons

Diabetes is a disease condition where blood glucose or blood sugar levels are too high within the human body. Glucose comes from the foods you eat. Insulin is a hormone that helps the glucose get into your cells to give them energy. With type 1 diabetes, your body does not make insulin. With type 2 diabetes, the more common type, your body does not make or use insulin well. Without enough insulin, the glucose stays in your blood. This can cause a condition known as prediabetes when blood sugar is higher than normal but not high enough to be called diabetes. Having prediabetes means a higher risk of getting type 2 diabetes.

The greed pricing of prescription drugs alone can make one sick, causing undue stress over how to pay the artificially high prices

Over time, having too much glucose in your blood can cause serious problems. It can damage your eyes, kidneys, and nerves. Diabetes can also cause heart disease, stroke and even the need to remove a limb. In 2015 diabetes was listed on 79,535 death certificates as the cause of death, and on 252,806 death certificates as an underlying cause of death. Increasingly the number of diabetes deaths is not caused by the disease itself, but by a diabetes sufferer’s inability to afford the prescription drug insulin to treat the disease. A fact that illustrates the bad, greed side of American healthcare.

The biggest problem with American healthcare is cost, and the biggest problem with the cost is the cost of prescription drugs. The prescription drug insulin is a prime example of the ingenuity of American for-profit healthcare to treat a healthcare problem. It’s also a prime example of how American for-profit healthcare greed can literally kill those who need the prescription drugs to live but can’t afford them.

40% of a medicine’s list price is given as a rebate or discount to the government and middlemen, like insurers and pharmacy benefit managers (PBMs). Unfortunately insurers do not share these discounts with patients who pay a deductible or coinsurance

A real life person who unfortunately is the ultimate example of death by healthcare greed is Alec Raeshawn Smith.  Alec started reviewing his options in February 2017, three months before his birthday on May 20 when at age 26 he would age off his mother’s insurance plan. His pharmacist told him his diabetes supplies, mostly insulin, would cost $1,300 a month without insurance. His $35,000 salary was too much to qualify for subsidies for Minnesota’s health insurance marketplace. The cheapest insurance he found had a $450.00 premium each month with an annual deductible of $7,600.00, meaning in addition to the $450.00 monthly premium Alec would have to spend $7,600.00 before the prescription drug co-pay benefit would kick in.

Alec decided going uninsured would be more manageable. He died less than one month after going off of his mother’s insurance. Alec was rationing his insulin, using less than he needed, to try to make it last until he could afford to buy more. He died alone in his apartment three days before payday. The insulin pen he used to give himself shots was empty.

The price of the same prescription drug can vary by hundreds or even thousands of dollars, depending on where you buy it, according to a new report by the U.S. Public Interest Research Group which surveyed hundreds of pharmacies and found large price differences for identical medications.

A logical question is why is a prescription drug that has been available to the public since 1922 unaffordable for anyone 97 years later. The biggest reason the prescription drug insulin is unaffordable for many Americans is because of something familiar to for-profit economics, a monopoly. Currently Eli Lilly, Novo Nordisk, and Sanofi – dominate more than 90% of the world insulin market. Often only one of these companies supplies insulin in a particular country, which means they more or less hold a monopoly there and can set prices as they wish. In 2 countries, China and India, there are domestic insulin companies that drive down the price. This demonstrates how more companies selling insulin in America would bring prices down.

Eli Lilly’s Humalog cost $20.82 in 1996 and now goes for $255.40, an increase of 1,124% over 20 years. Novo Nordisks’s Novolog first hit the market in August 2001 at $39.75, and as of July 2016, a vial comes with a list price of $255.40 exactly the same as Humalog

The 3 pharmaceutical companies are accused of conspiring to fix prescription drug prices, a practice known asshadow pricing.” Two lawsuits, one a class action suit filed by patients and the other brought by the state of Minnesota, allege that all 3 companies fraudulently set artificially high list prices for their prescription drugs while offering rebates to pharmacy benefit managers (PBMs). The rebates are offered in exchange for the PBMs adding the company’s prescription drugs to the healthcare plans the PBMs represent. The lawsuits contend that shadow pricing makes insulin less affordable for diabetes patients in high deductible healthcare plans, the uninsured, and senior citizens covered by the government Medicare healthcare program.

Another greed tactic of pharmaceutical companies is patent evergreening. Patent evergreening is when pharmaceutical companies take advantage of loopholes in the U.S. patent system by attaching new patents to the original 20 year patent. This ensures they can prevent competition and can keep prices high for decades. Sanofi, the maker of Lantus, is a prime example of this greed tactic. Sanofi has filed 74 patent applications on their popular diabetes medication alone, that means Sanofi has created the potential for a competition-free monopoly for 37 years. That’s almost twice as long as the already generous 20-year exclusivity period that exists to reward companies for bringing new drugs to market.

Finally, the most shameful greed tactic pharmaceutical companies engage in is pay-for-delay schemes & lawsuits. A pay for delay agreement is a patent dispute settlement in which a generic manufacturer acknowledges the original patent of a pharmaceutical company and agrees to refrain from marketing its product for a specific period of time. In return, the company receives a payment from the patent-holder. This means it is actually legal for one insulin producer to pay another one not to enter the market and produce insulin. A few years ago the company Merck announced plans to sell a biosimilar version of Sanofi’s Lantus. Sanofi sued, and eventually, Merck announced that it was no longer pursuing its biosimilar, presumably due to payments from Sanofi to stay away. If pay for delay schemes don’t work, the ‘big three’ can still sue other players, prolonging processes and pushing players out of the market because of legal fees and time delays. All of these are win-wins for companies and lose-lose for patients.

This is the position that the greed of pharmaceutical companies have forced many Americans into!!!

The prescription drug insulin is one of the most egregious examples of how greed in American healthcare denies treatment to those who can’t afford it, and literally kills people. All 3 of these shameful greed tactics can and should be prevented by law as part of any of the proposed Obamacare fixes. Democrats need to leave the impeachment of Donald Trump for any corruption to voters in the 2020 election, for now, they need to focus with laser beam intensity on eliminating the greed, corruption and profiteering taking place in American healthcare!!!

A Shiny Object That Deserves Attention

Now that Democrats are about to get their hands on Special Counsel Robert Mueller’s report on Russia /Trump collusion, some of President Trump’s critics claim the Dept. of Justice’s (DOJ) reversal in a pending legal case is meant to be a shiny object to draw attention away from Mueller’s report. Even if the critics are right it’s a shiny object that deserves EVERYONE’S attention.

On Monday the DOJ sent a 2 sentence letter to the Fifth Circuit Court of Appeals stating that the entire Affordable Care Act (Obamacare) should be invalidated. This is the shiny object because this was a sudden reversal, prior to the letter DOJ opposed Texas Federal District Court Judge Reed O’Connor’s 2018 ruling in Texas v. United States that Obamacare was unconstitutional. Texas v. United States was a lawsuit filed by Attorney Generals and Governors of Texas, Wisconsin, Alabama, Arkansas, Arizona, Florida, Georgia, Indiana, Kansas, Louisiana, Mississippi, Missouri, Nebraska, North Dakota, South Carolina, South Dakota, Tennessee, Utah, West Virginia, and Maine.

President Trump is once again trying to destroy healthcare for 20 million people, his latest attempt is to have the U.S. courts to declare Obamacare unconstitutional

The states argued Obamacare relies on the individual mandate that requires everyone to buy health insurance. The Supreme Court upheld the Obamacare individual mandate as a tax. Now that a Republican-controlled House and Senate eliminated the individual mandate penalty beginning in 2019, the mandate is no longer enforceable as a tax and thus is no longer valid. They further argued that without the mandate Obamacare is unconstitutional.

The first thing President Trump did to try to kill Obamacare was to stop making Cost-Sharing-Reduction (CSR) payments to insurance companies. CSR payments offset the cost to insurers of offering affordable plans to poor Americans.

Despite the fact that prominent conservatives like the National Review editorial board are critical of this legal argument, “The Department of Justice has determined that the district court’s judgment should be affirmed,” three Justice Department lawyers wrote to the 5th Circuit Court of Appeals, which is now considering the case.

This is literally what Republicans have been doing to Obamacare from day 1 of its inception, doing any and everything they can to sabotage it.

As usual with President Trump, his actions are contrary to his words. He campaigned saying that he would come up with a healthcare plan that would be better than Obamacare, plans that would be cheaper, provide better care and would cover people with pre-existing conditions. With this move by his Justice Dept. to invalidate Obamacare President Trump is making a lie of his campaign promises.

In fact, if President Trump gets his way and Obamacare is ruled unconstitutional, American healthcare would return to the days when healthcare was truly controlled, not by false government control Republicans lie about, but control by corporations who cared only about their profit and not our health. These were the horrible days of the penny-pinching Health Maintenance Organizations (HMO). Horrible days when Doctors had to call insurance companies to ask for permission to give us treatment. Horrible days when Pharmacist would call insurance companies to get guidance on whether to fill our prescriptions with the brand name or generic drug, Obamacare stopped all of that and gave control of our healthcare back to our Doctor’s.

People rightly think health insurance premiums are high, but they would be even higher than they are now without Obamacare

Giving control of our healthcare back to our Doctors was not the only good thing Obamacare brings to life. It also brings the following 4 good things to life for American citizens that President Trump never mentions:

1) The rate of rising healthcare cost for most people has slowed considerably.  In 2014 there was a 3% increase, in 2015 a 4% increase and in 2016 a 3% increase. The 25%, or the cases like Arizona’s 2017 100% premium increases with the high deductibles, affect the 10 million plus people buying insurance through Obamacare State exchanges.  85% of these people are not affected by the increases because they receive federal subsidies. So we are left with approximately 2-3 million people who make too much to qualify for the subsidies but don’t make enough to afford the insurance premiums. Democrats have just announced legislation to give those 2-3 million people the help they deserve.


According to Speaker Nancy Pelosi’s office, the bill unveiled last Tuesday would make more middle-class people eligible for subsidized health insurance through Obamacare, while increasing aid for those with lower incomes who already qualify. And it would fix a longstanding affordability problem for some consumers, known as the “family glitch.”

U.S. Sen. Ron Johnson, R-Wisconsin, said in 2017 he wasn’t worried about 22 million Americans losing health insurance but he still couldn’t support the Senate health care bill because it didn’t go far enough to dismantle Obamacare and he specifically cited his opposition to guaranteeing health coverage to people with preexisting conditions.

2) Rebated premiums Prior to Obamacare annual double digit premium increases hit everyone but since Obamacare, some have had their premiums rebated. Obamacare requires insurance companies to rebate consumers if the amount they spend on the policy holder’s health benefits and quality of care is too low. The insurance company must spend 80% of the premium they collect from the policy holder on their healthcare, and cannot spend more than 20% of it on the insurance company’s administrative cost. Since this requirement was put in place in 2011 through 2014, more than $2.4 billion in total refunds have been paid to policy holders.

This is the kind of healthcare coverage President Trump wants those who can’t afford health insurance to have, the kind that will put them 6 feet under

3) Obamacare prevents insurance companies from offering any plan that does not cover a minimum of 60% of actual healthcare cost. This requirement goes away with a repeal of the law meaning premiums and deductibles for everyone’s current health insurance plan will increase. President Trump tries to hide this fact by saying that people will have increased access to health insurance. What he really means is insurance companies will be able to offer many cheap plans that provide barebones healthcare coverage. With no requirement that insurance cover 60% of healthcare cost companies can design and sell any plan they want, regardless of what type, what quality and how much healthcare the policy holder actually receives.

This is how President Trump and Senate Republicans want to proceed leaving millions with no health insurance, guaranteeing many of them will die due to lack of healthcare

4) Obamacare is not a job-killer it has helped create jobs. Obamacare has led to 20 million people gaining health insurance and that’s created a great demand for healthcare workers to provide it. Since 2012 over 500,000 jobs were added to the health-care sector.  Private sector job growth has occurred every single month since Obamacare passed in March 2010. The healthcare sector created 234,600 jobs in the first half of 2016, including 39,000 new jobs in June, according to the Bureau of Labor Statistics (BLS). The 2016 growth outpaced the 225,300 healthcare jobs created in the first six months of 2015, a year that finished with a record 471,600 new jobs in the healthcare sector, according to BLS data. Nearly one in four jobs created in 2016 were in the healthcare sector.

If President Trump’s true intent is to provide a shiny object to divert attention away from the Mueller report, his marketing genius has struck again! He was smart to pick killing Obamacare as that shiny object and Democrats are equally smart to allow their attention to be diverted to it, especially now that the Mueller report has made it clear that President Trump didn’t collude with Russia. Now for Democrats, it’s damn and forget the impeachment torpedoes, its full speed ahead to save and fix Obamacare!!!

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