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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!!!

Should One Person One Vote Be Real???

In the 2000 election, the winner George W. Bush won 5 more Electoral College votes than the loser Al Gore, but Al Gore won 543,895 more Election Day people votes than George W. Bush. In the 2016 election, the winner Donald Trump won 77 more Electoral College votes than the loser Hillary Clinton, but Hillary Clinton won 2,868,686 more Election Day people votes than Donald Trump. The results of both these elections raise the question should we get rid of the Electoral College and make one person one vote real in America?

The short and logical answer is no. Believe it or not in America, the world’s freest democracy, when it comes to electing the President and the world’s most powerful person, one person one vote should NOT be real. It’s currently not real by design. The founding fathers established the Electoral College in the Constitution as a compromise between election of the President by a vote in Congress and election of the President by a popular vote of the citizens.

The Electoral College works a lot like Congress: The U.S. is divided into 435 congressional districts, each of about 710,000 people. Each district elects one person to the House of Representatives. Every state elects two senators. Electoral College votes are allocated the same way. (The District of Columbia is the exception; it doesn’t have representation in Congress, but it gets three electoral votes.) There are 538 total electors, each with one vote

The Electoral College is made up of 538 electors who meet in December following the national election and cast the ACTUAL votes that determine who is elected President. A person must receive 270 electoral votes to be elected. The 538 electors come from all 50 states and Washington D.C., each state’s number of electors is equal to the number of Congresspersons and Senators they have. One elector for each Congressperson and one for each Senator and Washington D.C. gets 3 electors making the total 538.

On Election Day citizens of America symbolically vote for the candidate of their choice but actually vote for a pre-chosen slate of state electors who will then cast the actual votes to elect the President. State electors meet in their respective state capitals in December to cast their votes. Once the results are certified by the states and D.C. they are then sent to Congress, where they are tabulated nationally in the first week of January before a joint meeting of the Senate and House of Representatives. In the event that no candidate received the necessary 270 Electoral College votes, the House without the Senate would themselves vote to decide the election.

The founding fathers designed the Electoral College because they didn’t think that citizens could be trusted to elect a President for the right reasons due to ignorance, gullibility, or manipulation of citizen’s emotions and passions. Alexander Hamilton writes in “The Federalist Papers,” The point of the Electoral College is to preserve “the sense of the people,” while at the same time ensuring that a president is chosen “by men most capable of analyzing the qualities adapted to the station, and acting under circumstances favorable to deliberation, and to a judicious combination of all the reasons and inducements which were proper to govern their choice.”

James Madison worried about what he called “factions,” which he defined as groups of citizens who have a common interest in some proposal that would either violate the rights of other citizens or would harm the nation as a whole. Madison’s fear – which Alexis de Tocqueville later dubbed “the tyranny of the majority” – was that a faction could grow to encompass more than 50 percent of the population, at which point it could “sacrifice to its ruling passion or interest both the public good and the rights of other citizens.”

Unfortunately its true that one of the reasons the founding fathers created the Electoral College was to aid slave states, but the principle of making a state with a small population equal to a state with a large population is correct

The ignorance and gullibility concerns of Hamilton’s 18th century America have been muted by America’s 21st-century technology, a better-educated citizenry, a robust mainstream media, and the internet. Madison’s 18th century “the tyranny of the majority” concerns are not muted and are still valid in 21st century America. There are plenty of 2018 examples of the tyranny of the majority at work in States throughout the country. From partisan majority gerrymandering, partisan majority legislatures passing repressive voting laws, the majority manipulating the rules for both registering to vote and casting a vote, and the majority manipulating the rules that determine who stays on the list of registered voters and who is removed. But his “factions” concerns could become a threat to democracy in an unforeseen way if the Electoral College is removed from the election process.

The last time a presidential candidate got over 50% of the popular vote was 2008 when Barak Obama got 52.9% of the popular vote, a feat he repeated in 2012 when he was reelected with 51.1%. Before 2008 it was over 30 years ago in 1988 when George H.W. Bush (the father) got 53.4% of the popular vote. 4 years later in 1992, Bill Clinton defeated him winning only 43% of the popular vote to Bush’s 37.4% and independent candidate Ross Perot’s 18.9%. Clinton was reelected in 1996 winning 49.2%.

In 2000 George W Bush lost the popular vote but won the Electoral College vote and in 2004 was reelected winning 50.7% of the popular vote. In 2016 Hillary Clinton won the popular vote with 65 million plus votes but lost the Electoral College vote to Donald Trump. Clinton’s popular vote win was only 48% of the total of all votes cast because independent candidates Gary Johnson and Jill Stein were also in the race. In each instance where the winner of the popular vote did not win a 51% majority of all votes cast, there was a 3rd party candidate in the race.

Barak Obama is the only President to win a 51% majority of the popular vote in the last 30 years, if the Electoral College is removed he might be the last

If America abandoned the Electoral College and adopted a system in which a person could win the presidency by only winning a plurality of the popular votes cast, would make the current situation worse. Because the more candidates there are in the race the fewer votes one candidate needs in order to have the most votes to win the race. In theory, a single issue candidate in a race with 10 other candidates could win the race by winning only 25% of the total votes cast. No person elected with only 25% of the votes cast could ever claim to have any mandate from the voters to truly lead and would start from day one as a very weak President.

Another problem that eliminating the Electoral College would create is the prospect of presidential campaigns ignoring states to a much greater degree than they do now. Over half (177,869,320) of America’s 329,093,110 population live in the 10 most populous states of California, Texas, Florida, New York, Pennsylvania, Illinois, Ohio, Georgia, North Carolina, and Michigan. A campaign could decide that a state like Wyoming with a population of less than a million people isn’t worth the effort. That it should focus only on the 10 most populated states and win the election without having to campaign in the other 40 states. In other words, millions of citizens would never have their votes sought after meaning their voices on the issues of the day would not be heard.

The only reason Iowa gets so much attention with such a small voting population and only 6 electoral votes is because traditionally its been the very first primary contest

The main rationale for keeping the Electoral College is that states like Iowa get the attention they would not in a true one person one vote election, but in reality, nobody goes to Iowa after the primaries for general election campaigning. The only reason people campaign in Iowa is because it’s the first primary contest and winning it can give a campaign early momentum. Once the general election campaign starts no campaign is heard saying that it needs to make stops through Iowa or Wyoming?

Because any campaign in search of votes, be they people votes or state elector votes, is going to where the greatest number of those sought after votes are gathered. Wyoming with only 3 electoral votes and Iowa with only 6 will lose out every time to the other 21 double digit electoral vote states. But one tweak of the Electoral College could change all that and make the problem of any state being ignored a true thing of the past.

If the Electoral College was removed from the election process it would give heavy populated states like California and New York an unfair advantage under a one person one vote election process

Currently, the District of Columbia and 48 states have a winner-takes-all rule for the Electoral College. In these States, whichever candidate receives a majority of the popular vote, or a plurality of the popular vote (less than 50 percent but more than any other candidate), takes all of the state’s Electoral votes. This aspect of the Electoral College is not mandated by the Constitution and therefore it’s up to each state’s discretion which is why Nebraska and Maine, do not follow the winner-takes-all rule.

Because Democrats have won the popular vote but loss the election twice the vast majority are in favor of getting rid of the Electoral College

If each state would follow the lead of Nebraska and Maine by allocating Electoral College votes to the candidate that wins the Congressional district within the state, would make all states viable hunting grounds for all candidates looking for Electoral College votes. No longer would campaigns focus only on battleground states, a state like Wyoming or Kansas with its 6 electoral votes would no longer be overlooked, to the contrary they would be viewed as places where 1 or 2 votes could be picked off regardless of whether it’s a blue or red state.

It would make it worth it for a campaign to expend the time and resources in non-battleground states to attract the votes which could lead to 1 or 2 Electoral College votes. In both the election campaigns of Al Gore and Hillary Clinton for President, had all 50 states allocated Electoral College votes based on who won the Congressional districts within the states instead of winner take all, American history would have recorded a President Al Gore and a President Hillary Clinton.

The Electoral College is currently configured for an 18th century America which can deny the will of the people’s popular vote. But a tweak in how Electoral College votes are awarded to candidates can make it a 21st century inclusive process that reflects the will of the people’s popular vote.

Like the rest of that grand document the founding fathers conceived over 200 hundred years ago, there’s logic in the concept and principle of the Electoral College that they designed. All it needs now is for 48 states to make a methodology tweak in how its Electoral College votes are awarded, which will make it as effective for electing the President in the 21st century as it was for the founding fathers when they elected the President in the 18th century.

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