I've held off responding to this Times article so I could let my take on this come into focus. The overriding theme of this article is that we, as a society, are paying too much for some segments of our health care, like diabetes. That raises my hackles, for sure, and was why I slept on this before I made any substantive comment.
I've been buying insulin since 1984 and transitioned from animal R and NPH to Humilin, a biosynthetic human identical insulin. From there I moved to Humalog and the other rapid acting modern insulins. While I had insurance coverage this whole time I did notice that the cost of insulin had skyrocketed. I wrote that off, in the beginning, as modern business recovering their investment in developing these new insulin formulations.
From the time of my diagnosis until now, I have benefitted from the improvements of the insulin. My control not only got better but I suffered less from hypoglycemia and had more energy.
Just during the last few months I became aware from commenters on this board that the same modern insulin that I spent over $200/vial was available in Canada for about $30/vial. When I commented that the Canadian health system must be subsidizing that cost, the Canadian members here pushed back hard and said there was absolutely no subsidy of this insulin. They said that the Canadian health care plan specified the sale price limit to the insulin producers and the producers could choose whether they want to enter the market or not. They concluded that the producers must be able to make a profit at $30/vial or they rationally wouldn't enter the market. That seemed persuasive to me.
But then I got to thinking about the enactment of the Medicare Modernization Act of 2003 (aka as Medicare Part D) in the US. This Act specifically prohibited Medicare from using their inherent market power as a huge buyer from bargaining with drug manufacturers to reduce costs. This, in my humble opinion, is the driver of today's runaway drug costs. The Medicare Modernization Act was a deliberate interference in the natural forces of the market to the benefit of Big Pharma. I call it corporate welfare!
The Veteran's Administration (VA) in the US did not make this same choice. They buy drugs in bulk and pass huge savings along to the ultimate consumers. The government and Big Pharma knew exactly what they were doing with Medicare part D since they had a long history with the VA. We, in the US, got fleeced!
Now, I realize that companies that invest millions in new technology need to recoup the costs of their investments but it appears that only US residents are funding that. I don't know, but perhaps it can be said, that the US is subsidizing the rest of the developed industrialized world when it comes to financing new drugs. All I really know is that we neutered the potent market forces that a large buyer in any market exerts when they go out to make purchases. This is antithetical to the perceived traditional conservative politics!
Diabetes should not cost so much but the fault does not lie with PWDs and their doctors. I assert that the fault lies with deliberate market interference as typified by the Medicare Modernization Act of 2003. I further assert that using market middlemen, the US insurance industry, parasitically drains valuable health care dollars and in return provides no benefit.
My fix, if I were king? I would institute a complete replacement of our health care system with a single payer universal Medicare-for-all and completely eliminate the insurance middlemen. It would be a public payer with private providers. I'm not holding my breath!