insulin – Sheila Kennedy

Joe Biden

Let me begin this post with an admission: I am older than Joe Biden, so I know a little something about the diminishing energy levels that accompany aging. I sometimes (okay, often) blank on words. On the other hand, I have a significant well of life experience to draw on, and so far, at least, I’m reasonably confident that the lessons of that lifetime have more than compensated for the relatively minor deficits of aging.

And I am over the constant media handwringing about Biden’s age.

Sure, given the challenges of aging, I wish Biden was younger–but after looking at what he has accomplished over the past three years by drawing on his lifetime of political and governmental experience, I realize that significant trade-offs would be involved. (Unlike Trump–who is only 4 years younger– Biden spent his time acquiring the knowledge and skills that have made him a very consequential President.)

In the last three years, America’s economy has added more than 13 million jobs—including nearly 800,000 manufacturing jobs. We’ve unleashed a manufacturing and clean energy boom. In 2021 and 2022, more than 10 million applications were filed for new small businesses—the strongest two years ever recorded. Since the pandemic, America has had the strongest growth of any leading economy in the world. Inflation has fallen for 11 straight months.

As my middle son observed, “Biden is the first President I’ve voted for who has exceeded my expectations.”

And as an article in the New Republic argues, there needs to be more recognition of the skills Biden brought to the job.

Nobody seems to have noticed this, but over the course of the spring, the country’s four leading freight rail carriers agreed to grant the vast majority of their workers paid sick days.

Everybody remembers what happened last December. The workers threatened to strike over such days, among other issues. President Biden, generally very friendly toward labor, made it illegal for the workers to strike. He was criticized by unions and workers and fellow Democrats and liberal media outlets, this one included….

When the workers prevailed, the International Brotherhood of Electrical Workers explicitly acknowledged that the Biden administration had

played the long game on sick days and stuck with us for months after Congress imposed our updated national agreement. Without making a big show of it, Joe Biden and members of his administration in the Transportation and Labor departments have been working continuously to get guaranteed paid sick days for all railroad workers.

As the article argued, the administration needs to start “making big show” of such accomplishments.

Biden has been a terrific president. The big legislation. The way he played Kevin McCarthy on the debt deal. The global leadership against Putin. The plain human decency restored to the White House after four years of self-obsessed thuggery. Oh—the 13 million jobs created since he took office, which is more jobs in 28 months than created under any other president, in all of our history, in a full four-year term.

As Jennifer Rubin recently wrote in the Washington Post, Biden has an economic record that has been working far better than most people anticipated but that the electorate doesn’t yet recognize.

The economy has created 13 million jobs, inflation has been more than cut in half, huge investments are being made in infrastructure and green energy, wage growth has begun to outpace inflation, the first drug price controls are going into effect and the biggest corporations will finally be forced to pay something in federal taxes. Yet polls show voters incorrectly think we are in a recession and remain negative about the economy.

As Robert Hubbell recently reminded us, “The constant hum of investigations into Trump’s many crimes is obscuring one of the great modern presidencies.”

Historians will look back in wonder at what Biden achieved in a presidency that began mid-pandemic before the smoke of a failed coup and insurrection had cleared. Despite those obstacles, his legislative record rivals or exceeds that of every president since FDR—a president who was mired in controversy throughout his tenure.

The Biden Administration has a three-part vision: targeting investment, empowering workers, and promoting competition. That vision includes enforcing antitrust rules and allowing Medicare to negotiate for lower drug prices. (Recent results: cheaper insulin and real wage growth.)

As the New Republic reminds us,

Liberals have a list of 50 things they want government to do, and they want those things done fast and to completion. Conservatives have a list of about two things they want government to do: Cut taxes, and punish people they disapprove of morally. For a presidential administration, satisfying that first group is a lot harder than satisfying the second

As someone has pointed out, It’s not how old you are. It’s how you are old.

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Affording To Live…

GOP lawmakers–including, of course, Indiana’s two Senators–recently blocked a Biden Administration effort to cap the price of insulin for Americans with private health insurance. (Americans on Medicare will see their out-of-pocket costs decline, thanks to other provisions of the Inflation Reduction Act.)

GOP opposition to the measure, which I can’t help thinking of as a manifestation of the Republican “Let them eat cake” approach to policymaking, reminded me of a recent discussion with my sister. Her doctor had rordered some medical tests, and when she was scheduling them, she was told that one of them–a test for cancer!–wasn’t covered either by Medicare or by her private insurance. The test was $300, and she told me that her first thought was “I can afford this, but what about all the people who can’t? What about people who don’t have an extra $300 but do have cancer?”(Fortunately, she didn’t.)

This conversation, rather obviously, wouldn’t have occurred in most Western democracies, because in those countries, health care isn’t just for people who can afford it.

When it comes to capping the price of insulin, the influence of Big Pharma–particularly Indiana’s own Eli Lilly–was front and center with the GOP.

Lilly’s enormous profits owe a lot to the high price of insulin. That’s especially ironic, given the generosity of those who first held the patent.

Before the 1920’s, a diabetes diagnosis meant a death sentence for people all over the world. The main treatment was starvation diets to prolong the inevitable.

In 1920, a Canadian physician and scientist named Frederick Banting began working on an idea to isolate and extract insulin. He worked in the laboratories of J.R.R. McLeod, a professor of physiology at the University of Toronto. The medical student Charles Best aided him in his work to test out insulin on dogs. Chemist James Collip worked with Banting and Best to purify and refine insulin for clinical trials in humans.

On January 23rd, 1923 Banting, Best, and Collip were awarded the American patents for insulin. They sold the patent to the University of Toronto for $1 each. Banting notably said: “Insulin does not belong to me, it belongs to the world.” His desire was for everyone who needed access to it to have it.

In order to make insulin widely available, Eli Lilly, Sanofi and Novo Nordisk were given the right to produce it, and they’ve turned it into a massive profit generator. As the linked article reports, “by 1923, insulin was the highest-selling product in Eli Lilly’s history, and profits from it accounted for over half of the company’s revenue.”

And that brings us to the recent refusal of Indiana’s Senators and other GOP recipients of Lilly largesse to ensure insulin’s affordability.

As The Intercept reports, Lilly Endowment–ostensibly separate and independent from the company–is not neutral when it comes to funding entities opposed to controlling the price of medications. The Endowment,”led in part by former Eli Lilly executives and still financed by corporate stock options” funds think tanks that “work to shield corporations from taxation or government regulation,” and has given millions of dollars to libertarian groups that lobby against price controls on insulin, categorizing those recipients as “community development organizations.” (The Endowment is also the largest shareholder of Eli Lilly, Inc., holding 104,161,053 shares worth approximately $31 billion.)

The Federalist Society, for example, has received over $1.5 million from the charitable arm over the last decade and is listed under “community development” grantees of the Lilly Endowment. The Washington, D.C.-based group is a professional society for conservative attorneys, with an eye toward pro-business ideological positions.

The Federalist Society funds included a $150,000 grant last year, at the same time that the group was sharply criticizing a new Minnesota law that forces manufacturers to provide free or affordable insulin to low-income residents. The law “[inflicts] an injustice upon companies that are regularly demonized in the media,” an attorney for the Goldwater Institute writes on the Federalist Society’s website.

Last year, Eli Lilly collected over $2.4 billion in revenue from its insulin products, including the brand Humalog, with roughly $1.3 billion of that from U.S.-based sales.

“One vial of Humalog (insulin lispro), which used to cost $21 in 1999, cost $332 in 2019, reflecting a price increase of more than 1,000%. In contrast, insulin prices in other developed countries, including neighboring Canada, have stayed the same,” wrote S. Vincent Rajkumar in the journal of the Mayo Clinic in 2020.

There’s much more detail in the linked article, and I encourage you to click through and read it. That said, the real issue is the one my sister identified: if government is supposed to provide a physical and social infrastructure within which citizens can flourish, isn’t access to health care and lifesaving medication as essential a part of that infrastructure as police, firefighters, roads and bridges?

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People Will Die..

How many ways can this administration kill people?

Scientists tell us that changes to environmental protection laws will lead to at least 80,000 additional deaths each decade.

The announcement that acceptance of refugees fleeing war and persecution will be capped at 30,000 per year–the lowest number ever–has been condemned by Amnesty International, The International Rescue Committee and Human Rights First. What those organizations labeled a “shameful abdication of our humanity” will result in untold numbers of deaths.

The GOP’s solicitude for the “rights” of the NRA continues to facilitate more than thirty thousand gun deaths each year.

Those are all fairly high-profile issues, and at least they’ve generated public debate.

Unfortunately, there has been much less publicity about the government’s ongoing refusal to impose rational regulations on Big Pharma. (Here in Indianapolis, our pathetic excuse for a newspaper simply ignored a recent demonstration protesting Eli Lilly’s pricing of insulin– instead, it ran a front-page “warm and fuzzy” article about the company’s new migraine drug). That failure, too, continues to kill.

If you wonder why single-payer healthcare has become such an overriding political issue, the case of insulin pricing may provide a clue.

Diabetes is one of the most common diseases in the U.S. Its incidence continues to climb, and huge numbers of diabetics are insulin-dependent.

According to information provided by an organization called “Insulin4All”

the price of insulin has increased 1123% since 1996. This isn’t because of new discoveries–prices have increased on medications that have been around for decades.
More than 7 million Americans are insulin dependent. More than 25% of those Americans have had to ration their insulin due to cost.
Over 6,000 GoFundMe pages are asking for money to purchase insulin. (Shane Patrick Boyle, an artist who had moved to Arizona to take care of his mother and was in between health insurance plans, died from diabetic ketoacidosis. He was $50 short in his Go Fund Me for insulin.)
Some people are paying $1400 a month for their insulin.

The Insulin4All organization is asking two things. First, it wants pharmaceutical companies to disclose their manufacturing costs and profits, along with their marketing expenditures. Second–and incredibly important for all health care, not just diabetes treatment–they want the government to allow Medicare and Medicaid to negotiate drug prices, like other countries’ governments do.

In all fairness, this isn’t the first administration and congress to place the bottom line of drug manufacturers above the needs of sick people needing medicines. It has to stop.

Big Pharma will claim that R & D costs a lot of money, and that those costs justify high prices for their products. It is absolutely true that research and development is costly–but it is also true that a significant percentage of those costs are covered by taxpayers who also deserve a return on their investment.

Since the election, the federal government has cut back on support for basic research (an enormously self-defeating, “penny-wise, pound foolish” policy). Data from the National Science Foundation shows that, since those cutbacks, federal agencies provided “only” 44% of the $86 billion spent on basic research. Before that, however, the federal share of all research routinely topped 70%, and it was 61% as recently as 2004.

In addition, foundations, state and local governments, voluntary health associations and professional societies support drug research and development.

No one is suggesting that Big Pharma forgo a reasonable profit. What is reasonable, however, cannot be determined without increased transparency about actual costs, and the share of those costs coming out of the taxpayers’ pockets.

People who need insulin are dying because they cannot afford it. A lot of people.

Maybe the drug companies could run fewer television ads prompting people to ask their doctors for Purple Pills and the like, and use those savings to bring down the cost of lifesaving medications.

And maybe an administration and a Congress less beholden to corporate interests and big money would consider policies less likely to kill people.

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