One of the many hopes of a Medicare-for-all program is that in giving our government a larger share of the medical “market” (for lack of a better term), Americans—collectively—will be able to negotiate down the skyrocketing costs of medicine. Every day brings tragic stories of Americans young and old, of all racial backgrounds, dying after rationing their insulin—the result of explosive increases in the costs of the drug. While some people’s diabetes treatments have risen from $24 to $80 per vial over the past decade, others face much more prohibitive prices. As diabetes patient Alec Raeshawn Smith’s mother told NPR in September, her son’s monthly bill for insulin and related supplies was around $1,300 without insurance—something he and his family could not afford. He died, having most likely been rationing a lifesaving medication he could not afford.
These aren’t outliers. According to a study by Yale University researchers, 1 in 4 people with diabetes are rationing their prescriptions. This is not a new phenomenon, but one that is getting worse with the continuing rise in drug costs.
The most severe cost of insulin deprivation is death, but people who survive with diabetes have to deal with the stresses brought about by rising and falling blood sugar levels. These can include passing out, losing one’s ability to control their temper, nausea, and dizziness. A woman recounted to the New Yorker’s Amanda Schaffer how she and her sister, who both have Type 1 diabetes, have shared and rationed their insulin due to its rising costs. It’s something that has driven her life, leading to her dropping out of college her first year: “I lost a lot of weight that year, about twenty pounds. When you don’t have insulin, you can’t eat much because you can’t correct your blood sugar. So I was barely eating. I was supposed to take four to five shots of insulin a day, and I was only taking two to three. I was lethargic all the time. I was rationing just so I could live. I knew if I ran out I wouldn’t survive more than a few days. That took a mental toll.”
The solution is cheaper insulin. The problem, as Audrey Farley writes in the Washington Post, is that many people are hoping that older types of cheaper insulin are the solution—they just need to go to Walmart! The problem with using older forms of insulin is that the level of planning for adults and children can be unrealistic, as the older, slower-acting forms must be taken well in advance of eating meals. The costs of older, slow-acting insulins may be less, but the possibility of error on the part of patients is much higher. When Trump breaks his campaign promises about lowering drug prices, he’s not simply being a corrupt liar—he’s complicit in our growing public health crises.
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