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Obamacare still isn’t working, part 3,957

by Resurgent Insider Read Profile arrow_right_alt

With impeachment and the 2020 election moving to the fore, less and less media attention is being paid to actual policy.

That’s unfortunate, because policy matters – including and maybe even especially policy that Democratic front runner Joe Biden personally helped put on the books.

Biden called Obamacare a “big &*$%^@# deal” when his boss signed it into law. He wasn’t wrong.

Unfortunately though, if you’re a diabetic, one of the ways that it has proved to be a “big &*$%^@# deal” is that it failed to curb insulin prices and incentivized the marketing of a lot of high deductible insurance plans, making mere staying alive a very costly proposition for diabetics.

For some people, these stereotypical Obamacare plans are great. For others, they’re definitely not. Diabetics seem to be definitively in the latter category, and the situation is not improving. From Newsday:

The cost of insulin products, which have gotten more sophisticated and accurate over the last decades, have soared over that time, and are produced under patent by only a handful of companies. Costs have gone up so much because the newer, more popular forms of analog insulin are more expensive to produce and are under patent and the three main U.S. producers have little competition.

[…]

Even those with insurance find the high cost of insulin prohibitive. Melissa Passarelli, 30, has had to ration her insulin despite having an individual policy purchased on the state’s New York State of Health market exchange. High deductibles and cost sharing for her diabetes care take almost a fifth of her net income.

Her employer, nonprofit Docs for Tots in Roslyn Harbor, reimburses most of her monthly premium costs, she said. But Passarelli’s yearly deductible is $4,000 and once she reaches that, she must pay half of the cost of each vial of insulin, with her share almost $200 for each vial, she said.

Between doctor visits, insulin, supplies, tests and other expenses, Passarelli spent $8,194.96, or 18 percent of her net annual income, on insurance-related health items, she said. If she hadn’t rationed her insulin — using less of it than the amount prescribed as best for her — her costs would have been even higher, she added. Now she is considering a move back to her parents’ home in South Huntington, when the lease runs out on her Astoria, Queens apartment. (emphasis added)

Unsurprisingly, a lot of advocates weighing in in this space are pining for Medicare for All, even though that would likely lead to restrictions on newer, more expensive, higher quality varieties of insulin being available and problems already existing for Medicare recipients who also struggle with insulin prices.

Expect a lot of debate about how to tackle this as the presidential race unfolds; whereas those touting Medicare for All primarily seem to be concerned about improving access, with a lesser emphasis on cost, the insulin conundrum makes clear that access is not the issue (the woman profiled spending 18 percent of her net annual income has insurance). Pricing is, and that leads into a sticky mess of debates about potential patent reforms, straight-up price regulation, Medicare reimbursement changes that would disincentivized price hikes and more.

In the meantime, the irony is that while Obamacare was supposed to be a solution to all kinds of problems, including this one, it’s actually non-taxpayer subsidized and free market solutions that seem to be helping patients:

Parent has traveled twice to lobby in Washington D.C. as a volunteer with the National Diabetes Volunteer Leadership Council, a small nonprofit that lobbies and advocates for educating consumers and providers.

Its executive director, Erika Emerson, said the group wants to educate those with diabetes about programs to obtain insulin at discounted prices, including a federal program called 340B that lets anyone obtain discounted insulin at community health centers (if, like Marotta is attempting to do, they can find a center that participates), and smartphone apps like GoodRx, Blink Health and InsideRX that provide coupons to cut drug costs. She wants pharmacists to be allowed to tell customers that insulin bought with cash can be cheaper than the price they’d pay using insurance and for people to know to use Cosco or Sam’s Club for less expensive drugs.

The 340B program discounts drugs for poorer Americans and costs taxpayers exactly zero dollars (it’s a kind of swap where drugmakers sell product at a discount in exchange for getting access to the treasure trove of entitlement money).

Smartphone apps are clearly good, old-fashioned capitalist innovation in action.

And while pharmacists reportedly are being barred from telling patients to pay in cash because it’s cheaper, that’s nothing that a little thing called “defending the First Amendment” couldn’t solve.

If Congress, or presidential candidates, are looking for easy solutions to this problem, freeing up pharmacists to speak candidly and openly with patients about how to save money seems like a good starting place. Maybe they could even unveil white papers outside their local Costco or Sam’s Club and give companies providing some solutions a little good press at the same time.

But doubling down on Obamacare does not look like a solution, and neither does Medicare for All.

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