The problem is there are newer formulations with advantages in terms of convenience, safety and durability. These require R&D to develop and are not universally available. (Diabetic friend had trouble finding his preferred formulation outside the U.S., U.K. and Sweden, for instance.)
We have huge problems with healthcare in America. But the insulin meme is misleading to the point of derailing discussions about legitimate reform.
If for some reason you would want to buy insulin, it would cost you 2-12 usd per vial/cartridge (3ml x 100units)
A cartridge of most modern European or American rapid insulin costs 5 usd [0][1] and the most modern long or ultralong insulins cost 9-12 usd [2][3]. Russian own insulins cost 2-4 usd per vial/cartridge.
Do you know why the same companies charge you at least 10 times more than a Russian citizen?
I wander what are the 'huge problems with healthcare in America' if overpaying 10 times for insulin isn't one of them?
[0] https://apteka.ru/product/apidra-solostar-5e32673ae911440001...
[1] https://apteka.ru/product/xumalog-5e327a1eae8baf00014d54fa/
[2] https://apteka.ru/product/lantus-solostar-5e32673a3d4c470001...
[3] https://apteka.ru/product/tresiba-flekstach-609a3db8c93e31dd...
Greets from curious person in the USA.
They only need be registered as unemployed. The law [0] is in Russian but Google Translate does a good job [1], see 5.d
Free medical care in Russia is far from perfect, of course -- sometimes you have to wait for a month for an ultrasonic scan, sometimes they give you Russian insulin instead of Danish, but they will save you from a heart attack, install a stent and provide with necessary medications for at least a year.
[0] http://www.consultant.ru/document/cons_doc_LAW_107289/7e136d...
[1] https://translate.google.com/translate?sl=auto&tl=en&u=http:...
I hear about the EU a lot. It is nice to get some perspective from your part of the world.
Cheers
They go do the doctor as they would normally do and when they start working again they'll start paying their share.
That's how it is in Spain. Also if you don't work, you don't pay the drugs, at least some of them. But the subsidized part of the price depends on your income.
See reply above.
If you are on some 'plan' then you are mostly likely not paying list. Your insurance company usually has cut some sort of deal with the distribution company. Usually that 'deal' includes not telling you about their deal and showing you only list price.
If you are not on a plan. Sometimes you can ask 'hey is there a no plan version' and sometimes they do have it. That can be hit or miss depending on who is working the register that day.
If you are not on a plan and they say 'nope thats the price' then you end up in that category.
I am sure someone could have said that about the twenty-odd formulations you mention when they were novel and not yet manufactured at scale.
There is, in Russia for example. But the most expensive I could find (Tresiba) costs 12 usd per cartridge (3ml x 100 units) [0].
[0] https://apteka.ru/product/tresiba-flekstach-609a3db8c93e31dd...
That’s not “a meme”, a bad type of insulin can kill you or send you to the hospital.
It's also a good idea to keep a sugar source available in case you can't keep food down for the amount of insulin you took (ie, you suddenly get nauseous after taking your insulin); which is also true of newer insulins, just less likely because there's less delay between taking it and eating.
But there's also a new release from Walmart for an analog insulin was just announced a few weeks ago! It's a Novolog equivalent and what many people are using today with insulin pumps and diets that have fast absorbing carbs: https://corporate.walmart.com/newsroom/2021/06/29/walmart-re...
The vials are around $70ish US dollars and the pens are around $85ish. That's a wayyyy more affordable rate (50-75% less) than paying out of pocket for Novolog or Humalog. Also keep in mind that manufacturers also have programs to assist you with insulin costs if you can't afford it.
One pen has 3ml in it. So if you weigh 70 kg, you go through one vial in 3-4 days.
People are willing to forego doses, reduce their nutrition to pay less. There are diabetics who die because they were trying limit their doses.
People also use Walmart insulin (insulin R), which us much much shittier than the modern insulins (fast acting insulins). It is much harder to control blood sugars with insulin R, because it's onset and clearing out levels are very long and inconsistent. You need to inject before you eat a meal, wait an hour, hope you don't get low and eat. You can survive on them but it's much harder.
People also use expired insulin (me included), because it doesn't expire 100%, its effects get less over time. People use second hand medical devices (insulin pumps), fix them themselves (because its out of warranty and they can't afford a new one), mod the devices by flashing open firmware so that they can do looping. Diabetics are used to gamble with their lives, because the pharma companies don't have our backs.
The real issue with diabetes is that you somehow survive, but if you don't have access to modern technology, you feel sick all the time because of ups and downs and you are much more susceptible to complications.
As a diabetic, you feel like a ticking time bomb.
People would definitely be willing to inject some backstreet cooked stuff. It's a life or death kindof thing. As a diabetic you leave so much things to chance that you probably simply won't care. Me at least, I am trying to survive, if I can't afford insulin and the only option I have is to use shitty insulin I'll take the chance. If I die, I die. Because I'll definitely die horribly if I don't take insulin.
The company we were working for was acquired by a VC backed larger entity who offered much less in terms of benefits. His out out pocket expenses increased quite a bit as the new entity self-insured and even the best health plan had really high deductibles and the coverage was not great even after that. IIRC it covered like 60-80%, its a bit foggy because I could basically never use it.
He was using blood test strips and injecting insulin because it was the only thing that fit in his budget. We talked about it very occasionally, I asked him if he could get the electronic insulin thing that attaches to your arm and talks to your iPhone, and he told me about the coverage and costs and he really couldn't swing the out of pocket.
This guy was pretty advanced in years and had controlled his diabetes pretty well, but I saw the inconvenience and sometimes normal forgetfulness affect him often. His mood would be unpleasant at times, and I could see that he was often not feeling ok. Eventually, his doctor had an old tamagotchi looking leftover electronic blood sugar monitor that he ended up giving him for free, I guess it was old enough it wasn't going anywhere. His doctor thought the diabetes could be better controlled and took it upon himself to try to get him to upgrade his quality of life.
He used that for a while and it was a bit janky but worked, I noticed his mood and demeanor improve quite a bit for a few months, this also improved our work, but he stopped using that because there was some upkeep on it that was also not covered in our plan. So he went back to the blood-finger-strips.
I felt pretty bad about this situation, this dude was stuck in a job that even I hated (and quit, nowadays I have BCBS from an actually good organization) because the old, acquired company had a really good deal: Employee Ownership. When the firm acquired and consolidated that company, they took on the employee ownership agreement. This was a huge chunk of this man's retirement, but the new deal required him to stay on in order to claim the benefits he had been planning on retiring with for 25 years.
He could definitely have quit and made more money with better benefits, but he would have lost his retirement strategy.
Even after I got a job and starting earning money, I hesitated getting a continuous glucose monitor because it costed so much. I was using the cheapest glucose meter that tested with blood, because the strips were cheap. It turned out that machine was inaccurate and my diabetes nurse gifted me a better glucometre.
I recently was able to switch to a continuous glucose monitor (the tamagochi type thing) and things got much better.
The “free” healthcare is great, but it’s not free comfortable healthcare.
IIRC the expensive insulin is the comfortable kind, that works better. The cheap insulin Americans can buy is the uncomfortable kind.
Most recently, I ran into an old acquaintance with a back problem that sounds like a slipped disc, and this poor dude doesn't have the coverage to get the surgery and treatments needed not to be in constant pain all day.
Hey, maybe he's wrong and its a $300 quick fix, but he's walking around with the free uncomfortable treatment we have in America.
Personally, I think healthcare is worth it. We should just pay for it and reap the incalculable benefits of a more effective society that is much less burdened by disease and chronic injury.
The US has a large number of socialized healthcare programs, several free healthcare programs, but nothing that is 100% universal. Americans don’t have any reservations about paying for healthcare for the poor, elderly, veterans, etc. People in the US generally hate the idea of anyone qualifying who makes more money than they do, which is one of the reasons why universal plans don’t go over well. The other reason is that a truly universal plan would probably uproot the existing health insurance system, which scares some people who are satisfied with the status quo.
Our existing systems are mainly a result of compromise:
> “let’s have a healthcare plan that covers everyone”
> “you want to tax the working class American to pay for healthcare for the rich? And bankrupt they insurance companies that insure our middle class? And kill jobs?”
> “ok, let’s compromise. Let’s make a plan that covers [insert group of people that voters will feel sorry for]”
And repeat about every decade or so.
That’s how America’s fragmented healthcare system was born.
This is where America should have answered "Yup, you betcha!" Because, you'd be taxing the rich even more, but since they'd also benefit from it, they'd have much less grounds to protest against it.
In places like Sweden, billionaires receive the same universal child benefit as everyone else, largely for this exact reason.
Politically, one would require a majority of voters in BOTH parties to want socialized healthcare, due to the division of powers, gerrymandering, the broken presidential election system, and so on. You could have 70% of the population being pro-socialized healthcare, but if the majority of those rest in one party and in certain regions, there still wouldn't be enough to get the majority in the house AND senate.
If other things are more important, voters might even be for it, but not even show up to the polls or vote for candidates that are all about that issue, because some other, bigger issue (in the eyes of the voters) needs to be addressed.
Climate change is a good example in Europe. Depending on country, you can get the majority of people who say they care about it, but come election time they will:
- vote for a populist party that doesn't give two farts about it
- vote for the old, "stable" option that is closer to their core values but never actually does anything about climate change
- decide not to vote at all for whatever reason
The minority actually votes for a green party. That might slowly be changing, but change doesn't come quickly from within unless forced (COVID being a good example).
Yes. In Britain (and I suppose in mainland Europe too) the jolt came at the end of World War II.
Society in general - and returning service-people in particular - refused to accept the status quo ante.
Supported by our American friends' economic largesse / self-interest, there emerged a social and geo-political revolution.
In that moment, amongst many other societal improvements, the NHS and decolonisation became firmly established.
Sort of. The conversations are mostly about expanding our existing socialized healthcare plans that cover over 1/3 of the population already.
Americans over 65 and those with some disabilities are covered by Medicare: https://en.m.wikipedia.org/wiki/Medicare_(United_States) This includes about 60 million people.
People with low income or some other qualifications are covered by Medicaid: https://en.m.wikipedia.org/wiki/Medicaid This includes about 75 million people and reportedly pays for about half of all births.
The affordable care act also subsidized health insurance plans for those with incomes up to 400% of the poverty level: https://www.healthinsurance.org/obamacare/the-acas-cost-shar... These subsidies go to another 9 million people or so.
There are gaps and I agree 100% that we need to continue closing such gaps, but the US actually does have a significant amount of socialized healthcare. Some of the proposals include simply expanding some of these programs to cover the remaining 8-9% of the population without healthcare.
The idea that the US doesn’t have any socialized healthcare is a bit of a myth. The reality is that we do have socialized health care, it just doesn’t cover everyone.
The headlines about insulin costing thousands of dollars per month are also misleading. Insulin is $25/vial at Walmart and you don’t even need a prescription from a doctor to get it. The expensive products are more recent, patented insulin analogs that are longer lasting but obviously shouldn’t be prescribed to someone without insurance who can’t afford them. The $25/vial insulin is equivalent to the generics you read about in headlines like this one.
Some initiatives have been put forth at the state level, but it's essentially impractical for US states to do it without active federal cooperation (which itself is practically unlikely without the same faction controlling the federal levers of power that would federally implement socialized medicine, making the state programs unnecessary.)
Also, currently due to the enormous money in US healthcare (the medicine market very much included) a lot of R&D costs are recouped there using these exclusivity strategies.
The biggest problem is that there are many effectively uninsured people in the US, and they are the sufferers of the aforementioned emergent system. (Even if there many "state pharmaceutical assistance programs", many people who would need it don't know about it, and even if they do the paperwork burden is substantial, and obviously it's just a stopgap measure.)
Other point I would like to make is that our healthcare is not “free”. It’s paid by high taxes be are obligated to pay to the government (the taxes are as high that I don’t even want to know the exact amount in my case but is around 25-30% of my salary).
I'd imagine that most people would stay signed on but it does give people who either distrust public institutions or just don't feel like they would benefit from a public option a choice.
Full disclosure: I am firmly on the side of socialised medicine.
It's considered political suicide to even openly discuss dismantling the NHS which is why even the Tories continue to tip toe around the issue even after having been in control of government for more than a decade at this point.
Aren’t there any initiatives in some US states to make socialized healthcare?