Walmart unveils low-price analog insulin amid rising diabetes drug costs
cnbc.com
cnbc.com
And I'm writing from Turkey which you would think it would be terrible in managing any public infrastructure including health.
My company pays equivalent to 400 USD per year for private health insurance, gives me unlimited access for surgeries, any treatment that I need to stay at hospital and a check-up per year. The insurance is valid in any private hospital including the ones that look like straight out of Space Odyssey.
You know what's more interesting? If you think this is a good deal, then almost everyone in Turkey thinks this kind of service should be provided by public healthcare system and demand it. Not only for the people that can pay 400 USD per year.
edit: I realized it sounds like you need to pay 400 USD for unlimited healthcare but you don't need to pay anything for the state hospitals. The insurance is for zero-cost treatment at the private hospitals. You do pay a contribution fee around 3-5 USD for every visit plus prescription at the state hospitals though. I believe it is for discouraging unnecessary visits to the hospitals but even that causes a stir.
In virtually all developed countries, it is provided. Hundreds of millions of people around the world live this way, right now.
The problem is that neither party wants to make deals. They both want to have their existing programs AND to add extra ones on too.
Everyone follows their incentives. None of them have the incentive to make a deal and get de-elected. They have lots of incentive to grandstand and call the other side bad-guys for being bad and not agreeing to this thing that "we all know is moral and right" that clearly we don't have some kind of 90% super-duper extra majority that all agree it's right. If we did, it would most likely be done already.
Nope.
Leaving aside the the current psychotic break the GQP is experiencing this year, universal health care is not something they've ever wanted.
Why? Well, the insurance companies and for-profit hospitals have big lobbying efforts to ensure that sort of thing absolutely will not get passed. Because it would kill the need for them (insurance) or hurt profits (hospitals).
UHC will not happen until there is serious reform with how politicians get elected, and how lobbying works.
Nope to that!
See I can make unfounded assertions too! It's fun.
> Leaving aside the the current psychotic break the GQP is experiencing this year, universal health care is not something they've ever wanted.
There's a difference between "I would never, ever vote for this under any circumstances because NO WAY" and "I'll get voted out if I allow an increase in spending on something that my voting base doesn't want".
In the same way that Democrats couldn't go to their voting bases and say "see we got universal healthcare! " if they had to give up the necessary funding in other places in order to make it budget-neutral, Republicans could only hope to get re-elected if they could go to their voting bases and say "look yeah we compromised, but it was on a thing that was budget-neutral! We didn't get a tax break for you, but we did eliminate all these other $horrible programs!"
I'm not saying that's good or right or what we want. But both sides are playing to their audiences and very much tuned in to what they want. That's what you have to do to get re-elected. That's why neither side is interested in compromising to make a deal. They'll get crucified for "not standing up for what WE believe in" and "compromising with that other side full of awful, evil people"
I don't really like that the US hasn't done much legislatively in the last 20 years. But, I, personally, myself don't get to decide how all this works. And neither does anyone else.
The "stances" the voting base take are largely shaped by influence campaigns of powerful interest groups. Both major parties (the minor ones too) are affected by this. Though one of the groups has gotten even stupider recently, and they actively vote against their own best interests.
Edit: grammar.
The idea that it's the voters that vote is actually true! That's how the system works. Corporations can influence that of course, probably to an enormous degree. But the corporations themselves don't vote. That's the system we've got.
The primary mechanism in our system is people. And people aren't logical, rational, economically-maximizing, or any of it. People are far more narrative-driven than they are rationally-driven.
THAT's what I would say that Republicans would get on board with a universal healthcare bill in which they could claim that they "destroyed" the Democrats by "obliterating" a bunch of "socialist pork". But that's absolutely going to ensure that the Democrats that "caved" in order to get something important done won't be able to get re-elected. And they care more about getting re-elected than they do about doing the right thing! Same on the other side of the isle! This isn't a partisan issue. Everyone wants to get re-elected way, way, way more badly than they want to do the right thing.
I don't like it. I don't think it's right. But it's extremely easy to see that neither party is compromising in any meaningful way these days. Both take hardline stances and don't budge. That's not a bug, it's a feature of American Democracy. It was designed such that if there wasn't wide agreement (or elected officials who would compromise) that things would grind to a halt. That was done so that nobody could run roughshod over the other.
Until we start getting richer such that the increases in spending are coming out of even bigger growth or we somehow manage to convince everyone that paying more and getting less is totally-A-OK this is going to be how it continues to go. Neither side wants to compromise, so their counterparties don't want to either. Deadlock is the name of the game.
> and they actively vote against their own best interests
I can understand how you'd think that. It makes a lot of sense. But it belies a terrible ignorance on your part. Animals don't make decisions on purpose to make their own lives worse in ways in which they KNOW they will end up worse. You can try and project your ethics onto other people all you want and use their relative-to-you irrationality to belittle them. But it doesn't work! Putting people down doesn't change minds. In fact putting people down might be the very thing that got Trump elected (re: deplorables).
I'm not saying Trump is good and Hilary is bad BTW. I'm just using that as an example of how unfortunate it can be to generalize one's personal ethics to the entire country and draw conclusions as a result.
Democrats could give up everything they hold dear, and I still don't think Mitch would make that deal.
I'm from Canada and we have Universal Health Care which is great.
So when it comes to health care many Canadians like to shit on the US.
On the other hand, Canadians are always complaining about not making enough money, getting taxed high and stuff. And many dream about going to the US where their money making potential is apparently higher.
So to many Canadians, at some point, the potential to make more money outweighs the UHC enough to leave Canada and go to the US to make it big.
So depending on where you are the capitalist nature of the US is a terrible thing and the thing that provides opportunities not afforded by one's own country.
Being in bottom 20 % of the USA seriously sucks.
That is the tradeoff...
I'm German from a low income family and I went to school with kids of millionaires and everyone walked through the same streets and went to the same bars. First time i went to the US I noticed what living in a bubble actually means. And the kids of the 'winners' seemed as neurotic as the kids of the 'losers'. There's an entire mindset of "if I not go into college X will I be where my parents are", "is such and such street safe", "should we move to X neighbourhood, is it better than Y". Even the "opportunities" that the people in the top 20% is basically are pure stress.
Yes, but that country is fairly huge. Even in densely populated Central Europe, we tend to make fun of sheltered kids from posh neighbourhoods (how many low income kids are there in schools of Nobelviertel, Hamburg? Perhaps a few well-chosen refugees). This effect is ten times stronger in the U.S.
I am not saying that this is right, just a description of the state.
BTW Unsafe streets are definitely a thing in Germany (or Czechia, for that purpose) as well. No one will, for example, move voluntarily to a neighbourhood with a high percentage of Roma population, regardless of how anti-racist was their education. Or to the proximity of a well-known drug dealing space. European hard drug problem is quite acute in some hotspots.
It isn't so cut and dried.
At any point these people can return to Canada and receive free healthcare again after only a year of waiting.
What these people are doing is betting that they won't have any crippling healthcare incidents while they're young and banking on the fact that they can always move back to Canada to receive free healthcare for the chronic health conditions that accrue in old age.
Many of these people are effectively leaches on the Canadian health care system as they do not pay taxes into it and then make use of it in old age when they return to Canada.
Long Wait times, inability to see specialists, or get surgeries or MRI's etc
US Care is expensive, and we need to solve that, but I still am not convinced turning it over to our inept worthless corrupt government is the best or only solution to the problems with paying for US healthcare
If you seriously believe the government is that bad, then fixing it should be your top priority. Above all else. You can't have a successful country if the government is corrupt. And you can't just patch and hack around its failings. That shit will eventually catch up.
The only way to resolve the problem of corruption is distribute and limit the power /authority any group of people has, instead we have slowly over the course of time vested more and more power into a ever growing federal government that continues to become more and more corrupt.
Power corrupts, Absolute Power Corrupts absolutely.
The US Federal government was designed to be very Limited and subservient to the people and the States. Over the last 230 years we in the US have lost sight of that, and instead many now believe the government is our sovereign, is the ruler, is the source of our rights, etc. We have lost sight that we are suppose to be self governing, and that our rights are natural not granted by government.
In my view the government that governs the least governs the best, and giving control over my health to said government transform the relationship between citizen and government in a ways irreparably harm the principle of self governance, and individual liberty.
I bet those Canadians are young and healthy, so they (think they) don't have to worry about healthcare costs. Those who suffer from chronic illnesses or are semi/retired aren't so hyped. In summary, what's good for a certain demography isn't necessarily good for the rest of the citizenry (like friends and family, who don't necessarily factor into the decision on where to work).
Exactly. I know a Canadian that’s in their late 30’s, has children, and mixed health record. Now that the adventures are over, they’re eager to move back. Similar stories for European friends that married and had families with Americans.
I live in Canada, I've also lived and worked in the USA.
I suggest you go and live and work in the USA. Be part of their system. Use their healthcare, send your kids to school, walk through WalMart, live your life.
Sure, when you're in the top 30% or so life is pretty good, as long as you can avoid everyone else in society who are struggling HARD. It doesn't take a rocket scientist to figure out why there is so much violent crime, so many people in prisons and so much violent policing in the USA - tens of millions of people are desperate and struggling for the essentials they need just to live.
You simply don't have that in Canada, the social safety net takes that away.
Canada has Walmarts that look suspiciously like the ones I’ve visited in the US. Plenty of poor people who get kicked off welfare or get penalized for getting a job.
Poverty is far from solved in Canada.
At no point did I say it was. Please don't jump to strawman arguments, it doesn't help anything.
I simply said there is much less poverty in Canada that in the USA. I think that would be very hard to argue against.
> Plenty of poor people who get kicked off welfare or get penalized for getting a job.
Every single one of them has perfectly acceptable heathcare, which is a HUGE step above the USA's poor.
Yes, Canada has poverty, but it's not nearly as severe as in the USA.
The claim was "Canada doesn't have a problem with violent crime, violent policing [ask First Nations folks about that!], or people who are desperate or struggling".
Which I said, is bullshit.
That's not the same, as there are tens of millions of people that don't have access to affordable healthcare in the USA. In Canada (and a host of other developed countries) there are none.
> The claim was "Canada doesn't have a problem with x, y & z, or people who are desperate or struggling".
No it wasn't.
The claim very clearly was: "Canada has much less of a problem with x,y & z and far fewer people who are desperate or struggling than the USA does".
And you said “You simply don't have that in Canada, the social safety net takes that away.” which is BS. Yes you have it. To a lesser degree than the US, but you have it.
And how many people just died in BC from the heat wave? 150+? How many in the US? The Canadian healthcare system might be universal but it’s poorly funded and easily overwhelmed.
Therefore, if you have a bad doctor or expensive care, it is your own damn fault. You just didn't try hard enough to find a good one.
It is the same thing with the debate about school vouchers vs. a standard public education for everyone. A heaping dose of "the free market fixes everything", for all life's problems.
I would rather not have a "choice". I would like to be able to select any nearby doctor, and be assured of getting competent care.
I'm not often in the situation where I have a wacky tropical disease that presents odd and incongruous symptoms, which would take a Dr. House to figure out. I am far more likely to have run-of-the-mill heart disease or a common form of cancer. I just need a doctor with some basic level of competence, who can just listen to me and help me through the common health problems of modern life.
I don't have children at all, and I don't mind paying taxes to fund schools, because when I'm old I want the doctor who is younger than to have gotten a good education. I don't expect any vouchers just because I don't have kids consuming public education.
Vouchers always seemed to me like an obvious scheme to defund public schools and let them rot, thereby punishing kids who were unlucky enough to be born poor.
So it doesn't defund public schools, but it does break the public school monopoly and allows competition among schools - they can cater to the needs of the community and experiment.
The real issue is: Why are schools failing?
When I was growing up, the vast majority of kids were educated in public schools. They weren't perfect, but they worked at least decently for the large majority of students, and did so for decades. Across the entire region. And they did that as a monopoly system you seen to despise so much.
So we had a system that worked, was scalable, replicable, and maintainable. What happened?
I don't have all the answers there, but at least once thing is clear, there is now an over-emphasis on testing. We had a system that was designed to give citizens important life skills, and turned it into a system that tries to produce drones that can pass tests.
This is exactly the kind of thing we used to criticize Asian school systems about. And now we are trying to replicate their failings. WTF
That's the thing that frustrates me about this debate. People seem to think that educating children well it's such a difficult problem, that it requires constant innovation. That it requires the "power of the free market" to solve. No, it doesn't. We have known how to do it for a long time. It just requires political will.
And that brings us to another factor, one political party is actively anti-science and actively anti-education. This was definitely not the case 30 - 40 years ago. Back then, they were both pro-public education.
Nobody really has any effective way to evaluate them, or at least, nobody does so on a broad basis or consistently. Some of them can’t pass fizzbuzz. Some of them can churn out CRUD apps, but have no idea what they’re doing when it comes to anything else. Some of them are extremely dogmatic about design patterns and tooling and ignore anything they don’t like. Some of them are inattentive or poor listeners. Some of them assume it’s Problem X they’ve seen a million times, but it’s not. Some of them are assholes. Some of them are really sharp and really engaged, but get overly excited and reinvent the wheel or spend a lot of time doing stuff that’s completely unnecessary and maybe even harmful.
I don’t know how to evaluate doctors until I see them, I have no idea if better doctors cost more or less, I doubt there’s a strong correlation because nobody else can evaluate them either. They either help me or they don’t.
I think it absolutely is necessary that I should be able to have a history and see the same doctor, and that I should be able to see another doctor any time I want for the same condition for a second, third, or fourth opinion. I have seen this be absolutely necessary for myself and others with common conditions that were resolved after seeing a different doctor.
I assume this is still possible in most if not all public health care systems (I live in the US but local doctors and hospitals are all government run, an interesting aside), but I am not sure. I recently had a conversation with a Canadian friend who has debilitating autoimmune disease his specialist is doing basically nothing for and he made it seem like it wasn’t possible, but I didn’t want to press.
Plus, about a quarter of Americans have “free” care already, via Medicaid and Medicare. Many of the rest have their employer hiding the true cost from them - they think the premium that comes out of their check is the actual cost. Some employers apparently even pay 100% of the premium cost.
So all these people are okay with the status quo, or even want to defend it. It’s the people on (increasingly common) high deductible plans, people with no insurance, or people who experience a catastrophic edge case (out of network provider for example) that hate it.
Also want to add: my child’s birth cost $20,000 (with insurance). When I would tell other Americans about this, the response was (usually) “you know you can get on a payment plan, right?”
The reason that Turkish healthcare is much cheaper than American healthcare is primarily because Turkish doctors are paid much less than American doctors. (As are Turkish nurses, and Turkish drug and device wholesalers, and so on.) There's a very simple solution to that. All you have to do is let Turkish doctors come to the United States and practice medicine. Or better yet let Turkish hospitals open entire branches in the United States and wholesale import their staff, equipment, and drugs from Turkey.
The reason that doesn't happen is because we have a cartel called the American Medical Association that continuously lobbies for antiquated barriers to foreign competition. Unless a physician does a residency in America (which good luck, if you're a foreigner from a foreign school), you will never be allowed to practice in the US.
https://www.ama-assn.org/press-center/press-releases/ama-fun...
The reforms also create a dramatic increase in bureaucracy.
For example, my daughter needs to see a specialist. I call the specialists office. I’m told there are too many patients. The doctor has to chose which to see. I need to call the primary, and have them forward my daughters info. The specialist office says she is not high enough priority and cannot be seen (my daughters condition is crippling, but not fatal as it is for others).
I call up the next specialist on the list. They are overbooked. I need to call up the primary and they a referral. I call primary again. I get referral again. Again the specialist decides not to see my daughter.
I call the next specialist … etc.
Did I mention that for some specialists the insurance info is out of date. They are not in fact in network. So once I get an appointment, I must verify with insurance they are in network.
I’LL PAY THE F*KING MONEY IF YOU GET RID OF THE BUREAUCRACY!!!
Obamacare increased bureaucracy. Clinton HMO increased bureaucracy.
I’m a highly compensated professional. My healthcare is free.
Medicare isn't public universal healthcare. The prescription plans, Medicare Advantage plans, and medigap plans are run by for-profit companies. $300-500 per month, and many good companies, like Thrivent, are getting out of healthcare completely.
https://www.livhospital.com/en/liv-branches/check-up-center
One last thing, probably there is a better English term for this but we have these government institutions in each neighbourhood. They are small and they employ 4-5 doctors and a couple of nurses that provide first level healthcare. (I would say there is a doctor for around 5000 to 10000 people) If you would go to your assigned doctor and ask for it, they do many of the blood tests at the same day and hand the results. This is a common procedure afaik and your doctor would be encouraging to do it every 12 months even if you don't ask for it.
Yes, we don't make too much money and pay about 25-40% income tax but we don't need to shill thousands of dollars for a facetime call with a doctor.
My suggestion would be to visit Turkey and spend those couple thousands USDs on check up and some nice vacation :)
They are contrasting that with their brief online sessions with their doctor that cost them $1000.
The emphasis on whole is to distinguish being the partial check up that they received for more money.
An average person's healthcare costs a few thousand dollars per year in EU. That includes people with innate conditions or other expensive treatments. Most of the countries have zero or only nominal out of pocket expenses.
https://ec.europa.eu/eurostat/statistics-explained/index.php...
https://www.healthcare.gov/coverage/preventive-care-benefits...
Don't do regular checkups, they're cash cows.
http://www.salaryexplorer.com/salary-survey.php?loc=221&loct...
Phrases like "you don't need to pay anything for the state hospitals" just means you are ignoring tax contributions, which isn't going to lead to any sort of reasonable comparison with other systems.
The inventor of insulin sold the patent for $1 because the thought that it would not be available to all was unconscionable.
It is absolutely unacceptable that insulin is not free and available to all (including to those who can afford it at the cost of financial stability).
The idea that someone without means should have to pay Walmart $86 for a worse low-budget insulin is disgusting.
Good thing the article is about Walmart now selling 'analog insulin' ie. modern version of insulin
Walmart sucks in a lot of ways, but this article does not demonstrate that.
I asked the driver if that bus was the free one (meaning, if that was the bus in which I didn't have to pay). The driver replied a bit angry that the bus trip was not free, it was complimentary.
The law was modelled around the companies’ existing patient assistance programs, and despite assurances from industry reps, PhRMA sued the state anyway just hours before the law was due to take effect[1]. This spring, their lawsuit was dismissed[2].
This law isn’t a great solution if you think that insulin should be free to all, but it is at least something that other states can use as a model to try to help their citizens access to cheaper, high-quality insulin.
[0] https://www.mninsulin.org/
[1] https://www.minnpost.com/state-government/2020/07/why-so-man...
[2] https://www.twincities.com/2021/03/16/alec-smith-insulin-aff...
My impression was: The crazy hoops and loops that Americans will go through for healthcare just to NOT implement a sensible social healthcare program.
I just joined one. My primary care physician recommended it. It's about 28% the cost of the regulated ACA plans in my area for my size family. Read that number again. And, it covers everything (except no pre-existing conditions) except for things like cosmetic surgery.
The list of things that the ACA plan didn't cover at all was confusing and pretty lengthy, and it had a $9k deductible (or more, many of the cheaper plans had $15k deductibles) per family member, and double that (two family member's worth) for a max family deductible. To me, that is crazy. And, for the cheaper plans, they required coinsurance, so if I had a disease that would cost $200k, I would owe $67k.
Most amazingly, there's no deductible except for the $400-per-visit deductible. (There's no free maintenance or co-pays or anything like that.) Everything is covered after the $400-per-visit deductible, and there's virtually no maximum. Go to the ER, max of $400. Go for a checkup, probably pay it yourself (unless it exceeds $400).
(One could argue that they should cover an annual checkup, but if it was just a matter of adding $150/year to everyone's plan, what's the point; that's an arbitrary amount that can be budgeted in once you know to expect it. Since it's people of that religion only, some built-in pre-qualification occurs to eliminate people who would just abuse the system.)
These health share non-profit organizations have paid out billions by cooperating and coordinating among their members, and you negotiate with the hospital directly as a cash patient and make your own choice of care and providers.
It's somewhat akin to how a credit union is dissimilar to a bank.
I personally find the idea fascinating and certainly prefer it to forced socialized medicine.
$400 is pretty close to the cost of an office visit, physical exam, metabolic panel, lipid panel, and EKG, which is what a primary care doc is going to order annually on something like 90% of Americans after a certain age.
It shifts the expense of routine care and checkups to the patient. If you view insurance as indemnification against unexpected loss, it shouldn't be paying for expected, routine costs.
That's also why car insurance pays you to install LoJack and homeowners insurance pays you to install fire alarms.
But this isn't true -- at least for any car insurance or homeowners insurance that I've purchased. You often receive a small discount, but the discount alone doesn't cover the cost of purchase/maintenance.
A health insurance analogy would be: Customer A pays $100/mo because he gets an annual checkup and takes the medicines the doctor prescribes. Customer B pays $200/mo because he hasn't seen a doctor since college.
Customer B could reduce his total out of pocket by $800 per year if he paid for the $400 visit.
You're foisting the sick and the elderly onto government programs, and patting yourself on the back for pulling yourself by your bootstraps.
They aren't the ones running government.
It's like the stuff we did when we were kids: "I'll do it because I want to, but not because you tell me to".
Things like the NHS or Germany health system (both I've experienced) are pretty good. But hod forbids the US implements those /socialist/ systems.
- "Most people with diabetes need at least 2 insulin shots a day. Some people need 3 or 4 shots for good blood sugar control." (https://www.aafp.org/afp/1999/0801/p649.html)
- "In November last year, Walmart launched the ReliOn Novolin 70-30 insulin pen. The cash price for a pack of five pens is $42.88, compared to $300 for the brand name option." (https://www.wfmynews2.com/article/news/verify-yes-walmart-do...)
So we're talking about $25 for 1-2 days of vital injections. Approx $4,500 - $9,100 annually.
A vial has 1000units and lasts about 2 weeks.
Analog insulins are different than the type that the $1 patent is for. They are much more advanced and are much more complex to make. That doesn't speak to whether or not the current prices for insulin are reasonable (they're not)... but you make it sound like "someone invented this and made the patent free, and now people are selling it for $86"... which is not the case.; not even remotely.
- Lilly wants to set the price at, to pick a random number, $100 per bottle.
- PBM says "I need to tell the insurance company I saved them 50%, so you have to charge _my_ client 50% of list price"
- Lilly wants their business, so changes the list price to $200.
- Then Lilly "graciously" lets people without insurance use a coupon to _only_ pay $100 for it.
Everybody gets to pretend they're the good guy. But the insulin costs $5 to make.. so really, they're not (once again, made up numbers).
My curiosity got the better of me, so I rang up my mother who's had type 1 since childhood.
She said 5x3ml vials of Lispro (or just about any brand) was approx. $40 in the pharmacy.
Once she's spent more than $275-ish in a calendar year, the insulin is free (well, tax funded) until December 31st.
This is in Norway, where the state presumably negotiates good deals with big pharma as they are basically a single customer buying goods for however many of a population of 5.5M need insulin (injected, that is)
> The idea that someone without means should have to pay Walmart $86 for a worse low-budget insulin is disgusting.
The article is talking about the modern formulation for $86. The older-style worse formulation is $25. As I understand it, and I may be mistaken, $86 is very competitive in this space. I don't disagree that maybe insulin should be funded by government at zero cost to the individual, but your description of the $86 formulation described in the article seems inaccurate.
You have to utilise incentives and regulation to keep prices down. One option is to adjust patent law to enable generic manufacturers to create competition. The downside of this is the generic pharma companies are usually off-shore (more profit that way) and also seem to just pretend to make the actual drug with some regularity (also more profit that way). Another option is for the US government to negotiate drug prices. The US market for medicine is so large that they would have incredible power to cut good deals. The downside to this option is that it will inevitably lead to some form of corruption eg. the drug negotiators don’t try too hard so they can get a cushy job at the drug company next year in their drug negotiating unit.
Anyway, I am fairly sure the latter option will happen soon, perhaps for some group of essential medicines.
Prior to 100 years ago, this conditions would have just been fatal. That you can keep yourself alive today for less than the cost of your mobile phone bill is a pretty good value proposition. I just don't understand the outrage.
Did these costs double between 2012 and 2016?
https://www.reuters.com/article/us-usa-healthcare-diabetes-c...
Its not worse, its significantly better. The version of insulin sold for $1 is human insulin, which has been available at Walmart for $25 for many years. The version being discussed here is human analogue insulin, which was invented by the pharma companies in the past few decades. Its significantly better tolerated, and the rates at which the body can uptake the insulin can be tweaked to be much faster or long-lasting. Its like comparing a Tesla to a Ford Model T.
Honestly, yeah. The quality of life improvement between the two is humongous. I've heard treatment on the older insulin therapies described as "a life ruled by the clock where a mistake means death."
What is going on is that big pharma is now charging a premium for the user experience, and not the actual cost of the product or amortizing R&D.
(Of course the caveat here is that a therapy regimen that uses ultra lente insulins exclusively may be suitable for some type II diabetics who hadn’t achieved appropriate glucose control on oral antihyperglycemics, and that insulin dosing with meals using rapid acting insulin on top of a ultra slow acting insulin may follow after a while).
And frankly, the best way to dismantle the system is through some form of publicly available, universal health insurance. I believe in the power of healthy, free markets as much as anyone, but the current healthcare system is anything but. The lack of a non-profit seeking provider of health care, in a space where customers options are to pay whatever is charged or simply die, is not a functioning market. The rebate system was born out of what was a legislative bandage over this issue. Continuing to try and come up with cute solutions that avoid government provided healthcare for all will see similar results. Its why Americans spend so much more on insulin, and most other forms of healthcare services, than the vast majority of the world.
Look...I agree with the majority of your point, the majority of healthcare doesn't deal with such an obvious binary...and we aren't going to make progress on this issue unless we're willing to also have the conversation about healthcare within your control - e.g. individual responsibility for your healthcare.
A number of close family members are doctors / surgeons of various kinds, so I've heard so many issues & complaints about the system. And while I would happily pay taxes to fix healthcare issues that are preventative (e.g. cancer screenings,) educational (e.g. nutrition,) and overall unpredictable (e.g. surprise brain aneurysms or the like,) I have no desire in paying for:
- Someone who drank so much and annihilated their liver, requiring significant & expensive surgery
- Someone who couldn't stop eating at McDonald's and hasn't touched a vegetable in a decade now wants lifetime insulin and kidney transplant
- A hypochondriac who wants to see their doctor for every scratch, off-color skin mark, etc.
- Someone voluntarily jumping off planes, doing dangerous sports, etc. without insurance, and expecting someone else will foot the bill
- Someone who wants every and any blood test because they coughed once
etc. etc. etc.
Again...overall I agree with a more central payer system, but you won't get the conversation started with all the groups involved unless you acknowledge that there's some element of individual responsibility that you need to control for as well.
None of us want to be taken advantage of, but I weigh protecting the most vulnerable and unfortunate, of whom there are many, more heavily.
The easiest way to find out if someone lacks health care access is to ask them if they work with their hands.
The classic example is drug testing welfare recipients which was proven to cost more than just giving it out.
Sometimes you have to chalk some of this stuff up to "the cost of doing business."
https://www.dailymotion.com/video/xc3x84
Why keep your moral condemnation limited to taking health risks? What constitutes healthy behavior is very fuzzy at the edges, I would prefer to condemn people based on who they vote for, or their religion. Why would I want to support the continued lives of people who I think cause health problems in other people?
That’s called an addiction. It’s a disease. And that should (and can) be fixed by a doctor.
> - Someone who couldn't stop eating at McDonald's and hasn't touched a vegetable in a decade now wants lifetime insulin and kidney transplant
Same thing + metabolism issues, aggravated by voluntarily aggressive marketing. Can and should be fixed by a doctor.
> - A hypochondriac who wants to see their doctor for every scratch, off-color skin mark, etc.
Psychiatric issue with real psychiatric or physical pain : can and should be fixed by a doctor.
> - Someone voluntarily jumping off planes, doing dangerous sports, etc. without insurance, and expecting someone else will foot the bill
Just make insurance mandatory for extreme sports like in most countries.
> - Someone who wants every and any blood test because they coughed once
Same as above. Hypochondriasis is totally documented as a real suffering and psychiatric issue.
All your examples are situations that can be prevented with preemptive medicine which is the norm in countries where you can see a doctor long before being sick. I’m not saying it’s easy or perfect, but it’s easier for doctors to prevent diabetes if they can follow patients regularly and check their vitals than if they only see them once a year or less because they can’t afford it.
But yours isn't even a selfish perspective, but a moralizing one. You don't like the idea of someone getting healthcare that you feel doesn't deserve it, and it seems like you don't care if that means you pay more for healthcare or receive worse healthcare outcomes as long as those people can't see a doctor.
Why this only becomes a problem when done at a state or national level, is not something I can fathom.
If anything, the larger risk pools would drive costs down.
Public healthcare won’t get rid of it.
There’s not one simple fix for this. If it’s truly going to be fixed, it’s going to require a lot of very tough fights against entrenched interests to eke out 5% here and 3% there.
My wife requires quite a bit more insulin while pregnant for example - she had to make changes to her pump's settings while in the hospital to accomodate it.
What I found: 1 unit of insulin will cover 10g of carbohydrates [1]
Humalog insulin comes in 3 mL (300 units) vials or 10 mL (1000 units) vials. [2]
The list price of a Humalog U-100 10 mL (1,000 units) vial is $274.70 [3]
In type 1 diabetes, most people need a total of 0.5 - 0.8 units of insulin per kilogram of body weight each day. [4]
In patients with type 2 diabetes, marked obesity, and insulin resistance, total daily insulin doses of 200 to 300 units are often required. In this setting, management for most patients includes a total of 1.0 to 2.0 units of insulin per kilogram per day; thus, in very obese patients, a larger total dose is required. [5]
In type 2 diabetes, the average weight is 96.5kg - 98.9kg. [6]
The average American weight in 2020 was 181 lbs. So around 82kg. [7]
With the above details, in type 2, about 100 - 200 units are needed per day. That’s $989 - $1978 per year. In type 1, $494 - $791.
1. https://www.medicalhomeportal.org/link/3822
2. https://www.nationwidechildrens.org/family-resources-educati...
3. https://www.lillypricinginfo.com/humalog
4. http://www.diabeticretinopathy.org.uk/prevention/insulindose...
5. https://www.patientcareonline.com/view/insulin-dosing-how-hi...
6. https://care.diabetesjournals.org/content/29/3/493
7. https://news.gallup.com/poll/328241/americans-average-weight...
This varies significantly from patient to patient actually. The same goes for basal rates (how much insulin you need to maintain a healthy blood glucose level excluding what you eat). As you mentioned, weight is a big factor but so are other things like age, sex, diet, activity level, stress level, and just how well your body reacts to the insulin. Some people respond very well to artificial insulin while others just don't for some reason. I believe it can also depend on how long you've been using insulin. Your body can slowly stop responding as well as it used to.
The numbers you came up with as an average sound pretty reasonable, but it's important to remember that daily dosage will vary quite a bit between individuals.
Additionally my pump (tandem x2) has a lot of loss due to their loading system. For 300 units loaded, you get 250 deliverable units. Reloads happen about every 5 days.
For use per month, I have 2 vials per month prescribed.
If you are thinking about cost: pump insertion sets and continuous glucose monitoring sensors are all very expensive as well.
I use Lantus as my long acting insulin, and Humalog as my fast acting insulin. I receive a shipment of three 10ml vials of each every 3 months (so I use 1 a month). I use 30 units of Lantus a day, and a variable number of units of Humalog, averaging 25 units a day. Thus, 1 vial of Lantus lasts me slightly over 30 days, which is how long you should use a vial of insulin before replacing it.
Figuring out how many units of insulin to take can be difficult. This year I got a Freestyle Libre 2 glucose monitor which has alarms which will alert me if my glucose goes above or below preset limits. Fortunately, I am sensitive to hypoglycemia; sensitive enough that I will wake up if I go low while I am sleeping, but I can still get as low as a glucose reading of 40 point before I feel the effects, which upsets me and freaks out my wife. The alarm is set for 80 points, so I can take some carbs before I get seriously hypoglycemic.
I adjust my Humalog injections based on my glucose readings and my carb intake using a formula I have adjusted over long experience. I may take as little as 1 unit (if I just need to bring my glucose reading down) or as much as 12 units with a meal, but most of the time I take about 8 units with a meal.
"Starting this week, the retailer will sell an exclusive private-label version of analog insulin, ReliOn NovoLog, to adults and children who have a prescription."
What's the implication for those who live in a state like Pennsylvania and do not need a prescription to buy insulin, much to the dismay of many in the medical community.
https://www.researchgate.net/publication/42769372_Murder_by_...
And finally, Wal-Mart has been driving this agenda through low priced insulins for years and deserves praise for that effort to affect change. Can we expect the same from Amazon now that they've chosen to enter the pharmacy business?
$879 is the cheapest casket if that's what you're after. The cheapest items were all urns.
Edit: Wait. Novo Nordisk, their producer, is one of the established insulin vendors. Why are they helping to reduce prices?
Also, does anyone have an estimate of how high the margins still are?
https://divabetic.org/2017/06/08/transparent-pricing-works-h...
They fear a Congressional inquiry and federal price caps. Normally, you'd expect a new medicine entering the market to get cheaper as the production ramps up, yet it's gone the opposite direction, even after the patent has expired.
The big insulin makers like Novo and Lilly have been bearing the brunt of the PR disaster that is drug pricing, but reaping little of the benefit, as, according to them, their revenue per unit has barely budged in decades. Increased costs are to appease the insurance companies/PBM middle men (because due to the rebate system, they don't actually have to pay those increased costs). Both Novo and Lilly have attempted ways to cut out the middle men, with reduced payment programs, like the one mentioned in the article, or through "savings cards". However insurance companies have gone out of their way to combat these, limiting their effectiveness.
I think what's notable here is that Walmart actually has enough corporate muscle to allow a pairing with the pharma companies that the insurance companies will struggle to combat.
source?
Wow. That's double the rate of a country like France. An ounce of prevention really is worth a pound of cure.
Looking around, first response on google shows US prevalence is much high higher and increasing while France is lower and decreasing
https://www.indexmundi.com/facts/indicators/SH.STA.DIAB.ZS/c...
We have the technology. The cure is cheap. It's criminally insane that the US doesn't make life-saving or life-bettering drugs more available for free.
Insulin of this type is used primarily to treat Type I diabetes.
The only "cure" I know about for Type I diabetes is insulin, the subject of TLA and as far as I can tell, the subject of GP's comment also. Your comment appears to be the first introducing the idea of diet, which suggests that maybe, as I said, you're confusing diet-related Type II diabetes (not the subject of the article) with Type I diabetes (the subject of the article).
You cannot improve your lifestyle to prevent Type 1. However, it is epidemic across the entire western/developed world -- incidence doubles every ~6-7 years.
The America bashing on this site really does get tiresome, especially with comments like this one that are just totally meaningless. Especially when America and France have the same percentage of diabetic people: https://ec.europa.eu/eurostat/web/products-eurostat-news/-/E...
https://data.worldbank.org/indicator/SH.STA.DIAB.ZS
France was just an example, but even your link proves my main point. It's not just diabetes. Heart disease is 2x as common in the US as in many other developed countries as well. I don't see how this is "america bashing" (of which I myself have been critical of in the past on this website). What I've presented is useful data that contributes to the discussion over healthcare costs.
Your link doesn't show that comparability.
France is the highest rate in EU at 10% for ages 15+, EU average is 6.9.
US average for ages 18+ is 13% [1] West Virginia has the highest adult rate of US states with 15.7% [2]
https://www.cdc.gov/diabetes/data/statistics-report/diagnose...
https://www.americashealthrankings.org/explore/annual/measur...