Insulin should be free!

History of Insulin

"In January 1922, Leonard Thompson, a 14-year-old boy dying from diabetes in a Toronto hospital, became the first person to receive an injection of insulin. Within 24 hours, Leonard’s dangerously high blood glucose levels dropped to near-normal levels."

#GOP Senator Susan Collins and Senator Joe Manchin alert!

Politics of insulin reveals the sickness of the United States health system. An echo essay published in the New Statesman, the United Kingdom edition (UK).

Build Back Better, Joe

"Joe Biden’s Build Back Better Act is the latest attempt to bring drug prices under control. It would cap prices for insulin and give the government more powers to negotiate with pharma companies."

Diabetics need insulin to stay alive but drug makers and Republican politicians ensure the price remains high.

By Charlotte Kilpatrick- A Franco-American journalist living in London. She writes about health and politics.

Until January 1922 diabetes was a death sentence. A hundred years ago, on 11 January 1922, a 14-year-old Canadian boy became the first diabetic to escape that fate by receiving an injection of insulin. Before that, those with Type 1 diabetes usually lived no more than two years after diagnosis. In 1923 the team of researchers who discovered insulin sold the patent to the University of Toronto for $1 because they wanted to keep the medicine affordable for everyone.

Flash forward 100 years and the price of insulin is anything but. Prices have soared: some formulations cost 1,000% more than they did at the turn of the 21st century. The price of one vial of Humalog insulin stood at $21 in 1999; it cost $332 in 2019, and many diabetics require more than one vial a month.

The reasons for the price rises are complex but can be whittled down to a simple fact: without insulin, diabetics die. Pharmaceutical companies that manufacture insulin have enormous leverage to charge whatever they want. In most developed countries diabetics don’t pay hundreds and sometimes thousands of dollars a month for insulin because governments regulate the price. The US, of course, is the exception. But with 10.5% of the US population diagnosed with diabetes — a percentage which is sure to grow — the rising cost of insulin has become a political punching bag.

It seems strange that a medicine invented 100 years ago has ballooned in price to the point that one in four diabetics reports rationing insulin because of cost. Yet despite its age, insulin remains relatively difficult to make. Unlike drugs such as paracetamol that are chemically derived, insulin is a biologic drug extracted from living organisms. Only three pharmaceutical companies — Eli Lilly, Sanofi and Novo Nordisk — produce insulin and control 90 per cent of the market.

This control makes it difficult for a generic drug maker to come up with its own version. By the time it could bring a generic to market, the big three insulin makers would have developed a newer version incrementally better than the older one. Because doctors naturally want to prescribe the best medicine for their patients, a company making a generic equivalent would find itself squeezed out of the market.

“Honestly, we sometimes call the big three insulin makers a cartel,” says Elizabeth Pfiester, founder and executive director of diabetes advocacy group T1 International. “They have demonstrated behaviour where they raise insulin prices in lockstep, and they have a near-complete dominance in the market. They also put large amounts of money into sponsorships and patient advocacy groups, so their influence is huge.”

Faced with growing pressure to lower prices, the pharmaceutical companies have started releasing cheaper formulations. Eli Lilly announced that it will make a so-called generic version of its Humalog insulin and sell it for 70% less, at $82.42 for an individual vial. Meanwhile, it charges Germans an even lower price of $55 for the exact same insulin.

Melinda St Louis, director of the Medicare for All campaign at Public Citizen in Washington, DC, says that giving the drug companies the power to decide insulin prices leaves diabetics at their mercy. “The reality is that a lot of people fall through the cracks. What we need to do to make insulin accessible for everyone is lower prices across the board,” she says.

Systemic illness
According to a 2021 report by the RAND Corporation, a think tank, sick Americans pay on average 256% more for medicine than people in 32 other countries. The price discrepancy is in part the result of the piecemeal nature of the US health insurance system, which favors large employers. Companies are only required to offer insurance to full-time employees: a waitress working 29 hours a week on her feet is not entitled to coverage.

Things could always be worse. A smoking diabetic who earns just enough in Dallas, Texas, to be above the poverty line to qualify for Medicaid (the government plan for the extremely poor) would be priced out of any of the plans offered under the Affordable Care Act, known as Obamacare.

Recognizing that some people could fall through the cracks, Obamacare provided states with free money to expand their Medicaid programs. Unfortunately for the hypothetical smoking diabetic, Texas is one of many Republican-controlled states that refused to accept the money on ideological grounds. 

Diabetics in other red states share the same grim luck. Six out of ten of the US states with the highest rates of diabetes have refused the Medicaid expansion to provide health insurance for poor people.

Build Back Better, Joe
Joe Biden’s Build Back Better Act is the latest attempt to bring drug prices under control. It would cap prices for insulin and give the government more powers to negotiate with pharma companies.

The sailing has been anything but smooth for Build Back Better. It barely passed the House of Representatives and is being held hostage in the Senate, where it needs every Democratic vote to pass. One Democratic senator who has voiced concerns is Kyrsten Sinema from Arizona, who says that negotiating drug prices with pharma companies would mean less money for research and development, and therefore fewer innovative drugs.

However, a 2017 study revealed that the premium Americans paid for the 20 best-selling drugs was $40 billion higher than the amount the drug companies spent on R&D. A Congressional Budget Office paper released in August reported that allowing negotiations could save the government 15-25% on drug costs.

In many cases Americans end up paying for the same medical research twice. The biggest public funder of drug research is the US taxpayer, through the National Institutes of Health, which contributes almost $52 billion to research. The results are then sold to pharma companies, which sell the drugs to Americans at jacked-up prices.

According to St Louis a cap on insulin prices is a step in the right direction, but it’s not enough. “The hold-out that we are seeing from some Democratic senators is an example of the outside influence of the pharma industry on our democratic process,” she says. “Sinema has received enormous amounts of campaign contributions from the drug companies that have all opposed [Build Back Better].”

Sinema, who raked in $1.1 million in campaign donations from pharmaceutical companies in three months, is far from the only recipient of Big Pharma money. The industry is the biggest spending lobbying group in the US, dishing out $352.8 million last year. That’s not the only way Big Pharma buys influence. It spent $6.65 billion in 2020 on advertising to convince patients to buy their medicines. That’s enough to bring five new drugs to market in a year.

For the moment negotiations on Build Back Better continue. Joe Manchin, Democratic senator for West Virginia, a state where 16% of the population has diabetes, is holding out on the legislation because he claims it will add to the deficit, and that poor families will spend the extra money from tax credits on illegal drugs.

Perhaps it hasn’t occurred to him and the 50 Republican senators who oppose the bill that poor families can’t afford to wait for lower prescription drug prices.

President Joe Biden advanced "gigantic legislation"

Echo New York Times essay by David Brooks*:

President Joe Biden came to the White House at a pivotal moment in American history. We had become a country dividing into two nations, one highly educated and affluent and the other left behind. The economic gaps further inflamed cultural and social gaps, creating an atmosphere of intense polarization, cultural hostility, alienation, bitterness and resentment.

As president, Biden had mostly economic levers to try to bridge this cold civil war. He championed three gigantic pieces of legislation to create a more equal, more just and more united society: the COVID stimulus bill, the infrastructure bill and what became Build Back Better, to invest in human infrastructure.

All of these bills were written to funnel money to the parts of the country that were less educated, less affluent, left behind. 

Adam Hersh, a visiting economist at the Economic Policy Institute, projects that more than 80 percent of the new jobs created by the infrastructure plan will not require a college degree.

These gigantic proposals were bold endeavors. Some thought them too bold. Economist Larry Summers thought the stimulus package, for example, was too big. It could overstimulate the economy and lead to inflation.

Larry is one of the most intelligent people I’ve ever known and someone I really admire. If I were an economist, I might have agreed with him. But I’m a journalist with a sociological bent. For over a decade I have been covering a country that was economically, socially and morally coming apart. I figured one way to reverse that was to turbocharge the economy and create white-hot labor markets that would lift wages at the bottom. If inflation was a byproduct, so be it. The trade-off is worth it to prevent a national rupture.

The Biden $1.9 trillion stimulus package passed and has been tremendously successful. It heated the overall economy. The Conference Board projects that real G.D.P. growth will be about 5 percent this quarter. The unemployment rate is falling. 

Retail sales are surging. About two-thirds of Americans feel their household’s financial situation is good.

But the best part is that the benefits are flowing to those down the educational and income ladder. In just the first month of payments, the expanded child tax credit piece of the stimulus bill kept three million American children out of poverty. Pay for hourly workers in the leisure and hospitality sector jumped 13 percent in August compared to the previous year. By June, there were more nonfarm job openings than there had been at any other time in American history. Workers have tremendous power these days.

The infrastructure bill Biden just signed will boost American productivity for years to come. As Ellen Zentner of Morgan Stanley told The Economist recently, it’s a rule of thumb that an extra $100 billion in annual infrastructure spending could increase growth by roughly a tenth of a percentage point — which is significant in an economy the size of ours. Federal infrastructure spending will be almost as large a share of annual GDP as the average level during Franklin Roosevelt’s New Deal.

But Summers was right. The stimulus — along with all the supply chain and labor shortage disruptions that are inevitable when coming out of a pandemic — has boosted inflation. In addition, Americans are exhausted by a pandemic that seems to never end.

And they are taking it out on Democrats. A recent ABC News/Washington Post poll revealed that voters now prefer Republican congressional candidates in their own districts by 51 percent to 41 percent. That’s the largest G.O.P. lead since this poll started asking the question, 40 years ago.

If presidencies were judged by short-term popularity, the Biden effort would look pretty bad. But that’s a terrible measure. First-term presidents almost always see their party get hammered in the midterm after their inauguration. That’s especially true if the president achieved big things. Michigan State political scientist Matt Grossmann looked at House popular vote trends since 1953. 

Often when presidents succeeded in passing major legislation — Republicans as well as Democrats — voters swung against the president’s party. Look, just to take a recent example, at how Obamacare preceded a Democratic shellacking in 2010. People distrust change. Success mobilizes opposition. It’s often only in retrospect that these policies become popular and even sacred.

Presidents are judged by history, not the distraction and exhaustion of the moment. Did the person in the Oval Office address the core problem of the moment? The Biden administration passes that test. Sure, there have been failures — the shameful Afghanistan withdrawal, failing to renounce the excesses of the cultural left. 

But the President Biden administration will be judged by whether it reduced inequality, spread opportunity, created the material basis for greater national unity.

It is doing that.

My fear is not that Democrats lose the midterms — it will have totally been worth it. My fear is that Democrats in Congress will make fantastic policies like the expanded child tax credit temporary to make budget numbers look good. If they do that the coming Republican majorities will simply let these policies expire.

If that happens, then all this will have been in vain. The Democrats will have squandered what has truly been a set of historic accomplishments. Voters may judge Democrats harshly next November, but if they act with strength, history will judge them well.

48th President of the United States

*David Brooks is a conservative political and cultural commentator who writes for The New York Times.

President Biden brings exceptional political experience to the White House

History News Network essay by Ronald L. Feinman:

When one investigates the history of the 59 presidential elections from 1789, through 2020, it is quite surprising to realize that the distinguished institution of the US Senate has not been a major factor in elections of presidents.

Only 17 presidents out of 45 have served in the US Senate, and only 15 were actually elected president, with John Tyler and Andrew Johnson succeeding to the office of president from the vice presidency.

Only the last seven presidents who served in the Senate were elected under the 17th Amendment popular vote requirement, since 1913 (Warren G. Harding, Harry Truman, John F. Kennedy, Lyndon B. Johnson, Richard Nixon, Barack Obama, Joe Biden).

Only three presidents were directly elected from the Senate to the White House (Warren G. Harding, John F. Kennedy, Barack Obama).

Only two presidents were elected president after serving in the Senate and also as vice president and being out of public office (Richard Nixon, Joe Biden).

Only four presidents served at least ten years in the Senate on the way to the White House (James Buchanan (10 plus); Harry Truman (10); Lyndon B. Johnson (12); and Joe Biden (36).

Six Senators who served ten years or fewer in the Senate served in that body much earlier than when they were elected president (James Monroe, finishing in 1794 and in the presidency in 1817); John Quincy Adams, 1808 and 1825); Martin Van Buren (1828 and 1837); William Henry Harrison (1828 and 1841); Franklin Pierce (1842 and 1853); and James Buchanan (1845 and 1857).

The following eight presidents served five years or fewer in the upper chamber: James Monroe, John Quincy Adams, Andrew Jackson, William Henry Harrison, Franklin Pierce, Andrew Johnson, Richard Nixon, Barack Obama.

It is clear that only four presidents who served in the Senate had distinguished careers in that body.

James Buchanan (1834-1845), who was significant enough that he started to purse the presidency and did so every four years from 1844 to 1856, when he was nominated and elected, after a distinguished career, including being in the House of Representatives and being House Judiciary Committee Chairman in one term; ambassador to the United Kingdom and Russia; and James K. Polk’s Secretary of State. (1845-1849).

Harry Truman (1935-1945), who gained prominence during World War II as the head of the Truman Committee investigating waste and profiteering in the defense buildup for World War II, and was chosen to be the vice presidential nominee in 1944, and succeeded to the presidency 82 days into the fourth term of Franklin D. Roosevelt.

Lyndon B. Johnson (1949-1961) who became Senate Majority Whip after two years, Senate Minority Leader after four years, and Senate Majority Leader for the next six years, after having served in the House of Representatives for twelve years. Johnson is acknowledged as the most formidable and significant Senate Majority Leader in American history, followed by three unhappy years as vice president under John F. Kennedy, and then serving five years and two months as an extremely activist president, setting records for accomplishments in domestic affairs, even more than his idol, Franklin D. Roosevelt.

And then, the “star” in years of service and leadership is our new president, Joe Biden (1973-2009), the only Senator who became president to have more years of service in the upper chamber than Lyndon B. Johnson, triple the number of years of Johnson, 12 to 36 years, which would have been longer if Biden had not accepted the vice presidency under Barack Obama. Biden became a major figure in the Senate, serving as Senate Judiciary Committee Chairman from 1987-1995, and Senate Foreign Relations Committee Chairman from 2001-2003 and 2007-2009. At this writing, Biden has the distinction of having been the 18th longest serving US Senator in American history, and the 6th youngest Senator ever to take the oath of office, having been elected a couple of weeks before his 30th birthday.

In the long run of history, therefore, LBJ and Biden will stand out as easily the most distinguished in their Senate careers, but with Johnson only making it to the White House from the vice presidency originally, and Biden having two failed attempts in 1988 and 2008, and only reaching the pinnacle of the presidency after being out of office for four years, and becoming president at the most advanced age (78)- (a mature elder statesman) -  of any president.

Maine Writer- Thank God for President Joe Biden.  He bring maturity, experience, compassion and demonstrated political leadership to build America back, better!