MINOT, N.D. — Insulin costs too much.
The why of that fact is complicated.
It's not like insulin is a new drug. The benefits of insulin for those suffering from diabetes were discovered back in the 19th century. Using insulin as treatment is a practice that's over a century old. There's been some innovation since then — most notably in the 1970's when recombinant DNA technology was developed, largely replacing animal-based insulin — but typically innovations make prices go down.
According to GoodRx.com, the average per-unit price of insulin has risen nearly 40% since April 2014, though it's worth mentioning that the price is down nearly 6% since a peak in 2019 (more on that in a moment).
People who need insulin really need it. It's not like it's some optional treatment. You either take it, or you suffer. In many instances, you die.
You'd think that a well-established product serving a market with consistent demand would be a recipe for price stability, and yet the price of insulin is growing at a clip that's many multiples of the rate of inflation with little evidence of change in the product to justify the higher prices.
Part of it is that the price of insulation is one of the many cost inflation resulting from the disconnect between Americans who consume health care and the companies who provide it. When it comes to paying the bill for health care, most of us are not the direct customer. We're often not even the direct customer of the insurance companies who are the first to receive our medical bills.
Most Americans are insured, in one way or another, meaning that when they get care their insurance company gets the bill first. We pay what's left after that. This has put care providers — from hospitals to pharmacies — in the position of serving insurance companies instead of patients.
Worse, those insurance companies typically don't directly serve us either. Less than 6% of Americans have a non-group health insurance policy. Nearly 50% of Americans have group insurance, meaning an employer is typically the actual customer for the policy, making the cost-benefit decisions about coverage with varying degrees of input from employees.
Make no mistake, you're the one paying for your health care, but you are insulated from that cost by those other layers, which is why prices, in the health care industry, often don't work the same way as they do at the grocery store.
What does this have to do with the price of insulin?
That price has stabilized, and even declined, in recent years, because the government has begun allowing more competition in the insulin market. Patents have expired, allowing generic alternatives to be developed and deployed, and the FDA has loosened up restrictions on "biosimilar" insulins which act in the same way as existing forms but are not identical.
As is almost always the case in any given marketplace, choice and competition deflate price inflation.
This brings us to Senate Bill 2183, which was recently defeated in the North Dakota Senate. It's aim was price controls for insulin, capping it at no more than $25 in out-of-pocket expenses for a 30-day supply of insulin.
The bill lost on a 26-21 vote, and the politicians on the losing side are already banging the drums of partisanship, casting the winning side as doing the dirty work of the evil insurance lobby. "I'm sorry if this would cause a problem for private insurance companies, but I would think the life or death of one of our citizens would be worth a little inconvenience in their having to figure out how to make this work," said an indignant Sen. JoNell Bakke, D-Grand Forks.
But government price controls are clearly not the solution to expensive insulin. They would represent another layer of bureaucracy, another padding of insulation, between the already thick divide between health care consumers and health care providers.
A price control does not address why a price is high in the first place. And a price control on only out-of-pocket expsenses doesn't really keep real-world costs down. Your up-front costs may be less, but your insurance company is still paying the full price. Long term, this sort of policy puts upward pressure on the cost of insurance.
Meaning you're still paying. Just in a more roundabout way.
As has already been demonstrated by recent insulin price drops, the solution to this problem is more choice and more competition. Our lawmakers should be focused on how to make those things happen, not dictating arbitrary price levels.
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Rob Port, founder of SayAnythingBlog.com, is a Forum Communications commentator. Reach him on Twitter at @robport or via email at email@example.com.