Insulin as a public service

April 13, 2019 (446 words) :: The public health crisis created by rising insulin costs is a strong argument for public provision of important drugs. This isn’t as impractical as it sounds.
Tags: public-services, intellectual-property

This post is day 103 of a personal challenge to write every day in 2019. See the other fragments, or sign up for my weekly newsletter.

Following on from a fragment from two days ago: If the market doesn’t give us affordable housing …

Insulin distribution is in a state of crisis right now, and it’s a disgrace. Prices have gone up astronomically in the last few years, and people are rationing their use of the drug accordingly. Note that the problem is of distribution, not production. Insulin can actually be produced quite cheaply; the limits are in the social structure, not in biochemistry or availability of raw materials. The problem is restrictive intellectual property laws, combined with corporations indulging in the blatant price-gouging imaginable.

In an ideal world, scientific development in its entirety would be conducted for social good, not for profit. Of course, it’s the process of getting there that seems difficult to imagine. In the here and now, it might help to come up with policies that both work within the framework of what’s possible now, while also paving the path toward more transformative opportunities in the future. Non-reformist reforms, in other words.

So here’s a proposal for taking public control of insulin production, assuming the power of the state as a lever, and starting from the conditions we have now (in the US, that means, a shitty and fragmented healthcare system). (It’s definitely incomplete, and there may be better historical examples, but I’m just dashing this fragment out quickly and haven’t had time to do research, for which I apologise.) Regulators could demand that pharmaceutical companies produce important drugs like insulin below a certain price, using details about the public health crisis as a way to build public support. If pharmaceutical companies refuse to do so, the patents could be deemed as not having been properly maintained, and thus released into the public domain. (This is probably harder than it sounds under the highly restrictive IP regime we have now, but it’s probably at least possible.)

Private companies could still be allowed to manufacture such drugs, but their price should come down to the cost of generics. If that fails to happen, that’s a good opportunity to create a publicly-funded, government-run institution for producing drugs, as Elizabeth Warren proposed in the Affordable Drug Manufacturing Act. And then once the benefits of affordable drug production become evident, it becomes a stake in the ground, making it natural to expand to other drugs as well.

In the long run, I think healthcare should be entirely a public service, free at the point of use, with important inputs (like drugs) being publicly-produced as well. Getting there in one go would be great, but in case that’s not possible, getting there in incremental steps might work too.

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