After watching the umpteenth “Non-24” ad on TV, I wondered who had the millions of dollars to buy thousands of TV ads to target the 100,000 Americans who are blind and the subset of them that struggle with daytime drowsiness. The answer is a company called Vanda Pharmaceuticals that produces a drug called Hetlioz. Vanda asserts that Hetlioz helps some blind people who struggle to regulate their sleep-wake cycle so that they can avoid being sleepy at work or at school. The problem is that the annual list price for one person to take Hetlioz is reported to be $148,000 per year. Can’t afford $150,000 for a sleep aid? Vanda says they will work with you.

Turns out, fewer than 1000 blind Americans actually take the drug (no great surprise). At nearly $150,000 per year, I did begin to see how Vanda could afford to reportedly spend $29,000,000 over the last two years to advertise the drug. Where does all that money come from?

This is just one example of an out-of-control healthcare delivery system. The average cost of insulin for America’s 1,250,000 Type 1 insulin-dependent diabetics has tripled over the last decade, leaving many diabetics making the lose/lose decision of paying their rent, utilities, or paying for their life-sustaining insulin. In response to increasing public outrage, Eli Lilly recently said they will begin selling a cheaper insulin, a generic version identical to their Humalog 100. Not surprisingly, Lilly will still continue to sell Humalog 100 at its regular price to insurers and employers. Cha-ching!

These are just two examples of the ongoing film-flam game that overflows the pockets of the drug companies and health insurers. So let the free market rule? Afraid of Medicare-for-All? Like debating on the phone with the insurance droid who says your policy won’t pay for the drug your doctor says you need? Enjoy navigating a healthcare system that selectively disadvantages many elderly people and lots of working folks who don’t have the time or energy to engage in prolonged gamesmanship with insurers whose profit margins are largely determined by how much care they deny?

What kind of a country do we want to be? At the end of the day, either everybody counts or nobody counts.

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