Unraveling Gordian’s knot

Posted: 08/29/2016 in Screwed
Tags: , , ,

Everybody’s up in arms over Mylan’s EpiPen controversy.  So today’s lesson in capitalism and the duty of congress comes from Jim Wright:

For those not familiar, the EpiPen is a drug autoinjector – basically an automatic hypodermic needle anybody can use. You pop off the safety cap, press the tip against muscle tissue and push, a spring-loaded needle stabs into your flesh and a measured dose of a drug (in this case Epinephrine (adrenalin)) is forcefully injected directly into the muscle tissue.

It sounds violent and painful and it is, it leaves a hell of a bruise (trust me on this), but you get to live which is always nice. Use of the EpiPen requires minimal training and can be used in seconds. And this matters because while epinephrine is used to treat a variety of conditions, in this case it’s being use to prevent anaphylaxis – i.e. a severe allergic reaction where breathing tissues – i.e. your throat! – can swell closed, which typically results in death via asphyxiation unless there’s somebody right there who knows how to perform a tracheotomy with a pocket knife and an ink pen. 

Having your windpipe close up is generally considered a pretty terrible way to go.

…Mylan increased prices for profit, certainly, because they have to make a profit for their shareholders and they have every right to do so, but that wasn’t the only reason. Scott [a commenter on another web page] says “taking the ACA out of the picture,” but the thing is you can’t take the ACA out of the picture. Complex economic factors and unexpected market pressures driven by implementation of the Affordable Care Act factor directly into the price increase – and that is entirely on Congress who has repeatedly and emphatically failed to act.  And to a certain extent on the President who has not made this flaw (and others) in his signature legislation a national issue and publicly demanded Congress stop screwing around and get on it.

This situation, and dozens more like it, could have been avoided, if Congress would do its goddamned job and start fixing the Affordable Healthcare Act – or even replace it with something better as Republicans have been promising for eight years now but have as yet failed to produce a single legislative improvement despite majorities in both houses. And without the ACA, the costs would be even higher and 20 million more people would be uninsured.

Congress could fix this.  That’s their job.  No legislation is perfect, it can’t be. The world is simply too complex. Legislation is too complex. Social Security, Medicare, the National Highway Act, the Voting Rights Act, the Anti-Trust Act,every major piece of legislation was flawed in some fashion. There are always unforeseen side effects. That’s Congress’s job, to fix those things and to keep fixing them as new problems emerge.

But they won’t.  And they won’t because just like Martin Shkreli, they’re more interested in their own selfish satisfaction than they are in keeping the rest of us alive.

Congress has always fixed the problems with various laws, in fact that’s about 80% of what they do. Right up until President Obama came along, when petulant childish obstructionism became more important than your life.

Congress would rather let you choke to death than give one inch to President Obama.

Then there’s the other side of the argument:

“THEY are the ones that invented the drug and the ability to dispense it…”

Wrong.  Wrong on both counts…Mylan didn’t “invent” epinephrine [it’s a naturally occurring drug].  And they don’t own it. Nobody does.

The amount of epinephrine per typical dose is at most a few cents. Combined with other compounds to increase the effectiveness of the drug and decrease side effects (variations of which are how you make generics), each injection costs around $1.00 US.

But what Mylan does own is the patent on the EpiPen autoinjector – the device that allows somebody going into anaphylactic shock to self-inject themselves with epinephrine. Or allows a bystander, any bystander trained or not, to do the same.  That’s what they’re charging you for.  But see, here’s the funny part: they didn’t invent that either.

The EpiPen was developed by Merck Pharmaceuticals from the Mark I NAAK ComboPen…Military folks, particularly those who serve on the front lines, are intimately familiar with this beast or the newer version called the ATNAA (Antidote Treatment Nerve Agent Auto-Injector).  It was designed by the US government during the Cold War specifically to help military people survive a nerve agent attack…Mylan acquired the various patents for the EpiPen and other autoinjectors from Merck when the company bought Merck’s generic drug division in 2007.

Mylan’s CEO, Heather Bresch, the woman people are right now comparing to Martin Shkreli, set about making the-easy-to-use EpiPen available to everybody…These efforts have directly and provably saved many lives…Of course she did it for profit. Of course she did. But she saved a lot of lives along the way.  That, that right there, is what a good CEO does…Now, a side effect of this increase in availability, combined with unforeseen side effects with the ACA, resulted in massive price increases for the EpiPen. Some of which was deliberate on the part of Mylan, but not allAnd so here we are caught between the rock of capitalism and the hard spot of our obligation to those in need.

And it’s not as simple as greedMylan didn’t develop either the drug or the device…The US taxpayer paid for the original design. That’s right.  The US government paid for the development and design and manufacture of the Mark I NAAK ComboPen.  Now, why shouldn’t the people who paid for that design have some say, via their government, in how that device is made available to the public?

We regulate prices for all kinds of products critical to the public good, either directly or through anti-trust laws.  Electricity is a good example here. We regulate utility prices specifically because in the modern world most people can’t do without electricity, and because electricity in many areas is a monopoly.  Without regulation that monopoly could raise prices to any level they wished and people would have to pay up or learn to do without.

Mylan – by deliberate design of their CEO – owns what is essentially a monopoly on the autoinjector market.  People die without it.  The same people who paid for its design through their tax dollars.  Tax dollars that Mylan has found a way not to pay.  So why shouldn’t those people have a say in how that the device is regulated and sold?

…Without the incentive of capitalism, this situation wouldn’t even exist and hundreds, maybe thousands, of people would be dying every year of anaphylaxis.  But Mylan’s interests are not ours.  And you’re a fool if you expect altruism from corporations.

It is the government’s job to balance capitalism against the needs of the citizenry via regulation.  And that responsibility rests squarely on Congress.  Congress has traded away your health and safety – and your tax dollars – in their mad vendetta against the President.  They are all, each and every one, responsible. And any death that results is squarely upon those sorry sons of bitches.

Congress could fix this. They could rewrite the tax laws to eliminate the loopholes, they could set fair regulation of critical medical devices including the EpiPen – regulations that are fair both to industry and fair to the citizens who need them – and they could use the resulting increase in federal money to subsidize in various degree EpiPens and other healthcare for all citizens exactly as the president intended eight years ago. They could do all of this today, right now. But they will not.

Mylan and the EpiPen is but one of a thousand similar problems that directly affect the quality of life for people all over the world. Every. Single. Day. Those problems could be solved if the people responsible would only do the job they were elected and paid to do.

But they will notThe only way to make this better for all of us is via the mechanism put in place by our Founders.  In the end, you hold the power.

Come this November, remember this betrayal. Remember this petulant, childish eight year long tantrum. These lousy sons of bitches would let your child choke to death before they cooperate with each other or the president and there’s absolutely no reason whatsoever to believe they will change in the future.

Remember that when you go to the polls to elect a new congress and a new president.  If you want a better nation, be better citizens.  If you want a better nation, you have to elect a better government.

“If you want a better nation, you have to elect a better government.”  Wow.  Nicely put.

The argument on both sides of the aisle is covered at length in Wright’s original column.  I have greatly abbreviated his blog here, just to give you the high points.  Wright deserves to have his entire dissection of the issue read.   I’ve cut out over half of his blog and you see how long this still is, but if you’re interested in the details (and the details are important), please go there and read the entire thing. 

But before you go, I would like to know this: could somebody please explain to me how Wright manages to stay so obviously sane in such an insane world?


Be seeing you.


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