Weird politics

Senate passage of the so-called Inflation Reduction Act was a great and surprising accomplishment. Just about nobody thought Joe Manchin was sincere about wanting  to make a deal, and nobody knew what the hell Kyrsten Sinema was thinking. It turns out Manchin has a core of sincere concern for the public interest buried in that coal tycoon, and Sinema was willing to go along with the deal as long as her obscenely wealthy hedge fund manager donors could keep their $15 billion tax break.

There was nothing the Senate Republicans could so about it since largely arbitrary and barely comprehensible Senate rules made this tax and spending bill immune from the filibuster. But there was one thing they could do to frustrate the Democrats, even though it meant screwing their own constituents, because we know what's more important to them. Because the Senate Parliamentarian, a person nobody has ever heard of, had ruled that capping people's out of pocket costs for insulin was not immune to the filibuster, they forced that provision out of the bill. 

Now, you may want to say that's because they have a principled opposition to price controls, commitment to the Free Market™, yadda yadda. However, this is not an example of the wondrous workings of the invisible hand. Frederick Banting discovered insulin in 1923, and he and his colleagues sold the patent to the University of Toronto for one dollar. People with Type 1 diabetes will die if they don't get a constant supply of insulin. Full stop. But right now there are only three manufacturers of insulin in the U.S., and they have been raising the price in lock step for the past decade. They're obviously price fixing but it's just too hard to prosecute them, apparently.

The price in the U.S. has tripled, but not in the rest of the world where they have sane policies that allow the government to negotiate the price of drugs. The U.S. constitutes 15% of the global market for insulin but accounts for 50% of drug company profits. Some people have to pay as much as $450 a month for their insulin and literally cannot afford it, forcing them to reduce their dosage, resulting in kidney and eye damage, among other consequences. Because of the arcane Senate rules, the bill still allows Medicare to negotiate on the price, but the price cap for privately insured people is out. (The provision would regulate insurance, rather than setting the price.) There's an overly complicated explanation of this folderol here, if you really want to get into the weeds.

Another funny thing -- most Senate Republicans have supported the cost cap on insulin right up to the moment when they had a chance to trash it out  of pure spite. Good luck explaining that to the voters.