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In his State of the Union address Tuesday night, President Joe Biden said the official COVID-19 emergency declarations will end in May, but the pandemic has refocused America on the need for reliable affordable health care.
Biden wants to make insulin more affordable, saying that insulin should cost patients no more than $35 a month. That is the limit that people on Medicare pay, but the president says it should be universal. Democrats have pushed for such a limit for some time, but the idea is likely to go nowhere, not even for a House floor vote.
But what about the 31 million people in the U.S. who lack health care coverage, exposing them to unaffordable insulin? A report in the medical journal The Lancet says:
Retail insulin prices (the amount one pays without insurance) have skyrocketed. Between 2007 and 2018, the cost of some insulin products has increased by more than 200%.
People with little-to-no health insurance coverage have reported paying more than US$1000 per month when higher insulin doses are required. These unreasonable prices mean rationing other priorities, including food.
Experts say a vial of insulin, which costs about $6 to make, sells for about $300 in the United States. In Canada, the same vial sells for about $40.
Even though insulin gets the press coverage, it is hardly the only prescription medication that patients say is out of reach. The Centers for Disease Control and Prevention says, at last count, half of all Americans currently take some kind of prescription medication and spend $348 billion on meds each year.
The Los Angeles Times reports that pharmaceutical companies are not the only ones to blame for the high drug prices:
Researchers at USC found that drugmakers’ share of revenue from insulin sales has declined in recent years — and a greater share is being siphoned off by pharmacy benefit managers, drugstores, wholesalers and insurers.
In 2014, the researchers determined, 30% of insulin revenue went to middlemen. By 2018, those same middlemen were receiving 53% of insulin expenditures.
Is it any wonder American drug prices are the highest in the world? More than half the revenue from one of the most widely prescribed medicines is being gobbled up by layers of intermediaries standing between manufacturers and patients.
“The middlemen, and particularly pharmacy benefit managers, have been effective in negotiating lower prices from manufacturers,” said Karen Van Nuys, an assistant professor at the USC Sol Price School of Public Policy and one of the lead researchers of the study.
“What they haven’t been doing is sharing gains from those lower prices with patients,” she told me. “They’ve been keeping them.”
Pharmacy benefit managers, or PBMs, are companies that haggle with drugmakers on behalf of insurers and large employers. In theory, they play a vital role in preventing drug companies from charging whatever they please for prescription meds.
In reality, as the new data show, PBMs keep much of the savings for themselves rather than passing them along to patients.
The president also says he wants to make the premium savings in the Affordable Care Act permanent. During the pandemic, the American Rescue Plan Act allowed more people to qualify for help to pay for their insurance. Some low-income individuals paid nothing. By one estimate, the act increased by 20% the number of people eligible for Obamacare subsidies. As things stand, the subsidies will expire at the end of 2025.
Mental health gets State of the Union attention
Biden made mental health a key focus of his speech. The White House provided data that says, “Forty percent of American adults report symptoms of anxiety and depression, and the percent of children and adolescents with anxiety and depression has risen nearly thirty percent.”
The State of the Union speech gave attention to suicide among veterans. In a pre-speech briefing, White House advisers said, “Suicide among veterans is a public health and national security crisis. Since 2010, more than 71,000 veterans have died by suicide — more than the total number of deaths from combat during the Vietnam War and operations in Iraq and Afghanistan combined.”
The president says the government will increase spending to help veterans suffering from the effects of their service.
Biden also says that we should do more to protect children online. And he says the Department of Education “will announce more than $280 million in grants to increase the number of mental health care professionals in high-need districts and strengthen the school-based mental health profession pipeline. HHS and The Department of Education intend to issue guidance and propose a rule, respectively, to remove red tape for schools, making it easier for them to provide health care to students and more easily bill Medicaid funding for these critical services.”
The White House made other announcements, including:
In the coming year, HHS will improve the capacity of the 988 Lifeline by investing in an expansion of the crisis care workforce; scaling mobile crisis intervention services; and developing additional guidance on best practices in crisis response.
HHS will increase funding to recruit future mental health professionals from Historically Black Colleges and Universities and to expand the Minority Fellowship Program.
The White House said, “Even before the pandemic, health workers were experiencing high levels of burnout, anxiety, and depression. Studies have shown that burnout have reached crisis levels, affecting up to 54 percent of nurses and physicians. This year, the Centers for Disease Control and Prevention will launch a new campaign to provide a hub of mental health and resiliency resources to health care organizations in better supporting their workforce.”
The president also spoke about the dangers of fentanyl. The Biden administration says it permitted the use of $50 million for local public health departments to purchase naloxone, released guidance to make it easier for programs to obtain and distribute it to at-risk populations, and prioritized the review of over-the-counter naloxone applications.
And, importantly, the administration announced plans to expand drug treatment to jails and prisons. The White House briefing papers said the administration will:
… Ensure every jail and prison across the nation can provide treatment for substance use disorder. Providing treatment while individuals are in jails and prisons, and continuing their treatment in their communities, has been proven to decrease overdose deaths, reduce crime, and increase employment during reentry. By this summer, the Federal Bureau of Prisons will ensure that each of their 122 facilities are equipped and trained to provide in-house medication-assisted treatment (MAT). Further, since more than 90 percent of individuals who are incarcerated are in state and local jails and prisons, the Centers for Medicare and Medicaid Services will provide guidance this spring allowing states to use Medicaid funds to provide health care services—including treatment for people with substance use disorder—to individuals in those facilities prior to their release.
Biden calls for a ‘tax on billionaires’
President Biden is, once again, calling for a 20% levy on households with a net worth of more than $100 million. The White House says it would affect about 0.01% of earners. Biden’s proposed budget includes that plan, too. He says it would raise $360 billion over the next decade.
But CNBC says there is little support among Republicans. Even if it survived Congress, the tax would face legal challenges. And even if the courts didn’t stop the idea, the IRS does not have enough agents to enforce it.
But just for fun, let’s see where most billionaires live in the U.S., or at least where they claim to live. Forbes says, “The U.S. has billionaires living in 42 of its 50 states. The richest of each are collectively worth $1.4 trillion.”
(Graphic by VisualCapitalist, data by Forbes)
Forbes counts 748 billionaires in the United States.
“They live everywhere from Arizona to Wyoming, though most call one of just four states home: California (with 186 billionaire residents), New York (135), Florida (78) and Texas (67),” Forbes says. “Eight states have no billionaire residents at all: Alabama, Alaska, Delaware, New Hampshire, New Mexico, North Dakota, Vermont and West Virginia. Another eight are home to just one billionaire.”
(Graphic by VisualCapitalist, data by Forbes)
Go here to see the list of the richest billionaire in each state.
The most common words used in every State of the Union Speech
Quartz examined every State of the Union Speech ever delivered before last night. Here is some of what they found:
(Quartz)
(Quartz)
Teddy Roosevelt used the word “men” a lot.
(Quartz)
You can track a change in tone in Franklin Delano Roosevelt’s speeches once the U.S. entered WWII:
(Quartz)
Lyndon Johnson launched the phrase “War on Poverty” in his 1964 State of the Union address. Ronald Reagan’s speeches were peppered with the words “freedom,” with that word being one of the most used in three of his seven State of the Union speeches.
The first time “health care” showed up in the top three phrases used in a State of the Union speech was Bill Clinton’s address in 1994. In 2002, the word “terror” broke into the top three words in a State of the Union speech. In 2002, President George W. Bush used the phrase “axis of evil.” And President Obama used the word “work” over and over in five of his seven State of the Union speeches.
The first televised State of the Union speech was Harry Truman’s in 1947, which was delivered in the afternoon. He read every word off of paper in front of him since there were no teleprompters then.
Historians love to point to Bill Clinton’s 1999 State of the Union speech, which he delivered the evening of the same day that his attorney had been standing in the U.S. Senate, defending the president during an impeachment hearing. Clinton’s speech lasted an hour. He never mentioned the impeachment.
In 2020, House Speaker Nancy Pelosi offered to shake Donald Trump’s hand before the speech. Trump snubbed her, then she ripped up his speech, calling it “a manifesto of mistruths.”
A mock State of the Union speech written by ChatGPT
The Associated Press instructed the artificial intelligence program ChatGPT to work up State of the Union speeches as they might have been written by some of history’s most famous people, including Aristotle, Martin Luther King Jr., Cleopatra, Elvis and Yogi Berra.
Most memorable State of the Union lines
Here are some of the most memorable lines from State of the Union speeches:
“In the future days, which we seek to make secure, we look forward to a world founded upon four essential human freedoms. The first is freedom of speech and expression—everywhere in the world. The second is freedom of every person to worship God in his own way—everywhere in the world. The third is freedom from want—which, translated into world terms, means economic understandings which will secure to every nation a healthy peacetime life for its inhabitants-everywhere in the world. The fourth is freedom from fear—which, translated into world terms, means a world-wide reduction of armaments to such a point and in such a thorough fashion that no nation will be in a position to commit an act of physical aggression against any neighbor—anywhere in the world.”
– Franklin D. Roosevelt, Jan. 6, 1941
“President Washington began this tradition in 1790 after reminding the Nation that the destiny of self-government and the ‘preservation of the sacred fire of liberty’ is ‘finally staked on the experiment entrusted to the hands of the American people.’ For our friends in the press, who place a high premium on accuracy, let me say: I did not actually hear George Washington say that.”
– Ronald Reagan, Jan. 26, 1982
