Healthcare, Justices, and Brazil

An brief introduction this time to Prof. Heather’s commentary. I am taking the opportunity to embolden the beginning of the three points Prof. Heather makes. Within those points, I also chose to emphasize a part of those points by italicizing them.

The cost of healthcare and in this particular instance, insulin is one of those items. The use of Insulin is approximately 100 years old. There is no secret formula or advanced technology to it. One would think by now, the old version of insulin would be readily available. It is not.

A generic version of insulin of the lifesaving diabetes drug used by 6 million people in the United States, has never been available in this country because drug companies have made incremental improvements to it, keeping insulin under patent from 1923 to 2014. “Why People with Diabetes Can’t Buy Generic Insulin – 03/18/2015,” (

The history of insulin portrays an example of the process described above called “evergreening.” Pharma companies make a series of improvements to important medications and extend their patents for many decades. This keeps older versions off the generic market. During Alex Azar’s reign as CEO of Eli Lilly, the global pharmaceutical company repeatedly increased the price of insulin. In the five years Azar was president, the U.S. list price of the company’s best-selling insulin drug doubled.

Another mind-numbing change to a much-needed product involved EpiPens. A physical change was made to improve EpiPen devices. This in turn allowed Mylan to increase pricing on a product which is similar to the old product. Joe Manchin’s daughter CEO Heather Manchin Bresch guided this change. Joe was the recipient of election funding from the company.

It is difficult to draw other conclusions to illegitimate price changes. However, some commenters still manage to do so. Dr. Perry had discussed the increased costs of Insulin. Commenters instead concluded it was for other unsupported reasons.

The other point I would make is in reference to SCOTUS. I and maybe we all have never seen a court like this one. Where trump’s priorities were fast-tracked through SCOTUS, Biden’s priorities were scheduled out more towards the ending of this SCOTUS session.

In the same court, we also have what appears to be two serious leaks of privileged court information. Roberts still has not commented on the leaks. What exists is a weak partisan Chief Justice and a lesser Supreme Court.

January 1, 2023,” Letters from an American, Prof. Heather Cox Richardson

I hit “send” on my new manuscript at about 6:00 yesterday evening and have spent the first day of the new year just relaxing and catching up on oh, so many things that did not get done in the last few months.

Often on January 1, I post about the Emancipation Proclamation, which President Abraham Lincoln signed on this day in 1863, but had thought perhaps just to post a photo tonight. It feels like we could all use another quiet day.

But there are three things I didn’t want to let slip by, because they both sum up 2022 and point toward 2023.

First, as of today, January 1, 2023, the out-of-pocket cost of insulin for Medicare recipients is capped at $35 a month. Insulin in the U.S. costs up to ten times as much as it does in other countries, and the Inflation Reduction Act, passed last August, both enables Medicare to negotiate certain drug prices with pharmaceutical companies and caps the cost of insulin.

Unfortunately, more than half the diabetics in the U.S. are under age 65 and thus are not covered by Medicare. This amounts to more than 21 million people. Senate Republicans rejected the Democrats’ attempt to apply the cap to private insurers. The vote was 57 to 43, meaning that 57 senators—including seven Republicans—voted in favor of the cap, but the filibuster means that it takes 60 votes to pass most measures through the Senate, so the cap for those covered outside Medicare failed.

Second, yesterday Supreme Court Chief Justice John Roberts issued the 2022 Year-End Report on the Federal Judiciary. It’s an interesting document, not just for what it says, but also for what it doesn’t say. The introduction is dominated by a discussion of the 1954 Brown v. Board of Education decision in which the Warren court overturned the 1896 Plessy v. Ferguson decision and required the desegregation of the public schools. It was a moment in which the Supreme Court’s stance overturned a long history of discrimination and appeared heroic.

The unstated comparison is to this summer’s decision of the Roberts court in Dobbs v. Jackson Women’s Health, overturning the 1973 Roe v. Wade decision that recognized a woman’s constitutional right to obtain an abortion. The comparison runs aground on the reality that Brown v. Board expanded equality before the law and Dobbs v. Jackson Women’s Health contracts it. It is interesting that Roberts feels obliged to use the court’s annual report to defend the court’s actions.

The report makes no mention of the leak of the Dobbs decision, a leak the right wing met with fury but that has come to appear to be associated with right-wing Justice Samuel Alito and thus seems to have fallen off their radar screen. The report does not mention popular demands for justices to have a code of ethics—demands heightened by news that Justice Clarence Thomas’s wife Ginni participated in attempts to overturn the 2020 presidential election but he did not recuse himself from making decisions about that attempt—but it does demand protection for judges for their safety, despite the court’s recent expansion of gun rights. “A judicial system cannot and should not live in fear,” Roberts wrote.

And third, Luiz Inácio Lula da Silva, known as Lula, was inaugurated as the new president of Brazil today. Lula replaces Jair Bolsonaro, the right-wing ally of former U.S. president Trump. Traditionally, an outgoing Brazilian president is supposed to pass the presidential sash to the incoming president as a symbol of the peaceful transfer of power. But Bolsonaro for weeks refused to accept the outcome of the election, and as he is now under a number of investigations, he flew to Orlando, Florida, Friday night and expects to stay at least a month while he sees whether the new government will pursue the investigations.

In his place, a 33-year-old garbage collector, Aline Sousa, representing “the Brazilian people,” presented the sash to Lula and placed it on him. A software developer at the inauguration told New York Times reporters Jack Nicas and André Spigariol,

“Lula’s inauguration is mainly about hope…. I hope to see him representing not only a political party, but an entire population—a whole group of people who just want to be happier.”

Seems like a good note to start 2023.

Happy New Year.