Believe it or not, we can learn something vital about healthcare from the US

The state can – and should – help to make people’s lives better, and has a duty to assist those who would otherwise get chewed up and spat out by the system

What on earth does insulin – and its soaring price in the US – have to do with a rather important competition between political ideas in Britain? More than you might think.

Let’s start with California’s governor Gavin Newsom, who was so appalled by the price of insulin stateside that he recently announced plans to spend $100m (£82m) to set up what amounts to a state-owned generic drug maker to produce it at a sensible price and sell it at close to cost to the state’s diabetics.

Why on earth should he need to do so a thing? Well, American “free market” capitalism sucks for type one diabetics, who suffer from an autoimmune condition in which, for reasons that are still not well understood, the immune system destroys the insulin-producing cells. Injectable insulin for those of us with the condition is therefore as important as access to breathable air. Or water. Or food.

A sizeable minority with the more common type 2 diabetes are in the same boat. Trouble is, surging prices mean that insulin in the US is now priced at the level of, I don’t know, caviar? Cristal champagne?

As reported by the Associated Press, the cost of insulin has ballooned from just $25 a vial in 1995 to a staggering $300 today. An insulin-dependent diabetic may need two or three a month of those – maybe more. Even with a work-based health insurance plan, the costs can be crippling.

In fact, it’s become so punitive that 14.1 percent of people with diabetes reached “catastrophic spending” as a result of their condition between 2017 and 2018, according to a recent study. This means that some 1.2m people spent 40 per cent or more of their post-subsistence incomes on insulin.

People inevitably end up limiting their use as a result of this. Some die, because the effects are potentially disastrous. Without insulin, diabetics can’t metabolise carbohydrates, which build up in our blood and attack our livers, kidneys, hearts, eyes. Insulin deficiency mucks up just about everything.

Why is this price-out happening? Simple. It is because the “small government, get out the way of business” approach favoured by the American right – and also the British equivalent, which we’ll get to shortly – frequently leads to the weak and ineffective regulation of “free market” capitalism.

Cut too much “red tape” and the latter devolves into a sleazy system of cronyism and cartels which engage in price gouging, including vital products such as insulin.

Enter Newsom, whose action has been facilitated by a couple of key patents coming to an end. Say what you like about California’s governor (he’s recently declared the monkeypox outbreak a “state of emergency”) but if he pulls this off it will be a stroke of genius. It will save lives. Whatever the trajectory of his future career, he will be able to say: “I did that.”

You’re now probably asking what this has to do with Britain? Well, I’ll tell you. Newsom is saying that the state can – and should – intervene to improve people’s lives when the market fails, as it all too often does. Of late, we’ve been hearing the Tory leadership contenders outlining a rather different vision: that of the free enterprise, smaller state, low tax world favoured by conservative Republicans in the US.

In a couple of years, when we in the UK go to the polls, we will have a choice. On the one hand, there will be a party dedicated to cutting taxes for the (relatively) wealthy, narrowing the size of the state and slashing the regulations that protect people from the sort of situation that kills diabetics in the US.

The competing view is that the state can – and should – help to make people’s lives better, and has a duty to assist those who would otherwise get chewed up and spat out by the system. This is more or less what the Labour Party looks set to offer, although it’s high time for Keir Starmer to get off his backside and communicate it with some conviction.

We in Britain obviously have the NHS, which currently provides insulin for free – and is able to use its vast buying power to obtain insulin and other drugs at a fraction of the cost US consumers pay. Free at the point of need. It’s a wonderful idea. No wonder people get misty eyed about it. But let’s not kid ourselves: it is under threat as a result of cruel conservative philosophy.

When Labour accused the Tories of planning to privatise the NHS during the last election, it was ridiculed. Fact-checkers were quick to criticise. Yet the NHS is being privatised. It is happening quietly, by stealth, as a result of chronic underfunding and the government’s refusal to develop a coherent post-Covid recovery plan.

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It is happening through people spending more and more on treatments that it can’t – or won’t – provide: physiotherapy, podiatry, psychotherapy and other mental health services. And the list goes on.

How long before lifesaving drugs are added to that lot? You think I’m exaggerating? Listen to the Tories’ rhetoric and consider how similar it is to that you will hear from some Republicans across the Atlantic.

The two parties are friendly. They pal around with each other. So that shouldn’t be so very surprising.

American crony capitalism has led to one of its states contemplating becoming a generic drug maker to stop its people from dying. If we don’t wake up to the threat, how long will it be before a Mayor of London, or of Manchester, or of Liverpool is flying over to Cali with a view to setting up a clone?