Chapter 500 - 232: Addictive Dose (Part 3)
"If you try to confront them head-on in the market, they’ll crush you with money."
"You don’t have that kind of money."
"So, you can’t fight them like a businessman."
"You have to fight them like a politician."
"You have to use administrative power and legislation to forcibly bend the market’s rules. It’s the only way you’ll stand a chance against them."
"But, Mr. President,"
Leo asked.
"The pharmacy benefit managers are so powerful. They’re bound to have people in Washington and the State Assembly. If I go after their profits directly, is that even legal?"
"Legal?"
Roosevelt laughed.
"The winds have shifted, Leo."
"Look at Washington. The government just signed the Inflation Reduction Act."
"There’s a historic provision in it: Medicare finally gained the power to negotiate drug prices directly with pharmaceutical companies."
"This power is still very limited, of course—only at the federal level and only for a few drugs."
"But it opened a legal precedent."
"It legitimizes government price negotiation."
"What you need to do is bring that sword here to Pennsylvania."
"You need to go to the governor, to the State Assembly."
"If the federal government can negotiate, why can’t our state?"
"You need to push for state-level legislation that allows local governments to form non-profit drug purchasing alliances."
"You’re going to use federal precedent to pass state law."
"That’s why we’re going to Harrisburg."
The car exited the highway and entered the city of Harrisburg.
The Lincoln sedan drove over the bridge spanning the Susquehanna River. Leo leaned back in his seat, watching the buildings grow denser outside the window.
The car passed through a narrow street where several ragged homeless people sat by the roadside.
They were huddled in a corner, their bodies twisted at odd angles, their eyes vacant and unfocused.
One of them, a young man with a needle still in his arm, had his head thrown back, a strange expression of both agony and ecstasy on his face.
Leo’s gaze lingered on the young man for a few seconds, his brow furrowing slightly.
’Mr. President,’
Leo thought.
’These homeless people... most of them are victims of the opioid crisis.’
’If our Mutual Aid Alliance gets off the ground, if we can eliminate those cheap, addictive painkillers from prescriptions and replace them with more scientific physical therapies...’
’Maybe there would be far fewer tragedies like this.’
"That’s right, Leo."
Roosevelt’s voice held a note of agreement.
"The reason the United States has so many homeless people, so many addicts, is because someone is systematically creating them."
"Look at the drug formularies of the major insurance companies today."
"In the formularies for United Health or Anthem, OxyContin or fentanyl patches are classified as Tier 1 drugs."
"That’s the lowest tier, the so-called ’preferred drugs.’ For most policyholders, the copay for these drugs is extremely low, close to zero even."
"You can get a month’s supply for about five US dollars."
"And what about non-opioid painkillers? Like buprenorphine? Or a course of physical therapy?" Roosevelt countered.
"They’re Tier 3 or even Tier 4 drugs," Leo picked up, "or special treatments that require prior authorization."
"The copay for physical therapy is at least fifty US dollars per session, and non-addictive alternative drugs cost more than ten times as much as OxyContin."
"Exactly."
Roosevelt said, "Leo, that’s the calculation those vampires made."
"Opioids are cheap and fast-acting. To push these drugs, the pharmaceutical companies give huge rebates to the pharmacy benefit managers. So the PBMs put them on the Tier 1 formulary and recommend them to insurance companies."
"The insurance companies, eager to save money, are happy to go along with it."
"Imagine you’re a steelworker in Pittsburgh. You throw out your back lifting something heavy, and the pain is so bad you can’t sleep."
"You walk into a clinic, and the doctor looks at your cheap insurance card."
"The doctor knows you need physical therapy, massage, a non-addictive analgesic."
"But the doctor also knows you can’t afford it."
"If you go for physical therapy, you won’t have money for food next week."
"So the doctor can only sigh and prescribe you a cheap bottle of OxyContin."
"He’s helping you save money, but he’s also personally pushing you into hell."
"It’s a form of legal murder."
"They use cheap drugs to numb the workers’ nerves, letting them slowly rot away in addiction, all to maintain that low-cost healthcare system."
"That’s why the Rust Belt is full of addicts."
"It’s not because they want to do drugs."
"It’s because they’re in pain."
"It’s because they’re poor."
Leo thought of the young workers he had seen at the construction site in the South District.
They worked themselves to the bone, but during their breaks, someone was always hiding in a corner, swallowing some kind of pill.
This massive medical-industrial complex wasn’t just sucking blood; it was dealing drugs.
They had turned the entire working class into a population of slaves who couldn’t survive without drugs.
’I have to control the formulary,’
Leo roared inwardly.
’Just cutting prices isn’t enough.’
’I have to seize back the power to set the drug formulary.’
’In my Citizen Health Mutual Aid Alliance, I will never allow this to happen.’
’We have to pull back those who have already been destroyed by painkillers.’
’I’ll be saving this city’s workforce.’
Roosevelt nodded in approval.
"That’s right."
"A worker lost to addiction has no productivity."
"Save these people, and you save the factories’ output."
"Leo, that is the greatest meaning behind what you’re doing."
"We talk about power, about votes, about cold numbers and strategic games. But you must remember, all of those things are just tools, just accessories."
"When you pull a worker who was forced to rely on drugs because of pain back into the light, allowing him to earn an honest living and support his family with his own two hands..."
"When you give a family that was desperate because of poverty a reason to hope again..."
"You have changed their destiny."
"That is your greatest achievement as a leader."
"It’s more valuable than winning any election or passing any law."