Living in a democracy means citizens have responsibilities. One which not enough people take seriously is determining who their elected officials truly represent and then holding them accountable for their choices.
This can be difficult for the average voter. The legislative process is rarely straightforward. Amendments can alter the nature of bills in Committees or during floor votes. Lobbyists may work to insert hidden provisions in legislation benefitting their clients. A vote which seems to mean one thing may mean something completely different because of political party maneuvering.
The communication machines of elected officials often distort the meaning of legislation and amendments. Skillful press releases claim legislators always cast their votes in the best interests of their constituents no matter what the subject of the vote may be.
But every so often a vote takes place which cuts through all the rhetoric and is so basic every voter can understand what it means. It has to be a simple yes or no vote, the issue must be understandable to everyone, and there needs to be a clear choice for each elected official.
Such a vote took place during the U.S. Senate debate on the Inflation Reduction Act, legislation containing multiple provisions impacting the federal government’s approach to combatting climate change and health care. The final vote on the legislation saw all 50 Democrats supporting the bill, while all 50 Republicans opposed it. Vice President Kamala Harris cast the deciding vote which sent the bill to the U.S. House of Representatives.
The bill is full of provisions which Senators could claim would benefit or harm their constituents and which they could use to justify their final vote. But as the bill was debated, a vote on one particular provision regulating the cost of insulin demonstrated whether Senators were truly representing the interests of the people of their state or supporting the greed of the pharmaceutical industry.
The cost of insulin is dramatically higher in the United States than in other countries. A report prepared by the RAND Corporation for the U.S. Department of Health and Human Services in 2020 showed that in 2018 a standard vial of insulin cost $98.70 in the United States and averaged $8.81 in the 32 countries that are part of the Organisation for Economic Development and Cooperation (made up of Western European nations).
The American Action Forum estimates 8.3 million Americans used insulin in 2020 and that number could increase by 20% by 2030. With the high cost of the drug, many of those in need of the life-saving protections of insulin struggle to afford it.
Nearly 100 percent of the insulin used by Americans is manufactured by only three companies – Ely Lily (based in the U.S.), Novo Nordisk (based in Denmark), and Sanofi (based in France). Like most pharmaceutical companies, they spend millions of dollars each year trying to influence elected officials. And with numerous provisions of the Inflation Reduction Act focused on prescription drugs, their lobbying efforts were intense in the months and weeks leading up to the vote.
U.S. Senate rules are complicated and antiquated and often appear designed to make it difficult to pass any meaningful legislation. One rule states non-budgetary issues require 60 votes to pass. The full Inflation Reduction Act was determined to be exempt from the 60-vote rule, but certain amendments were not. One non-exempt amendment would have limited the amount any American must pay for a vial of insulin to $35.
The pharmaceutical companies attempted to make this vote complicated by citing the costs of research and development, but insulin is a well-established drug with stable manufacturing costs. Some Senators tried to make the case that the issue was not germane to the Inflation Reduction Act, but prescription drug costs for Medicare beneficiaries were already an integral part of the bill (including limits on the cost of insulin for Older Americans) making that argument laughable.
In the end the vote came down to the interests of Americans and their families who would benefit from bringing the price of insulin down to only 4 times the cost in other countries instead of 10 verses the interests of three pharmaceutical companies realizing enormous profits from the sale of insulin.
Fifty-seven Senators (all of the Democrats and 7 Republicans) voted with the American people. 43 Senators, all Republicans, voted with the pharmaceutical companies, so the amendment failed.
It is rare a vote so vividly demonstrates who U.S. Senators represent – the people of their state or their campaign donors. The constituents of the 43 Senators who favor the interests of the pharmaceutical companies now have a responsibility to hold these Senators accountable for their preference the next time their name is on a ballot.
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