Americans with diabetes are forming caravans to buy Canadian insulin at 90% off

I… don’t think this works the way that you think it works.

As far as I know, there is no subsidiary for employer-sponsored insurance, although the cost of the insurance is deductible from both the employer and employee side. (Meaning if the employer spends $2000 a year on the insurance, they don’t have to pay taxes on that $2,000; if the employee spends $4,000 on it over the year, that is taken out pre-tax, and they don’t have to pay taxes on that.)

Even people without sponsored plans should consider tax implications of healthcare. If you have a HSA or MSA compatable plan, those are both taken out pre-tax and decrease your tax bill. If you didn’t use a HSA or MSA, you might be able to deduct those expenses if they were more than a certain percentage of your income. I’m not sure if the non-employer sponsored health insurance plans are still deductible or not. If you spend a lot of money on healthcare, you really need to talk to a tax expert to figure out how to save money on taxes.

There is a LOT of misinformation out there on this. Most people seem to have incorrect ideas about how insurance works and how taxes work.


The problem is that with the lower price in Canada, demand goes up as people use it as directed, getting their complete doses instead of trying to play that game where they can dose as little as possible while not directly killing themselves, instead killing themselves over the long term.

Demand also goes up as the poorer customers don’t die off as fast, since they don’t guess wrong or die of diabetes related secondary issues since their disease is well controlled.

/s. Kind of. Not really. Damn these companies suck.


It’s a stretch to even characterize it as a “system.”


They had to pay $14000 (on top of premiums) before their prescriptions were covered? Yikes. That is one shitty plan.

(We get our insurance through the ACA too, but it’s way better than that. Just another part of this “system” that makes no sense.)


It’s simple, treat insulin as a regulated substance. Give to people with diabetes a “I am diabetic card” (that is useful also in case one arrives unconscious in A&E) and ask them an older recipe made by a Canadian GP.
I suppose that a pharmacist will not give free Vicodin or Codeine to a random US tourist, and because insulin could be used by bodybuilders for doping and has dangerous side effects, a stricter regulation could be enacted without directly mention the US shoppers.

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It isn’t just that the insulin there is magically cheaper to make and distribute–
It’s the same damn company selling to two different countries at two different prices.
It is one supply.


These aren’t looters but health refugees, trying to save their lives or their family’s. The measures they are taking are perfectly legal, but even if they weren’t I wouldn’t blame them.

The selfishness is all on the part of the pharmaceutical manufacturers and their shareholders.


If it works the way you describe, it works exactly as I think.

Any time a person or corporation pays less taxes (through deductions in this case), they are being subsidized by those who cannot take that deduction.

If an employer is spending a million dollars on health insurance, that’s a million dollars not being taxed. If employees’ health insurance premiums are taken out pre-tax, that further decreases tax revenue. The government still needs money to run, so everyone else is paying an increased share.

I receive no tax break for my insurance, therefor my taxes are helping to pay for someone else’s. To me, that counts as a subsidy.

Aside from the part about me being wrong, I agree with your post.

[ETA: I’m not arguing against the deductions, just pointing out some of the hidden costs of our jacked up system.]

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That’s correct, but I think what they’re getting at is that use of one buyer’s supply (Canada) doesn’t adversely affect the availability or pricing of another buyer (US patients). It’s artificially inflated with one and not the other because they can and because fuck you.

ETA: Not fuck you you, understand. Fuck the American patient.

EETA: And no burth control for that fuckin’ because Jesus wrote the constitution!

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The supply problem isn’t on the manufacturer’s end. It doesn’t matter if there’s a warehouse somewhere that has lots on hand. Saying that Canada can just buy more later, doesn’t mean there’s no supply problems. The supply problem is at the distribution end.

Healthcare systems budget for a certain demand, and when something weird happens (like an unexpected caravan of American healthcare refugees) then they won’t have the stock on hand or the budget ready to buy more on a day’s notice.

It’s like bringing ten people to a three-person dinner party and then saying there’s lots of food at the supermarket, so what’s the problem?


I think it’s mostly ironic though, there are people that are fleeing to America for the same reason, trying to save their family. Instead their children are being ripped from their arms and they are being told that these people are a threat to America. However, these Americans taking Canada’s limited drug supply only think of their own lives where in this case, it could cause actual Canadians to die.

Can you explain to me the difference between “health refugees” and actual refugees? I would really like to know why one group is seen as a courageous and another group is seen as potential terrorists that are threatening a countries way of life?

Yes, what you’ve just described is nonsense. It takes into no account how life-saving medication arrives inside the body of the consumer. Insurance only works to siphon funds from consumers while providing as little benefit as the market allows.

Drug supply chains are not so fragile and disconnected and it’s not difficult to watch the supply chain to deal with oversupply and under-supply situations. Also, insulin isn’t bought by healthcare systems. It’s bought by pharmacies who can and do redistribute supply to areas with a shortfall or areas that have a greater profit potential as needed. It’s not as if stock arrives at one location and can never be moved.

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I used the term because I don’t see them as different, except in degree. In your words, “Instead of fixing their broken ass system through voting they take the easy route of going to another country, looting their system…” Would you say that of Central American refugees trying to get into the US?


Maybe not obvious to folks who greet needy caravans at the border with AR-15’s. We greet ours with doctors heavily armed with scrip pads. These are your heavy-duty, milspec scrip pads, automatic script pads that flip the page mechanically when the signature hits. Assault script pads, these docs are not pissing around. It helps to have an American doc with your history handy so they don’t have to go through a long diagnostic effort. Hence the “caravan”.

Seriously, the story delicately skips around that detail, creating the impression they just walk into the drug store like it was buying twizzlers. It would be awkward for a doctor to have written a dozen large insulin prescriptions the same day, and the the profession would check that he was making at least a minimal effort to actually diagnose, getting an American doc to confirm the history is real, and confirm it was for personal consumption and not somebody buying to resell, which would bring the whole thing crashing down.

You can imagine people reading this very story and planning to set up an arbitrage business, so everybody involved has to work to prevent that. Particularly the Canadian doctors enabling it, as it could cost them their careers.


The pharmacists are literally the ones warning of potential drug shortages.

Of course things can be moved, but not always before unknowably large demand. The global inventory of cows makes no difference if you just sat down to a too-big bowl of cereal.

They can’t be expected to keep stock if they don’t know how many Americans are potentially going to be visiting.

You’re saying it’s “not difficult” for pharmacists to monitor their supply chains, to the people actually doing it, in a story where they’re the ones telling you it’s a danger.

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If you dig a little you will find that a pattent on long acting synthetic insulin expired in 2014 and generics were approved in Europe and for sale in Mexico, Peru, China and India without any state approval. Here we can’t buy this cheap generic because the FDA, a government agency, is being at best, inneficient, at worst, criminally corrupt. If left to “the market” I could buy it today.


Well, so much for the theory that in a free market system, the price of everything falls to the price of manufacture plus an average 8% profit.

[The Fortune 500 average 8% and it’s considered a fair assumption figure; if you try to take 10% profit, somebody willing to take 8% will take your business. When IBM made an average 16% profit over a long period from mainframes, that was used as evidence they had a monopoly that could not be broken through price competition.]

Providers in heavily-regulated markets generally still make great profits via a kind of regulatory capture: they know the most about their own business, and can usually present convincing tales of how expensive it is to be them, and how they need 20% profits over the apparent manufacture cost to cover all their other many problems. Clever accountants inflate the cost of the problems.

All that applies in Canada and our drug companies are pretty happy. Normally, you would prefer a free market to cut through all that bullshit by enabling a competitor to make an offer at a real price. But that just doesn’t work in some markets for some things.

We Canadian liberals, who often fight with Canadian conservatives on that point, would like to thank the USA for such dramatic proof that we’re right, and the Canadian conservatives should all be sent to ice floes.


Apologies if this is a dumb question, but in my defence I come from a country with a mostly functioning health care system. Am I right in thinking that this:

Nystrom has health insurance in Minnesota through the Affordable Care Act. But she’s on what she calls a high-deductible plan: She pays $370 US a month for the plan itself, but has to pay a $7,800 US deductible before her plan will cover her insulin.

means she has to pay over $8000 before her insurance will contribute a penny to her costs?

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Insulin can be bought in Canada without a prescription, even by Americans. However, it may require a consultation by a pharmacist.