(Written by Allison Brown)

Rating: 3.5 out of 5.

The cost of healthcare in the United States is at an all-time high. If one suddenly loses their job or falls off their parents’ insurance, out-of-pocket costs can reach the thousands, leading many to neglect their health. Even with insurance, high deductibles and co-pays make it hard for the average American to afford necessary expenses. Pharmaceutical and insurance companies, as well as drugstores, treat basic human rights like a business. Each entity is more concerned about profit than healing their clientele. Pay or Die, from directors Rachael Dyer and Scott Alexander Ruderman, comes at a time more vital than ever to educate the public. It might be one of the most informative documentaries this year about the dire straits of our country.

Insulin prices, in particular, have been a recent topic of conversation for my family. My father has dealt with type 2 diabetes for most of his adult life, and my mother recently developed the illness as well. He was thankfully able to wean off insulin years ago (prior to the current price gauging) with a healthier lifestyle, but others are not so lucky. This film solely tackles type 1 diabetes, which appears to be more severe. I do wish both ailments received equal time to better understand both perspectives, but I think the film’s focus puts the requirement of insulin into a more critical perspective of life or death.

In 1996, the first analog insulin was sold for $21, but now the same amount, only about a month’s worth, sells for a whopping $290 a vial. Well-designed animated infographics and timelines help to visualize the drastic price jumps both in time and in the bureaucracy of our healthcare system. With such exorbitant insulin prices, afflicted individuals are forced to ration their medicinal supply, which inevitability puts them at risk to diabetic ketoacidosis. As a result, trying to save money may land a diabetic in the hospital or even drive them to sudden death.

Pay or Die puts a highlight on three stories: politically active parents of a 20-something diabetic who wrongfully passed away, a mother and preteen daughter duo on the cusp of homelessness traveling to Canada to purchase medication, and a millennial woman recently diagnosed during the pandemic trying to decipher her new diagnosis, and the new practices she must take on. The most powerful element is the highlight on so many stories of young adults dying solely because they chose not to ask for financial help. It is heartbreaking to see how directly the greedy choices of those steering the healthcare system affect consumers.

The protests and political action undergone by the subjects of the film are clearly working. According to an article from the Wall Street Journal published a mere two days prior to this review, Eli Lilly just cut list prices of insulin by 70% and will be capping out-of-pocket costs to an affordable $35. One can only hope the rest of the market will follow their lead.

Pay or Die shines a light on the unethical state of our healthcare system when it premieres at the 2023 SXSW Film Festival on Saturday, March 11th.

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