Pay Or Die

SXSW Film Festival 2023 REVIEW! Pay Or Die, directed by Rachael Dyer and Scott Alexander Ruderman, is about the impossible dilemma many Americans face: pay exorbitant prices for insulin regularly and risk financial ruin, or pay higher hospital bills when sick and risk death. As the documentary wastes no time pointing out, death can sadly come very swiftly for some people with diabetes, who could die quicker from high blood sugar than from thirst if they miss their daily dose.

Hence, Pay Or Die opens with the story of parents who lost their son from ketoacidosis mere days after being dropped by their insurance and before their paycheck would enable them to buy insulin. Mind you, insulin can cost more than one’s rent. This terrible choice and life gamble is not an isolated story. The filmmakers follow families from Minnesota to Oregon, all from various backgrounds, suffering the same problem. They have to deal with imminent life-threatening risks due to rationing, loss of insurance or income, or managing the disease during a pandemic.

“…pay exorbitant prices for insulin regularly and risk financial ruin…”

But what unites many of them is how this nightmarish situation pushes them or their loved ones to advocate for a cause that is almost uniquely American when it comes to insulin. Soaring healthcare costs is a problem all over the world, even in places supposedly misconceived as having “universal healthcare.” But everywhere else, insulin still costs a fraction of what it does in the States. The situation is now quite tragic, with prices skyrocketing 1000%, and we learn that the precious medicine has now become one of the top 10 most expensive liquids.

There is only one known and predictable culprit: greed. Insulin is controlled by a handful of pharmaceutical companies making appalling profit margins for everyone in the chain, from the manufacturers to the pharmacies. Of course, insurance companies are profiting from the misery of sick people. What is more outrageous is that insulin was invented to be accessible to those suffering from severe but treatable autoimmune diseases. This approach of treating healthcare as a business is infuriating for most of us struggling to pay for prescriptions, but when it makes a life or death difference, it is just evil.