Drugs and Money (and the High Cost of Health Insurance)

My asthma medication retails for $400 a month. Thank god I have health insurance.

The medication contains two ingredients, developed in the 1990s and the 1970s, that if sold separately, would be long out of trademark and available for pennies a dose.

But big pharma is manipulating medication availability so that they can rake in big bucks by finding ways to create new combinations in new delivery hardware to keep medications under trademark for decades.

USAToday reported two years ago what the CEOs of some of the pharmaceutical companies were getting paid:

AstraZeneca, the manufacturer of the medication I take, isn’t on this list, but its CEO, Pascal Soriot, made $13.4 million in 2016.

I have no idea what my health insurance company is paying for the medication after my $25 copay, though I suspect they're negotiating some kind of discount. Health insurers' CEO salaries have spiked in recent years, and they too are pulling in millions of dollars:

Salaries in millions of dollars, 2016

There are a lot of reasons why health care costs in the United States are spiraling out of control. One of them is that big pharma and health insurance companies are tossing the ball back and forth in an orgy of greed, while passing on increasingly high prices to consumers in the form of higher policy costs, higher deductibles, and higher co-pays.

Making people ration health care because they can't afford it is terrible policy. It often leads to higher health care costs down the road. The only way to stop this is to take the profit motive out of the picture.

There are No Bike Lanes in New York City

New York City's Department of Transportation publishes a map of bike lanes, and according to the cycle advocacy group Transportation Alternatives, half a million people ride a bike on a regular basis.  There are 10,000 Citibikes and an estimated 450,000 trips by bike every day on more than 1000 miles of green-painted lanes marked with bike icons all over the city. Mayor de Blasio's administration has been promoting Vision Zero, an attempt to keep drivers from mowing down pedestrians and cyclists. (Nevertheless, in 2017 almost 5,000 injuries were reported, and 130 people on foot or on bikes were killed in crashes with motor vehicles.)

Without enforcement, the bike lanes don't work as bike lanes. 

They function as pedestrian overflow: people jogging, walking with dogs and shopping carts and strollers and fishing poles and kids on scooters and coffee trucks and hand trucks and all the other things New Yorkers carry around.

They function as temporary stopping and parking lanes for tour buses, delivery trucks, police cars, school buses, and taxi cabs, on top of all the private vehicles whose owners are loading or unloading groceries, kids, or their latest Ikea purchases.

Alarmingly, they also get used as passing lanes by drivers in a hurry.

New York City hasn't created infrastructure for short-term parking, so the demarcation of all of the "bike lanes" fills a real need -- and forces cyclists to weave in and out of the line of traffic block after block, making cycling even more dangerous.

But what really convinced me that New York City does not have bike lanes is the dumpster on Suffolk Street.

The last time I was on that block, there were several other vehicles parked or stopped around it. If the city were remotely serious about allowing bike lanes to be used by bikes, that dumpster would have gotten towed immediately, and someone slapped with a hefty fine. It's been there for a week already.

Oddly, the streets that feel safest are the ones marked with "sharrows" -- arrows indicating that motor vehicles are supposed to share the road with cyclists. There's no weaving in and out of traffic, and there's not enough room for them to get blocked indefinitely by Fed Ex trucks and cab drivers.

But sharrow lanes are right next to parked cars, and drivers and passengers don't look before they open their doors. I've only been doored once, thrown into (fortunately stopped) traffic, but I've completely lost track of the number of near misses.

Free street parking massively subsidizes car ownership, and it has to go, to be replaced by metered parking expensive enough to keep the spots clear for short term parking and official vehicles. Obstruction of bike lanes by police cars and other official vehicles needs to stop, as this sets the example that the bike lanes are a free-for-all. Cyclists are 150-pound assemblages of flesh and bone atop 25-pound machines, but the culture of New York City treats us as equivalent to ten-ton trucks.

The city needs to fix this. Bike lanes need to be bike lanes.