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How Public Pharma Can Fix Our Prescription Drug Crisis · We Can Do Better

• Fran Quigley: Hello and welcome to We Can Do Better, a podcast about ending poverty in our time. I am your host, Fran Quigley. I'm a law professor. Each week I go with my students to eviction court where we represent some of the millions of people in our country who are facing the loss of their homes. Many of those people, including our clients, are also forced to skip filling prescriptions, and they often even go hungry despite living in the richest nation in the world. We can do better. So, this podcast lifts up the many people and organizations who are working to make housing, health care, and a decent life and forcible human rights for all. That means today we are excited to speak with Mara Hennigan, who will be talking about life-saving prescription drugs and how something called public pharma could finally make those medicines affordable. Mara is the director of the Health and Political Economy Project at the New School's Institute on Race, Power, and Political. economy, which we'll hear more about, where she works on health focused policy and programs. Mara has also served in multiple economic justice roles in her hometown of Chicago, including work on guaranteed income and medical debt cancellation. Mara, welcome to We Can Do Better. Mara Heneghan: Thank you so much, Fran. That was a wonderful intro to both myself but also kind of the work I know we share in common. Fran Quigley: Well, good, good. Well, I want to hear more about I know our listeners are going to hear more about your background, but but also don't want to bury the lead, right? In in this important work that you're doing. So the data show consistently that four out of every ten Americans skip filling prescriptions because they just can't afford them. And affordability of prescription drugs is is consistently at the very top of what Americans care about in terms of economic issues and and frankly their everyday life issues. And it's certainly a struggle that we see with our low-income clients. So you've been working on something called public pharma. And so can you tell us a little bit about what public pharma means and what can't that can do to address this crisis that we're in the middle of? Mara Heneghan: Absolutely. I think public pharma can seem like a really technical concept because we're thinking about pharmaceutical manufacturing. There's a lot of research that goes into that process, but and then you know kind of all the way through distribution to patients. But I think it's really at its simplest form the public sector building the capacity in any or every part of that pharmaceutical value chain, from development to manufacturing to distribution. And in some ways I think about it as removing the middlemen who are Fran Quigley: I need to go to I don't know. So again, it was really good things to follow the product. ⁓ How long is that in the system? They ⁓ they got a new general. ⁓ Mara Heneghan: the source of a lot of the profiteering we see across that value chain now. Fran Quigley: And those middlemen are enormously profitable middlemen. And and you say middlemen, but the the rhetoric from the pharmaceutical industries, well, they're the creators. They're the ones who are are are main are are doing the research and manufacturing the medicines. You know, when you talk about public pharma, we talk about putting the the the public and government into those some of those roles. I mean, how is how is that possible when you hear the rhetoric that we're just Just the genius of the pharmaceutical industry is the only reason we have these drugs to begin. Mara Heneghan: A very important question. I think the first thing I would say is that a lot of the development happening that ends up kind of becoming privately manufactured pharmaceutical products starts with publicly funded research. That could be funded through our federal government, that could be led by researchers at public universities across the country. So there is already a lot of public investment behind those initial seeds of development. I think we also know that there's Fran Quigley: I'm just gonna follow. ⁓ Mara Heneghan: Some of why the expertise to develop these pharmaceutical products live in the private sector right now is because we've hollowed out our private public sector over decades. And we have previously had capacity within public institutions to do this work, and I think we can return to that relatively easily. Fran Quigley: Then I'll see if it's high. It's important. ⁓ you've actually used the terms in writing that you've done. And we're gonna link in the show notes ⁓ to a couple of different articles. One is a recent article by you and and Dr. Vincent Roy and US News and World Report ⁓ talking about ⁓ I believe the the terminology uses is tur using drug manufacturers drug manufacturing ⁓ can and should be treated as essential public infrastructure, like roads, like. police, like libraries, like other ⁓ firefighting, et cetera, that that we think is important for our survival and thriving, which of course medicines are as well. So ⁓ is is that the the framing there, is that something that that that ⁓ that you're trying to talk to folks about is in terms of public infrastructure? Mara Heneghan: Absolutely. I think about the public infrastructure piece from really a government and public planning side of things. So we've seen in we can take COVID as a really recent example for a lot of listeners about what happens when medicines aren't readily available for us as a public good. We had there was a lot of public investment that went into vaccine development that ultimately allowed us to remain healthy and return back to a more semblance of normal life. But there was also a lot of supply to chain disruptions in that. During the pandemic. And right now, so much of our pharmaceutical manufacturing happens offshore, is not able to adapt to the public health needs of our communities. And so bringing those functions back into public settings and having public control over and interaction with that process, I think, really serves us both from ⁓ responding to crises, but also for preparing ourselves for kind of meeting everyday needs across a range of public health issues. Fran Quigley: Mm-hmm I think this is fine. And we now finish the topic or any other polls or the Mm-hmm. Mara Heneghan: And so I that's the infrastructure at the government level. And I but I don't want to lose sight of the infrastructure at the kind of household and individual level, which is just to say that in the same way that a lot of the public institutions you mentioned provide public good at a broad level, they also provide really important individual services to people in their day-to-day lives. And so I think we have to think about public pharma both from this societal planning perspective, but also for the ease and the affordability it can bring to households across the country. Fran Quigley: It's really well. Wait. Yeah. And and this is not just some hypothetical idea, right? ⁓ this is ⁓ happening in California right now in particular. It's been being discussed in places like New York and Michigan. So can you tell us a little bit about ⁓ the Cal Rx, if I pronounce that Cal Rx ⁓ initiative for for insulin in particular. Mara Heneghan: Absolutely. So CalRX is California's initiative to manufacture insulin at low-cost, transparent prices and ensure it reaches Californians across the state. This initiative is a couple years old and was announced alongside a broader initiative to develop other medicines, including naloxone and soon to be albuterol distributed through a school-based system. And so I think it's really exciting to see kind of this initial focus on insulin. Importantly, insulin. Fran Quigley: Mm-hmm. Mara Heneghan: Has been off patent for a hundred years. So I think to your earlier point about the ways that pharmaceutical companies need to be compensated for all of the development and research they're doing, insulin is an important case study for us to look at to understand that those myths can really fuel profiteering off of pharmaceutical products that have nothing to do with kind of that narrative at this stage. ⁓ And also, insulin is life-saving. It is essential for people living with type 1 diabetes. Having even just Fran Quigley: Yeah, this one. Thank you. Mm-hmm. Mm-hmm. Yeah no. Mara Heneghan: Short disrupt disruption in their ability to access insulin can result in hospitalization and even death. And so it's really critical to make sure that there's essentially no way for somebody who needs insulin to get denied insulin based on the cost. Fran Quigley: We could just use that. And then we have a thing. Mara Heneghan: and so I think it's really exciting to see a government, a state government, understanding that responsibility and understanding the need. We see insulin rationing as a huge problem across the country based on affordability. And the Calarex's ability to start providing this at a very low cost within a couple years of announcing the initiative, I think really shows what government can do here when it kind of sets its sights on this as a as a policy goal. Fran Quigley: And they didn't believe it. Mm-hmm. In ⁓ never And then for the And by by lower costs, I think if I if I saw something that you ⁓ have have written previously that the cost is about eleven dollars per pen when for ⁓ from the for profit industry was charging eighty bucks for the same pen, is that right? ⁓ Mara Heneghan: Mm-hmm. Yes. And that number can go even higher depending on folks' insurance coverage, which I think is another piece of the system that we that public pharma can help us really start to spread the message around, which is essentially that list prices that are coming from pharmaceutical companies are often, from their view, the starting point for a negotiation. A negotiation with insurers, a negotiation with public payers through Medicare and Medicaid. And so those list prices can sometimes be deceptive, and they'll t pharma companies will turn around and say, well, no. One actually pays that price because sometimes you'll see insulin at at much higher prices than that $80 number. And I think we have to have to think long and hard about why those initial list prices are so high and what kind of distortions that fuels across the market. But yes, to the point about CalRX, the $11 per pen can save people tons of money, and it can all it also means that there's ideally an affordable option if your insurance coverage for some. Fran Quigley: We might do. Well I think it was probably odd. Any point is it part of it? And also making as well as the thing if you like for the Mara Heneghan: reason isn't being accepted at the pharmacy counter. And so it can really be kind of an emergency option even for people who do have other insurance coverage to know that they have an available resource if and when they need it. Fran Quigley: And then now Right. Right. Well, when when you talk about why those prices are what they are, ⁓ so I'm speaking to you from my hometown of Indianapolis, Indiana, which is also the hometown of Eli Lilly and company. And there's been a series of of actions and demonstrations by ⁓ persons living with type one diabetes who are insulin dependent and their and their families outside of Eli Lilly headquarters, where they are one of the most profitable companies in the world and and have been for quite some time. And one of those demonstrations was a vigil by family members who had lost a loved one who could not afford their incident. And as a result, as you said, this is a life or death question, ⁓ not just a comfort or a short-term health situation. These are relatively young people ⁓ who who did not have ⁓ good insurance coverage or couldn't afford it otherwise, and and they and they died as so ⁓ this is. No exaggeration to say your work is life saving. So thank you for for everything you and others are doing. And I also wanted to to lift up what you talked about albuterol. So we we do our work in eviction. For evictions are very disproportionately ⁓ young family families with young children, and many of them are our kids who have asthma, who are dependent on albuterol. And ⁓ without that medicine being affordable, those children's lives are are both. very difficult and some and sometimes even at risk. So that's exciting. That that's that's next on the Calorex ⁓ agenda is is a affordable ⁓ publicly provided butaryl. Mara Heneghan: Yes, from what I know, they're hoping to launch this summer. ⁓ and a thing I think is really interesting here for the public pharma movement more broadly is that through this initiative they're partnering with the Department of Public Health to distribute to kind of create a central ordering system basically where public schools across the state can purchase that albuterol it will be available in the school setting. I think it's really kind of exciting to think about how public agencies can work together here. And like you mentioned, this is a resource for a lot of children and so having schools involved in this initiative and able to kind of ensure that they have medicines accessible to their students is really exciting and seems like an obvious next iteration of public pharma as we think about where else we public agencies are already serving people and can really meet that need more easily. Fran Quigley: He's perfect. Yeah. Yeah, that's exciting. And and so we've talked about California, but ⁓ if I'm I'm not not mistaken that Michigan and New York and maybe some other places are are looking at possible ⁓ public drug manufacturing as well. Mara Heneghan: Yes, they are. ⁓ New York State has the New York Affordable Drug Manufacturing Act, which their legislation should legislative session just wrapped up recently. ⁓ and that bill did not make it all the way through the session, but did make it much further than it had before. It's taken up by both the House and the Assembly in New York State, and I think I think we've got some exciting momentum going there, led actually by New York's Insulin for All chapter. so I expect to see that reintroduced in future sessions, and it's been really fascinating. Fran Quigley: Excellent. Mara Heneghan: Fascinating to watch public awareness build and see legislators, I think, more interested than ever in engaging with these types of creative models for manufacturing. I will say that one, the New York's bill is modeled in part off of California's, and California is currently Fran Quigley: You want to Okay. Mara Heneghan: able to produce insulin through a they're not doing direct manufacturing. So in my mind it's kind of quasi public pharma. I think it's a really essential step and a really essential flag in the ground for public pharma initiatives. But they are working with a nonprofit pharmaceutical manufacturer who's doing that actual kind of that side of it. And then California is ensuring that it can be distributed. And that's a publicly funded contract. And so I think that that also can get us some really interesting insight into kind of the data that is often Fran Quigley: Okay. Mara Heneghan: considered proprietary information by private pharmaceutical companies so we can continue to evolve the public pharma strategy. So New York's bill is modeled off of California's and that it gives the state, should it pass, it would give the state the ability to either manufacturing itself or to contract with a nonprofit pharmaceutical manufacturer. And then in Michigan and Ohio we see similar bills. If I'm not mistaken, Ohio's bill does not allow for direct manufacturing but only allows for kind of work Working with a public-private partner or a nonprofit pharmaceutical manufacturer. So that's something to watch, I think, as we think about kind of where these ⁓ bills are popping up, really trying to understand if a state is aiming to do direct manufacturing or if they're more interested in a part a kind of partnership at this early stage. And then we've also seen a bill signed recently in Oklahoma that allows for manufacturing as well. And so it's fun for me to see kind of where these where they're popping. Fran Quigley: Yeah, this is Mara Heneghan: up across the country. And I think to your point earlier, it's it's because this is such an important issue to so many people in so many different political climates and geographic settings and it's really a an essential problem we need to solve. Fran Quigley: Yeah. Yeah. And and ⁓ to your point about the the the legislators being interested, the public being inter well, the public's interested, politicians are gonna be interested, right? And and even we have an initiative, ⁓ big splashy initiative ⁓ by President Trump, which I'm gonna ask you about here in a few minutes. But I don't wanna I don't wanna lose the train of what's really making a difference. Spoiler alert, this is it's not gonna be the Trump program. But ⁓ when you talk about public pharma, we've talked a a lot about the ⁓ Mara Heneghan: Mm-hmm. Ha ha ha. Fran Quigley: you know, the the involvement in the manufacturing stage and in the manufacturing, et cetera. But also you've written about ⁓ the the public either at the state level, at the federal level, using its enormous purchasing power because ⁓ the state level ⁓ of the Medicaid purchases, et cetera, that it's essentially government is always pharmaceutical industry's biggest ⁓ biggest customer, right? So ⁓ the the question I guess is, you know, what Mara Heneghan: Mm-hmm. Fran Quigley: What can and and and as you have written about, you know, what has the federal government already done to and some states have already done to to use that enormous purchasing power to kind of blunt the the price gouging that otherwise might happen. Mara Heneghan: Absolutely. Just to make sure kind of listeners fully understand the scope of how much governments are spending in the pharmaceutical sector, governments are the purchaser of health insurance for their state for their employees, so that can be Fran Quigley: Yeah. We're all the little upper controls off if you want to think of them. And then for not only provides the kind of the idea to do. ⁓ Mara Heneghan: Hundreds of thousands to even millions millions of people, depending on the environment. They're also covering pharmaceutical costs for people who are getting care through their public systems, who are incarcerated or under the care of the state in other ways. And then, of course, we have public health insurance programs where government is the primary payer. So that's Medicare, Medicaid, CHIP. There's all of these ways in which government is already spending money in this system. Fran Quigley: All of the everything are no Mara Heneghan: And we know that at least some portion of that money is going to private pharmaceutical profits. And so I think it's just important to really conceptualize how big of a pot of money we're talking about, because that gives us some understanding of how creative we can be here. To your point, we have Medicare drug price negotiation, which was authorized under the Biden administration's Inflation Reduction Act. And it's begun to by being able to negotiate drug prices in this setting. Fran Quigley: And so we need to stick on it because that's the line. ⁓ it's not ⁓ necessary. Right. Mara Heneghan: As opposed to just accepting kind of a monopoly price that's been set by private pharmaceutical companies, we're seeing the federal government really being able to leverage the purchasing power that it has in the same way that I think we would expect any large private employer to do in a negotiation. We would expect kind of to happen in a functioning market, but because the government was pr prohibited from doing that before. Fran Quigley: You wanna do it? Mara Heneghan: Private companies were knew that they could that they kind of had a captive audience here with the with federal money and that the government wasn't going to suddenly stop purchasing drugs under the Medicare program. So I think it's really important to think critically about that purchasing power, to kind of use it in existing negotiations, and to also think about how we want to. Fran Quigley: I haven't put it in the pound. Yeah. ⁓ maybe we can do Mara Heneghan: Regulate or investigate where public money is being extracted from public systems to fuel private profits. Fran Quigley: Right, right. And as you say, the just the idea of using negotiating power, ⁓ a lot of this is is getting out of the ⁓ you know, the the worst aspects of capitalism. But that's actually just a a fundamental tenet of capitalism, right? When you've got a lot of leverage, you're going to use it and the in the in the government has very intentionally not done so, which of course isn't done in the vacuum, either the pharmaceutical industry has is oftentimes been the leading Mara Heneghan: Yes. Fran Quigley: lobbyist spender and the leading campaign spender. And so the these haven't been accidental ⁓ policies that have happened. So but so you talk about public pharma in terms of you know sometimes it's about ⁓ manufacturing, sometimes about leveraging purchasing power. ⁓ but also, you know, the goal of course is to have affordable insulin for people who need it affordable albuterol, affordable blood pressure medicines, etc. ⁓ so can you talk a little bit about kind of the the even more aggressive, if you will, option of actually the ⁓ the government licensing on currently patented medicines to generic drug manufacturers. Because if folks don't know, just because a medicine, as you mentioned, insulin discovered more than a century ago, doesn't mean that portions of it and in delivery systems aren't under patent. I think there's been some drugs that have had literally hundreds of patents. So people in my profession, lawyers, Have done really good work for the pharmaceutical companies and have lots and lots of patents. So sometimes there really is a ⁓ is some monopoly, legal monopoly in the way of getting this medicines ⁓ affordable to people. But the federal government in particular has options here. So can you talk a little bit about what the federal government can do? And and I and I think in your position, ⁓ and I would agree with you, ⁓ should do ⁓ to make medicines affordable. Mara Heneghan: Absolutely. So my disclaimer here is that I'm not a lawyer, but I get to work with a lot of lawyers who are very committed to kind of thinking creatively about how the law could serve public pharma here and ultimately serve patients. So the federal government could use its authority under some kind of what is colloquially known as section 1498, ⁓ which in which they'd have to provide reasonable compensation to the patent holder and then could produce Fran Quigley: Yeah. Mara Heneghan: Whatever medicine we're kind of talking about here with a generic producer. actually on GLP ones is where I see the most momentum on this push right now. There's been advocacy because from state governments or state agencies because GLP one costs are consuming so much of public budgets right now. ⁓ and so we've seen petitions to the US Department of Health and Human Services under both the Biden administration and the Trump administration asking them to invoke Section 14. Fran Quigley: Yeah. ⁓ speak I need. s Mara Heneghan: ninety eight and thus ensure that that these patents are not preventing people, preventing competition in the market and preventing people from being able to access generic options for potentially life-saving medication. I think it is, as you mentioned, there's a it is a pretty ⁓ seen as a pretty controversial idea, but it is ultimately kind of the federal government understanding what a public health crisis is and and what its responsibility towards people who need these medicines are. Fran Quigley: Yeah, it's not. But if you don't But it's on the fair. ⁓ Right, right. And I w I would say again, just to keep that theme going, it's seen as a ⁓ an aggressive option because it's been framed as such by folks who make a whole lot of money ⁓ off of the current monopolies that have been granted by government. But it's also something that's been done many, many times in US history in a variety of ways when there is a crisis, when there's a public with public health crisis, when there's a ⁓ public safety crisis, when there's Mara Heneghan: Yes. Fran Quigley: ⁓ national security crisis the the federal government has on many occasions said, okay, we're gonna go in and we're going to make sure that this ⁓ good is manufactured at a reasonable and available at a reasonable cost. And we will pay. Again, as you mentioned, the the the patent holders do get compensated. They just don't get compensated whatever number they want to ⁓ to gouge the public with, which is what unfortunately happens so often now. ⁓ and you said you're not a lawyer, but ⁓ some pointy headed law professors ⁓ including your hosts today have have written about this in the past. Other people who are ⁓ much more expert than I am about the the technical aspects ⁓ have written about it so we'll we'll put a couple of of links in the show notes but very very common for this to be done very well justified to be done and it in then it becomes a question of political will. And so that that might be a good time to to pivot to the whole politics question. So it because Mara Heneghan: Mm-hmm. Fran Quigley: affording medicine is such a critical issue. As you mentioned a bipartisan issue, it cut it cuts across all kinds of ⁓ economic spectrums, really. It does you do not have to be poor to struggle to afford your medicines, depending on what the medicine is and what your your need for it is and and whether it's on a monopoly pricing ⁓ scheme. So we have even ⁓ politicians include up to and including the President of the United States proposing, I'm gonna fix the drug Pricing prices. So we've ⁓ a few months ago we saw the rollout of something called Trump RX. And G R UMP, then Rx as in ⁓ prescription. And ⁓ that was touted as being something that's gonna make a real difference in drug pricing. So what about Trump Rx? What does it do? And and maybe more importantly, what doesn't it do? So ⁓ I think Mara Heneghan: Sure. So kind of on a factual basis, Trump Rx is an online platform that lists dozens of medications and shows a price that might be lower than kind of you would find the list price on a manufacturer's kind of website, let's say. in my view that's Kind of the extent of what it does. If folks are familiar with Mark Cuban's cost plus drug, it's relatively similar, even in the design of the website. And so I think. Fran Quigley: It does be with the Mara Heneghan: Even at the very start, we shouldn't, it was a flashy announcement, but it wasn't necessarily an innovative idea. and then I think on the actual drivers of people's pharmaceutical costs, it does very little. And the piece you mentioned before that Dr. Victor Roy and I wrote together gets into more detail on this, but I think one of the biggest Fran Quigley: ⁓ I think for the What do we think? ⁓ Mara Heneghan: kind of gaps in this program that I would say also applies to cost plus drugs is that it doesn't interact with the insurance system. Trump RX does not accept any insurance. It's entirely out of pocket purchasing. Cost plus drug interacts with will accept some insurance, but a limited number. And I think that that's if you are somebody who has insur health insurance and has a kind of Fran Quigley: Well just I ⁓ And the real Mara Heneghan: does not have a super high deductible, it's very unlikely that Fran Quigley: I don't know. Mara Heneghan: either of these platforms, but specifically Trump RX, is going to help you because you will be paying for out of pocket for the list price on the website and you will still have to meet your entire deductible to get your insurance to kick in on other healthcare needs you might have. I think it's just another example of kind of the complication within our healthcare system where it's really difficult as a consumer, which they want us to think of ourselves as, right? You have to be a responsible consumer and just kind of evaluate your options. This is a really good example of how difficult that is. Fran Quigley: ⁓ It's And it was just hard to do. Thank you. ⁓ Mara Heneghan: Because I'm now gonna have to, if I need something and I'm looking online, I'm gonna have to sit down and think about, okay, how many times would I have to purchase it from Trump RX before my insurance deductible would kick in? What is the price I'm purchasing at in each system? Because price is essentially shiftable here. And so it's I think it's really hard to to knowing, to know for sure that you're getting a good deal when purchasing through Trump RX if you have insurance. Fran Quigley: Yeah, I'm I know it's Mara Heneghan: I think if you don't have insurance, there are instances where these they might provide a good option for purchasing, but you still have to pay out of pocket. And so that is still a huge hurdle for most for a lot of people who don't have health insurance. ⁓ And and while the medicine might be $50, $100 here, that is a big cost for a lot of people. And so I think it's not delivering the affordability it promises to, and it's not recognizing the Fran Quigley: Yeah. Mara Heneghan: Essential nature of interacting with the health insurance systems we all pay high premiums into. So I think it is flashy, and I think it was an acknowledgement that this is a problem the Trump administration feels like it has to show some effort in solving, but I don't think it's really attacking the underlying drivers of high pharmaceutical costs here. Fran Quigley: No. Yeah, yeah. And I think to to quote from your piece is about eighty-five percent of Americans with insurance for prescription drugs, their copays are gonna be cheaper than than what they can get, anything they can get on from bar X. And and to your point, which you mentioned earlier, it's not like the President of the United States doesn't have things he can do. He he can actually ⁓ invoke, as you mentioned, the fourteen ninety-eight option and sh and he can for for for to make it simple. ⁓ he can actually license generic manufacturing of medicines. He has his administration has the ability to do this, ⁓ provided authority provided to them under you know by Congress long ago. So could have done better. ⁓ sounds like the the Mark Cuban Cost Plus Drug Company, I wanted to ask you about that, but it sounds like that's a little better, but not much, and still not attacking the underlying cost issues the way the public plama is. Mara Heneghan: Yeah, I again I think my I I would agree that both of them Fran Quigley: Yeah. Mara Heneghan: kind of don't get at the long-term impact on the drivers here, which are manufacturers' pricing power, the untransparent intermediaries we talked about that are kind of at each stage siphoning some amount of money for their own profit, and then looking into ensure our cost shifting and really trying to understand where the money in our system is going. Neither of them are designed to do either of those things. I think I reserve my IR for Trump RX specifically, because cost are or cost plus drugs might Fran Quigley: ⁓ being for the model we can go and what we do with that. I know I want to talk. And I actually remember my Mara Heneghan: actually be the best or one of the best ways a private billionaire like Mark Cuban can intervene in the system. But I think our f the federal government has a responsibility to use the tools and resources and authority that only the federal government has to intervene. And I think that that would look really different than kind of a a different version and a rebranded version of an existing platform. Fran Quigley: ⁓ one did Mm-hmm. sorry. Right, right. And then and and follow the lead. It's it's ⁓ it's disappointing that we see states like California and New York and Michigan that they have to to do this on their own, but it can't be done at the federal has hasn't been done at the federal level, hasn't been the political will to do that. So you you talk in in your piece as well about you know this is something that can be done, the tools are there, the legal ability is there, there are generic drug manufacturing ⁓ companies ready to go right now if they can be licensed to do so. It could be that it's a government-run manufacturing process, but it could much more quickly and easily be a government-contracted manufacturing process, which is done in so many other sectors. So we don't, but it's not happening. At least it's not happening outside of the promising new efforts in California and elsewhere. what needs to happen for this to become a reality and we to see one of the most pressing public health issues and one of the most pressing political issues actually be resolved and and life saving medicines be something that's affordable for everyone. You know, how how do we get there politically? Mara Heneghan: It's such an important question because we have, like you mentioned, we have a lot of the tools we need. We also have brilliant research done by legal scholars and policy advocates and patients who've really testified about their first hand experience when they can't access these medicines. And so while I Fran Quigley: So my ⁓ supporting me. I don't even know what's Mara Heneghan: Always support new research and new ways of thinking. I think that we some of this is building political power and building political will. To me, part of it starts with helping people understand that even if this is not an issue that they're facing currently, it's an issue that will likely touch them across their lifetime, ⁓ or somebody that they love. And I think really helping Fran Quigley: So you think about the schedule? If it just got all the time, I mean that's all I'm just thinking. I mean it can be all of our own which I think you're ⁓ Mara Heneghan: Put that into perspective for people can show why this is so near and dear to so many people's hearts. And you know, I think we see the broader idea of affordable healthcare or healthcare affordability as a really politically motivating factor right now. And I think we need to make public pharmaceutic pharma more legible to people and so that it feels like a kind of obvious part of that. Fran Quigley: Yeah, so you know like ⁓ there's part of ⁓ the Mara Heneghan: healthcare affordability agenda rather than some kind of off to the side new idea that we haven't really explored yet, which I think it it gets discredited as often. I think we're gonna need so that's kind of my Fran Quigley: What I'm going to put off of the diamond file. Mara Heneghan: political awakening side of things. I think we just need to help people understand the impacts that this could have to their ability to afford medicines. And I think sometimes people feel it's too good to be true. And to me that just shows that our system is so broken that people can't believe we have a way to solve it. And I genuinely think we have a lot of ways to solve it actually. Fran Quigley: We're gonna need to sleep in we need that we Mm. I also become ⁓ Mara Heneghan: I also think on the kind of policy side of things, we need to do more economic modeling to really start to make the case for how this can help state budgets and federal budgets. We need to that modeling is often challenged by the fact that a lot of this data is considered proprietary. And so I think we need to be strategic about how, as we bring more public initiatives online, we're really using those as learning opportunities, not only to improve the kind of direct care patients are receiving, but also to Fran Quigley: I mean we're trying to talk about you. Yeah. Yeah, we look at Mara Heneghan: To improve public functioning as a whole and public knowledge of the system. And I think we also need to continue to uplift how harmful existing in this current system is to us all. And really sharing the stories, like you mentioned, of ⁓ patient advocates here are some of the best champions for this work because they're so able to directly relate a really complicated system to the really immediate needs that people face every day. Fran Quigley: I think. Okay. Yes. Yes. Well we hopefully we'll get some folks from T one International, which is the type one diabetes patient leading one of the patient leading patient organizations on the show soon as you say that they they can articulate the message in a way that that that none of us who are lawyers or or advocates ⁓ that aren't directly impacted personally can do. But I I do want to the shout out that ⁓ Mara Heneghan: Mm. Fran Quigley: ⁓ there I'm gonna put in the show we'll put in the show notes ⁓ a link to some work by Democracy Collaborative about why we need a public option in pharma with some nice graphics that our our friend Dana Brown, who did that work for Democracy Collaborative and now is with ⁓ Vaderbelt University, ⁓ is doing work I know as ⁓ in partnership with with you on on this. And so we'll we'll link to some of that. And it's just so important what you're doing is by telling people this is possible, that it's legal, that it's it's feasible, that it can be done. Because of course, on the other side, we have an industry that is making, well, I think if I'm not mistaken, it's a trillion dollar industry, right? We're not talking about hundreds of billions anymore. I think a trillion dollar industry that is understandably existentially motivated to not let this happen because there's so much profit being made off of people's illness and struggle right now. So so the fact that you're letting folks know that it doesn't have to be this way, theme of the of the podcast, we can do better. Mara Heneghan: Mm-hmm. Is this? Fran Quigley: ⁓ that we actually have this. So ⁓ and I think if I'm not mistaken, there's some polling that's a few years old, but like about 70% of voters would support government stepping in to produce generic drugs when the prices are too high. I imagine with full understanding, it'd be it that number would be even higher because folks across all political ⁓ spectr ⁓ spec across the entire political spectrum have this need or crisis, either themselves or in their families. So so thank you for doing that. And I but I want to ask you a little bit of how you got to this. And I know that ⁓ you do your work from Chicago, shout out Heartland Advocacy, ⁓ as I ⁓ a couple hours down the road in Interstate 65 talking to you. in Chicago, your work, you you worked on anti-poverty issues that that are a big part of this show and a big part of our our our discussions every week anyway, ⁓ including guaranteed income, medical debt cancellation, et cetera. You know, what kind of work did you do? Mara Heneghan: Mm. Yes. Fran Quigley: And you know, how did how does that lead you to to doing the the pharmaceutical public pharma work, the health justice work you're doing now? Mara Heneghan: Absolutely. I love ⁓ talking to other Midwesterners on these issues because I think we often a lot of innovative work comes out of the Midwest and it does the praises don't get sung quite as much as they should. Yes, exactly. Fran Quigley: Yeah, shout out flyover country, right? Mara Heneghan: What in I in Chicago I've served in public service roles and specifically I was director of policy in for Cook County Board President Tony Preckwinkle during the pandemic, where we got to do some of the programs you mentioned. And really I think serving during a crisis that is both impacting people's health and their immediate safety, as well as their economic security, just highlighted how inter interconnected those issues are. Fran Quigley: Yeah. And maybe I think certainly so I don't think they're not the other. ⁓ ⁓ Mara Heneghan: Don't make policy in that vein. So I would have, prior to the pandemic, I would have described myself as doing economic justice work, I would have described myself as working kind of in policy, but I wasn't ever thinking about the connections so explicitly to our health system. I might have thought about the connections to people's health kind of outcomes, let's say. But thinking about the health system and in Kokani, we're fortunate to have a public health care system. ⁓ Thinking about that as a place people are interacting with government every day, where Fran Quigley: ⁓ I've done I didn't think so that's what we didn't talk about. ⁓ yeah, I'm gonna Most people are Mara Heneghan: Similar to eviction court, the needs that people have across their lives are really present. So, like you mentioned, representing tenants who you also know are going to struggle to afford the inhaler for their child. We have people coming into public health systems who we know don't have the money to afford food when they leave. And I think that position helped me. Fran Quigley: Yeah, it's a we didn't Mm-hmm. So I think that we're going I don't know Mm-hmm. ⁓ Mara Heneghan: Really start to think about how I could dedicate myself to both economic justice and health justice. ⁓ And I got to do programs that I think really fall in that economic justice category, like the Guaranteed Income Program, which was the largest publicly funded pilot at the time, and think about how Fran Quigley: Well and I think we're just all And then ⁓ here's the provision of ⁓ Mara Heneghan: Either we're measuring health outcomes there for people, and also how we're using that interaction between somebody enrolling in the Guaranteed Income Program to make sure we understand what their health needs are too. And then the medical debt cancellation program is one I'm particularly proud of. We launched the first publicly funded medical debt cancellation program in the country, funded by money from the American Rescue Plan Act, which was passed under the Biden administration. Really thinking about we have this one-time influence. Fran Quigley: We don't really But I mean I I Maybe Mara Heneghan: Of money to a local government. We know people are struggling economically. What is one of the biggest returns on investment we can make here for a one-time program that we don't know if there will be funding for moving forward because of the nature of the federal funding? And so we Fran Quigley: Yeah, yeah, well. Mm-hmm. And because you just Mara Heneghan: Began canceling medical debt for residents of Cook County. And when you look at that, there's not only the kind of economic outcomes that come from that, but there's also people avoid going to the doctor if they hold medical debt because they're worried that they're re-entering an institution to which they owe money, which is understandable. People are denied care. And so really some of these programs Fran Quigley: Yeah, when you ask the mountain once you have a lot of messages. ⁓ Yeah. Mara Heneghan: just showed how important it is for us as policymakers or advocates to think about the interconnections between health and economic justice for people at the kind of in their day-to-day lives. Fran Quigley: It was front problems. Yeah, that's that's that's great. And and politically and economically astute, because they said the concern was that that would be one time dollars. It turned out they were one time dollars, right? And ⁓ and standing up a program that that needed to you know to to have its full effect to to continue for ten years wasn't gonna be feasible. Unfortunately we see that a lot in the housing and the eviction context. But paying off people's medical debt, you can do that right away. Mara Heneghan: Mm-hmm. Mm-hmm. Fran Quigley: And that has an impact right away. And ⁓ that's that's terrific. ⁓ so let me ⁓ let me go ahead and and let you go with understanding that folks we can we're gonna keep following public pharma. It's so important, it really is the answer to to the challenge that we're facing. And ⁓ we're gonna put some ⁓ some links into folks can can learn more about what's going on. ⁓ but how, Mara, would people, you know, continue to follow ⁓ via social media or websites or what have you, ⁓ what's going on with public pharma, what the developments are, ⁓ the promising developments in California and Michigan and New York, etc. I mean, how how would how would people keep ⁓ keep up to date on what's going on? ⁓ very good people. Mara Heneghan: ⁓ we're excited to keep people informed through a newsletter we put out about quarterly through the Health and Political Economy project so people can sign up for that at our website that I can make sure we link in the show notes. ⁓ and then follow the Institute on Race, Power, and Political Economy on Instagram, Twitter, ⁓ LinkedIn as well. So we'll we kind of love to keep up people updated that way. I'd also shout out the incredible organizers with T1 International that you mentioned before. They have a really Fran Quigley: That's okay. Okay. ⁓ then for you guys about the happening, you know. I'm just gonna make it to the table. They have to be together a lot of time. ⁓ Mara Heneghan: Good, a lot of this the momentum in this space has come from champions around affordable insulin, and so they have a really good finger on the pulse for the legislation that's moving and really important data to share. And then I'd also say we have we I get to co-lead the Partnership for Public Pharma, which doesn't have too much of a web presence yet, but will soon, and that's an organization or a kind of emerging group of scholars and advocates of. Fran Quigley: And it comes up the current job. And I didn't want to. ⁓ do you mean oop ⁓ Mara Heneghan: and organizers who are really trying to think about where momentum can go. And so we're really eager to engage new people and to understand where this is happening across the country. So we'll have ways to join that soon and we'll have kind of that will be shared in the Health and Political Economy project newsletter. Fran Quigley: Wonderful. And so it's the Institute on Race, Power and Political Economy from the New School. And again, we'll put the the website and ⁓ that'll the website will have guidance on how folks can sign up for the newsletter and then we'll put some links to social media and of course tag you all when we ⁓ publicize the episode and and the folks at T one International. So we'll make sure that folks know how to how to keep up on this and then again hopefully in their states. Mara Heneghan: Mm-hmm. Fran Quigley: And hopefully someday in the near future at the federal level, we'll have legislation moving, we'll have programs moving that will deserve and and need public support because there's going to be pushback from the folks who are making billions right now, right? On the current ⁓ status quo. ⁓ so So Mara, thank you so much for joining us on on We Can Do Better. So on on behalf of our clients who we see every week, thank you. ⁓ thank you for what you're doing on behalf of hundreds of millions of people, unfortunately, who are struggling to afford health care in the United States. Thank you for your important work. And ⁓ thank you to our listeners for joining us for this conversation. Hopefully, this is another step towards health justice for all. so until that happens, we will see you next week. And remember, we can do better.