It seems like everyone has heard of the EpiPen, a seemingly magical device that instantly saves you from the throes of extreme allergic reactions (anaphylaxis) when you dramatically stick it into your thigh.  If you have been following the news lately you know the company that makes the EpiPen, raised the list price of the life-saving device from $94 at the time they purchased the rights to sell the EpiPen in 2007, to $609.  After a public outcry over the $609 list price, Mylan released a generic version for $300, still not small change.  This week the company was troubled further with a voluntary recall of specific lots of defective EpiPens.  And recent allegations accused the company of raising their prices that high to pay kickbacks to pharmacy benefit managers (PBMs) - the middlemen between drug manufacturers and insurance companies - in an attempt to quash competition.

The bottom line for people for whom this is a lifesaving device is that it is not available to many people who need it, for the simple reason that they can't afford it.  It is unimaginable to think that you are lying on the ground, your blood pressure reduced to dangerous levels, wheezing, suffering hives and who knows what else, and knowing that if you just had more money you could have survived.  When your last dying thought is that you could have afforded an EpiPen if greedy middle-men hadn't pushed the price too far out of your reach, well... not a good way to die, and certainly not a good reason.

Life has gotten complicated.  When we were cavemen we just clunked food on the head to drag back to the family cave for lunch.  No additives, no preservatives.  We just ate what we are naturally built to consume.  These days everything has unpronounceable ingredients that we not only can't say out loud, but have no idea what they really are.  It should come as no surprise that a lot of people have life threatening allergies.

I can't explain peanuts, though -- in a society raised on peanut butter and jelly sandwiches it is positively horrifying to think that some people die from peanuts.  Stories abound of a person merely kissing someone who has just finished a peanut butter sandwich, then collapsing to the ground in anaphylactic shock.  If that amorous person is lucky enough to have a dose of epinephrine and a way to inject it, the symptoms may be reversed within minutes, even though the romance may be doomed.  If not, our love bird may need a hearse instead of an ambulance.

The EpiPen's reputation as a magic cure certainly makes it the most sexy example of modern medicine being too expensive to actually help some people.  But it is certainly not the only example.  My eye doctor will put drops in your eyes and do the standard tests to diagnose you.  Or you can pay a bit more for a machine that produces a picture of the inside of your eye, giving a more comprehensive look that may lead to a better diagnosis and solutions to your vision issues.  Not life threatening, but still a modern medical miracle that is financially out of reach for some people.

My doctor prescribes a high dose of vitamin D that the insurance companies decided not to cover any more last year.  I thought it was pretty expensive, but the pharmacist told me that when you consider that one dose lasts a week, the cost wasn't too terrible.  I understand that now, but if it is not too terrible, isn't it just a little terrible?

Have you ever needed an MRI?  Two years ago the average cost of an MRI was $2,611 according to Medicare data.  To be fair, a new medical MRI machine can cost a million dollars, so hospitals need to make that back somehow, though I am guessing that they make a good profit on the use of those machines.  And it costs a lot to develop and test new medicines and get them certified for sale.

It's not like all those wonderful science fiction stories and movies where miraculous cures are available and everybody seems to be able to get them.  I thought it was hysterical when, years ago, I read that the medical instruments used in the 1960s Star Trek series were actually exotic looking salt shakers found in local antique shops.  You could get zapped by all manner of futuristic weapons, or simply be punched in the nose, but once the doctor waved one of those salt shakers over you, you jumped off the examination table, enthusiastically insisting you were ready to get back to work.

In that future nobody had to pay for... well, anything.  That makes the Affordable Care Act seem like curative extortion by comparison.  But in our world today someone has to pay.  Guess who? (hint: look in the mirror).

So the high cost of medicine is not a simple black and white moral issue.  These miracle cures would not exist if someone didn't pay for their development, so we have to pay.  What is clearly immoral is individuals and companies who jack up the prices for inordinate gain.  When lives are at stake there is no justification for that kind of greed.

One article I saw claimed that Mylan, ironically a maker of lower cost generic drugs, is simply the victim of a corrupt system, and the PBMs are the villians in this story.  You have to pay to play, so to speak. I don't know the truth of that, but it is very clear that it is immoral to accept a kickback to place one drug manufacturer on the 'hey use me, my price is better' list and prevent those who don't pay from a vital distribution channel.  People who do that are as much murderers as those guys with the striped shirts and black masks who shoot people during bank robberies.

The ugly truth is that we live in a sad world where we could all be healthy and have straight, white teeth, but we can't.

For my part I am going antiquing as soon as I finish writing this.  I'm gonna stop paying for medical insurance, stop going to the doctor, and get me some exotic looking salt shakers!