PAY OR DIE (2023) - Mark Reviews Movies

Pay or Die, MTV Documentary Films

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Review by Mark Dujsik | October 31, 2023

Either by design or because of recent events, Pay or Die feels like a limited examination of what was and again could be a health crisis in the United States. The subject is people living with type 1 diabetes, specifically the struggles to obtain insulin under the country's outdated, illogical, and, in many ways, immoral health care system. That's a potentially controversial statement, but for those who need further evidence that it's an accurate description, this movie provides a good amount of it.

Some of that comes from simple numbers and statistics, as directors Rachel Dyer and Scott Alexander Ruderman, with the help of assorted experts on this system, explain the basics. At the time of filming (from 2018 until late 2022), about two million people in the United States have type 1 diabetes (For reasons that are unclear, the movie acknowledges but otherwise ignores the more prevalent form of the disease). These people depend on insulin to survive, and the cost of that drug, manufactured primarily by only three pharmaceutical companies, has risen exponentially over the decades.

The majority of the movie's impact, though, comes from personal testimonies. At the heart of the narrative is a couple whose son died at the age of 26—less than a month after he aged out of being included on his parents' health insurance coverage. That's not a mere correlation. It's the cause, because, even with a well-paying job, the out-of-pocket cost of insulin was simply too high.

This couple leads a fight to pass legislation in Minnesota that would provide a financial safety net for people like their son. That battle is both heartbreaking, because the two are so open about sharing their grief and their passion to prevent similar tragedies, and infuriating, because the pharmaceutical companies and their lobbyists and their allies in the state legislature seem so apathetic to human suffering in both their words and actions.

There are two other stories here. One, about a mother and daughter who both have been diagnosed with the disease and find it less expensive to drive to Canada to buy insulin than to purchase it in their home country, is revealing as an on-the-ground account of the day-to-day financial struggle of simply trying to survive under this system as it stands. The other, about a young woman who is diagnosed during the COVID-19 pandemic, barely registers.

That means Pay or Die seems to be scratching only the surface of its subject, and the last-minute acknowledgment that the problem of the affordability of insulin has been significantly lessened doesn't help its case, either. Obviously, things can change overnight and without warning under the current system, so there's still work to be done. However, there's a much bigger picture in that regard that this movie, which comes up short on presenting the bigger picture of its own specific subject, barely touches.

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