LIGHT THE WAY

Light the Way | Merchant Ship Collective

““Woe to those who make unjust laws,
to those who issue oppressive decrees,
to deprive the poor of their rights
and withhold justice from the oppressed.”

— Isaiah 10:1–2, New International Version (Bible Gateway, n.d.)

This scripture is not symbolic. It is diagnostic. It describes what happens when laws and policies are engineered to protect power while quietly transferring harm onto those least able to absorb it.

Older adults did exactly what they were told to do.

They worked.
They paid taxes.
They raised families.
They served communities.
They funded Medicare, Social Security, and public infrastructure for decades.

They trusted that when their capacity declined, the system they paid into would protect them.

Instead, that system now asks them to make impossible choices.

This is not because resources are scarce.
This is not because medicine is impossible.
This is not because solutions do not exist.

It is because profit, political influence, and corporate protection were allowed to outweigh human life.

This is not a mistake.
This is not a misunderstanding.
This is a predictable outcome.

Enough is enough.

Now let’s talk about numbers, because the numbers tell the truth.

Independent cost analyses estimate that the manufacturing cost of a five-day course of nirmatrelvir–ritonavir (Paxlovid) is approximately $13–$15 (Barber et al., 2023). After federal bulk purchasing ended, Pfizer set the U.S. list price at approximately $1,390 per course (Citizens for Responsibility and Ethics in Washington, 2023; FirstWord Pharma, 2023).

Under Medicare Part D, many beneficiaries are still required to pay hundreds of dollars out of pocket. In documented cases, patient responsibility exceeds $800, depending on deductible status, coinsurance tiers, and plan design.

Now place that cost next to income.

As of 2024–2025, the average monthly Social Security retirement benefit is approximately $1,900–$2,000 per month, before Medicare premiums and supplemental insurance costs are deducted (Social Security Administration, 2025). For seniors relying on Supplemental Security Income, the maximum federal benefit is under $1,000 per month.

That means one prescription can consume:

This is not a budgeting failure.
This is forced scarcity.

Research consistently shows that cost-related nonadherence—when patients delay, ration, or abandon prescriptions due to cost—is associated with higher hospitalization rates, disease progression, reduced quality of life, and increased mortality, particularly among older adults with chronic conditions (Dusetzina et al., 2018; Karter et al., 2020).

When the math makes adherence impossible, harm is no longer accidental.

It is designed into the system.

Here is how that harm unfolds in real life.

An older adult is prescribed a medication they need to survive or prevent serious decline. Medicare approves it. The pharmacy informs them the remaining balance is $840 due today.

They do the math.

Their Social Security check is about $1,900. Rent or a mortgage consumes most of it. Utilities, food, transportation, and other prescriptions take the rest.

There is no category left where $840 fits.

So they delay filling the prescription.
Or they split pills.
Or they stop taking it entirely.

This is not neglect.
This is forced triage.

Health deteriorates. Chronic conditions worsen. A preventable hospitalization occurs. Whatever savings existed disappear. Rent falls behind. Eviction follows.

Once housing is lost, recovery becomes nearly impossible.

Medications are lost or stolen.
There is no refrigeration for insulin.
There is no safe place to rest, heal, or recover.
Emergency rooms become the only care left.

Living on the street accelerates illness. Exposure, infection, and exhaustion do what age alone never would.

Eventually, the person dies.

The death certificate may list heart failure, infection, or complications of chronic illness.

But the true cause of death was economic exclusion—being asked to absorb an $840 bill for a drug that cost $15 to make.

This is how people who did everything right still die on the street.

This harm is not random. It is produced by systems working together.

There are no documented cases of former members of Congress becoming homeless because they could not afford medication.

Not one.

This is not because the data is hidden.
Not because the issue is too complex to track.
And not because lawmakers are uniquely resilient, disciplined, or immune to illness.

It is because the system does not expose them to the same risk.

Members of Congress earn a base salary of approximately $174,000 per year, with leadership earning more. While serving, they receive employer-subsidized health insurance, access to comprehensive federal benefit structures, and eligibility for long-term retirement systems that include a pension, Social Security, and the Thrift Savings Plan. Even after leaving office, most retain professional networks, consulting opportunities, and financial insulation that prevent medical bills from cascading into housing loss.

They are not asked to absorb an $800 pharmacy bill on a $1,900 monthly income.
They are not rationing medication to keep the lights on.
They are not choosing between prescriptions and rent.

The system does not turn on them.

That protection is not accidental. It is structural.

Now contrast that reality with the lives of older adults outside the halls of power.

Each year, hundreds of thousands of adults aged 55 and older experience homelessness in the United States, and medical debt, untreated illness, and healthcare costs are consistently identified as major contributing factors. Among Medicare beneficiaries, cost-related medication nonadherence is widespread and strongly associated with worsening chronic disease, preventable hospitalizations, functional decline, and housing instability (Dusetzina et al., 2018; Himmelstein et al., 2019).

When older adults lose housing, recovery becomes statistically unlikely. Health deteriorates faster. Mortality risk rises sharply. What begins as an unaffordable prescription often ends as irreversible collapse.

There is no comparable pathway for lawmakers.

Not because they live more responsibly.
Not because they face fewer health challenges.
But because the policies they design protect them — and expose everyone else.

If a system were merely flawed, its failures would be evenly distributed.

They are not.

They land, predictably and repeatedly, on people with fixed incomes, aging bodies, and no margin for error — while those who write the rules remain structurally insulated from their consequences.

That is not complexity.
That is design.

A system that distributes harm so predictably — while protecting those who design it — cannot claim neutrality.

Pharmaceutical companies use patent protections to set prices far above manufacturing cost, regardless of public investment or public need. Insurance companies and pharmacy benefit managers then determine how much of that inflated price is shifted directly onto patients through formularies, specialty tiers, coinsurance, deductibles, and coverage gaps.

These are financial decisions, not medical ones.

When those decisions predictably cause older adults to forgo care, lose housing, and die earlier than they should, the harm is structural.

Responsibility does not disappear just because it is distributed.

Pfizer is not unique—but it is instructive.

During the COVID-19 pandemic, Pfizer benefited from massive public investment and public trust. Governments funded research, guaranteed purchases, expedited regulatory pathways, and absorbed early risk so products could be developed and distributed quickly. That public investment saved lives.

Public investment also creates public obligation.

Independent researchers estimate that the production cost of Paxlovid is approximately $13–$15 per treatment course, yet Pfizer’s U.S. list price rose to roughly $1,390 once federal purchasing ended (Barber et al., 2023; Citizens for Responsibility and Ethics in Washington, 2023). That increase occurred without a corresponding rise in manufacturing complexity, ingredient scarcity, or scientific novelty.

The burden of monopoly pricing was transferred directly to Medicare beneficiaries.

Pfizer’s COVID-19 vaccine initially demonstrated high effectiveness against severe disease and death (Polack et al., 2020). Subsequent peer-reviewed studies and CDC analyses have shown that protection against infection wanes over time and that protection against severe outcomes, while more durable, also declines—particularly among older adults—prompting repeated booster recommendations (Klein et al., 2022; Centers for Disease Control and Prevention, 2022). Post-authorization surveillance has also documented rare but serious adverse events, acknowledged by federal health agencies as part of ongoing risk-benefit evaluation.

None of this means vaccines “do not work.”
It means policy must evolve with evidence—and must never ignore aging bodies, fixed incomes, and differential risk.

When pricing, mandates, and coverage policies fail to account for these realities, public health stops being protective and becomes punitive.

This conversation is often framed as if survival alone is the metric that matters.

That framing is dishonest.

Quality of life matters.
Dignity matters.
Preventable suffering matters.

Financial strain related to medical costs is associated with worsening physical health, increased depression and anxiety, reduced adherence to treatment, earlier functional decline, and increased mortality among older adults (Kahn et al., 2015; Himmelstein et al., 2019).

When this strain leads to homelessness, exposure, untreated illness, and death, the outcome is not an unfortunate coincidence.

It is the predictable endpoint of policy choices.

Justice is not abstract. It is practical.

If we were serious about protecting older adults, justice would require cost-based pricing for essential medications, firm caps on Medicare out-of-pocket costs, real negotiation authority for Medicare, housing protections tied to medical vulnerability, and public-health policy that adapts as evidence evolves.

These are not radical demands.
They are the minimum requirements of a humane system.

I will not accept a system that asks elders to choose between medication and food.
I will not call predictable harm “unfortunate” to make it easier to tolerate.
I will not confuse profit with innovation or price with value.
I will not remain silent when silence protects power and abandons people.
I will remember that dignity does not expire with age.

God of truth and justice,

We come to You not asking for comfort, but for courage.

Forgive us for the ways we have normalized harm and accepted explanations that protected power while abandoning people.

We lift up our elders—those who worked, paid in, served, and trusted—now forced to choose between medication and food, housing and healthcare, survival and dignity.

This was never Your design.

Give us eyes to see systems that crush instead of protect.
Give us the strength to name injustice without flinching.
Give us wisdom that does not bow to profit and resolve that does not break under pressure.

Let policies that exploit be exposed.
Let laws that withhold care be overturned.
Let those who profit from suffering be confronted with truth they can no longer ignore.

And for those already hurting—those rationing pills, sleeping in cars, or praying not for healing but for endurance—be near to them now.

Do not let us leave this prayer unchanged.
Make us people who act, speak, and refuse silence when silence costs lives.

We ask not for ease, but for justice.

Amen.

Refuse the language that hides harm.
Stop calling people “noncompliant” when they are being priced out of care.
Stop calling this “complex” when the math is clear.
Demand accountability from insurers, pharmaceutical companies, and policymakers who benefit while elders suffer.

Speak. Write. Vote. Advocate. Witness.

Silence is not neutral.
It always protects the status quo.

A society is judged not by how it treats the powerful, but by how it treats those who can no longer fight back.

Older adults upheld their end of the social contract.
They worked.
They paid in.
They trusted the system.

A system that now leaves them choosing between medication, housing, and survival has failed—ethically, structurally, and morally.

This is not radical.
It is humane.

Enough is enough.

In solidarity,
Lyndsay LaBrier
Merchant Ship Collective
Light the Way Newsletter

Barber, M. J., Gotham, D., Khwairakpam, B., Hill, A., & Bingham, R. (2023). Estimated cost-based generic prices for nirmatrelvir/ritonavir for COVID-19 treatment. Journal of Virus Eradication, 9(1), 100070. https://doi.org/10.1016/j.jve.2022.100070

Centers for Disease Control and Prevention. (2022). Safety considerations for COVID-19 vaccines. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety

Centers for Disease Control and Prevention. (2022). COVID-19 vaccine effectiveness and waning protection. Morbidity and Mortality Weekly Report. https://www.cdc.gov/mmwr

Citizens for Responsibility and Ethics in Washington. (2023). Pfizer spiked Paxlovid’s price after public investment. https://www.citizensforethics.org

Congressional Research Service. (2023). Salaries and benefits of Members of Congress (R43194). https://crsreports.congress.gov

Dusetzina, S. B., et al. (2018). Cost-related nonadherence and its association with outcomes among Medicare beneficiaries. Health Affairs, 37(11), 1791–1798. https://doi.org/10.1377/hlthaff.2018.05104

Himmelstein, D. U., Lawless, R. M., Thorne, D., Foohey, P., & Woolhandler, S. (2019). Medical bankruptcy: Still common despite the Affordable Care Act. American Journal of Public Health, 109(3), 431–433. https://doi.org/10.2105/AJPH.2018.304901

Kahn, J. R., Pearlin, L. I., & Schieman, S. (2015). Financial strain and health among older adults. Journal of Health and Social Behavior, 56(2), 217–234. https://doi.org/10.1177/0022146515586963

Karter, A. J., et al. (2020). Out-of-pocket costs and medication adherence among older adults with chronic illness. American Journal of Managed Care, 26(5), e135–e142.

Klein, N. P., et al. (2022). Waning protection after COVID-19 vaccination in older adults. Morbidity and Mortality Weekly Report, 71, 1–7. https://www.cdc.gov/mmwr

National Coalition for the Homeless. (2023). Homelessness among older adults in the United States. https://nationalhomeless.org

Polack, F. P., Thomas, S. J., Kitchin, N., et al. (2020). Safety and efficacy of the BNT162b2 mRNA COVID-19 vaccine. New England Journal of Medicine, 383, 2603–2615. https://doi.org/10.1056/NEJMoa2034577

Social Security Administration. (2025). Monthly statistical snapshot. https://www.ssa.gov

U.S. Government Accountability Office. (2022). Prescription drugs: Medicare Part D spending and beneficiary cost burden. https://www.gao.gov