REVIEW: ‘Pay Or Die’ Dares to Search for Hope

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Pay or Die - But Why Tho

Harrowing reality is worse than dystopian fiction in Pay or Die. The SXSW 2023 documentary feature dares to search for hope in the bleak circumstances of individuals that carry the burden of accessing an unaffordable, but vital medicine. But is there any hope to be found?

Directed by Rachael Dyer and Scott Alexander Ruderman, Pay or Die follows three families that have been devastatingly impacted by the American insulin affordability crisis. For Type 1 diabetics, not having access to insulin means that they will be dead in a matter of days. Pay or Die shares an unflinching glimpse into the financial and personal repercussions of trying to access a grossly overpriced, but life-saving medicine. Set against the backdrop of the COVID-19 pandemic and in a moment of increasing political unrest and activism, Pay or Die centers the uniquely American battle between the value of human life and the value of profit as it plays out in U.S. politics.

As a documentary, Pay or Die is incredibly effective in contextualizing America’s insulin affordability problem both on the intimate, human level and within a broader global scope. Through succinct illustration and explanation, the documentary takes aim at the unique nature of this crisis as a symptom of American culture and begs the overall question: “How is it that, in the richest country in the world, Americans are being held ransom by astronomical insulin prices when other developed countries charge so much less for this life-saving medicine?”

The film introduces a quick history of the discovery and development of insulin (the scientist the discovered it intentionally kept costs low, because he believed in providing access to the life-saving drug), as well as a behind-the-curtain peek at how pharmaceutical companies, doctors, and politicians are entangled in a co-dependent profit web. Expert insight shows the huge gap in the exorbitant cost of insulin in the United States versus its affordable price tag in other countries, and connect that directly back to the selfish interests of a handful of industry giants. In short, pharmaceutical companies in the United States are successfully running a scam on American patients that does not and cannot exist in any other developed country. It’s shocking information that hits a heartbreaking note when juxtaposed to the tragic realities of the families that carry that burden.

As a viewer, one is able to recognize the senseless nature of this crisis when the facts are laid beside the lengths that these families must go to in order to receive life-saving care. The cost is parents suddenly losing children when that child ages out of being a dependent on their parent’s healthcare. The cost is homelessness when rent money goes to medicine. The cost is young people being fed through a healthcare system that offers minimal support or education on how to navigate a Type 1 diabetes diagnosis.

Pay or Die shines as a piece that is deeply human. Within its exploration of the fragile nature of human life and the uphill battle of humanity versus unfeeling agenda, there is a spark of empathy. The point is not the hopelessness of the crisis, but the optimism of the individuals that are surviving it and the perseverance of the activists that are fighting. Pay or Die is a heavy watch, but it dares to hope.

Pay or Die held its World Premiere on Saturday, March 11 at the SXSW 2023 Film and TV Festival in Austin, TX. Pay or Die will also host SXSW 2023 screenings on March 13 at 3pm and March 16 at 2:30pm.

Pay or Die
  • 6/10
    Rating - 6/10


Pay or Die shines as a piece that is deeply human.

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