SXSW: “PAY OR DIE” REVIEW

By David Baldwin

PAY OR DIE follows the stories of three families who have a connection to Type 1 Diabetes and are struggling with the price of insulin in the United States. More specifically, it centers around Nicole Smith-Holt, her activism, and her lobbying to get a new health bill passed in Minnesota – named Alec’s Law after her late son who died from diabetes complications – that would force pharmacies and insulin makers to provide emergency supplies of insulin to diabetics in need for a more reasonable price.

PAY OR DIE is not so much a discussion around insulin and Type 1 Diabetes, so much as it is a full-blown Horror film. I sat, riveted in my seat, listening to the startling statistics and stories around insulin prices, Diabetics who have been forced to stretch their insulin reserves as long as possible and have survived, and the family members mourning the loss of the ones that did not. It is absolutely harrowing hearing these tales, and often flabbergasting and downright disgusting. Filmmakers Rachael Dyer and Scott Alexander Ruderman rightfully take Big Pharma to task here repeatedly, comparing the insulin prices to other countries and showing just how much they fleece from these individuals with a terminal disease. It outright includes an entire section where a mother and her 11-year-old daughter (both with Type 1 Diabetes) drive from Seattle to Vancouver to buy up supplies for nearly five-times less than what they would have paid in the US.

For someone who has a minimal understanding of the US healthcare system, PAY OR DIE is a necessary watch that will have you crying and raging in your seat. My only complaint was around the timeline the film sets for itself. It is chronological in terms of the profiles of each family, yet bounces around almost erratically between them with no real sense of what year we are in. We are at one point following a young woman navigating a recent diagnosis in 2020 alongside Covid-19, and then suddenly back in time to Smith-Holt leading rallies at Eli Lilly headquarters. It does not take away from the central message or theme of the film thankfully; it just would have benefitted from being more cohesive and cleaner edited.

PAY OR DIE screens at SXSW ’23 as follows:

Mar 11 at 3:15pm at Alamo Lamar E

Mar 13 at 3:00pm at Alamo Lamar C

Mar 16 at 2:30pm at Alamo Lamar B