A Canadian gap you too can fall through

October 9, 2019 6:31 AM

Canada is the only industrialized country with universal medicare that does not provide coverage for medications, leaving us with the second-highest drug costs in the industrialised world, after Americans, despite pharmacare being recommended by major national commissions in Canada dating back to the 1960s and despite multiple promises by previous Liberal governments.
posted by clawsoon (25 comments total)

Is it 'cause of the money?
posted by Reasonably Everything Happens at 6:46 AM on October 9, 2019 [1 favorite]

This would be nice — especially since I found out that my employer's (otherwise surprisingly nice, for a charity) insurance doesn't cover preventative inoculation, so I'm out $600+ for Shingrix shots for the two of us.
posted by scruss at 6:50 AM on October 9, 2019

The third link has a pretty good discussion of all the factors which have gotten us where we are. Healthcare is provincial jurisdiction and there's been federal/provincial bickering; many voters frame healthcare as a fixed pot, so they think that spending more on drugs means spending less on doctors and nurses; private insurance companies make a lot of money and don't want to lose their profits.
posted by clawsoon at 6:59 AM on October 9, 2019 [3 favorites]

In Qc there’s a public option or you can have your own plan (mostly through your employer) you have to be on one or the other.

Some political parties are even advocating creating a public agency to act as a single buyer for the whole province and leverage that buying power and also to do some production of genetics that aren’t produced because of low margins. Beats me why we dont already do that it seems like a no brainer.
posted by WaterAndPixels at 7:10 AM on October 9, 2019

The 4th link by, former Sun Media correspondent & Ezra Levant buddy, Brian Lilley fails to mention that the Tories are the only major national party that doesn't have a plan for pharamcare (to date).
posted by Ashwagandha at 7:11 AM on October 9, 2019 [1 favorite]

A more detailed discussion, with numbers, of recent prescription medicine spending in Canada is available here. It is definitely worth a look and clarifies why pharmacare is a critical bit of health care we are missing.
posted by Ashwagandha at 7:20 AM on October 9, 2019 [1 favorite]

All of the details in the world won't change the fact that the profit motive is an immoral and inefficient way to get people the treatments they need to live. Anyone who says otherwise wants to sell you something (or is, for some reason, invested in the idea of someone else doing it. Possibly literally).
posted by Reyturner at 7:25 AM on October 9, 2019 [3 favorites]

When Tommy Douglas introduced universal health care to Canada in the 1960s, he had to cut out pharmacare and dental to push it through. However, the intention was always to introduce programs for both at a later date.... As a result, nearly 10 per cent of Canadians who don’t have private health coverage can’t afford the drugs prescribed to them and are having to choose between food and medication.

A reminder that rationing something always makes the price climb, as an artificial shortage is created. We're talking about pennies per pill on the margin that is denied care. The state controls the laws that the drug companies use to protect their ownership over manufacturing and distribution, and with all that power the government must force a deal to buy the last mile of drugs at cost for those who can't pay, a failure which directly causes diseases to increase. It is more evidence which suggests that evil is maintained to service a status-conscious worldview.
posted by Brian B. at 7:27 AM on October 9, 2019 [4 favorites]

I have coverage, but the Quebec provincial coverage is not exactly amazing -- the prescription plan costs up to $636 a year (it's paid with and based on income tax) and then on top of that you can pay up to $93/month for prescriptions (everything beyond that is covered). The good thing is that if you do have a private plan, it must cover at least as much as the public plan offers, so there's no weird crap about birth control or whatever. (There are all sorts of arcane things so that a group insurance plan isn't overly penalized when a member has a Very Expensive Condition.)
posted by jeather at 7:30 AM on October 9, 2019

I’m pretty sure my employer’s insurance plan is more than that (hard to tell a bunch of other things are bundled in it...maybe my last Releve-1 form has the answer).

The fact that most Canadians are already covered in some way makes it hard to get traction on the issue politically, and a reason I had doubts about Jagmeet’s strategy of bringing it up constantly at the last debate. At the core it’s a good thing to make those programs public and universal but it’s not perceived as a core issue by a lot of people.
posted by WaterAndPixels at 8:08 AM on October 9, 2019

I remember that coming up, possibly here, in a discussion of the case of the infamous Canadian bus murder. The guy who did it was declared insane, treated for his mental illness and had returned to normal, and was being released... and yet his medication to keep him from another such episode wouldn't be covered! Which sounded like a not-safe situation for him and everyone around him.
posted by tavella at 8:21 AM on October 9, 2019

The fact that most Canadians are already covered

That "most" can mean a lot of different things.

From the article I linked to -

"The majority of public drug spending in 2017 was for a relatively small number of individuals. Public drug programs paid $2,500 or more toward drug costs for 13.8% of beneficiaries, accounting for 69.7% of public drug spending."

and

"About 1 in 4 Canadians received a benefit from a public drug program in 2017. Individuals living in low-income and rural/remote neighbourhoods were more likely to receive a benefit. "

As the population ages and there is a greater amount of economic division those numbers are only going to continue to rise. Getting ahead of that problem is absolutely critical for our health care system. The Liberals, NDP, and the Greens all have paid lip service to doing something about it. The Conservatives have not which I think is telling.
posted by Ashwagandha at 8:43 AM on October 9, 2019 [1 favorite]

Most private plans in Quebec offer better than the government plan because they cost more and no one would be interested in it otherwise. Honestly it's a perfectly fine deal if you need A Lot of meds -- if you're on thousands of dollars a month you're still paying max 150 including your income tax contribution -- but if you're like me, and need physio but not drugs, it's not particularly awesome. Better than no public option, obviously.
posted by jeather at 8:48 AM on October 9, 2019

The fact that most Canadians are already covered in some way makes it hard to get traction on the issue politically

I have been shocked by the level of Fuck You Got Mine that some people display.

A co-worker of mine worked in restaurants into his 30s in jobs that didn't offer adequate dental care. Five years after getting his tech industry job, maxing out his coverage every year, he finally caught up with all the dental work he needed done. But when I said something about how this was a perfect example of why Canada needs proper universal dental (and prescription) coverage. His reaction? "Fuck no, I don't want to have to pay for that."

I spent years and years with only sporadic health insurance. Even when my coverage seems secure I instinctively hoard my medication so that if I lose it I'll at least have a buffer of a few months worth of pills. I never want anyone else to feel this way. I don't want people to be afraid of losing access to their (often vitally important, sometimes lifesaving) medications because they've lost their job or failed to qualify for disability or welfare coverage.
posted by Secret Sparrow at 10:06 AM on October 9, 2019 [5 favorites]

The fact that most Canadians are already covered / That "most" can mean a lot of different things.

I think you guys are talking about two (actually three) different programs/perspectives.

As WaterAndPixels says, most Canadians are already covered because their employer has a health insurance plan that provides for some prescription coverage.

Ashwagandha's link is to a report on public drug spending plans, which are aside from the employer coverage and are really two programs in the same bin. One program covers groups in need (low income, seniors) for all prescriptions just like an employer's coverage would, with deductibles and maxes and the rest. A second program covers high-cost drugs needed to treat important conditions (some cancer drugs, Hep C, macular degeneration, rheumatoid arthritis, Crohn's) straight out. This is a part of why the statistics cited are so skewed.

So for instance, I'm a kidney transplant recipient; as a result, I take a bunch of immunosuppressants. Most of them I get at the pharmacy and I use my employer's insurance like any of my coworkers. But one of my drugs, Prograf, is only through the public high-cost plan and I have to go to a hospital pharmacy to pick it up four times a year. (I just checked an American online pharmacy website, and each 100-day supply I get from the hospital would cost US$6500.)

But none of it changes the fact that we just need national health care system that realizes that taking pills is something people do to care for their health, and that eyes and teeth are parts of the body that need health care. It's so stupid.
posted by Homeboy Trouble at 10:15 AM on October 9, 2019 [1 favorite]

A co-worker of mine worked in restaurants into his 30s in jobs that didn't offer adequate dental care. Five years after getting his tech industry job, maxing out his coverage every year, he finally caught up with all the dental work he needed done. But when I said something about how this was a perfect example of why Canada needs proper universal dental (and prescription) coverage. His reaction? "Fuck no, I don't want to have to pay for that."

Which is hilarious because he's already paying more for worse care that leaves 1 in 4 in the cold to the benefit of a few hundred rich parasites.

So, unless he's one of those rich parasites, he doesn't even got his.
posted by Reyturner at 10:33 AM on October 9, 2019 [3 favorites]

And still Americans travel north to get meds at a better price.
posted by doctornemo at 11:09 AM on October 9, 2019 [1 favorite]

The fact that most Canadians are already covered in some way makes it hard to get traction on the issue politically

This is the same type of bias as the "most people are healthy most of the time" issue. You're healthy right up until you are not. You're covered by drug plans right up until you're not. You're rich right up until you're poor. And the most terribly inevitable of all ... you are young right up until you are old.

The number of people who are covered in some way is not a static status. People move into and out of coverage plans all the time. Some people without even realizing it. Others with foreknowledge make medical decisions based on it (I had my problem causing wisdom teeth all yanked in one go more than 25 years ago at the age of 24 and 45 weeks. That was the last time I ever had full dental coverage).
posted by srboisvert at 11:13 AM on October 9, 2019 [6 favorites]

Yeah, and if you're covered by your job and you get sick and can't work, you're... no longer covered by your job and can't get back to work. Which is a bit backwards.
posted by klanawa at 11:20 AM on October 9, 2019 [3 favorites]

Estimated effects of adding universal public coverage of an essential medicines list to existing public drug plans in Canada:

Commissions on the Canadian health care system have repeatedly concluded that universal, comprehensive public pharmacare is the most equitable and efficient means of achieving access to appropriate and affordable care for all Canadians. Our study showed that adding universal public coverage of a model list of essential medicines to the existing complement of public drug plans in Canada could address most of Canadians’ pharmaceutical needs and save billions of dollars annually. Doing so may be a pragmatic step forward while more comprehensive pharmacare reforms are planned.

Research suggests links between universal drug coverage and reduction in deaths from diabetes

Catastrophic Drug Coverage in Canada:

Efficiency

Some health economists question the efficiency of maintaining the current mix of private and public drug coverage plans. They argue that private drug coverage plans are less efficient than public ones: because their revenue is based on a percentage of the expenditures made through their programs, they have no incentive to control the rising costs of their plans or to limit their formularies to reflect the most cost-effective medications. Furthermore, the administrative costs of Canada’s public health insurance programs are lower than those of private plans, amounting to 1.3% as opposed to 13.2% for private plans.

Finally, public drug coverage programs have more purchasing power than private insurance companies and are therefore able to negotiate better prices for pharmaceuticals through product listing agreements (PLAs), which establish a price for each drug included in a prescription drug plan on the basis of volume, thus helping to lower the overall costs of their programs. These factors, combined with the costs associated with tax subsidies provided to employers who sponsor these programs, have led some commentators to argue that cost savings could be achieved through the establishment of a single-payer public drug coverage system, provided that efforts were made to control the cost of such a program.

This bears repeating:

Furthermore, the administrative costs of Canada’s public health insurance programs are lower than those of private plans, amounting to 1.3% as opposed to 13.2% for private plans.

*pounds table*
posted by mandolin conspiracy at 12:30 PM on October 9, 2019 [5 favorites]

The Quebec plan does not cover everything. A friend's brother underwent many years of cancer treatment, and most of his high priced medications were not covered by it. It was honestly such a huge out-of-pocket outlay that I (self-employed) am actively seeking a private plan so as to be covered should I require similar types of non-covered medication here in Quebec in the future.
posted by jordantwodelta at 4:08 PM on October 9, 2019

Drugs are expensive because of monopoly drug patents. The retail cost is 10 to 100 times the cost of producing the drug. Drugs would be relatively cheap if all research were government funded so that all drugs were generic.

Keep in mind that most "free trade" agreements are nothing about free trade but about protecting monopoly patent and copyright property.
posted by JackFlash at 7:12 PM on October 9, 2019 [1 favorite]

A co-worker of mine worked in restaurants into his 30s in jobs that didn't offer adequate dental care. Five years after getting his tech industry job, maxing out his coverage every year, he finally caught up with all the dental work he needed done. But when I said something about how this was a perfect example of why Canada needs proper universal dental (and prescription) coverage. His reaction? "Fuck no, I don't want to have to pay for that."

I worked in restaurant jobs till I was nearly 30 that offered literally no dental or pharmaceutical coverage whatsoever. Now that I'm self-employed things are worse. How many jobs do I need to hold down to keep my teeth anchored to my jaw?
posted by Evstar at 7:16 PM on October 9, 2019 [2 favorites]

I'm currently working int he generally underpaid hospitality industry. So many coworkers are worried that even though they have no drug coverage currently their taxes will go up horribly to cover universal coverage. "Dude, if your company pays you so little that they don't even offer a laughable drug plan your taxes aren't going to move anywhere near what a national pharmacare plan will save you."
posted by Mitheral at 6:53 AM on October 10, 2019

The Quebec plan does not cover everything. A friend's brother underwent many years of cancer treatment, and most of his high priced medications were not covered by it. It was honestly such a huge out-of-pocket outlay that I (self-employed) am actively seeking a private plan so as to be covered should I require similar types of non-covered medication here in Quebec in the future.


Interesting, my father got approved for a 65k cancer treatment from the government within a few days of the doctor asking. (IIRC it is an off-label use for a rare disease, covered in some cases for the other disease which has a lower dosage.) Though this is a treatment done mostly inpatient. He's just sitting on the approval for now until they start treatment.

I wonder how the special approval process is decided, for drugs that aren't on the list.

Anyways, yes, the Quebec plan doesn't cover everything: I've heard all sorts of complaints about what it covers for diabetes, though I can't remember the specific limitations.
posted by jeather at 7:00 AM on October 10, 2019