Is How We Pay for Prescription Drugs Killing Canadians?
Canadians — by and large — view health care as a right. In that light, we do a reasonable job of ensuring that all Canadians have decent access to hospital and doctor care.
That unfortunately is not enough to give complete health care coverage. We fall egregiously short when it comes to prescription drugs. For some unfathomable reason, we treat this little nugget as a privilege. A privilege granted to those with a good job with benefits, and when we are generous to the very poor and the elderly.
As to the other 3,500,000 Canadians who can't get drug insurance? Well, suck it up buttercups.
It is critical to recognize that when we view access to medicine as a privilege, we open the door to private insurance. And almost magically, the profit requirements of insurance companies immediately outweigh the needs of the sick. To ensure this profit they routinely deny health coverage to many Canadians because — from their perspective — the sick are inconveniently too expensive to cover.
A friend from a previous life, Joanne Spetz, at University of California of San Francisco’s Institute for Health Policy Studies recently remarked about the belief that health care is a privilege, “If you take that position to the extreme, one would have to be comfortable with letting people die on the street.”
I think she is right. And I think when it comes to prescription medicine, we in Canada are — comfortable.
So, is our approach to paying for prescription drugs killing Canadians?
The short answer? Yes.
A paper in the Journal of the American Medical Association (April 2017) entitled, “Association Between US Norepinephrine Shortage and Mortality Among Patients With Septic Shock,” showed that a 2011 shortage of a fairly important but basic drug led to premature death. Not having access = bad.
A second paper, “Did Medicare Part D reduce mortality?” looked at this issue the other way around. This paper in the Journal of Health Economics (Feb 2017), showed that when you add access through a previously unavailable drug program, you reduce mortality by 2.2%. Having access = good.
And, yes, I do realize that these are US papers, but when it comes to drug coverage we have the very same system as the Americans.
But what is key is to note that the directionality of both papers show the same thing: access to drugs reduces mortality.
So given this, and knowing that we have 3,000,000 Canadians who are either under- or uninsured, it is rational to conclude that Canadians ARE indeed dying as a result of our patchwork drug system. A system that is predicated on accepting that access to drugs is a privilege which leans heavily on private drug insurance provision.
If you apply that 2.2% reduction in mortality to Canada, that means 225,000 may have needlessly died since 1966 because we “forgot” to finish the health care system — 6000 in the last year alone.
Now, the statisticians and policy folks are going out of their mind right now worried about the modelling and whether it is generalizable, which I think it is as the Medicare system in the States, was EERILY similar to the Canadian system. At least until they added drug coverage.
But, really, the actual number is irrelevant, because what you really need do is ask yourself a few questions:
- How many deaths of Canadians over the last 50 years do you think is an acceptable number?
- How many dead Canadians are you willing to accept to ensure private drug insurance companies are profitable?
- How many dollars per dead Canadian is a reasonable amount of profit?
Sadly we cannot do anything about the past. But shouldn’t that number be zero starting today? Shouldn’t Canadian’s very lives be more important than corporate profit?
- Lazarus, D. (2017, May 19). Miss USA spoke for many Americans when she said healthcare isn't a right. Los Angeles Times. Retrieved from http://www.latimes.com/business/lazarus/la-fi-lazarus-healthcare-preexisting-conditions-20170519-story.html
- Vail E, Gershengorn HB, Hua M, Walkey AJ, Rubenfeld G, Wunsch H. (2017). Association Between US Norepinephrine Shortage and Mortality Among Patients With Septic Shock. JAMA. Apr 11;317(14):1433-1442. Retrieved from http://jamanetwork.com/journals/jama/article-abstract/2612912
- Huh J, Reif J. (2017). Did Medicare Part D reduce mortality? Journal of Health Economics. 53 (2017) 17–37. Retrieved from http://www.sciencedirect.com/science/article/pii/S0167629617300577