Saving Hospitals for the COVID-19 Crisis

I'm a life-long severe asthmatic from Nova Scotia and one of your most at-risk citizens. I live with my Dad who, while still quite spry at 81, is also vulnerable due to his age. We’ve been socially isolating for some weeks now—before it became cool. I expect I’ll have to self-isolate much longer than most. Clearly no longer cool.

First, let me just say how pleased I am you've made funds available to Canadians unable to work at this time.

This is vitally important, but also conceals a serious problem.

People with chronic illness have expenses the rest of Canadians don’t. Out of any federal support, we will still have to shell out for drug co-payments or pay for medication completely out-of-pocket. To make matters worse, people who normally keep a three to six month supply are now being asked to limit prescriptions to a 30-day supply. That can triple, quadruple and more, the amount paid out in filling fees at the pharmacy. For me, that means 13 daily medications to deal with asthma, high blood pressure and anxiety. You can imagine my 20 percent co-payments can really add up. Now add in tripling or sextupling the filling fee.

I’m pretty sure you’re not giving out emergency funds just for us to turn around and hand them over to multinational drug companies or my pharmacy.

Since we will absorb these extra costs that others don’t, the very same problems that exist now will persist. Diabetics will stretch their insulin, asthmatics will skip doses, high blood pressure will go untreated. And who knows what will happen to work-based plans with so many facing lay-off. What if they suddenly lose coverage?

This is the very worst time in history for any of these things to occur.

People who do not have ready access to medications are more likely to see their conditions deteriorate. Playing Russian roulette with their health increases the likelihood of ending up in hospital unnecessarily.

That would be monumentally bad timing.

One of the best ways of preventing health decline, particularly during this crisis, is to ensure ready access to prescribed medication. When Canadians have unfettered access to the drugs they need, they remain more stable and out of hospital.

So, this would be THE perfect time to introduce national universal public pharmacare paid entirely by the federal government and eliminate co-payments, at least for the time being. With the provinces and territories in the COVID-19 trenches, this is not a good time to move into sclerotic multilateral discussion and negotiation.

And this is not the time to apply more patches to the current ineffectual pastiche we call our drug "system." One that looks chillingly similar to the US health care system. As such, it has many of the same problems: escalating prices, people forced to choose between food and medications, and millions without appropriate insurance—if they have it at all.

Clearly, we need to be LESS like our neighbours to the south, not more.

The easiest way to implement this would be for the federal government to start to pay for all drug costs for all Canadians directly. Before whip up your disappointment face, paying for drugs does not infringe on the provincial role of delivering care. The feds promise to pay the bill. We sort out who owes what to whom later.

But get on with it.

And I mean all drugs, whatever people are on right now, be they brand-name or some of the new high cost drugs. This is not the time to quibble. Yes, expanding the formulary will be required, but again, we can square things away later. Once the pandemic eases we can work to move people to cheaper generics where appropriate. Or implement differential co-payments for people that insist on brand name drugs only.

It might even be a good time to loosen restrictions on publicly available medications. A good example of this would be the new drugs for cystic fibrosis. Yes, they are outrageously and indefensibly priced and often have negligible benefit, but ANY—I mean ANY—improvement for people with CF right now would be a very good thing. The worst place I can imagine for them to be at this time is unnecessarily in hospital with a chest infection.

Remember, the point of introducing Pharmacare during this crisis is to keep people out of hospitals who don’t need to be there.

As long as possible.

But here’s the really crazy part.

We would ultimately save billions of dollars each year that it stays in place. At a time that government money is just flying out the door.

A universal program means we eliminate multiple and duplicative administrations that eat up huge amounts of resources—particularly in private insurance. With about 100,000 private plans I think you can imagine the savings, since private plans are 13 times MORE expensive to run than public ones. That’s a ton of wasted money. Why would we squander resources running separate redundant plans for the rich or well-employed, when all Canadians deserve the same access to medication.

Universality also means we would be what economists call a monopsony or single buyer. Canada would finally have leverage to negotiate with drug companies in our favour, rather than the other way around. That’s just one of the reasons that New Zealand—with one-eighth population—pays one-tenth the price we do for a generic version of amlodipine for high blood pressure. A generic, by the way, actually made right here in Canada.

Yes, taxes would go up, but private spending would go down…much, much more. Private health insurance premiums would plummet, so individuals would save money, as would business.

To get a sense of the savings we need only look to similar systems that DO include drugs in their public plans. A good example is Finland, who tied with us in the most recent World Health Organization health system ranking. If we could get the kind of prices they get for drugs, we would save $15 billion dollars each year.

With the federal government paying for drugs, provinces would have immediate access to funds they would normally use on drugs to combat COVID-19 now and to deal with the increasing stress being placed on our front-line health workers. Once it is contained the funds could then be used to ensure we are never again caught so flat-footed.

There is very little that Canadians like me can do directly in this crisis. Help us stay out of hospital and save the system for when it’s needed most.