Let’s finish the job and implement Pharmacare

Medicare is a good idea but incomplete without Pharmacare. Let’s finish what we started in the 1960s. The plan was always to finish our health care system but realization of that dream got lost in perennial federal-provincial squabbling.

image: Green Party

Canada is an anomaly among nations. We are the only industrialized country with a universal public health care system but no Pharmacare.

Every study of Canada’s health care has identified the lack of Pharmacare as a major gap in our system.

Medicare without drug coverage doesn’t even make sense. What good is a health care system that prescribes drugs but doesn’t cover them?

What we now have is a mess. Drug coverage in Canada consists of a patchwork of 100 public and 100,000 private insurance plans. Some working Canadians are covered by employer-funded private plans. Seniors and those on social assistance are covered by publicly-funded provincial plans. Indigenous people, military members, federal inmates are covered by federal plans. Low-income Canadians struggle. In B.C. they have to pay up to the deductible amount.

Studies show that some low-income Canadians go without prescribed drugs because they have to buy groceries and heat their houses first. Women typically suffer more than men. Nearly two million Canadians reported not being able to afford one or more drugs in the past year. Unfilled prescriptions result in an additional burden on our health care system –patients end up going back to their doctor or to the hospital.

What we have is a mess and it’s ridiculous. When I go to the hospital, prescribed drugs are covered by Medicare and dispensed from the hospital pharmacy. When I walk out the door of the hospital, I’m on some other plan if I’m lucky, no other plan if I’m not.

The model of Medicare provides a good template for Pharmacare. While Medicare is universal in that it covers everyone, it is not universal in that it covers everything. This is especially true for Pharmacare as technology offers ever more expensive remedies. Pharmaceutical companies are coming up with new, expensive, drugs. Some are only marginally better, some no better than generic drugs. Pharmacare should not cover every conceivable pharmaceutical.

Drug spending in Canada has grown significantly over the past few decades, from $2.6 billion in 1985 to $33.8 billion in 2017, and the share of GDP spent on drugs has more than tripled from 0.5% to 1.6% over this period.

Pharmacare will reduce the amount we pay for drugs. Canadians pay among the highest prices and spend more on prescription drugs than citizens of almost every other country in the world. Among Organization for Economic Co-operation and Development (OECD) member countries, only the United States and Switzerland spend more per person each year on prescription drugs and pay higher patented drug prices than Canada.

The bickering between the federal government and the provinces over Pharmacare must stop. Now’s our chance. The federal government has opened a dialogue. What do you think? You can answer the questionnaire and make a submissions until September 28.

 

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Self-administered death made easier

A new drug in Canada will make medically-assisted death easier. It can’t come soon enough.

image: Bayshore Healthcare

If I had a terminal illness that made my life a living hell, I would want medical assistance in dying (MAID). Since it has been legal in Canada since 2016, it should be easy. All I have to do is find a doctor who is willing to administer the drugs. And then make sure I’m living in the right place -that’s where things get tricky, as Horst Saffarek found out.

Horst Saffarek lived in a Catholic residential care facility in Comox, B.C. When his lungs began to fail, he wanted help in dying. The publicly-funded Catholic institution wouldn’t allow MAID at their facility, citing moral principles.

Horst was becoming frailer each day and breathing became difficult. His daughter, Lisa Saffarek, told CBC’s The Current:

“It’s scary, you know, especially when you can’t breathe, every moment is scary.”

Horst was faced with the choice of essentially suffocating to death or he could be transferred to a facility that allowed MAID. He was transferred to Nanaimo where he would have to wait ten days as required by law.

I can only imagine the terror that he was going through: struggling with every agonizing breath and seeing relief being delayed.

“Dad was obviously very frail,” said Lisa Saffarek, “We did need to transfer him. He was ended up, you know, his oxygen levels were falling, and we wanted to try and meet his wishes.”

The transfer from Comox to Nanaimo, an hour and a half ride by ambulance, was gruelling. Horst Saffarek died the day after the transfer without the comfort of MAID.

Not only was Horst Saffarek’s suffering needlessly prolonged, but his family felt anguish as well. Lisa and her sisters had planned to spend the last moments of their father together but they were robbed of that:

“But it just – it took away from us being able to celebrate dad and just to enjoy our last moments with him.”

The law protects doctors by allowing them to opt out of MAID. Institutions have no such legal option. Religious healthcare facilities receive public funding same way that others do. If a procedure is legal, and public funds are involved, how can an institution prohibit it?

In small centres like Comox, religious healthcare facilities are the only ones in town. Because they employees are not necessarily religious, and neither are the patients, the title “religious facility” loses meaning. In reality, they are public facilities with an historic religious origin.

The solution is to take matters into one’s hands. A new drug has been made available to make that happen. Secobarbital, the most common drug used in many countries, is now available in Canada. Unlike existing drugs that can take a long time, Secobarbital is fast-acting, doses are a relatively small in volume, and self-administration is easy.

Existing drugs can take hours, even days, to work. They taste bad. They don’t work if they cause nausea and vomiting, or when the patient falls asleep before consuming the large volume required.

For those who suffer from an agonizing terminal illness but live in remote or small communities where there is only one doctor who doesn’t provide MAID, or they live in a care home that decides to flout the law, Secobarbital could provide relief.

Horst Saffarek’s experience leaves me wondering why I should suffer the vagaries of the anachronistic legacy of institutions, and other’s moral values, that impose themselves on my life and death. Whose life is it, anyway?