About that drug plan ...

... that I blogged about the other day. I have some additional notes.

A couple of days ago I made a comment about how Canada as a whole should consider the Québec model for Pharmacare -- which combines "play or pay" (i.e. you have group or individual coverage from a private plan, or you must buy into the government's drug plan on your tax return) with a standard set of co-payments for public or private policyholders-- as a template for a national strategy.

There is one big problem that I would have with the Québec plan (which also is a common thread even with the "catastrophic" plans in other provinces): While there is a cap on the maximum an individual can pay each month, and people on social assistance or students are supposed to get their drugs with a lower to no co-pay at all -- the fact is the co-pay, up to when you reach the cap, is still 31%. So for instance, if a drug is $15 (with dispensing fee) you have to pay $4.65. (It started at 25% but has been creeping up ever since.)

Well, what if you have 10 or more drugs a month? Even if you're protected by the "max cap" it's still a big hit for people who have a fixed income each month. I mean, that's $77 or so each month that could go for groceries, utilities, etc. It's not as bad as the States where people are forced to choose between food and drugs -- in this case it's more like choosing which drugs you need the most to live.

While a universal plan does improve the quality of life for people in Quebec (as does universal day care -- real day care, not the $100 "take it and shut up" money Harper provides) this is still a big drawback.

It's pretty much the same in Britain, whose NHS was famously lauded in Michael Moore's Sicko. A great movie, but you would have to go to his website and his notes about the making of the film, where he discusses a fact he conveniently left on the cutting room floor for the print that went to theatres: The co-pay for drugs, which is universally applied regardless of income, really hits hard for the working poor who earn just enough to be above the low income cut-off to be exempt from the out of pockets. (Presently the amounts are £7.10 in England, £6.85 in Northern Ireland, £5 in Scotland and zero in Wales.)

Yes, poor Brits are still healthier than the richest American, but what's the point of having the drugs if you can't feed yourself -- or pay the BBC license for the "telly"?

So perhaps what's required for a Canadian solution is something that is more fairly applied across a larger segment of the "sandwiched" populace but still ensures universal drug coverage. The maximum that people would pay in a month would still be $100; but those with middle incomes -- for example those in the $30 to $50k range might pay a lesser maximum, say $50 or perhaps less, and so on down the line while indigents would get full coverage. And the starting point needs to be somewhere rather above the so-called low income cutoff.

The "devil is in the details." Obviously, we don't want everyone to suddenly become addicted to drug-treatment drugs, or to take out prescriptions for Viagra™ on the public tab.

But done right, I believe a national drug plan would put us one step closer to the "Just Society" that Trudeau spoke of.

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