Wednesday, February 11, 2009

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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2 comments:

MERBOY said...

I bet they could fully fund a drug plan like that by legalizing and taxing marijuana.

BlastFurnace said...

I certainly would agree with that proposal, Merboy -- and it would also put traffickers out of business and ensure the supply of THC met safety standards. But itt's a hot potato and it certainly won't happen while Harper is in office.

Also, once you "leeglize" the bong, what else gets decriminalized?

My preference would be to use the cost savings that would come from charging everyone the same price for drugs -- right now, according to a pharmacist I know, there's a set price for seniors and those on welfare, and a multitude of prices for everyone else depending on who's the insurer (private, worker's comp, etc.) Prices are certainly lower than they are in the States, but many countries in the EU are even lower and they still have strong pharma industries.