National pharmacare, as run by omniscient angels

Marc-André Gagnon’s solution should be read by citizens of every political orientation

by Colby Cosh

Marc-André Gagnon’s appeal for national pharmacare, published this past week by the Canadian Centre for Policy Alternatives, should be read by citizens of every political orientation. Yes, Prof. Gagnon has a simple, government-driven panacea for the ills of Canadian prescription-drug policy; but government is sometimes the cause of those ills, as his analysis is unprejudiced enough to show. I learned something especially horrifying about Quebec’s healthcare system from his paper [emphasis mine]:

In Quebec, prescription size was 37.4% smaller than the Canadian average. This is because the province’s public drug insurance program requires that prescriptions be renewed each month, unless the patient has special permission (for example, for a trip abroad). The Régie de l’assurance maladie du Québec [Quebec Health Insurance Plan] (RAMQ) requires that pharmacists fill orders of no more than a month, albeit repeats on prescriptions are allowed. Patients who have a chronic condition and take medication such as antihypertensives (for high blood pressure) or statins (for high cholesterol) on an ongoing basis must therefore have their prescriptions filled monthly, simply for administrative purposes. It would be easy to give these patients three- or six-month prescriptions, as is usually done in other provinces, without it affecting the quality of care. There are no studies in the medical literature showing any kind of therapeutic advantage to a monthly renewal of prescriptions for people with a chronic condition.

…The only reason for this state of affairs is that Quebec, as part of its Pharmacare program, wanted to make deductibles more “equitable” by establishing them on a monthly basis so that the costs would be spread more evenly over the year. Since deductibles are monthly, prescriptions must be monthly as well, increasing the number of prescriptions and associated fees. The workload for pharmacists is artificially increasing at a time when Quebec has a serious shortage of hospital pharmacists (Daoust-Boisvert 2009).

I take blood pressure medication, so if I ever move to Quebec I’ll be able to join the Pharmacare program and get my drugs for a modest upfront deductible—but at about sextuple the cost to that province in dispensing fees and paperwork, and sextuple the cost to myself in visits to the drugstore. (Imagine the carbon footprint!) If I were to value my own time realistically, the nuisance would cut deeply into the savings to me, and it might well represent an outright loss to many workers.

What equally infuriating inefficiencies could we expect a national pharmacare program designed by politicians to incorporate? Why, none at all; the only conditions are that Prof. Gagnon must design the program, the design must be adopted with absolutely no political modifications, he must be smart enough to have foreseen and prevented all possible hazards from Quebec-style perverse incentives and trough-wallowing, and he must rule the program forever with an iron fist and never retire, die, or grow inattentive. Given all of those assurances, I will be happy to endorse his scheme unreservedly.

National pharmacare, as run by omniscient angels

  1. There is no economics case for universal pharmacare. You cannot reduce costs with price controls, which is the essence of Gagnon's argument, that somehow price controls work if you call them by a different name.

    In one segment of the news, we have the government of Cuba finally admitting that socialism is a failure now that most Cubans can no longer afford to feed themselves. In Canada, we have know-nothing researchers trying to replicate Cuban policies with grand national socialist schemes.

    • Well since not one word of that is true, it can safely be discarded.

    • "You cannot reduce costs with price controls, which is the essence of Gagnon's argument…"

      Did you so much as open the article? Can you please quote the section that references "price controls?"

      • Did you even read what s_c_f wrote?

        which is the essence of Gagnon's argument, that somehow price controls work if you call them by a different name.'

        • Well, the blind leading the blinderer.

          Ok, can you/he please quote the section that references "price controls" under any name?

          • You're the one who put "price controls" in brackets, dude. You're the one who apparently can't read. Then you lash out at those who can.

          • In quotes, not brackets.

          • So neither you nor scf can quote a part of the document that recommends price controls, "price controls" or price controls called "by a different name".

          • Why would I have to? I merely pointed out that s_c_f did not specifically cite the term, which you claimed he did. Again, instead of lashing out at me, how about admitting the mistake and taking some responsibility? Why always deflect? I never made any comment about the contents of the report, merely about his characterization of them. Or do you not understand this? Does it have to be spelled out even slower?

          • scf, kicking off this pointless thread above: "You cannot reduce costs with price controls, which is the essence of Gagnon's argument, that somehow price controls work if you call them by a different name.

            Maybe you need to spell it out slower, but by my reading, scf did indeed cite the term 'price controls.'

    • "There is no economics case for universal pharmacare."

      …until, like me, you acquire a spinal cord injury or similarly catastrophic injury. I was one of the lucky ones who happened to have employer health coverage but I've encountered too many others who were totally vulnerable. I doubt if you have a clue about the wasted human resources, wasted time, and hidden costs absorbed by the health care system and the "community-at-large" because people are at the mercy of big pharma. You are advocating on behalf of an industry that is ruthless and heartless.

      • Big governments are no less heartless. In fact, once you get a heartless monopolistic government program, there is no turning back, there are no longer any alternatives, you're stuck with the heartlessness.

        That's why people in Canada wait on average 8 hours for ER treatment, and in western Quebec people wait on average 20 hours. It's rather heartless to sit in an emergency room with an emergency medical condition for hours and receive no treatement. In Ontario is takes on average 13.5 hours to be treated when you have a serious condition.
        http://www.torontosun.com/news/canada/2009/05/03/http://www.cbc.ca/health/story/2008/05/21/ot-er-w

        Average surgical wait times are 4 months. Heartless. http://www.cbc.ca/health/story/2007/10/15/waittim

        Heartlessness abounds in big government programs.

        • One:
          Your wait tieme data is quite old. And the numbers you quote as "averages" are not. When you use fact-bullets printed in the Toronto Sn as your source, you may wish to look for their original source. If you wish to use statistics to make your point, make sure they're accurate.
          Two
          You are comparing systems that use differen means of measurement. See One, above.
          Three,
          Worst of all: You are purposely stirring up the actual definition of "waiting time". Those numbers you use? the Ontario number, for instance. 13.5 hours. Your words make it seem that it's the average time to get seen in an emergency room. What that number (from last May) sactually says, is 9 of 10 patients are triaged, assessed, tested, treated and either released or admitted within that 13.5 hour number. Not an average.

          • One: they're accurate. And two, it doesn't matter if they're a year old, nothing has changed. Typically, things are worse every year. Also, you don't get the results for year X until year X+1, for obvious reasons.

            Two: No I'm not.

            Three: You obviously don't understand what the word "average" means. Secondly, you're just wrong about the 9 of 10. Thirdly, if you're attempting to argue that treating people 9 of 10 people in less than 13 hours is somehow commendable, then you have a deranged mind. For one thing, we're talking about 13 friggin hours. Secondly, this would mean that the remaining 1 person is waiting a mind-boggling 22 hours minimum. Yes, you are seriously arguing that a 10% chance of waiting 22 hours is a good thing. 22 hours!

            Four: statistics like this have been compiled for every province, and the cross-Canada result is that it takes on average 9 hours to be treated. That's a fact. People like you who continue to argue that this is somehow acceptable show what kind of an ideologue detached from reality you are.

          • It's not an average. Which makes your entire post pointless. Unless you understand that the number you're repeating is not an average, but an actual measurement, you won't see the error in the numbers you're throwing around.

          • OK…so 9 hours is not the average amount of time you'll wait to get through Emergency, it is the time you should expect it will take you to get through Emergency based on actual measurement.

            I doubt many people doing their 9 hour stint sitting there are placated by the semantics of it all.

          • No. I'll try to be clearer. My apologies if I've not done that.

            9 hours is the point where 90 per cent of all patients have already been seen, treated and either sent home or admitted to hospital. It's not an average.

            If you're in that 10 percent who are over and above 9 hours spent in the emergency room, chances are you're already in the back and waiting for a test or the results of your scans to be checked over.

            Or, it means you came in with an ear infection, which puts you way down at the bottom of the triage scale. Or you came in as part of a car accident, and that 9+ hours includes emergency surgery and time in recovery before they even admitted you.

    • Cuban policies – did you miss George Bush's unfunded pharmacare program?

      • Nope. That was his biggest mistake. But Cuba has demonstrated over a period of 50 years what socialism does. The failures are ubiquitous and obvious for anyone to see. We'll need to wait a while to clearly see the failures of Bush's program.

        • Enough with the phony Cuban diversion, please. They've decided to boot some people from
          the government payroll. We'll see how that plays out. And pretend that it could never happen here.
          There has been no indication that they plan any change to their medical ( or educational ) system.

          That may well come. People get old and die off, leaving no one who remembers why they had a
          revolution in the first place. The same may well apply here .. written as someone whose living
          memory includes the pre-Medicare days.

          • They've decided to boot some people from the government payroll.

            They've decided to boot 10% of the national workforce instantaneously. That's more than the total unemployment figure in Canada or the US during the middle of a recession. It's not a trivial thing. Laying off 10% of the entire country at once is not trivial.

            I'll talk about Cuba until the cows come home as long as there are people in Canada trying to emulate Cuba.

          • Well, gosh darn … I'm gonna have to move my compound up higher into the Cape
            Breton hills. And tell Bobbi (Buns) Guevara that her nefarious schemes have been
            exposed. She'll be shattered.

          • Why don't you head down to Miami and tell the same joke to a Cuban audience and see what kind of reception you get.

          • Been to Miami. Been to Cuba. But this thread is about neither, so I'm done.

            Oh, Cuba was a far nicer place. But Nouvelle Ecosse rocks.

  2. Yes, we need national pharmacare, instead of 10 different systems of insanity.

    • You make a strong case indeed for bigger, more universal insanity.

      • Or maybe being one country instead of ten, and buying in bulk, and using some common sense?

        • They've just decided to buy in bulk now – has nothing to do with a national pharmacare program though… but thanks for the irrelevant tangent.

          • Oh really? Well maybe if we'd had less BS, and more common sense…and one country….. long ago, we'd have a decent system already.

      • Having only read the snippet in the your article, I'm not sure where the sextuplet figures coming from, but I'll let the hyperbole slide because it does seem to be an unnecessary added cost.

        As for a potential solution, look no further than the next sentence in which Gagnon recommends giving those patients longer prescriptions. Easy enough. It is worth considering universal pharmacare, warts and all, drawing from existing systems and proposing practical solutions. Dismissing it outright is actually more ideologically narrow-minded than publishing a paper for an alternative.

        Also, since we're talking about high blood pressure here, maybe the extra exercise on the way to the to pharmacy (using actual, not carbon footprints) would actually be a good thing.

        • Living in Alberta, I can buy six months' worth of drugs in a single visit. This figure would be one month in Quebec. I'll let your use of the word "hyperbole" slide.

          • Then use that as a benchmark for a national system.

          • uhm, there was an important clause in there colby: albeit repeats on prescriptions are allowed.

            most pharmacists (i have never been denied such a request) are willing to fill additional repeats at once. But more broadly the Quebec scene does not sound much different from Ontario or BC to me. I am have chronic arthritis throughout a good portion of my body, I get a prescriptions that provide a months were of meds, with repeats included that cover anywhere from 6-12 months (depending on the timing of appointments with the rheumatologist). some pills I will choose to fill multiple months at a time, others not so (mostly one script that runs about $1600 per and my insurance is currently a pay up front get refund later system). and my prescriptions have operated the same way in periods of residency in Ontario and BC.

            the article does not make clear to me this can't happen in QC either.

            of course the much broader point is i we were to embark on a new national prescription strategy of some sort, would the government manage to install the most efficient and effective system possible straight away? no. could anyone?no. could politics add additional unnecessary problems? of course. would there be potential to improve on what problems were included over time. yuppers. does imperfection at the outset or along the way preclude a strong rationale for such a programme? only the silliest among u would think so. (which is not to say there are not other valid reasons to discredit such an idea).

          • No, Quebec pharmacists can only dispense a month's worth of medication at a time without special permission. I don't know how it can be made clearer than "The RAMQ requires that pharmacists fill orders of no more than a month," but you can try reading the full section in the Gagnon paper on "Analysis of prescription size" if it will help. (It might.) Your scenario of "filling multiple months at a time" is specifically not permitted; the refills only obviate the need for additional doctors' visits to match every monthly prescription.

          • thanks for the clarification. it can't. but that was not what was written. i do think it is clearer without the additional clause (albeit repeats on prescriptions are allowed). that said i take your point on the refills. it seems silly to me to as would have though basic accounting and math could ameliorate quebec's concerns (although it would not make my life any different given the above). it is also doesn't change my broader point or have me better understand why you are railing against the idea simply because there are likely to be design and implementation problems

          • But we're not talking about a "design problem". We're talking about an "equitable" policy that happens to impose cost and inefficiency on everybody, implemented with success and even defended as such. Quebec doesn't have any "concerns".

          • Howis the Alberta one doing – everyone happy there?

          • such a fatalist colby, such a fatalist.

          • Back it up.

          • ?? Back what up? Six divided by one?

          • Consider scalability. For example, if I own one cat, I have costs associated with that (shelter, food, litter box). Now, suppose one day I go all crazy cat lady and buy another five cats. Will six cats cost me six times as much as one cat? No. It will definitely be more expensive, but as a consumer I'd do my best to figure out the actual costs, weigh the pros and cons before I invest in more furry friends.

            My main point is that it's irresponsible to dismiss a national pharmacare program based on the single point that Quebec's month-to-month policy increases administration costs. Gagnon admits it is not the best setup and proposes a solution. He also demonstrates that admin costs for the current public program are 1.3% versus 13.2% for private plans. Isolating that single nugget of information, you could make the case for a complete overhaul of the system.

            What I've appreciated most in reading his report are the four scenarios he presents and I'd love to read a comprehensive critique of those plans.

          • (I'm perfectly willing to concede that Quebec's pharmacare program may cost six times what it does in Alberta, if the numbers back it up, so it's essential that we have a press that is able to do the research and present the information to the readers so we can make up our mind)

        • "Canada's National Pharmacy Program: Where pointless inconvenience to you to the customer isn't an error, it's part of our mandate"

  3. What equally infuriating inefficiencies could we expect a national pharmacare program designed by politicians to incorporate?

    ***

    Since only Quebec does this, surely you mean "the same Quebec politicians who put an inconvenience into the system which no other province incorporates?" I wonder how much they save themselves by having a system which automatically resets itself monthly. I'm not saying it displaces the inconvenience to everyone else, just wondering how much it offsets.

    • No. See my post above.

      • Do you mean to say that BC also has forced monthly billing. You mention three month perscriptions. for certain extra-sensitive drugs.

        • I think my post went in the wrong place. In BC my doctor (who is very familiar with my illnesses over the years) prescribes for a year, but the pharmacy can only fill three months worth. Thios not the case with all drugs, and I gave examples (sleeping pills, narctotics, very expensive drugs. innovative drugs, first time drugs for this patient). Those exceptions are small compared with the total drugs prescribed.

  4. Why, none at all; the only conditions are that Prof. Gagnon must design the program, the design must be adopted with absolutely no political modifications, he must be smart enough to have foreseen and prevented all possible hazards from Quebec-style perverse incentives and trough-wallowing, and he must rule the program forever with an iron fist and never retire, die, or grow inattentive.

    Even then it wouldn't work well, for the reasons that private sector innovation would be stifled, the lack of price signals, lack of competition and innovation, scarcity, and the many other failures of socialist systems.

    • Pruivate sector innovation is a load of crap.

      • Yes! Obviously the ability to get your prescription filled while grocery shopping was a government edict. Otherwise we would have to wait 6 months to get 1 month of medication. How wonderful our government.

        • Depends where the pharmacy is. I get my prescriptions at Safeway while I shop, dont you?

      • Pr[u]ivate sector innovation is a load of crap.

        Quoth Blacktop, using a government designed and built computing device, transmitted over government-operated phone line or cable or cellphone frequency, and permanently housed on a government server for all to admire.

        Cell phones with more processor power than a home computer had two decades ago. Ipods. Pacemakers. Cholesterol-lowering drugs. Newer and better insulins. Yup: Pretty crappy, that private sector innovation.

        • I do believe we were talking about health care and in that private sector innovastion is a lot of crap. The only innovation is to take as much money out of the system as possible. Inmnovation comes from individuals largely, coupled with medical input. many of the drug innovations are discovered by individual scientists and priivate pharmas bring them to the market. Many innovations developed by pharmas can be deadly in one area but helpful in otghers. Thalidopmide. for example.

          • Many innovations developed by pharmas can be deadly in one area but helpful in ot[g]hers.

            That's what you call a load of crap?

      • Saying that private sector innovation is a load of crap is as silly as saying that the free market is the best way to handle every single aspect of our economic existence.

        • Once again we were talking about a specific – private sector in health care is a lot of crap.

          • Ah, point taken.

    • the lack of price signals about effective medical treatment. *belly chuckle*

      • I invite you to travel to any country where price signals were lacking for a long time to get "effective" medical treatment – this includes eastern Europe, southeast Asia and some other countries. Then have a laugh at the wonderful treatment you receive.

        • That is not a question of "price signals"but standards.

      • Here's some examples:

        wait times in Canada cost billions: http://www.nationalpost.com/news/story.html?id=23

        In Ontario, patients with serious health concerns take an average of 13.5 hours to be diagnosed, treated and moved to a hospital bed or released. In Toronto, emergency room waits for minor conditions range from five to six hours and for serious conditions from 11 to 22 hours. http://www.torontosun.com/news/canada/2009/05/03/

        The lack of price signals leads to inefficiency, scarcity and rationing.

        • Not if it is run properly. Wait times are also a product of triaging. It is appropriate for a sniffle to wait days if necessary if the ones ahead in the que are more serious cases. This fuss over wait times is a product of individual self-importance. What is the wait time for emergencies (imminent risk of death if not treated ) urgencies (imminent risk of deterioration if not treated), elective (no imminemnt risk of death)/ It is quite possible to have very long wait lists with no threats except to the self=-importance of the person waiting. I have been closely involved in developing such systems. In many case the wait is in the doctors office because of his own limitations. The critical factor in waiting time varies. It can be an imbalance or ashortage of surgical beds. It can be a shortage of fully staffed operating rooms (or in the case of MRIs, a shortage of machines and trained staff), It might be a shortage of anesthitists, although this is usually a short-term problem. Or it could be that a specific surgeon is so good and so popular that many GPs refer their patients to him/her. Overall, there could be a shortage of money which leads to the above shortages. I have found that most often the shortage is due to other services stealing beds that should be used for surgery (for exampple, a medical patient brought in and "emergency" on the weekend and then it is decided that the p[atient needs surgery, and put on that week's slate thus jumping the que. This requires a better discipline among doctors and often an engineered wait list system can bring that about, as I did in several hospitals during my working career. .

          Finally, "price signals" are inappropriate when people's lives are at stake. What is required is that the public understand that waiting times are not casually determined. You are probably warming your bum on a chair in the witing room because somebody else's life is being saved elsewhere. Also, substantial sums of money are being throwwn at the problem by way of additional staff, additional beds or enlarged Emergency facilities.

          • Not if it is run properly.

            That's funny.

          • Yes, that's the most ridiciulous and nefarious argument that every socialist makes. It goes like this"Every socialist scheme has failed, but I'm smart enough to make it work this time. We've just got to do what I say". The argument of the arrogant ideologue dictator who lacks any modicum of humility, modesty or wisdom, and who fails to understand that the problems of information distribution, the lack of price signals, and the lack of competition are unassailable by any individual or group of human minds.

          • - Not if it is run properly.

            - Yes, that's the most ridiciulous and nefarious argument that every socialist makes.

            By the way, it's also an argument that people of all political persuasions like to make in defence of central bankers. I know it's a bit off topic, but few people ever mention monetary systems and socialism in the same sentence, even though the former in essence represents a government monopoly of money and, as a result, interest rates.

          • I'd agree with you, to an extent.

            There are examples like Zimbabwe and others where the central bank has essentially robbed every citizen of all savings by printing money.

            However, in most places where inflation is held to a low number, the effect of the central bank is not so nefarious, it's often harmless. A small amount of inflation is natural (since interest on loaned money is also natural – a dollar today should be worth a little more than a dollar tomorrow, the price of forgoing spending and lending to someone else for that individual to spend it).

            Also, there are ways to get around a flawed monetary system – by investing in hard goods, stocks, and other instruments.

            I also don't think there is a real alternative (the gold standard is flawed in so many ways), and every country needs a currency, and every currency needs a central bank.

            However, I've come to the opinion that the central banks of many countries were the primary cause of the financial crisis (very convincing article here making this argument: http://www.nybooks.com/articles/archives/2010/sep… ). So I think that as time goes by, the understanding of the role that central banks should play should improve. But there's no question we are all at the mercy of the whims of the central bank which can have a profound effect on our lives.

          • I should add, that while I think the article cited is very good at debating what are the truly plausible causes of the financial crisis and recession (probably the most convincing I've seen), I think the final prescription is fatally flawed – that governments should step in to replace the spending that has been reduced by consumers "issuing debt and continuing to spend as the private sector pulls back". This idea is flawed because it is simply impossible for government to accomplish this work – for all the same reasons that socialism fails, it is completely and physically impossible to replicate the behaviour of millions of individual citizens (their spending behaviours primarily) with central planning.

          • I don't happen to be a socialist, scf. As a matter of fact I have been supporting the Conservbatives until lately when they pulled some dumbos which are well known on this thread. But it has been demonstrated that we have a much better health system than when the private sector pretty well had it all to itself. Which reminds me of an appropriate joke.

            Farmer Brown was working in his lush green field when Parson Smith rode by on his muje.

            "Gooday Parson Smith,"said Brown stopping work and wiping his brow.
            "Gooday Farmer Brown. That's a wonderful field you and the Good Lord have made. "
            "Waal " said Brown, remembering the thistles, bracken and ragweed, "You should have seen it when the Lord had it all to hisself. "

            The private sector is what you had in the States with 34 million uncovered citizens, probably mostly blacks or Hispanic. Does that please you?

            Socialism is the NHS in Britain 50 years ago and there is a vast difference.

          • But it has been demonstrated that we have a much better health system than when the private sector pretty well had it all to itself.

            Really. Where has this been demonstrated?

            You mention the United States. It does not have a free market system. If it did, you'd probably have more people with health insurance at lower costs.

            You mention our system. It is unsustainable as currently constituted. Provinces are already spending almost half their budgets on health care, and this will only increase without, you guessed it, private intervention.

          • You mention the United States. It does not have a free market system. If it did, you'd probably have more people with health insurance at lower costs.

            I should probably already know this, but which portions or aspects of the US system are non-free market? Certainly there are free market participants, no?

          • That is not what i said, friend. I said that a public health scheme can be well run – I didn't say if it is sufficiently financed but that goes without saying.

          • Perhaps it is funny in your jurisdiction. and that is because it is not run properly.

        • Olase stop using that "average" line. It's incredibly inaccurate. See my reply to your earlier post.

          • The word average is a very simple concept, but you seem unable to grasp it. Try a 3rd grade math class.

            The average time to be either admitted to the hospital or treated/discharged in a Canadian ER is 9 hours. That's a fact.

            The line is perfectly accurate. And I will continue to tell the truth. There's always people like you that cannot believe the truth when I trot out these simple statistics. Anyone who's spent any time in Canadian ERs knows that they are true, except for the lucky few who've been, well, lucky. And then there are the ideologues like you who prefer to believe in fantasy as opposed to reality.

          • No, it's nonsense because waiting lines are usually triaged. If you are dumb enough to go to the emergency with a runny nose, you wait. If you are in themidst of a heart attack you are usually at the head of the line. If you hospital emerghency doctors don't triage cases the maybe they need smartening up. If your hospital has a doctor on call but an experienced trauma nurse, the waiting will also be triaged to the best of her training and experience, which in my studies has usually been pretty good. If you have an on call emergency system then you are goping to wait – possibly until the doctor deals with another case.

          • Here's a source that proves you wrong: http://www.waittimealliance.ca/June2009/Report-ca

            Figure 4 and page 10 first paragraph.

            This is in addition to the ones already provided about western Quebec, Toronto and Ontario.

            Do you need a math tutor to teach you what the word average means? I can recommend one, Mr. Civil.

          • Don't get snarly. Read this also:

            Please note that the CAEP targets are absolute maximum
            wait times as opposed to the median/average data collected
            by the WTA. This means that the numbers being
            reported below will have a range of patient waits embedded
            within them, with some patients waiting a shorter time and
            some patients waiting a longer time than the average or median
            wait time.
            To be clear, these two CAEP target numbers reflect not
            the average wait time expected but rather the maximum
            acceptable length of stay. For example a higher acuity patient
            i.e. multiple injury car accident may be seen quicker but ultimately
            is waiting longer to get into an inpatient bed in the
            hospital. These higher acuity patients usually require a barrage
            of medical interventions to stabilize them before they are
            admitted to an inpatient bed (that has to be available or
            found) in the hospital, which is when their measured wait
            stops. This is why the maximum length of stay is longer for
            higher acuity patients.

          • Thanks, Blacktop. You've made my point for me, but more clearly than I seem to be able to.

            SCF. THAT'S why trying to extrapolate data out of wait-time averages is ridiculous.

            Also, if you'd like more recent date, look on the various provinial gov websites. For instance, Ontario puts up monthly ER wait times from a selection of hospitals. http://www.health.gov.on.ca/en/public/programs/wa

  5. Such systems … they've been tried in other jurisdictions .. are an indirect effort to get physicians to
    pay more attention to their prescribing habits. It has to be indirect because you can't personally or
    professionally offend the sensitive souls by slappin' them upside the head while screaming " why
    is this poor old lady on 22 different medications plus whatever she buys otc ?".
    But, putting aside CC's picking of bureaucratic nits it's obvious that a public system could never
    work in North America. Because we're so,so special.

    • I know, right?

      Colby says: "I learned something especially horrifying about Quebec's healthcare system from his paper [emphasis mine]:"

      You know what I found especially horrifying? Not some easily-rectified bureaucratic snafu but the fact that Canada's drug costs are second-to-worst and that growth in our costs are worst amongst countries examined.

      Seriously, who would focus on that little anecdote of bureaucracy given the stark reality described in that document?

      • Sorry, I"m not into the long form

    • From the Globe:
      quote
      B.C., in particular, is held-up as a model. The province has the lowest per capita drug costs, its residents use the least medication per capita and they pay the lowest unit prices for their drugs. That is because B.C. has aggressively used policy like therapeutic substitution – where the drug plan pays for the cheapest equivalent drug, usually a generic. endquote

      What BC can do on itys own so can other provinces on their own.. , .

  6. A presription for another big-government failure. Universal 'health care' is an expensive myth that is not sustainable as it is, adding more layers of spending isn't going to help.
    The current medical sytem is four tier – the powerful come first, medical personnel and their families second, certain government workers third – and then there's the rest of the herd that pays for it all. That was said by a physician. It's not a fair system and it will bankrupt the country if not reformed.

    • Tired. Old. Mantras.

      • Yes, nonsense

  7. Is BC a country? No.

    Canada is…and we either act as one, or we split up and go our separate ways.

    We've had quite enough of this BS 'free market', 'every man for himself' nonsense.

    • You may feel free to respond to my articles in troll-like fashion, but I don't really think it's too cool to answer an extensive, informed contribution that way. "Is B.C. a country? No." That's a nice magic formula but it doesn't really address, solve, or clarify anything. We're a federal state and B.C. is one of the components. We have a constitution. And Blacktop did not mention the "market", free or otherwise; he is speaking in FAVOUR of his province's public pharmacare. In short, this is the very stupidest comment I have seen here in nearly a year. Please do not pollute the thread.

      • Disagreeing with someone is not being a troll. Please look up the definition of an internet troll.

        I don't say things….ever…to cause a commotion. Wth would be the point of THAT?

        We need a national system of pharmacare. It's cheaper, more efficient, and better for both the economy and the end users, If you consider that kind of thinking 'pollution' then perhaps it's your ideology that is the problem….because you know we are moving to it sooner or later.

        The state of our finances will require it, even if our common sense doesn't catch on.

      • Bam! Blacktop just got "Emilied".

        (Emily's trollish responses are so prolific and so obnoxious that commenters have even coined a verb in her honour.)

        • No, morons who can't argue have come up with an excuse.

      • I live in B.C. as well and we have been at the mercy and whim of whatever provincial govenment we happen to have at the time. Frequently cuts are made, not based on the best medical practice. Irrational decisions are made on what drugs are covered. For example, the best bone densit y drugs are only paid for after someone has suffered a fracture. A national standard, would hopefully eliminate this.

        • Thay is not true – about being at the mercy. There has only been one government that cut into Pjharmacare – the present provincial liberal govt. And why pay for bone density drugas across the board if only a few need them? If your bone density was low your doctor could have made a special case as I mentioned in my post, I have several times required a special drug; my doctor made a case and I am taking three specially approved drugs right this minute.

          Given the financial situation today, I think the BC Pharmacare is the best going. What makes you think a national program can't be cut and hacked if it can't be afforded? That is the key thing – Can we afford it?

          Emily, your appeal for a national program is because your provionce has avoided one. Colby Cosh is right. I am simply stating that our program is satisifactory as far as I am concerned. This öne country "song" of yours is sweet but it ain't the truth. Education and health are clearly in the provincial jurisdiction and if your province doesn't recognize its responsibilities that's too bad. The only time the feds contributed a lot of mony was at the inception of Hospital Insurance and Medical Insurance in each province with 50% dollars fror capital and operating costs with exclusions. Since then the feds have gone to block funding,. The problems with "medicare" are that block funding allowed each province to deploy the money in their own preferred direction. In some cases it is misdirected.

    • "Canada is…and we either act as one, or we split up and go our separate ways. "

      Ohhh! Ohhh! Ohhh! The second one! Let's do it, Emily!

      • Hey, if I were 20 years younger I'd start an Ontario separatist party, and leave the backwoods folks in their own dust.

        • LOL the thumb votes are hilarious….but if anybody leaves Canada, it will be Ontario, not Quebec or Alberta.

          • Good, because Ontario will never leave Canada.

          • Don't count on it.

        • The only separation that needs to be done in Canada is Northern Ontario from Southern Ontario. Lets make it harder for them Toronto folks to steal our natural resources huh!

          • You've always been welcome in Manitoba!

  8. Boy you anti-government types are having a field day with this aren't you?

    What you forget is that any type of insurance plan comes with bureaucratic silliness. You only need to look south of the border for examples of private insurance companies implementing stupid procedures just to save a buck or two. The existence of imperfections does not logically lead to the conclusion that nothing should be done.

    There are plenty of examples in the world of government run insurance programs that work well. None are perfect. No private insurance scheme is perfect either. Welcome to a world of human created systems.

    • Agreed. 100%.

      'Never let the perfect be the enemy of the good.'

    • Can you explain why we are all FORCED into a single lousy system, rather than have a choice among various imperfect systems? Competing systems have an inherent desire to stay in business by limiting their imperfections. Monopolistic systems, well, don't.

  9. Every provincial jurisdiction across the country has similar programs and have had for a
    number of years. They have had a marginal effect on prices. Enough to make old folks in the
    US envious. But that's not a terribly robust standard.
    The only jurisdiction to take a whack at the system lately is Ontario and they elided around the
    big boyz to get a boot into the pharmacy-supplier kick-back games. That is useful but only at the
    margins. Some other provinces – depending on the provincial ideology – may do the same.
    But we are a small country with small health jurisdictions and easily subject to industry carrot-and
    -stick machinations. A better read, I think …
    http://thechronicleherald.ca/Opinion/1202487.html

  10. What's remarkable is how central controlled markets have utterly failed, have proven utterly disasterous in their attempts at more efficiently and equitably distributing goods or services as compared to free markets, how we've learned that controlling markets is like tampering with the ecosystem (decide something 'here', and screw up the system 'there' to calamatous unintended consequences – the road to socialist hell being paved with good intentions),

    And yet leftist academics think it is still viable.

    Only from the arrogant, insular sheltered world of academia, can you have a belief in systems that have proven in the real world to be disasterous.

    When even Castro has given up on it, it's time to call it a day on socialism (and all its subtle incarnations).

    • You actually believe that a market manipulated by big pharma is "free"?

  11. Colby's up to his old tricks again. He highlights Quebec's provincial pharmacare system, highlights one problem as it would affect him personally, and then uses this to butress his libertarian philosophy – gov't stay out of my life.

    So, let's look closer at Colby's technique. Go to the report – you'll find two provincial pharmacare systems – BC (with lowest per capita costs in Canada) and Quebec with the highest. And which system are the author's advocating? You'd think by Colby's last paragraph it would be Quebec's. Nope. Pretty much using BC's as the model, and Quebec's as the model to avoid.

    Details. They can be so annoying…

    • So what's the problem?

      • It's called cheerypicking facts. No problem for me, I figured out Cosh a long time ago. Others are more gullible. I can hardly wait for his book review of Levant's latest.

        • And if the fact which horrifies him most is an easy to fix problem with filling perscriptions, it seems that the system is good to go with a few simple tweaks.

    • Yes, so how can you be certain we'll end up with the BC model and not the Quebec model? Do you think Quebec intentionally set out to have an inferior model? The only reason we can identify Quebec as inferior is that we don't have a national program, so we can compare different systems. That's the whole point of having competition. Without competition to reinvigorate the system, we're surely end up with something worse than in Quebec, since there would be no gauge available to measure results and efficiency which enables improvement (which is exactly what is killing our medicare system).

      • I'm not certain of anything. If you go through the report, they identified areas where real savings can be realized, under certain assumptions. The fact that they have actual systems up and operating, with actual real costs adds weight to their findings. This is not the gun registry starting from scratch. There is a system in place. Duplicating it/rolling it out across the country is one option. Of course, in AB/Sask, which has 3rd and 2nd less costly per capita costs (age demographics is a factor) the benefits may not be as great. But,that is a different argument.

        • Once we duplicate and roll it out, it will start to deteriorate from that point onwards, until it becomes worse than all existing systems in Canada, due to the lack of competition.

          • scf, you don't know what you're talking about. Look, the demographics in Canada (aging boomers) requires that all gov'ts look at all ways to reduce/control healthcare costs or the gov't will go broke. Your attitude is an impediment to innovation through economies of scale. But, I'm not going to change your opinion. So, I'll quit trying.

          • equires that all gov'ts look at all ways to reduce/control healthcare costs or the gov't will go broke.

            So you want government to pay for all their prescriptions?

          • I'm not advocating anything. If anyone should be advocating a revamped national pharmacare system it should be someone in Quebec [ahem]

          • Odd, that. You seemed to be defending "innovation through economies of scale" as some sort of good reason to hand over still more of the marketplace to government.

            Yup. I just re-read your comment, and that's exactly what you were doing.

          • I'm saying don't rule anything out simply due to ideology, something you seem to embrace.

          • "Look, the demographics in Canada (aging boomers) requires that all gov'ts look at all ways to reduce/control healthcare costs or the gov't will go broke. Your attitude is an impediment to innovation through economies of scale."

            So your argument here is that we need to find more 'economies of scale' because our costs are about to skyrocket because there is a larger scale in the future. You wanna dance that one around in your head a bit?

          • That makes no sense. Maybe it does to you.

  12. Great. We will be like UK and form a body called NICE or the like and it will be set up expressly to deny people the most advanced treatments available all in order to save money. I find it odd that people are so keen to allow bureaucrats control over their health when all bureaucrats care about is cost. We all better hope that we, or our loved ones, don't get any diseases that might need cutting edge medicines.

    "Cancer patients are to be denied drugs which could keep them alive after the NHS rationing watchdog ruled that they are too expensive.' Daily Telegraph, Aug 2008

    "Up to 20,000 people have died needlessly early after being denied cancer drugs on the NHS, it was revealed yesterday. The rationing body NICE has failed to keep a promise to make more life-extending drugs available." Daily Mail, March 2010

    "Patients in England and Wales are being denied a powerful new arthritis drug on the NHS despite a decision by Scottish health authorities to provide it to sufferers for free." Daily Telegraph, Jan 2010

    • No, we definitely don't want the British system.One of the better aspects of our system which was a guiding principles was the following philosophy which was cited when the Juistice of the day who did the initial recommendations (paraphrased)
      .1. The relation between doctor and patient should stay the same. The patient should have his/her choice of doctor and can refuse trteatment..
      2. Where there are options, the patient should have his/her choice of hospita iwthin the limitatios of the hospital.
      3. The relationships between doctor, hospital and patient should remain the same
      4. The financing of care should largely be invisible, although a statement after the fact can reveal the costs of care to the patient. . Notwithstanding, an eligibility process should be carried out. The prime aspect is ways and means.

      In BC there have been various improvements and modifications within the spirit of the program:
      Day care Surgery was instituted for simple procedures not requiring an overnigjht stay. This is in addition to minor surgery performed in the Emergencty Room. (about 1970)
      A dental care program for children was instituted. (about 1973)

      Some time before 1972 a Pharmacare program was instituted for low income (welfare) persons and later etended to senior and later still to include the population. In about 2002 the Pharmacare program was reduced, a dental care program for children was eliminated except for certain persons who paid a premium. Secondary services (chiropractic, physiothereapy, optometrist examinations, acupuncture etc were either eliminated or drasticaly cut back. The health system was reorganized wit the intention of rationalizing the management . I think the purpose was to distance problems from the political level. It doesn't'. It has added several levels of management and eliminated or reduced direct ministry control and in the p[rocess drastically reducing or emiminating vital services. Elimination of whole hospitals, of critical care beds, of regular beds, reduced l;ab and xray availability in some cases, and slashed various asepcts of the long-term care program, closed long term facilities and brought in a new level of care that was working well in the home only to have those people in facility care because it was a popular buzz-word .

  13. Perhaps BC would become a strong argument for a working model? I wouldn't force them to give up their system should they decide that it's what is the best interests of British Colombians.
    However if they wished to partake in a process that would give equal drug access for fellow Canadians regardless of province; I hope that their voice would be there.
    I do see that "Emily" is saying that having ten separate provincial drug programs is causing some antagonism for residents in provinces where ministers can't get a working model together because of politics.

  14. How many competing natural gas companies does your dad get to choose from?

    If, as I suspect, your answer is ONE, then you have selected a rather bizarre example of a free market in order to blast a free market.

    • " …. then you have selected a rather bizarre example of a free market in order to blast a free market."

      No kidding. If Tony and his dad lived in Ontario, their electricity bill would be quite high but it would have nothing to do with business or the market and everything to do with government trying to fix a problem that does not exist by making people pay significantly more than market rates.

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