Nov. 30, 2002
OTTAWA (CP) - For Vivienne and Richard Anderson, reform of medicare to cover the catastrophic cost of prescription drugs can't come soon enough.
They are among 100,000 Canadians who face annual drug costs in excess of $5,000.
And yet, threatened as they are with insolvency while coping with chronic, debilitating illness, the Fredericton couple could in some ways be considered relatively lucky.
Over the last 10 years, Richard Anderson has spent all his savings, cashed in his RRSP, used up a timely federal pay equity settlement and gone hat in hand to welfare - all to pay for medically necessary medications for his wife.
Surprisingly, Anderson has a good job in the federal civil service with a drug insurance plan.
"There are people worse off than we are," Anderson said with some bewilderment in a phone interview.
"Some people aren't even in a drug plan."
The Andersons, both age 57, are among the 62 per cent of Canadians who have private drug insurance. Another 19 per cent fall under government drug coverage - mostly seniors and people on social assistance - and seven per cent have some mix of private and public insurance.
About 12 per cent of the population has no drug coverage, although a recent Senate report suggested only 600,000 Canadians - two per cent - couldn't get some degree of assistance in a crisis.
Canadians spent $12.3 billion on prescription drugs in 2001, about 12 per cent of the universal health care budget.
More than half - 55 per cent - of this cost was carried by private insurers and individuals. The rest was picked up through various federal and provincial government plans.
None of these figures relay the true scope of the problem.
Consider the Andersons.
Vivienne suffers from scleroderma, a chronic, auto-immune disease that brings with it a host of complications.
Notwithstanding Canada's purported comprehensive medicare system, the Andersons pay thousands of dollars each year for health care.
In the ebb and flow of fighting her illness, 1999 was the year Vivienne's medical expenses peaked.
Anderson spent $50,000 on drugs and medical supplies and equipment. His drug plan covered 80 per cent of selected items.
"That particular year, we ended up paying $17,000 out of pocket," he said.
Income tax provisions allowed him to claim about $3,500 of that.
"Because we ran out of savings quite early on, we were getting help from the provincial welfare people," said the soft-spoken Anderson.
"This is what used to happen before medicare came in. People had to ask for help. Whether they got it or not, it's a hard thing to do."
Two years ago, Anderson received a pay equity settlement of about $30,000. That ended his welfare assistance, and he has since spent the settlement - mostly on medical expenses.
"Now I'm about to ask for help again from welfare."
Vivienne was re-admitted to hospital two weeks ago.
It is a sadly illustrative tale, relayed with conviction by Richard Anderson to the Romanow commission during a stop in Fredericton last April.
Comprehensive pharmacare, however, remains elusive.
The Romanow report has recommended a $1-billion plan to reimburse provincial drug plans for catastrophic drug costs - those above $1,500 for individuals. The report also calls for a national agency to oversee drug policy and costs, and a national system of assessing which drugs should be publicly covered.
"Over time," said the report, "these proposals will . . . lay the groundwork for the ultimate objective of bringing prescription drugs under the Canada Health Act."
But targeted measures on catastrophic drug expenses don't meet the approval of some critics.
"That, to my mind, is really only a half measure," said Dr. Joel Lexchin, an emergency physician, professor of health policy at York University and international consultant on pharmaceutical issues.
Lexchin estimates a "first-dollar" pharmacare program would cost taxpayers an additional $5 billion annually.
He says this is the primary impediment to the policy, "although you would still save money on the overall drug bill.
"Single-payer systems, like we have with medicare, are the best way of controlling costs," Lexchin insisted.
"It puts all the decision-making in one body and gives that body much better bargaining power . . . with pharmaceutical companies."
The amount spent on prescription drugs almost doubled between 1996 and 2001, and the pharmacare debate is inextricably tied to the pharmaceutical industry.
"There's a lot of work that has to go into framing a pharmacare program," said Michael McBane of the Canadian Health Coalition, a left-wing lobby affiliated with the Canadian Labour Congress.
"If you open up a generous drug program and don't rein in drug profits, you will bankrupt Canada within a very short time. We can't afford 30 per cent drug profits being siphoned out of health care budgets."
The Romanow report recommends creating a national formulary of drugs that should be covered. The plan would curb the impact of "powerful lobbying efforts" by the pharmaceutical industry, and would help negotiations toward volume discounts.
The report, which also advises Ottawa to review the Patent Act to stop drug companies from using tactics "not in the public interest," will be hotly debated by the pharmaceutical industry.
In a submission to the Romanow commission, the industry lobby group waffled on the public-private funding question but insisted any policy must focus on the patient first.
To that end, drug makers should be able to advertise their products directly to consumers, argued Canada's Research-based Pharmaceutical Companies.
Those drugs, in turn, should be deemed medically necessary based not only upon clinical data but upon " the individuality of patients' . . . perceptions, preferences and responses to drugs."
Clearly, a battle between the brand-name drug industry and government regulators is looming.
In the meantime, the quibbling between industry and governments and among provincial and federal administrations continues apace, leaving people like the Andersons frustrated and angry.
The Romanow recommendations, said Richard Anderson, "may take years to implement. Meanwhile, what do I do?"
He asked that one message be imparted to Canadians.
Two years ago, Anderson started the first Canadian chapter of the Well Spouse Foundation, a U.S.-based support network for spouses of the chronically ill. Through his work he has met the families of victims of car accidents, paralysis, strokes, brain injuries, multiple sclerosis and Lou Gehrig's disease, among others, with crippling drug bills.
"This can happen to anybody," said Anderson.
"I know people don't want to think about it, but there we are."
© 2001 MediResource.com