If we did a good enough job with it, Ontario could spread Pharmacare to the rest of Canada says Dr. Danielle Martin.
Asked what one issue she would like to see in the present provincial election, Martin never even hesitated. Unlike other initiatives that are national in scope, Ontario is big enough on its own to negotiate better drug prices and implement a universal drug plan.
Speaking at Ramsay Talks last night in Toronto, Martin said Pharmacare could begin with “20 drugs to save a nation.”
She says we could pick out 20 generics that are proven to help Canadians manage chronic disease. In Ontario the savings would be so great that the province could theoretically pick up the tab for the rest of the country and still reduce expenditures.
“Let’s focus on the ones that have the biggest bang for the buck,” she said.
That claim alone should be enough for any politician on the hustings to stand up and take note.
As an example, Martin compares the cost of atorvastatin (marketed under the brand name of Lipitor) in Canada and New Zealand. New Zealand – with about a third of the population base of Ontario – pays 2.4 cents per pill for the generic. In Canada we pay 32 cents per pill. Similarly Rampiril, which is used to lower blood pressure and treat congestive heart failure, sells for 25 cents a pill here in Canada and can be found selling for 5 cents in the United States.
While Ontario has moved to put a cap on generic drug prices, these are still artificially high. Her Rotman interviewer even raised his eyebrows when Martin suggested that there was a role for competition between drug companies in a single-payer pharmacare system.
The former founder of the Canadian Doctors for Medicare describes the present pharmaceutical environment as a “patchwork of public and private players” that creates dramatic inequities between provinces.
She says Canadians cherish Medicare because it is based on need, not on the ability to pay. Yet 30 per cent of our health system remains outside of that system, including drugs.
As a result, one in ten patients cannot fill a doctor’s prescription because of cost.
The second big idea that Martin has embraced is that of knowing when less is more. She highights the fact that 14,500 U.S. cancer deaths per year are ascribed to excess radiation from unnecessary CT scans. A more responsible path would not only reduce related deaths, but free up resources for those who truly need a CT Scan. Similarly, doctors are over-prescribing medications that may not be necessary for their patients. She calls this a “national epidemic.”
She acknowledged the work of Canadian physicians in launching a national campaign called “Choose Wisely Canada,” based on a similar campaign south of the border. The audience chuckled when Martin highlighted another campaign with the slogan “don’t just do something, stand there.”
“Even good tests when used on the wrong people or at the wrong interval can harm people,” she said, giving the example of a healthy patient who was sent for an angiogram after a stress test set off potential warnings about heart disease. It turned out his heart was free of any blockage, but the test triggered a stroke that has ended his athletic pursuits.
Martin says that part of the maturing process for her as a doctor was realizing that she can’t eliminate risk.
The biggest change we could make in improving the health of Canadians has little to do with the work Martin does.
She gave the example of a resident in social housing whose health began to deteriorate because of mould in her unit following a flood. It took two years to get her moved to another unit. In that time the severe asthma she developed meant she couldn’t exercise, which in turn led to depression and other debilitating health effects.
“She was sick not because of her asthma, but because of her poverty,” says Martin.
Martin is advocating for a national guaranteed income supplement for all citizens, not just seniors. Similar to the seniors guaranteed income supplement, it would top up the income of those living below poverty.
“The investment required would be modest,” she says.
Not only would it benefit individuals such as her patient in social housing, it would also reduce anxiety among those who endure precarious employment.
Martin said this was tried in Dauphin, Manitoba in the 1970s and found to be successful. Hospitalizations in the control group were down, especially for those suffering mental illness. She says it’s time to update the experiment and start new pilots now.
The Canadian doctor did speak about the event that generated the kind of attention Martin is now experiencing. Little did she realize that an obscure U.S. Senate hearing would transform her profile, claiming her appearance gathered more YouTube views than some cat videos.
Part of an international panel of experts, her appearance before the Senate hearing was brief. Martin was impressed by a former Minister of Health from Taiwan who described that country’s response to rapid industrialization.
“They woke up and found themselves (to be) a wealthy country,” said Martin. Taiwan set up a blue ribbon panel to look at health systems around the world. With no present system in place, Taiwan was open to change.
Martin says they chose the best parts of systems from around the world.
“It looks very much like ours, in insurance, but it includes everything,” she said.
For Canada it is harder to change something that is already in motion.
She also called Dr. Brian Day lawsuit in BC “the biggest threat to Medicare in a generation.”
She fears that if he is successful, it will have a ripple effect across Canada.
Day is suing the BC government to pave the way for extra billing and the right for doctors to work both in and out of the public system.
“If he wins there won’t be much left of Medicare in BC.”
Martin highlighted studies done in Australia that showed areas with more two-tier health care lengthened waits in the public system.
“Every system has stories of patients whose care went wrong,” she said. There is nothing unique about public Medicare that leads to difficult cases.
While her interviewer suggested that there was no appetite for either new taxes or deficits, Martin generated applause when she said “somebody tax me please – I think our country is worth it.”
Increasing public benefits is the best way to: a) ensure all segments of society benefit from economic and productivity growth; b) moderate inequality; c) stimulate the economy: it increases disposable income (something tax cuts never deliver on because they’re paid for with cuts to social spending and higher government debt.)
This is why we had phenomenal GDP and productivity growth during the post-WW2 era; and dismal GDP & productivity growth now — plus towering inequality and declining middle class — after 3 decades of free-market reforms.
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