Should Canada have a NATIONAL Drug Plan?

[Topaz]

I"m in favour of this because many low and middle-class Canadians don't make enough to cover the expenses of drugs, even if they have a plan that covers 80%, most of the time they have to cough up the money, then get reimbursed, so many just don't do it. I also would like to see coverage for "natural" items, which would drop the prices of man-made drugs, through competition. The government could take some of the billions out of the CPP fund for this and it could either give it to all Canadians or just to a portion of Canadians whose income is a certain level. https://ca.news.yahoo.com/call-growing-louder-national-prescription-drug-plan-163445407.html

[Smallc]

I'm not in favour of it. There's too much abuse of the system that we already have.

[cybercoma]

NB has a provincial one and it's absurd. It punishes the self employed and those who are employed part time without benefits. If you make $50000-60000/year and are self-employed, then you have to pay something like $1400/year for drug coverage that doesn't even cover birth control. At that rate, you may as well put a little extra into full coverage from Manulife or Blue Cross. It forces young, healthy working-age people to subsidize the medical benefits of the aging NB population and quite frankly is just another reason for the working-age population to leave this province, as if the lack of jobs and needing to be bilingual wasn't enough.

[Smallc]

That sounds a lot like Manitobas system. I know for the aboriginal system, many people abuse their prescriptions, either selling them or not taking them but at the same time not cancelling them. All of this is on the government tab and costs is all a great deal of money. I'm not in a hurry to have that extended to everyone. I'm actually in favour of what Australia recently did, charging a $7 fee for doctors visit.

[cybercoma]

I had the premiums wrong. Here's the link: http://www2.gnb.ca/content/gnb/en/departments/health/MedicarePrescriptionDrugPlan/NBDrugPlan/Premiums.html

Individuals making
$26,360 or less have to pay $67/month
up to $50,000 pay $117/month

up to $75,000 pay $133/month

over $75,000 pay $167/month

It discriminates against individuals who do not have families because those who are single with children or married with or without children pay:

up to $49,389 pay $67/month

up to $75,000 pay $117/month

up to $100,000 pay $133/month

over $100,000 pay $167/month

Mind you, those are GROSS income numbers, so the amount you make before you pay provincial and federal taxes.

Also, if you crunch the numbers, you'll find that the percentage of individuals' income that goes towards the drug plan are not progressive. Although the thresholds for the drug plan are gross income, I'm going to use the 2009 after-tax income quintiles just to have some point of reference. Earnings in 2014 will obviously be somewhat greater and gross earnings would be greater still. Nevertheless, this will give us 5 points of reference to compare the rate at which people will pay into this drug plan. These are calculated using the "individual" cost, as opposed to the cheaper "family" costs.

1st @ $15,400 it's 5.19% of your gross income
2nd @ $27,200 it's 5.15% of your gross income
3rd @ $37,500 it's 4.27% of your gross income

4th @ $49,600 it's 2.82% of your gross income

5th @ $83,500 it's 1.92% of your gross income

The NB Drug Plan is an embarrassment. The uninsured wealthy pay far less, as a proportion of their income, than the part-time uninsured working poor. The drug plan is actually the exact opposite of a progressive tax scheme, but the Tory government that implemented it is adamant that it is not a tax. It's insurance. Nevertheless, the premiums cost less for those who earn more than those who earn less.

[cybercoma]

That sounds a lot like Manitobas system. I know for the aboriginal system, many people abuse their prescriptions, either selling them or not taking them but at the same time not cancelling them. All of this is on the government tab and costs is all a great deal of money. I'm not in a hurry to have that extended to everyone. I'm actually in favour of what Australia recently did, charging a $7 fee for doctors visit.

There's going to be abuse in every system. I don't think that's a good enough reason to condemn it. That's like saying we shouldn't have social assistance because some people "abuse" it. The number who do is very small compared to those who actually need it and are using it. My problem isn't with the drug plan idea itself, but how it has been implemented.

[Smallc]

The number isn't all that small, unfortunately (at least not in my area) It's why our ERs and waiting rooms are full of people with the sniffles who never need to be there. I'm very in favour of universal care, but it needs o be cashed in some way to add a disincentive for over use.

[hitops]

I"m in favour of this because many low and middle-class Canadians don't make enough to cover the expenses of drugs, even if they have a plan that covers 80%, most of the time they have to cough up the money, then get reimbursed, so many just don't do it. I also would like to see coverage for "natural" items, which would drop the prices of man-made drugs, through competition. The government could take some of the billions out of the CPP fund for this and it could either give it to all Canadians or just to a portion of Canadians whose income is a certain level. https://ca.news.yahoo.com/call-growing-louder-national-prescription-drug-plan-163445407.html

As a doc I would say this a terrible idea. We should actually go the other way and start making people pay a small portion of all of their health care costs, just as we do for drugs. This is how it works in France, and they manage to treat at an even lower cost than we do, and have lower waiting lists. The French are able to purchase third-party insurance to cover that portion or get it through work, just as we do for drugs.

In contrast, is the UK where they do cover drugs. That system is a complete wreck, as I repeatedly hear from the multiple physicians I work with who came to Canada to get away from it. A recent quote by my colleague, a medical oncologist (chemo doc) "giving chemo in the UK is easy, it's always the same few drugs because nothing is covered". This is the typical, predictable result of trying to provide everything for everyone - everyone gets equal, crap care.

The waiting list problem in the UK is worse than ours, as is the lack of timely access. Everything that doesn't work in our system, is even more broken in the NHS. British doctors come here to earn more and work in a more functional system. Canadian docs go to the US for the same reasons.

Canadians need to realize that we have can this dream system where everything is free and fast and high-qualify, maybe if we double everyone's taxes. Maybe. Without doing that, it's not going to happen. It takes money to run awesome, high quality services. It takes money to attract qualified personnel. A lot more than we put in now. A lot more than you are willing to pay, most likely.

There's going to be abuse in every system. I don't think that's a good enough reason to condemn it.

Yes it is, if it degrades the quality of the whole system. 'It's not Somalia', is not an acceptable consolation. There are many examples of how the overall system can be improved. Expanding coverage will without a doubt make it worse.

Edited October 6, 2014 by hitops

[Smallc]

Exactly - a small cost would go a long way to improving the system.

[hitops]

Exactly - a small cost would go a long way to improving the system.

We should continue to allow natives to get everything free though, as evidence by how decades of completely cost-free (including drugs) services has transformed them into the prosperous and self-sufficient people they are today.

[Smallc]

Unfortunately, medical coverage is a constitutional guarantee.

[Bonam]

NB has a provincial one and it's absurd.... It forces young, healthy working-age people to subsidize the medical benefits of the aging NB population and quite frankly is just another reason for the working-age population to leave this province, as if the lack of jobs and needing to be bilingual wasn't enough.

Kind of like all government healthcare benefits or in fact most all government programs work. And here I thought you were a lefty...

As for the OP... healthcare is a provincial matter so not sure why drugs plans would be done on a national level, doesn't make sense. And certainly raiding CPP is not the way to do it. Young people already have no hope of ever getting back what they put in to CPP without raiding it for even more unrelated benefits for current seniors.

[overthere]

Unfortunately, medical coverage is a constitutional guarantee.

and, it primarily a provincial constitutional responsibility. Not federal. Alberta has no overall drug plan, and people live as long and as well as anywhere that does. I shudder to think of the bureaucratic gong show resulting from a federal Dope Department.

Is there some reason that NB cannot improve their plan?

The waiting list problem in the UK is worse than ours, as is the lack of timely access. Everything that doesn't work in our system, is even more broken in the NHS. British doctors come here to earn more and work in a more functional system. Canadian docs go to the US for the same reasons.

The UK also has a thriving private system, and it includes many of the best doctors. They can and do double dip into the public system, or it may be the other way around.

[overthere]

As a doc I would say this a terrible idea. We should actually go the other way and start making people pay a small portion of all of their health care costs, just as we do for drugs. This is how it works in France, and they manage to treat at an even lower cost than we do, and have lower waiting lists. The French are able to purchase third-party insurance to cover that portion or get it through work, just as we do for drugs.

I have close family in France, and as I recall they pay about 15 Euros or so to their family physicians each visit. It is not onerous, but enough that you don't use the system casually or as a hobby, as happens here.

[Smallc]

I was talking ad aboriginal health care. There's nothing provincial about it.

[overthere]

I was talking ad aboriginal health care. There's nothing provincial about it.

and I was pointing out the same constitution you referring to has health care for the great masses as a provincial responsibility .

So are drugs. Nothing prevents any province from listing or delisting services, including drugs.

While you're rereading the document, see if you can find a reference other than your anecdote to back up

I know for the aboriginal system, many people abuse their prescriptions, either selling them or not taking them but at the same time not cancelling them.

How do you know? Are you a First Nations pharmaceutical statistician? Your posts about First Nations have more than a whiff of nastiness about them, and this is yet another. White people sell their prescription drugs too, got numbers on those for comparison? A chronic problem in the general population is not taking their presricptions as directed, so lets have your non-anecdotal comparison of that too.

And you can wrap it up with some commentary on how a lay person of any race or colour can go about cancelling a prescription at whim. Issuing , changing or cancelling prescriptions is something only doctors or sometimes pharmacists can do in some provinces.

[Smallc]

Let me start with this - I am in a position to know things that most people aren't. Part of my business is pharmaceutical distribution. I know who is getting what and where it's going. I'm also involved with emergency services in my community in a very direct way, which again, puts me in the know. Beyond that, another part of my business involves direct consultation with the FN health department in the reserve nearest me. I have access to statistics there that I can't share with you.

As to any nastiness towards first nations people in my post; as I am engaged to an aboriginal person, and love her more than I ever could have imagined loving anyone, I'm going to have to attribute what you're feeling to your own victim mentality.

[Smallc]

I'll also point out that if I don't pay for my pills because I don't care and I'm not taking them, the pharmacy will stop sending them. That's the difference I'm talking about. Whenever you get something completely for free (you live on reserve and not only do you not pay for your medication, but there are also no insurance premiums and you don't pay any tax) you don't take ownership of it. That's a reality of humanity that transcends skin colour.

[cybercoma]

Kind of like all government healthcare benefits or in fact most all government programs work. And here I thought you were a lefty...

As for the OP... healthcare is a provincial matter so not sure why drugs plans would be done on a national level, doesn't make sense. And certainly raiding CPP is not the way to do it. Young people already have no hope of ever getting back what they put in to CPP without raiding it for even more unrelated benefits for current seniors.

Again, I'm not against the program. I'm against the way it's structured and how it has been implemented. This was the brainchild of a Tory government by the way. That probably explains why you pay less as a proportion of your income the more you make.

[Smallc]

Under our system, it's the opposite. The more money you make, the more you pay as a percentage of your income. It can end up being a lot of money before you're eligible.

[cybercoma]

My concern with our provincial plan is that people who make little money are paying over 5% of their income in the pan and they still have to pay 30% of the cost of the prescriptions. This may actually increase their costs. You'll notice that this is just Phase 1, the voluntary stage. The government insists that the premiums will drop in Phase 2 (beginning April 2015) when everyone is required to be enrolled. They also say they'll implement subsidies for low-income earners. Whatever the hell that means. You would think they would have just worked this all into the plan to begin with and just rolled out a comprehensive model from Day 1. It's just such an incredible mess for a much needed program. I find it offensive. This is something that can do a lot of good for a lot of people, but the way it was handled is asinine.

[hitops]

My concern with our provincial plan is that people who make little money are paying over 5% of their income in the pan and they still have to pay 30% of the cost of the prescriptions. This may actually increase their costs. You'll notice that this is just Phase 1, the voluntary stage. The government insists that the premiums will drop in Phase 2 (beginning April 2015) when everyone is required to be enrolled. They also say they'll implement subsidies for low-income earners. Whatever the hell that means. You would think they would have just worked this all into the plan to begin with and just rolled out a comprehensive model from Day 1. It's just such an incredible mess for a much needed program. I find it offensive. This is something that can do a lot of good for a lot of people, but the way it was handled is asinine.

A more sensible system would just be national insurance where everyone pays 10% of health care, 20% of drugs and dental or something like that. Caps for each of $1000, $500 and $500 or something.

[cybercoma]

That plan would be more generous than the one the provincial Tories put in place here. Actually, I kind of like the idea to be honest. Everyone pays a percentage of their costs 10%-20% with a maximum that changes based on the individuals' gross income. Low income families would have a lower cap than those who are better able to pay. This would be a more comprehensive medicare program that would also discourage spurious visits to emergency rooms and drug seeking from people with narcotic dependencies. I like it.

[hitops]

That plan would be more generous than the one the provincial Tories put in place here. Actually, I kind of like the idea to be honest. Everyone pays a percentage of their costs 10%-20% with a maximum that changes based on the individuals' gross income. Low income families would have a lower cap than those who are better able to pay. This would be a more comprehensive medicare program that would also discourage spurious visits to emergency rooms and drug seeking from people with narcotic dependencies. I like it.

Private insurance purchased yourself or got through your work, can cover the 10-20% as well, just like like in France.

http://en.wikipedia.org/wiki/Health_care_in_France

See the chart for an idea of how this works.

Edited October 6, 2014 by hitops

[dre]

Cut the patent protection window in half, and flood the market with cheap generics.