Healing Gaia

Walking to the Mailbox Will Not Replace the Need for Pharmacare

Conditions that used to be treated in hospital are now treated at home, thanks in part to drug therapy. But drug therapy only works if you can afford the drugs.

By Doreen Nicoll
Published October 06, 2015

Shock and dismay understate the way I felt after reading Lena Scholman's opinion piece, "A short walk and the cure for what ails us", in the Hamilton Spectator.

Can Scholman really be naive enough to believe that a short walk is the cure all that should replace universal pharmacare?

Scholman points out, "The government already subsidizes the medication of seniors and the most vulnerable." And, "the biggest savings are for the expensive drugs for rare conditions. So do we need a universal drug-coverage Program? Or, so we need free drugs for five to 10 per cent of the population?"

But when Scholman stated, "when everything is free, our default is to take the easy way - and demand things we don't really need," then I knew she was living in a world vastly different from Canadians who are have precarious employment or make up our nations working poor.

Let's get a few things straight. The Canada Health Act provides coverage for physician services, hospital care and pharmaceuticals used while in hospital. This means post-surgery painkillers are available free for the three or so days a patient is in hospital, but not for the three week period when they would be required at home.

For an individual without coverage, the cost of easing pain may have to be balanced against rent or groceries - especially when they are also prescribed antibiotics, stool softeners and other medications necessary to return their health.

Or, how about the single mother of two children who is employed by a reputable university as a sessional instructor, which means she's living at or below the poverty line without any benefits? Both of her children fall ill, but there is only enough money to fill one prescription. Which child should she choose, Ms. Scholman?

Or, the parent working two or three part-time jobs to make ends meet. Their child is diagnosed with strep throat - not a big deal, not life threatening. That is, unless it goes untreated with simple antibiotics and turns into scarlet fever, which can leave a child with heart and hearing issues and can even be fatal.

By the 1970s, provincial governments recognized that the rising costs of prescription drugs was becoming a financial burden on those with low or fixed incomes. Provinces began offering drug coverage to certain sectors of the population, including those receiving social assistance and seniors.

But by the 1990s, some provincial governments realized that this was also a real issue for sectors of the population at risk of experiencing financial hardships. Included in this group were Canadians between the ages of 18 and 34, living on low to middle incomes, or working part-time.

It further needs to be pointed out that there have been significant changes made to health care system. Conditions that used to be treated in hospital are now treated at home, thanks in part to drug therapy.

But drug therapy only works if the patient can afford to purchase the drugs. And these need not fall into the category of expensive drugs for rare conditions. These prescriptions include the $30 that's not in the budget for ten days of antibiotics; $300 per month for antifungal medication that will continue for a year; $180 for inhalers; or ongoing medication for high blood pressure.

In her paper, Catastrophic Drug Coverage in Canada, Karin Phillips writes:

Some studies have demonstrated that increased out-of-pocket costs for prescription drugs have resulted in negative health outcomes. For example, one researcher found that patients 65 or older were less likely to fill their prescriptions when they had to pay for them. This in turn resulted in increases in their rates of hospital admissions, emergency care and visits to physicians. These results have led health policy researchers to argue that prescription drugs need to be considered medically necessary under the Canada Health Act.

So, Ms. Scholman, although I too believe in preventative measures and do think that walking is a great way to stay fit, your argument - "when everything is free, our default is to take the easy way - and demand things we don't really need" - is an insult to Canadians. Thank you, but I really don't want you advocating for my health care because it's well documented through good research that we need universal pharmacare and we need it now.

Doreen Nicoll is a feminist and a member of several community organizations working diligently to end poverty, hunger and gendered violence.

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By arienc (registered) | Posted October 06, 2015 at 09:34:50

I think the point of the article is that often times people will look for a quick fix for their problems instead of making changes that are difficult. For example, instead of changing one's diet and exercise, it's much easier to just take a pill. "Free" or socialized pharmaceuticals just tips the balance that much further in favour of the easy fix, which carries with it all of the unintended consequences and reduces people's ability to be resilient and self-sufficient.

While the idea that "walking to the community mailbox replaces the need for pharmacare" seems a bit flippant, the column makes some very good observations. We shouldn't consider that an insult - Canadian people are human beings, and it is human nature to do the things that require the least effort possible over those that are more difficult. We have a lot of issues with physicians prescribing medicine instead of giving patients a proper diagnosis, and to treat symptoms rather than root causes of health issues. We need to think about how a universal pharmacare program would impact those issues before moving forward with such a program.

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By fmurray (registered) | Posted October 06, 2015 at 20:40:32

Good rebuttal, Doreen. The article in the Spec seemed to be written by someone with a lot of privilege and a simplistic view of society's problems and challenges.

Another point is that we should have and maintain a strong postal system. The crux of the matter is not "now people will get exercise", it is the fact that there is a steady erosion of the public services that are the foundation of our country. I know that sounds grandiose, but I think a good postal system is a basic feature of a well-developed society. Not to mention that Canada Post, a crown corporation, is not losing money and in fact is making scads of money. Reducing services should not be an option here. The problem is, as with any business, if service levels are reduced, fewer customers will use your service and the cycle continues.

Also, flippantly telling everyone they need to get out for a walk to pick up their mail is ridiculous. There are many people who cannot "get out" and will now have to rely on others to perform this new task for them.

Eliminating Canada's postal system is not a smart move by the Harper government.

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