Comments on a National Pharmacare Strategy

Hello ghouls and ghosties, welcome to October!

My life is a little crazy right now between the PhD, and upcoming travel for some writerly related appearances, more on that on my other blog, if you’re interested.

As a result, this week instead of a traditional blog, I’m posting the comments I provided to the Government of Canada on a National Pharmacare strategy. Comments closed last Friday, September 28th, but you can still find information on the project here, and reach out to your MPs.

As always, if you like the work I do, you can:
Buy Me a Coffee at ko-fi.com

~~~~

September 27th, 2018

Dear Ministers Taylor and Morneau,

Thank you for the opportunity to provide comments on a National Pharmacare program for Canadians. I am proud that my country is moving forward on this program and is investigating how to best provide comprehensive healthcare for all Canadians.

I am a PhD candidate at the University of Waterloo, specializing in bioethics and health policy, and in this letter, I outline three concerns which I believe need to be addressed as this program moves forward, and are reasons for which I advocate for a program of comprehensive universal coverage, delivered through public insurance.

Concern 1: The risk of economic exploitation to which workers are exposed, should a national pharmacare strategy continue to be tied to employment.

Concern 2: The risk that a national pharmacare strategy may be inaccessible if it merely “covers the gaps” or otherwise requires proof of need.

Concern 3: The risk that a national pharmacare strategy may be an affront to the dignity and privacy of those in need if it merely “covers the gaps,” or otherwise requires proof of need.

Sincerely,
Samantha Lynne Sargent

PhD Candidate

University of Waterloo,

Waterloo, ON

Concern 1: The Risk of Economic Exploitation

In one iteration of the program, you suggest that since private insurers are a large part of the landscape of pharmacare for Canadians, that a National Pharmacare Strategy could be one that merely “fills the gaps” that the current private insurance system does not cover. There are clear risks here to workers, especially in an environment which does not adequately investigate or penalize employers for unsafe working conditions, unfair labour practices, and cultures of harassment. Employees may feel a need to stay with their employer, due to their healthcare coverage, rather than move positions. The ability to pay for necessary medications should not be a part of this calculus. Unless all employers are mandated to provide health insurance to all workers, including part-time and contract workers, employees may feel unable to mobilize and resist these practices by finding new work, especially as work is increasingly gig-based and precarious. Furthermore, the tying of healthcare to employment makes unemployment additionally financially devastating, and means that unemployment may lead to worse health outcomes.

Concern 2: Accessibility

Delivering a program of pharmacare through universal public coverage is one that best ensures accessibility to the most vulnerable groups. Onerous applications, verification of income, and other government beauracracies are a barrier to accessibility for individuals with disabilities, the elderly, the homeless, and those with mental health concerns. It takes a certain level of resilience to be able to navigate and complete applications and verifications, and the structure of these applications can lead to situations where a citizenry is unaware of their rights to coverage, or is unable to access the supports they need to obtain coverage due to fatigue/lack of time/etc., and this burden is placed in unequal ways. Furthermore, providing proof of insurance or proof of coverage may be an issue for some vulnerable groups, such as the homeless. A centralized universal pharmacare would reduce the need to provide proof of coverage. Universal public coverage would be the most accessible option to Canadians, and therefore, would provide the most benefit to those most vulnerable and most in need of free pharmacare.

Concern 3: Dignity & Privacy

Similarly, delivering a program of pharmacare through universal public coverage is one that best ensures the dignity and privacy of all those accessing care. Although, dignity and privacy also require that the range of drugs that are covered by the plan be broad, so as to ensure that additional declarations of need are not necessary. If care is universalized and broad, those who need care are best integrated into the general populous and able to access it without fear of shaming or being a ‘burden’ on the system. Furthermore, it means they will not have to release potentially sensitive private data to access care, or that all citizens will have to release potentially sensitive private data equally, which will ensure that the privacy gap between those who have the need to access public services and those who do not need to access public services does not widen. This is especially important in an information age, when algorithms are increasingly used to determine eligibility for public support programs and are informing future decision-making.

 

Concluding Thoughts:

A national pharmacare strategy is integral to the realization of healthcare for all. There is no universal healthcare unless individuals are able access the medication they need to stay healthy. Pharmacare in many cases is a requisite part of health. Currently, many Canadians forego needed medications due to cost barriers. This is especially true of young Canadians struggling to enter an increasingly precarious job market while simultaneously battling mental health concerns. Pharmacare is inseparable from health, and a healthy citizenry is ultimately better for all, and will relieve burdens placed on our healthcare system due to crises that would be preventable through pharmacare. Therefore, a national pharmacare strategy should be as comprehensive and accessible as possible, while being minimally intrusive to patients’ privacy, so as to ensure adoption and access for all citizens.

Sources:

Anis, A., “National pharmacare: a dog’s tale.” CMAJ Sep 2004, 171 (6) 565-566

Busby, Colin and Muthukumaran, Ramya, Precarious Positions: Policy Options to Mitigate Risks in Non-Standard Employment (December 2, 2016). C.D. Howe Institute Commentary 462.

Chouinard, V., Crooks, V. ‘Because they have all the power and I have none’: state restructuring of income and employment supports and disabled women’s lives in Ontario, Canada, Disability & Society, 20:1, 19-32

Eubanks, Virginia. Automating Inequality. St. Martin’s Press, 2018.

Gibson, Barbara E. et al., Health Care Access and Support for Disabled Women in Canada: Falling Short of the UN Convention on the Rights of Persons with Disabilities: A Qualitative Study. Women’s Health Issues, 22(1) 111-118.

Goffin, Peter. “Many Ontarians with Mental-Health Issues Must Choose between Food and Meds.” The Toronto Star, 30 Dec. 2016.

Hwang, S. et al. “Universal Health Insurance and Health Care Access for Homeless Persons”, American Journal of Public Health 100 (8), (August 1, 2010): pp. 1454-1461.

Johal, S. & Thirgood, J., “Working without a Net: Rethinking Canada’s Social Policy in the New Age of Work.” Mowat Center Research #132. 2016.

Saunders, Rob. “Risk and Opportunity: Creating Options for Vulnerable Workers.” Canadian Policy Research Networks. Vulnerable Workers Series No. 7, 2006.

Stanbrook, M., Hébert, P., Coutts, J., MacDonald, N., Flegal, K., “Can Canada get on with national pharmacare already?” CMAJ Dec 2011, 183 (18) E1275; DOI: 10.1503/cmaj.110643

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