Canadians pride themselves on “Medicare”.  Under the Canada Health Act the provinces and territories are required to provide health care which is:

Publicly administered on a non-profit basis by a public authority.

Comprehensive: The health care insurance plans must cover “all insured health services provided by hospitals, medical practitioners or dentists”

Universal: All insured persons must be covered for insured health services “provided for by the plan on uniform terms and conditions”.

Portable between provinces and territories.

Accessible. The insurance plan must provide for “reasonable access” to insured services by insured persons, “on uniform terms and conditions, unprecluded, unimpeded, either directly or indirectly, by charges (user charges or extra-billing) or other means (age, health status or financial circumstances)”.

For in-hospital care, it works pretty much as advertised. Fall and break your hip? Free emergency room visit, free medical and surgical assessment, free surgery. Have a heart attack? Free ECG and cardiac bloodwork, free angiography, free revascularization. Breast cancer? Free mastectomy, free breast reconstruction, free radiation therapy. Pneumonia? Free admission, free chest XRay, free IV antibiotics. Bad knee? Free arthroscopy, free MRI, free knee joint replacement.

Surgery is free in Canada

While you are in hospital, all you will get billed for is your TV and your phone calls. Everything else is covered.

So what is the catch? Wait until you leave hospital!

Suddenly it’s a few bucks here for crutches, a few bucks there for outpatient physiotherapy. Your chemotherapy is no longer paid for, your blood thinners are not covered, and you have to pay for outpatient antibiotic therapy and for your pain killers.

There are huge gaps in Canada’s so-called “socialized medicine”. Dental care is not covered until you get sick enough to have to be admitted to hospital. Glasses are not covered, nor are hearing aids. However, the biggest single issue is that outpatient medications are not covered.

The lack of drug coverage creates some bizarre inequities. If you need IV chemotherapy you can come to hospital and get it free as an outpatient, but if the drugs you need to fight cancer can be swallowed, you have to pay for them. If your angina requires open heart surgery, you can have that for free, but if all you need is some calcium-channel blockers, you have to open your wallet. If your prostate needs surgical removal, that is free, but if it is just a bit enlarged and you only need medication to help you pass urine, that is at your own expense.

So, what happens? For a start, over 10% of the time patients never even buy the medication they are prescribed. Great healthcare system: You get a free consultation with a doctor, free investigations, but then you do not take the medicines you need because you cannot afford them.

Patients have to pay for outpatient medication

Many people have private health insurance, often partly funded by their employer. If they get sacked or choose to change jobs, they lose their drug plan. The Canadian system for funding medications is pretty much as bad as the American system for funding surgery. It’s a curious hotchpotch of people paying for their own out of pocket, private health insurance, government funding for children, the poor and the elderly, and employee benefits (until you lose your job). Many people are unable to afford care: Rent, food, medicine, which two will you pay for if you cannot afford all three?

It is ridiculously inefficient. Every time a physician is about to write a prescription he or she has to ask the patient what insurance cover the patient has, and chose a medication based on affordability, rather than prescribing the best drug for the job. It creates administrative costs and allows the pharmaceutical industry free range to market a variety of similar products in different price ranges.

Most other wealthy countries with state-run healthcare include medication. In fact, Canada may be the only country which excludes prescription medicine from its healthcare system.

A single payer system would be able to get a much better deal from the pharmaceutical companies, it would greatly reduce administrative costs, and it would provide universal coverage.

Why is this system allowed to exist?

Firstly, because it suits the insurance and pharmaceutical industries. They make big money out of the current system, on the backs of employers and the sick. The drug companies threaten to move their headquarters and research out of Canada if we change the system. It is blackmail.

Secondly, drug costs scare governments. There have been a lot of very expensive new drugs developed recently, with more in the pipeline. Governments do not want the expense of paying for them, not do they want the political hassles of deciding which patients are eligible for which drug. They would much rather see insurance companies or pharmaceutical companies be the bad guys here.

Thirdly it is said that “we cannot afford it”, as if we are not paying for these drugs now. Someone is paying for the drugs already, plus insurance administration expenses and some extra profits for the pharmaceutical industry. Sure, we do not pay for it directly, evenly and fairly through taxation. Instead, drug costs are a tax on the sick, especially those with chronic illnesses.

Please, Canada, get with the program: Canadians are justly proud of their “medicare” but it desperately needs to include “pharmacre”!