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Canada Is Our ?Health Care Canary In The Coal Mine?

by Catgic / September 14, 2006 7:38 PM PDT
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Talk about mixing Apples with Bananas. Since when does
by Ziks511 / September 15, 2006 4:03 AM PDT

the US system, outside of Medicare and Medicaid, pay for drugs? Even the Canadian system doesn't pay for drugs, unless you have private insurance. So this issue has nothing to do with Canada's health care system in any way shape or form. They're encouraging doctors to prescribe mindful of the cost of pharmaceuticals to the patient

The cost of prescribing is not a function of a failed or ailing Canadian system, it is a function of the cost of newer generation Pharmaceuticals and the prices charged by American based or multi-national Pharmaceutical companies. It has nothing to do with Socialized Medicine, and many new drugs are reformulations or variants on older cheaper drugs which have passed their patent exclusivity and are now available via good old competitive economics, multiple sources driving down prices.

And where did your quotation come from, I couldn't find it in the article.


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Since when?
by Evie / September 15, 2006 4:32 AM PDT

Lots of insurers cover prescription drugs these days as part of the basic health insurance plan.

Talk about hypocritical -- US insurers are slammed if they try to keep costs down in terms of which meds are covered, etc., but the Canadian government doing the same is just being prudent?

Free market healthcare is the way to go. We pay for food and shelter, other essentials for living, why should healthcare be "free"?

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Don't impute that hypocrisy to me, I think insurers are
by Ziks511 / September 15, 2006 8:41 PM PDT
In reply to: Since when?

prudent to hold down health care costs. Up here a doctor can override that prudence by writing "No substitutions" on the prescription. I don't like the substitute Ventolin they supply here, it doesn't seem as effective as the name brand, but I haven't applied to my doctor yet for the "No Substitution" prescription so that should take care of my bona fides. On the other hand I am enormously glad for Effexor, a new generation anti-depressant with additional effects which is very expensive (like nearly $300 a month), but there are no other drugs in its class, and I've been through all the SSRI meds and they just don't do the job as well. Thank god for extra insurance.

My point, Evie, since you missed it was that the increase in the cost of medication in no way indicates a weakness in the Canadian Health Care System. It is mostly a problem outside that system except for seniors, and possibly the indigent. The reccommendation to avoid prescribing reformulations of existing drugs, or where older drugs have proven as effective as newer drugs viz. Vioxx and the whole cox-inhibitor range which in study after study did no better than Naproxen or Ibuprofen, both of which are available over the counter without the lethal side-effects, is merely prudent and is intended to save the consumer and the insurance companies money, not just the Canadian Health Care System. Nor have I ever slammed US insurers for keeping the costs of medication down, just cutting people off from treatment, and not covering pre-existing conditions like asthma, which I've had since 1948 long before health insurance. Healthcare is not free here, everybody pays for it rather like an insurance plan, though some tax revenue does occasionally top up the plan. But it works well if you could experience it for yourself. The woman who spoke at the Run to End Breast Cancer was diagnosed one week and operated on the next. So much for the horror stories of waiting times, at least for cancer. A friend of ours on the other hand waited 4 months for a hip replacement, a non-critical problem you see. You seem determined to misconstrue what I say or try to put me in the wrong. I'm just telling you what I see here, and what I know to be true from the experience of my wife, and our circle of friends. I don't have to make anything up.

(Please note however to use Enteric Coated Naproxen, it's really tough on the lining of your stomach, it's one of the things that keeps my wife in business, injecting bleeding arteries in the stomach from too many Non Steroidal Anti-Inflammatories or NSAIDs. Should you develop a bleed in the stomach they will inject it with adrenaline which will cause the artery to close down, they also use cyano-acrylate glue, assuming it doesn't harden the second it hits the injection catheter which is a common problem and expensive at $75 an injection catheter). I trust Dr. Bill will agree at least somewhat with what I say since it has been in the literature from the States, which is where I read it (Yes, I read my wife's mail, but only after she's finished with it, survival you know).



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I'll have to quibble on the Vioxx vs. ....
by Evie / September 15, 2006 10:46 PM PDT

... Aleve, etc. Vioxx was the only med that helped my back. I hope I never have that pain again because I'm not sure what I'll take the next time. I kinda think that's why it was such a popular drug.

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Have you tried Robaxin/Robaxisal/Robaxacet generic name
by Ziks511 / September 15, 2006 11:33 PM PDT

Carbamazole? It works for me, though it usually means I lose a day because it can make you very woozy if taken every 4 hours until the pain goes away. After that I could work taking it every 6 to 8 hours to keep the pain under control. I popped a disc catching a falling patient around 1977, and although it has healed fairly well according to my last CT scan, I still get sciatica when standing for longer than about 30 minutes or so. My doctor says its for two reasons, 1. I'm old and my discs are drying out, and 2. I'm overweight because I haven't been doing enough exercise. I think its because I'm too fat and old, so we have agreed to differ.


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Since I had PT ...
by Evie / September 15, 2006 11:40 PM PDT

... I haven't had the problems for the past 4 years. The Carbamazole sounds familiar as one that was tried. I sometimes have bad pain in the mornings, but once I get moving around I'm OK and I am one to take as few meds as possible. My hubby knew I was sick my last bout cuz I actually went out and purchased cough suppressant!

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I don't know ...
by Bill Osler / September 15, 2006 9:09 AM PDT

It sounds like just another day at the office to me.

I get 'love notes' from insurance companies almost daily saying something along the lines of 'we think you should prescribe drug A instead of drug B because it will save money.' I always wonder: 'Whose money?'

I'm usually happy to oblige if the patient is willing to change, but it is terribly confusing because one insurance company prefers drug A, another prefers B and yet another prefers C. It's not like the cheapest drug is the same for all patients. The price savings depends on which drug company is giving what insurance company the biggest kick back (a/k/a price concession) at any given time, and the preferences change from year to year.

Personally, I'd rather just practice medicine and not have to worry so much about which drug company has cut the best deal with what insurance company in an effort to boost market share.

But back to the link. It isn't just Canada, and it isn't new. It's every day right here in the US.

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If we allow ...
by Evie / September 15, 2006 9:12 AM PDT
In reply to: I don't know ...

... the "cost saving practice" of allowing the Federal government to negotiate drug prices, however, it will be a DISASTER!

Evie Happy

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Sleaze creeps in everywhere, its depressing.
by Ziks511 / September 15, 2006 11:58 PM PDT
In reply to: I don't know ...

As you say, you'd rather just make the best call you can for each and every patient, and then adjust as necessary without considering who's getting what from whom.

In Britain they have a National Formulary updated every 6 months which has all the reccommended drugs. For chronic reflux and heartburn they substituted some cheaper drug (by about 3 pence per box, I remember that clearly) for Losec/Omeprazole, the precursor to Nexium, for reflux. One of the Gastroenterologists my wife associated with would not prescribe it because it had a side effect. Suicidal depression in a few people never troubled by depression before. My wife then interviewed her patients with that in mind and found a significant incidence of depression (around 14% if memory serves) in people who never had it before. She changed their meds. She then instituted a new set of questions while doing a history, and if the patient had had depression before they got Losec/Omeprazole, and all other patients were asked to immediately report signs of depression and their med would be changed. All it really meant was that both my wife and Ian were called in every 6 months and were told they were prescribing too many "non-Formulary medications". They then did their song and dance about depressing side effects, the Medical Director wrote it down, and they left. No discipline or anything, just an irritating meeting every 6 months. I'd be curious to know if anybody did a study, I know Ian was pushing for one.

I'm sorry I can't remember the name of the drug, but it was not one I'd heard of either in the US or in Canada so it may have been purely European in use.


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Just Another Day At The Office
by Catgic / September 17, 2006 4:11 AM PDT
In reply to: I don't know ...

The thrust of my original ?Canary In The Coal Mine? post was on creeping ?$ocialized Medicine Think? here in the U.S. I see it, and based on your post you do too. The CBC News article posted on www.cbc.ca/ contained what I considered to be a small example of socialized medicine think up in Canada, reflections of which can be seen down here in Yankee Doodleland.

I contend that the ?independent group of health and drug researchers at the University of British Columbia?urging the province?s doctors to prescribe older, cheaper drugs to patients in an effort to curb rising costs.? were neither INDEPENDENT nor PATIENT-CENTERED.

It is not that they were not being ?honest? medical professionals. It is just that being immersed in Canada?s socialized medicine system made their recommendation to prescribe older drugs to curb overspending demonstrate that they embrace lowering HEALTH COST more then elevating the level of delivered HEALTH CARE.

You are largely correct when you say, ?It isn?t just Canada, and it isn?t new. It?s every day right here in the US.? All this means is that socialized medicine think has made its way south of the Canadian border.

I recognize that you are a practicing heath care professional provider, whereas, I am a only a practicing health care recipient. But even a non-medico health care recipient like me knows what the euphemism ?love notes? from the insurance companies implies.

The medical professionals I know personally all would, ?rather just practice medicine and not have to worry so much about which drug company has cut the best deal with what insurance company in an effort to boost market share,? but that is not reality. Doctors get ?graded? by health insurance companies in the areas of their prescriptions, referrals, medical tests and other categories of medical practice that drive health care cost up.

Surely you are aware that if a ?I?d rather just practice medicine and not have to worry about the insurance company? doctor starts wandering too far off the health care delivery reservation they will face subtle, and sometimes not so subtle repercussions from the heath insurance companies.

Here in the U.S. we are not yet where Canada and the U.K. are regarding delivery of ?socialized medicine,? but we are on a slippery slope and slowly sliding toward the great abyss.

Rob Boyter?s above post on treatment of GERD is a prime example of how prescribing Formulary Medications versus Non-Formulary Medications in the medical delivery system is used to jerk around patients suffering side effects from prescribed ?In-Formulary Medications. JP Cool

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Socialism may play some part, but ....
by Bill Osler / September 17, 2006 4:59 AM PDT

A lot of the insurance company interference in prescribing practices just represents an attempt by the insurance companies to lower costs, which is not an inherently socialist proposition. I would argue that insurance companies in a purely free market environment would likely engage in the same behavior.

In any event, SOME of the requested changes are not bad. I get notes from some insurance companies telling me that patients are apparently filling prescriptions less often than expected, or telling me about potential drug interactions when patients are taking other medications prescribed by a specialist who may not have communicated with me.

My guess is that the recent appearance of these letters regarding formulary issues is one of the downsides of the data processing revolution we have seen over the last 10-15 years. Without the Internet and high speed computers storing large drug databases the insurance companies would not be able to process the information required to review prescribing decisions in a timely manner. IOW, the only reason insurance companies didn't do this kind of thing in the past is that the process would have been too cumbersome to make it useful.

Personally, I think we are just seeing the natural end result of our desire to insure ourselves against an increasingly large number of potential problems. Security has costs, some of which are not immediately obvious. Patients do not always understand or accept the process, which adds to the complexity. Also, the fact that there is not necessarily an easy way for me to know what formulary issues a given patient may have complicates things.

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Re: Socialism may play some part, but? I should add...
by Catgic / September 17, 2006 7:43 AM PDT

Your pair of come-back posts are informative, and make good top-level points that I essentially agree with.

History clearly shows that the U.S. Government first strongly embraced socialism and made it part of its operating structure beginning back in the 1930s. Over the years since that first New Deal, the U.S. Government has been ?progressively? transforming itself into a ?Cradle-To-Grave? social democracy by the federal bureaucracy building process of ?One More New Deal At A Time.? Acts and laws like the Social Security Act and its myriad of follow-on Amendments, Old-Age Survivors & Disability Insurance, Federal Insurance Contributions Act, The Great Society?s War On Poverty, DI, SSI, Medicare, and Medicaid and more.

History shows us that there is no going back. No society in the past has, and no society in the future likely will. Once citizens belly up to and feed from the government trough whose golden contents are paid for by OPM [Other People?s Money], they will never vote for a politician who wants to cut back on either their portion size or slow their frenzy of feeding. The phrase, ?Entitlement Programs are the Third Rail of politics? says it all. All and any attempts by elected representatives to reform social programs like Social Security and Medicare have essentially failed, end up costing more money and can keep them from getting voted into office or get them voted out of office.

I recognize that the structure and operations of our government and country is a high-low mix of social democracy and social capitalism. I am a realist and embrace the current state of our society as my reality. I have served in it against all enemies foreign and domestic; pursued and pursue life, liberty and happiness in it; conducted profitable business in it; funded and continue to fund its operations and recently have qualified to belly up to its trough to savor and partake of its golden bounty.

Dez daze I tellz all doze hard werkin? folkz out der ta juz keepz on toilinz hard unda da Massa?s tax whip. Weez hurd da tittle-tattle dat da ?lock box? iz neer emptee, but wee po retiree folkz down here inda south still needz da moneyz. If?n yaz needz ta fetch diz retired electromagnetic field hand and hiz bride-for-life, wee beez Oceanside upta da big white sand castle howz on da sand dune, lokated juz paz da briar patch onz da Spaze Coazt?restin? an? sippin? U.$. Mint Julips. JP Cool

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I should add ...
by Bill Osler / September 17, 2006 5:02 AM PDT

One other twist to the process:
The newer medications are not always better.
There are times when the newer medications are better than the only ones, but in many cases the newer medications are just more expensive. So, even though the insurance company motives are hardly pure, the result is not necessarily bad.
Unfortunately, we do not know enough to be sure which of the cost saving measures are negative, positive or neutral from a patient perspective.

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Re: the definition of "old"
by Angeline Booher / September 16, 2006 1:16 AM PDT

Some medications are "tweaked", like producing once per day pills versus twice per day. Sure, there is a convenience factor. But I found my twice-a-day allergy med worked better for me than the once per day version of the same med. That's why I opted to stick with the twice a day version of my blood pressure med rather than going to the once per day one. No real money savings.

I noticed a recent TV ad in which a manufacturer combined it's BP med with it's cholesterol reducing one. Personally, I'd compare prices for any money saving.

After so many years, meds can go generic, which means they are "old enough". I have been pleased when a couple of my tried-and-true ones went generic.

I notice that hypnotics are back for sleep. (We gave elderly psych patients chloral hydrate for sleep, and it worked well.) I don't know what they added to one of the newer hypnotic sleep meds that "put you to sleep" and now "keep you asleep". Maybe a time release layer???

I reckon my point is that the term "old prescription medications" might be misleading. I believe that most insurance companies in the US urge the prescribing of "old enough to be generic" forms.

With our insurance companies, the cost is spread among all subscribers to the individual policies. In Canada, the cost is spread under their program.

(I've read that the administrative costs of our insurance runs about 40%, while Medicare runs about 2%.)

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