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Everything you wanted to know about pharmacare but were afraid to ask
166 Plays2 years ago
Chris Parsons of the Nova Scotia Health Coalition (formerly of the Dog Island podcast) joins host Duncan Kinney to walk him through Canada's currently terrible pharmacare system, what is in the works between the Liberals and the NDP and why the struggle for pharmacare is not only winnable but absolutely key to the left staying relevant.
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Transcript
Introduction and Guest Introduction
00:00:12
Speaker
Friends and enemies, welcome to The Progress Report. I am your host, Duncan Kinney, recording today here in Muskewiskeigan, otherwise known as Edmonton, Alberta, here in Treaty Six territory, on the banks of the mighty Kasiska-Saw, or the North Saskatchewan River. Joining us today is Chris Parsons, the Provincial Coordinator with the Nova Scotia Health Coalition, and also a former, former fellow podcaster, a member of the Dog Island Gang.
Past Podcast Reflection
00:00:40
Speaker
Chris, welcome to The Progress Report.
00:00:42
Speaker
Thanks for having me, Duncan. And yeah, I mean, no longer me podcaster, but I was part of the the very small initial wave of Canadian political podcasts before every podcast was actually just a YouTube channel. That was so, yeah, now I'm chatting with you about what's been my day job for the last six years.
00:01:05
Speaker
Yes, but like any good podcaster, it's very easy to get drawn back into it. Whatever the line is from the Godfather, once I thought I was out, they pull me back in. Here you are. Yes, it is a curse.
Why Does Canada Need Pharmacare?
00:01:18
Speaker
But I'm just glad that we've heard the archives of that podcast and people can't listen to it.
00:01:25
Speaker
Yes. So if you do want to listen to Dog Island, go to, no, nevermind. I enjoyed it. It was a fun podcast. It's very hard for me to get, you know, news from Nova Scotia here in Alberta and from people who kind of like sounded like me and had similar politics to me. So I'm obviously doing a podcast full-time with like other people is fucking work and all good things must come to an end. But anyways, RIP Dog Island.
00:01:51
Speaker
Yeah, I mean, we made $50 off of it off the two year run of that podcast. And I'm glad you appreciate it. I will say our goal was always when we set out was to be like, oh, we want to explain Nova Scotia to other leftists. And we want to introduce and talk about Nova Scotian issues to Nova Scotians from a left perspective, which they might not have
00:02:13
Speaker
have otherwise gotten that perspective previously, and I think we've sort of accomplished both over those years, and I'm glad we called it quits when we did. It's, you know, things have shelf lives, particularly when they're your silly hobby with your friends, and yeah.
00:02:29
Speaker
Yeah. And but we're not here to talk and reminisce about podcast pass. You are here to talk about a very specific thing, a specific thing that you actually know a shit ton about and have like done a lot of work on over the years. And like you said, it is this is your like day job. You know, you work at the Nova Scotia Health Coalition. I think the the analog here in Alberta would be Friends of Medicare, right? Yeah. Yeah. So we're one of several provincial health coalitions. Most of them are called like the province acts coalition.
00:02:58
Speaker
our health coalition, whereas in Alberta for historical reasons, it's the Friends of Medicare, and I've worked closely with those folks there. Now it's Chris Gee and Alyssa, but previously it was my good friend Sandra and Alyssa. So I think all three of those folks are incredible, and Alberta is very fortunate to have them.
00:03:19
Speaker
Yes, friend of the show, Sandra Azakar, she's been on a couple of times and yeah, she's fantastic. But yeah, so we're here today to talk about the struggle for, you know, pharma care or, you know, medicine for all.
00:03:35
Speaker
And, you know, there's been some recent developments, you know, we've, we've seen Alberta's or sorry, Canada's kind of two centrist parties come together in a supply agreement to kind of keep this minority liberal government afloat for the next four years.
Vague Steps Toward National Pharmacare
00:03:53
Speaker
And one of the preconditions of this agreement was movement, I guess, on pharmacare. I wouldn't call it like a, a pharmacare plan or a pharmacare agreement. It seems,
00:04:03
Speaker
still seems pretty tentative. But I think there are some, both some positive steps and some just like, I think there's just a huge information gap out there when it comes to like, what the fuck pharmacare is, and how it would actually work, and the infrastructure that's kind of already in place to get us there and the like, the literal like super villains and bad guys that are trying to keep it down.
00:04:28
Speaker
And that's why I wanted to have you on is to give us the lay of the land. So are you ready for this chat? Yeah, I'll do my best. I think I'm breaking the podcaster's code by having done research about this, particularly in this case, years of it. So it feels in some ways like a betrayal, but hopefully we can chat in some depth, I think, about what pharmacare is, what it's actually going to take to win it. And one thing that I think is
00:04:57
Speaker
I think it's sometimes worth having the conversation, but like the political machinations of what this means for the NDP and the Liberals. But I think that that's actually in some ways been like a real distraction and really dominated a lot of the conversation. And I would like to get that in some ways it's a brass tax, both about like what farming care might look like, but also I'm excited to talk about like the actual politics of this and what it's going to take to struggle in a better system.
00:05:17
Speaker
Yeah. Like we're not, we can't just depend on these political fucking losers at the top of parties to actually give us free medicine. It is going to take struggle. I think that's important to kind of continually say, but what I'm curious about is like, what is on the table right now? Like, what is the system that we have? How close are we to actually getting medicine for all and what was agreed to, uh, you know, between the liberals and the NDP just recently?
00:05:43
Speaker
Yeah, absolutely. I'll start with the first question is like sort of what does the system look like now? And the answer to that is, is that it is largely privatized and incredibly fractured. So right now, if you need to access prescription drugs for the vast majority of people, you either access it by paying fully out of pocket, or you have a health plan, which is that you got either through
00:06:04
Speaker
you know, your student union at your university, or for most people, their employer or their partner or parents' employer. And those are private plans, and so there's a private broker who sells your employer or your union or your student union on the plan, and then it's administered by a company like Green Shield or Blue Cross.
00:06:26
Speaker
In addition to that, there's also each province has a patchwork system of different provincial healthcare plans, right? So in Quebec, there is something that sort of looks like pharmacare. It's limited, it's expensive, it doesn't cover everything, it doesn't cover everyone, but it exists. But in most provinces, it ends up looking more like things like in Nova Scotia, we have like a seniors drug plan.
00:06:48
Speaker
So once you reach a certain age, you can have limited drug coverage if you don't have coverage through current employer, pharma care, something like that. It looks like plans for, for example, people who are government employees,
00:07:04
Speaker
The military is a big one. And it looks like specific plans that are targeted in some cases, in some provinces, to low-income people. And then there's also coverage of drugs for, in some cases, particularly expensive pharmaceuticals through what's often called special programming, potentially, and that would be things like cancer drugs or very expensive other ones. And then importantly, and I think this is one of the things that is really confusing with the Canadian system, is that
00:07:30
Speaker
you are covered if you receive medication in the hospital. So because national Medicare in Canada, universal health care, covers care in hospitals, if you need prescription drugs while you're in a hospital bed, they will give those to you. But then the second you're discharged, you're sort of on your own and after the light of paying you out of pocket or paying
00:07:52
Speaker
or relying on a plan you might have either through employment or otherwise. And that's sort of the broad scope of it. Like there's a lot of different details and there's a lot of like differences, province to province. And really the fact there's so many different plans and so many differences, province to province, so many different ways of accessing it is part of the problem that we actually want to solve. Because this is a really expensive system, right? And I think that that's really the important thing is what is on the table of a national pharma care plan will save money. We're talking about going from about
00:08:19
Speaker
roughly $20 billion in spending per year in this sort of chaotic system where sort of the anarchy of the market increases administrative costs, it increases the cost of individual drugs because we can't leverage bulk purchasing, we can't build a public system to buy these drugs, we often don't know province to province what drugs cost. All of that anarchy costs at least $5 billion more per year than if we just built a national system to do it.
00:08:44
Speaker
And so what's on the table is in some ways unclear, right? So it's fairly vague actually in terms of what is being proposed, but what we have in concrete terms in terms of this agreement between the NDP and the Liberals is
00:09:01
Speaker
is to introduce national pharma care in sort of like two steps that they've started that they've proposed initially. One of them is to pass a candida pharma care act by the end of 2023 and that's just an act that won't itself create pharma care and I think we will talk about that a bit later and then after that tasking the national drug agency to develop a national formulary of essential medicines and a bulk purchasing plan
00:09:23
Speaker
by the end of this agreement and this agreement between them is supposed to run until 2025. So those are the very first steps. So we're talking about the first steps by 2025 and what we believe and what every indication has been is the general plan of what we're gonna get for pharma care is gonna be based off of a report that was authored by a committee that was chaired by former Ontario health minister, Eric Hoskins, which was released in 2019, which essentially calls for in a lot of ways
00:09:54
Speaker
Not the perfect universal farming care plan, but a universal farming care plan that is robust and does most of the things that we want. And that would be a single plan that covers all Canadians. So it's not importantly a fill in the gaps plan, which is what some people, particularly insurance agency industry has advocated for. A fill in the gaps plan would be cover only people who don't have existing coverage, which means you're only going to cover the most expensive people and a fairly small number of people. The Hoskins plan calls for like a plan that covers all Canadians
00:10:21
Speaker
that is parallel and akin to universal healthcare, and that allows the federal government in the provinces to do things like negotiate bulk purchasing, to streamline administration, to have a single formulary, which is the list of drugs that are covered, to do all of those things, and probably would end up being jointly funded by the provinces and the provincial government, but actually administrated on the ground level by the provinces through sort of existing healthcare administrative infrastructure.
00:10:50
Speaker
All that is to say, what is on the table is in broad scopes, universal pharmacare, but it's no guarantee
State Support and Public Pharma Production
00:10:56
Speaker
we get that. And I actually think that an important part of the discussion that I think is being missed is that the actual details of what this is going to look like are not set in stone. We could end up with a system that actually ends up looking a fair bit
00:11:11
Speaker
like a subsidy to the insurance in the pharmaceutical industries and which only offer sort of minimal care to a small number of Canadians. Or we could end up with a program that allows us to actually like build a really truly like public system that could start incorporating things like public ownership of the production of generics and that sort of thing. And I think that that's sort of the battle going forward is like, what are we going to get? Well, we don't know yet. That's what the politics are. Right. That's what they're like us doing work is, is to figure out what it is we're going to get.
00:11:40
Speaker
So you're sitting here and telling me that an actual national pharma care plan would save $20 billion a year. But really all I hear when you say that is that Johnson Johnson, Pfizer, Novartis, Merck, GlaxoSmithKline, you're telling me they're going to make $20 billion less? So it would save, just to be clear, it would save $5 billion.
00:12:00
Speaker
I don't care about the number. When you talk about saving money, what you're talking about is pharmaceutical companies profiting less off of selling medicine. In a lot of ways, yes, mostly. It's also saving money off the administrative costs.
00:12:18
Speaker
People who are really in favor of the free market forget is like, it is an immensely inefficient way to administer something like it's an efficient way to administer human life, like just throw that out there and be honest about that like from the get go. But particularly when you're dealing with a social program like this where it's like, why do we have
00:12:38
Speaker
you know really a half dozen large actual insurance providers and dozens and dozens of different insurance brokers who are the middleman between your employer who's purchasing the plan on your behalf and then we have literally in this country thousands of different individual health care plans that cover different things that different people administering them who then have to talk to these brokers who then talk to these actual providers who are then talking to an underwriter who's actually sort of like
00:13:07
Speaker
ensuring the whole thing, right? We have all of this layers and layers on layers of just like people pushing around paper. Yes. And just so you can get medicine to like literally save your life or dramatically improve. Yes. So like there's these administrative costs and every one of those has, you know, executives and middle managers and almost and every one of those companies has shareholders who have to get their dividends out of it and who have gotten very good dividends over the years. And so like you've got all of that. And then you've also got the pharma care industry who make an
00:13:35
Speaker
the pharmaceutical industry who make an incredible amount of money largely on drugs that are either being new drugs or largely developed using public money or simply they are building off of existing patents that have existed for an incredibly long period of time and simply sort of extending those patents or in some cases you know simply like
00:13:57
Speaker
making a lot of money because they're the only company, even if there isn't a patent, who's willing to produce that medication because we don't have a public alternative to do it itself. So yeah, like this money I think is savings. And I think we need to think of it not purely as in the abstract as administrative savings and bulk purchasing savings, but actually it is that question of like, this is a question of class politics and a question in the sense that we are asking to build a system that is going to provide services to all people, particularly the people who need it the most are the working class and the poor.
00:14:26
Speaker
And to do so, we need to go to battle with these incredibly large wealthy companies who profit off of the misery of other people, if we're being honest. And so I think that that is in a way like a central question of how we ought to do class politics in this country is like, yeah, let's ensure they make less profit and at the same time make sure that all of us get the things we need in order to be healthy and ideally thrive.
00:14:54
Speaker
Yes, so I live in the wonderful province of Alberta and here in the 90s we decided to like deregulate is the kind of term of our use, but essentially privatize our electricity utilities here in this province. And we essentially sold them off to private actors who then still got, who then got a monopoly to just sell that electricity back to us. So we essentially like let the market take over, you know, how we get electricity in this province.
00:15:20
Speaker
When it comes to like pharmacare and medicine, like how much like capitalism do we allow? How unfettered is the like the market when it comes to like how the system works? So like the answer is sort of like incredibly unfettered. And then but also the answer is also like entirely reliant on the state. Right. So one of the things I think that's really important is that in Canada, like healthcare in Canada is so much about Canadian myth making and Canadian like hagiography of like specific men.
00:15:49
Speaker
And one of those specific men that we always think about is sort of Jonas Salk and the invention of insulin or the discovery of insulin rather.
00:16:09
Speaker
But the thing is, is that for most of human history, what he said was actually unremarkable. It's actually really only been
00:16:21
Speaker
really the 20th century and even then it's been like only the second half of the 20th century where the idea that you could actually patent medications and control medications through intellectual property was considered normal and that was largely a process that happened in the United States and I think that that's like that sort of American intellectual property law
00:16:43
Speaker
is like, has really infected the way that we think about it. And I think that it allows us to forget the fact that the protection that the pharmaceutical industry receives under our laws to allow them to take medic, to use medication, which, um, and oftentimes they didn't actually like quote unquote invent themselves. And if they did, it was done using government money. The fact that they can prevent other people from producing it, even if it would save their lives.
00:17:08
Speaker
is like not a natural thing. And that actually is a reliance on like a really robust state and a really robust state enforcement system and a system of international treaties that I think like it means that it is actually not in many ways in some ways like as deregulated as they would like to say it is. And I would say that there's a quite good book on this topic by a guy named Alexander Zajczyk. I think it's actually called patenting the sun.
00:17:35
Speaker
But beyond that, I think that as a whole, most people access drugs through a pre-privatized system. And I think even with universal pharmacare, we are unfortunately going to have to keep a lot of those elements of privatization there. And I think the battle is to try to build a system that allows us to phase those elements out over time, as well as get rid of as many of them as soon as possible. So for example,
00:17:55
Speaker
pharmacies in this country are almost universally private companies. A universal drug plan would still rely on pharmacies in order to actually disp private pharmacies to actually dispense drugs. Most of them at this point are almost entirely full of a handful of chains. And importantly, and I can't really get into this, but there's
00:18:12
Speaker
a very small, really only two companies really that actually distribute drugs to those pharmacies that have a, and one of them has almost entirely the monopoly on it. So like that is a very consolidated, very industry that's very profitable. So part of a universal pharma care plan, part of what we actually have to do is do things like on a small level limit dispensing fees, right? Like we need to set a national standard of like how much can a pharmacy actually charge you to dispense medication to you? Because much of the money that pharmacies actually make
00:18:42
Speaker
and themselves directly is from dispensing fees, not margins on the sale of the pharmaceuticals themselves. So that's one thing we have to do. One thing we have to do as well is create rules about actual disclosure on the cost of drugs that are charged to plans. We can get into that in a bit. I think that's a pretty fascinating story. But also I think in the long run, what we actually need to do is we need to
00:19:03
Speaker
use this as an opportunity to build a domestic pharmaceutical production capacity in this country, an industry to produce generic drugs that is publicly owned. We can't just give money to the pharmaceutical industry and say, please build a private industry and we're going to subsidize your profits doing so. This is an opportunity to create a single buyer
00:19:26
Speaker
for a massive number of medications. So there's a handful of medications that account for really like about 300 that account for the vast majority of the medication that's actually used.
00:19:37
Speaker
in this country and much of it is generic, most of it is generic. And if we can produce most or some of those and begin selling it from a public facilities into a public drug plan, then we can bring costs down. We can also rebuild an industry that is an alternative to things like the fossil fuel industry, albeit it's not the greenest industry in the world compared to things like education.
00:20:03
Speaker
care work it's not it's not bad but it is far greener than the tar sands and it's something we need and also eventually we could create the capacity to begin rebuilding a generic drug export industry in this country so like it also needs to be seen as again like it's a political show but also like it's an economic potential for economic development and i think that that's a big part of it is
00:20:25
Speaker
If we just sit back and just watch this be whatever we want it to be, then we're going to see far more involvement, far more control from private industry than we would like to see. There's a lot to digest there, but the last thing you talked about, the publicly owned control and controlled generic manufacturing base, I think is an absolutely fantastic idea, especially for
00:20:49
Speaker
the place that I live. I live in Edmonton. I live on Treaty 6 territory. You know, within Treaty 6, there is a literal clause that's like, a medicine chest shall be kept at the house of each Indian agent for the use and benefit of the Indians at the direction of such agent. And this medicine chest clause, you know, it has been interpreted as like, oh yeah, like you have to provide healthcare to everyone. You have to provide medicine to people who live on the, to Indigenous folks who live
00:21:17
Speaker
on the territory and so like are onto the treaty land and so like scaling that up like it makes an incredible amount of sense for this particular area to get into manufacturing generic drugs. We have the industrial space and capacity and engineering know how like if you
00:21:36
Speaker
Just drive around the outskirts of Edmonton and you will see, you know, refineries and petrochem projects as well as the workforce, the like the construction trades workforce to build those facilities. And honestly, when you're talking about manufacturing things like saline water or aspirin or like, you know, like, like you said, there's a list of 300 drugs that are like 80% of all of the like pharmaceutical costs in this country. I mean, I pulled that 80% number out of my ass, but 300 drugs that are the vast majority, right?
00:22:02
Speaker
Yeah, that's the vast majority. And I also think that when we talk about pharmacare, the other thing to keep in mind is we're not just talking about drugs in
Implementing National Pharmacare: Challenges and Steps
00:22:09
Speaker
a lot of cases. We're also talking about things like medical equipment that's necessary to dispense those individual levels. So for example, insulin pumps, right? So what we're actually talking about is a diagnostic equipment like checking blood sugar levels and those sorts of things. So what we're actually talking about is like
00:22:30
Speaker
that industry that also considered it as like a starting point to sort of rebuild a high-end like high-tech medical plastics, medical manufacturing, all this sort of medical stuff like the very like basic things that we sort of stopped doing when we abandoned the concept of like a developmental state in terms of like economics and we just sort of like tried to move into some combination of financialization and the service economy and an exportation of
00:22:56
Speaker
of all manufacturing, we just gave up on the idea of doing any sort of high-end, high-margin manufacturing. So even under the confines of capitalism, there's a better way to do that for the Canadian economy and that a publicly owned and publicly nurtured industry of building not just pharmaceuticals, but also the various other tools that people need to use them that would hopefully be covered under National Pharmacare, I think is a really key part of that.
00:23:26
Speaker
In places like Saskatchewan and Alberta in particular, that's going to be important as we try to phase out, not even try to, when we inevitably have to phase out the fossil fuel industry. My partner's father works like many Atlantic Canadians, two weeks on, two weeks off in the entire sands.
00:23:46
Speaker
And he has a lot of technical know-how that he's built up over the years of doing that job that I think is reasonably transferable into manufacturing if we rebuilt it. And I think that that's one of the things we have to do is we do have to be realistic about the idea that if we don't want to wait for the collapse before we get rid of the tar sands, if we want to try to phase it out earlier before it kills us all.
00:24:07
Speaker
We have to be able to say to people, this is your job that may not pay as much, but it's going to be comparable. And building this sort of public pharmaceutical industry, I think, is a key part of that. It's not the only one. We're going to find a lot of different ways to replace the sorts of work that's attached to that. But it certainly is one of them.
00:24:24
Speaker
Yeah, it's not the silver bullet. It's not a high margin business. You're not making the fortunes that are currently being made in oil and gas with the price of oil being, whatever the fuck it is right now, $100, $100. Yeah, and you won't have the adjacent oil field suppliers, which are such a huge part of that particularly politically.
00:24:39
Speaker
It's an industry and like it is a real job and it is like stuff that has to be made and that is absolutely required for us to live in the custom of which we have become the manner in which we have become accustomed to to be able to go to the hospital and to be able to get tests and to get medicines, you know, like this is this is like we got to do it and
00:24:59
Speaker
Someone's got to do it, right? And the more people that do it, paradoxically, the cheaper it gets for everyone. Yeah. Especially when the public is owning the means of production here and it's not, there's the profit motive at the heart of all this. Yeah. And I think the other thing to keep in mind too is like, I think there are people who are probably listening to us say like, Oh, it'll be great if we, um, if we should like make sure everyone gets the prescription medications that they need. And they probably listen to it and say like, look, people are over medicated.
00:25:28
Speaker
and like it's bad, we should figure out natural solutions to these things. And like, they're not entirely wrong. Like there's some extent where it's like sometimes there's people then talk to you about crystals, but then sometimes there's actually like really legitimate concerns, right? Because we've actually seen the degree to which the pharmaceutical industry is predatory, right? And that has in a lot of ways made people's lives much worse, not just in the fact that it exploits people directly through the process of
00:25:55
Speaker
taking their labor in exchange for substance. This is why the most research and innovation has come on drugs that treat chronic diseases. Yes, because it takes a long period of time. But the other thing is that paradoxically, a national pharma care plan, properly designed, will reduce the amount of inappropriate prescribing that's done. And that's actually really important, is that right now,
00:26:22
Speaker
We often, we don't have national, we don't have a lot of good national data in real time in terms of prescribing drugs, right? So part of what's going to happen with the, there were hope it's should happen. And one of the things we have to fight for to ensure happens is that part of the mandate of, or now the Canadian Drug Agency, which is a newly formed agency, which is going to handle things nationally, like the formulary, which is the list of drugs that is proposed is that that agency will also be tasked with being independent of industry.
00:26:50
Speaker
and doing things like tracking prescribing trends. But also doing things like providing independent information to doctors and patients about drug use and drug facts. It will determine which drugs are actually included on the formulary and therefore people can access them through the plan on the basis of whether or not they provide medical benefit.
00:27:13
Speaker
not whether or not they are marketed extremely well. The important thing right now is Health Canada, which approves drugs. It operates on a partnership model with industry. It's not an oversight body, it's a partnering body. And its approval of drugs are based essentially on the fact of like, is it medically effective when they ask that they don't say, is it medically more effective than existing drugs? Just does it improve the condition, right? So if you create a, if you bring them
00:27:40
Speaker
a pain medication that is better than nothing, but worse than things currently in the market, they're still mandated to approve that. What we're looking for is a plan that says that we don't need more versions of drugs that are mediocre. We need the best drugs available to people. And I think that that's an important part of this is if we actually want to reduce things like overprescribing, we need a national body that's tasked with tracking it, setting out rules for what's covered.
00:28:04
Speaker
setting out rules for how prescribing happens. And that's what a national drug agency would ideally do. And I think that's, again, part of what we need to fight for is not simply just buying all the drugs we can from the pharmaceutical industry, but actually setting up a system that benefits patients. So Chris, you've sold me. I'm all in on free medicine for all, pharmacare.
00:28:27
Speaker
Who are our enemies in our fight or struggle for this? And what are they doing to keep this idea down? Yeah, so I mean, I think the major opponents are going to be private industry, of course. And I think that a minor opponent is going to be some portions of
00:28:52
Speaker
the pharmacy industry or like the industry of actual like pharmacies, like the stores, the dispensing pharmacies, right? And that is, I think it's important that that's not pharmacists, right? Like a lot of pharmacists really, most pharmacists really see themselves as medical professionals who want to help patients. And they're unfortunately stuck in a situation where there are very few pharmacist jobs in public hospitals. And therefore they do most of their work in like private pharmacies. Sometimes they own them as franchises
00:29:21
Speaker
Sometimes they work for someone else. They're not our enemies, right? The enemies are a small portion is pharmacies themselves who are going to want to make sure that their dispensing fees aren't touched. They're going to want to make sure there's no growth in a competing series of public pharmacies, which really we ought to have. In every hospital, you have a public pharmacy that you just can walk up to and use.
00:29:43
Speaker
a national pharmacare plan in order to get your medication. Every community health clinic should have one version of that as well. But they're going to fight to make sure that that doesn't happen. But that's relatively minor compared to the two other major groups we're going to see. So the first one is the private insurance industry, which is the extended health care benefit company that you have to file your claims through. And again, that's sort of a layered industry. You probably interact
00:30:09
Speaker
on a day-to-day basis if you're lucky enough to have drug coverage with Green Shield or Blue Cross is the big one that's my own one right now. But there's a middle layer which is the brokerages, the extended benefits companies that usually for employers cover sort of like a wide variety of benefits including purchasing and negotiating on their behalf in theory deals with
00:30:36
Speaker
these insurance actual companies. And those are companies like Morneau, previously Morneau-Chapelle, which is of course the family company of the former finance minister who was- It's called something else now, didn't they rebrand to like some anodyne fucking name? Morneau-Chapelle, I had to deal with them previously when I registered a health plan for a
00:31:00
Speaker
student life works in 2021 is now is now life works. But yes, it incredibly evil and massive and profitable company. Yeah, it's no more nose company. And they really have been like, their big thing was consolidation, just buying up all of the competitors, we don't have any trust laws in this country anymore. So like they, you know, they bought, they bought up all their competitors, and they're a massive, big version, they handle like all kinds of things, right? So like, they cover healthcare, but they also cover like life insurance. But they also do
00:31:30
Speaker
just like human resources consulting for companies. So often the company that is purchasing on behalf of your health care on your behalf is also making sure that your company has a wage suppression strategy, for example. In the press release for the rebrand here, they describe themselves as a leading provider of technology-enabled total well-being solutions.
00:31:52
Speaker
Yeah. And this is the other thing is like they have been very keen on expanding their coverage of what they offer and trying to offer. In some cases, offering services directly. In some cases, partnering with companies like Maple or Well or other virtual care companies to try to introduce sort of coverage of like being able to call a doctor and have that paid for privately, right? So they're keen on expanding privatization, but
00:32:18
Speaker
The important thing with it is that like they get paid for the most part, in almost all cases, they negotiate as a percentage of, they'll get paid like a 4% management fee on the health plan. So then the premiums. So if your premiums go up, they make more money, right? Which is like the opposite of what they theoretically have a fiduciary duty to do, which is negotiate on behalf of the members of that plan.
00:32:45
Speaker
So they're going to fight it. They have already fought it. And what they want to fight for is they want to fill in the gaps plan. They want a plan that's only going to cover those people who are not already covered by a health insurance plan that has pharma coverage. Because what they actually want to do is they want the government to take all those people who are really expensive to ensure. So they want people who have chronic conditions, who are going to use tens of thousands of dollars on drugs every year.
00:33:14
Speaker
They want them out of the plan because those are the things that the people that bankrupt plans, right? Yeah, it's like the private school model, right? It's like let the public schools take all the like kids with disabilities or kids who need lots of help and the private schools will just take the cream at the top. Yeah, exactly or just yeah and just like rich people have better educational outcomes and they have better health outcomes by virtual being rich straight up right like you're not you
00:33:38
Speaker
are much less likely to get virtually every disease if you're wealthy enough to not have to worry about things. So they want to take those people who are already employed, they don't want to take retirees who account for a huge, like older folks account for a huge percentage of our healthcare spending. They don't want to take people with chronic illnesses. And so they're going to fight not against farming care itself, but they would actually like a fill in the gaps plan because that
00:34:02
Speaker
takes any pressure off them to cover the people who are most expensive and they and most importantly the people who have the like most chaotic sort of chaotic but like have the most are most likely to have extremely high drug costs in a single year right they're gonna like create massive like spikes in a plans coverage right because that also causes people to like choose to simply like remove their plan from
00:34:26
Speaker
or get rid of their plan in some cases. So they want to get those. And then the other, I think the biggest opponents of this are going to be the pharmaceutical industry. And that is because the current system is set up essentially to allow them to simply print money. So for example, in Canada, with the existing drug plans that each province has, which again, mostly cover things like seniors and low income people, or as well cover
00:34:55
Speaker
employees, in many cases, of provincial governments, the pharmaceutical industry puts in clauses and contracts where they do not allow provinces, in most cases, to share what they actually pay for a specific medication with other provinces. They say that that's a proprietary secret. It's a trade secret. And therefore, when Nova Scotia is negotiating for the introduction of
00:35:21
Speaker
say, Trikafta, which is a recently introduced, incredibly expensive, but very good, sister fibrosister. When Nova Scotia negotiated coverage of that, they couldn't go to another province and say, how much are you paying for this? Are we getting a good deal, right? They can't do the thing that you do when you try to determine which home Wi-Fi company you're going to use, and you ask your friends, like, has anyone, like, what are you paying, right? Criminal governments can't do that.
00:35:48
Speaker
the pharmaceutical industry has like this system setup that ensures that on patented drugs that they can make an incredible amount of money with almost no oversight. There is an agency and I think this is important and important story of the last few years called the PMPRB in Canada. The Canadian patented medicines review price review board and their job is essentially to set what limits we do have.
00:36:12
Speaker
on the price of patented medications in this country. And they, for the first time in about 30 years, began a process, I believe in 2017, that sort of wrapped up in 2019, right before the pandemic, to reevaluate some of the rules of how they set the upper limits on prices of pharmaceutical drugs in this country. So just to jump in here, this public body, this obscure public body that's responsible for
00:36:37
Speaker
setting the prices of drugs, the high end of prices of drugs. It's like to stop the Martin Shkreli's of the world from just buying up patents and then just jacking up the price by 3,000%. Yeah, it sets a ceiling on it. It just says, this is the most you can charge. And it essentially does it with a small list of comparator countries that are basically like, here are some countries that are similar to Canada. We use a convoluted formula to figure out using the prices of these drugs in those countries where possible, what you can charge for this drug here.
00:37:06
Speaker
And the big changes they tried to introduce were allowing provinces to share information on what they're paying for drugs. And then the other one, there was a number, a whole bunch of other smaller changes, but the really big one was this change that they proposed to what the comparator countries were. So a big example of this is they wanted to take out Switzerland, which is a very small company with very high drug prices that demographically looks nothing like Canada, other than the fact that it is white over Canada is nearly as white as Switzerland at this point.
00:37:35
Speaker
the pharmaceutical industry lost their minds. And they essentially saw this, rightfully, as the first step in an attempt to regulate them in any significant way. And also an important first step in setting the stage for pharmacare. So they went to war with the PMPRB and essentially decided, along with the help of both a number of conservative MPs, but also the Fraser Institute and other think tanks,
00:37:59
Speaker
to just they're going to destroy the PMPRB. They're going to say like this body needs to not simply not make these changes, but they need to be just destroyed so that other agencies realize that we will like do everything we can to just make sure you no longer exist if you challenge our power.
00:38:15
Speaker
And they did so with the help of, and I'm going to try to word this as delicately as possible, patient groups in Canada who receive the majority or in some cases virtually all of their funding from the pharmaceutical industry directly.
Industry Resistance and Tactics
00:38:31
Speaker
And that is not all patient groups in this country, but is many of the most vocal.
00:38:34
Speaker
and they sided with the pharmaceutical industry because the pharmaceutical industry said that, look, we already have developed these drugs. They're available in other countries. Chris, I got to jump in here. It really does sound like we need a public inquiry to get to the bottom of the foreign funding of these patients groups.
00:38:48
Speaker
I'm in Nova Scotia where we're going to port a peak inquiry right now, so I'm not in like the public inquiry mode of believing that we're going to get to the truth of anything with that. But that is a different podcast and no longer the type of podcast I do, particularly when I'm on the clock with work. But they like essentially, yeah, like they, I mean, that is what they did, right? Like these are multinational corporations who fund advocacy groups in Canada and those advocacy groups happened to.
00:39:12
Speaker
Support their attempts to ensure that these companies can charge whatever they want for medication right because the company said look if we can't charge literally any whatever amount of money we want for medications. We have these medications but we will make sure they are not available in your country and people who need them to live will die or they will suffer and live much worse lives.
00:39:33
Speaker
Yeah, go to the head of a puppy, that kind of stuff. Yes. I like to think that if I were in that situation and a multinational corporation told me that I'm willing to let you die unless you help us convince your government to let us soak them, for whatever money they're worth, that I would, rather than calling for an elimination of the body which tries to regulate drug prices in the country, I would instead be calling for the imprisonment or worse of the CEOs and shareholders of those companies.
00:40:01
Speaker
But I'm also not in that situation. So like I understand the desk. I don't understand because I haven't been there. But I am incredibly.
00:40:11
Speaker
like sympathetic to the plight of people that say like, I don't care what happens, I need this medication from me or my loved one to survive. And I think the fact that the pharmaceutical industry is willing to manipulate those people in order to, in the name of profit, is a sign of how vicious that industry is, how without any sort of like moral authority or morality at all it is, but also how dangerous of an opponent it's going to be when it comes to the question of pharmacare. If they're willing to do that in order to get what is like a very bureaucratic, reasonably small change,
00:40:42
Speaker
to how drug pricing is set, imagine what they're going to do with the things that we've talked about, which is an attempt to build a national farming care plan that does things like limits overprescribing, that limits the ability to use marketing to push drugs that are not more effective, and which is also talking about ideally introducing the public production of pharmaceuticals, of generic pharmaceuticals. Imagine
00:41:07
Speaker
what they're going to do with pharmacare. And that's, I think, the battle that we're about to face, right, is we can't think that if we get an act in 2023 and the government somehow survives until 2025 and we get this formulary, that we suddenly have pharmacare. That's not how the plan is built, but also that there are years, at least three years, likely more, of an ongoing battle where the pharmaceutical industry is going to do everything in their power to destroy this program. So if we want it, it's not good enough to just think that, like,
00:41:35
Speaker
this deal gets it. That's not how power works. That's a very naive view and an unserious view of how politics work. And I think that we need to, when we talk about the politics of this, the conversation is not the machinations of a handful of backing people in Ottawa and liberal and NDP parties. The politics of this are how the fuck are the working people of this country and the poor people of this country and the marginalized people of this country going to build the power necessary to go to war with the multinational
00:42:04
Speaker
pharmaceutical industry and a incredibly domestically powerful and politically well-placed insurance industry to ensure that we get a plan that we should have had decades ago. And so that's the fight. Like that's politics to me. Everything else is fucking fantasy sports.
00:42:21
Speaker
Yeah, the stakes here are incredibly high, right? We're talking about medicine and drugs that will literally save people's lives, that will drastically improve the quality of life of regular ass people. And the reason why I asked, like, who are the bad guys, who are the enemies that we have to defeat here is, like, this is a class struggle, right? This is literally a struggle that gets to the core of, like,
00:42:47
Speaker
what how evil capitalism is and what must be done to defeat it and like the stakes are high not only in the case of like people will die and people leave this medicine in order to live or to live anyway halfway comfortable lives but the bonus of all this is that if we do win we get to crush the pharmaceutical industry like simply put one of the most evil agglomerations of people in capital to like ever exist and uh that is a huge fucking bonus too yeah exactly i think that for a lot of
00:43:16
Speaker
the left in this country, we don't fight capital directly that often anymore. I think that often our target is unfortunately sometimes cultural, but often is simply like arms of the state. So it's an indirect fight against big corporations.
Public Action and Advocacy for Pharmacare
00:43:32
Speaker
I think indigenous struggles, I think indigenous struggles around self-determination and control of land and resources and
00:43:43
Speaker
Existence are an exception to that. I think that at times, largely the best parts of the climate justice movement are an exception to that.
00:43:53
Speaker
But I think that, particularly I think on the socialist left, we've been scared of taking on the pharmaceutical industry. In the pharmaceutical industry, one on an unprecedented level over the last two years. One of the reasons they've been able to bully government about the PMPRB and delay implementation of these rules and cause second guessing is because they made the implicit threat that if you don't comply with this, it's going to make it really hard for us to get
00:44:20
Speaker
They did it. It's a classic shake down. They essentially did the like, oh, that's a real nice story you got here. Shame if something were to happen to it, right? They pulled that move. And like, that's like an industry that has consolidated its power that is incredibly powerful globally.
00:44:36
Speaker
that we need to take on. And I think we should, on the left, welcome the opportunity. This is a thing that is an incredibly popular program. It's a program that fits into a national narrative about this thing that many Canadians are often with very little thought very proud of, which is universal pharmacare.
00:44:51
Speaker
It's a program which would help everyone. It's a program which makes good policy sense on a nuts and bolts level of saving money and reducing expenditures. And it allows us also to take on a big private industry in what is a battle between the people and the corporations.
00:45:10
Speaker
and see if we've got what it takes. Because we need to be able to do that to build a better world. And this is not going to build that better world on our own. But it's a fight which is part of that process. And it's a fight which allows us to learn how to do that again. And I think that we need to do that. And I think that it needs to be a fight that happens on a number of different fronts. And it really has to come from the bottom up. This isn't something that's going to be given to us by decree
00:45:37
Speaker
Jagmeet Singh and Justin Trudeau or Prime Minister Christie of Freeland in a few years or whoever. Oh, God. You shut up. Well, that is the coherent thought, I think, to end it on. When you fight, you win. And this is a fight worth taking on. Chris, thanks so much for coming on the pod. How can people get involved in this struggle? And where would you direct people to direct their energies? There's also as well as to follow along with the work that you're doing.
00:46:04
Speaker
Yeah, I would say a couple different things. If you want to follow us, I'm personally on Twitter at Culture of Defeat. Our organization is on Facebook, the Nova Scotia Health Coalition, or underscore NSHC on Twitter, although that's not updated super frequently. You can check our website. But I would suggest on the local level, most provinces have a provincial and territorial health coalition. So the Manitoba Health Coalition, Saskatchewan Health Coalition,
00:46:28
Speaker
the BC Health Coalition, the Friends of Medicare, the Ontario Health Coalition. There's all of these local groups provincially who I think could use, we all could use an injection of energy, we're all exhausted coming out of the pandemic. I would get in touch with them and see like what you can do to help see what campaigns they're involved in. I would also say like, I think that this is a struggle where the labor movement
00:46:49
Speaker
has been pushing on it. And I think they should be committed in many cases of doing a very good job on it. But that struggle needs to be renewed and needs to become a struggle that's happening from the rank and file, not simply kind of happening out of research and policy offices, not happening sort of leadership. And I think that getting involved in your local union
00:47:07
Speaker
encouraging them to back the campaign, but also encouraging them to find ways that members can be mobilized and involved in it, I think is another really good way to do it. And I would also just beg people to not fall into the trap of just, I've seen a lot of really well-meaning people being like, oh, we're going to have farming care by 2023. Like, thank you, Jagmeet Singh. Don't do that. I think that's my last piece of advice is just like, we don't have shit yet, right? We have the first step in fighting towards it and pretending that we have it.
00:47:34
Speaker
because the political party you back is part of the process of writing some legislation which will help do that is counterproductive. It's not just not helpful. It actually undermines what we actually need to do, which is articulate the need for a struggle and then engage in that struggle. And so get involved in the groups that are struggling and like do not just get out of the way if you're not going to do that. I guess it would be my point. So I really urge folks to do that for sure.
00:48:03
Speaker
There you go. Thanks so much for coming on, Chris. Folks, if you have any notes, thoughts, comments, things you think I screwed up on, I am very easy to get ahold of. You can reach me on Twitter at at Dunkin' Kinney. You can reach me by email at dunkincayatprogressalberta.ca. Also, if you like this show, please support it. Become a monthly donor. There is a link in the show notes. Also, a quick thanks to Jim Story for editing this podcast. As always, thank you to Cosmic Family Communist for our theme. Thank you for listening and goodbye.