Quality health care?

While enterprising politicians and reporters make headlines by bashing the pharmaceutical industry or by escorting American seniors to Canada to buy “price-controlled” drugs, the real issue is being ignored: access to quality health care through appropriate coverage and reimbursement.

American seniors and other patients should be warned that lower prices do not equal better access. If this were true, Canadians would have the best access to new medicines, yet in fact, the opposite is true. As a family physician from New Brunswick, a province that shares a long border with Maine, it is both fascinating and troubling to watch the political posturing over drug prices in Maine.

In Maine, the issue of prescription drug access has been well hidden by a political smoke screen that focuses on government-controlled drug prices in Canada rather than on prescription drug coverage for those that are currently uninsured or under insured.

Seniors in Maine should be thankful that the courts have overturned Maine’s imprudent attempts to unilaterally impose price controls. In striking down Maine’s attempts at drug price controls the U.S. District Court Judge correctly noted that the state should have “a strong interest in assisting its economically and medically needy citizens.” However, to date it appears that the state’s interest in this matter does not extend to expanding prescription drug coverage for the elderly.

Even with government-controlled prices many of my elderly patients on fixed incomes cannot afford their medications. In Canada, every province has addressed the prescription drug needs of seniors by providing prescription drug coverage. When the New Brunswick provincial drug plan was first introduced it provided prescription drug coverage that adequately met the needs of most patients.

Unfortunately, as with most government-run drug plans, over time, restrictions on reimbursement for new drugs and other cost control mechanisms like prior authorizations, have meant that today only older less effective drugs are covered, making it difficult for physicians to ensure that their patients get the safest and most effective medicines available.

For the past several weeks, New Brunswick physicians have been boycotting the prior authorization requirements of the government run drug plan because it harms patients and impedes a doctor’s ability to prescribe the best treatment for patients.

Years ago, Canada had a health care system that was the envy of the world. Unfortunately years of cost controls and rationing have taken their toll. Just last month newspapers in Maine carried front-page stories of New Brunswick patients being bused to Maine for cancer treatments. Rationing, cost controls and expenditure caps in Canada are further compounded by the “one size fits all” approach that does not allow patients the choice to access services outside of the government run system in Canada.

The political leadership both in Maine and in the U.S. Congress would do well to learn from both the strengths and the weaknesses of Canada’s 35 years of experience with government-run health care. Its strength is in the comprehensive coverage it provides for insured services. Its weakness is in its cost controls and rationing and the lack of choice that it provides to patients.

The courts have given Maine a second chance to make coverage, not controls, the issue. Hopefully, when the dust has settled after this election, instead of Canadian-style price controls, Americans will have a Medicare prescription drug benefit that provides both coverage and choice: one that Canada can learn from.

Anthony Lordon is a physician in New Brunswick.