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 Post subject: Go Canada
PostPosted: Mon Mar 05, 2018 11:50 pm 
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Common sense from North of the border!

https://www.theglobeandmail.com/news/national/opioid-addiction-should-be-treated-with-prescribed-medication-when-possible-new-canadian-guideline-says/article38205601/


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 Post subject: Re: Go Canada
PostPosted: Tue Mar 06, 2018 12:09 am 
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It is about time the truth came out about this medication that can save countless lives. Canada, you rock!

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 Post subject: Re: Go Canada
PostPosted: Tue Mar 06, 2018 8:29 am 
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Wow! I've always thought Canada was awesome!

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 Post subject: Re: Go Canada
PostPosted: Tue Mar 06, 2018 12:47 pm 
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Did you see that the buprenorphine medication only costs $153 a month, and that's in Canadian dollars, which is about $119 in U.S. dollars.

Amy

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 Post subject: Re: Go Canada
PostPosted: Wed Mar 07, 2018 10:28 am 
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Amy-Work In Progress wrote:
Did you see that the buprenorphine medication only costs $153 a month, and that's in Canadian dollars, which is about $119 in U.S. dollars.

Amy



That just means that big pharma is enjoying the opioid crisis ...probably as much, if not more than the addicts who are using opiates and still enjoying the high. It's a sad thing...just knowing that someone is cashing in on people who are so close to dying.

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 Post subject: Re: Go Canada
PostPosted: Wed Mar 07, 2018 1:34 pm 
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I've never doubted that big pharma is enjoying the opiate crisis. But the Canadian government has put cost controls on pharmaceuticals and I can't see that happening in the states because of the way our elections are allowed to be influenced by the money from big corporations and the people who use their wealth to maintain the status quo.

Amy

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 Post subject: Re: Go Canada
PostPosted: Fri Mar 09, 2018 1:07 am 
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I have a patient who drives or takes a bus 6 hours from Ontario (Canada) to see me for treatment. The nearest buprenorphine program for her is 8 hours away, and has a wait of over a year. I appreciate that the government 'up there' understands the advantage of medication-assisted treatment, but they still have to find doctors to prescribe it!

The secret to affordable healthcare in Canada is 'queuing', which has people on both sides arguing about the true time people wait for care. But there is no question that elective and priority procedures require significantly longer waits than would be acceptable to most of us in the US. It is easy to say we wouldn't mind waiting, but most of the people who call me to schedule appointments get upset when I have nothing open for a month. Waiting a year for a psychiatry visit during a depressive or psychotic episode, or waiting for a year on crutches for a knee scope, will generate a great deal of anger at whichever party ushers in THAT system-- and I'm sure money will be spent on both sides of that battle!

The Canadian Institute for Health Information is one of the agencies that collects average wait times for PRIORITY procedures https://www.cihi.ca/sites/default/files/document/wait-times-report-2017_en.pdf. Their benchmark for repair of a hip fracture is less than 48 hours. When I was an anesthesiologist, I would be woken up to go in for repair of a broken hip, and the repair would be complete within 8 hours of the patient coming in the door. Waiting two days in traction with a dislocated hip fracture would be a very uncomfortable experience (not counting the ambulance ride to hospitals, which are much further apart), but it lowers costs further, since mortality increases with wait time in these typically elderly patients. The times in the study are a bit misleading because they are for priorities-- not for general, non-priority care. Even for priorities, breast cancer surgery requires waiting a month, and a couple months for other cancers. Half of patients wait longer than 3 months for an MRI, whereas you'll have one in hours in small-town Wisconsin.

There is a balance in there somewhere, of course. But cutting costs will require very large changes for consumers. The favorite statistic for one side of the argument in the US is comparing infant mortality, which is claimed to be a measure of good healthcare... but that's only accurate if we let social services serve as the best proxy for quality of healthcare. Most patients in the US receive healthcare in their hometowns that has little to do with the issues that lead to infant mortality (like prenatal care that is absent due to the patient's lack of seeking it, and cocaine use during pregnancy). My satisfaction with healthcare ebbs and flows depending on the illness, but I see 'quality' as being the nature of the care provided to people who want care... not the care provided to the person who has medicaid, with laws the prevent denial of care during emergencies or pregnancy, but who never sought care).

There are many sources of data; the next linked study shows the big differences on both sides of the equation, with higher costs in the US and longer waits in Canada, especially for non-emergency surgery or specialty care. I like this one because it has doctors decide when the wait is too long. I suspect that consumers get used to either system, but doctors form their opinions (hypothetically at least) based on safety: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3298024/

I thought it interesting that the number of doctors thinking changes are necessary in healthcare systems are not all that different between Canada and the US.

We all know the current system is failing. Yes, Republicans haven't poured the tons of money into the system that would be necessary to make the ACA work.... but Democrats didn't provide for that funding either when the law was passed, even with a filibuster-proof majority in the Senate and control of the House and Presidency. They knew the costs would have caused even more of them to be voted out, so instead of writing the expense into law, the President had to fund the massive bailouts to health insurers to get them to participate. The spending was unconstitutional of course, since only Congress can appropriate money.... and the hope was that the next President would keep the funding going and whether the court challenges (a risk grossly underestimated for a law supported by only half of the country). Meanwhile even with Obama trying to save his signature accomplishment, insurers only received ten cents on the dollar to cover their losses, so by 2016 most parts of the US has only one or two companies that participated in the exchange. About 4 years ago I had 4 or 5 insurers to pick from (down from 10-15 competing for my business 10-15 years ago). Each year for the past 4 years the insurer I happened to choose left my state, requiring me to change not only doctors, but hospitals, from the one in my town to one about 20 miles away. This year I had one choice-- 21 K for a healthy 50-y-o couple, with 10 K per person deductibles. Not much choice and not so affordable. Trump removed the personal mandate starting in 2018, but after a couple threats last year he is still paying the insurance bail-outs.... at least until the Supreme Court finds the payouts unconstitutional, which most legal scholars predict will happen eventually. Thank God that the healthcare system is faster than the legal system!

I don't know the answer, but it won't be easy, and half the country will any answer to be unfair. Nobody needs a hospital and fully-staffed ER in their town.... until they do. Your 2-y-o has a seizure, then another.... are you OK with waiting 2 months for a neurologist or 6 months for a pediatric neurologist, then another 3 months for an MRI, knowing the seizure could be caused by a malignant cancer? Knowing that each seizure makes it less likely that eventual medication will be effective? Or if your spouse has colon cancer are you OK waiting 2 months for surgery, knowing how serious things get if a few cancer cells spread to the liver?

None of this even gets into the fact that most of the advances in surgical technique, cancer treatments, and medication development come from the US. Canada 'freeloads' on those developments with their cost controls, so that a greater percentage of the cost for development is paid by consumers in the 'free-market' US. Canadian numbers also benefit by having 30% of their healthcare costs paid through private contracting (i.e. rich people paying for faster care), including by patients who travel to the US. That 30% reduction in needed care artificially lowers the apparent costs for healthcare in Canada.

Tough decisions ahead. Good reasons to exercise, eat right, and stop smoking!


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 Post subject: Re: Go Canada
PostPosted: Fri Mar 09, 2018 3:56 pm 
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I have a very good friend in Canada. She lives in Quebec province. Her younger son is 2 and has had pneumonia twice and for a while they thought he might have a form of cystic fibrosis. She has taken him to the hospital several times while they have tried to figure out what he needs in terms of medications and therapies. Her son is seen right away. Alex, herself, had abdominal pain and went to the hospital for it. They quickly diagnosed her with an umbilical hernia, admitted her, and performed surgery to fix it that same day. Her experience has been that anything emergent is taken care of right away.

At the other end of the spectrum, her older son was sexually abused by the father of her younger son. The amount of effort and time she had to spend trying to get psychological help for her son is disgusting. He JUST started individual therapy as his problems weren't deemed serious enough before. So they had put him in group therapy, which he was kicked out of for behavior problems (duh), and only then did they decide to have him try individual therapy. Meanwhile CPS was having both boys do supervised visits with this man! Apparently the social worker in charge hadn't read the file and didn't know how bad the abuse was. They didn't believe Alex (my friend) for a long time, even though they had her older son's statement about what happened!!

I think it's a good example of the pros and cons of the Canadian system. My friend is so typically Canadian that she, at first, didn't advocate for her son because she didn't want to seem rude. (Plus she was neglected by parents with addictions, so it's hard for her to think of herself as important or able to affect change.)

Obviously, priority care hasn't been an issue for Alex. She and her sons have always been attended to right away for priority issues. So, perhaps there has been improvement in that area.

Meanwhile, my husband, who has nerve issues in his right arm causing pain and weakness, is having to wait until the end of March for surgery. He started the process of getting checked out for it in late January. So things aren't perfect here in terms of queuing either.

And we need to find a way to prevent political decisions made with only corporations in mind. How can we ever get to a fair system when so much money is allowed to be spent to lobby and influence our elected officials. And unfortunately, those politicians keep telling us that the best way for our lives to improve is to give corporations what they want in terms of profits and influence. That's just a pack of lies. But it convinces a lot of people.

Amy

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