Forum 360°: Drug insurance - where to go from here?

Tuesday, November 13, 2012

On November 12, 2012, Dr. David Gratzer was interviewed by well-known journalist and television host, Amanda Lang at Desjardins Insurance's Forum 360° in Toronto. Dr. Gratzer delivered a keynote speech addressing the issues surrounding drug insurance and if there are any solutions in sight.

Physician and author of Code Blue: Reviving Canada's Health Care System, Dr. Gratzer is often quoted in the media on health matters, and he has published articles in over a dozen newspapers and magazines including The Wall Street Journal and The Washington Post.

Desjardins Insurance's Forum 360° events discuss current issues in group insurance.

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[Situation: Journalist Amanda Lang interviews Dr. David Gratzer about the role of the pharmaceutical industry.]

Amanda Lang: Welcome to 360° Forum. I'm here with Doctor David Gratzer and we're talking about the role that pharmaceuticals plays in healthcare system. But I want to start with where we stand in terms of medicine. Because there's really been an arc and it's just the last few decades, when we've seen the real pace of change happen in medicine.

David Gratzer: Well, Amanda, as you know, medicine has been transformed, not only the last 600 years, but really in the last 6 or 7 decades. First clinical use of penicillin transforms the world. But since then: steroids, anti-psychotics, open-heart surgeries… The medicine of today is very different than even just 7 decades ago.

Amanda Lang: So characterize this era, relative to some of the other periods that in recent memory we've gone through.

David Gratzer: At the risk of seeming a bit glib, before 1941, first clinical use of penicillin, I would say: medicine: garbage. Well-meaning, well-intentioned. Science is there. In terms of clinical use for you as a patient? Poor. Then you have this period of cure: the antibiotics and suddenly people are much better and don't die of infection as they did before. Then you've got this era of care, which increasingly, we felt, which is, people live longer but not necessarily healthier. I think right now we're in an era of choice. Where increasingly we can choose for treatment and the types of treatment and the pharmaceuticals we may or may not want to have.

Amanda Lang: Let's talk about that care and choice here that we're in now because (David Gratzer: sure.) when it comes to pharmaceuticals, and especially when we think about who's paying what, that's problematic because there are people who can avail themselves of all kinds of drugs (David Gratzer: right) and it costs to the system (David Gratzer: right), who maybe would say… you know, "Don't have the sugary drink and you won't have the diabetes"; "Don't have the greasy food and you won't have the heartburn." Where's the line that we draw here?

David Gratzer: Well that line is blurred. First of all, there are whole drugs that have nothing to do with improving our health. The so-called "lifestyle" drugs. Rogaine for hair loss, which increasingly is important for me. But alas, very different than penicillin in 1940 which is about life or death (Amanda Lang: right). But we're also blurring the line in terms of what sort of conditions we treat and how we treat them. Hypertension is a great example. Millions of people in North America take a drug but probably should watch their diet more and exercise more. So, who makes these choices? Well, right now, in the public system and the private system, no one really. I think in the future, whether we’re talking about pharmaceutical benefits in the public system or the private system, increasingly, people are going to ask harder questions.

Amanda Lang: And does it make sense for insurance companies to play a pretty critical role in that, since they have all of the data about who's using what and what the demographic breakdown is?

David Gratzer: Doesn't matter whether or not it all makes sense. Doesn't matter whether or not it's fair, it's life! I mean, increasingly costs go up and we don't get value for money, and payers, be they public or private, are becoming active managers. You need Lipitor, do you actually need the brand named patented drug at $2.50 a pill? Could you get by with the generic at $0.50 a pill? Could you actually do some exercise? Well, increasingly insurers in the private system in Canada are saying, "Well, we'll push you into the generic." But in the future, I think health is going to be much more in the public discussion.

Amanda Lang: We tend to be down on the system in Canada because of its costs and no question, the costs are escalating. (David Gratzer: absolutely) How do we stack up? How are we doing?

David Gratzer: Well, as you know, I'm a critic of the system. I think it's unsustainable, I think we do a lot of things wrong. But this is actually a feel-good conversation, because context is so important. We've never done better in terms of healthcare. People have heart attacks, they don't just survive, 88% return to their work within a year if they are under the age of 65. I'm a psychiatrist. I don't just treat people and hold their hand. Many of my depressive patients return back to the workforce within months and so on. So, there's never been a better time to be alive. Medicine has never been able to do more for people, but the cost will continue to be an issue

Amanda Lang: Alright, and that's the balance we're looking at. We appreciate your time today.

David Gratzer: Thank you.

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