I think Mr. Webber's amendments amount to a difference without a distinction. Changing my word “emergency” to “immediate” is of no consequence whatsoever. In fact, I would argue that “emergency” probably has more impact than “immediate”.
Second, as to adding fentanyl, fentanyl is an opioid, so when you say “opioid crisis”, that includes fentanyl. When he adds the words “in light of the crisis in Canada”, that's already understood. It's just an elaboration on the opioid crisis.
Finally, to determine what action would be taken, my motion is to undertake an emergency study of the opioid crisis in Canada. I believe it is obvious, clear, implicit and understood from the motion itself to be a study to determine what action should be taken. That's understood.
I don't think any of the amendments add anything to the motion as it stands. With great respect, it appears to me that pride of authorship is trying to take priority over getting to the actual substance of it, which is to get this committee to recognize the opioid crisis and to start studying it as soon as possible.
The reason that I don't think “immediate” is appropriate is that “immediate” suggests a certain time for action. An immediate study would mean we start studying right now. Do we suspend the pharmacare study right this moment and get at it? I didn't think that was fair to the committee. Although we, on all sides of this table, recognize the importance of this issue, we also recognize that we'll have to do a little bit of planning. We have to get witnesses before this committee that will be able to give us good advice on opioids. That's going to take a little bit of time, so I don't think we can start this study immediately. My motion recognizes that it's an emergency. It gives us the flexibility to take the next three or four days to suggest witnesses and to allow the analysts to plan the meetings. We have witnesses lined up for pharmacare for next Monday and Wednesday.
I think my motion does everything Mr. Webber wants it to do. If we're really interested in this, let's get at it, vote on the motion, pass it, and then we can get at the pharmacare study.
I have a point of order, Mr. Chair.
The reality is that the committee is the master of its own domain and it can study whatever it chooses. As the committee's mandate on its website says, “The Standing Committee on Health may also study matters the Committee itself chooses to examine.” If the committee decides that it's going to study this hospital or any hospital, it becomes in order.
I'd normally not bring a matter related to a particular hospital to a federal Commons committee. This is not a normal circumstance. We now have multiple federal ministers involved in the matter. We have a federal agency, the National Capital Commission, which is exclusively the mandate of the federal government, involved in identifying possible locations for this site. One of the locations proposed is Tunney's Pasture, which is, as you know, a hub for federal public servants. It's entirely federally owned land.
In other words, all of these matters are in the federal sphere. I wish they weren't, quite frankly. I think a lot of times local Ottawa residents wish that the federal government weren't so involved in localized decisions of this nature, and if that were the case, then I wouldn't be here today.
Mr. Chair, I can assure you, you being a very assertive representative for your area, if the federal government were involved in locating a hospital in your community, you would be at this table pounding your fist very aggressively and you would insist that it was in order. Fortunately, for most communities, the federal government is not involved in selecting a site location for a hospital. In my case, unfortunately, it is involved and, I would argue, far too involved. Because of that, it is appropriate that we, as a committee, study that question.
Why the health committee? Very simply, the facility in question is a hospital which is by definition a health care issue. I ask that we have a vote on the matter and if members agree with you that this hospital should not be studied in the health committee, then they can cast their vote accordingly, and if they agree with me that we ought to consider it, then we can work with your clerk to schedule times for hearings.
I'm not here to waste time. I'm not going to run out the clock; I know you have witnesses. All I'm asking for is a vote on my motion.
Thank you to the members of the committee for the opportunity to participate in the hearings today on the development of a national pharmacare program.
As was said, I am Jim Keon. I'm the president of the Canadian Generic Pharmaceutical Association.
CGPA is the national association that represents Canada's generic pharmaceutical industry. For more than 50 years, Canada's generic pharmaceutical industry has played a vital role in the country’s healthcare system and its economy by providing safe, effective and proven alternatives to more expensive brand-name medicines.
Increasing access for patients and helping ensure the viability of drug plans—and, more generally, of the healthcare system—are key values of Canada's generic pharmaceutical industry.
To further gauge our contribution, some data provided by IMS Brogan is significant. In Canada, generic drugs are used to fill 69% of all prescriptions, but represent only 22% of the $26 billion spent each year on prescription drugs.
I will say a few words on national pharmacare. We believe that a national pharmacare program in Canada has the potential for improving prescription drug care in Canada for Canadians. CGPA would welcome the opportunity to play a key role in building a better prescription medicine coverage system for all Canadians. A national program could lead to better and more efficient decision-making regarding which drugs should be covered and how and when they should be prescribed.
There may also be savings by rationalizing the duplication caused by the varied formulary listing processes employed by each separate province and territory, which increase administrative costs for both drug plans and pharmaceutical manufacturers, and leads to uneven patient access and care across Canada.
I will add a few words on what we have been doing so far. I think it's important for the committee to know that in terms of sustainability and national coordination, CGPA and Canadian provincial governments, primarily, are already engaged in significant and direct actions that are yielding important results.
In 2010, Canada's provinces and territories established the pan-Canadian Pharmaceutical Alliance, or pCPA. All new brand drugs in Canada are now considered for national price negotiation through pCPA, and earlier this year on their website it was indicated that over 100 joint negotiations had been completed.
For the generic side, which I'm speaking to, participating jurisdictions, which now include the federal government and the federal government plans, and CGPA agreed to a national generic tiered pricing framework. As part of that pCPA-CGPA framework, beginning back in April 2013, 18 of the top-selling, high-volume generic prescription medicines had their prices reduced to 18% of the equivalent brand-name drugs. That saves the health care system more than $1.6 billion over the life of the agreement. These results are important given that the total annual or reimbursed generic prescription drug sales in Canada are only $5.5 billion out of the total spend of $26 billion.
I won't go through all of my comments.
A PMPRB-based study earlier this year indicated that the most effective way to save further would be to increase utilization of generic medicines. Not only has the pCPA-CGPA framework provided enormous savings to the Canadian health care system, it also has fostered greater pan-Canadian co-operation. Despite the strain on the generic pharmaceutical supply chain in Canada from the lower pricing, it has helped to bring much-needed stability and predictability for manufacturers attempting to bring cost-saving generics to the market.
Again, I will not go into detail, but I think some of the studies that we have seen on national pharmacare, in our view, provide unrealistic estimates of savings. As I said already, we have been negotiating with provinces on pricing, and now with the federal government drug plans, for several years, and unless you think that the provinces have done a very poor job, they're already getting prices that they've negotiated and feel are fair and just.
I will make a few closing remarks.
Due to the developments such as the pCPA-CGPA national generic tiered pricing framework, generic prescription medicines have never been of greater value. It's time for Canadians to fully capitalize on these lower prices by increasing utilization. As noted above, the PMPRB report, the “CompassRx” report, released last year confirmed that the most significant factor for controlling prescription drug costs in Canada would be to increase utilization. The use of generic medicines saved governments, employers, and patients nearly $15 billion last year. It is estimated that for every 1% increase in the use of generics, Canadians would save an extra $434 million. I said in my comments in French that the utilization in Canada now is at 69% of all prescriptions that are filled with generics. In the United States, it's 89%. We still have a long way to go to increase utilization and savings.
In closing, significant progress has been made through the pan-Canadian Pharmaceutical Alliance, specifically the pCPA-CGPA national generic tiered pricing framework. If a national pharmacare program is to be implemented, the generic pharmaceutical industry and generic prescription medicines will be key to its viability and sustainability. CGPA and its member companies remain committed to working cooperatively with all stakeholders to improve prescription drug coverage for Canadians.
Thank you for the opportunity to appear.
On behalf of the BIOTECanada members, thank you to the committee for giving us the opportunity to speak today about these very important issues.
I'll briefly introduce our industry.
Biotechnology is a pretty broad envelope. It includes health biotechnology, but also for BIOTECanada we have members that are in the industrial, agricultural and environmental space. We'll focus uniquely on the health side today, but we do have members in the other parts of biotechnology.
On the health side, our members include many of the large multinational corporations that are brand names that everybody is familiar with across the country, but they are a very small percentage of our membership. The vast majority of our membership is comprised of small commercial companies that have a new innovation they're trying to commercialize. They're across the country in every province and are usually found in clusters that are centred around either hospitals or post-secondary university institutions. They are driving these innovations forward. They're driving the innovations forward for a world that's in a bit of trouble right now. Whether we're at 6.5 billion or 7 billion people, we're moving very quickly to 9 billion people. That's putting enormous pressure on the planet. It's changing our environment and we're dealing with a changed environment. We need to find solutions for those pressures that are being placed on the planet but, more importantly, for the pressures that are being placed on the people who reside on the planet. That's where biotechnology comes in. It's a solution to many of those challenges.
In the health space in particular, as we see with the emergence of new diseases across the world, we also see the growth of what we could consider traditional diseases, ones that we've been used to in the western world, that are emerging now in other countries. As their economies grow and they start to take on a more western-style diet, we're seeing similar diseases emerge there. Obesity, hypertension, diabetes, asthma, all of those we've been used to are starting to become prevalent in those countries as well. We have to find solutions for those.
We also have to take advantage of the fact that we can now map the human DNA. We know what the genome looks like and we have an ability to predict what sort of diseases are going to impact people, but also, we can come up with very specific cures for those challenges. That's an enormous opportunity. It's an enormous economic opportunity for Canada, because as a country we have a long-standing history of developing innovation in this space, from early days of vaccines, whether it's in the polio world, right through to developing solutions for other issues, including our contribution to the Ebola virus.
There's more to come. There's a great opportunity out there for this country, and we have, as I say, a long-standing history. We have a great set of institutions. We're developing great science and scientists who are moving these innovations forward.
I'll give you one example of an innovation. It comes out of New Brunswick. It is based on the saliva of the shrew, the lowly shrew that is a sort of little forest mouse. It has a paralytic quality in that saliva, and the paralytic quality is peptide. There's a professor out of UNB who has discovered there's an application there for a rare form of ovarian cancer. That's a remarkable development from something that seems so innocuous as a shrew out of the woods. But he has to get financing and partnership to move that forward and create a Canadian company, and that's the sort of membership we represent.
There's thousands of those out there across the world. Canada's not the only one developing these. We know there's more coming. There are great solutions. We're seeing solutions to what were once death sentences, whether it be in the world of AIDS or other afflictions, that are no longer death sentences. These are cures for many of these diseases, or at least prolonging life and turning them into simply chronic illnesses rather than a death sentence.
That's enormous innovation, but they do come with a cost. We're aware of that. We know the pressures that the provincial governments and the other payers are under. We think it's an important and timely opportunity to have this sort of study to figure out what those solutions can be to address it. At the end of the day, what we want to make sure of is that the solutions get to the patients. It's about health care. The industry absolutely stands ready to address those challenges with all the stakeholders, as Mr. Keon said. We do want to sit down. We think we can be an important part of the solution, driving this forward on behalf of all patients.
I'll leave it at that. Thank you very much, and I look forward to questions.
Good morning, and thank you, Mr. Chair and committee members, for inviting me to speak with you as you explore the development of a national pharmacare program.
I'm a fourth year medical student at the University of Saskatchewan's College of Medicine, and I'm currently serving as the vice-president of government affairs for the Canadian Federation of Medical Students.
The CFMS represents over 8,000 medical students from 15 medical schools in Canada. In total there are 17, and the Fédération médicale étudiante du Québec represents the rest of those students. As the national voice of Canadian medical students, our mission at the CFMS is to connect, support, and represent our membership as we learn to serve patients and society.
The CFMS is grateful to be here to present our medical student perspective on the issue of pharmacare. It is our hope that in conjunction with other stakeholders we will be able to inform the body's final recommendations to Parliament.
Let it be known that the CFMS strongly recommends public universal single payer pharmaceutical insurance that will help our future patients to access the medications they need through an evidence-based and cost-effective system.
To highlight some of the problems with the current system, we've focused on the fragmented coverage and the exorbitant costs. Canada is the only nation in the Organization for Economic Cooperation and Development, OECD, with a universal health care system and no corresponding universal pharmaceutical coverage.
Outpatient pharmaceutical costs are covered by a combination of public, private, and out-of-pocket sources, and vary widely between regions and individuals. This fragmented system is financially untenable. Our annual rise in prescription drug expenditures is increasing faster than any other country in the OECD, and our medication prices are among the highest in the world, approximately 30% above the OECD average. Due to the relatively low proportion of public funding of pharmaceutical expenses, these costs come out of the pockets of your constituents and our future patients. Under the current state of affairs, one in 10 Canadians cannot afford their prescribed medications, with an even higher rate for low-income households.
As outpatient pharmaceutical therapy in many cases presents, replaces, or has come to complement the in-hospital treatment that our publicly funded system was created to cover, it's clear that a move toward covering outpatient pharmaceutical therapy is needed to keep our health care responsive to patient needs. Quality patient care does not stop at the hospital door, but ensures continuing care in the community.
For benefits that we see for pharmacare's access to medicines, the 2013 C.D. Howe Institute's report examined medication compliance in jurisdictions with different out-of-pocket costs and showed that a lower cost leads to a greater adherence to medication. By far the greatest compliance is in the U.K. and in the Netherlands where coverage is universal and copays are very low.
There is also safe and evidence-based prescribing that will come with pharmacare. Creating a national formulary of insured medications would help standardize practices and ensure that Canadians are being prescribed safe, effective, and evidence-based therapies from coast to coast to coast. It should be noted that best evidence prescription guidelines have cost-effectiveness as a key component in their creation. As such, covering necessary medications does not mean covering new and expensive drugs in most cases. Having a national pharmacare program would inform research aimed at improving prescription practices and ultimately would save costs.
On lower costs to the system, administrative costs of private health insurance amount to 15% of the total cost in Canada compared to 3.2% for publicly administered health care. Moving to a single payer system in Canada would save up to $1.3 billion, by some studies, abolishing the need for advertising in the private insurance market.
Another analysis showed that the government could expect the most likely base cost increase—and I know you've heard from Dr. Martin and Dr. Morgan—of about $1 billion, which the authors did not view as prohibitive to justifying a single payer pharmaceutical model. Employers and other providers of private medication coverage would save up to $8.2 billion according to the same recent analysis. In total, the net savings on prescription medication would decrease by $7.3 billion with that plan in the study from Morgan et al.
To highlight the medical learner perspective, and where the medical students are coming on this issue, we find that it's a cognitive dissonance that we have to reconcile the true state of access to medicines in this country with what we're taught in medical school. We're taught that in Canada all persons should have access to the care they need, that every life is equally precious, and that it's our role to treat patients in accordance with the most up-to-date principles of science and evidence.
However, as we move out of the classroom into the wards and into practice, we witness our professors and mentors spending hours fighting for patients, advocating for their access to needed medications. We also see that our future practice will in many cases be defined by something we are not really trained to do, which is trying to work around the system in order to ensure access for our patients.
What is worse is that the outcomes of these advocacy efforts are neither consistent nor sustainable. For every patient we are able to help, we know there are many we will not. This generates an added level of professional stress, which is not conducive to physician or system wellness and will ultimately impair our ability to deliver the quality care all patients deserve. A national pharmacare program would help mitigate these problems and allow us to focus on what is most important: treating our patients.
Personally, I recently had a disheartening experience. A patient I was seeing in clinic had not been in to see his physician for over two years, which is totally normal for a 40-year-old male. However, this patient is a type 2 diabetic and needs routine screening. I asked what was keeping him away for so long. The last time he had been in, he was going through a divorce. He had since lost his job and ultimately could not afford his medications. He was now back, two years later, with a job that covered his health expenses through the company's health insurance plan. As you can imagine, he had many negative consequences from two years of non-compliance with diabetes medication: weight gain, high cholesterol, vision problems, and the list goes on. The implications of that to the health care system in the future are something I haven't calculated, but I know it would be quite high.
Unfortunately, medical students hear stories like mine all too often, when we are on the wards, in our discussions with preceptors, and in conversations with our peers. It is difficult to reconcile the treatment protocol we learn in class, as learners, with what we are asked to practice in the community. We learn which medications have the best evidence for treatment, yet when we practice in the community, we must learn a new set of prescribing skills, which includes looking for the cheapest cost and the drugs that our patients can actually afford.
Our organization's position is that students across the country are passionate about the issue. For the past few years, our organization has chosen pharmacare to be the focus of our advocacy efforts. As many of you are aware, or I hope you are, we hold an annual lobby day on the Hill. Both in November 2014 and February 2016 we came to discuss pharmacare with the members.
Furthermore, we have launched a campaign called “Humans of Pharmacare,” where we are gathering ideas and stories from physicians, pharmacists, medical students, allied health professionals, and patients about how our current system is negatively impacting the quality of health care delivery.
In the spring of 2015, our organization passed a motion entitled “Pharmacare: Promoting Equitable Access to Medications”, which can be viewed in its entirety on our website. The four key recommendations from that paper are as follows:
Number one, the Government of Canada should establish an evidence-based national formulary of safe, efficacious, and cost-effective medications.
Number two, the Government of Canada or a pan-Canadian agency should support bulk purchasing for all medically necessary medications. Since that publication, the federal government has joined the pCPA. Although there is sure to be an increase in savings on top of the $490 million, with the federal government being a part of it, the pCPA is far from a perfect solution. Public insurance plans cover only 42% of national medication costs, and coordination between provinces is a complicated process. The pCPA has significant natural and logistical limitations as well. With the consolidation of a fragmented system of coverage into a single purchaser for the country, we can expect increased purchasing power to drive down prescription costs.
Number three, the Government of Canada should support the development of a public, universal, single-payer pharmaceutical insurance, as I highlighted at the beginning.
Number four is that we want to see collaboration between medical education stakeholders in Canada to ensure that the implementation of pharmacare is accompanied by renewed educational efforts for evidence-based prescribing, which is an important piece of this.
Our membership has spoken loud and clear. Pharmacare is important to the future physicians of this country, those of us who will be taking on writing prescriptions and treating patients in the years to come. Public, universal, single-payer pharmaceutical insurance is needed in Canada, and any other manifestation of the same would be a disservice to our patients and society. Pharmacare truly is the missing piece to Canada's universal health care system.
Thank you very much. We look forward to your recommendations.
Thank you for the opportunity to speak with you today about a matter that touches us all, access to medicines for all Canadians.
I'm the chief science officer at the Canadian Diabetes Association, and I speak to you in that capacity, because having access to medicines is essential for more than three million Canadians who've been diagnosed with diabetes.
People with diabetes rely on medications to manage their disease and to achieve better health outcomes and quality of life. Unfortunately, not all of these patients have access to prescribed medication because of cost. This is problematic for the individual, their family, the health system that has to manage the health impact of poorly managed diabetes, and also to our society. We've become a country where access to essential medicines is determined by the place you live and how much money you have.
A survey in 2014 shows that 32% of people with diabetes took three to four drugs, 40% took five to nine drugs, and 12% took 10 or more medications. As you know, public coverage varies widely, depending on an individual's age, the amount and type of medication required, and their income. With private insurance such as employer insurance plans, drug access also varies considerably.
Hefty out-of-pocket costs can force people to have to choose between paying for food and rent or buying medication and supplies. People with low incomes but above the threshold for social assistance, those who work part-time, and those who are self-employed are the ones most impacted by out-of-pocket costs. We hear stories about people who have to make tough choices to pay for medication and the resulting impact that has on their physical and mental health and on their families. There are parents with type 2 diabetes who forgo their medication because their children need things like clothes and school supplies.
Drug costs are particularly difficult for chronic disease patients and those earning a low income. One study showed that 23% of people with chronic disease skipped medication due to cost compared to 10% in the overall population. In the diabetes population, our 2015 survey showed that 25% of people with diabetes reported that their adherence to prescribed therapies was impacted by cost. In another study, people with diabetes who lacked insurance were five times more likely to skip medication compared to those with insurance. Some individuals cut their dose in half just to make the medication last longer. The risk for medication non-adherence is greater for an asymptomatic condition like diabetes because, if the person skips the medicine today, they may not feel any different; however, over the long term, medication non-adherence increases the risk of the complications of diabetes such as blindness, amputation, and heart disease.
More and better treatments for diabetes have become available, and they are leading to better health outcomes for those who take them. Over the last two decades the rates of major complications of diabetes, such as heart attack, amputation, and stroke, have been cut in half, and that improvement is attributed almost entirely to the use of evidence-based therapies. Unfortunately, not all Canadians stand to benefit from these advances because they can't afford them.
There have been studies that have shown that a national pharmacare program or drug plan, one that replaces the current mix of public and private plans, could reduce public and private spending on prescription drugs. I'm not here today to advocate for a specific model, because there are benefits and costs to each of the different approaches, and these have not been clearly laid out for Canadians to understand. It is clear that getting people the medicines they need by removing cost barriers is something that resonates with Canadians.
This brings me to our first two recommendations: first, that the Government of Canada study the benefits and costs of various approaches to national pharmacare that would offer universal access to Canadians and publicly report on the results; and second, that the Government of Canada should adopt an approach to national pharmacare with a goal to reduce out-of-pocket costs for people with diabetes, to eliminate costs as a barrier to optimal drug therapy and better health outcomes.
It's critical that people with diabetes be active participants in the design, development, and implementation of a system that will ultimately be serving their medical needs. Patients must be at the centre of changes to the system. Our next recommendation is that people with diabetes be included as active participants in the development and implementation of the government's approach to national pharmacare.
As a clinician, I know that getting patients the right medication for their condition is partly the responsibility of the health care provider, so a national approach to pharmacare that is about improving access to needed medications should include supporting optimal clinical practice. One of the most effective ways to promote appropriate prescribing behaviour is with the assistance of proven technologies such as the electronic medical record.
Decision support tools encourage evidence-based prescribing by health care practitioners to help ensure individual patients receive the most clinically appropriate, safe, and cost-effective treatment for their disease. Providing health care practitioners with best practice information at the point of care to support their decision-making has been shown to improve outcomes, specifically for patients with diabetes. This support is an important component of leading the charge to ensure the right patients get the right drugs. So our final recommendation is that the Government of Canada take a leadership role in implementing support tools for diabetes management by incorporating electronic medical records into health systems within their jurisdiction and encouraging the provinces to do the same.
Again, thank you for your interest in this vitally important topic and for the invitation to speak with you. I look forward to our conversation.
Thank you very much for your testimony.
I have to say that I quite regret that we weren't able to hear your full 10-minute presentations because of timing on the committee, but if you would consider submitting your remarks, I can absolutely assure you that I and my colleagues will read them quite faithfully to make sure we've heard your full comments. So thank you for that and thank you for what you represent.
My first question is for Mr. Casey. It's dealing with the affordability of immunotherapy and biologics associated with immunotherapy. There's a really good example, I think, that we've read about. Paul Henderson, our very famous hockey player, was diagnosed with a form of leukemia and the treatment was Imbruvica. I'm probably mispronouncing that. It was very successful, but the cost of that is about $100,000 per year, and that could continue for the rest of a person's life, depending upon the response to it.
The median individual income in Canada is around $27,600. Even for the highest one per cent of Canadians, the average income is $381,000. So we come to the amazing new treatments and drugs that will absolutely lead to return to health and ongoing life, and how we afford them. We've also heard that the employer-based private sector plans, because of some of the burden of these new drugs, are either cutting back the percentage that they'll cover or simply cutting pharma significantly out of their benefit plans for their employees.
It strikes me that either we embrace the new technologies and through a national pharmacare program look to how we share the costs of these treatments collectively, or we end up with a very small percentage of Canadians who can afford a private insurance plan that would provide coverage.
Do you have any reaction, any thoughts, on how we make these drugs affordable, and any reaction to my comments about pharmacare versus private plans?
I want to thank all the witnesses for being here today. I want to throw out a few questions.
Mr. Keon, maybe you could start with the answers, because I do appreciate your institutional knowledge. I think you've been coming to this committee since I've been on it, on and off since 2004.
You made a comment that I think is really important. Why are we doing this, and how do we actually define the problem? We've heard from different people that some of the statistics we're relying on are from a Canadian standpoint and haven't even been really updated since the Romanow report.
A lot of assumptions are being made. I believe Mr. Davies repeated a couple of things we've heard over and over, that 20% of Canadians don't have adequate coverage. Yet we don't really know who defines adequate coverage. He mentioned seven million Canadians walking around without coverage; they can't afford the medicines they need. We do know there are a lot of Canadians out there who don't have coverage, but they don't seem to have a problem financially covering their medication, maybe because of different financial situations they find themselves in.
If you take a look at a long-term situation, and, as I said, some of these statistics have not been updated since the Romanow report, Canada has changed a lot. Employment benefit relationships have changed greatly. We have more people working part-time. We have pensions and pension benefits that have changed. We have more seniors, as a demographic moving into a situation where maybe they have coverage now because they're a little bit older.
I want your opinion and that of the rest of the panel. Do you think the federal government should update its statistics to ensure that we have an accurate picture of the current medical benefits situation in Canada?
Also, without recent statistical evidence, do you think our recommendations could be irrelevant, albeit well-intentioned? What are your thoughts on that?
Thank you all for coming.
I have a very quick comment to Ms. Harris.
Thank you. I know how busy it is to be a medical student. I graduated in 1993, and for you to have the time to do this with your studies is a tremendous accomplishment.
Regarding the heartbreaking story that you told, I'll tell you that after 20 years of medical practice, you will see that on a weekly if not a daily basis depending on your practice, which is one of the reasons I am now in this new career.
In regard to diabetes, this is something I've been using in many of my examples, and again, from my practice. I practised emergency medicine in an inner-city hospital. There was a very poor population and a high number of aboriginal patients. We know the rate of diabetes in that population. I see the costs of non-compliance; they are acute. I know that people with severe DKA, diabetic ketoacidosis, will often end up in the intensive care unit, and we know how expensive that is. Then add in amputations, heart attacks, strokes, and dialysis.
I may be asking a question that has already come to you in a different way. Just in relation to this disease, if you look at what non-compliant patients, the ones who are non-compliant because they can't afford it, are costing the system in medical costs compared to what it would cost to make sure that everyone had their medication paid for by a universal system, would there be a balance? Would it still be costly to be supplying everyone with their insulin, or would that be more or less offset by these savings to the system?