Chapter 17 :   A Claim of a Right to Health Care

Section 1. Case Presentation   Summary by James Rowe, QCC, 2005

Hawaii and Mandated Health Insurance

READ: Hawaii Plan

            In 1975 the Hawaii prepaid Health Care Act went into effect, having been passed the year before. The act required all employers to provide health insurance coverage for all their workers excluding part-time workers who work less than twenty hours a week, equal to 1.5 percent of their wages or 50 percent of the insurance premium. Owing to this, 96 percent of Hawaiians have health insurance, compared to the pre-act 17 percent, with the unemployed and seasonal workers being covered by state subsidies. The coverage encapsulates hospital bills and physician visits, but not prescription medications, vision care, or dental. The result has been, in general, extremely satisfying to the public, and the people have come to enjoy healthier lives, including the lowest level of mortality from breast cancer in the nation, as well as one of the lowest infant mortality rates. Moreover, health costs are thirty percent lower compared to the mainland, with competition from Kaiser Permanente HMO and Hawaii Medical Service Association (a Blue Cross organization) contributing to these low prices, as well as the nature of the system spreading the risk of an expensive procedure over the entire state, also assisting in this lessening of costs.  

            The initial impact of the bill affected small businesses the most, as most large-businesses at the time of enactment all ready provided healthcare. However, despite what may be considered the usual course, the rise in costs owing to the imposition of this mandatory insurance did not significantly cause businesses to collapse, nor did unemployment rise. In fact, more small businesses than any other state in the nation actually support the notion of compulsory health insurance, as well as many small businesses that opt to pay the entire premium seeing their insurance coverage as a way of helping them keep their valued workers. Big businesses share this general approval, also. Of course, not every aspect of the system is liked, with businesses being concerned as to whether or not the state would keep costs reasonable, a fear which was made manifest when the state mandated that all health insurers and HMOs add mental health, drug and alcohol treatment, mammograms, well-baby care, and in vitro fertilization to their coverage. Resenting this move, the businesses rightfully wonder what next they shall be forced to pay.

            Despite the success of this system in Hawaii, it is not necessarily nationally applicable. Hawaii enjoys a small population, a healthful climate, and a workforce heavily apart of unions which can influence businesses. Hawaii has also enjoyed low unemployment and owing to the fact that it has more physicians than specialists, has always been on the vanguard of providing preventive care which ultimately leads to less expensive procedures down the road. That this is not the case in other states would inhibit the capacity for those states to have such a system, as well as the fact that owing to geographical limitations, businesses have less of an opportunity to move out of Hawaii. Whether a similar, although adjusted, system might not be applicable in other states, is yet still a matter of dispute.

The Canadian System: 

            Owing to the United States’ medical system failing to provide for all, some people have increasingly looked towards our neighbour to the North for a new system which may better suit our extensive needs. Canada, in contrast with the United States, has adopted, since 1971, a single-payer national health insurance, which provides one-hundred percent coverage, and although not without draw backs, is worthy of further investigation.

            As noted, the Canadian system was established in 1971, and unlike Great Britain’s system, the Canadian government neither nationalized hospitals nor made doctors employees of the government, but rather did it eliminate most forms of private medical insurance to be replaced by a government plan which was to be administered by the ten Canadian provinces. Paid for by a variety of provincial and federal taxes, it is not so much “socialized medicine” as critics called, but more analogous to Medicare or Social Security. Moreover, the comprehensiveness of the system can be seen that under the plan physician services, diagnostics, testing, hospitalization, surgery, long-term care, prescription drugs for those over sixty-five, and mental-health care are all covered, with the need for private insurance in Canada regulated to the few things which are not covered under the Canadian system. Also, although there is freedom given to the provinces in exactly how much to cover people, each provincial system must correspond to the five principles of the Canadian Health Act, namely, universality, portability, accessibility, comprehensiveness, and public administration. Owing to all this, each Canadian citizen is guaranteed access to a physician and may go to see any primary-care physician wanted and no cost will be incurred should one need hospitalization, testing, or surgery. No patient bills, claim forms, co-payments, or reimbursement is necessary under the Canadian system, with there being only a need to show one’s ID card to get medical services. After treatment physicians need only send the bill to the provincial insurance plan and within two to four weeks he is paid. By minimizing paperwork, this portion of the system is particularly suited for cutting unnecessary expenditures. This system also enjoys an exceedingly high popular rate, with nine out of ten Canadians affirming in 1992 that the health care system is one of the few things which makes Canada the best country in the world to live, with only three percent of Canadians in another poll wishing for an Americanized system, although popularity as a whole for the Canadian system has lowered over the last decade. Most importantly, it also seems to work at both reducing costs and keeping a high level of success, with the infant mortality rate in Canada actually being lower than the United States.

            The Canadian physician is not, on a whole, displeased with this system, either. Although they make less money than their American counterparts, the reduced burden of paperwork and insurance hassles usually makes up for this in part, although some physicians still are not pleased with having to fixed fees for their services determined by the government and Canadian physicians see more patients than their American counterparts. Moreover, the Canadian system, being more focused on primary care, produces more Canadian physicians who are general care practitioners, as opposed to the increasing specialist preponderance in America.

            The Canadian system is, however, not perfect. High-cost medical technology is not nearly as invested in, with the United States usually leading Canada with several times the amount. Similarly, owing to the general-care focus, Canada significantly lags behind the United States in specialist care. Owing to this, long-wait times are common whenever a Canadian must avail himself of these resources, sometimes even reaching the six month point. However, not all procedures have this wait time, with the Canadian government showing treatment usually starts within a week of requesting. Yet despite the Canadian government saying otherwise, it would seem that Canadians support some reform to fix this flaw in their system, with 74% reporting that they’d support user fees that would reduce demand on the medical system in order to hasten the process. Canada has also cut revenue sharing with the provinces, forcing many mergers or closures of hospitals, alongside other limitations placed on the places available for Canadian medical schools. With rising demands, many have also taken to crossing the border to the States in order to seek medical treatment there, with some suggesting that this may be stopped if Canada allows for some for-profit private hospitals to offer Canadians with the money to pay for services that which they desire. In 2002, the government also suggested that $4 billion dollars more be spent on health care to help tackle some of these problems, but critics point out that this may simply be shoveling money onto a system which needs fundamental change, not more money.

            Although positive in many respects, many believe the Canadian system would not fit within the American national character, owing to its restrictiveness, the individualism of the American people, and the unwillingness to vastly increase taxes for medical coverage. Others, however, hold to a more enthusiastic view of the possibilities for the Canadian system to address US woes over the uninsured, the portability of insurance, the lack of universal access, and rising prices. Yet despite what would happen otherwise, if the US were to switch to the Canadian systems, both the insurance companies, doctors, and hospitals would all, to varying degrees, suffer financially, although at the same time, some doctors may be more free to practice medicine in a manner which they deem best. Currently, there is no true resolution to whether or not Canada could provide a model for the United States, and there are no plans in the works to truly change the US system towards it.  

CASE:  “Managed Medicaid at it’s Worst by Alison Prunty (NCC, 2009)


Brian and his Gaucher’s disease, treated with orphan drug by   Paola Kasouto(NCC, 2009)
            Brian, a 2 year old was diagnosed with gaucher’s disease when his spleen grew abnormally large.  He was one of the people used to experiment on with the drug Genzyme.  His condition got extraordinarily better, but when taken off the drug it worsened critically.  He has continued biweekly infusions of the drug and is currently in astounding health, leads a normal life, and has a passion for swimming.  The downside to his situation is the cost of the medication.  It costs around $360,000 a year, therefore it was hard for his father to find a job that would cover this particular expense.  The job he was currently at when his son got diagnosed was very small therefore the cost would be spread amongst a few amount of people so he had to find a larger company to work for.  He now works for a cable company going to about 60-70 doors everyday, but he says it’s very worth it but fears for his son’s future and how would he manage the cost of his treatment.  The reason for such high costs is due to the rarity of the disease leading to high costs to be able to cover for the production of the drug as well as a significant profit for the drug companies.  
This article consists of a compilation of rare diseases.  One of the diseases is Tourette’s which drug companies don’t want to research a drug to help cure it.  There was research underway but it got terminated.  Then there’s a case of Gaucher’s disease in which the situation above was described.  He states “Do you know how many employers Brian may put bankrupt?”
Details on Brian’s case and how he was used for experimentation on the drug Genzyme for Gaucher’s disease.
This article describes the US’s orphan drug law and how it grants the manufacturer 7 years of no competition, meaning that no other company is allowed to produce the drug with the same active ingredient.  This law is believed to be responsible for the surge in orphan drugs to the market.
Orphan drugs for rare diseases
How cost is a big factor on treatment.

Case: Orphan Drugs   by Theresa Walling and Clara Shamatanga (NCC, 2009)
Discription: How the drug companies discontinue making an Orphan Drug because too few "patients" will be purchasing them in order to bring in the big bucks. 
 What is an Orphan Drug?
Article describes what an orphan drug is, and how the United States and European Union governments support orphan drug research and development.
Find information here about drugs developed to treat rare diseases and disorders.
Top Orphan Drugs Approved in 2008
Marketing approval for orphan drugs, specialty drugs created to treat rare diseases, is always exciting. In 2008, the U.S. Food and Drug Administration (FDA) approved several of these drugs that were particularly important.
Orphan Drugs Approved by the FDA for Marketing in 2007
Information about the orphan drugs approved by the U.S. Food and Drug Administration (FDA) for marketing in 2007, including trade and generic names, use, date of approval, and manufacturer.
Orphan Drugs Approved by the FDA for Marketing in 2006
Article lists the orphan drugs approved by the FDA for marketing in the US in 2006, their uses, and their manufacturers.
Two Orphan Drugs Approved
Treatments are now available in the U.S. for two rare diseases: Fabrazyme, for Fabry disease, and Aldurazyme, for MPS I. Both are storage disorders with devastating effects in their severest forms.
Trends in Orphan Drug Research for 2006
Article reviews trends in orphan drug research and the biotechnology industry in 2005 and 2006.
Orphan Drugs Approved in 2005
These orphan drugs (specialty drugs to treat rare disorders or conditions) were20approved by the U.S. Food and Drug Administration (FDA) for marketing in the U.S. in 2005. Internet links for more information are provided where available.
Trends and Issues in 2005 for Orphan Drug Research
Article reviews trends and issues regarding orphan drug research and the biotechnology industry.
Orphan Drugs Approved in 2004
These orphan drugs (specialty drugs to treat rare disorders or conditions) were approved by the U.S. Food and Drug Administration (FDA) for marketing in the U.S. in 2004. Internet links for more information are provided where available.
Orphan Drugs Designated in 2003
These drugs and treatments were granted orphan drug status by the U.S. Food and Drug Administration in202003. With each drug is listed what condition it is designed to treat, and which company is sponsoring it. Links to more information are provided where available.
Orphan Drugs Approved in 2003
These orphan drugs (specialty drugs to treat rare disorders or conditions) were approved by the U.S. Food and Drug Administration (FDA) for marketing in the U.S. in 2003. Internet links for more information are provided where available.
Orphan Drugs 2002
Here is a list of the orphan drugs--medications and treatments for rare diseases--approved in 2002 for marketing, with links to more information about them and the conditions they were designed to treat.
FDA Puts Hold on Gene Therapy Studies
The U.S. FDA temporarily halted gene therapy studies after two children who receive d this experimental therapy for a rare disorder developed cancer. The studies will most likely resume, but with new cautions.
Vaccines for Rare Diseases
What is an orphan vaccine? Why isn't this method of prevention or treatment being developed? Learn how you can network with other concerned individuals, participate in clinical trials, and advocate for more research and development.


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