Social inequities are increasing. The well-off are getting richer and the poor are getting poorer and more numerous. It is estimated that approximately one in four households struggle to pay for groceries, housing, medicine and heating every month.
Homeless people suffering from various dependencies, mental disorders, financial insecurity or wild evictions cannot always find the resources to rebuild a somewhat decent life.
RPAs close, among other things, because residents losing their independence cannot afford to pay for basic care essential to their well-being, such as hygiene care and meal assistance.
It is estimated that there is a shortage of 10,000 to 20,000 health care workers in Quebec. The service offering is deficient. Waiting lists for surgery, medical imaging and other professional services are growing in the public network.
The richest have the leisure to turn to the private sector to avoid waiting lists, often at great expense however, while draining human resources, already in short supply, out of the public network. The vast majority of Quebecers cannot afford the luxury of private life.
Furthermore, advances in medicine are remarkable, but extremely costly. Gene therapy for Duchenne muscular dystrophy or hemophilia B costs a million dollars. Treatment of acute lymphoblastic leukemia with CAR-T cells costs $500,000.
Luxurna, for hereditary ocular dystrophy, costs a million dollars. Fortunately, these diseases affect a very small number of patients and are less likely to strain health budgets. Ozempic at $400 a month seems a bargain, but could theoretically be taken for life by a billion obese people, most of whom do not have the income to pay $5,000 a year.
We hope very soon to diagnose Alzheimer’s disease at an early stage with a simple blood test measuring amyloid and to begin treatment with, for example, Donanemab at a cost of $30,000 annually for several years. More and more expensive therapies are being developed for chronic diseases that affect large sections of the population.
Insurers, private or state, will not be able to cover these exorbitant costs in their entirety for long. Especially since the climate crisis with its share of deadly heatwaves, droughts and floods, the energy transition and the migration crisis are sure to put a severe test on public finances in the short term, not to mention increased military spending necessary in these times of multiple wars, cyberattacks and arms races.
I very much fear that scientific and ethical committees will have more and more heartbreaking and difficult choices to make in the future to approve or not certain treatments based on their costs, their short and long term effectiveness, the hope of patients’ lives, the number of potential beneficiaries and the ability of governments to pay, etc.
There will always be medical assistance in dying or palliative comfort care for those who cannot pay out of pocket and who will not meet the criteria imposed by committees of wise people and governments in debt and solicited from all sides. Two-tier medicine will grow, as will social inequities.