If issues like this were resolved solely on the basis of anecdotal evidence (regardless of how personal), a lot of flawed opinions and policies would be embraced. Any individual may have an unusually positive or negative experience. An individual may even have a series of such experiences, but, if for every positive experience, there are ten negative experiences, a problem still exists, regardless of how satisfied that one person may be.

Several of the comments in opposition to my argument are directly contradicted by details of the recent decision by the Canadian Supreme Court. For example, the Supreme Court cited testimony that 95% of Canadians seeking a knee replacement were forced to wait more than one year. A significant portion of these people waited nearly two years. The Supreme Court also wrote that, for more life-threatening treatable conditions, some "patients die as a result of waiting lists for public health care."

The Court also stated that "The prohibition on obtaining private health insurance is not constitutional where the public system fails to deliver reasonable services." The ruling clearly implies that, at least in the Court's opinion, such services are not delivered by the Canadian healthcare system.

Universal healthcare is based on the illusion that treatment will be readily available. By artificially limiting the incomes of doctors, nurses, technicians and other healthcare professionals, the Canadian goverment has insured that the number of these critical professionals will progressively diminish relative to the population. Whether healthcare professionals simply relocate to the US or young Canadians choose to avoid careers in medicine because the years of medical training are not perceived to be worth the final outcome, Canada will have a shortage of medical professionals. The ultimate culmination of this process will possibly be a Soviet-style healthcare system.

Certainly the disparity in drug prices needs fixing; around here they organize tour busses to visit the Canadian casinos and drugstores.

As I understand it, the drug companies make enough from domestic sales and government contributions to cover their extensive research and development costs and still make a healthy profit (I have nothing against companies making a profit; without that incentive, why would they exist?). Since we locals cover their R&D costs, they can make a profit by selling overseas for just a little more than the cost of manufacturing, which is relatively low.

So when a foreign government refuses to pay more for a drug (saying, in effect, that if you don't sell it to us, we just won't provide it to our people), the drug company grumbles, but makes the sale, and a small profit.

It seems to me that since we locals, and our government, have contributed so much to the bottom line of the drug companies, we should have a mechanism to recoup some of our contributions from the foreign sales. My proposal would be a flexible tax on the exportation of drugs, higher when to foreign government is paying a very low price, and lessening when the foreign government is willing to pay something close to the domestic price.

I think it is simplistic to say that having for profit companies involved in health care must increase the cost of health care. It ignores the fact that efficiencies can contribute to profitability. Anyone who has looked at a domestic hospital bill will realize that the billed item (what you would be charged without insurance) is invariably far higher than what you and your insurer end up paying. I just happen to have a dentist's bill to my daughter here. For an oral exam, the submitted amount is $30. The approved amount is $21, of which the insurer pays $8.40 and I pay $12.60.

Yes, the cost of health care is soaring, but we live in a society where we don't take care of ourselves, where obesity among even children is rampant, where we drink, smoke, and cavort unsafely, yet we are living longer and longer. The advances in medical understanding and treatment are phenominal; miracles become routine, and we pay our physicians and researchers very well, as we should. Like anything in life, you get what you pay for.

As I understand it American doctors are paid a good deal more than their counterparts in other Western countries - which is not to say that the latter (at least in my country)aren't doing pretty well. The "you gets what you pays for" argument only gets you so far - human motivation is a complex thing and revolves around many factors, only one of which is money (and you're hearing this from a former salesman).

The drug companies are certainly entitled to be recompensed for their R&D costs, but there's more than a strong suspicion that their claims are wildly exaggerated, and that part of the vast sums they spend on P&A, influence-peddling and other activities finds its way into the "R&D" bucket.

Maybe the lower prices these companies are receiving for their product in countries with an effective national buying scheme still represent very good margins by most standards? If so, the American taxpayer would be better served ion introducing a comparable scheme in the US, rather than in playing the drug companies' game by allowing them to bump up the price of exported drugs. This would disproportionately harm the poorest countries, those without the capacity to make their own drugs.

There's an aspect to the reason for lower brand name drug prices in Canada that is seldom reported in the U.S. (or Canadian for that matter) press.

In 1992 the Canadian government extended the length of time for patent protection for the brand name drug companies - the quid pro quo was a Price Review Board that establishes pricing (including profit) for newly approved drugs (drugs already approved aren't subject to the PPRB)- subsequent price increases are based on inflation. The pharmaceutical companies were part of the process and accepted the pricing review in exchange for extended patent protection.

The other aspect of the lower pricing is the provinces and federal governments' buying power - although that argument seems hollow to me given the absolute small size of Canada - for example, the province of Ontario may be purchasing for 4 million people (or so) but Kaiser Permanente (sp?) or any of the large HMOs or the VA certainly have that many or more in their rosters.

It's for the above reasons I think the pharmaceutical companies have a case to make that non Canadians should not be buying significant quantities of Canadian drugs - the brand name pharmaceutical companies made a deal in good faith (longer patent protection but pricing review) but it wasn't contemplated that a signficant volume would go outside of the country.