Diagnosed with ovarian cancer in July of 2004, Rhonda Morey knows she will likely not live long enough to see her girls grow up. So she has made them keepsakes: hand-stitched blankets for when they turn 13 -- they are 6 and 4 now -- and embroidered handkerchiefs for their wedding days.
There is something else Ms. Morey may leave behind, something she dreads -- as much as $4,000 of the $10,000 she put on her credit card to pay for cancer treatment.
The 33-year-old from South Brook, Nfld., has expended as much energy whittling down her credit-card debt as she has fighting a cancer that has invaded her kidneys, lungs, bladder and stomach lining. She sells Christmas crafts in two stores in the small logging town, clips coupons and even wrote a pharmaceutical firm requesting free anti-nausea pills -- ones she had previously rationed because, at $30 a capsule, she simply couldn't afford them. The company sent a three-month supply.
"You have so much on your plate, like, 'Am I going to live or die?' " said Ms. Morey.
"Then it's like, 'Oh my God, my drugs, how am I going to afford these drugs? And what happens if you don't have a credit card?"
Those are common questions, sometimes crushing ones. In a country where health care rivals hockey as a point of national pride, an estimated 3.5 million Canadians have inadequate public or private insurance protection against the risk of catastrophic drug expenses, according to Fraser Group, a market information firm that serves the employee-benefits industry. But nowhere is it worse than in Atlantic Canada, where 600,000 people -- about 24 per cent of the population -- have no coverage at all.
Cancer patients in Atlantic Canada are often victims of geography, living in provinces where the social safety net does not include significant pharmacare coverage. For many, the moment they leave the hospital, the nightmare of how to afford cancer drugs begins.
"The feedback that we get continually is that the financial impact and the financial worries that go with the cancer diagnosis can create as much worry and concern as even the cancer itself," said Peter Dawe, executive director of the Newfoundland Labrador division of the Canadian Cancer Society.
Although Canada's health-care system is based on the principle of equal access, that has never been the case when it comes to drugs. Cancer patients who require costly drugs out of hospital receive the medicare equivalent of a kiss-off.
Those without coverage often work for small employers in the farming, fishing or tourism industries that do not offer drug programs, said Ken Fraser, president of Fraser Group. They are also the self-employed, even professionals such as doctors, lawyers and accountants. As well, some people decline coverage from employers or government programs due to premiums, he said.
"If you're not in a group plan, it's difficult to find an individual policy with adequate catastrophic drug coverage," Mr. Fraser said. "As a society, we've been able to put someone on the moon faster than we have been able to come up with a catastrophic drug plan in Canada."
The call for a national pharmacare program can be traced back 42 years to a Royal Commission on Health Services report. A national pharmacare program was also recommended by the National Forum on Health in 1997 and in the Liberal Red Book that same year.
More recently, a 2002 report by Senator Michael Kirby proposed a plan to deal with catastrophic drug costs, one in which the federal government would cover 90 per cent of expenses above a $5,000 annual limit.
In that same year, Roy Romanow, head of the Commission on the Future of Health Care in Canada, proposed the federal government reimburse 50 per cent of public drug-benefit plans above an annual personal threshold of $1,500.
But exhaustive study of the problem has not translated into help for patients, who live with the grim reality that life with cancer can be not only excruciating but expensive.