I just wanted to respond a bit on the so-called rationing question. I think there's an assumption here that a new drug is necessarily going to be better than what existed before, and that certainly does not hold up to the evidence. If you look at large series of evaluations of new drugs, only a very small minority are actually breakthroughs that make a significant difference to health. The large majority are what are called “me-toos”, where you have a small change to a molecule—another triptan for migraine, another beta blocker for blood pressure, and so on. Those are the majority of drugs that we have.
I work as a drug evaluator, so I'm involved in a lot of comparisons between drugs, basically carrying out the reports on safety and effectiveness that provincial governments or the common drug review might use as a basis for their decisions. The question we always looked at was, is there evidence of an advantage in terms of safety or effectiveness, or both, for a newer drug compared with other drugs that exist? If there isn't, and if the newer drug is costlier, why would it be a rational way to use public tax revenues to pay more money for something that's more expensive but is no better? If it's better, yes. Or you have these restrictions where some people can use certain things as a second line.
The idea that you simply pay whatever the asking price is because it's newer and that doing so will give you a better health system is certainly not something that has stood up to scrutiny.