By James Fife
As regular readers of Points North realize, I have found my late-life discovery of dual nationality has usually been a boon, rather than a bane. So far, I have not come across many instances where I felt more than an amusing tension between my Americanism and my Canadianism. Up to now, the effect of being both nationalities at once is the highly beneficial one of prompting me to appreciate differences and divergent perspectives I may not have been aware of otherwise.
But recently, that has changed. The current, cross-border, prescription-drug controversy raises a new dilemma for me I haven’t faced before. I’ve come to a point where I feel a new need to choose sides, not just observe the differences.
I have written previously about the disparities between the U.S. versus Canadian health-care systems. That disparity in national attitude and practice is well-known, both North and South. But recently, it has emerged as a major issue in the U.S. over access to Canadian supplies of prescription drugs, which, typically, are priced ten-times less than comparable medicines in the U.S. In particular, the ability to afford and access insulin for those with Type 1 diabetes, a matter of life and death, has come to the fore. Given the high cost to American diabetics, even with insurance, some have turned to rationing their supply, risking health repercussions from under-dosing to save money. The problem has become a focal point in our 18-month-long, presidential campaign. So, shortly after candidate Bernie Sanders accompanied a group of insulin-buyers into Canada to dramatize the crisis, the Secretary of Health and Human Services in the Trump administration announced plans to relax the regulations on importation of prescription medicine.
For me, having learned something about the Canadian system second hand, including some of the history of its establishment by reading the life of Tommy Douglas, I feel I have some skin in the game on both sides now, possessing some awareness and sympathy for the effects on both sets of my fellow citizens. But it creates a dilemma. On the one hand, I am happy that Americans, fed up with a profit-crazy system that clearly needs reining in, are acting independently, taking steps to force Big Pharma to face competition that will drive down their insane prices.
But I am also aware there are concerns among my fellow Canadians that allowing Americans to swoop up Canadian pharmaceuticals to their hearts’ content may result in there not being enough to go round, leaving Canadians short on their own supply of life-giving medicines. The concern is great enough that Prime Minister Trudeau has taken to assuring the Canadian public the government will act to protect the supply to ensure adequate access. Meanwhile, the NDP have called for more than assurances and want to know the concrete steps that will be taken.
Like most of the policies of the current U.S. administration, I am suspicious of a ‘solution’ to high drug prices that relies on shifting the problem to someone else’s doorstep. Ironically, it sounds like the same complaint Trump has leveled at the refugees and migrants coming to the U.S., insisting the origin-countries fix their own problems, not ship them North (all without offering any assistance to bring about that fix). Instead of fixing the problem in the U.S., curbing the wide-open price-gouging of drug companies, the plan is to suck up cheap drugs from Canada. Not that the U.S. has never exploited Canada in the past, but now this latter-day, colonialist attitude strikes a personal chord with me I didn’t feel before.
In a way more immediate than I have previously felt, I am alarmed at how blinkered the current drug-import debate is playing out in the U.S. I am glad for my fellow Americans to see growing resistance to this untenable situation. But I feel for my fellow Canadians at how the debate here fails to consider whether importation has an unfair effect on Canada. For the first time, I am feeling the pain of both my compatriots: the frustration with glacial, government action, but also umbrage at a case of spread-eagle, resource-grabbing at its worst.
I hope I can reconcile this dilemma by taking a principled stand that covers both sets of concerns. I believe that by my saying, like a good Canadian, “Clean up your own mess first,” I am also being a civic-minded American by insisting, “Let’s not kick the can down the road, but solve this issue ourselves.”
I have to admit, I never foresaw this more divisive effect of the split-personality I have felt after learning of my dual status. I’m a bit surprised how automatically I recognize the two sides and their concerns. I think that’s new. I like it, because it confirms to me that our move North has had the expected benefit of broadening horizons I may not even have been aware were narrower. But with the drug-import debate, it shows it can create a greater quandary than I anticipated.
If the premise of the John Candy film “Canadian Bacon," about a modern U.S. invasion of Canada, ever comes (closer) to reality, I’ll be in a real pickle. But to the extent that the importation debate serves as a sequel—called “Canadian Insulin,” maybe—I am happy to learn that my nationality/ies will not cause me to jettison logic and fairness in favour of rank tribalism. Unlike some I could name.