Reverse “Cherry Picking”


I’ve had this thought for some time, and I’ve explained it in conversations but never posted it here.

The current process of determining when something is “excessive demand” is to take the medicals for every person in the family and then picking the one that has a condition requiring treatment and using that to declare the entire family is inadmissible.

I’m having a difficult time how this seems fair to a reasonable person.  The numeric value is computed as an average over the population.  So, how do you take the average of one group and the worst case of a second group and make any reasonable determination on such basis.

Instead, I would suggest this is a form of reverse cherry picking – you pick the worst sample of the group and then discard the entire group.

My suggestion: if you find yourself in this situation, make the argument.  Get someone at IRCC to explain why this is fair.  I’d suggest that what makes more sense is to compare average to average between groups.  So a family with three children, one of whom needs special education services, would be evaluated as a family.

Perhaps I’m wrong here.  I’m interested in hearing people’s opinions on this.

 

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Defending Healthcare: A Different Perspective


Positive Living I recently read an article under the banner “Fighting Words” entitled “Defending healthcare“.  The authors in that article threw down an interesting jingoistic saying.

Right now, there’s a legal attack before the courts that could turn Canada’s medicare system into the type of system found in the United States.

I understand the authors’ desire to inflame passions and press forward with their point, but of course I thought of the benefits that the US system has over the Canadian system when it comes to those that Canada deems to be “medically inadmissible”. The Canadian Healthcare system covers most people in Canada but in exchange for this universal coverage the Canadian system systematically refuses anyone with certain medical conditions entry into the Canada.  Indeed, the very disease of most interest to the authors and readers of this magazine (HIV positive people) is the one disease that Citizenship and Immigration Canada refuses as a matter of policy. I’m sure there are folks who understand that the written policy is to perform an individualized assessment of people.  But pragmatic experience in helping people with medical issues has taught me that in fact HIV is one of those conditions that are refused as a matter of course. Thus, while the authors view their healthcare system as being a wonderous thing, my perspective is that is is the fundamental justification of a morally bankrupt system intent on classifying anyone with HIV (or Down’s Syndrome, etc.) as being an unmitigated drain on society. The US system does not discriminate in this fashion.  The US immigration system is not tied into the costs of the US healthcare system.  The Canadian immigration system is. And it continues to get worse.  Essentially, anyone immigrating to BC would automatically be excessive demand because the province pays for all drugs (albeit in exchange for your agreement to enter the UBC research study.) Once Canada permits pre-exposure prophylaxis (PReP) not only can a disease condition be used to refuse someone entry into Canada, but even being at high risk could theoretically be used to justify the same thing. While I don’t post too much here anymore, I continue to communicate with people trying to find their way through the medical inadmissibility system.  Recently I communicated with someone who was given a fairness letter without any cost estimates at all. Just the blanket assertion that their treatment was expensive and paid for by the public healthcare system. I must admit, I was incensed at it.  Why?  Because the persons treatment was the only treatment that doesn’t exceed the threshold.  It’s all generics (Neverapine, Lamivudine and Zidovudine).  Using the Quebec published numbers, the cost was something like CAD$2,500 per year. So much for “individualized assessment”.  Hence my claim that, like it or not, it leads to systematic refusal of people with specific health conditions.  Like HIV. If you want a better health care system, stop using it to discriminate against people that want to come here but cannot because they might use it.  At least come up with some mechanism that balances inputs from outputs. In the meantime, pardon me for disagreeing with this blanket rosy self-congratulatory claim of superiority.  It rings hollow.

Spousal Sponsorship: A story of “how it really works”


When dealing with Citizenship and Immigration Canada (CIC) one is often presented with what seems like a Kafka-esque set of requirements.

In all fairness, for the vast majority of applicants, there are few problems because their case is straight-forward and can be quickly and easily evaluated.

Of course, those of us who find complications can experience what often seems like an impenetrable maze of highly subjective rules, regulations, etc. That certainly applies in the case of medical inadmissibility.

I had a great time meeting with an old friend yesterday.  Over drinks we caught up with each other’s lives.  He has just recently applied for Canadian citizenship.  An American originally, he went through the sponsored spousal category.  I was surprised when he told me that it required 24 months to complete everything.  I recall how nervous he was towards the end (he had a work permit, but his employer had laid him off.)

It turns out he ran into pretty much the same issue that I’m facing.  He found out about his condition shortly before he submitted his application for permanent residency (so at least not as part of the immigration physical.)  What surprised me is how many “hoops” he had to jump through in order to be successful.  This included a requirement that he be on medication and that he sign affidavits guaranteeing that he and his spouse were monogamous and that they would practice safe sex.  To be blunt, I was aghast at such requirements.  It seems highly invasive for any government to impose such requirements on a rather personal and intimate relationship.

Of course, I find this ironic – in the case of a skilled worker, a personal guarantee to pay for a public service is discounted.  So why would a personal guarantee as to sexual conduct between spouses be considered valid?

I have not delved substantially into describing my own research and opinions on the efficacy of the life saving drugs for HIV, but I am more skeptical than the press, doctors and ASOs are about their efficacy and the current treatment paradigms. I am not saying that I have the answers, I’m merely disturbed by the fact that there are so many doubts and questions to which I have not been able to obtain satisfactory answers.  It is an essential component of informed consent to understand treatment decisions. But I’ll save that conversation for another day.

Doctors, while certainly very learned, have been known in the past to collectively accept scientific conclusions that were later proven false.  For an example (but hardly the only one), do a search on Onanism for an interesting history on a common cause for a number of human conditions. We scoff now, but at the time this was all taken seriously. So I have proceeded with caution.

Bottom line: I find the idea that one can be forced to take medications to fly in the face of “informed consent” and I am amazed that any doctor would find it ethical to allow a patient to proceed in the face of such coercion.  I guess I’ll just have to wait and see what actually happens.

 

Finding Others


Flag of British Columbia
I’ve been fortunate to speak with others about this issue at length, including people who have been successful – although against long and difficult odds.

One person with whom I spoke recently had an amazing story that provided me with quite a bit of insight.  For the purposes of this discussion I will call him Alexander. He is an American citizen but his partner is from the EU.  US immigration policy does not recognize same-sex couples, so the partner in such a case must seek to either win the immigration lottery or seek economic immigration (tied to having valuable skills.)  For whatever reason, Alexander’s partner did not qualify for economic immigration. They survived for quite some time by having his partner just leave the US periodically (e.g., by the expiration of the usual 90 day visitor visa granted to people from the EU.)

Of course, that eventually didn’t work ask well, as the US immigration folks eventually do realize that the visits are rather frequent.  So they had to find an acceptable alternative and settled on Canada.

At any rate, Alexander had a highly valuable set of professional skills and had his company transfer him to their BC office (via the NAFTA intra-company transferee category.)  This allowed his partner to come along with him and they started the permanent residency application process.

Much like me, he found out his medical issue after his immigration physical.  Of course, being in BC on a legal long-term work permit, he qualified for BC’s medical service plan, and thus was eligible (prior to PR) to take advantage of the medical services available in BC.  His company also had private insurance and crafted a plan that would ensure the province did not need to pay for his medical costs.

After submitting his proposal, it was rejected by CIC due to the excessive cost rationale. At that point his local attorney seemed a bit out of his zone of comfort, so he worked with another attorney in Toronto (another medical inadmissibility expert) whom I’ve heard others recommend in the past.  They put together an application for judicial review, which was rejected.  Thus, there was no court review of the decision.

At that point he started working on a Temporary Resident Permit (TRP) with the Toronto lawyer.  It was around that point that his attorney said that the filing was strong enough on its own that it would be worth filing again with the additional information.  This time they filed under the provincial nominee program, documented that his skills were in high demand (letters from his employer, for example), ensured that the company’s insurance coverage would apply, started taking the drugs and demonstrating that the insurance was paying for it, obtained a letter from the head of the BC clinic stating that the government was not paying for his meds and with all of this in hand was able to convince the immigration doctor (“DMP”) that while he had a medical condition, it would not be a financial burden on the province.

This time, his application was successful.

The total process required five years and cost around $50,000.

I found the conversation very insightful and oddly comforting – others have done this and been successful at it.

Gulp… planning the first trip out of Canada


airplane image

Getting ready for my next trip

So I will need to travel to the US soon; I don’t even know the details of the trip yet, although it’s just a week away (this isn’t that uncommon.)  It will involve multiple stops (at the moment it looks like Seattle, San Francisco, Detroit – then that first crossing back into Canada for a meeting in Toronto, New York, back to Seattle and then home.)

I’d be lying if I said I wasn’t a little nervous about the whole affair.  I’ve certainly crossed the border numerous times (since my first border crossing in August 1967.  I had to check with my mother to get to at least the right month although the CIC forms ask for this in the standard day/month/year format.)  I crossed back into Canada last month, so this isn’t even the first time since being denied.

Of course, I’m now tweaking buttons here – I’ve requested judicial review, I’ve taken the (perhaps questionable step) of requesting a TRP from Seattle, I even sent some more documents to New York City (although I expect they’re just going to toss them in the trash, the fact they weren’t showing on the CAIPS notes I received yesterday bothered me because it means they didn’t consider my input into my own case.)  Rocking the boat means there’s a greater likelihood of getting wet.

I will be carrying a stack of documents with me though – “just in case”.  I suppose I’ll be appealing on H&C grounds (e.g., my spouse is in Canada, my home is in Canada, my job is in Canada, my employees are in Canada.)  Of course, I will also be showing that I’m not an imminent threat to cause the collapse of the Canadian health care system due to my excessive demand (let’s ignore the fact that my financial contributions alone far outstrip even the estimated costs.)

Ironically, the only real health issue I have right now is related to excessive stress.  Needless to say, this isn’t really what the doctor ordered.

Opting out


opt-out

Opting Out

In British Columbia, it technically IS possible to “opt out” of the Medical Services Plan.  I found this surprising, given that it seems to be a fundamental assumption within the immigration process that this is not an option.

So, here’s my question: if you can opt out for a year, why not allow someone to opt out for 5 or 10 years?  Is this not a “reasonable accommodation” for someone with a disability?  It doesn’t seem as if it would be onerous on the government to implement such a (binding) scheme, although I suppose that doesn’t prevent one from moving to a different Province.

Of course, the “move between provinces” argument isn’t one I’ve seen used (after all, I could have said “I’m going to Ontario” and then decided after a month that I wanted to “go to Vancouver” and nobody would have noticed or cared.)

I’m going to ask my attorney about this, because in everything that I’ve read “public healthcare” is expressed as a right.  Of course, so is “not taking an HIV test involuntarily” and yet you have to agree to take one for immigration.  So, why not make taking a ten year “opt out” be sufficient?  In that way, you’ll have ten years of paying into the system without taking anything out.

And, lest you wonder, it is possible to buy private health insurance to live in Canada – I know, I’ve researched it.  Finding a policy that will cover you with a pre-existing condition is even possible, but such policies have substantial limitations upon them.  In the case of HIV, they generally cap their coverage and do not cover prescription drugs.

Of course, as I pointed out in my own report (the one that CIC seemed to ignore,) anyone in that position would figure out a way to order the drugs via an offshore pharmacy – why pay 10x the cost for the same chemicals if you can avoid it?  While we can argue the morality of such a decision (cheating those poor starving, struggling pharmaceutical companies) for an individual forced to pay out-of-pocket it is still the prudent decision.

Reasons


Canadian Federal Court

Canadian Federal CourtCanadian Federal Court

So this morning I received an e-mail from my attorney including the reasons for the rejection.  What it boils down to is “the applicant wants to move to British Columbia, and given British Columbia’s policy of paying the full cost of medication, the applicant is medically inadmissible due to excessive demand.”

This is as I had concluded. My attorney is telling me:

My initial reaction is that this decision makes the same error that was addressed by the Supreme Court in Hilewitz, confusing mere eligibility for a program with probability of demand.  In your case we submitted undisputed evidence regarding lack of demand; the application was refused based upon your eligibility for the program.

While I have not really discussed it up to this point, I have done quite a bit to educate myself on the current treatment paradigms.  The clinical practice varies dramatically from what I have found in the research data – and the research information is all over the board.  I suspect this is because there is actually too much money available to fund research – this encourages far too many people to submit far too many ideas.  In addition, it relies upon a system that becomes de-facto self-perpetuating (e.g., in order to obtain and maintain funding you have to gain the blessing of those in power, and those in power only approve research that is in agreement with the current paradigm.)  In some ways, we may have been better off in the days when funding sources for research were numerous and varied – simply because it eliminates some of this conformance-based policy practice.

At any rate, the current treatment paradigm here in British Columbia is to prescribe pharmaceutical drugs to everyone who is either at risk or diagnosed.  Those pharmaceuticals are quite expensive, at least in Canada, because they are subject to patent protection (although some of those patents are starting to run out.)  Thus, the essence of the current CIC policy, combined with the policy of British Columbia, is that anyone who is not medically exempt is ineligible for immigration.   The irony of this is that the amount of money they are considering (roughly $58,000 over 10 years) is less than the amount I’ve already paid (in two years) in just income taxes here in British Columbia. But this isn’t a cost/benefit decision, this is a pure cost decision.

Bottom line: I’ve now spent quite a bit of money pursuing my own protocol – running tests for things that actually matter (according to the scientific literature that I’ve read, although I have to keep in mind that it is wise to be skeptical of such literature,) taking treatments that might work (a bit more speculative) and finding other affected people who have experience in avoiding the mainstream paradigm (which is “oh, we’d best put you on chemotherapy because otherwise you might get sick!”)  Protocols such as I’ve been following aren’t even an option in the mainstream public funded health care system, despite the availability of peer reviewed scientific data in support of them.

At any rate, this response means the timer is now ticking – there are 30 days to file the “Application”.