Bill Morneau is wrong to rule out universal pharmacare – Opinion/Editorials – Any effort to improve Canada’s hodgepodge of private drug plans and patchy public coverage would be welcome, but what we really need is a universal approach.
March 1, 2018.   By

It may be the quickest climb-down in the history of budgetary promises. Just one day after Bill Morneau vowed in his third budget to create an advisory panel to explore the idea of a national pharmacare plan, the finance minister was already tamping down newly raised hopes.

There will be no pharmacare “plan,” he said on Wednesday, but instead a pharmacare “strategy” that “deals with the gaps,” is “fiscally responsible” and “doesn’t throw out the system that we currently have.” True to his government’s preference for targeted over universal programs, the finance minister seemed to be saying that supplements to the current dysfunctional mess will have to suffice.

Forget the advisory panel’s process. Forget the mountains of evidence. Universal, it seems, is out.

That’s a shame. As the Star has written many, many times, Canada needs a universal national pharmacare program. We are the only country in the world with universal health care that doesn’t also offer universal drug coverage, and for this we have paid a price.

Our existing hodgepodge of private drug plans and patchy public coverage puts too many Canadians at risk. At any given time, thousands face aggravated illness and needless suffering because they can’t afford the rising price of drugs; nearly a quarter of all households report having at least one member who over the last year has not filled a prescription due to cost.

Our system is ridiculously expensive, not only for individuals but also for governments. Other countries achieve far lower drug costs by purchasing medicine through a single, national buyer of pharmaceuticals. Studies have put the potential public savings of a universal and comprehensive pharmacare program at several billion dollars per year. Any effort to close these gaps would be welcome, but what Canada really needs is a universal approach.

Hopes were raised high by the budget’s nod to pharmacare and the appointment of Eric Hoskins, Ontario’s recently departed health minister and one of the country’s most persistent pharmacare advocates, to lead the advisory panel.

But what’s the point of the panel if Morneau already has the answers? Surely Hoskins, wisely tapped for this task, should be allowed to consider without prejudice how to maximize the health benefits and savings, while looking at options for constraining the start-up costs.

Moreover, rejecting the possibility of a universal program greatly undermines the idea’s potential upside. The government has said its goal is to ensure “all Canadians have access to pharmaceuticals.” But targeted programs always have gaps. Only a universal approach guarantees universal access.

Plus, the projected savings that have made comprehensive drug coverage such a popular proposal in policy circles depend in large part upon the program’s universality. Most of the savings created by a pharmacare program would be achieved through the bulk-buying of drugs and the elimination of bureaucracies – potential benefits at least partly forgone by the sort of means-tested approach that Morneau is hinting at.

Morneau doesn’t really mean “fiscally responsible.” He means politically palatable. With no plan to return to a balanced budget, the finance minister wants nothing to do with the inevitable initial costs of such a project, even if avoiding these means forgoing enormous long-term savings.

Of course, the potential start-up costs are daunting, but they vary wildly depending on design and they needn’t be shouldered by Ottawa alone. They don’t necessarily entail more debt, either. The government could, for instance, deliver on its promise of saving billions of dollars by closing unjust and ineffective tax loopholes, which could – again, design depending – cover a significant portion of Ottawa’s share of the burden.

Morneau’s comments seem to short-circuit the important process his budget began and undermine its potential long-term benefits. National pharmacare will be a plank in the New Democrats’ next election platform. One hopes the Liberals’ “strategy” amounts to more than neutralizing the NDP’s promise without offering a real pharmacare “plan” of their own.

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