Moving slowly on pharmacare is better than not moving at all

TheGlobeandMail.com – Opinion/Editorials
Feb. 28, 2017.   Globe Editorial

One of the great oddities of Canada’s universal health-care system is that it isn’t paired with universal pharmacare.

Every other industrialized country that has a national insurance program covering physician and hospital care also offers something close to universal free prescription drugs. But not Canada. Here, one in 10 people who are prescribed a medication cannot afford it, and fail to treat their condition properly.

This discrepancy has long puzzled Canadians. They find it strange that drugs used in hospitals are covered by medicare, but those prescribed after discharge, and which might prevent a return trip to the hospital, are not. A treatment that heals with a scalpel is covered; one that heals with a continuing drug prescription usually is not. This seems self-defeating.

Policy-makers, provincial health ministers and business owners are confused, too. Study after study has shown that Canada is missing out on a golden opportunity to lower Canadian health-care spending, and lower the cost of generic drugs in this country – which happen to be among the highest in the world.

A new analysis by the Canadian Medical Association Journal is the latest to conclude that average Canadian prices of the most commonly prescribed generic versions of drugs are sky-high compared with other countries. Costs are 60 per cent lower in Sweden and 84 per cent lower in New Zealand, both of which have types of universal pharmacare.

Even the United States, which has by far the highest health-care costs per capita in the world, has lower-cost drugs – 47 per cent lower, according to the CMAJ.

A universal pharmacare system gives a country the power to negotiate lower prices, the CMAJ and others have consistently argued. It also eliminates the administrative inefficiencies of Canada’s current set-up, which is a hodge-podge. Many businesses manage employee drug plans, provinces have a mix of plans covering seniors and low-income people – and the rest of Canadians, who pay for physician care through their taxes, pay for drugs out of their wallets.

Paying for prescription drugs in Canada is an overpriced crapshoot. Ability to pay depends on where you live, your age, or whom you work for. In 2015, Canadians purchased $26.2-billion worth of prescription drugs. Private insurance plans, largely funded by businesses, covered 35 per cent of those costs. Individual Canadians paid 22 per cent of total drug costs, out of pocket, while government plans picked up the rest.

Too many people are forced to choose between buying drugs and paying for other essentials. Even for businesses and private plans, costs could be lower. And, as already noted, one in 10 Canadians suffers through an ailment without paying for the prescribed pharmaceutical treatment.

All of this is well-known. A year rarely goes by without another report on the subject, and yet Canada has never taken the leap from its patchwork system to universal, single-payer pharmacare. We are stuck, with no solution on the political horizon.

You would think Canadians would be open to a drug plan that matched the generosity of the rest of the medicare plan. Unsurprisingly, polls have consistently shown support for national pharmacare. One taken in July, 2015, put it at 91 per cent.

The problem, of course, is that any plan would result in higher government spending, and therefore higher taxes. The burden now carried by company drug plans and individuals would be shifted to government. Canadians would end up spending less on drugs, but more of the spending within that smaller envelope would be borne by taxpayers – and raising taxes, even if it means lowering a private cost, is always a difficult sell.

What sane politicians would want to open that can of worms? Taxes and spending aside, the complications in pharmacare include figuring out which drugs a plan should cover – a fraught and possibly political process that could leave some medical conditions out in the cold and people angry as hell.

The CMAJ’s solution is to call for baby steps. It wants Ottawa to create a national pharmacare system for a list of 117 “essential” generic drugs that are commonly prescribed. This model list would be based on one created by the World Health Organization, tweaked for Canada’s needs.

Based on the CMAJ’s analysis, such a plan would reduce the annual costs to individuals and businesses by more than $4-billion, while only increasing government costs by $1.2-billion.

That means the average Canadian would end up with more in his or her pockets. And Canadian businesses, which already bear much lower health costs than their American peers, thanks to medicare, would see their drug burden reduced.

Canada has never finished the job it started when it brought in universal health care. Here’s a chance to finally get it done.

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