Social Policy in Ontario

Canadians deserve better than fake Pharmacare

Posted on August 2, 2023 in Health Policy Context

Source: TheStar.com — Authors: Jasmine Gite, Melanie Bechard

TheStar.com – Opinion/Contributors
August 2, 2023.   By Melanie Bechard,  Jasmine Gite, Contributors

“A public single-payer approach would allow us to “buy in bulk” and achieve lower prices. Australia used this technique to reduce its spending on hepatitis C medication by 80 per cent, thereby saving the Australian government more than AUS $6 billion over five years.”Dreamstime.com

To sustainably save our health-care system we need a universal, single-payer approach to Pharmacare, not a fill-the-gaps approach.

Canadians are in desperate need of hope. Between a health-care system struggling to keep emergency departments open and skyrocketing costs of living, this summer has been difficult for many. We need solutions that can keep people healthy without breaking the bank.

Pharmacare offers a glimmer of hope. About 1-in-5 Canadians do not have coverage for prescription medication. As physicians, we often see patients ration their medication and skip doses due to their high costs, which leads to preventable complications.

Studies suggest that public coverage of necessary medications could prevent 220,000 emergency department visits and 90,000 hospitalizations, while saving Canadian households $350 per year. But we can only expect to see these benefits if we do Pharmacare right.

The federal Liberals and New Democratic Party have committed to introducing a Pharmacare Act before the end of 2023. Some have called for an inadequate “fill-the-gaps” approach that only covers medications in specific circumstances, such as for those who do not already have private insurance.

The 2019 Advisory Council on the Implementation of National Pharmacare studied this and made a clear recommendation: “Medicare doesn’t just fill the gaps and neither should Pharmacare.” To sustainably save our health-care system we need a universal, single-payer approach to Pharmacare.

Supporters of a fill-the-gaps approach claim that we cannot afford to provide medications to everyone and that we should focus public funds on those who are currently uninsured. But this ignores the two major benefits of a single-payer system: economies of scale and administrative efficiency.

A single-payer system can use its bargaining power to negotiate better prices and reduce costs. Currently, Canada’s per capita drug spending is the fourth-highest in the world since prices are negotiated by multiple payers — individual provinces, territories and private drug insurance plans.

A public single-payer approach would allow us to “buy in bulk” and achieve lower prices. Australia used this technique to reduce its spending on hepatitis C medication by 80 per cent, thereby saving the Australian government more than AUS $6 billion over five years.

A fill-the-gaps approach is a short-sighted Band-Aid on a system that is bleeding out. It may appear to have lower upfront costs by only covering those who are uninsured, but it is less efficient when factoring in the administrative costs of verifying eligibility.

In a single-payer system, your doctor or pharmacist can spend more time providing care and less time going back and forth between the government and insurance companies to figure out who is going to cover what. When people are sick and need care, they need to know that their medications will be reliably covered.

Another challenge with a fill-the-gaps system, sometimes referred to as means-testing, is that it is easier to erode over time through neglect. For example, means-tested programs may only cover medication for people below a certain income level.

If the program isn’t tied to inflation, the number of people eligible would decrease over time despite feeling the squeeze of higher costs of living.

A single-payer approach to Pharmacare is fair for all. Newcomers, those with limited literacy skills, or unhoused people can face barriers to accessing social programs. Many of us have struggled to understand our tax forms or our private insurance benefits — imagine trying to navigate the system in a different language or without a fixed address. When it comes to health care, single-payer systems streamline the process and avoid unnecessary delays in care.

We have a once in a generation opportunity to do Pharmacare right. Don’t be duped by fake Pharmacare — half-measure, Band-Aid programs that only fill the gaps and will cost us a lot more in the end without maximizing the benefits.

If we don’t get Pharmacare right the first time, naysayers will claim it doesn’t work and we’ll lose all progress toward real universal coverage.

We must adopt a public, single-payer approach to Pharmacare. Let’s shoot for the moon — not our feet.

Dr. Melanie Bechard is a pediatric emergency physician in Ottawa and chair of Canadian Doctors for Medicare. Dr. Jasmine Gite is a family physician and palliative care fellow in Ottawa.

https://www.thestar.com/opinion/contributors/canadians-deserve-better-than-fake-pharmacare/article_9aecd930-b7f8-50d5-b798-085bc7b6bbfa.html

Tags: economy, featured, Health, ideology, participation, pharmaceutical, standard of living

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