Social Policy in Ontario

Morneau prefers a public-private pharmacare plan, but government health committee may disagree

Posted on March 2, 2018 in Health Policy Context

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NationalPost.com – News/Politics – What Morneau seemed to be proposing, one expert says, is something like Quebec’s drug plan, which currently boasts the highest per-capita drug costs in Canada
March 1, 2018.   Maura Forrest

OTTAWA — Finance Minister Bill Morneau’s suggestion that a new national pharmacare program might simply fill the gaps in the existing system is raising the ire of health experts and labour groups who say “overwhelming evidence” shows that a national public drug plan is the only way forward.

Morneau’s apparent preference for a public-private system could also create tension within his party’s ranks if an upcoming report from the majority-Liberal health committee recommends a universal drug plan, as several observers say is likely.

On Tuesday, Morneau tabled a budget that announced an advisory council on pharmacare, to be chaired by former Ontario health minister Eric Hoskins. But speaking at the Economic Club of Canada on Wednesday, Morneau suggested a new program might only provide drugs for Canadians not already covered by existing private plans.

“We need a strategy to deal with the fact not everyone has access, and we need to do it in a way that’s responsible, that deals with the gaps, but doesn’t throw out the system that we currently have,” he said.

That wasn’t what experts like Marc-André Gagnon, an associate professor of health policy at Carleton University, wanted to hear. “This is something different,” he said. “This is not national pharmacare.”

Gagnon says the only groups opposing a universal plan are those with skin in the game: private insurers, drug companies and pharmacists, who stand to lose if drug prices fall under a public plan.

What Morneau seemed to be proposing, he said, is something like Quebec’s drug plan, which currently boasts the highest per-capita drug costs in Canada. Quebec’s system requires employees to enrol in private plans where available, and those without coverage end up on a mandatory public plan.

Gagnon said one problem with the Quebec plan is that private insurers tend to cover virtually all drugs, which makes them much more expensive than public plans. “You cannot have a system that says we accept to pay for anything at any price,” he said.

Drug costs in Quebec have “gone out of control” since it was launched in 1997, said Steve Morgan, a professor of health policy at the University of British Columbia. “There’s no credible independent body … that has ever recommended, ‘You know what? That’s the system to go with,’” he said.

But Stephen Frank, president of the Canadian Life and Health Insurance Association, said most Canadians with private insurance are happy with what they have, echoing Morneau’s comments. “What you don’t want to do is enact a reform that would put any of that in jeopardy,” he said. “What you want to do is build from where you’re at.” He said a hybrid public-private system could fill the existing gaps “very quickly.”

This week’s budget announcement comes as the House of Commons health committee prepares to table its own report on a national pharmacare program later this month, after nearly two years of study.

Several observers say it’s likely the committee members will recommend some form of universal plan, which could place them at odds with the finance minister’s vision for drug coverage. “I think we’re up for a very interesting debate inside the Liberal Party,” Gagnon said.

Morgan, who appeared before the committee during its last public hearing in the fall, said Liberals on the committee were clearly leaning toward some type of universal plan. One committee member, Liberal MP John Oliver, told a panel in December that he hopes to see national pharmacare implemented starting in 2020.

“If (the committee report) is reflective of the testimony, it will have to be a report that recommends pharmacare,” said Sebastian Ronderos-Morgan, with the Canadian Federation of Nurses Unions. Morneau’s position, he said, “flies in the face of the overwhelming evidence” that a universal public drug plan is the best solution for Canadians.

NDP health critic Don Davies also sounded confident about the committee’s stance. “I think you’ll find a strong consensus on the health committee that (a national public plan) is the best way to go, not the system Bill Morneau described,” he said Thursday.

In the Commons on Thursday, Morneau took a more muted tone on pharmacare in response to NDP questions, saying only that the government will “look for expert advice to tell us how best to do this.”

http://nationalpost.com/news/politics/morneau-prefers-a-public-private-pharmacare-plan-but-government-health-committee-may-disagree

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