Ontario NDP has a political winner in universal pharmacare plan

Posted on April 25, 2017 in Health Debates

NationalPost.com – Full Comment
April 24, 2017.   Chris Selley

Big ideas are busting out all over the place this week. On Monday in Hamilton, Premier Kathleen Wynne rolled out the government’s basic-income pilot project: the government will pay participants roughly 75 per cent of the low-income measure, minus 50 cents of every dollar of earned income. *

The idea enjoys support across the political spectrum: it’s supposed to be a more efficient, liberating way to deliver benefits. It’s also disliked across the political spectrum: some on the right see it as encouraging idleness; some on the left see it as a cheaper way to screw the poor. Back at the legislature, NDP Leader Andrea Horwath was unveiling something it will be much harder for her opponents to argue against: a semi-universal pharmacare plan.

By 2020, a New Democrat government would fund around 125 “essential medicines” that treat the most common conditions. According to UBC public health economist Steve Morgan, whose research underpins the proposal, that would cover roughly 44 per cent of prescriptions filled in Canada — 77 per cent if you include “comparable” drugs. In the NDP’s vision, Ontarians who have private coverage beyond “essential medicines” would continue to enjoy it.

The budgeted cost is $475 million, to come from “economic growth,” a “minor reprioritization of government funding” or “a fair and progressive … new revenue source.” But the idea is to save money down the line, not cost it. A study by Morgan and other researchers, released in February, found the U.S. Department of Veterans Affairs pays 47 per cent less than Canadians for the generic versions of 117 “essential medicines.” The public health systems in Sweden and New Zealand pay 60 per cent and 84 per cent less, respectively.

Pharmacare supporters have long complained that Canadian provinces simply buy generics wrong: instead of using their purchasing power to bargain drug-makers down, they pay a percentage of the cost of the patented equivalent. By amassing as much purchasing power as possible and eliminating the inefficiencies of a multi-payer system, they argue, nationwide universal pharmacare could cut costs dramatically. Ontario alone wouldn’t pull as much weight as the entire country — but there are roughly as many Ontarians as there are Kiwis and Swedes put together.

The idea will certainly find an audience: According to the Ministry of Health, in 2015, 2.2 million Ontarians had no drug coverage; patients spent $2.5 billion out of pocket on prescriptions. In a 2015 Angus Reid poll, 25 per cent of Ontarians reported not filling a prescription, skipping doses or splitting pills because of the cost. And this is unique among countries with universal health care, Morgan argued at Monday’s press conference: all the others cover prescription drugs. “Cost-related barriers to prescription drugs are reported by only about one in 50 residents of the United Kingdom,” Morgan noted in a 2015 paper.

Considering the degree to which we fetishize medicare, Canadians have been strangely accepting of this gaping hole in the “universal” system. (Even the federal Liberals’ 2015 platform didn’t promise to fill it, and it promised practically everything.) The idea certainly has its critics: they argue it will shift billions of dollars currently borne by the private sector to taxpayers, and foist inferior coverage upon already-insured Canadians. But it’s going to be bloody hard to argue against it on the campaign trail without looking either heartless or unsupportive of universal health care. This sure looks like a winner issue for Horwath’s NDP.

Pharmacare supporters have long complained that Canadian provinces simply buy generics wrong

Health Minister Eric Hoskins spent Question Period and a scrum with reporters afterward insisting there is “no distance” between his position and Horwath’s. He even shouted out across the aisle to Tommy Douglas. “For the past three years our government, myself, the premier, have been strong and relentless advocates … for a national pharmacare program,” he said. “In fact I would argue that we have been the largest and strongest political voice nationally on this issue.”

That’s all very nice — but Horwath is promising to go ahead and do it, and Hoskins didn’t have a very good answer as to why his government wasn’t. Each province has its own health-care system. Each covers some things and doesn’t cover others. Hoskins rattled off all sorts of measures the Liberals have already taken to make it cheaper for Ontarians to get their meds, which had the effect of highlighting the degree to which he controls their access to prescription drugs. So why wait? Universal health care started in Regina, not Ottawa. Like it or not, there’s no reason universal pharmacare couldn’t start in Toronto.


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