Social Policy in Ontario

Pharma-Scare Tactics: Dispensing Garbage Takes

Posted on March 5, 2024 in Health Debates

Source: Substack.com — Authors: Ryan Meili

Substack.com – A Larger Scale
March 5, 2024.   Ryan Meili

Late last week the Liberal federal government tabled legislation on National Pharmacare. I’ve long been a proponent of a national drug program. It makes no sense to me that we use the buying power of our provincial and federal governments to provide universal access to screening and diagnosis and then leave treatment to the market. That’s why no other OECD country with universal health has failed to include pharmaceuticals. Canada’s outlier status has led to us paying among the highest prices in the world for medications. Skyrocketing prices have left a quarter of Canadian patients who require medications skipping doses, splitting pills or not filling prescriptions at all.

You can read a more developed argument for Pharmacare in this post from October, 2023: https://substack.com/redirect/dd21c5df-cd4b-433e-88f5-cd0f797b1824?j=eyJ1IjoiMnJxNXR4In0.SfxecLDRRUfCc0a3RWV8Q3dsXoMdbZzWCVZ1p0w3Hq4

There are things to like about the federal legislation as announced. Under pressure from the Federal NDP, the Liberals backed away from their preferred “fill-the-gaps” model and went with single-payer, at least for this first phase. Single-payer is the most efficient way of providing coverage for all who need and decreasing costs through bulk-buying. As former Ontario Health Minister Dr. Eric Hoskins wrote in his report for the federal government, “Medicare doesn’t just fill the gaps and neither should Pharmacare.”

There are also legitimate questions to be asked. We have seen wildly varied estimates in costs and savings. How confident are we in our numbers? What are the opportunity costs of this investment now versus other measures that could impact health upstream?

This announcement promises to start with two categories of treatment: contraceptives and diabetes medications. British Columbia and Manitoba have already started providing birth control coverage. Advocates in Saskatchewan and other provinces have called for the same measures, arguing this approach saves money and protects women by decreasing unplanned pregnancies. As for diabetes, percentage of Canadians who are diabetic continues to grow, going from under 5% to nearly 8% in the last twenty years. Diabetes and poverty go together with Canadians dealing with food insecurity are twice as likely to develop diabetes. This further strengthens the argument for reducing the cost of that class of medications.

However, there are dozens of other deserving and important categories of treatment. Why contraceptives and not antibiotics? Why diabetes and not hypertension? Ultimately a full basket of essential medicines is the best model for cost reduction and patient care. This stepwise approach risks not getting all the way there and missing out on the best aspects of a universal plan.

The other questions are more political. This legislation came about as result of the Confidence-and-Supply-Agreement that has the federal NDP supporting the Liberals and preventing a federal election before 2025. How stable is a policy that came about through such an arrangement? Will the Liberals, having dodged the bullet on an early election actually carry through on even the first steps, let alone the full program? Or is this simply what André Picard called a “politically expedient pilot project?” And in the event of a Conservative government, will it be torn up the moment they get in, leaving this as nothing but false hope?

Garbage Takes

These are all worthwhile debates, debates of substance, but that’s not what the opponents of Pharmacare are relying on. Instead, they’re bringing forward an argument of fear based on a false dichotomy.

In a recent National Post article, Quebec Economist and private care advocate Emmanuelle B. Flaubert declares Pharmacare a “bomb waiting to detonate your coverage.” Her argument is that if there is a federal public plan that covers less than current provincial or private plan, people would lose that better coverage. I am at a loss to follow the logic here, as there is nothing about the existence of a foundation program that would inhibit other plans from covering more. In fact, by covering the costs of some medications, more funds would be available for other plans to expand their coverage. Strangely, Flaubert chooses Quebec as the example of risk yet cites how that province, with the most extensive public plan in Canada, also has the most medication coverage by private plans.

Nothing is stopping provinces or private companies from building on a national plan.

Does the fact that your hip surgery is covered by Medicare mean your private insurance can’t cover extra physio? Does the fact that you had your cataracts operated on in a public hospital mean your plan can’t cover glasses? Of course not. Nothing is stopping provinces or private companies from building on a national plan, and we have experience to see that’s the case.

We also have experience with these arguments. These were the same fears used to resist the introduction of Medicare in Canada, with fears of losing doctors creating panic and proving unfounded. South of the border the same cases were made about Obamacare, but instead of losing their insurance, millions more Americans now have coverage or have better protection against prejudicial policies like those around pre-existing conditions.

Unfortunately, it’s not just one academic making these arguments. Quebec and Alberta have indicated they’ll opt out of the program, and similar arguments have been made in Saskatchewan. In 2019, I asked then-health minister Jim Reiter his government’s stance on Pharmacare. His reply was to ask, “What if what’s proposed by the federal government is actually a less comprehensive program than what we have in Saskatchewan?“

The answer to that question is simple: take what’s good about National Pharmacare and build on it, just as we’re able to do with Medicare. There is nothing to prevent provinces from going above and beyond a federal program, there is nothing to prevent private plans from going above and beyond a federal program. The idea that increasing public funding to health care would somehow limit access to coverage is illogical and not borne out by the evidence. Let’s have the real debate about the best approach to prescription drug policy in Canada, and leave the scare tactics and garbage takes where they belong.

https://open.substack.com/pub/ryanmeili/p/pharma-scare-tactics?r=2rq5tx&utm_campaign=post&utm_medium=email

Tags: Health, ideology, jurisdiction, participation, pharmaceutical, privatization, standard of living

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