The Liberal government shouldn’t go soft on pharmacare

Posted on in Health Policy Context

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TheStar.com – Opinion/Editorials
March 1, 2019.   By

It can look a little tattered around the edges, but Canadians routinely and fiercely defend their universal, publicly funded health care system.

Just look at the outrage generated over the mere possibility that the restructuring of Ontario’s health care system by Doug Ford’s Progressive Conservatives will open the door to more private delivery of medical services.

And yet there’s a glaring gap in our medicare system that gets far too little attention: the lack of universal access to prescription drugs, an ever-growing component of health care.

The Royal Commission on Health Services that created Canada’s public system saw the need for a national pharmacare program all the way back in the 1960s. But politics got in the way of doing the right thing then and Canadians have paid a high price ever since.

That price is paid with too many people sicker than they need to be because they can’t afford to pay for their prescriptions, and actual dollars — billions of them annually — through unnecessarily high drug prices.

Canada is the only country with universal health care that doesn’t include universal drug coverage.

It’s little wonder, since the lack of one undermines the other.

Now, years after two royal commissions, a national forum and too many reports to count have called for national pharmacare, the federal government has indicated that it’s finally ready to move on this in its March 19 budget.

That’s welcome and long overdue.

But it’s worrisome that Finance Minister Bill Morneau has also suggested that the government is planning to fill the gaps rather than deliver the universal medicare-style plan that the Commons committee on health recommended just last year.

If that’s the case, it will be a real missed opportunity.

Certainly it’s easy to see the political appeal of a plan that simply seeks to patch up the holes between workplace private insurance plans, federal programs and provincial/territorial benefits, largely targeted to children, seniors and the poor.

Prime Minister Justin Trudeau would not face pushback from the private insurance industry. Liberal MPs would not be inundated with calls from voters worried that they might get less under a universal program than they do with their existing plan, especially if they’re lucky enough to have a good one. And the government would not have to embark on negotiations with the provinces, many of which are led by Conservative premiers spoiling for a fight.

That’s all pretty daunting. And in an election year no less.

Still, it’s worth the effort to finally get this right.

The benefits of a robust national pharmacare plan are substantial, both in improving health outcomes for millions of Canadians and reducing overall costs. The farther off that ideal the government goes, the fewer of those benefits we’ll see.

Canada spent an astounding $34 billion on prescribed drugs last year, according to the Canadian Institute for Health Information. Of that, about 40 per cent was publicly financed and the rest covered by private insurance or individuals paying out of pocket.

It’s not only an enormous sum, it’s a far bigger one than it should be.

Canadians pay the highest drug prices in the world, but for the United States and Switzerland. There is no good reason for that. The average OECD country spends a third less per capita on drugs than Canada does.

Nationally, we pay more for drugs than doctors. And that bill is going up.

According to the Parliamentary Budget Officer, billions could be saved annually through a national pharmacare program with its bulk buying of drugs and stricter regulations on prices.

Much of those savings, though, would go to individuals and employers, while increased costs would be transferred to the public purse. The challenge of figuring out a fair and feasible way to address that is what has kept all those reports calling for pharmacare sitting on shelves, collecting dust.

But it’s imperative that the government finds a way forward, and soon.

The price of medication isn’t just a problem for the millions of Canadians who can’t afford their drugs now. It’s a rising problem for the quality of coverage in workplace plans and the sustainability of government drug benefits for seniors and the poor.

These days, many cancer patients don’t receive chemotheraphy drugs in a hospital — where the cost is picked up by the public health-care system — but are sent home with a prescription for pills to pick up at the drug store.

That innovation means that even people with insurance struggle to afford their co-payments and can quickly hit their plan’s lifetime caps. What’s next?

Workers already see employers responding to the rapidly rising costs of benefits by diminishing their coverage with increasing co-pays, fees and caps, and reducing drug options.

And those are the people who have workplace benefits. That’s increasingly not the case for workers, especially in low-wage fields, who face a never-ending cycle of part-time, contract and temp agency jobs that provide few benefits.

Maintaining this inadequate patchwork costs everyone — governments, individuals and businesses — far more than it should. That’s not good for anyone, including those who enjoy good coverage now.

We know Canada’s medicare system is less costly and delivers better health than the U.S. public-private mix. It’s time the federal government saw pharmacare in that same light.

As the Commons health committee put it: “In short, it will save money and lives.”

https://www.thestar.com/opinion/editorials/2019/03/01/the-liberal-government-shouldnt-go-soft-on-pharmacare.html

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