The Trudeau government’s weak start on pharmacare

Posted on March 9, 2019 in Health Policy Context

Source: — Authors: – Opinion/Editorial
March 9, 2019.   By

The federal government released a report this week on national pharmacare — the missing piece of Canada’s public health-care system.

But don’t hold your breath; universal access to prescription drugs isn’t coming anytime soon.

And that’s awfully disappointing.

In the government’s own words, the problem we face is clear: “The existing patchwork of prescription drug coverage is leading to poorer health for some and higher costs for all Canadians.”

And yet this new report gets us no closer to solving that problem.

How can that be?

A year ago, the Trudeau Liberals set up an advisory council to figure out how to implement national pharmacare. Since then, the debate has centred on whether this would be the universal public drug plan that has long been called for, or a watered-down version aimed at filling in gaps in the existing system, which leaves millions without affordable drug coverage.

Thanks to federal Finance Minister Bill Morneau’s repeated suggestions that the government was focused on a gap-filling strategy, hopes that the Liberals would move on the universal plan that Canadians need were not particularly high.

Still, the council’s interim report doesn’t even manage to hit the much lowered bar of a gap-filling plan.

The council’s public brief, let’s remember, was to provide advice on “implementation of national pharmacare.”

But its report contains no plan for pharmacare at all. It talks only about creating “building blocks” that could someday, maybe, contribute to a plan.

How can nearly a year’s worth of effort given birth to so little? And especially when the destination — national pharmacare — was already laid out?

There were cross-country consultations, stakeholder roundtables, town hall meetings, 150 written submissions and 15,000 answers to an online questionnaire. All for an eight-page report — about a page apiece for each of the seven members of the expert advisory council.

Dr. Eric Hoskins, a former Ontario health minister and chair of the council, says a more robust report will come later this spring. But that lets the government off the hook from taking any steps forward in its March 19 budget.

Surely Canadians had a right to expect more by this point.

The report once again sums up the problem with our patchwork of private and public drug plans. Canada spends more per capita on drugs than almost any other country, yet leaves as many as 20 per cent of Canadians uninsured or woefully under-insured. Canada spends more on drugs than doctors and that bill is going up.

It warns that “without reform, the system will soon be at the breaking point.”

But neither the Trudeau government nor its advisory council has yet been willing to follow through to the obvious answer: universal national pharmacare.

The report’s only substantive recommendation is for a national drug agency and formulary, essentially a master list of prescription drugs that should be covered.

And that agency, it says, should be developed “in full and equal partnership with provinces and territories … as well as patients/citizens, clinical experts and others … and Indigenous peoples.”

That’s quite a list. Getting agreement on any change in health care from all those groups could take years. All the while millions of Canadians will remain sicker than they need to be because they can’t afford their prescriptions.

The proposed new drug agency might be useful with any future pharmacare plan or, as the panel itself points out, “even in the absence of national pharmacare.”

But the way it has been rolled out makes it a delay tactic far more than a building block for a proper plan.

The Royal Commission on Health Services that created Canada’s public system in the 1960s recommended public prescription drug coverage, but was not heeded. It’s long past time to fix that mistake.

It’s all too easy to see why this broken system has lasted so long. Change won’t happen without pushback from the private insurance industry and challenging negotiations with provinces. It will transfer costs from individuals and employers to the public purse. Figuring out a fair way to deal with all that won’t be easy.

But the longer the government delays the harder it becomes and the higher the price we’ll pay — in poorer health outcomes and unnecessarily high drug prices.

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

This week’s report rightly landed on the core principles of national pharmacare. It must ensure all Canadians have access to the prescription drugs they need, coverage is consistent and portable across jurisdictions, and skyrocketing drug prices are reined in.

A gap-filling strategy means we’ll always be struggling to plug the next hole that appears and leaves far too much scope for drug prices to keep rising. The best way to meet the aims is through a universal public plan.

It bodes ill that the Liberals’ advisory body didn’t manage to say exactly that.

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