Social Policy in Ontario

When Prime Minister Stephen Harper, along with the health and immigration ministers, tried to justify cutting refugee health coverage in Canada they argued it was about fairness. Providing prescription drug coverage to refugees was unfair, they claimed, because other Canadians do not have such coverage. They were at least partly right.

As a country, we provide universal access to medically necessary hospital care, diagnostic tests and physician services based solely on need. It’s a point of national pride. But Canadian “medicare” — as it is affectionately known — ends as soon as a patient is given a prescription to fill.

Provincial drug plans cover only limited populations, such as seniors or social assistance recipients, or limited costs (such as costs exceeding “catastrophic” deductibles). Private drug insurance is a perk not easily obtained by Canadians who are retired, self-employed or employees of small companies.

The patchwork of drug coverage in Canada has consequences that cost us all.

A recent study found that one in 10 Canadians can’t afford to fill their prescriptions as directed. Such financial barriers often increase costs elsewhere in the health care system — from the public purse. For example, if a parent cannot afford the necessary drugs for a child’s asthma, they may be forced to visit the emergency department when the asthma gets out of control.

Thus, the question is not whether it is fair to provide refugees with prescription drug coverage; the question is whether it is fair — and even fiscally responsible — not to provide such coverage to all Canadians.

In a recent essay in Healthcare Policy journal, we show how the omission of Pharmacare from Canadian medicare came about as an accident of history, the correction of which is long overdue.

Canada’s health insurance system was developed in stages, starting with the components of health care that were the most important at the time. Coverage for hospital care and diagnostic tests was established in the 1950s, followed by coverage for medical care in the 1960s. The fathers of our medicare system intended that Pharmacare and homecare be established next.

Pharmacare never happened, but the need for it is stronger than ever.

The range, use and availability of pharmaceuticals has increased dramatically over the past 30 years. As a result, prescription drugs are one of the most important components of contemporary health care. They are also one of the most costly forms of care.

Canadians now spend more money on prescription drugs than they do on all of the services provided by physicians in this country. And, while many drugs are available at modest cost, a new wave of biological drugs is coming to market with price tags of thousands of dollars a year; in some cases, thousands of dollars a month.

The need for Pharmacare has not gone unnoticed. In 1997, the National Forum on Health recommended expanding Pharmacare across Canada, but the pharmaceutical industry lobbied against such reforms, arguing that Canada could not “afford” the cost of a national Pharmacare system. Such arguments are repeated today.

In truth, a universal Pharmacare program would save Canadians billions of dollars; some estimate up to $10 billion per year.

The proof is found in virtually all countries comparable to Canada, countries like Australia, Denmark, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom. In comparison to Canada, pharmaceutical spending is lower and has been growing more slowly in all of these countries. Yet they all provide better, more equitable access to prescription drugs than Canada through universal Pharmacare systems of one form or another.

In the 2012 Emmett Hall Memorial Lecture, Dr. Michael Rachlis said that medicare was one of the best expressions of Canadian democracy because Canadian citizens wanted it and had to fight for it.

If Canadians take pride in their medicare system, and want to achieve better access to medicines at lower costs than they pay today, then maybe it is time for the original vision of medicare, which included Pharmacare, to be completed as planned.

Perhaps it is time to fight for Pharmacare. Not just for refugees, but for all Canadians.

Steve Morgan is an expert adviser with EvidenceNetwork.ca and associate professor and associate director of the Centre for Health Services and Policy Research at the University of British Columbia. Jamie Daw is a policy analyst with the Centre for Health Services and Policy Research.