Social Policy in Ontario

Pressure for pharmacare is building. In Ontario, it has become an issue in the provincial election campaign. Federally, Finance Minister Bill Morneau has promised to look into it. Now a Commons committee has thrown its weight behind the idea of a universal, national program to provide all Canadians with necessary drugs at little or no cost.

Titled “Pharmacare now: Prescription medicine coverage for all Canadians,” the report by the Commons health committee is unusually bold for a political document. By calling for all medically necessary prescription drugs to be covered by medicare, it is recommending the biggest change in Canada’s premier social program since extra-billing by doctors was outlawed in 1984.

There’s nothing new about the concept of pharmacare. The 1964 royal commission that led to national medicare recommended that drugs eventually be covered by public health insurance. So did another royal commission in 2002.

Other countries, most notably Australia and New Zealand, have fully functioning universal pharmacare programs that both serve the citizenry and save money.

Canada, by contrast, is characterized by a hodge podge of public and private drug schemes.

If you are a patient in hospital, medicare will cover your drug costs. But once you go home, it won’t.

Some people qualify for public programs because they are old, some because they are poor.

Still others qualify because they have specific diseases or because they must spend an inordinate portion of their income on drugs.

Across Canada there are more than 70 separate, public drug programs.

Most Canadians are privately insured either through workplace or individual drug plans. But as the cost of prescription drugs rises, the scope of coverage in many of these private plans is being scaled back.

Somewhere between 10 and 20 per cent of Canadians have no drug coverage at all. Of those who do, fully 10 per cent can’t afford the required user fees or co-payments.

In short, it’s a mess — an expensive one. Canada has the third-highest per capita drug costs in the industrial world. Only the U.S. and Switzerland do worse.

While the provinces have begun bulk-buying in an effort to reduce the costs of their public plans, private insurers — and their customers — are at the mercy of the pharmaceutical industry.

In a report done for the committee, the Parliamentary Budget Office calculates that while universal pharmacare would cost governments $7 billion annually, it would provide Canadians on the whole with net savings of $8.1 billion a year.

To put it another way, any increase in taxes attributable to pharmacare would be more than compensated for by out-of-pocket savings.

Still, any talk of tax hikes makes politicians nervous. After announcing plans to look into pharmacare earlier this year, Morneau backtracked, saying he merely wanted something to fill in the gaps rather than a new program that covers all Canadians. Since then, he has backtracked on his backtracking. But the point is that the spectre of universal pharmacare appears to have spooked the finance minister.

To their credit, the MPs on the health committee were not so easily spooked. Conservative members issued a dissenting report calling for more study. But even they didn’t dismiss universal pharmacare out of hand (although they did dismiss raising taxes to pay for it).

The committee’s NDP members agreed with the recommendation for universal pharmacare but issued a supplementary report urging the government to move farther faster.

Experts routinely produce well-researched reports calling for universal pharmacare. Politicians routinely ignore them. What’s different this time is that a group of politicians has endorsed the concept.

And while it would be naïve to suggest that parliamentary committees have real power, perhaps this report is a sign that, finally, this eminently sensible idea is gaining political traction in Ottawa.

https://www.thestar.com/opinion/star-columnists/2018/04/19/universal-pharmacare-the-right-prescription-for-canada.html