What is it that Doug Ford doesn’t understand about pharmacare?

Posted on September 20, 2020 in Health Debates

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TheStar.com – Politics/Political Opinion

Doug Ford and his fellow premiers were singing the same tune Friday as they importuned Ottawa for more money.

But for all their private talks — and public talking points — the premiers are fighting yesterday’s war instead of bracing for tomorrow’s battle to keep Canadians healthy.

COVID-19 is stressing health-care budgets — hence their distress call for the nearly doubling of federal funding. But the premiers’ single-minded rescue mission for medicare looks increasingly like a closed-minded search-and-destroy mission for pharmacare.

Ahead of next week’s federal throne speech, which could finally launch a truly national drug benefits plan, the provinces are telling Ottawa to mind its own business — even though pharmacare is the unfinished business of universalmedicare coverage conceived more than half a century ago. It’s a pre-emptive strike that could hurt us all.

All these years later, a pandemic is precisely the time to cure what ails medicare — not merely with more funding but a long overdue updating, through a companion pharmacare program that makes it truly comprehensive. Yes, the worst of times may be the best possible time for universal prescription drug coverage, because now is when so many millions of Canadians — who previously relied on their private workplace plans — are suddenly jobless, joining the ranks of millions before them who fell between the health-care cracks.

When my Toronto Star colleague Tonda MacCharles put Ford on the spot Friday, asking if he’d be open to a federal foray into pharmacare, the premier reflexively deflected and pivoted. But his studied bonhomie — cheerfully joining his provincial counterparts in demanding more money for health care, while politely (but firmly) discouraging Ottawa’s efforts — cannot disguise how much of an obstacle the premier of Canada’s biggest province remains to life-saving prescription drugs for all, all the time.

The political problem with pharmacare is that people don’t see the need for it until they desperately need it. That’s why Ford’s first act as premier, in 2018, was to dilute and dismantle the embryonic pharmacare program put in place by his predecessor, Kathleen Wynne.

Within hours of his supposedly populist government taking power, the Progressive Conservatives downgraded Ontario’s new OHIP+ from a universal program (for young and old) into a charity program for the most needy — only. Put another way, Ford opted for U.S.-style “Medicaid” targeting the poor and elderly, versus Canadian-style medicare for all.

That’s Canada’s pharmacare paradox: We take pride in medicare and belittle Americans for mocking it as “socialized medicine,” yet we are little different from them in coasting on what we already have with workplace benefits.

Just as Americans cling to their “Cadillac” private health plans rather than embrace a truly national health insurance program, many Canadian voters are all too comfortable with their private (or elderly) drug benefits to bother demanding a universal pharmacare program. Now, Canadians are realizing how elusive workplace plans are proving to be — vapourized by the unemployment of a pandemic, the precarious employment that predated it, or the economic uncertainty that will surely follow it.

In the 1960s, politicians compromised on medicare by deferring a full prescription benefits plan until funding could be found, but in those days drugs tended to be administered in hospitals at no cost to patients. Today’s more sophisticated prescription drugs are more likely to be taken at home, and are much more likely to be essential life-saving treatments than they were decades ago.

Yet Canadian politicians still defend the fiction of universal medicare without medicines for all.

This isn’t merely a question of compassion or ideology, but economic efficiency. Today’s fractured prescription plans — divided between private and public (the latter cover only the poor and the elderly), split among 13 provinces and territories — only guarantee that Canada pays among the highest prices in the Western world.

A national pharmacare program would give us the scale to save billions of dollars, by using our consolidated purchasing power to drive down inflated prices charged by multinational drug companies. That’s how Wal-Mart reduces costs — squeezing its suppliers — so why doesn’t our business-loving premier see the advantage?

Yes, the initial bill looks daunting, so why do private sector economists and think tanks support the idea? The overall savings are compelling, especially if governments require employers to rebate money now being spent on superfluous private plans.

The premiers keep complaining about rising health-care costs, so why not embrace the one big idea that could control costs dramatically? COVID-19 is a time of crisis, but it also confers an economic opportunity for health care.

The minority Parliament in Ottawa also presents a political opportunity that should not be wasted. The governing Liberals are mindful of NDP pressure to fulfil their federal campaign promises on pharmacare (long a priority for New Democrats).

Money need not be an obstacle, because a well-designed plan will pay dividends — not just in lower drug costs but in better health outcomes. The biggest barrier, it turns out, is a lack of political will, an excess of ideology and an abundance of obstinacy.

Medicare has long been sacrosanct for Canadians. It’s long past time, all these years later, to follow through with pharmacare.


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