Social Policy in Ontario

Ever since the founding of medicare, medicines have been conspicuously left off the list while politicians deferred pharmacare for the future. That was a half-century ago, and our leaders still haven’t followed up.

At least not nationally. Ontario, however, offers a cautionary tale for how fast pharmacare can rise to the top of the agenda — only to be derailed by opposing political agendas, fierce resistance from private insurers, public ambivalence and voter apathy.

Two years ago, much like today, the provincial wings of the rival Liberals and New Democrats made competing proposals to phase in pharmacare programs. The unpopular Liberal government of then-premier Kathleen Wynne implemented full coverage for seniors and young Ontarians (age 24 and under) early last year.

Then Wynne lost the election. Basking in its putative political honeymoon the Progressive Conservative government of Premier Doug Ford gutted the universal coverage in Ontario’s pioneering OHIP+ program.

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Health Minister Christine Elliott issued a terse news release announcing the Tories would “fix the OHIP+ program” to make it more “cost-effective.” In the aftermath, Canada’s biggest province has become a dead end for pharmacare.

Why did Ford’s Tories undo universality? How did they get away with it?

The voting public didn’t buy into free prescription drugs in a big way. Pharmacare lacked a vocal provincial constituency last year, just as it lacks a powerful federal advocate this year, despite broad (if soft) support in public opinion polls.

Today, as the federal Liberals and NDP pick apart each other’s proposals, federal Conservative Leader Andrew Scheer is dismissing them both — calling pharmacare unaffordable and unworkable. Just as Ford did last year.

Will Canadians learn the lessons of Ontario’s lost opportunities?

It is an enduring paradox of this country — and province — that we view medicare as a quintessentially Canadian trait, even though we remain an international outlier: No other Western country with universal health coverage excludes prescription drug coverage as we do.

About 20 per cent of Canadians, or 7.5 million people, lack prescription drug coverage — leaving them unable to afford vital drug therapies to fight illness and stay healthy. That percentage is destined to grow in a gig economy defined by precarious work.

As most economist now argue, universal pharmacare is eminently more cost-effective than a fractured system of private insurers dreaming up their own rules for eligible drugs and deductibles. Much like universal medicare, pharmacare is based on a single-payer system that eliminates duplication on delivery and eligibility while profiting from economies of scale.

Even more than medicare, however, pharmacare allows for a single-buyer system that yields stronger purchasing power, reducing costs from drug manufacturers the way Walmart squeezes suppliers. That’s why universal pharmacare isn’t merely about equity and ideology, but efficacy and efficiency.

So why did pharmacare die without so much as a whimper from the Ontario public?

It turns out that the underlying principle of universality isn’t universally loved in Canada anymore. Free drugs are a hard sell in a country where 80 per cent of people are already covered by the 1,000 public and 100,000 private plans that have created such an atomized patchwork.

If I’m all right Jack, why should I care about Jill’s prescription drug needs? If Jill gains pharmacare, will my premium private workplace plan be undermined?

That’s precisely how the medicare debate has played out in the U.S. for so long. After decades of delay, it’s hard to pry Americans away from their private plans, which is why Obamacare initially encountered so much resistance.

A new report this month from a federal panel chaired by Dr. Eric Hoskins, Ontario’s former health minister, makes the case for a phased-in pharmacare program to replace the country’s patchwork system. Canadians spent $34 billion on prescription medicines last year, and pay the highest drug prices of any country with universal health care; pharmacare would save $5 billion a year, Hoskins argued.

The challenge is to make those savings feel real, not notional. When Hoskins introduced Ontario’s OHIP+ program last year, voters complained about higher taxes without believing they would benefit from lower workplace premiums. In fact, the average family would save $350 a year under the new federal proposals, and the average business would be spared $750 per employee in drug coverage — but that cost-benefit tradeoff must be spelled out clearly to persuade people that the savings end up in their pockets.

It’s long past time for pharmacare, just as it was surely time for medicare all those decades ago. But based on Ontario’s short-lived experiment with universal drug coverage, its time may never come — unless politicians and voters learn the lessons of history.

Martin Regg Cohn is a columnist based in Toronto covering Ontario politics.

https://www.thestar.com/politics/political-opinion/2019/06/17/why-are-we-forever-chasing-the-dream-of-a-universal-drug-plan.html