Social Policy in Ontario

Why Canadian governments resist sensible pharmacare

Posted on March 18, 2015 in Health Policy Context

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TheStar.com – News/Canada – A national, universal drug plan makes sense on all levels except the political.
Mar 17 2015.   By: Thomas Walkom National Affairs

In Canada, national pharmacare is the great idea that never comes to pass.

Since 1964, numerous royal commissions and advisory bodies have called on Ottawa to introduce a pan-Canadian, universal drug plan.

Numerous studies have shown that such a plan would save the citizens of this country a considerable amount of money.

A study published this week in the Canadian Medical Association Journal is only the latest.

Yet nothing ever happens on the pharmacare front. Indeed, as my colleague Carol Goar pointed out recently, governments are, if anything, moving in the other direction.

Are Canada’s politicians simply perverse?

To answer that requires, first, an idea of how national pharmacare might work.

The model looked at in the CMAJ study is as good as any. It would charge users just $2 for every prescription filled ($10 if the drug were brand-name). It would establish a national formulary of eligible pharmaceuticals.

Most important, it would have the national drug plan use its buying power to negotiate good deals with pharmaceutical manufacturers.
That’s what countries ranging from Britain to Switzerland to New Zealand do.

If Ottawa did the same as the least of these countries, the study says, universal pharmacare would save Canadians somewhere between $4.2 billion and $9.4 billion a year.

Businesses that now offer their own workplace drug plans would save, as would their employees. Individuals with no access to drug plans would save. In net terms, Canadians as a whole would save.

These findings, incidentally, echo those made by the federal government’s National Forum on Health in 1997, a 2010 study done by the Canadian Centre for Policy Alternatives, a 2013 report for the C.D. Howe Institute and a 2014 study for the Canadian Federation of Nurses Unions.

So that’s what the experts say: pharmacare is a good idea, both socially and economically.
In rhetoric, the politicians aren’t far behind.

Justin Trudeau’s Liberals say they would “address” critical health-care issues such as pharmacare. Tom Mulcair’s NDP promises to “expand public coverage for prescription drugs.”

Even Prime Minister Stephen Harper, when he was in opposition, called for a limited national pharmacare program.

Nonetheless, this very good idea that almost everyone lauds is never put into action.

The reason is not cost. Study after study shows that in net terms pharmacare would save money.

Rather, the reason for this insufferable inaction is that a national drug program would shift costs from the private to the public sector — from what we pay out of one pocket (prescription costs and insurance premiums) to what we pay out of the other (taxes).

The CMAJ study, for instance, calculates that in its base-case scenario, pharmacare would result in governments paying $1 billion more. That figure would be more than offset by the fact that Canadians would, on the whole, pay $7.3 billion less.

Yet politicians feel, with some reason, that they are judged not by the overall good they do the country but by their handling of taxes and budgetary deficits.

That contradiction bedevils parties of all political stripes.

In 1975, Saskatchewan’s New Democratic government established a model pharmacare program that offered comprehensive coverage to all of the province’s residents.

But in 1993, in an effort to deal with fiscal deficits induced by a major economic recession, another NDP government virtually demolished the universal scheme.

Similarly, Jean Chrétien’s Liberals set up the National Forum on Health to look into pharmacare. But when the forum reported, they kicked the idea down the road.

At a time when the Liberals were promoting tax cuts and deficit reduction, they did not want to be seen taking on new financial obligations.
In those days, even the Star editorial board dismissed universal pharmacare as “pie in the sky.”

Still, like most good ideas, this one never goes away. Ontario Health Minister Eric Hoskins wrote in the Star last fall that pharmacare, as well as being economically sensible, would fill a gap in health care “that we can no longer afford to ignore.”

He called for political courage. We shall see if such a thing exists.

< http://www.thestar.com/news/canada/2015/03/17/why-canadian-governments-resist-sensible-pharmacare-walkom.html >

Tags: budget, economy, featured, Health, ideology, jurisdiction, mental Health, participation, pharmaceutical, standard of living, tax

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