The Premiers' Drug Deception

Canada needs a universal, national program that covers the costs of medically necessary prescription drugs.  That much is obvious.

The current patchwork of provincial plans that subsidize drug costs is a disgrace.  The Canada Health Act mandates universal, government-funded physician and hospital services for all Canadians.  In spite of the health system's stresses and strains, everyone--from Newfoundland to British Columbia--has access to those publicly funded services.

But government funding for the pharmaceutical drugs that doctors prescribe outside of hospitals varies wildly across the country.  What Canadians pay depends on where they live, on their income, and on their supplemental coverage by private drug insurance. 

In 2003 Canadians, on average, used $620 of prescription medications.  If they lived in Prince Edward Island, they paid $436 of that out of their own pockets.  But if they in Manitoba, they paid only $291; the government paid the rest.

Drugs cost more, but do more

Averages, however, don't tell the whole story.  Many medications, particularly new ones, are hugely expensive.  Paying for them can, in extreme cases, lead to financial ruin.  Canada's medicare system was established to remove financial barriers to health care.  What's going on?

A few trends are clear.  Drug costs and drug usage are increasing rapidly.  Twenty years ago the total bill for medications was around $4 billion; last year it was nearly $20 billion. 

One reason for this rapid escalation is the remarkable increase in drug effectiveness.  When Canada's medicare system was established in the 1960s, health care focused on services by physicians and hospitals.  Today prescription drugs can treat what was then untreatable, can keep us out of hospitals, and can help us live longer.  We now spend more on drugs than we do on doctors.

Other reasons for high drug costs are less benign: Drug companies use extended patent protection to gouge patients and prevent use of generic drugs.  We're suckers for the "newest, greatest" drug, even when older medications are equally effective.  Drug companies now market drugs-particularly so-called "lifestyle drugs"--directly to the consumer, driving up demand and use.
Feeling distracted?

Regardless of drug company shenanigans, patients need access to medically necessary drugs.  Other countries with universal, public health care systems have done far more than Canada to ensure access to prescription drugs for all their citizens.  So when Canada's provincial premiers proposed a national pharmacare plan, they were addressing a real weakness of Canada's health system.

However, the motives behind the premiers' proposal are, at best, self-serving.  They'd obviously like to have the federal government assume the $7.5 billion that the provinces presently pay for drugs.  And since drug costs are the most rapidly escalating area of health spending, they'd like to have that hot potato off their plates.

The premiers would also like to distract the public from their own failures to assist with drug costs. The provinces' performance has been shoddy. Indeed some provinces, like British Columbia, have actually reduced public help with drug costs in recent years.

At its root, the national pharmacare proposal is just a political diversion. The premiers don't want new federal health funding linked to real, and needed changes in the health care systems the provinces run.  If the federal government spends all its promised new money on a drug program, no funds will be left to compel provinces to make changes, changes needed to get wait lists down and improve access.

A better approach

Here's a better idea: Change the Canada Health Act to include coverage of medically necessary drugs.  Set up a federal/provincial cost-shared pharmacare program to protect all Canadians from high drug costs.  Use the rest of the promised federal increases to health spending to compel provinces to live by the spirit as well as the letter of the Canada Health Act.

The time for the political gamesmanship that the provincial premiers are engaging in is over. It's time to make some real changes in our health care system.   

Paul Ramsey is a former NDP MLA and Cabinet Minister.  He now teaches at CNC and is a Visiting Professor in the Political Science Program at UNBC.