A prescription for better health care

For the sake of Canada’s health care system, it is time for the federal government to get serious about national pharmacare. Yes, pharmacare. Here’s why. The U.S.-based Commonwealth Fund recently ranked Canada’s health care system second among eleven comparable countries—second to last, that is. Only the American health care system is worse. Even before the pandemic, Canada desperately needed improvements in long term care, mental health care, primary health care, and pharmacare. Yet, provinces will not commit to any of these long-overdue reforms despite asking the federal government for tens of billions in new, annual federal health transfers. This is a depressingly familiar story in Canada. From 2004 to 2014, the federal government gave provinces an extra $41-billion to “fix health care for a generation.” Provinces used this no-strings-attached money to do little more than maintain the status quo—which, as a reminder, is the second worst health care system in the developed world. The federal government must not repeat the mistake of giving provinces cash without guaranteeing significant improvements in health care. The fastest way to improve health care today and for generations to come—while also generating billions in health care savings that provinces can invest as they see fit—is for the federal government to fund the implementation of national pharmacare. A universal, public pharmacare program has been recommended by five national commissions since the 1960s, the most recent of which was the 2019 Advisory Council on the Implementation of National Pharmacare. Every one of these commissions recommended national pharmacare because it would improve equity in access to necessary medicines across Canada while producing more savings for Canadians than it costs government to run—meaning it more than pays for itself. According to the most recent implementation plan, the first stage of national pharmacare is to provide universal, public coverage of a list of essential medicines. This would involve covering over 100 of the most important medicines in Canadian health care—ranging from antibiotics to warfarin—that account for nearly half of all prescriptions in Canada. This stage of national pharmacare was to begin in 2022 with approximately $3.5-billion per year in federal funding. The plan was for provinces to pay the balance of the cost by way of the $4-billion they would otherwise be spending on essential medicines used by beneficiaries of existing provincial drug programs. Provinces have balked at this, worrying their share of the costs would be bigger. If, however, the federal government funded the entire cost of this first stage of national pharmacare, no province could refuse universal access to essential medicines for their residents through a plan that would immediately save provinces four billion per year in public drug plan costs. Research shows the improved access to essential medicines would reduce demand for other health care services, thereby generating provinces billions more in health care savings. Not to worry; it is not just provincial governments that would save billions. Canadian households would save over $1-billion per year in out-of-pocket medicine costs and employers and unions would save over $3-billion per year. The national pharmacare implementation plan then recommends adding universal coverage of additional medicines each year so that, by 2027, the program would cover all medicines of proven safety, efficacy, and value. Depending on how much of this expansion the federal government pays for, provinces could receive between $4-billion and $20-billion per year in direct savings to provincial budgets, while households would save $6-billion per year and employers would save $16-billion per year. Thus, the federal funding of national pharmacare implementation would immediately improve access to medicines across Canada while generating billions of dollars in savings that could be used—by provinces, households, and businesses—to invest in other components of the health care system that also desperately need attention. If the alternative to this sort of strategic federal investment is to simply increase the Canada Health Transfer without securing commitments and accountability from the provinces, Trudeau will be repeating the mistakes of the past and Canada will have the second-to-worst health care system for another generation. Canadians deserve better. Now more than ever, national pharmacare is Medicare’s prescription. Steve Morgan is a professor in the UBC School of Population and Public Health. Twitter: @SteveUBC The Hill Times