Action, not talk, needed on pharmacare

The federal government has created an advisory council to examine the feasibility of a national pharmacare program. According to the council’s terms of reference, it is to “conduct a fiscal, economic and social assessment of domestic and international pharmacare models … consult extensively with Canadians and meet with … health-care experts, patients, interested stakeholders, and provincial, territorial and Indigenous leaders [and issue] its final report in spring 2019.”

Good luck with that. The Franklin expedition had better odds.

We’ve already had umpteen reports on how to create a national drug plan. None of them led anywhere. Why should this latest be different?

And while we’re at it, who are these “interested stakeholders”? Could it be the same outfits who’ve been agitating in favour of a national drug plan these past 50 years? This is a setup from the get-go.

But setup or not, it remains mission impossible. First, there is no agreement among the provinces about which drugs should be covered in a national plan. And for a simple reason.

There are huge disparities in the financial strength of Canada’s provincial governments. Some can afford generous coverage, others cannot. That isn’t going to change.

Second, there are significant barriers to the federal government launching such a scheme. Constitutionally, health-care delivery is the exclusive domain of the provinces.

It might be possible for Ottawa to deal with that by merely bankrolling the plan and not actually running it. But that only invites a host of political difficulties.

Ottawa currently uses transfer payments to help the provinces deliver health-care programs. Yet history proves that mechanism can’t be trusted.

In the 1960s, when the federal government first encouraged provinces to introduce hospital and primary-care coverage, Ottawa split the bill roughly 50/50. But that compromise wasn’t honoured.

Last year, federal transfers for health care totalled $36 billion. Provincial spending on physician and hospital care came to $140 billion — four times Ottawa’s contribution.

Extreme care has to be taken with these numbers. All of our governments, federal and provincial, change their accounting schemes on a regular basis. It’s extremely difficult to make reliable comparisons over time.

But the point is clear enough. While Ottawa might promise generous support to get a national drug plan off the ground, what happens down the road is another matter. The provinces know this.

Let’s try a different approach. The real obstacle to any universal pharmacare plan is the fact that we do a dreadful job controlling costs.

Canada currently pays more for drugs than any other industrialized country but two — the U.S. and Switzerland. A national drug program isn’t going to change that.

Here’s a better option. In the Netherlands, a pharmaceutical company called Leadiant Biosciences recently raised the annual cost of one of their life-saving drugs from $46,000 per patient to $262,594. No excuse was offered, for there was none, but Dutch insurance companies were forced to withdraw their coverage.

However, this act of naked greed prompted a revolt. In Amsterdam, a group of pharmacists found they could produce Leadiant’s medication for a fraction of the new price — indeed, for less than the old price. Since the drug was no longer on patent, they went ahead.

Now, Canada has several hospitals large enough to make their own drugs. A consortium of hospitals in Vancouver, Calgary, Toronto and Montreal could probably supply the whole country.

We would have to indemnify them against lawsuits by big pharma, a notoriously litigious crew. But I’m pretty sure our pockets, collectively, are deeper than theirs.

Bottom line: We don’t need an advisory council crisscrossing the country and wandering the corridors of provincial legislatures looking for answers.

What we need is action. If the Netherlands, with an economy half our size, can make its own drugs, why can’t we?