Why rich kids deserve free prescription drugs

Phased pharmacare is finally coming to Ontario.

Now some opponents want to phase it out before it even begins.

A half-century after Canada took the first halting half-step toward truly universal health coverage — medicare without medicines — we need to take the final step toward truly universal coverage. That means providing all effective drugs to all people of all means and all ages.

The first phase announced in last week’s Liberal budget would limit access to young people up until age 25. But its key provision is that prescription medicines would be provided to everyone in that age group regardless of their income — or their parents’ income.

The idea has ignited a backlash from critics in the Progressive Conservative opposition who question why rich kids, or the sons and daughters of millionaires, should be entitled to medicine at no cost. It’s a fair question about the inherent unfairness of rich folks getting a free ride.

Except that the same question could just as easily be applied to medicare, which provides universal coverage without age restrictions of any kind. Why accept universality for medicare but not pharmacare?

The answer is that the rich don’t get a free ride either way. They pay more than their fair share in our (still) progressive tax system, for which they derive the same benefits as everyone else under medicare, just as they would with pharmacare.

Remember, these are primarily health insurance programs, not charitable giveaways to poor or cash-strapped parents. Medicare isn’t like the old universal baby bonus (rechristened the child benefit), providing cash with no strings attached — something the rich don’t need, and get taxed back on anyway.

If not for medicare, health insurance would otherwise be offered by private sector companies, as it is in the U.S. Private insurers would compete with one another to screen pre-existing conditions, reduce benefits, overrule doctors and constrain coverage. Medicare and pharmacare are insurance programs that provide coverage people actually need, rich or poor, while sharing the costs along actuarial lines. The political benefit of universality is that you get buy-in from everyone. The economic benefit of universal medicare is that it saves lives — and, yes, money — by helping people who might not otherwise get treatment.

The ideological appeal of universal pharmacare is that it also offers the benefits of bulk buying. By pooling our purchasing power provincially (and ultimately nationally) government drug insurance would save billions of dollars annually.

Pharmacare isn’t charity, it’s efficiency. In future, as the private sector slowly rolls up drug benefits the way it has phased out pension plans, the pressure will increase on governments to pick up the slack.

The latest Liberal budget plan isn’t perfect. It does not yet provide full coverage for all age groups. If you are between 25 and 65 (seniors get virtually free drugs), you will still be left in the lurch — dependent on your employee benefits plan if you are employed, or government drug benefits if you are on welfare, or nothing at all if you are between jobs and fall between the cracks.

The mystery is why it has taken so long for pharmacare to catch up with medicare, leaving Canada as the only major industrialized country to have one without the other. Years from now, we will wonder why we dragged our feet instead of taking the inevitable next step, allowing our love affair with medicare to blind us to the scandalous and obscene absence of universal pharmacare across Canada.

Ontario’s program, covering 4,400 drugs in the provincial formulary, will one day be seen as the first step along the way. Full credit also to the New Democrats for providing details of their own thoughtful proposal three days before the budget.

Both plans have strengths and weaknesses. The NDP design limits coverage to the 125 most common and effective drugs, with modest co-payments for people of all ages. Targeting the top medicines for bulk purchasing has the advantage of getting the “biggest bang for the buck,” as NDP Leader Andrea Horwath argues.

But a future NDP government would leave itself exposed to relentless criticism for excluding other life-saving drugs demanded by patients in need. The Liberal plan is simpler to implement because it covers all drugs in the formulary, reducing the risk that patients might improvise by substituting free drugs for their more costly prescribed medications. But it excludes most adults, many of whom will remain vulnerable.

The point isn’t to pick apart the rival plans, but to welcome them for taking us partway. The next step requires the federal government to play its part on pharmacare as it did with medicare and public pension plans — by funding the final phase of a national and fully universal pharmaceutical program.