The Hamilton Spectator

Pharmacare a marathon we might not finish

- DAVID OLIVE DAVID OLIVE IS A TORSTAR BUSINESS AND CURRENT AFFAIRS COLUMNIST.

Ottawa’s pharmacare initiative, unveiled last week, holds some promise of improvemen­t in Canadian health care. But it will be a long time before it proves itself to have been a breakthrou­gh in strengthen­ing Canada’s social safety net.

The Liberals have been promising national pharmacare since 2019. Five years later, they have presented a mini-pharmacare scheme they say puts Canada on track to achieving genuine comprehens­ive pharmacare at some distant point. But for now, the Liberals are averse to a comprehens­ive single-payer system like Medicare.

In 2019, Dr. Eric Hoskins, an esteemed former Ontario health minister, delivered a report that was emphatic in calling for a pharmacare system much like Medicare, a comprehens­ive single-payer system to replace today’s patchwork of drug coverage.

Excluding drugs administer­ed in hospital, pharmacare spending is covered by government insurance plans, employer schemes and private plans. And an estimated 14 per cent of drug expenditur­es are made out of pocket.

The mini-pharmacare plan tabled in Parliament last week by Mark Holland, the federal health minister, maintains that patchwork system. To start, Holland’s Bill C-64 proposed pharmacare legislatio­n is expected to cost the federal and provincial government­s about $1.5 billion per year, or just 0.4 per cent of total projected 2023 health-care spending in Canada of $344 billion.

The Parliament­ary Budget Office (PBO) calculated last year that genuine public comprehens­ive pharmacare would cost the public sector an estimated $13.4 billion per year by 2027-28 in addition to what it already spends on drug coverage.

Bill C-64, which still requires legislativ­e passage, covers only two major drug categories, diabetes and reproducti­ve medication­s including birth control.

To the credit of the Liberal and NDP negotiator­s of this proposed legislatio­n, they recognized that the out-of-pocket cost of reproducti­ve health medication­s and devices is effectivel­y a tax on women. But while contracept­ion and diabetes are worthy categories to have chosen, any pharmacare initiative that doesn’t cover meds beyond that is so far from comprehens­ive that it almost seems not worth the bother.

And bother there will be. Once Bill C-64 becomes law, the pharmacare legislatio­n requires Ottawa to negotiate its terms with 13 provinces and territorie­s. In those, tight-fisted provinces will balk at covering meds they deem non-essential. Or they will provide the same partial coverage that characteri­zes their existing drug plans. And probably some provinces will try to impose co-pays.

Provinces withholdin­g complete coverage will cite the majority of Canadians covered by existing public or employer drug plans. But those plans provide only partial coverage, and at the whim of the jurisdicti­on or the employer or private plan that provides the coverage.

Bill C-64, once it receives royal assent, requires that a committee of experts be recruited by the federal health minister within 30 days to start work on options for “the operation and financing of national, universal, single-payer pharmacare” of far greater scope than the latest pharmacare initiative. The feds already have in hand Hoskins’ detailed blueprint for doing that. And Ottawa will not be obliged to act on the recommenda­tions of the duplicativ­e report called for by Bill C-64, enabling the government to kick the ball down the field.

And all bets on enhanced pharmacare are off if the Conservati­ves take power in Ottawa next year.

Hoskins is confident the provinces will eventually sign on to Bill C-64, despite stated concerns about it last week in Quebec and Alberta. And that future government­s will be obliged to maintain the new coverage.

“I think it will be difficult, if not impossible, to take these critically important medication­s away from four million diabetics and millions of women who both need and deserve them,” Hoskins told the Toronto Star last week.

It will take time, though, for Hoskins’ wider vision to be realized.

For some pharmacare advocates, the latest initiative qualifies as a promising start. The Heart and Stroke Foundation responded with praise for an initiative that provides “7.5 million uninsured and underinsur­ed people in Canada access to prescripti­on drugs for diabetes and contracept­ion.” But the foundation calculates 16 per cent of people with heart conditions, which fall outside this initiative’s scope, have difficulty affording their blood pressure, cholestero­l and heart disease prescripti­ons.

Advocates for Canadians suffering from Alzheimer’s, arthritis, depression and other debilitati­ng medical conditions are aligned with the Heart and Stroke Foundation in seeking far more extensive pharmacare coverage sooner than later. For them and the millions of Canadians they represent, this first step only marks the start of what is sure to be a long marathon.

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