Pharmacare plan poor public policy
The Trudeau government recently inked a much-anticipated pharmacare deal with the NDP. Weeks of talks produced draft legislation that sets out a framework for national pharmacare alongside a single-payer plan to cover just diabetes and contraception drugs.
This deal might represent a political win for Prime Minister Justin Trudeau and NDP Leader Jagmeet Singh, by prolonging the life of an unpopular Liberal minority government while throwing a life raft at the sagging New Democrats. But it makes for poor public policy considering the current state of health care in Canada.
We must remember that while Ottawa is responsible for establishing some national health-care standards through the Canada Health Act, it’s provincial and territorial governments that are primarily responsible for the delivery of health-care services. And while more federal spending in the health-care sphere is welcomed, we must recognize that the proportion of federal spending on health care has declined over the decades, shifting a greater financial burden on the provinces.
Canadian medicare is an insurance program; by its nature, insurance is about confidence. Promising a national, singlepayer pharmacare program when at best the federal government is launching a pilot project to serve merely two of many deserving patient groups risks undermining confidence in our health-care system, rather than enhancing it.
On Tuesday, we will learn just what part of the cost of a singlepayer Pharmacare program is being funded considering overall cost estimates of $40 billion annually, much of that from new spending.
The trouble with a narrowly applied single-payer model is that it wipes the slate clean for diabetes and contraception drug coverage that millions already have confidence in. Plowing ahead with a single-payer model for those accessing diabetes and contraception drugs actually risks undermining confidence by disrupting existing coverage flowing from employer, private and provincial drug plans.
A single-payer pharmacare program may also exacerbate the administrative burdens faced by doctors while failing to address existing coverage gaps for all other patient groups.
Our current model isn’t perfect. But the solution to improving it lies within addressing its remaining gaps, not creating a new government-run program that will cost billions to mostly cover people who already have coverage.
The Canadian Life and Health Insurance Association (CLHIA) says 27 million Canadians already experience pharmacare through workplace plans and — like it or not — those private insurance plans offer coverage for nearly twice as many drugs as even the best public plan. This fact alone underscores why the federal government should avoid disrupting existing benefit plans and instead target available investments for the smaller minority who lack satisfactory drug coverage.
In 2017, the Wynne government introduced OHIP-plus. Under this program, all children and youth under 25 were eligible for free prescription drugs. Mostly it extended public payment for coverage already provided by parental employer plans.
The policy triggered significant disruption, including burdensome paperwork.
Within days of taking office in 2018, the Ford government adjusted the program to focus benefits on those who lacked existing prescription drug coverage. This so-called “fill the gaps” model continues to be the right approach, particularly when government budgets are strained.
A targeted approach directing available resources at those Canadians experiencing affordability barriers represents the best opportunity for Trudeau’s Liberals to assert pragmatic fiscal management while seriously moving-the-needle toward universal drug coverage.