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By Barbara Mintzes
Of all the countries with national health insurance programs, only Canada doesn't cover drug costs. Last year, the National Health Forum, a government-appointed panel that spent two years researching Canada's health care system, recommended a national pharmacare plan covering all Canadians, saying that it would save money and improve patient care.
As a follow-up to the Forum's recommendations, the federal government organized a pharmacare conference in Saskatoon in January. About 300 people attended, representing doctors, pharmacists, provincial health ministries, the multinational and Canadian drug industries, universities, patient groups, consumers, and community groups.
Keynote speaker Judith Maxwell, President of the Canadian Policy Networks and a board member of Mutual Life Assurance told the audience that 90% of Canadians already have their drugs covered. Maxwell told the conference that only small changes were needed to "fill the gaps". Worried about this misleading start to the conference, a group of about 40 concerned delegates, including Mike McBane and Kathleen Connors of the Canadian Health Coalition, lobbied to get universal publicly funded pharmacare back into the discussion.
The next day, Health Minister Allan Rock cautiously agreed that a universal pharmacare plan might be the fairest and most efficient way to provide drugs. "In the end," he said, "high quality health care will not be assured if an increasingly large proportion of medically necessary services are left outside the system." Don't expect universal pharmacare in the near future; Rock stressed that the federal government won't impose any new programs on the provinces.
Groups representing consumers, seniors, aboriginal peoples, unions, and health care advocates believe universal pharmacare should be part of our health care program. They argue that medicines are a necessary part of health care and say a single buyer has more clout to keep prices down. Many employers favour pharmacare too, because if drugs were paid from taxes, they would no longer have to pay for them under employee health plans. On the other hand, private insurance companies would lose the business from employers' private insurance plans and so don't support universal pharmacare. Likewise, the Pharmaceutical Manufacturers' Association of Canada [PMAC], which represents multinational drug companies, doesn't want a universal pharmacare plan because it would probably push down drug prices and limit new drug sales. That's because new drugs are generally more expensive, so if an equally effective, yet cheaper alternative exists, pharmacare might not include the new drug.
But can we afford a pharmacare plan? As Kapil Khatter of the National Anti-Poverty League told delegates, "We are already paying for drugs," he said. "The question is, 'who pays?"' Most people in unionized or white collar professions are covered by their employer-sponsored insurance plans. Part-time workers and non-unionized low wage workers, aren't usually covered. Drug coverage is also inconsistent: people on welfare get drugs covered but unemployed workers on EI don't; status Indians do; Métis and non-status do not, and drugs for chronic illnesses are covered differently in different provinces. Khatter says that Canada's piecemeal approach to drug coverage is fundamentally unfair.
The economic arguments favour pharmacare. Quebec brought in a mixed public-private drug insurance plan last year. Kathleen Gorman, from a Quebec consumer coalition, told delegates that poor working families have seen their costs go up because they have to pay hefty private insurance premiums. A preliminary analysis by B.C. economist Steve Morgan showed that Quebec's new system saved the province more than $300 million last year, but cost the elderly and poor almost exactly that amount more than they used to pay.
After the conference, a national working group on drug policy was created to keep lobbying for universal public pharmacare. The group also supports public accountability in the drug regulation process and stronger controls on drug promotion.
To get in touch with the pharmacare working group, contact Barbara Mintzes at (604) 254-0470 Fax (604) 254-0477 or e-mail her at bmintzes@compuserve.com .