Steve Morgan, an economist at the University of British Columbia, has been advocating for pharmacare for 20 years, so it’s understandable that he’s enthusiastic about the announcement last week that Ontario’s government will cover medications for people 24 and under. The government’s headline-grabbing plan in this year’s budget won’t cover all Ontarians (as the New Democrats propose to, with a smaller number of drugs) but he thinks it’s a good starting point.
“This children’s expansion is symbolically really important,” Morgan told TVO.org Monday, “and I’m sure when we write the histories of pharmacare in Canada this will be seen as the time when a clear principle was laid down by a provincial government: In Canada, our medicare system is universal and public, and so our pharmacare system should be as well.”
Across Canada, provinces generally pay for hospital bills, including medications administered in them, but public funding for drugs generally ends at the hospital doors. Prescriptions filled at a pharmacy and taken home are only covered by employers’ health insurance plans, if at all. Public health care advocates have argued for years that this amounts to the “unfinished business” of Canada’s public health care system.
Morgan, for example, says that in his research he hasn’t found a single other comprehensive public health care system that doesn’t cover prescription medications. (The United Kingdom’s NHS pays for all drugs minus a nominal co-payment, while in France the government covers different drugs to varying degrees.) Morgan was co-author of a 2015 article which estimated that providing national, universal drug coverage would cost $15.1 billion. It’s a large sum, but less than the $22 billion we as a country — both individuals and governments — currently spend. (The savings would largely be due to the efficiencies of publicly funded care). In effect, Canadians would cough up more in taxes to save the even greater sum we currently, collectively pay in the existing system.
Cost is one thing, health outcomes are another — and the health benefits from any expansion of pharmacare to low-income Ontarians could be substantial. A 2012 article in the journal Diabetes Care found that health outcomes for Ontarians with lower socioeconomic status (SES) jumped when they reached the age of 65 and were suddenly covered by the province’s existing drug benefits plan for seniors. The paper estimated nearly 5,000 deaths could be prevented annually if low-SES groups had prescription drug access throughout their lives. The effect of the Liberal government’s plan is likely to be more muted, since it is smaller in scope. Still, Dr. Monika Dutt, a physician with Doctors for Medicare, says she sees the struggle families go through every day, and thinks the pharmacare expansion will help.
“Just knowing, now, that people have a way to pay for their children’s medication is a huge relief,” Dutt says. “It’s good for their health, it’s good economically, and it’s good for the healthcare system when [without coverage] someone doesn’t show up to the ER because they couldn’t afford the insulin to control their diabetes.”
As it stands now, Ontario will be offering a patchwork system: free pharmacare from birth to 25, reliance on employer health plans for 40 years with programs for those on social assistance and some other targeted groups, then public coverage again (this time, with users paying fees to access the public plan) after the age of 65. Dutt and Morgan both hope that Ontario’s plan will start the ball rolling towards a more comprehensive system.
At Queen’s Park, the Liberals and New Democrats are arguing over who’s plan is superior. Morgan’s work informed the NDP plan to cover the 125 most common medications for all Ontarians, and Dutt said her personal preference would have been to start with that plan and build out from it.
But Morgan also says there’s no reason not to do both: Ontario could start with the Liberal plan and, in time, add the New Democratic plan to it. The cost-savings created by the NDP’s plan (through bulk purchasing of drugs and the lower prices a single buyer could negotiate) would in fact make the Liberal plan less expensive as well, since many of the medications on the NDP’s list would be ones that are prescribed to younger patients.
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The fate of any further pharmacare expansion will depend, in part, on several elections. Morgan says that if the B.C. election next week results in an NDP government, the combination of progressive governments in Victoria, Edmonton, and Toronto will create a year-long window during which three of the country’s largest provinces will be allied on a public pharmacare plan — a force to be reckoned with in Ottawa.
But, he says he’s concerned about remarks from Progressive Conservative leader Patrick Brown. On budget day Brown panned the Liberal announcement as a giveaway to “a millionaire family with no problems to drug access.”
“We don’t exclude billionaires from driving on our roads or attending our schools or hospitals so they should probably benefit from pharmacare as well,” Morgan argues. He worries that a PC win in Ontario’s 2018 election could close the window for truly comprehensive national pharmacare. “If Brown wins in 2018, then it’s probably over until at least the next Ontario election.”
In a debate that’s largely been between the Liberals and NDP over whose pharmacare plan is better, the Tories are notably keeping their pledges more modest — and vague, at least until the party’s policy convention in November.
“The Liberals’ proposed plan won’t cover take-home cancer treatments, nor important drugs for rare diseases,” PC health critic Jeff Yurek told TVO.org by email. “Their plan also fails to address the issues in the drug plans we currently have, such as bureaucratic red tape that limits proper access to drug coverage. Should we have the honour of forming government we will look at how to improve access to services for all Ontarians.”
There’s a political risk for the Tories in all this: Polls show Canadian voters want broader pharmacare coverage, by a huge margin. And the political cost of taking health care coverage away from people once you’ve extended it to them is extraordinary: witness the fireworks in the United States over attempts to repeal the Affordable Care Act. Playing the spoiler to a larger national debate isn’t likely to be any more popular. If Ottawa and other large provinces come to a deal on pharmacare, would any Ontario government want to be the reason it fails?
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