Why Universal Pharmacare Is Doomed

“Hell hath no fury like a bureaucrat scorned.” – Milton Friedman

First, let’s get something out of the way.  I support the concept of Universal Pharmacare. From a basic human standpoint, I’ve seen many patients who cannot afford prescription medications go without them. It’s awful to see their health deteriorate when treatment could have been available.  Providing a social safety net is part of the Canadian ethos.  It’s almost un-Canadian to not have Pharmacare when places like Australia and pretty well all of Western Europe have it.

From a purely fiscal point of view, Pharmacare makes even more sense.  People who develop complications from untreated illnesses cost the health care system much more. Additionally, there are significant cost savings because a Canadian Pharmacare program will allow for bulk purchasing of drugs, which lowers costs.  It will also reduce the cost of running a business in Canada, thus helping the economy.

Currently Health Care is considered to be a Provincial responsibility,  and every Province has its own Drug Benefit Program for seniors and those on social assistance. Which of course means that each Province has their own formulary (the list of drugs that are covered by the provincial drug plan) and there are some differences. Ontario, for example, doesn’t provide coverage for some of the newer Cancer drugs that many Western Provinces do. Having a Canada wide formulary will mean we can fix these regional discrepancies and provide equitable treatment for all Canadians.

But if it Pharmacare is such a great idea, why is it doomed to failure?

For the same reasons that so many good ideas die in Canada – politicians and bureaucracy.  You see, politicians can’t see beyond their next election cycle, and their need for votes.  Bureaucrats can’t see beyond the need to perpetuate their own organizations and protect their own jobs.  It’s a toxic combination that has vexed health care in Canada for decades.

To understand this, let’s look at what should happen to make Pharmacare a success.  The federal government should come up with a Canada wide formulary.  This part shouldn’t be too hard; there are likely many commonalities between the varying Provincial formularies, and coming up with a list of necessary drugs should be easy.

Then the Canadian government should form a central agency, to negotiate a price and pay pharmaceutical companies for these medications.  In essence, Ottawa should take over the role of the Provincial drug formularies and establish one Canada-wide plan.

In order to pay for this, the Canadian government should reduce transfer payments to the Provinces by the amount of money they spend on their own programs.  Ontario currently spends $4.2 billion dollars a year on its Drug Benefit program.  So clearly, what the Canadian government should do is say to Ontario – “Look, we’ll take over the drug benefit program, you close down yours, and we will cut your provincial transfer payments by $4.2 Billion per year, since you don’t need it anymore.” And there’s problem number one. How do you think that will go over with the cash strapped government in Ontario?

From a politician’s point of view, they are going to risk angering the bureaucracy because this means there will be less jobs – economies of scale mean you need fewer people to run one big organization, then ten smaller ones.  This means the various civil service unions will be up in arms about closing the Provincial Drug Benefit programs. Granted upsetting bureaucrats probably won’t bother Ontario Premier Doug Ford as he has already signalled that he is going to reduce bureaucracy, but Prime Minister Trudeau (especially given his recent falling popularity) is likely going to want all the votes he can get.  Civil servants still donate to political parties – and he will not want to anger them.

Now if you have a strong-willed leader of your Pharmacare strategy, you can probably still make this change.  But alas, Trudeau hired the widely disliked and ineffectual Eric Hoskins to lead this program.  Hoskins’ main claim to fame is his utter and complete failure as a Health Minister in Ontario.  As predicted, he didn’t survive the disaster he made of Health Care.  It’s clear he jumped at the chance to get a cushy taxpayer paid job, as he knew he was going to lose his own riding of Toronto St. Paul (which was supposed to be one of the safest Liberal ridings in the Province).  His hiring does NOTHING to engender confidence that an effective Pharmacare program is possible.

What will we likely be left with?  Probably some sort of hybrid system.  This will be promoted to be in “the interests of recognizing regional diversity”.  Ottawa will create an agency to provide “oversight” and purchasing of a certain list of medications.  Then the Provinces will keep their own agencies, and buy the drugs via Ottawa. If you happen to need a drug that isn’t on the approved list, you can apply for an exemption to the Province (this part exists now).  But then the Provinces will likely turn you down and then you have to apply to Ottawa.  Goodness knows how much paperwork will be involved, and how many delays.

The end result?  TWO layers of bureaucracy for National Pharmacare, more civil service jobs, more money (and time) wasted on Provincial/Federal interplay.  How will this help?

Pharmacare is long overdue.  I just wish our politicians had the guts and foresight to implement it in a reasonable, efficient, businesslike manner.

Author: justanoldcountrydoctor

Practicing rural family medicine since 1992. I still have active privileges at the Collingwood Hospital. Currently President-Elect of the Ontario Medical Association.

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