By Steve Morgan and Linda Silas
Nearly a quarter century ago, the federal government hosted a conference on national pharmacare in Saskatoon – the birthplace of Canadian medicare. The meeting was extraordinarily frustrating to delegates who anticipated action, not talk, at the time.
We know because we were there.
You see, that Saskatoon meeting was held on the heels of Prime Minister Chrétien’s 1997 National Forum on Health. Echoing previous national commissions, the Forum recommended the implementation of a universal, comprehensive, public pharmacare program to work alongside Canadian medicare.
Yet, there we were, an audience of approximately 300 health professionals, experts, public representatives and stakeholders gathered to “engage in dialogue” on an issue that already had a very clear answer.
Why this focus on more consultation, when we already knew what was needed? Because the most powerful stakeholders – most notably, multinational drug companies – were opposed to the Forum’s policy recommendation on national pharmacare.
The national pharmacare system recommended would have reduced Canadian drug costs dramatically, meaning savings for governments, businesses and households. More Canadians would have access to medicines because they would be fully covered, but manufacturers would no longer be able to charge more in Canada than they did in comparable countries.
Drug companies preferred that Canada adopt a system of mandatory private insurance based on the model they had just convinced the Quebec government to implement in 1997 – at great cost to Quebec households and businesses. Insurers favoured the Quebec model too – what industry wouldn’t want people to be legally required to purchase their products without regulations on profit margins?
Fast forward a quarter century, and this story is playing out again.
Options for national pharmacare have been studied extensively, with every serious national inquiry leading to the same conclusion: a universal, comprehensive, public pharmacare program would improve access to necessary medicines while saving billions of dollars every year.
The latest major government report on pharmacare – the June 2019 report of the Advisory Council on the Implementation of National Pharmacare – provided yet another principled, evidence-based, and practical plan for a universal, comprehensive, public pharmacare program.
In 2019, the Liberals campaigned on a promise to act on that plan. Such a national pharmacare system was mentioned in the 2020 Throne Speech, Budget 2021 and 2021 mandate letters. But there has been little concrete action toward implementation.
Instead, the federal government has reverted yet again to “stakeholder engagement,” rather than policy action.
This doesn’t bode well for Canadians. For example, following extensive stakeholder engagement, the federal government recently walked back implementation of the new regulations for prescription drug prices just days before they were to take effect. The reason? Drug companies weren’t happy.
Rather than implement policies designed to put public interest first, the government has promised to consider the pharmaceutical industry’s proposals for price regulations. That is the very definition of regulatory capture: when regulated industry shapes the regulations to benefit firms, not consumers.
Here’s the thing: major public policies to establish lasting institutions in the public interest cannot be arrived at by stakeholder consensus. If Premier Tommy Douglas and Prime Minister Lester Pearson had believed that, Canadian medicare would have never gotten off the ground because of the medical profession’s fierce opposition to public health care.
Had Prime Minister Pierre Trudeau thought consensus was the path to solving challenges in the health care system in the 1980s, we would not have the Canada Health Act. We would, instead, have a pay-for-access system that would likely replicate the extraordinary cost and inequity seen in the U.S. health care system.
Delaying implementation of national pharmacare further in pursuit of consensus among stakeholders is a fool’s game. Citizens strongly support the immediate implementation of a universal, public pharmacare program, even as a policy priority during the COVID-19 pandemic. They needn’t be further consulted.
Drug companies, on the other hand, do not want what is best for Canadians. They want what is best for their shareholders: weak policies and, therefore, high prices.
Every year that passes without implementing a national pharmacare program wastes billions of dollars, causes a million Canadian families to struggle to make ends meet, and results in hundreds of premature deaths.
But it is not too late to implement a national pharmacare program that becomes a lasting, positive legacy for generations to come. It just requires leadership: true leadership that champions the public interest over powerful stakeholders.
A federal election is not a bad time to find out who will commit to clear, concrete action on national pharmacare, and who would prefer to continue with the fool’s game.
Steve Morgan, PhD, is a professor of health policy at the University of British Columbia. Linda Silas is a nurse and President of the Canadian Federation of Nurses Unions.