Opinion: There are signs of hope for a pharmacare plan

The SNC-Lavalin scandal is very Canadian. It is an uproar over something that didn’t happen.

The Quebec engineering company was not offered a plea bargain that allowed it to avoid criminal conviction for bribery. Former attorney general Jody Wilson-Raybould was not convinced by the prime minister and his office to proffer such a plea bargain.

Yet this business has consumed journalists, including me, for weeks.

Meanwhile, the real world goes on. In this world, one of the more important political events last week was the reminder that Justin Trudeau’s Liberal government has committed itself to some form of pharmacare.

I say some form because the government’s Advisory Council on the Implementation of National Pharmacare is still coy about what its final recommendations will be.

Theoretically, the council could take the minimalist road and recommend a so-called fill-in-the gaps model that would fall short of what is needed to give all Canadians full access to necessary prescription drugs.

But the council’s interim report released last Wednesday suggests its final recommendations will be considerably more ambitious. One of the failures of Canadian medicare is that it doesn’t cover drug costs incurred outside of hospital. Instead, a hodge-podge of programs – some public, some private – has grown up to fill the vacuum.

Most Canadians have some kind of drug coverage. But it varies wildly. Some face high out-of-pocket costs in the form of deductibles or co-payments. Others do not. About 20 per cent of Canadians have no real drug coverage at all. Yet Canadians pay among the highest prices in the world for pharmaceuticals.

The advisory council report notes that Canadians spent $34 billion on pharmaceuticals last year and the cost continues to rise exponentially.

A universal pharmacare program, such as that enjoyed by every other major industrial country that offers universal health care, would go a long way toward solving this cost problem. That’s the conclusion of health economists who have studied the issue.

It’s also the conclusion of the Commons Health Committee, the New Democrats and from time to time the Liberals. But universal pharmacare, while it would cost Canadians less in total, would cost Canadian governments more – which is why finance ministers are wary of it.

Finance Minister Bill Morneau’s preference is a more modest pharmacare system aimed strictly at those with no other form of drug coverage – a fill-in-the-gaps program.

The problem with this is that it would tack on another dissonant part to the Rube Goldberg contraption that is the Canadian drug system, without addressing costs in any meaningful way.

The advisory council says it has not decided whether to recommend a universal medicare-style drug regime where all Canadians would be covered. That is to be announced in its final report, due by mid-June.

But there are encouraging signs. One is that the council is headed by former Ontario health minister Eric Hoskins, an advocate of universal pharmacare.

The second is that in its interim report the council calls for the formation of an arms-length national drug agency to oversee whatever system the government decides on. It would use its buying power to negotiate drug prices with the big pharmaceutical companies and develop a formulary of drugs to be publicly covered.

Theoretically, such a federal-provincial-territorial-Indigenous agency could co-exist with a fill-in-the-gaps system. But it makes more sense to adopt something more comprehensive, such as universal pharmacare.

Of course, none of this guarantees action. The government may ignore the recommendations. It’s done that before. Or it may say it is adopting the recommendations, yet do nothing. That has also happened. In that sense, all of this too is very Canadian. But it is arguably more important than parsing who said what to Jody Wilson-Raybould.

Thomas Walkom is a national affairs writer.

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