When the government of Saskatchewan pioneered public health care in Canada in 1962, it covered the two main components of such a system: the services of physicians and hospitals. When other provinces, and finally the federal government, later extended medicare to the national level, it was still confined to these two admittedly important but insufficient-on-their-own benefits.
Tommy Douglas, the main proponent of public health care in Canada, always envisioned this two-pronged program as just the first step toward complete health care coverage. His ultimate goal was to have prescription drugs, dental, vision, and other important services added to the system, as they already were in most countries in Europe. If those countries could afford such comprehensive care, he reasoned, so could Canada.
More than half a century later, however, his vision of providing Canadians with all-inclusive health care remains unfulfilled. The biggest gap, of course, is the lack of universal public drug insurance. One in four Canadians has no drug coverage, and thousands are unable to fill prescriptions because they can't afford them. Many of those covered by private insurance plans are beset by rising premiums, deductibles, co-payments, and by fluctuating levels of coverage from province to province.
Dr. Danielle Martin, vice-president of medical affairs at Women's College in Ontario, said she has experienced "many heartbreaking moments" when dealing with families unable to pay for puffers or insulin for their sick children.
The main argument advanced against the adoption of pharmacare in this country is that it would lead to an "unaffordable" increase of costs. This is a specious and unfounded claim. In fact, the reverse is true. Pharmacare would save Canadians and their governments as much as $10 billion a year in the cost of pharmaceuticals.
Look at the evidence
If you think this contention is improbable, you haven't read or heard about an authoritative study conducted eight years ago for the Canadian Centre for Policy Alternatives (CCPA). Compiled by researchers Marc-André Gagnon and Guillaume Hébert, it utterly demolished the myth that incorporating drug insurance into medicare would deplete government treasuries. On the contrary, it presented solid facts and figures that proved pharmacare would actually lower government costs, as well as improve the health of those in need of prescription drugs. The enormous financial gains to be derived from tapping the bulk purchasing power of all levels of government would, in itself, vastly reduce pharmaceutical expenditures.
So persuasive was this study that it was widely acclaimed by health care experts in both Canada and the United States.
Marcia Angell, M.D., former editor-in-chief of the prestigious New England Journal of Medicine, hailed the study as "a well-done analysis that clearly shows a universal publicly funded prescription drug program to be not only better for Canadians, but cheaper. The only downside is that the pharmaceutical companies might have to trim their obscene profits."
In her last remark she pointedly identified some of the most powerful opponents of a pharmacare plan in Canada.
Economist Robert Evans, an expert on health care costs at the University of British Columbia, was even blunter. In welcoming the Gagnon-Hébert study, he explained the failure to implement pharmacare: "Big Pharma, private insurance companies, anti-tax ideologues, and apathetic governments have kept this public program of drug cost coverage beyond our reach."
And, sure enough, this 30,000-word study, with its score of informative charts, graphs and tables, was indeed denounced and even ridiculed by the drug and insurance companies, by right-wing commentators and media pundits. The opposition was powerful enough to squash the CCPA study and leave the country devoid of pharmacare ever since.
Provinces vs. Ottawa
A significant positive development, however, was that nearly all the provincial premiers at that time were impressed enough to urge the federal government to add drug coverage to the services provided under public health care. Successive Liberal and Conservative federal governments, however, repeatedly rejected this appeal. Despite the well-founded findings of the Gagnon- Hébert study, they continued to fall back on the mendacious excuse that pharmacare is unaffordable.
But this recalcitrance by the federal government should not have remained a deterrent to the provinces. The premiers should always have kept in mind that medicare originated at the provincial, not federal level -- in Saskatchewan. So could the extension of public health care to include prescription drugs, as well as dental and vision coverage.
What was needed was the emergence of another provincial premier with the courage and foresight of Tommy Douglas. Former Ontario premier Kathleen Wynne actually filled that role a few years ago when she extended pharmaceutical coverage to children and to adults younger than 25. But, after she was displaced by ultra-right-winger Doug Ford in the last provincial election, this promising health care improvement has been stalled. Given its popularity with Ontario voters -- especially parents of the four million youth now having cost-free access to more than 4,000 prescription drugs -- Ford doesn't dare scrap it. But neither will he ever enhance it, or even prevent its erosion by the private companies and clinics whose growth he so blatantly encourages.
It's up to voters in October
I had nevertheless anticipated that the extended pharmaceutical system introduced in pre-Ford Ontario would exert pressure on the other provinces to emulate the significant advance made there by Kathleen Wynne. But it seems that Canadians outside Ontario, inexplicably, remain content with the far inferior and much costlier levels of public drug care required for their ailing teenagers and 20-year-olds.
The only hope, then, for the creation of better public health care in Canada rests with the current federal government. It is very likely that the Justin Trudeau-led Liberals will be promising the provision of some form of pharmacare during the upcoming pre-election campaign.
Given the notable promises Trudeau made during the 2015 election campaign that were subsequently broken, it is not easy to count on a promise of pharmacare this time actually being kept. But it appears to be the only hope, however tenuous, that Canada will finally start providing its citizens with the kind of comprehensive health care coverage that most Europeans have enjoyed for so long.
Much will depend on Canadian voters. If most of them vociferously demand that all the contending candidates and parties make pharmacare an unbreakable priority, it may really come into effect next year. And that breakthrough could soon afterward lead to the addition of dental and vision care, ultimately making Tommy's grand vision a reality.
Well, we can dream, can't we?
Ed Finn grew up in Corner Brook, Newfoundland, where he became worked as a printer’s apprentice, reporter, columnist, and editor of that city’s daily newspaper, the Western Star. His career as a journalist included 14 years as a labour relations columnist for the Toronto Star. He was part of the world of politics between 1959 and 1962, serving as the first provincial leader of the NDP in Newfoundland. He worked closely with Tommy Douglas for some years and helped defend and promote medicare legislation in Saskatchewan.
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