Former NDP leader Tom Mulcair advocating private/public pharmacare

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Mighty Middle
Former NDP leader Tom Mulcair advocating private/public pharmacare

Saying on CTV Question Period this AM that Jagmeet Singh is taking the wrong approach with his 100% universality plan. Mulcair saying Singh should look to Quebec private/public pharmacare system as the gold standard. As this is also about Provincial jurisdiction

https://www.ctvnews.ca/video?clipId=1868750

 

Pondering

He has also been beating the anti-deficit drum. 

Aristotleded24

Who is this Tom Mulcair guy that anybody should listen to? Is he someone important?

Ken Burch Ken Burch's picture

Mulcair won't stop until he has either pressured Singh into moving the party as far to the right as it was in 2015 OR until the NDP is simply wiped off the map.  He will never stop trying to punish his old party for deposing him as leader.  

Aristotleded24

Ken Burch wrote:
Mulcair won't stop until he has either pressured Singh into moving the party as far to the right as it was in 2015 OR until the NDP is simply wiped off the map.  He will never stop trying to punish his old party for deposing him as leader.

Mulcair, Mulcair, that name sounds vaguely familiar, but I can't put my finger on it. Did he do something important? Did he even do anything at all? Ken, do you have any information that can help jog my memory a bit?

Sean in Ottawa

Interesting to note that the Quebec system is ahead of other places and does do a lot to help people access drugs. It could be argued that it is tested and would stand a better chance of adoption. Maybe that is part of the point?

Something needs to be done now. The Quebec system is ahead of what the federal Liberals are proposing is it not?

Could someone explain the detail of how it works? I have had someone explain it to me but I did not understand a private component so am missing something here.

JKR

Are people in Quebec happy with their system?

Unionist

JKR wrote:

Are people in Quebec happy with their system?

It's a whole heck of a lot better than anything in any other province. Including all those provinces that have seen NDP governments come and go, and do nothing on this front. And somehow, we manage to finance it for decades now without the slightest input from the feds. Interesting that some would see Mulcair as the villain here. Bizarre, actually.

Unionist

Sean in Ottawa wrote:

Interesting to note that the Quebec system is ahead of other places and does do a lot to help people access drugs. It could be argued that it is tested and would stand a better chance of adoption. Maybe that is part of the point?

Something needs to be done now. The Quebec system is ahead of what the federal Liberals are proposing is it not?

Could someone explain the detail of how it works? I have had someone explain it to me but I did not understand a private component so am missing something here.

Check this out - then let me know if you have any questions. It's kind of like Obamacare for drugs. Better than nothing (i.e., better than the rest of Canada). 

Mighty Middle

Unionist wrote:

Interesting that some would see Mulcair as the villain here. Bizarre, actually.

Because it runs counter to the universality argument that Singh is advocating.

JKR

Unionist wrote:

JKR wrote:

Are people in Quebec happy with their system?

It's a whole heck of a lot better than anything in any other province. Including all those provinces that have seen NDP governments come and go, and do nothing on this front. And somehow, we manage to finance it for decades now without the slightest input from the feds. Interesting that some would see Mulcair as the villain here. Bizarre, actually.

In that case I think Mulcair's contribution here is positive. Hopefully during this term the Liberal government will establish a pharmacare program across Canada at least as good as Quebec's. I have no problem with the participation of the private sector as long as the program is universal and comprehensive.

Misfit Misfit's picture

In response to Sean. The Saskatchewan NDP had a pharmacare plan in place under the Blakeney administration back in the 1970s. It was very successful.

i personally think that we should look at many other options of what works or has worked in the past before blindly endorsing a public/private partnership option that one province currently uses.

Misfit Misfit's picture

Allan Blakeney government

"That gave the government some equity ownership and a larger share of the rent from the resources. He used those revenues to create a variety of programs, including a pharmacare program, children’s dental care, community based schools and public housing in poor urban areas."

I know that there are those who are hostile to the Saskatchewan NDP, but please do not redefine what they did accomplish many years before anyone else could.

lagatta4

The first Parti Québécois government also brought in dental coverage for children (including teens). Trying to remember when that was abandoned.

Pondering

No it isn't good enough. There are still elderly people who don't take drugs due to the co-pay. Universal is better. I don't know why it is even a debate. 

Sean in Ottawa

Misfit wrote:

In response to Sean. The Saskatchewan NDP had a pharmacare plan in place under the Blakeney administration back in the 1970s. It was very successful.

i personally think that we should look at many other options of what works or has worked in the past before blindly endorsing a public/private partnership option that one province currently uses.

I agree but I still think that the Quebec model is more progressive than what most of us have now and promoting it is not a right wing idea. One reason for promoting it would be to say here is something presently functioning. 

I am not sure of what is left of the Sask plan but it and the previous plan ought to be debated as experiences that can inform us.

I prefer a public only plan myself but any plan is already better than none and it is hard to deny that.

Misfit Misfit's picture

Sean wrote: "I agree but I still think that the Quebec model is more progressive than what most of us have now and promoting it is not a right wing idea. One reason for promoting it would be to say here is something presently functioning."

Private industry is in business for profit. Public funding can always provide a service more efficiently and cost effectively. And once you have private involvement established, I don't know how you can ever get rid of them. I believe that this is a very dangerous argument to entertain. I believe that it is a sovereignty issue and is about the right of the government to run and control a vital service independently of the private and for profit motive. I cannot overemphasize my disdain for this option.

Grant Devine destroyed these social programs and much much more. He wrecked our province beyond recognition. 

Lagatta wrote: "The first Parti Québécois government also brought in dental coverage for children (including teens). Trying to remember when that was abandoned."

The Saskatchewan plan included all children thru grade 12. As a girl growing up, I thought of Quebec as a sister province. They were the two most progressive provinces in our nation's history. I am deeply saddened when I think of how they are now.

I strongly respect Quebec people for working hard to keep Canada out of the Iraq war. I still look to your province for leadership and progressive innovation.

Pondering wrote: "No it isn't good enough. There are still elderly people who don't take drugs due to the co-pay. Universal is better. I don't know why it is even a debate."

Agreed 100% in full! Also agreed on your comment about Alberta and 100% control of women to choose on her own btw.

Unionist

Please don't misunderstand my comments about Québec's drug program. It's not even close to "good enough". We need universal pharmacare, single payer, the same as medicare - with government(s) having a monopoly on buying and distributing pharmaceuticals, and ultimately establishing/nationalizing the means of production. In the meantime, a single payer can negotiate the best possible terms with private or foreign manufacturers.

jerrym

Research on the Quebec pharmacare program by Canadian universities has concluded that while it provides coverage to a greater proportion of the population than other provinces, it has major problems. 

Canada has the third highest pharmaceutical costs in the world, behind only the US and Switzerland, the homes of many of the pharmaceutical giants. Comparing our costs to the US because it is next door is misleading because their costs are extremely, thanks in part to legislation that says government procurment procedures must pay retail prices. 

As the following article notes, Quebec pharmaceutical costs are 75% higher than those of countries with universal pharmacare. A national program based on the Quebec model or something similar would expect to incur similar high costs. The co-payments etc. in Quebec pharmacare also mean some patients, especially the poor, do not fill prescriptions. 

The Canadian university research concludes that the biggest winners in the Quebec pharmacare system are, guess who, the pharmaceutical companies. And the federal Liberals and Tom Mulcair now want to introduce this kind of pharmacare to all of Canada. I wonder why.

If we introduce a hybrid public/private model it will be extremely hard to get rid of because of pharmaceutical corporate lobbying and political party donations, as we have seen in the US. It could also run into trouble with the Canada US free trade agreement stating the need for corporations to be compensated when displaced by government actions. 

Quebec introduced a private-public drug coverage system in 1997. In contrast to a universal public drug plan, the Quebec system requires all employers that provide any health benefits to also provide private drug coverage for their employees. Seniors, people on social assistance and anyone else who does not get private coverage through their employers are required to contribute to an insurance-style drug plan from the provincial government.

"Quebec introduced an insurance-based drug coverage system 20 years ago that was supposed to save taxpayers money," said Steve Morgan, a professor in the school of population and public health at UBC and lead author of the study. "We found that it came at an astounding cost to Quebecers."

Researchers at UBC, Carleton University, Concordia University and the University of Montreal examined the benefits and costs of Quebec's system, 20 years after it was implemented, and compared the results to the rest of Canada and similar countries around the world. ...

"Private and public spending for medications is 75 per cent more per person in Quebec compared to countries with universal pharmacare," said Marc-André Gagnon, a professor at the school of public policy and administration at Carleton University. "However, as compared to these countries, we are far behind in terms of access to medications: more than twice as many Quebecers cannot fill their prescriptions for financial reasons."

The researchers also found that the increased coverage in Quebec is disproportionately expensive for low-income individuals and families compared to households with higher incomes. The premiums under Quebec's partially-subsidized public drug plan can amount to more than three per cent of a $40,000 household income, but only 1.6 per cent for households with an $80,000 income.

Workers with private insurance offered through their employers can end up paying even more as insurers are able to raise premiums annually. Researchers found that the private plans can cost 10 per cent of a person's income if they are a part-time worker.

"The biggest winners in the Quebec system have been the industry stakeholders that have made billions more than they would have made if Quebec had implemented a universal public plan 20 years ago," said Morgan.

A recent report from the parliamentary budget officer estimates that a universal, public pharmacare system would save Canadians more than $4 billion per year while this study suggests that applying Quebec's private-public model in all provinces would cost Canadians over $5-billion more per year than they currently pay.

The researchers say these findings should be considered as the federal government contemplates different models for providing universal pharmacare to all Canadians.

https://www.sciencedaily.com/releases/2017/10/171010105636.htm

jerrym

The following article looks at what Canada could learn from other countries when it comes to implementing pharmacare. 

 Canada can look to other countries for ideas on what to adopt and what to avoid, but it can’t copy another system wholesale, says Steve Morgan, a professor of health policy at the University of British Columbia.

No country funds prescription drugs through an entirely different mechanism than they fund the rest of their health-care services. You don’t separate prescription medicines from hospital care and physician services because . . . you can’t get a prescription without going to see a doctor, and many prescriptions are designed in some sense to keep you healthy and out of hospital.” ...

Canada can look to Britain for pointers on phar­macare copayments, partly because its constituent countries have some leeway in implementing their own plans [somewhat like Canadian provinces]. Residents of Northern Ireland, Scotland and Wales, for example, enjoy free prescriptions, while those in England have a modest copay of £8.80 per prescription.

As well, British residents requiring more than three prescriptions in a three-month period or more than 12 prescriptions each year can buy prepaid certificates that reduce the copay. Plus, seniors, young people under 16, people on social assistance, pregnant women and new mothers qualify for free prescriptions altogether. Importantly, Britain’s system doesn’t have deductibles or coinsurance. For expensive drugs treating rare diseases, even a 10 per cent coinsurance can be prohibitively expensive, notes Morgan [which is why I prefer the free prescriptions of Northern Ireland, Scotland and Wales to England's system]. ...

“Now, you could think there must be massive waste in the way drugs are being consumed because there are no user fees,” and therefore no economic incentive to reduce use, says Marc-André Gagnon, a health policy professor at Carleton University. But, he argues, that’s not the case at all, as Britain minimizes over-prescribing and the associated costs by pricing drugs based on their therapeutic value.

The National Institute for Health and Care Excellence and the Scottish Medicines Consortium review certain expensive drugs to ensure they’re worth the cost. If the review provides a positive guideline for a drug, every local primary trust — the equivalent of a local health authority — must include it on its formulary. But if it provides a negative guideline, primary trusts can still cover it. ...

There is a national blacklist of drugs that aren’t covered by the public system, but besides that, primary trusts decide on local formularies independently. This fragmented system, argues Morgan, fails to harness the country’s collective buying power. ...

New Zealand, on the other hand, successfully wields its consolidated market power. “In terms of getting value for money, they are the best ones,” says Gagnon. “They will use every trick in the book to reduce prices.”

To do so, the country relies on two main tech­niques. One is its national formulary and the other is its national pharmaceutical insurance plan that acts as the sole buyer of drugs covered by that formulary.​

 

Many have criticized New Zealand’s restrictive formulary, arguing it excessively limits patients’ choice. For example, a 2016 study by the Canadian Health Policy Institute found that, of 248 drugs in nine clinical categories, 90 per cent were approved for marketing in Canada compared to just 74 per cent in New Zealand. It warned that reduced access to drugs could lead to an increase in hospitalization.

“Generally speaking, as it relates to newer medicines, the New Zealand system does take a cautious approach. It wants rock-solid evidence that the drug is comparatively safe and comparatively effective in relation to other treatments,” says Morgan. “As a consequence, it’s not that New Zealanders will never get access to those treatments, but that access may take a little more time. It’s fair for patients to say they want to have access more quickly, but as a system, they’ve got to weigh the pros and cons.” ...

By having only one pharmaceutical buyer, New Zealand can “go to the pharmaceutical companies and say, either you meet our price or we won’t list you on our formulary,” says Blomqvist. “And the result of having a single buyer that can threaten to reduce sales in a substantial market to zero means that single buyer has a very powerful bargaining position.

Interestingly, New Zealand’s single-payer system began in the mid-90s as a way to guarantee supply, not reduce costs. As a small, isolated country with a nearly non-existent local pharmaceutical industry, it wasn’t easy to drum up supply when the need arose.

“So what they started doing was requiring manufacturers to guarantee supply,” [something Canada should consider since many Americans are coming across the border to buy drugs in Canada, Trump is encouraging it, and if there is a supply shortage corporate greed would tend to push for supplying the US first where prices are much higher]  says Morgan. “Manufacturers of generic medicines had to guarantee the medicine would be available as needed by the popu­lation, and if it could not meet the demand, it had to pay for the brand name drug or another licensed generic to be supplied. ...

As New Zealand demonstrates, the tendering process can be powerful, but Canada won’t be taking advantage for quite some time. In January 2018, the pan-Canadian Pharmaceutical Alliance came to an agreement with the generic drug industry: the latter would reduce prices by 38 per cent in exchange for suspending open tenders until 2023. “The amount of savings would have been way more substantial with tenders compared to the deal that we got,”  ...

But Morgan still sees a role for private payers in a Canadian system. “If universal pharmacare means a public payer buying that core formulary, unions and employers may continue to wish to have complementary private insurance,” he says, noting employers’ plans could cover copay­ments, treatments that haven’t yet been added to the national formulary and brand name drugs. ...

In 2015, Denmark’s national pharmaceutical procurement organization Amgros launched the Nordic Pharmaceuticals Forum in which Denmark, Iceland and Norway developed a shared procurement model for drugs for rare diseases, as well as for preferred antibiotics. Sweden is participating as an observer, since it has a more decentralized pharmacare system than the other countries. ...

Because of their relatively small populations, these countries have had difficulty procuring numer­ous drugs. “We would like to invite [manufacturers to supply] the Nordic countries and they would have a good contract based on that,” says Sonne. That is, the Nordic countries are taking the New Zealand model to the next level through international collaboration. [The cost savings of a national Canadian program would save money for all provinces through bulk buying, and even more so for the ones with small populations].

Austria, Belgium, Ireland, Luxembourg and the Netherlands participate in a similar project focused on orphan drugs. Their group, Beneluxa, runs joint product assessments, horizon scanning, pricing negotiations and reimbursements. ...

Canada’s provincial public drug plans negotiate collectively with drug manufacturers through the pan-Canadian Pharmaceutical Alliance, but those negotiations aren’t binding on each province. That, argues Morgan, is problematic: since manufacturers aren’t guaranteed the entire public Canadian market, they’re not as likely to offer their best price.

“Canada has to recognize that the idea of going it alone by province or, heaven forbid, by individual corporate drug plan is ridiculous because you are virtually powerless in the high-stakes world of pharmaceutical price negotiation,” says Morgan. “You need the power of collective buying and the power of being united in the decision to say no, so you can’t get whipsawed by [a company] saying you should cover this [drug] because your neighbouring jurisdiction does.”

https://www.benefitscanada.com/benefits/health-benefits/bc-9-lessonsfrom...

Pondering

To praise compromise on this concedes the argument that a mixed system is somehow cheaper and that universal pharmacare would cost too much. 

We also need more Canadian manufacturing and development of drugs especially the ones so cheap to produce the companies can't be bothered. 

Sean in Ottawa

Pondering wrote:

To praise compromise on this concedes the argument that a mixed system is somehow cheaper and that universal pharmacare would cost too much. 

We also need more Canadian manufacturing and development of drugs especially the ones so cheap to produce the companies can't be bothered. 

No it does not. Compromise does not imply a better solution it implies a solution that might get greater support and therefore be doable over one that is thought would get too much opposition.

Compromise is often based on opinions (which can be wrong) rather than objective fact. Each position is more likely to start with objective facts from one point of view or another and a compromise over political support ensues. this is why often compromises are politcally possible but often the worst of all worlds.