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 benefits.
But Tommy Douglas, the main proponent and creator 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 treatments added to the system, as they already were in most countries in Europe. If these 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 ailing 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 highly improbable, you haven't read or heard about an authoritative study conducted six years ago for the Canadian Centre for Policy Alternatives. 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 enhance government revenue as well as 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 lower pharmaceutical costs.
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.
Robert Evans, an expert on health-care costs who teaches economics at the University of British Columbia, was even blunter. In welcoming the Gagnon-Guillaume 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 crush 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 the 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, have repeatedly rejected this appeal. Despite the well-founded findings of the Gagnon-Guillaume study, they have continued to fall back on the mendacious excuse that pharmacare is unaffordable.
But this recalcitrance by the federal government should not remain a deterrent to the provinces. The premiers should always keep 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, and even dental and vision coverage.
What's needed today is the emergence of another provincial premier with the courage and foresight of Tommy Douglas. Such a provincial leader would pioneer the long-delayed extension of medicare that Tommy envisioned, starting with pharmacare.
Could this public health-care champion possibly be Ontario Premier Kathleen Wynne?
She may seem an unlikely reincarnation of Tommy Douglas, given the cuts in medical care and the mass layoffs of nurses that have occurred under her administration. But last spring she announced that, starting on January 1 next year, all children in Ontario, as well as adults younger than 25, will have their full prescription drug costs covered, regardless of family income. The program will provide access to 4,400 drugs by the province's four million children and young adults. It will greatly expand the Ontario Drug Plan, which already covers prescription drug costs for about 900,000 families on social assistance, and another three million seniors.
This is a significant development that has been broadly praised by health-care practitioners. Dr. Martin said it puts Ontario far ahead of the other provinces. "All that remains is to close the gap for citizens between age 25 and 65," she pointed out, "and I hope that's up for discussion as we move toward next year's provincial election."
Public pressure mounting
Wynne may not win re-election in 2018, but, if pharmacare in some form is introduced before voters go to the polls, its popularity will ensure it won't be scrapped after the election, no matter which party takes power.
Following that election, the pressure on all the other provinces to emulate Ontario will mount to irresistible levels. They will find it politically untenable to deny their citizens the same improved pharmaceutical coverage.
I don't think it's overly optimistic to expect that, as with the services of doctors and hospitals initiated in Saskatchewan, the provision of public prescription drugs in Ontario will inevitably spread across the country over the next few years. Pharmacare will then become an integral part of the federal medicare program.
That breakthrough is bound to open the health-care floodgates and swell compulsion to fill the remaining gaps in our health-care system. That rising demand will lead, in time, to the inclusion of dental, vision and other services that comprise the comprehensive public health-care plans in other advanced countries.
Tommy's grand vision could even become a reality within another four or five years.
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