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Canadians are used to broken promises about how their governments will make drugs cheaper and more widely available. Some may therefore find a radical solution enticing, touted in a new study: the creation of a national public pharmacare program. But nationalization is the wrong approach. Instead, Canadians should expect results soon, especially if they hold health ministers, meeting in St. John's this week, to account for their latest commitments.

Although we aspire to provide good public health care in Canada, we already have a two-tier system: much psychological and dental care, and 55.5 per cent of drug expenses, are paid privately, either out of pocket or through private plans. This squeezes the working poor and the self-employed, who do not have employer-provided plans but who make too much money to qualify for public subsidies.

So some may take heart from a new study for the Canadian Centre for Policy Alternatives, promising more coverage and national savings of up to $10.7-billion if a national public plan is created.

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Such a plan would, however, result in costs governments are ill-equipped to handle, and effectively result in a transfer of taxpayer funds to richer Canadians currently covered by private plans. Meanwhile, all drug costs, regardless of who pays, are increasing, at a rate of 10.5 per cent a year since 1985.

A hint of a better path comes from the study itself; it suggests the largest share of savings would likely come not from nationalization but from "the cancellation of the industrial policies artificially inflating drug costs."

Ontario and B.C. have already begun to innovate, with cuts to the prices it will pay for generic drugs, savings that should benefit private plans too. Fresh off these reforms, they promised at the health ministers' meeting to take the lead on a "pan-Canadian purchasing alliance" for drugs and medical supplies.

The provinces need to act fast to overcome their jurisdictional concerns and implement the plan. For the savings, once achieved, should be directed back to vulnerable Canadians, by helping to fund a national catastrophic drug plan.

Catastrophic drug care - life-preserving medication that is expensive and not covered by existing plans - holds a special place of shame in Canadian politics. A 2003 first ministers' meeting ended with a vow that governments would "take measures, by the end of 2005-06, to ensure that Canadians, wherever they live, have reasonable access to catastrophic drug coverage."

Yet almost nothing has been done. The federal government has lost interest and the provinces have largely let the issue drop. With the recession, ongoing price increases, and high prices for new cancer drugs in particular, Canadians are more vulnerable to unnecessary financial hardship and risks to their health.

Solving the drug needs of all Canadians won't come with one policy change. But a catastrophic drug plan, funded in part through other savings in the drug system, is within reach. Governments have promised much; they should be able to deliver this one, crucial, thing.

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