Beyond its dwindling but still politically powerful defenders, no one really still buys the apophthegm about Canada's single-payer health-care system being superior to any other. But politicians remain too scared by voters or outgunned by lobby groups to tamper with the model.
Yet, were you designing a universal health-care system from scratch, with the twin goals of equity and efficiency in mind, you would never look to Canada. First off, our system is not even universal. Truly universal health care would include basic coverage for prescription drugs and dental and eye care. But most middle-class Canadians depend on private insurance or pay out of pocket to cover such expenses. That makes Canada unique, and not in a good way, among self-proclaimed providers of universal health care.
Indeed, private sources account for almost two-thirds of the $34-billion Canadians spent on prescription drugs in 2014. Countless Canadians can't afford the medications they're prescribed, so don't take them. Many others go without other basic necessities just to pay for their drugs.
This is the dirty little secret of Canadian health care that, while occasionally acknowledged, usually gets short shrift in the endless debate over "saving" medicare. All of the oxygen gets sucked up in doctor salaries and the seemingly intractable quandary of how to reduce wait times.
These are problems a country as rich as Canada need not have. But we remain ideologically wedded to the myth of public health care without facing up to our contradictions. Why is private health insurance verboten for most surgeries but acceptable for outpatient prescription drugs?
The assumption is that there's no money to expand public coverage for drugs. Health care already accounts for more than 40 per cent of provincial program spending. Yet, plenty of countries offer more comprehensive public health coverage for less. By also allowing citizens to buy private insurance to cover doctor and hospital services, Britain ensures that those least able to pay have better care and faster access to the public system. And they get "free" drugs, although a maximum co-payment of £8.05 applies.
Britain came first overall in the 2014 Commonwealth Fund ranking of health systems in 11 developed countries. Canada? We're No. 10.
Embracing elements of the British model would require major changes in the way doctors are paid and hospitals are funded. But as Ake Blomqvist and Colin Busby note in a recent C.D. Howe Institute study, allowing doctors here to practise in both the public and private spheres would absorb the slack of underutilized labour that's currently in the system. And with access to supplemental private income, doctors might focus less on squeezing more out of government.
The authors refute the "slippery slope" argument employed by foes of private insurance, countering that so-called dual practice by doctors has not hurt Britain's public system. Rather, only about 12 per cent of British citizens hold private insurance, while competition from the private sector has made the public sector more efficient and results driven. That frees up public monies for other health needs, such as drugs.
This brings us to a new study in the Canadian Medical Association Journal suggesting that Canada could save $7.3-billion annually, about one-third of the amount it now spends on 31 major classes of drugs, by adopting a universal prescription plan to replace the patchwork of public and private plans that leaves huge swaths of the population without drug coverage. The private sector would save $8.2-billion, but governments would spend $1-billion more.
While employers might jump at the idea, the insurance industry and brand-name drug companies would not. A more realistic goal might be a national pharmacare plan similar to Quebec's – with caveats. Quebec mandates public insurance for its 3.3 million residents not covered by a private plan. Premiums range from zero for low-income earners to $611 for others.
Quebec's drug plan has hardly been a model of cost control (though there have been recent efforts to turn the tide) and premiums cover only a fraction of the program's cost. But a smarter financing model for doctors and hospitals, with an assist from the private sector, would make national pharmacare easily affordable and Canadian health care a step closer to being universal.