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Canada’s chattering classes – academics, pundits, policy-makers, politicians – are hot to trot on pharmacare, which would extend publicly funded health insurance beyond hospital and physician care to cover prescription drugs.

But the public, the folks who pay the bills with their taxes? Not so much, it turns out.

New polling shows support for pharmacare is lukewarm. The survey, conducted by Nanos Research and commissioned by National Public Relations, asked: “Do you think a new national universal drug program managed by the government of Canada in Ottawa will do a very good, good, average, poor, or very poor job of the following”:

  • Ensuring access to the best medicines for patients: 42-per-cent very good or good, 30-per-cent average and 24-per-cent poor or very poor;
  • Managing the costs related to prescription medicines: 38-per-cent very good or good, 25-per-cent average and 31-per-cent poor or very poor;
  • Spending tax dollars for a national pharmacare program well: 34-per-cent very good or good, 26-per-cent average and 33-per-cent poor or very poor;
  • Making the right decisions when the government chooses which medicines doctors can prescribe to patients: 30-per-cent very good or good, 31-per-cent average and 33-per-cent poor or very poor;
  • Ensuring that a national pharmacare program is lean and does not create unnecessary paperwork: 24-per-cent very good or good, 28-per-cent average and 42-per-cent poor or very poor.

“The key takeaway here is that there’s a heavy dose of cynicism,” says Nik Nanos, chief data scientist and founder of Nanos Research.

That’s unsurprising, given that governments constantly promise us better medicare, but access remains spotty, waits continue to grow and costs continue to increase. Why would the public now believe that grandiose plans such as pharmacare would come to fruition?

Mr. Nanos says that, based on the polling, he would tell promoters of pharmacare they “have to get beyond the slogans to the nuts and bolts and focus on how they will achieve their objectives.”

To do so, we need to ask Canadians to debate and discuss two questions openly: Why do we want pharmacare? Why do we need it?

Too often, one is left with the impression that proponents of pharmacare think we should provide access to drugs for the sake of providing access. Of course, access matters – but the ultimate policy objective should be better health outcomes, both individually and collectively.

We should strive for a pharmacare program that ensures timely, equitable and consistent access to prescription drugs, appropriateness of therapy, and affordability – for patients, providers and taxpayers.

The polling numbers suggest the public understands at least some of these nuances.

But this survey looked at only one version of pharmacare – a centralized program operated by the federal government.

Currently, about 25 million Canadians have private prescription-drug insurance, largely through their employers; another eight million, mostly seniors and people on social assistance, are on public drug plans, and another 3.5 million people have inadequate drug coverage, and sometimes no coverage at all. While those numbers are hotly contested, there is no question that medicare is falling short by failing to provide universal coverage for prescription drugs.

You can fix the problem by building a whole new system, or by patching the cracks in the existing non-system.

Of course, there are variations on each of these approaches, which are articulated well in a recent report from the Conference Board of Canada. The authors outlined five different models of pharmacare: Comprehensive public coverage with a centralized national model, as mentioned in the poll; public coverage of essential medicines, which would guarantee the basics to all, supplemented by private insurance; public coverage with income-based deductibles, which would provide coverage based on household income, much like existing programs for seniors in British Columbia and Ontario; an individual mandate, which would make prescription-drug insurance mandatory, whether it is purchased privately or provided publicly, as is the case in Quebec; or optional public coverage, that would give Canadians the option of purchasing public-drug insurance.

To overcome the public’s skepticism/cynicism, we have to stop presenting pharmacare as a black-and-white choice between a massive new government program or the status quo.

If we truly want pharmacare – universal access with the goal of better health outcomes – then we need a full debate about these options, and their advantages and disadvantages.