Donald Trump, keep your hands off our drugs

There’s a satisfying irony in U.S. President Donald Trump’s latest effort to lower the punishing cost of prescription drugs in his country.

His solution? Let Americans buy their drugs in Canada, a country whose health-care system Mr. Trump has in the past derided as a socialist failure.

All of a sudden, our complex medical regime has become the face-saving solution to a problem plaguing a President seeking re-election, while at the same time being a remedy he would never consider in his own country, and which he is happy to mock.

Mr. Trump is encouraging at least one group of people to cross a country’s southern border, in search of a better life.

In a time when American politics provides very little in the way of grace, we should savour the moment. But not for long. Canada, too, has a problem with expensive pharmaceuticals.

There are many uninsured Canadians who can’t afford their meds, or who skip doses to save money, thereby putting their health at risk. The Liberal government wants to implement pharmacare, similar to medicare, which would make all prescription drugs free, but that’s a long way off.

Still, Canadians are luckier than Americans.

A 2017 study by the Commonwealth Institute found that the United States spends the most in the world on pharmaceuticals every year: US$1,011 per capita.

That is considerably more than second-place Switzerland, which spends US$783 per capita. Canada comes in fourth, with average spending of US$669 a person. Compared with almost every other developed country, Canadian drugs are expensive. But compared with the United States, our drug spending is quite low.

That’s not because Americans are taking more meds. It’s because they’re paying way more for each pill.

That differential was highlighted last month when a busload of Americans travelled to a pharmacy in Windsor, Ont., to purchase insulin at one-tenth the price charged back home. Senator Bernie Sanders, one of the main contenders for the Democratic presidential nomination, rode with the so-called caravan, most of which was made up of reporters.

Mr. Sanders knows that the cost of drugs will be an issue in the 2020 U.S. election. Mr. Trump knows it, too, and claims that lowering costs is his priority. His proposal to let people buy drugs in Canada – which has a very low probability of going anywhere and shouldn’t overly worry Canadians – was his second stab at the problem.

Last year, his administration floated the idea of making pharmacies and insurers give the bulk-purchase rebates they get from drug companies directly to consumers, instead of pocketing the money themselves. That, too, is unlikely to result in lower prices in time for the 2020 election, if ever.

Both proposals are more heat than light from a President who wants to be seen to be doing something about an issue whose solution faces three major hurdles.

The biggest one is the patent-drug market is a beast unto itself. In the United States, if a company has a useful drug under patent, it can charge what it wants, market forces be damned.

As well, some of the biggest pharmaceutical companies in the world are based in the United States, and they have tremendous influence in Washington. Finally, a Congress lubricated by donations is loath to regulate drug prices.

Canada, on the other hand, is freer to control drug costs, which it does in two ways.

The Patented Medicine Prices Review Board sets ceiling prices for new patented drugs and limits the amount by which they can rise every year. And, as the main providers of health care in Canada, Ottawa and the provinces use their buying power to get better prices for patented and generic medications.

In contrast, the two biggest public American health-care programs, Medicare (for seniors) and Medicaid (for the poor), are prevented by law from using their buying power to negotiate lower prices.

Changing that would lower drug costs, as would regulating price ceilings, but those are no-nos for a Republican President and are not on Mr. Trump’s radar.

Better, then, to try to outsource the solution to a country whose politics allows for what may well be the only viable way of controlling patent drug costs. Welcome to the socialist paradise of Canada, Mr. Trump.