In 1964, after three years of study, Justice Emmett Hall, the Progressive Conservative judge and chair of the Royal Commission on Health Care Services, recommended that Canada create a system of universal health insurance. Politicians picked up the ball and ran with it, and for two generations we’ve had medicare. It’s not perfect but, compared with what came before, it’s an overwhelming success.
Back in 1964, millions of Canadians were counting their pennies to pay the doctor; today, all Canadians are insured. Yet, medicare costs far less than the system in the United States, which leaves millions of Americans uninsured or underinsured. The U.S. health-care system, the world’s most expensive at more than 17 per cent of gross domestic product, is two-thirds more costly than ours. If we were spending as much on health care as our southern neighbours, it would eat up an extra $150-billion a year. And yet the average Canadian, remarkably, lives three years longer than the average American.
Medicare works. But the version Canada got is less ambitious than what Justice Hall originally called for.
The “establishment radical,” as his biographer called him, didn’t want to limit public insurance to doctors’ visits and stays in hospitals. He believed it also had to include prescription drugs. He suspected that pharmaceutical treatments would come to play an ever greater role in medical care, and he was right.
That’s why it’s time for Canada to finally include prescription drugs in medicare. It’s time to create a national pharmacare program. And in 2019, if the political stars align, that’s just what Canada might get.
Every major Canadian report on health care since Justice Hall has called for a comprehensive pharmacare program. The consensus view is that it would improve public health while simultaneously lowering drug costs. It would do for drugs what medicare did for the rest of health care.
When it comes to getting medical treatment from a doctor or a hospital, Canada has universal health insurance. In the United States, it’s what the Democratic Party’s presidential aspirants are about to start pitching to American voters, under the banner of “Medicare for All.”
But when it comes to drugs, the Canadian system is the broken American system. If you’re hospitalized and you’re given prescription meds, it’s free. But once you walk out of the hospital with a prescription to fill, you may be on your own. Coverage is a mix of private insurance and out-of-pocket spending, with the provinces and territories filling some of the gaps with a grab bag of local programs, each unique to its jurisdiction, for groups such as seniors and the poor.
In terms of pharmaceutical coverage, Canada in 2019 still looks a lot like Canada circa 1964.
And that has led to two problems – the same problems premedicare Canada suffered from, and which still afflict the U.S. health-care system.
First problem: While most Canadians have workplace drug insurance, part-time workers, the self-employed and the precariously employed or unemployed usually aren’t among them. Even for those with insurance, it’s contingent on remaining with the same employer. Government programs are limited and selective, creating a safety net that’s filled with holes.
As a result, many Canadians on medication don’t take it as prescribed by their physician, for reasons of cost. A recent Angus Reid survey found that nearly one in four Canadians said that was true of someone in their household. A 2013 study found that 10 per cent of Canadians were not properly taking a medication because of cost – compared with just 2 per cent in the United Kingdom, where drug coverage is part of the public health system.
Second problem: In a largely privatized system, the government has little ability to control costs. That’s true across the U.S. health-care system and in Canada when it comes to meds. Canadians are the world’s third-highest spenders on drugs, at nearly $1,100 per person in 2017. The British, in contrast, spend barely more than half as much. Their public system gives them the ability to negotiate better deals and put downward pressure on drug prices.
Canada has the opportunity to do better; to improve the average Canadian’s access to necessary medicines while lowering the bill for businesses, taxpayers and citizens. We’ll explain how – the economics and the politics – later this week.