British Columbia struck the first blow. Saskatchewan, Manitoba, Newfoundland and New Brunswick followed suit. Ontario is poised to join them.
Fifteen years ago, Canada had a working model of a national pharmacare plan. Seniors in every province, regardless of income, were entitled to public coverage for all prescription drugs. Their only out-of-pocket expense was a small co-payment.
Today, the program is partially dismantled. Half of the provinces have scaled back their seniors’ drug benefits. The rest of the system looks shaky.
There has been no nation-wide analysis and very little public commentary, just snippets from individual provinces.
Now a Montreal think-tank has pulled it all together. The Institute for Research on Public Policy has just released an informative study, Are Income-Based Public Drug Programs Fit for an Aging Population?
The institute commissioned three health care specialists — two from the University of British Columbia and one from Harvard — to track the retrenchment, analyze its impact and offer advice to the provinces that haven’t ratcheted back seniors’ drug benefits.
The authors acknowledge that financial pressures the provinces face are real. Canada’s population is aging, drug expenditures are escalating and the economy is no longer robust enough to accommodate rising costs. What they question is the wisdom of restricting access to medicine for the highest-needs segment of the population.
Former B.C. premier Gordon Campbell was the first Canadian politician to curtail drug coverage for seniors. Shortly after taking power in 2001 he imposed a three-year budget freeze on his province’s health ministry. The following year, he raised the co-payment on seniors’ prescriptions to $25. In 2003, he implemented an income-tested plan — “Fair PharmaCare” — requiring better-off seniors to contribute up to 3 per cent of their annual income to the cost of their medications.
Over the next decade, four of his counterparts followed his lead, imposing restrictions on seniors’ drug benefits. In 2012, former Ontario premier Dalton McGuinty went part-way. He reduced public drug coverage for seniors with incomes over $100,000. They are now required to pay the first $100 of their annual drug bill and a $6.11 co-payment (triple the standard seniors’ fee of $2) for each prescription. In 2013, Alberta indicated it was considering the B.C. model. That is where things now stand.
The appeal of eliminating universal drug coverage is obvious. It reduces the burden on the public purse. It makes medicare more sustainable. It targets benefits to those who really need them.
What’s not to like? Three things, the authors say:
•It is detrimental to the health of seniors. The more financial barriers governments put in front of elderly residents, the less likely they are to fill their prescriptions. Seniors in B.C. forgo drug treatment at twice the rate of their Ontario counterparts. Although they pay the highest price, taxpayers lose, too. Providing older people with medically necessary drugs is much cheaper than paying their hospital bills when their condition becomes unmanageable.
•It penalizes Canadians over 65 with chronic conditions or serious disabilities. “In effect the deductibles under income-based programs are tantamount to imposing a specific income tax on people with the highest medical needs,” the authors say. This violates the spirit of medicare.
•And it is financially inefficient. By unloading the cost of medications on seniors and private insurers, governments reduce their leverage in the pharmaceutical marketplace. The fewer citizens they buy for, the less bargaining power they have.
There is a fourth drawback the authors don’t mention. The premiers are pushing a full-fledged pharmacare plan out of reach, in defiance of the will of their citizens. Public opinion polls consistently show that 75 to 90 per cent of Canadians want medically necessary drugs brought into medicare.
That was part of the vision forged by Saskatchewan premier Tommy Douglas and chief justice Emmett Hall, chair of the Royal Commission on Health Services half a century ago. They recommended that the cost of hospitalization be lifted from families’ shoulders first; physicians’ fees would be covered next; and finally prescription drugs would be publicly insured.
Today Canada is the only country in the developed world with a universal public health care system that excludes coverage of prescription drugs. Policy-makers were inching in the right direction until the turn of the millennium. As of 2000, seniors, social assistance recipients and aboriginal people had full drug coverage.
Now the premiers are moving backward, creating an inequitable patchwork of drug coverage for seniors and lowering the likelihood of pharmacare for everyone else. The short-term savings may look appealing. The long-term costs will add up in ways Canadians haven’t begun to contemplate.