Cost More and Deliver Less: Another Multi-Billion Dollar Government Initiative

Commentary, Healthcare & Welfare, Susan Martinuk

The Advisory Council on the Implementation of National Pharmacare has presented the federal government with its plan for the creation of a universal, single-payer, public pharmacare system. A government program that covers prescription drug costs for every citizen sounds very caring and rooted in Canadian values. But, closer study reveals that it is just one more multi-billion dollar government initiative that will cost far more than expected and deliver far less.

The plan is most striking in its lack of innovation; its ideas are steeped in ideology rather than critical thinking and in some cases, reality. The Advisory Council has chosen to perpetuate the ideals of our beleaguered healthcare system, proudly proclaiming that a national pharmacare program is the way to “complete the unfinished business of universal health care. That can be our promise, and our legacy, to each other and to all future generations.” 

But universal healthcare is already collapsing under its own financial and administrative weight. It is currently characterized by long wait times, patients lying on stretchers in hallway, not enough hospital beds, and dangerously overcrowded emergency departments. The crush of an aging population on this system is just beginning.  

It hardly seems reasonable to replicate or exacerbate the bureaucracy that undergirds such conditions. 

Yet, it is this badly-managed chaos that the Council wants to “complete” by adding the enormous burden of universal pharmacare. If the plan proceeds as is, there is no doubt that pharmacare will be our legacy to future generations; unfortunately, it will be one that is laden with debt, administrative disaster, and questions that start with “Why?”.

Beyond its ill-conceived premise, the proposal calls for pharmacare to unnecessarily take on the financial burdens of private insurers and wealthy citizens. The Advisory Council claims that one in five Canadians cannot afford to pay for their medications. Other studies have made varying determinations about how many truly require assistance, but even if we accept that 20 percent of Canadians are in dire need of help, that still leaves a robust 80 percent who are not (whether it be through wealth, private insurance or public insurance). 

Why would the Council propose that a national pharmacare program take on the burden of paying for prescription medicines that are currently being purchased without hardship and/or are already covered under private or provincial drug plans?  

Rather than bringing all Canadians under the government-pays-all umbrella, the Council could have utilized experts and critical thinking to devise a plan that would clearly identify and help those in need. 

It is frustrating to have to remind those in charge of the treasury that our nation is already some $675B in debt and, however generous we wish to be, Canada simply does not have the resources to pay for drugs that are already being paid for by non-government sources. 

Obviously, there will be benefits for some, but putting all Canadians into a one-size-fits-all program also has the potential to reduce the quality of care for others. The Council’s plan is to create a national formulary of essential drugs that will be covered under the program. The catch is that it will only cover drugs that are “evidence-based.” That means pharmacare will be restrictive in the medication options it covers, and this could result in a significant downgrade in coverage for some.

It could also force some Canadians into a change of medication that may not be beneficial. Our individual biology and genetics are precisely why we have multiple drugs to combat the same problem – each one can have varying degrees of efficacy in different people.   

The term “evidence-based” sounds reasonable and, in many cases, it is. But, it also results in lengthy delays in the drug approval process and can become a complex exercise in bureaucracy. Consider the province of Ontario where trying to get an “evidence-based” PET scan for cancer patients has become such a complicated process that many doctors no longer bother to make the recommendation.

All of the above means that Canadian taxpayers may be buying prescription drugs for those who can easily afford them, taking on the financial obligations of private insurers and corporate health plans, and perhaps having to set aside the one drug that has always worked for them in favour of a drug listed by the formulary.

These are just some of the nasty side effects – there are many others, and they collectively guarantee that universal pharmacare will be quite a legacy, indeed.