Op-Ed from Bill VanGorder, Chief Advocacy and Education Officer

Earlier this month, the federal government unveiled Bill C-64, its long-awaited pharmacare legislation. The new bill lays out a plan for the government to work with provinces and territories to provide “universal, single-payer, first-dollar coverage” for a number of contraception and diabetes medications. However, if this is the beginning of a federal program that replaces existing drug plans, the question remains: will this approach give us better access to medicines? Here’s the short answer: It won’t. In fact, we’ll pay more, get less, and wait longer.

The problem is that a single public program will inevitably make it harder for Canadians to access many of the newest and most effective treatments. Public drug plans are notoriously slow at covering new drugs. In fact, Canadians on public plans wait about three times longer to access new medicines than those with private coverage.

Why does this matter? Waiting an additional 1-2 years for medicines that can treat cancer, Alzheimer’s, and other serious conditions can mean the difference between life and death. Government-run plans are also much more limited in terms of what they offer than private plans. This means the majority of Canadians (including 1 in 3 seniors) who have private insurance will experience worse overall coverage under a single federal plan.

Offloading all Canadians onto a single public plan could also lead to serious access disruptions. We saw some of the challenges a few years ago when Ontario moved all youth under 25 to the OHIP+ government administered plan. During the transition, many Ontario kids lost coverage for medicines that were previously available to them under their private plans. A radical overhaul of the current drug insurance system could lead to similar challenges, with potentially devastating consequences for many older Canadians who rely on their medicines and can’t afford any disruptions to access.

We also need to consider the opportunity cost. Canada’s health system is crumbling under the weight of an aging population and limited health system capacity. We wait for hospital beds, family doctors, diagnostic procedures, appointments with specialists, surgeries, access to long-term care, home care, and the list goes on and on. Do we really need a $40-billion/year single-payer pharmacare plan to replace a system that works well for most, or should we be using this money for other, more pressing areas of our health system?

Obviously, we can and should do more to address challenges in the current system.

For instance, many people face high out-of-pocket expenses for their medicines due to insufficient spending and coverage of medicines by public drug plans. This can be a major financial burden, particularly for seniors, many of whom are on fixed incomes.

We also need to achieve more equitable access. At the moment, provincial drug plans vary in their drug coverage and co-payment policies—some are faster to fund, others take much too long. Too often, access to medicines and health outcomes depend on where a person lives. This is unfair. But, instead of throwing out the baby with the bath water, should we not be looking to enhance every Canadian’s coverage?

We can build on the successful mix of public and private programs to achieve universal coverage through a targeted approach that focuses on those most in need: the uninsured, underinsured, and those facing affordability challenges. We’ve already seen this model successfully implemented recently in the federal government’s 2021 funding agreement with Prince Edward Island. The province used this dedicated funding to help expand the number of drugs it covers and reduce out-of-pocket costs for Island residents.

This approach respects provincial and territorial jurisdiction in healthcare, will likely face fewer barriers to implementation, and can be achieved much more quickly than a complete overhaul of the current system.

Ultimately, paying more to get less is not good policy. It’s time to start focusing on solutions that maximize the value of our healthcare investments, ensuring that every Canadian has access to the medications they need without sacrificing quality or affordability.

By Bill VanGorder, Chief Education and Policy Officer of the Canadian Association of Retired Persons (CARP), Canada’s largest advocacy association for older Canadians.

Originally Published, Canada Health Watch April 14, 2024