Pharmacare: More government could mean fewer drugs

To help, or at least, to do no harm.

This principle should apply not only to health care, but also to public policies.

During their recent convention, NDP members indicated their support of Justin Trudeau’s government was at stake if it did not create a new government monopoly drug insurance program.

The monopolistic nature of the proposal could not have been clearer, as members ruled out any system allowing Canadians to choose to deal with an independent insurer rather than the new government monopoly.

In their eagerness to make sure everyone has access to an insurance plan covering their prescription medication, the New Democrats seem to want to tear down an entire system that actually works well for the vast majority of us.

At the moment, there are about five million Canadians who do not have drug coverage, according to a recent Conference Board study. This represents around 14 per cent of the population.

For these people, the absence of coverage is not due to the fact they are uninsurable, but rather their choice not to be insured. Think, for instance, of a recent post-secondary graduate in good health, who prefers to devote the few hundred dollars a year that a drug insurance plan would cost to reimbursing their student debt. For such people, introducing a universal drug insurance monopoly would entail significant costs they currently do not choose to bear.

There is nonetheless a part of the population, around 2.8 per cent of Canadians, who are ineligible for drug insurance. While it may be laudable to want to make sure these people have access to drug insurance, this need can be much better met with a targeted program, offering coverage to those without access today, than with a new structure upending a system that works well for the majority of us.

Moreover, it must be recognized that introducing a government monopoly over drug insurance would not be without risk for the majority of Canadians who enjoy private drug coverage.

In Canada, practically all drugs covered by a government drug plan, such as the Régie de l’assurance maladie du Québec (RAMQ) or the Ontario Health Insurance Plan (OHIP), are also covered by private insurance plans. The reverse, however, is not true.

This means private insurance plans systematically cover the costs of a greater number of drugs than do the public plans.

In Quebec, for example, the insurance offered by RAMQ covers a little more than 8,000 different drugs. The numbers are even more flagrant in Ontario, where OHIP covers fewer than 7,000 different drugs. Private insurers, for their part, cover more than 13,000.

By imposing a single government insurer, the NDP proposal would transfer all Canadians to government plans that are less generous than the better quality coverage offered by private insurance.

And while the debate may seem to be all about pitting big numbers against each other, it is important to recognize for those who depend on drugs reimbursed by private plans, it’s a question of quality of life, of the effectiveness of treatments and of access to the drugs that are best adapted to a person’s needs.

Although there are all sorts of financial arguments about the capacity of the federal government to pay for such a huge new program under current circumstances, the most important considerations should be the impact that introducing a single drug insurance plan would have on the health of Canadians.

That’s where the idea of helping, or at least not harming, comes in. What the New Democrats are proposing at the moment is to introduce a plan that, in order to help a small proportion of the population, would harm the vast majority of our fellow citizens.

Instead of threatening the insurance coverage we have, Ottawa should figure out how to allow the last 2.8 per cent of ineligible Canadians to obtain insurance, if they want it.

Emmanuelle B. Faubert is an Economist with the MEI. The views reflected in this opinion piece are her own.

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