Evidence of meeting #14 for Health in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was cost.
A recording is available from Parliament.
3:30 p.m.
Liberal
The Chair Liberal Bill Casey
We'll call the meeting to order. Welcome everybody. I look forward to today's presentations. It looks like an interesting group. I'm sure we'll learn a lot today.
I was talking to Ms. Kurl, who has a plane to catch, so we're just going to rearrange the schedule a bit and ask her to make her presentation first, so that in the event she has to leave early, she can.
From the Angus Reid Institute, Ms. Kurl, if you could, go ahead and fire away.
3:30 p.m.
Shachi Kurl Executive Director, Angus Reid Institute
Thank you.
Good afternoon, ladies and gentlemen. My name is Shachi Kurl, and I am executive director of the Angus Reid Institute. I am very pleased to be here with you today to talk about a subject of great importance to Canadians.
Our institute, which was founded in 2014, is a non-partisan and not-for-profit polling organization. In order to promote a better understanding of the major public policy issues and trends in public opinion across the country, we make all of our polling data available to Canadians, free of charge.
3:30 p.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
Mr. Chairman, could I pause for a moment? I notice that some of the witnesses are looking for their translation devices. Maybe we can make all the witnesses aware of the channel.
3:30 p.m.
Executive Director, Angus Reid Institute
In the name of transparency, and also to further the ability of policy-makers, interested parties, and the general public to understand where Canadians are at on particular and important issues of the day, we make all of our data and information available to the public at no cost through our website.
What we wanted to do with the study that was conducted in July 2015, in partnership with the Mindset Foundation, representing a general population sample of Canadians in every region and of the main census demographics, was to take the temperature of Canadians and get a sense of the prevalence and incidence of those Canadians facing cost pressures and other access barriers around their prescription drugs.
What we found, to begin with, was that nearly one in four, a quarter of, Canadians say they are either not taking prescription drugs, skipping doses, splitting pills, or finding other ways to reduce cost and access barriers to the prescription medications they are being recommended to take by their doctors and specialists. Right away, we were able to surmise that this is an issue and one that is putting some pressure on a not insignificant segment of Canadians in this country.
In terms of who is struggling most, that national number sits at just under one in four, but we tend to see a little more struggle and a little more cost pressure for those living in British Columbia and Atlantic Canada. There is some variability, and some of that may be attributable to the fact that in British Columbia, for example, provincial governments only have so-called catastrophic drug coverage. In Atlantic Canada there are other limitations to the nature of drug plans relative to other provinces such as Quebec and Ontario. When we use the word “struggle”, we're talking about those who are identifying themselves as not adhering to their prescription drugs by dosage and not necessarily filling their prescriptions as often as they should be because of the costs involved.
Costs and barriers do go hand in hand, and they affect Canadians on two different levels. One is by age. We do see barriers that are a bit worse for the youngest Canadians. This isn't entirely surprising, given that younger Canadians are often those who are dealing with the least stable work. They may not have jobs that offer comprehensive drug coverage or drug benefit plans of any king. For them, access to pharma is a little less stable, and they may be experiencing more pressure, although you do see almost as many Canadians aged 35 to 54 expressing that they are having some struggles as well.
Income is also a driver of that cost barrier. Those who have lower household incomes are expressing higher levels of struggle and problems with filling their prescriptions, but that isn't to say that higher-income earners don't struggle as well. The reason for that is that you can have brand-name drugs and experimental drugs that can be quite costly. Even though some Canadians are earning more, they may still be facing barriers. Indeed, 16% say they are facing those barriers because some drugs are prohibitively expensive. If people are not covered, then they're figuring out how to deal with that themselves.
We wanted to get a sense of how many Canadians are paying out of pocket for their drug expenses. Overall, you see that about 30% say they're paying some amount less than $100 per year. There are about as many saying they're paying $500 or more. Something like one in five, about 20%, are saying they're paying between $1,000 and $3,000 per year.
What's notable here is that those in that $500 or more out-of-pocket expense bucket include about one-third of Quebeckers. This may be attributable to the fact that they are dealing with monthly deductibles and other costs associated with that province's mandatory drug plan. Ontarians, by contrast, have some of the lowest out-of-pocket burdens. Only 14% say they paid $500 a year or more, in the last year, for their prescription drugs.
When we think about access to drugs and access to prescriptions, we also want to ask, “Are you worried about this? Have you been worried, and going forward is this something that's going to be increasingly on your mind?” A routine question we ask of Canadians every three months is, “What are the top issues now facing you, your family, your household?”
Of course, health care is always at the top of that list, along with the economy. But within that subset of health care, what this clearly tells us is that prescription drugs and drug coverage and access are at the top of that health subset.
In the last year, 25% told us they have been worried about how they or their family members would be able to afford prescription medication. Looking ahead, we asked them to think about a decade from now, when they're going to be 10 years older. In response, the level of worry jumped to nearly half, and 46% said they were either very worried or worried about how they were going to pay for their prescription drug costs 10 years from now.
From looking at Canadians' own experiences, at the personal or household level, of accessing drugs and being able to fill their prescriptions, we shifted to some broader opinions on where they stand on the idea of a pharmacare plan. I want to provide a caveat on this. We are experts in measuring public opinion and measuring where Canadians are on particular issues. We are not health policy experts. When we ask this question and present these data, we recognize that without further specifics on what a pharmacare plan might look like, there are some limitations on the interpretation of these findings.
I want to underscore that what I'm presenting is valid as an initial temperature-taking, as opposed to the final word, on public opinion on these issues.
We put a number of value statements in front of Canadians. I'm presenting three that speak to where Canadians are in their general views on pharmacare and access to prescription drugs. These are by no means all the statements that were put in front of Canadians. If more information is wanted, or a greater level of detail, I'm happy to provide that, or you can find it online at angusreid.org. We've provided that link for you.
What you see is that public opinion certainly tilts toward—albeit it's not necessarily a majority—value statements that indicate, on a conceptual level, that Canadians are in favour of access to prescription medication. They favour being able to get the drugs they need for their health.
On support for a pharmacare plan, we asked: “Do you yourself oppose or support adding prescription drugs to the universal health coverage of 'medicare'?” To further explain what we meant, we added: “so that all Canadians have access to prescribed medicines without having to pay out of their own pocket”.
Again you see very strong consensus for this concept. Only 15% oppose or strongly oppose such a plan; nearly a half say that they strongly support it. Again, it is conceptual. I have to underscore that again.
What's notable and significant in this finding is that when you combine it with some other findings, some 70% of Canadians think that the status quo in terms of drug coverage today is in need of improvement. Moreover, when it comes to reform, again, a great majority believe that the pharmacare coverage they face in their country—and, of course, it is a bit of a patchwork when you go from province to province—is better served by having a national plan across the board.
Now, who should pay? It's always easy to find Canadians in support of particular plans, or ideas, or policies, but when it comes to the stickier details of who administers and who pays, this is where we tend to find a little less consensus. On the issue of administration and who should be involved, you see that about a half, a very slight majority, believe this should be something that both the provinces and the federal government should have some involvement in and be working together on. The margins, about one-quarter, say that it should be the federal government that runs the show, about one-quarter say it should be up to the individual provinces.
How should it be funded? You see there at the top for context, again, that's your 87% overall saying that yes, there is support for adding prescription drugs to medicare. That's your reference point on support, but in terms of particular funding costs and funding options, the only funding option that reveals any majority and consensus support is around restoring a federal corporate income tax to its 2010 levels of 18%. Canadians are not particularly warm to an increase in the GST to pay for such an idea. They are not particularly warm to increasing the basic income tax on incomes over $40,000 to 23%. They are, at best, milquetoast on the idea of charging a pharmacare premium of $180 per year for all Canadians over the age of 18.
3:45 p.m.
Liberal
3:45 p.m.
Liberal
The Chair Liberal Bill Casey
Oh, perfect. Thank you very much. I didn't want you to think I was cutting you off when you said the government was supposed to pay, but anyway....
3:45 p.m.
Executive Director, Angus Reid Institute
It's corporations that they want to pay.
3:45 p.m.
Liberal
The Chair Liberal Bill Casey
Now we'll move to Mr. Romanow, whose comments we look forward to.
You're going to share your time with Mr. Marchildon, I understand.
3:45 p.m.
Roy Romanow Commissioner and former Premier of Saskatchewan, Commission on the Future of Health Care in Canada, As an Individual
Thank you very much, Mr. Chair and members of the committee. It's a great pleasure and an honour to be here.
Thank you very much for the opportunity.
Greg Marchildon is my colleague. He's the executive director of my commission and currently the professor and Ontario research chair in health policy and system design at the University of Toronto.
We are each going to speak for five minutes. I'll address the recommendations of the royal commission relevant to the present mandate of your parliamentary committee and the leadership question of whether we can move forward. Dr. Marchildon will put forward two options describing how we might move forward as a country, especially in light of the public opinion polls we just heard.
Unfortunately, the challenge we identified in 2002—which seems like yesterday—remains the same today. In fact, there's a long history of commissions and studies recommending national pharmacare, dating all the way back from Emmett Hall's report in 1963-64, to my own commission report in 2002. While the current and potential benefits of prescription drugs are undeniable, the benefits will only be realized if prescription drugs are integrated into the system in a way that ensures they are appropriately prescribed and utilized, and that costs can be managed. As we said in 2002, the issues are national in scope, and the problems are similar in every part of the country.
As a consequence, we argue that only a pan-Canadian approach will allow us to address the triple challenge of access, cost, and integration identified in the report. While I'm pleased to say that at least modest improvements have been made in terms of catastrophic drug coverage in a number of the provinces since 2002, but access still remains limited and uneven. Poor working and self-employed Canadians continue to have no coverage. Roughly 50% of Canadians have no public drug coverage at all, which is one of the lowest levels of coverage in the OECD. Private sector, non-unionized employees, and women have far less job-based coverage than public sector, unionized employees, and men. There are also significant differences in provincial coverage for retired individuals 65 and over, and those on social assistance.
When it comes to cost, we have made little or no progress. We are second only to the United States in terms of costly generic drug prices, and near the top of the OECD group of nations for patented drug costs. This is directly due to the fragmentation between private and public coverage, the loss of leverage with the pharmaceutical industry, and variations in the practice by having disparate federal, provincial, and territorial programs.
We have made modest progress on improving coordination since 2002 through the common drug review program and the pan-Canadian Pharmaceutical Alliance.
I would say, Mr. Chairman, and committee members, that we need to go much further to achieve the kind of integration required to improve access and quality of service to average Canadians in a fiscally sustainable way.
This brings me back to the steps I suggested in the report and the steps that we need to take to achieve real progress on access costs and integration. They are as follows: one, the establishment of a single national formulary; two, the creation of a powerful national drug agency that would regulate both patented and generic prescription drugs, provide analyses of both clinical and cost-effectiveness, and be the guardian of a national drug formulary; three, the linking of medical management, best practices, and guidelines with primary health care services; four, doing a comprehensive review of the Patent Act to address continuing problems, such as evergreening and the proliferation of so-called me-too drugs.
I want to emphasize how important federal leadership will be to achieving the goals of a national pharmacare plan and getting us out of our current situation. I say this as a former premier. I'm talking about federal leadership, national leadership. The public wants a strong federal role in advancing this much-needed step forward in reform. Will Ottawa act on this issue, just as Prime Minister Pearson in a minority federal government in the 1960s did, by overcoming opposition to implementing the goals of medicare? This does not mean compulsion, but it will mean setting out a national vision with clear objectives, supported by some non-negotiable, national criteria, which must be accepted before any provincial or territorial government can gain benefit of the federal investment in pharmacare.
At this point, I'll ask Dr. Marchildon to review the two main options in achieving the national pharmacare plan, and in either case the federal government will need to take a strong leadership role.
Greg.
3:50 p.m.
Dr. Gregory Marchildon Professor and Ontario Research Chair in Health Policy and System Design, Institute of Health Policy, Management and Evaluation, University of Toronto, As an Individual
As Mr. Romanow pointed out, I am going to focus my remarks on two options. Both can achieve the job, but they each have very different trade-offs in terms of their relative strengths and advantages and their disadvantages.
The first is the traditional program that is financed in part by the federal government under a few national criteria, and then administered and financed for the remainder by the provincial and territorial governments. This is the way in which medicare was introduced, first through universal hospital coverage in the 1950s, and then through universal medical care coverage in the 1960s.
Although very few proponents of national pharmacare have spelled out the governance form it would take, I think this is really the approach that is assumed by most, because it is what we are all most familiar with. That came up in the Angus Reid survey, where 50% of Canadians seemed to agree with that kind of approach, I suspect mainly because of the fact that they are very familiar with it.
The first advantage of such an approach is that we already have some history and experience with it. However, there are also some very significant disadvantages, including the extensive time required for negotiation involving numerous veto points by individual governments, the dilution of accountability between orders of government, and the difficulty of monitoring and enforcing national standards, as we have experienced in medicare over the last 40 to 50 years.
The second option is a national pharmacare program financed and administered entirely by the federal government. While jurisdiction in most areas of health care is principally provincial, pharmaceuticals are one of the only subjects in which the federal government has a secure constitutional foothold. Coverage would be provided to all Canadians by the federal government and would replace private and public coverage plans currently in place with a single universal plan.
The advantage of this approach is that it establishes a single purchaser and a single regulator. This offers the greatest potential to keep costs down, to keep the lines of accountability as clear as possible, to establish—and, more importantly, maintain—a single national formulary based on both cost and clinical effectiveness, and to eliminate individual and regional differences in coverage and access to prescription drug therapies.
The disadvantages include the lack of experience with such an approach, the fiscal risk that is assumed by the federal government alone, and the possibility that some provincial governments might reject the approach, despite the clear financial advantages of having this major cost pressure removed from their own budgetary responsibilities.
However, I think that this last disadvantage can be addressed by allowing provincial governments to opt out—of course, they don't have to come in—and carry on with their existing programs, but without any financial compensation. In any event, this should also be the rule as applied to any federal-provincial-territorial program option, as I have described in the first option.
On this, we wish to thank the committee for this opportunity, and we look forward to your questions.
3:55 p.m.
Liberal
The Chair Liberal Bill Casey
Perfect. Thank you very much.
Now we move to Innovative Medicines.
Mr. Monteith and Mr. Skinner, are you going to divide your time?
3:55 p.m.
Glenn Monteith Vice President, Innovation and Health Sustainability, Innovative Medicines Canada
No, Chair, I'll do the initial address.
Thank you very much for having us here. I'm Glenn Monteith. I'm the vice-president, innovation and health sustainability, for Innovative Medicines Canada, the association representing Canada's innovative pharmaceutical industry.
With me is Brett Skinner, executive director of health and economic policy at Innovative Medicines Canada.
Innovative Medicines Canada represents more than 50 innovative pharmaceutical companies. Our membership includes start-ups through to well-established international pharmaceutical companies. Our association advocates for policies that support a strong and robust life sciences economy in Canada and that also ensure access to innovative medicines for Canadian patients.
Our sector is an important partner in Canada's health care system. We interact every day with public and private health plans. In addition, we're at the table with the pCPA as a trusted partner in the sustainability of Canada's health care system. The sustainability is fundamental to Canadians.
As a principle, we believe all Canadians should have fair, equitable, and affordable access to the medicines they need when they need them. We are therefore pleased to be here to speak on the topic of pharmacare.
I want to begin with some preliminary facts about the role of our member companies within Canada's current health care system. Spending on patented medicines has declined from 8.4% to 6.4% of total health care spending in Canada between 2004 and 2014. According to the PMPRB's most recent data, in 2014 the prices of patented medicines in Canada were on average 13% lower than the median international price and 31% below the international prices at market exchange rates. Another way to describe it that they were 19% below the median prices and 45% below the average prices at purchasing power parity.
Adjusted for inflation, per capita spending on patented medicines was lower in 2014 than in 2003. For 25 of 27 years under the PMPRB regulation, patented medicines' price increases were less than the consumer price index. What this means is that medicines have become more affordable over time relative to inflation. According to the PMPRB's annual report, in 2014 Canada actually ranked third of eight countries in terms of the average prices of patented medicines at market exchange rates. In same comparison using purchasing power parities, Canada ranks number four.
Rather than being a cost-driver in the health care system, innovative medicines contribute significantly to its sustainability, from avoided hospitalizations and shorter hospital stays to fewer invasive surgical procedures, and the avoidance of what sometimes can be a lifetime of chronic illness or disability.
Without access to medicines, these health care costs would become much greater and health outcomes poorer. Innovative medicines also lead to reductions in health system costs. For example, here in Ontario in 2012 we know that out of the $1.2 billion that was spent on six classes of innovative medicines, the expenses were offset by more than $2.4 billion in savings and productivity gains alone. Today in Canada, all hospital administered medications are publicly funded. Outside the hospital setting, the majority of Canadians have financial coverage for innovative medicines under a collection of private drug plans designed for the working population, as well as public drug plans run by provinces and territories that are focused on vulnerable populations such as seniors and those on social security.
The system works well for most Canadians. If pharmacare is only about saving money, there is a belief that the only way to do that is by severely restricting access to innovative medicines. I do not believe Canadians want this. However, we do believe a program or programs could be developed to focus on the following challenges in the current system.
First is the challenge of the uninsured and the underinsured. Despite the strength of our system there are Canadians who do not qualify for either public or private drug coverage, or who do qualify but still struggle financially to fill their prescriptions.
Second is the challenge of the quality of drug plan coverage. This is an issue with the number of drugs covered in public drug programs. In a study that we conducted, we found that of the 121 new medications approved by Health Canada from the period 2010 to 2014, only 37% received public reimbursement as of December 31, 2015, across the provinces accounting for at least 80% of the eligible national public drug plan population. As a result, Canada ranks 18th out of 20 countries in that regard.
Third is the challenge posed by the time to listing in public plans. Canadians in public plans also wait inordinately long to access innovative medicines. On average, it takes 449 days to list a medicine in a public drug plan, even after it has been approved by Health Canada. As a result, Canada ranks 15th out of 20 countries in our comparative study.
The fourth challenge, as indicated by data from another study, is that coverage in Canada's private drug plans is much better than in public plans. Of the 464 new drugs approved for sale by Health Canada during the period 2004 to 2013, 89%, or 413 were covered by at least one private drug plan compared to only 50%, or 231 drugs that were covered by at least one public plan as of January 31, 2015.
Our industry has defined a set of principles to guide discussions on the development of a pharmacare program as follows: first, our first priority is patient access to necessary medicines to meet diverse patient needs; second, we believe that maintaining the prescriber-patient relationship and choice are both critical and fundamental rights; third, we must address the gaps in care and access to treatment for the uninsured and those who cannot afford it; fourth, we believe in direct public funding for those most in need; fifth, the economic and societal benefits of medicines and vaccines must be considered; sixth, Canada's health care system must support innovation and the adoption of groundbreaking science and technologies to improve health outcomes; and seventh, any program must provide the best standard of care for all Canadians, not simply cost-containment driven solutions. Programs focused on cost-containment often mean reduced access to medicines, the exact opposite of what we would hope for Canadians.
I passionately believe that we should build systems that will facilitate greater and more timely access to innovative medicines, improving health outcomes, and securing the future of our Canadian health care system.
Thank you for your attention. I look forward to your questions and comments.
Thank you.
4 p.m.
Liberal
The Chair Liberal Bill Casey
Thank you very much.
Now, we'll go to our visitor on the screen. Dr. Monika Dutt, chair of the Canadian Doctors for Medicare.
I saw you taking a picture of us a little while ago.
4 p.m.
Dr. Monika Dutt Chair, Canadian Doctors for Medicare
I was going to apologize for that. I was excited to see Roy Romanow and forgot I was on screen.
4 p.m.
Chair, Canadian Doctors for Medicare
Oh, I took one of you earlier.
Thank you very much. Canadian Doctors for Medicare is grateful for this opportunity to present to the House of Commons Standing Committee on Health on the development of a national pharmacare program. Canadian Doctors for Medicare was established in 2006. We give a voice to physicians across the country who are dedicated to improving and protecting our single-payer medicare system. As medical professionals, we are firmly committed to evidence-based health care policy.
I know that across many hours and days you've been listening to a range of evidence, a range of testimony. I was trying to think of a comparison to what I do in my daily practice as a family doctor. I was thinking about a family coming to me to ask if they should vaccinate their baby. They've collected a range of information, a range of evidence from a number of different places, but as you can probably imagine, different evidence should be given different weight, and not all of the evidence or all of the information is always credible. As a family doctor I need to take into account the best available evidence, and of course, I would recommend to them that they should immunize their baby.
Similarly, I have no reservations in recommending to you that I think Canada needs a national pharmacare program.
Leaders across the country at different levels of government have been speaking in favour of national pharmacare to different degrees. At a recent press conference in January, after meeting with the federal, provincial, and territorial health ministers, Dr. Jane Philpott said that philosophically, the concept of pharmacare is an important one to address. I think as we've seen from the Angus Reid poll, Canadians across the country also agree that this is an important issue and something that Canadians do want to see happen.
Beyond philosophical alignments, popular support, and improved health outcomes, this committee is also considering whether or not implementing pharmacare in Canada is administratively feasible and fiscally responsible. Canadian Doctors for Medicare is pleased to provide evidence to the committee demonstrating that a publicly administered single-payer system is the drug insurance model best able to provide cost management, reduce administrative expenditures, maximize health effects, and lower costs to taxpayers.
In terms of where we are now, as was mentioned in the previous presentation, there are a number of people in Canada, about 60% of Canadians, who are covered by private health insurance coverage for health care services such as prescription drugs. As was also pointed out, often that coverage is not adequate or we don't get as good value for money as we could through these private insurance plans. Others either have no coverage at all or are covered by an assortment of public drug plans, with different criteria depending on the jurisdiction. In Ontario alone there are six different public drug programs that provide coverage for medication costs based on a range of criteria such as age, income, socio-economic status, and ailment.
To be frank, this model is fairly clumsy and more expensive than it should be. It falls short of what Canadians need, and often leaves many who are most at risk without drug coverage. Again, as a family doctor I see this often in my practice.
I can tell you about a teenage boy who has diabetes and requires insulin, whose father worked, actually, out in Fort McMurray prior to the fire. He works intermittently, so has drug coverage intermittently. His mother works full-time, but in a low-income job without benefits. Of course, they do the best they can to always ensure that their son has the medications he needs, but occasionally they struggle, and they can't pay for all their needs. That's when they come to see their physician, to see me, to ask if there's anything they can do, if there's a cheaper option, if I have any drug samples. That's not the way I want to practise medicine. That's not the way this teenage boy should have to deal with his health.
Then there are simple situations. I had a woman in her 50s who needed antibiotics for pneumonia. She didn't want to tell me that she couldn't afford her medications. She came back in worse condition than before, and then we ended up talking to the pharmacist, trying to find a different option, a cheaper option, and ended up giving her something that wasn't the first-line medication. Thankfully, she recovered, but again, that's not how she should have to deal with her health.
This current public-private mix of drug coverage programs does not work, and its effects are being felt by our families. And there is a cost to all of us.
In terms of cost, every emergency physician across the country weekly sees patients who are there because they cannot or did not take their medications, and that puts a cost burden on our health care system. Not surprisingly, we see that most often with low-income individuals who aren't able to pay for their medications.
We know that even a small cost barrier, say just $10, to pay for medications is a barrier that prevents them from taking their medications. Not only is the high cost of drugs a factor, but dispensing fees, co-payments, and deductibles also need to be considered. These costs have an impact on whether people take their medications at all or whether they take them consistently.
To illustrate this, I want to walk you through a study that was done in the U.S. It was led by a physician who noticed that people, after having a myocardial infarction or a heart attack, were not taking the medications they should be taking to prevent the complications that often come after a heart attack. His team divided people into two groups.
All of them had some kind of drug coverage, but in one group they topped up that group to have their medications fully paid for, and the other group stayed on their current drug coverage plan. What they found in the end was that the total number of vascular events or negative events that happened to the people who were fully covered was far less than the other groups. They had fewer strokes and fewer other health impacts than the other group. Not only that, they were far more likely to take their medications and, significantly, the total health care costs fell by $5,700 U.S. per person on average in the group that had their medications fully covered.
That study was replicated in Ontario by Dr. lrfan Dhalla. He looked at the costs and benefits of providing free medications to patients after they had a myocardial infarction or a heart attack. These are patients who either did not have private insurance or their public insurance wasn't sufficient to cover their medications. What they found, after providing free medication to these individuals to prevent illness after a heart attack, was that they had improved health outcomes and lower average costs than in the current system.
Within two weeks of the new government coming into power last October, a group of 331 health professionals and academics signed an open letter to Prime Minister Justin Trudeau urging him to put pharmacare at the top of the Canadian health care agenda. Getting this type of consensus, of this magnitude, is often a difficult undertaking. However, in this case, the letters had signatories from every province, including physicians, pharmacists, and nurses, professors from 34 universities across Canada, 10 recipients of the Order of Canada, and 11 Canada research chairs. These experts, like Canadian Doctors for Medicare, were swayed by a case based on strong data-driven evidence in favour of implementing national pharmacare.
As I mentioned before, as we speak about evidence again, we urge the members to consider the quality and source of the research that's coming to them through this process. For instance, one research paper challenged the accuracy of an article published in the Canadian Medical Association Journal that was praised by the Canadian Institutes of Health Research. The CMAJ article demonstrated the impressively low cost of implementing national pharmacare. The paper that criticized it was not submitted to a peer review journal where a baseline for research standards can be met. In addition, several sections in the report make contradictory claims about the cost. We've attached this analysis of that paper, which we shared earlier this year with the minister, and we encourage the committee, as we did the minister, to receive all of the evidence, but weigh its credibility carefully.
Perhaps even more importantly than focusing on one organization and one critique, it's essential that the committee also look at implementing a national pharmacare program that challenges the perspectives and current dominance of the pharmaceutical and insurance industries. If we only tinker with the public programs without challenging that infrastructure, we run the risk of causing more harm than good to the health of people across Canada.
Instead, what the federal government and federal representatives can do is to join the growing momentum across Canada. In the last week alone, both the Federation of Canadian Municipalities and the B.C. Chamber of Commerce formally adopted policies calling for action on pharmacare. Support for prompt action on pharmacare is literally growing broader by the day.
Canadian Doctors for Medicare joins those groups and hundreds of others in advocating for a prompt implementation of a national drug coverage program because we see first-hand the consequence that gaps in drug coverage have for the health of our patients. The cost of not implementing pharmacare is too high in terms of health and the public purse. We urge the government to work collaboratively with the provinces and territories, and provide national pharmacare to Canadians.
Thank you.
4:10 p.m.
Liberal
The Chair Liberal Bill Casey
Thank you very much.
As a committee we have had great presentations, including today. We're very grateful to everybody for making these presentations.
We'll now go to question period for our first round. Members each have seven minutes for questions and answers.
We will start with Mr. Oliver.
4:10 p.m.
Liberal
John Oliver Liberal Oakville, ON
Thank all of you for your presentations. As always, they were very insightful, each with a slightly different perspective, so we're learning from every group that comes in.
My first question goes to Mr. Romanow. In your 2002 study, I think you debated the big gulp, as it were, versus an intentful, staged introduction of pharmacare in dealing with issues. That is before us today.
Some groups who have come before us, such as Innovative Medicines, have suggested that the status quo is working pretty well, but that for uncovered and uninsured Canadians we need to do something more incremental to cover them. Others have said that to really manage this, to achieve the savings that are there, to move this forward, we need to make a bigger change.
Do you have a view on that?
4:15 p.m.
Commissioner and former Premier of Saskatchewan, Commission on the Future of Health Care in Canada, As an Individual
My view would be as follows: in the report of 2002 we wanted an introduction, if I could put it that way, to a national pharmacare plan, mindful of fiscal concerns and mindful also about the capacity or ability of governments and the various agencies of government to be able to accurately assess the efficacy of the drugs involved.
Since that time, which is now 14 years ago—how time flies, Mr. Chairman, when you're having fun—things have changed quite dramatically. I am coming to the view, and I think, perhaps, if I had to redo the report a second time, I would be saying, that we should be moving to a full-scale deal that covers people's demands.
I'm going to cite one little figure here, and I think you received this submission earlier. We looked at it. It was submitted, I think, on April 18, 2016, by Marc-André Gagnon of Carleton University. Total per capita prescription drug expenditures from 2000 to 2012 in the United States were $1010, and in Canada $865. ll the rest follows. We're right up there.
I think the urgency now is more pronounced than it was 14 years ago.
4:15 p.m.
Liberal
John Oliver Liberal Oakville, ON
I have a quick question about who pays. Obviously, right now both public and private sector employers are providing drug benefits to their employees—most are—and about 60% of Canadians are covered through private insurance plans, both through public and private employers.
What's your view? There is clearly evidence that there would be billions of dollars in savings for Canadians as we move toward a pharmacare model, but the cost for the government to implement such as scheme is a taxpayer cost because they are taking on a greater burden on behalf of Canadians. Do you see a way to do this through corporate taxes? Would you recommend a change to maybe reduce the benefit costs that employers have, but at the same time capture some of that to help pay for a public plan?
4:15 p.m.
Commissioner and former Premier of Saskatchewan, Commission on the Future of Health Care in Canada, As an Individual
I do see a way. With your permission, Mr. Marchildon and I have talked about this. May I have your permission for him to give the specific response?