Health Committee on June 6th, 2016

[Darshan Singh Kang, Liberal, Calgary Skyview, AB]

My questions are for Dr. Dutt. You organize the professionals who work on the ground every day in the Canadian health care system. My first question is related to pharmacare. What are some of the myths that your organization has busted with regard to benefits from private insurance for medical necessities, such as hospitals and physician services?

[Dr. Monika Dutt]

The myths specific to pharmacare or to medicare in general?

[Darshan Singh Kang, Liberal, Calgary Skyview, AB]

Relative to pharmacare.

[Dr. Monika Dutt]

Relative to pharmacare, I guess a myth that's come out through the discussion today is that our current plans are doing a good job.

First, it is clear that private insurance plans aren't covering what people need, that they aren't covering enough, and we don't get good value for our money from them. Second is the the myth that having these multitudes of public plans covers the people who should be covered. It's clear those plans are not covering the people who may need coverage the most, and they're not covering people in a comprehensive way.

The only way to address that is to have a comprehensive program that does cover everyone. That would benefit all Canadians, because as Angus Reid has shown, it isn't just low-income people who need some drug coverage, but that everyone who would benefit. Similar to medicare, it's a system that we all pay into, so that we can use it when we need to use it.

That's probably the biggest myth, that our system right now is working. The second myth is about cost, which has also been debated and discussed here today, that it's too costly to implement. It has been shown that it's too costly not to implement and that the cost savings would be significant.

[Darshan Singh Kang, Liberal, Calgary Skyview, AB]

That was my next question, the cost. How significant will the cost savings be? Do you have a number?

[Dr. Monika Dutt]

We do use the CMAJ study as one of our main peer reviewed evidence-based studies showing the cost savings. It was published in the Canadian Medical Association Journal. It was peer reviewed. It was done by Steve Morgan, an economist at UBC, along with several other health policy experts.

It showed that there would be significant savings both to the private plans as well the public plans. I don't have the numbers. Overall, there would be a saving of $1 billion to government when you weigh out what the cost of the plan would be and who would be saving money. There would be savings both by government as well as private employers and private companies. Both of those areas would save money.

There would also be a cost to the program. If you are saving $7 billion overall, there would still be a cost of implementation. The overall savings would be about $1 billion in the most probable scenario.

[Darshan Singh Kang, Liberal, Calgary Skyview, AB]

What kind of coverage would we be looking at under pharmacare? This is maybe a hypothetical question, but what will be covered?

When somebody gets Blue Cross, they have basic coverage of 70% and the rest they pay from their own pocket. When we have pharmacare, what kind of coverage do you think we should have in place?

[Dr. Monika Dutt]

Our organization has endorsed the Pharmacare 2020 plan. If you search Pharmacare 2020, you'll find that it's by some of the same people who put together the study that was in the Canadian Medical Association Journal. As has been said today, the actual implementation is a complicated process, but what that means is that conversations need to happen on how that would actually look in practice.

Pharmacare 2020 outlined a number of principles that need to be kept in mind when putting together this national pharmacare plan. That's an excellent starting point to go from. It looks at things like coverage of prescription medications at little or no direct cost to patients through pharmacare, because we know that having any kind of co-payment raises a barrier to people being able to access the medications.

I won't go over the whole list, but it does give some basic items that should be included in a national pharmacare program that you can then use to start that conversation of what a national plan would look like, because there are federal-provincial jurisdictions that need to be worked through.

[Darshan Singh Kang, Liberal, Calgary Skyview, AB]

My concern is that when we come out with pharmacare, many people who are on medications may be left out of pharmacare coverage. We have to develop this so that we're going to cover everybody. That's my concern.

[Dr. Monika Dutt]

Your question is, how will we cover everybody?

[Darshan Singh Kang, Liberal, Calgary Skyview, AB]

Yes. Say in Alberta, an existing condition isn't covered. How will we handle coverage for those people under pharmacare?

[Dr. Monika Dutt]

I'm not sure I understand the question.

[Darshan Singh Kang, Liberal, Calgary Skyview, AB]

Say I have an existing condition and we all go over to pharmacare, will there be some coverage for people who have existing conditions? I'm keeping the costs in mind.

[Dr. Monika Dutt]

What needs to happen is that a national formulary needs to be developed, and that is definitely going to include the medications that Canadians need most. Then there needs to be a process by which other medications can be included or applied for. We know that the major lack in our health care system now is that it's not designed to deal with someone who has a chronic condition. Initially when medicare was created, people were dealing with more acute conditions. That's another reason pharmacare is so important, because more and more people are dealing with chronic conditions that require medication. Yet we don't have the medication coverage program in place to support those changes in health care needs across the country.

[The Chair, Liberal, Bill Casey]

Your time is up. Thanks very much.

The Angus Reid survey said that 26% of Atlantic Canadians have had an inherent problem maintaining their pharmaceuticals or prescriptions. You're in Sydney, Nova Scotia.

[Dr. Monika Dutt]

I am, yes.

[The Chair, Liberal, Bill Casey]

Does that sound right to you, that 26% of people aren't able to buy the prescriptions they are prescribed?

[Dr. Monika Dutt]

It sounds right. I don't have those numbers in front of me, but looking at the levels of poverty in our province and at what Mr. Romanow spoke to—or maybe it was Greg Marchildon—the fact is that Atlantic Canada is less able than other provinces to supply both public and private plans. That sounds reasonable to me, and it's what I see in my practice.

[The Chair, Liberal, Bill Casey]

Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

Dr. Marchildon, as Mr. Romanow said, Canada is the only country in the world that has a universal medicare system that does not include a universal pharmacare system of some type.

We're also heard from witnesses that we should be looking at a made-in-Canada solution, but certain concepts have emerged that, it has been suggested, would allow us both to save money and to afford universal coverage. Those include having a single formulary, perhaps a national one; having an efficient, evidence-based drug approval process to get on that formulary; having a streamlined, perhaps single, administration, perhaps a public one; bulk buying; perhaps giving certain manufacturers exclusive access to the Canadian market, as New Zealand does, for a period of time, which allows lowering of costs, and we've heard about the cost savings related to non-adherence.

You have proposed one such uniquely Canadian version, and that is to have a federally administered system. I'm just wondering if I could give you a minute or so to comment on that and to make the case for it.

[Dr. Gregory Marchildon]

I put that forward as an option because it's not generally thought of as an option in this country because of our history. I wanted to fully explore the advantages and disadvantages of that option, and to deal with some of the difficulties we've had with block funding over the last 30, 40 years. Block funding has done certain things well, but other things it has not done well, and I feel this option addresses those issues in a much more effective way.

It is very difficult to maintain a national formulary if you have 13 provincial and territorial single-payer plans. Even assuming they're single payers, it's going to be very difficult to have a single, national, pan-Canadian formulary that they will agree to at all times. Therefore, that allows for a lot of negotiating around the edges, lobbying etc. Interest groups can do a great deal to take advantage of that situation. Discipline can break down, and that's why I say that the federal option is one that will deliver a greater level of discipline. The potential of that discipline has to be exercised.

[Don Davies, NDP, Vancouver Kingsway, BC]

I haven't read what you may have submitted on that, but if you haven't, I would invite you to submit something on that to the committee. It takes more than a minute or two to explain the broad—

[Dr. Gregory Marchildon]

I'd be happy to submit something on both option one and option two if the committee desires.

[Don Davies, NDP, Vancouver Kingsway, BC]

On the other hand, Mr. Romanow, some witnesses and even some members of this committee have asserted that government is not capable of managing a streamlined, publicly administered system in a cost-effective manner, particularly with the private sector involved. As a former Premier of Saskatchewan, what's your comment on that?

[Roy Romanow]

This may sound a little too glib, but in 1962 in Saskatchewan when there was a province-wide doctors strike, the same argument was being advanced that some form of publicly funded system whereby the plan was delivered through doctors—basically that was the mechanism—wouldn't work, and of course it did.

When you say that it can't be done.... Not say, but when there's a hint that somehow there isn't a perfect consistency to it, I think that's probably true. Illness, treatment of illness, and drugs do vary a little bit in terms of what they deal with or don't deal with. It won't be perfect delivery of health care, and here I'd defer to the doctors who are in the room.

However, what we're trying to do here is to develop a social program, socio-economic program, health program that on balance acquires the drugs that scientists dealing with the most serious of illnesses tell us are generally effective. The doctors, knowing of this list, apply the medicines on the plan that are effective for their particular patients, and nowhere in the system is money a barrier to delivery of that program.

Will it be a completely perfect circle with no deviations and the like? Probably not, but it will certainly be one where we will remove this fast-rising component of health care costs, namely pharma costs, from the delivery of health care on the value that everybody, regardless of whether you are rich or poor or what your gender or background is, is entitled to the best possible care.