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.