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.