Clearly, I would favour holding discussions as a beginning, because I do believe that with rational men and women getting together for discussion and consideration of the facts—and these are not always absolute answers—compromise can result and allow the best plan to come forward. If I didn't believe in that, I would not have been involved in all of the experiences that I have been. Invariably we live in a federal system, which is a difficult system. Our federal system is a difficult system, and at some stage or another we may well find ourselves at an impasse. If I may take briefly some extra time to give you an example. Sometimes political will, in the best sense of the word—political, small p—simply has to be used.
I had the pleasure a few years ago of talking about health care at Saint FX University in the Allan J. MacEachen Lecture Series, and Allan J. was there. He was seated to my left. The president, Sean Riley, said, “Allan J. wants to say something after you finish your address”. You can imagine my trepidation at that. He described the political leadership in the following context, after describing the fact that the federal cabinet was truncated on the debates, numbers, and outcomes, and divided for a whole number of reasons and couldn't come to a conclusion about whether or not medicare should include pharmacare, as recommended by Emmett Hall back in 1964-65, and by me in 2002. MacEachen's answer was—and it'll be brief, Mr. Chairman, with your consent—that, well, it would be unnatural and unexpected for the provinces to remain silent. They took advantage of the divisions within cabinet by renewing their opposition to medicare—strike “medicare”, and put the word “pharmacare” in there. Pearson felt the full brunt of the provincial premiers' discontent on the subject of medicare. Eight provincial premiers confronted him with complaints that the federal government had no right to force the pace of medicare, and so on. It was in this atmosphere of provincial opposition and division within the cabinet that Mr. Pearson finally decided—according to MacEachen—that he would go ahead with the medicare program. Without this decisive action at this time, and because he finally made the decision, we may have lost the whole issue.
My point in retelling this is that there will be scientific debate about how the costs are to be judged or evaluated, including their distribution, and what that will mean for the system and outcomes. We've heard some of those comments today. If we have any model to build on, then it is this one that I give you. It took federal leadership by a federal government in a minority situation to implement medicare. I don't think anybody around this committee table would say that was a wrong decision. I could be wrong, but I doubt it. There were many doubts about it. There are many doubts about pharmacare, and perhaps even some competing figures in that regard. However, on the principle and the philosophy of it, since it naturally follows from medicare, and since the drug costs in our current system are the next highest to America's—all the others beat us, the European countries—I think there's a model there for us to follow.
Sorry to be long-winded, but I think that is exactly what I would say should be done, as a former practitioner of the dark arts of federalism, because of the evidence internationally and nationally