Good morning, everybody.
I'm the director of the University of Ottawa Centre for Health Law, Policy and Ethics. I want to thank you for listening to me today. I want to thank you for the work that you're doing here today and for your service generally. My brother-in-law in New Zealand is an MP, so I kind of feel your pain a bit.
I completely disagree with the former speaker, so I guess that's good. Maybe that's why you put us together. I am going to speak on why in fact we do need universal pharmacare—not necessarily national pharmacare, but certainly universal pharmacare.
To cut to the quick of it, essentially in most provinces we have a U.S.-style system for prescription drugs. Poor people are covered, working people are mostly covered through private health insurance, and provinces kind of pick up the elderly. Increasingly, they are de-insuring the elderly, particularly those they describe as the wealthy elderly, so they cover the poor elderly.
Then there is always a gap of people who are uninsured in Canada. That's about 18%. That has been persistent, and it isn't getting any less through provincial reform; it's getting worse. That's the problem that we have to deal with.
I'll give you one piece of research that I think is deep and profound on this issue. It is from the Institute of Clinical Evaluative Sciences in Ontario, probably the best research institute we have in the country. Work by Dr. Gillian Booth on access to prescription drugs for young and middle-aged people under the age of 65 in Ontario found that close to 1,000 young and middle-aged people who are diabetic die every year for want of access to something as basic as insulin, which, by the way, we invented. Banting and Best made one of the great Canadian discoveries, and we can't make sure through our governance system and our insurance systems that people get access to this most basic drug.
We also know that the U.S.-style approach results in U.S.-style costs. Ake has already spoken to the fact that we're a high spender, relatively.
Justice Emmett Hall, a smart man, said back in 1964, “prescribed drugs should be introduced as a benefit” and “its authorization should be an early objective of the Canadian Parliament”. That was 52 years ago. He didn't put it into the basic set of benefits back in the day because he thought it was too expensive and that we should wait for the cost of pharmaceuticals to come down.
Maybe he wasn't as smart as we thought: they haven't come down, and that's because they're not part of a single-payer plan. They're not part of a concerted effort on the part of government to purchase those drugs.
We know that every other developed country around the world that has a universal plan includes prescription drugs in its basic benefit package. We're standing out in the world for not doing that, so I disagree with Ake. I think we are a relatively poor performer these days precisely because we're not doing a good job on insuring pharmaceuticals, community care, and home care, and that's causing all sorts of other problems with our hospitals and physician services.
What can we do about it? I do agree with Ake that it's important that whatever we do is not too much of a burden on the provinces and is respectful of federal-provincial relationships and the Constitution. There are two basic scenarios in my mind.
The first is to expand the Canada Health Act to include community-based pharmaceuticals. Then you say, “You're just going to spend gazillions.” No, not necessarily, if you stipulate as part of the Canada Health Act that the provinces must have a fair process to decide what to include in the basic benefit package. They would be choosing then. For example, they may say that insulin is a higher priority than fixing my bunion. I can go and have my bunion fixed—and actually my doctor organized all of that in a few weeks, free—but people are dying for want of insulin. Surely no rational, reasonable kind of health care system would permit that.
I think if the Canada Health Act could be opened up to include community-based pharmaceuticals and a respectful requirement that provinces have a fair and transparent process to decide what is in and what is out, it would leave them to decide. That leaves them to decide that they'll fund insulin but they won't fund bunions. That's completely doable.
The other way is the kind of bigger bang approach, I guess, which is that the federal government itself would permit this.
Sorry; I should go back and say that the concern we presently have is that we all have private health insurance. We don't want to lose this stream of funding. The Canada Health Act does not necessarily require that everything be tax financed. Provinces charge premiums currently, and you could do this. You could finance this in part through CPP payments.
You could also funnel the funding from the private health insurers into a central plan. The private health insurers would essentially pay a premium to the central plan to do the buying. This is a proposal that Aidan Hollis at the University of Calgary has put forward. I think it's a pretty good one, and I detail it with a bit more specificity.
The final idea is that the federal government do it itself. That's the big bang approach. I actually do have a figure here; we did a bit of a back-of-the-envelope calculation. For about $5 billion, you could cover 150 essential drugs for all Canadians.
I could talk a little about that proposal, but there you have two viable proposals. I don't think either of them would break the bank, and they would put us back on a par with other competitive nations to make sure we deliver health care to the people as they need it.
Thanks for listening to me.