Yes, different provinces have different approaches, and that's part of the problem. Across the country we have a wide variety of approaches, and it does depend on where you live. For example, British Columbia does insure everybody, but it has a 30% copayment for pretty much everybody. That is obviously quite a deterrent to those on a lower income and causes problems of access.
Of great credit to Quebec is that it has a universal prescription drug plan. We might not necessarily like its design, but it does have it; however, there are again significant copayments for people at point of service. To me, that's the basic problem. No matter how you design this health care system or national pharmacare, you've got to make sure that people are not deterred because of financial constraints from getting access to the medications they need.
I disagree with Ake that the way to do this is somehow just to leave the status quo in place. Big bang reform around managed competition, even those models that he's talking about, has involved huge government moves—for example, in the Netherlands it meant regulating the private health insurers so that they compete with each other. The private health insurance plan is the public plan. Everybody's in; it's all risk adjusted. They pay in what they can; they get back from it according to their need. There are very small or no copayments at point of service for needed drugs. That's a totally different idea from just leaving it as it currently is.
It's the same with Obamacare. He's moved forward on this, but it wasn't just from leaving the status quo in place. What we saw year after year was little nibbles around the margins, such as introducing benefits for the under-fives and that kind of thing, but no sustained plan to make sure that people who didn't have private health insurance were covered.