If provinces wished to do so, in my view they could negotiate a lot harder than they do with pharmaceutical companies to extract better benefits, but it does help if you have a universal plan that everybody's part of so that you're not shifting the cost from from public to private. The mission of the government, then, is very clear. We're buying pharmaceuticals for our health care system.
My husband actually ran PHARMAC in New Zealand. He was the chief executive officer until I imported him to Canada, and he's just down the road if you need him.
He gave me an example: in 2013, for simvastatin, which is a cholesterol-lowering drug, New Zealand paid 2.4¢ compared to 62.5¢ in Ontario. This is just by hard bargaining, basically commercial bargaining. The New Zealand public insurance plan negotiates hard, just like an HMO in the United States. HMOs in the United States do not pay anywhere near the prices you see as the list prices. They are negotiating hard to get commercial deals for very low prices.
The Canadian way has basically been to cross-subsidize pharmaceutical companies. That gets to your point, because we think we're creating jobs. If we want to subsidize pharmaceutical companies, we should do that in a transparent and open way, and not through high prices that patients have to pay at point of service. If we want to give them transfers, let's do that if we think that's important, but on the same basis we think about automobile companies and all that kind of stuff. It should not be hidden away in prices people have to pay out of pocket to get needed health care.
We can do a lot better. We could do it in a Canadian way, if that was what the provinces wanted to do. I think that's perfectly acceptable. Otherwise, the provinces could do it themselves. There may be a problem with whipsawing, with deals being done between different provinces. That would have to be monitored to watch for drug companies trying to take advantage of that situation. The better way to go would be a Canadian approach, but it would have to have voluntary provincial agreement.