Thank you.
I'm an economist and professor of health care policy who has studied pharmacare systems for 30 years. I have published over 150 peer-reviewed research papers on related topics, and I serve on the World Health Organization's technical advisory group on pricing policies for medicines. I have no financial ties to commercial interests in this sector, and I have no have financial ties to health professionals, unions or other groups who also take an active interest in this file.
I am here simply because I wish to help Canada develop the institutional capacity necessary to fairly and efficiently provide access to necessary medicines in a very complex sector that involves some of the world's most powerful corporate interests and very serious, truly global challenges regarding the reasonableness and transparency of pricing.
I want to start by saying that we do not need another study of whether or how Canada should implement a national pharmacare program. These questions have been thoroughly investigated by four separate inquiries since the mid-1990s. All of these inquiries have recommended that carefully selected, medically necessary prescription drugs be included in Canada's universal single-payer public health insurance system.
The latest of these studies, the June 2019 report of the advisory council on the implementation of national pharmacare, was conducted by a council of experts from across the country and chaired by Ontario's former health minister, Dr. Eric Hoskins.
The Hoskins council, as it is known, consulted with provinces and territories. It consulted with first nations. It consulted with patients, health professionals and other stakeholders in the sector. It consulted with Canadians from coast to coast. It concluded with a detailed and feasible plan for implementing a universal single-payer public pharmacare program that would save Canadians billions of dollars every year while improving access to medicines from coast to coast and reducing strains on our health care system.
The foundations of Bill C-64 are backed by thorough discussion and analysis. I believe Bill C-64 can, if the government actually wishes to do so, move us toward the fair and efficient pharmacare system that has been recommended by commissions time and time again.
However, as it is written, Bill C-64 will not do this. This is because it does not make absolutely clear what type of pharmacare program the bill would establish. This ambiguity in Bill C-64 allowed the Parliamentary Budget Officer to conclude that the system that would be created would be a fill-the-gaps pharmacare system involving a patchwork of literally thousands of private and public drug plans. Indeed, even the Minister of Health testified yesterday that he would create such a program with the powers that Bill C-64 would give him.
This would be disastrous for Canada because patchwork pharmacare systems inject needless and costly inefficiencies into the system. They impose significant inequitable financial burdens on individual households and employers, they diminish a country's purchasing power on the global market for pharmaceuticals and they isolate the management of medicines from other key components of the health care system.
It would be especially problematic to have for-profit insurers involved in the core of a national pharmacare system. This is something that only the United States permits. It is problematic because insurers can actually profit from higher drug prices through higher administrative fees charged to plan sponsors. They can also profit by pocketing secret price rebates that they can and do negotiate with drug manufacturers and pharmacies.
If the first stage of national pharmacare is allowed to be a fill-the-gaps program involving a mix of private, public, for-profit and not-for-profit insurers, subsequent stages of national pharmacare will almost certainly be locked into that model too.
If, contrary to the recommendations of its own advisory council on the topic, the government wishes to implement a fill-the-gaps system, then it can leave Bill C-64 as it is, because that is what this legislation will deliver. In this case, the NDP should understand that their supply and confidence agreement has been broken.
If, on the other hand, the government does indeed wish to implement the recommendations of its own advisory council on this topic, then it must amend Bill C-64 to set out crystal clear standards for a national program that will prove that Canadians are, in fact, stronger together. That is what Canadians deserve, but as the bill is currently written, that is not what Bill C-64 will deliver.
Thank you.