Hey there, time traveller!
This article was published 15/6/2015 (1809 days ago), so information in it may no longer be current.
Health ministers from seven provinces and territories issued a joint statement on June 9 on their recent meeting on how to achieve a national pharmacare program. The message? We're still talking about it.
Despite our deep commitment to our cherished medicare program, Canada remains the only advanced industrialized country with a public health insurance system that does not cover prescription medications.
Federal minister Rona Ambrose did not attend the meeting and did not sign the statement.
One can only hope the conversation does continue. The need for comprehensive drug coverage for all Canadians grows more pressing each year and the current patchwork of public programs for the poor and elderly, private insurance tied to a person's employment status and specialized programs for those with high drug costs not otherwise covered, according to recent research, results in Canadians paying far more than we should, while getting less than we need.
A comprehensive national program of drug insurance could save money in the system.
The fear I have, though, is that we will rush to conflate a national program with a federal program. I fear that unless the federal government provides some ill-defined leadership on the issue, it will soon fall off the governmental radar. For some reason there appears to be a belief the health care system cannot be reformed, expanded or improved unless Ottawa is at the table and an active participant.
Somehow, as a nation, we have come to believe it was federal leadership that built medicare. That simply is not true.
Medicare was built in the provinces. The federal government provided resources and encouragement for the provinces to move in the direction of a single-payer publicly administered system, but that was not so much leadership as it was marketing. They took an existing product created in one province and made it easier for other provinces to buy into. But with the passage of the Canada Health Act, the federal government declared themselves the "stewards and protectors" of medicare. And we believed them.
Yet, federal "stewardship" achieved very little. Governments of both Conservative and Liberal stripe were only too happy to sacrifice medicare's financial stability to serve other government ends and to leave the provinces to figure out how to cope with preserving a program that had come to be a defining national characteristic. It was the provinces that added to medicare what we policy wonks call "non-Canada Health Act services" like home care, long-term care and, yes, public drug insurance programs.
And what defines a "non-Canada Health Act service? It is one that is paid for entirely without federal health transfer dollars.
Ironically, it is the Harper government that has most consistently practised what it preached, for both good and ill, when it comes to medicare. For all of Jean Chrétien and Paul Martin's deeply felt love of Canada's most-cherished social program, they never hesitated to unilaterally cut health transfers in order to achieve their more important goal of balancing the federal budget. And all the while they insisted that they were the 'stewards' of medicare.
At least Prime Minister Stephen Harper has been consistent in his disinterest in playing a leadership role in health care policy. His government has lived up to its financial obligations to provide funding and let the provinces alone to run their systems as they see fit. They even continued to pay out the $40-billion Health Care Accord monies to the provinces, despite the fact there is virtually no evidence the provinces were spending it as they had agreed to when then prime minister Martin declared the agreement a "fix for a generation."
But it is that very indifference to health care policy that drives so many concerned with saving medicare to distraction. "How can we follow if you will not lead," they cry. How can there be a national health care system without Ottawa at the forefront?
Easy. Federal isolationism is driving the provinces to the inescapable conclusion they can and perhaps must be the stewards of medicare on their own. They can, collectively, lead health policy innovation as they have always done individually.
And while federal participation and support for a national drug insurance scheme would be welcome (may be necessary eventually for it to be fully realized) the provinces should not be allowed to use federal non-participation as an excuse for inaction. They have already started on things such as bulk buying of drugs to increase their leverage with pharmaceutical companies. That's leadership and it can be built on.
But it will take the political will of the provinces, and pressure from citizens who want them to modernize and expand health insurance coverage. The door should always be open to the federal government to participate, which would make an easier go of it. But their absence cannot allow the provinces to throw up their hands.
The provinces built, administered and sustained health care in this country. They have always been its true stewards. It's time they claimed the role publicly. And they can do that by constructing a national pharmacare program.
Tom McIntosh is head of the politics and international studies department at the University of Regina.
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