Health
National pharmacare – might it be a pig in a poke?
From the Macdonald Laurier Institute
By Nigel Rawson and John Adams for Inside Policy
No Canadian should have to choose between paying for medicines and paying for rent or food. National pharmacare has been proposed as a remedy to this situation.
“When will Canada have national pharmacare?” asks the author of a recent article in the British Medical Journal (BMJ). Better questions are: will Canadian pharmacare be the system many Canadians hope for? Or, might it turn out to be skimpy coverage akin to minimum wage laws?
In its 2024 budget document, the federal government proposed providing $1.5 billion over five years to support the launch of national pharmacare for “universal, single-payer coverage for a number of contraception and diabetes medications.” This has been hailed as a “big day for pharmacare” by some labour unions, patients and others, including the author of the BMJ article who said that national pharmacare should be expanded to cover all medication needs beginning with the most commonly-prescribed, clinically-important “essential medicines.”
In its budget, the government stated “coverage of contraceptives will mean that nine million women in Canada will have better access to contraception” and “improving access to diabetes medications will help improve the health of 3.7 million Canadians with diabetes.” Why not salute such affable, motherhood and apple pie, sentiments? The devil is in the details.
The plan does not cover new drugs for diabetes, such as Ozempic, Rybelsus, Wegovy, Mounjaro or Zepbound, all based on innovative GLP-1 agonists, where evidence is building for cardiovascular and weight loss benefits. This limited rollout seems based on cheap, older medicines, which can be less effective for some with diabetes.
The federal government has also consistently under-estimated the cost of national proposals such as pharmacare – not to mention other promises. In their 2019 election platform, the Liberals promised $6 billion for national pharmacare (the NDP promised $10 billion). Keen analysis shows that even these expansive amounts would be woefully inadequate to fund a full national pharmacare plan. This makes the $300 million a year actually proposed by the Liberals’ look like the skimpy window-dressing that it is.
National pharmacare, based on the most comprehensive existing public drug plan (Quebec’s), would cost much more. In 2017, using optimistic assumptions, the Parliamentary Budget Officer (PBO) estimated the cost for a national plan based on Quebec’s experience to be $19.3 billion a year. With more appropriate assumptions, the Canadian Health Policy Institute estimated $26.2 billion. In June 2019, the federal government’s own Advisory Council on the Implementation of National Pharmacare put the cost at $40 billion, while a few months later, the tax consulting company RSM Canada projected $48.3 to $52.5 billion per year. Five years later, costs no doubt have soared.
Even with these staggering cost a program based on matching Quebec’s drug plan at the national level would fail to provide anywhere near the level of coverage already provided to the almost two-thirds of Canadians who have private drug insurance, including many in unionized jobs. Are they willing to sacrifice their superior coverage, especially of innovative brand-name medicines, for a program covering only “essential medicines”? Put another way, are Canadians and their unions prepared to settle for the equivalent of a minimum wage or minimum benefits?
The PBO has estimated the cost of coverage of a range of contraceptives and diabetes medicines as $1.9 billion over five years, which is more than the $1.5 billion provided in the budget. However, this figure is based on an assumption that the new program would only cover Canadians who currently do not have public or private drug plan insurance, those who currently do not fill their prescriptions due to cost related reasons, and the out-of-pocket part of prescription costs for Canadians who have public or private drug plan coverage. This is major guesswork because existing public and private drug plans may see the new federal program as an opportunity to reduce their costs by requiring their beneficiaries to use the new program. If this occurs, the national pharmacare costs to the federal government, even for the limited role out of diabetes and contraceptives, would soar to an estimated $5.7 billion, according to the PBO.
Our governments are not known for accurate estimates of the costs of new programs. One has only to remember the Phoenix pay system and the ArriveCAN costs. In 2017, the Government of Ontario estimated $465 million per year to extend drug coverage to every resident under the age of 25 years. What happened? Introduced in 2018, prescriptions rose by 290% and drug expenditure increased to $839 million – almost double the guesstimate. In 2019, the provincial government back peddled and modified the program to cover only people not already insured by a private plan.
Although we believe governments should facilitate access to necessary medicines for Canadians who cannot afford their medicines, this does not require national pharmacare and a growing bureaucracy. Exempting lower-income Canadians from copayments and premiums required by provincial programs, as British Columbia has done, and removing the requirement to pay for all drugs up to a deductible would allow these Canadians access sooner, more simply, and more effectively.
Moreover, it isn’t just lower-income Canadians who want help with unmet medicine needs. Canadians who need access to drugs for diseases that are difficult to treat and can cost hundreds of thousands of dollars per year also require assistance. Few Canadians whether they have low, medium or high incomes can afford these prices without government or private insurance. Private insurers often refuse to cover these drugs.
The Liberals provided a separate $1.5 billion over three years for drugs for rare disorders, but no province or territory has signed a bilateral agreement with the federal government for these drugs and no patient has received benefit through this program. Even if they did, the $500 million per year would not go far towards the actual costs. There is at least a zero missing in the federal contribution, as the projected cost of public spending on rare disease medicines by 2025 is more than threefold what Ottawa has budgeted.
Expensive drugs for cancer and rare disorders are just as essential as basic medicines for cardiovascular diseases, diabetes, birth control, and many other common conditions. If a costly medicine will allow a person with a life-shortening disease to live longer or one with a disorder that will be severely disabling left untreated to have an improved quality of life and be a productive taxpayer, it too should be regarded as essential.
The Liberals and NDP are working to stampede the bill to introduce the pharmacare program (Bill C-64) through the legislative process. This includes inviting witnesses over the first long weekend of summer, when many Canadians are away, to appear before the parliamentary Standing Committee on Health three days later.
Too much is unknown about what will be covered (will newer drugs be covered or only older, cheaper medicines?), who will be eligible for coverage (all appropriate Canadians regardless of existing coverage or only those with no present coverage?), and what the real cost will be, including whether a new program focusing on older, cheaper drugs will deter drug developers from launching novel medicines for unmet needs in Canada.
This Bill as it stands is such a power grab that, if passed, the federal Health Minister never has to come back to Parliament for review, oversight or another tranche of legal authority, it would empower the Cabinet to make rules and regulations without parliamentary scrutiny.
A lot is at stake for Canadians, especially for patients and their doctors. Prescription medicines are of critical importance to treating many diseases. National pharmacare must not only allow low-income residents to access purported “essential medicines” but also ensure that patients who need specialized drugs, especially higher-cost innovative cell and genetic therapies that may be the only effective treatment for their disorder, are not ignored. Canadians should be careful what they wish for. They may receive less than they anticipate, and, in fact, many Canadians may be worse off despite the increase in public spending. Time to look under the hood and kick the tires.
Nigel Rawson is a senior fellow with the Macdonald-Laurier Institute.
John Adams is co-founder and CEO of Canadian PKU and Allied Disorders Inc., a senior fellow with the Macdonald-Laurier Institute and volunteer board chair of Best Medicines Coalition.
David Clinton
Involuntary confinement is currently enjoying serious reconsideration
Sometimes a quick look is all it takes to convince me that a particular government initiative has gone off the rails. The federal government’s recent decision to shut down their electric vehicle subsidy program does feel like a vindication of my previous claim that subsidies don’t actually increase EV sales.
But no matter how hard I look at some other programs – and no matter how awful I think they are – coming up with better alternatives of my own isn’t at all straightforward. A case in point is contemporary strategies for managing urban homeless shelters. The problem is obvious: people suffering from mental illnesses, addictions, and poverty desperately need assistance with shelter and immediate care.
The Audit is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.
Ideally, shelters should provide integration with local healthcare, social, and employment infrastructure to make it easier for clients to get back on their feet. But integration isn’t cost-free. Because many shelters serve people suffering from serious mental illnesses, neighbors have to worry about being subjected to dangerous and criminal behavior.
Apparently, City of Toronto policy now requires their staff to obscure from public view the purchase and preparation of new shelter locations. The obvious logic driving the policy is the desire to avoid push back from neighbors worried about the impact such a facility could have.
As much as we might regret the not-in-my-back-yard (NIMBY) attitude the city is trying to circumvent, the neighbors do have a point. Would I want to raise my children on a block littered with used syringes and regularly visited by high-as-a-kite – and often violent – substance abusers? Would I be excited about an overnight 25 percent drop in the value of my home? To be honest, I could easily see myself fighting fiercely to prevent such a facility opening anywhere near where I live.
On the other hand, we can’t very well abandon the homeless. They need a warm place to go along with access to resources necessary for moving ahead with their lives.
One alternative to dorm-like shelters where client concentration can amplify the negative impacts of disturbed behavior is “housing first” models. The goal is to provide clients with immediate and unconditional access to their own apartments regardless of health or behaviour warnings. The thinking is that other issues can only be properly addressed from the foundation of stable housing.
Such models have been tried in many places around the world over the years. Canada’s federal government, for example, ran their Housing First program between 2009 and 2013. That was replaced in 2014 with the Homelessness Partnering Strategy which, in 2019 was followed by Reaching Home.
There have been some successes, particularly in small communities. But one look at the disaster that is San Francisco will demonstrate that the model doesn’t scale well. The sad fact is that Canada’s emergency shelters are still as common as ever: serving as many as 11,000 people a night just in Toronto. Some individuals might have benefited from the Home First-type programs, but they haven’t had a measurable impact on the problem itself.
The Audit is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.
Where does the money to cover those programs come from? According to their 2023 Financial Report, the City of Toronto spent $1.1 billion on social housing, of which $504 million came in funding transfers from other levels of government. Now we probably have to be careful to distinguish between a range of programs that could be included in those “social housing” figures. But it’s probably safe to assume that they included an awful lot of funding directed at the homeless.
So money is available, but is there another way to spend it that doesn’t involve harming residential neighborhoods?
To ask the question is to answer it. Why not create homeless shelters in non-residential areas?
Right off the top I’ll acknowledge that there’s no guarantee these ideas would work and they’re certainly not perfect. But we already know that the current system isn’t ideal and there’s no indication that it’s bringing us any closer to solving the underlying problems. So why not take a step back and at least talk about alternatives?
Good government is about finding a smart balance between bad options.
Put bluntly, by “non-residential neighborhood shelters” I mean “client warehouses”. That is, constructing or converting facilities in commercial, industrial, or rural areas for dorm-like housing. Naturally, there would be medical, social, and guidance resources available on-site, and frequent shuttle services back and forth to urban hubs.
If some of this sounds suspiciously like the forced institutionalization of people suffering from dangerous mental health conditions that existing until the 1970s, that’s not an accident. The terrible abuses that existed in some of those institutions were replaced by different kinds of suffering, not to mention growing street crime. But shutting down the institutions themselves didn’t solve anything. Involuntary confinement is currently enjoying serious reconsideration.
Clients would face some isolation and inconvenience, and the risk of institutional abuses can’t be ignored. But those could be outweighed by the positives. For one thing, a larger client population makes it possible to properly separate families and healthy individuals facing short-term poverty from the mentally ill or abusive. It would also allow for more resource concentration than community-based models. That might mean dedicated law enforcement and medical staff rather than reliance on the 9-1-1 system.
It would also be possible to build positive pathways into the system, so making good progress in the rural facility could earn clients the right to move to in-town transition locations.
This won’t be the last word spoken on this topic. But we’re living with a system that’s clearly failing to properly serve both the homeless and people living around them. It would be hard to justify ignoring alternatives.
The Audit is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.
Health
Canadian media might not be able to ignore new studies on harmful gender transitions for minors
From LifeSiteNews
When the UK National Health Service’s bombshell Cass Review condemning gender “transition” for minors was published, virtually the entire Canadian press engaged in a voluntary blackout.
Unless you were reading an alternative news source, an international news source, or the National Post, it was as if Cass Review — and its findings — had simply never existed. Many media outlets did not run a single story; the state-funded CBC ran precisely one, and it was a laughable hatchet job claiming that the massive study was “biased.” They did not interview a single person associated with the research.
The Canadian press has functioned for years as a propaganda arm for the transgender movement, even as the gender ideology house of cards topples in in the U.S. and the UK, where there have been genuinely robust debates informed by scientific evidence rather than ideology. Thus, I wonder how they will deal with new studies by Canadian researchers that reach many of the same conclusions.
As Sharon Kirkey of the National Post reported. “The evidence surrounding the use of puberty blockers and cross-sex hormones in children and teens identifying as transgender is of such low certainty it’s impossible to conclude whether the drugs help or harm, Canadian researchers are reporting.” The research was funded by the Society for Evidence-based Gender Medicine (SEGM) and McMaster University, considered to one of Canada’s top institutions of higher hearing, and published this week in the journal Archives of Disease in Childhood.
“There’s not enough reliable information,” said Chan Kulatunga-Moruzi, one of the authors of the two new reviews. “We really don’t have enough evidence to say that these procedures are beneficial. Few studies have looked at physical harm, so we have really no evidence of harm as well. There’s not a lot that we can say with certainty, based on the evidence.” (Here, I would note that there are now thousands of testimonies of detransitioners testifying to the harm that sex-change “treatments” have caused them, but this is a remarkable admission nonetheless.)
The researchers conclude that doctors should approach these “treatments” with extreme care, clearly communicating with parents and children and — notably — checking “whose values they are prioritizing” if they should decide to prescribe cross-sex hormones or puberty blockers. As Kirkey put it with devastating understatement: “Originally considered fully reversible, concerns are emerging about potential long-term or irreversible effects, the Canadian team wrote … Questions have been raised about the effects of fertility or what impact, if any, they might have on brain development.”
The researchers painstakingly went through the available evidence on both cross-sex hormones and puberty blockers (Kirkey irritatingly refers to them as “gender-affirming hormones”) for those up to 26 years old. To analyze the evidence, they “graded” it “using a scoring system co-developed by Dr. Gordon Guyatt, a celebrated McMaster University scientist who coined the phrase evidence-based medicine.” As Kirkey reported:
After screening 6,736 titles and abstracts involving puberty blockers, only 10 studies were included in their review. While children who received puberty blockers compared to those who don’t score higher on “global function” — quality of life, and general physical and psychological wellbeing — the evidence was of “very low certainty.” Very low, meaning researchers have “very little confidence in the effect estimate” and that the true effect “is likely to be substantially different from the estimate of effect.”
It gets worse. The research also debunked the perpetually asserted claim utilized by trans activists and their political allies to enforce their agenda: that these drugs are necessary to prevent depression and suicidal ideation. According to the researchers: “We are very uncertain about the causal effect of the (drugs) on depression. Most studies provided very low certainty of evidence about the outcomes of interest; thus, we cannot exclude the possibility of benefit or harm.” Again, despite the careful understatement, this is devastating: Thousands of children have been subjected to these treatments on the premise that they prevent harm and are harmless.
Indeed, the second review, which analyzed 24 studies, reached the similar conclusion of “very low confirmatory evidence of substantive change” not just in depression or health overall but even in gender dysphoria itself. As Kirkey noted: “Many studies suffered from missing data, small sample sizes, or lacked a comparison group.” The researchers concluded: “Since the current best evidence, including our systematic review and meta-analysis, is predominantly very low quality, clinicians must clearly communicate this evidence to patients and caregivers. Treatment decisions should consider the lack of moderate- and high-quality evidence, uncertainty about the effects of puberty blockers and patient’s values and preferences.”
Imagine for a moment that you are a teen or young person who started these treatments after having been told, with utter, aggressive confidence, by counselors, psychiatrists, and doctors that they were both harmless and necessary — that they could even save your life. Imagine being a parent who subjected your child to these treatments, convinced by “experts” that this was the best thing you could do to love your son or daughter. I have written these words too many times to count: This is a medical scandal of unprecedented proportions in this century, and those that perpetrated it must be held accountable.
World Economic Forum pushes digital globalism that would merge the ‘online and offline’
President Trump Signs Executive Order Banning CBDCs
Democracy Betrayed, The Scathing Truth Behind Canada’s Foreign Interference Report
DeepSeek: The Rise of China’s Open-Source AI Amid US Regulatory Shifts and Privacy Concerns
-
Alberta2 days agoAMA challenged to debate Alberta COVID-19 Review
-
Business2 days agoTariffs Coming April 1 ‘Unless You Stop Allowing Fentanyl Into Our Country’
-
National2 days agoAll 6 people trying to replace Trudeau agree with him on almost everything
-
espionage2 days agoDemocracy Watch Calls Hogue Foreign Interference Report “Mostly a Coverup”
-
Alberta2 days agoWhen America attacks
-
Daily Caller2 days agoTrump’s ‘Drill, Baby, Drill’ Agenda Will Likely Take On An Entirely New Shape
-
Health2 days ago
Canadian media might not be able to ignore new studies on harmful gender transitions for minors
-
Business1 day agoTrump’s executive orders represent massive threat to Canadian competitiveness