Now It's Up To The Provinces

Premiers don’t require federal help to implement Pharmacare
July 1, 2011

Canadians generally are not as wildly and uncritically patriotic as Americans. We don’t continually wave the Maple Leaf flag and boast about our country’s social and economic pre-eminence. But most of us – quietly and unostentatiously -- are proud of Canada and glad we live here.

The closest we come to jingoism is on Canada Day, when we put our patriotism enthusiastically on display. Last July 1st, on the lawn in front of the Parliament buildings, Prime Minister Stephen Harper joined the happy throng of celebrants. “What’s the best country in the world?” he shouted.

“Canada! Canada! Canada!” they cheered.

Well, Canada is certainly a better country than most others, including the United States, but it is far from the best. In fact, for the past decade, we have been slipping further behind most European countries in a wide range of living standards, especially in the growing gap between our wealthiest and our middle and low-income earners.

More than 700,000 children in Canada live in poverty, and our overall poverty rate is worse than in 18 other OECD countries.

Nearly 800,000 Canadians – as many as 300,000 of them children – have to depend on food banks to stay minimally nourished. UNICEF now includes Canada on its list of the “most child-unfriendly nations in the world.”

Canada’s reduced spending on social programs as a percentage of its GDP (now around 13%) drops us down to 25th place among 30 major industrial nations.

Our failure to excel in these and other qualities of life is all the more inexcusable because Canada is so lavishly endowed with all the resources needed to create the “just society” Pierre Elliott Trudeau used to dream about.

The prospect for the next four years, under a regressive conservative federal majority government, is for Canada to continue backsliding and become even less entitled to boast about being the best country to live in.

But such an ongoing decline under the Harper majority regime is not inevitable. Canada, after all, is a confederation in which the provinces have primary jurisdiction in providing social services – including health care. Although they depend on the feds to share the costs of most programs, they don’t necessarily have to wait for Ottawa to take the initiative in implementing or expanding them.

This was exemplified most remarkably by Tommy Douglas when he championed public health care in Saskatchewan, and when his successor as premier, Woodrow Lloyd, enacted the first Medicare legislation in Canada in 1962. This was accomplished despite fierce opposition from the Canadian Medical Association, the pharmaceutical companies, most business leaders, and by almost all the daily newspapers. And it became so successful and popular that several other provinces were compelled to follow suit and set up their own public health care system, culminating in 1967 with the introduction of a national Medicare program.

One of the big remaining gaps in this program, however, is the lack of universal public drug insurance, which is an integral part of the public health care systems in most other developed countries. Several years ago, all the premiers called on Ottawa to add drug coverage to the services provided under Medicare. But their appeal was rejected by both successive Liberal and Conservative federal governments, mainly on the specious grounds that it would entail an unaffordable increase in costs.

On the contrary, as an extensively researched CCPA study last year established beyond doubt, Pharmacare would save Canadians and their governments as much as $10 billion a year by reducing the cost of pharmaceuticals. The study – by Marc-André Gagnon – was endorsed by medical and drug experts, including Dr. Marcia Angell, former editor of the prestigious New England Journal of Medicine, and Robert Evans, an authority on health care costs who teaches economics at the University of British Columbia. Dr. Angell said that “a publicly funded prescription drug program would not only be better for Canadians, but cheaper. The only downside,” she added, “is that the pharmaceutical industry would have to trim its obscene profits a little.” And Prof. Evans bluntly accused Big Pharma and “apathetic governments” of keeping this public system of drug cost coverage beyond our reach.

Our provincial governments, knowing it would be futile to ask the majority Harper government to move on the Pharmacare front, should now take the initiative themselves – and as quickly as they can. If a collective effort can’t be mobilized, it would still take only one courageous premier to set a precedent that the others, sooner or later, would have to emulate. Such a pioneering province would reap at least $1 billion in cost reductions -- more than $2 billion in the case of one of the larger provinces – decisively demolishing the myth that Medicare is becoming unsustainable.

The premiers of our two most populous provinces – Jean Charest in Quebec and Dalton McGuinty in Ontario – are both facing elections this fall, and, according to the polls, may also be facing defeat. The one election campaign pledge that might turn their fortunes around would be to make a firm commitment -- if their governments were re-elected -- to establish a provincial Pharmacare program in the first year of their new mandate. It would suffice if either of these premiers acted on his own, or even if Manitoba’s NDP Premier Greg Selinger decided to be Pharmacare’s provincial pioneer. Better still would be if all three of these central provinces introduced public drug insurance coverage in concert. The more provinces involved, the greater the financial advantage from their bulk purchasing power. (Some provinces already partially cover drug costs for seniors and/or young children, but not for everyone as would be the case under Pharmacare.)

Of course, the main beneficiaries would be the many thousands of Canadians – nearly one in four – who have no drug insurance coverage, and are often denied necessary medical care as a result.

With our CCPA study to back up their claim that Pharmacare would cut health care costs, not increase them, what could Charest and McGuinty (or Selinger, or any other premier) possibly lose by making public drug insurance their top priority? They would certainly have a great deal to gain, including having their names enshrined in Canadian history alongside Tommy Douglas as the “fathers” (or “mothers”) of Pharmacare.

Unlike the widespread opposition to Medicare that Tommy had to overcome in the early 1960s, today’s premiers would have the support of most doctors and perhaps even some elements of the corporate media in expanding Medicare to include drug coverage. Our study making the economic case for Medicare was praised by some daily newspapers, including The Montreal Gazette. “A universal national drug plan,” that paper stated in an editorial, “would ensure that, when potentially life-saving drugs are approved, they are made available on an equitable basis to all Canadians…”

Granted, the big drug companies could be expected to launch a vociferous and well-funded attack against a program that would significantly lower their profits -- and they might well have the Harper government behind them. But surely this would not be such a deterrent that it would scare off all 10 premiers. If so, it would be tantamount to giving Big Pharma a veto to block public drug coverage at any time, at any level.

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If the provinces actually do decide to do an end run around the Harper majority government and bring in Pharmacare on their own – as they can and should – it could set an important precedent for curbing Harper’s autocratic powers over the next four years.

It could lead, for example, to the provinces jointly moving to take the lead in establishing a much-needed national child care program. This would not be as financially feasible for them as Pharmacare would be, but even if all the provinces started by elevating their child care services to the superior level already provided in Quebec, the building-blocks for a national program could be put in place – even without Harper’s help. There is also a possibility, slim though it may be, that pressure by federal opposition MPs, by child-care organizations, and even some media outlets, would then persuade Harper, however belatedly and reluctantly, to join this provincial-led project. He might be moved by a fear of losing his populist political image, if not by the benefits a national child care program would bestow on the country’s parents.

Even more probable, perhaps, for Pharmacare as well as child care, would be Harper’s aversion to having the political benefits from introducing these programs go solely to the premiers. They would get all the public thanks and admiration, while he would be portrayed as the power-mad PM who wanted to deny Canadians these additional services. Whether this unpleasant prospect would prompt him to drop his opposition to more social spending and actually co-finance such provincial initiatives is open to question. But, either way, the premiers and the opposition MPs could enjoy subjecting Harper to this kind of pressure, which might well override his majority advantage.

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Another possible initiative that could originate at the provincial level is fixing Canada’s unfair first-past-the-post electoral system. Its flaws were all too shockingly exposed in the May 2 election, which gave the Conservatives four years of majority government power with less than 40% of the popular vote and the support of less than 25% of eligible voters.

The solution to this travesty, of course, is the one adopted by most other purportedly democratic countries: some version of proportional representation and the formation of coalition governments. This is the only way that the votes cast for different political parties gets translated into a fair allocation of seats in the legislature.

It may seem that a successful adoption of this democratic electoral system by one or more Canadian provinces is beyond the realm of possibility, given that all four previous attempts failed. Two PR referendums in B.C., one in Ontario, and one in Prince Edward Island resulted in voter rejections. But these failures should not preclude further initiatives. Let’s not forget that these plebiscites called for 60%-plus approval, not a simple majority, and the first one in B.C. fell just short of the required 60%. The kind of P.R. system proposed in all four votes was arguably not the best or most appropriate for a Canadian province, and was not adequately explained or promoted.

What is needed is a provincial party and government that is wholly committed to converting its electoral system to P.R. and to welcoming the formation of a coalition if the results of multiple-party voting necessitate it. Such a government would choose a P.R. system most suited to its province’s needs, would clearly explain it through all means of communication, and would require a simple majority approval, not 60%. (After all, under P.R., every party benefits equally from every vote cast for its candidates, no matter the size of the riding.)

With these changes in how a P.R. referendum is conducted, the prospects for a favourable outcome would be much greater than they were in the four previous attempts. Once that province holds an election using the P.R. process, its true democratic outcome will be evident. It will then be only a matter of time before other provinces – and eventually the federal government – follow the lead province’s example.

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If these three potential province-driven programs were rated on their likelihood of being effected, or even initiated, Pharmacare would have to get top billing. But Pharmacare’s success could then embolden one or more provinces to undertake child care and even P.R. as an effective way to neutralize and circumvent the misuse of power by the majority Harper government.

 (Ed Finn is the CCPA’s Senior Editor.)