by Thomas Walkom
By embracing the concept of a universal pharmacare system, Ontario’s Liberal government is bucking a national trend.
It is also bucking its own record, particularly as it relates to seniors.
The announcement Thursday that the province will set up a new drug benefit program to cover all Ontarians under 25 regardless of income represents the latest round in a debate over health care that has been going on since the 1960s.
On one side are those calling for universal, publicly funded programs that will benefit all. On the other are those who want means-tested programs that will benefit only the poor.
This debate roiled the country in the lead-up to national medicare. The universalists won that argument.
What emerged in 1968 was a publicly funded health-insurance scheme that covered all Canadians – rich and poor – who needed physician or hospital care.
Pharmacare was supposed to be the next chapter in the national medicare saga. The federal government did its bit by establishing a so-called compulsory licensing regime that allowed generic drug makers to sell cheaper versions of brand-name pharmaceuticals.
The provinces, meanwhile, set up drug programs aimed at specific populations – usually the elderly and poor.
Started in 1974, the Ontario Drug Benefit program provided free pharmaceuticals to welfare recipients and those 65 and over. Welfare recipients were, by definition, means-tested. But the elderly qualified simply by being old.
In effect, the original ODB, set up by Bill Davis’ Progressive Conservatives, was a compromise between the means-testers and the universalists.
But as pharmaceuticals became increasingly expensive, thanks in part to pressure from brand-name firms anxious to toughen up patent rules, the universalists lost ground.
In 1993, Bob Rae’s New Democratic Party government announced plans to require co-payments and deductibles from well-to-do seniors using the drug program.
Rae never followed through. But his successor, Conservative Mike Harris did. In 1995, all but the poorest seniors were hit with a $100 deductible as well as user fees of up to $6.11 per prescription.
Meanwhile, provincial governments across the country were experimenting with a new kind of means-tested program to provide so-called catastrophic coverage to anyone needing costly drug therapy. Ontario’s Trillium drug program, for instance, covers pricey medicines. But the deductible is equivalent to roughly 3 per cent of the recipient’s household after-tax income.
In British Columbia, Saskatchewan and Manitoba, universal drug programs for seniors were cut back and replaced with means-tested catastrophic schemes.
Ontario’s Liberal government tried to follow suit. In 2012, as part of its austerity agenda, it announced plans to make well-to-do seniors pay deductibles equivalent to 3 per cent of income.
But an election intervened and the changes were never made.
Last year, Premier Kathleen Wynne’s government tried again, announcing plans to raise the deductible for all but the poorest seniors from $100 to $170 and the maximum per-prescription user fee from $6.11 to $7.11.
That too was beaten back by opposition from seniors’ groups, who wisely viewed these increases as the thin edge of the user-fee wedge. Wynne backtracked.
Now, it seems, the Liberals have rediscovered religion. They are trumpeting their new drug plan for youth as universal. They are making direct comparisons to medicare, which allows no user fees or deductibles. They are even using the Ontario variant of medicare as the plan’s name, labelling it OHIP+.
They have not yet explained why, if people under 25 are best served by a universal drug scheme with no means test, no user fees and no deductibles, those 65 and over are not.
The Wynne government’s universal drug plan for youth makes some sense. It would make more sense if the province’s publicly funded drug plan for seniors were amended to reflect the same principle of universality.
If this were to happen, we would be two-thirds of the way to a real provincial pharmacare plan. That would be something to crow about.
Thomas Walkom appears Monday, Wednesday and Friday.
Copyright 2017-Torstar Syndication Services