Dear Minister Philpott,
It is fantastic news that as a family doctor you are our next federal health minister. You will know very well that our healthcare system shows its age. Born in the middle of the 20th century, its primary focus on doctors and hospitals is outmoded as technology shifts and our health needs change. But forging change in Canadian heath care has proved an extraordinary challenge.
In the past, the stickiness of the status quo means that even if new federal dollars for healthcare are transferred to the provinces, they will be spent mostly on increased fees for physicians and hospitals. You will also know too well from history that real change won’t happen by providing more federal money with unconditional transfers.
Real change will require helping provinces to shift the focus of our health system away from those who are relatively well resourced to new areas of care, such as essential pharmaceuticals and homecare.
So what should you do?
First, and most importantly, you should accept and endorse a shared responsibility for healthcare in the federation.
The Harper decade was a dark one for healthcare leadership. His mantra was that all healthcare decision-making was a matter for the provinces. It has since become a common refrain for media pundits to claim healthcare is a matter of exclusive provincial jurisdiction although our Constitution clearly provides it is a matter of shared jurisdiction.
Federal leadership in healthcare does not mean dictating to the provinces what to do or how to do it, but it does mean bringing provincial leaders together in the spirit of cooperation and under shared initiatives with specific targets, goals and money attached.
There are two areas that could most benefit from critically needed federal-provincial shared leadership: pharmaceutical drugs and long-term care/homecare.
We are the only developed country with a universal health system not to insure its citizens for prescription drugs. This means too many Canadians are going broke to afford their essential medicines or forgoing them altogether, and costing Canadians far more in acute health services in the long run.
But apart from the access problem, we also have a cost problem – we spend a lot on medicines. Indeed, the OECD has just issued a report showing Canadians are (still) paying some of the highest prices for pharmaceutical drugs in the world.
We are in this situation because we rely on multiple (and largely unregulated) private insurers with most government plans covering the poor and very old. Neither have been strong bargainers on our behalf with pharmaceutical companies.
So how do we shake up the status quo? We need universal drug insurance covering all Canadians. We can’t go on with a medicare that doesn’t cover essential drugs like insulin or cancer medications, for example.
It is a false economy to think the expansion of public money is a luxury we can’t afford when, overall, if we had universal drug insurance we would have better control of total (public and private) spending than we presently do — and the ability to negotiate better prices for drugs.
To get there we could follow in the footsteps of Australia. In the 1940s, Australians changed their constitution so the federal government assumed jurisdiction over pharmaceuticals. An appropriate first reaction might be that a constitutional change in Canada has a snowball’s chance in hell, but it may be easier than you think. Canadian provinces once agreed voluntarily to just this kind of arrangement for pharmaceuticals during the last Liberal administration. Don’t say no this time.
Another option might be to amend the Canada Health Act to tie fiscal health transfers to provinces on the condition they provide some form of insurance for important prescription drugs. How they do this would be their decision, but leadership from the federal government would go a long way in making critical medicines accessible to all Canadians.
Finally, Canada needs real change in homecare and long-term care. Prime Minister Trudeau already promised $3 billion dedicated to homecare, but please make sure the provinces are required to use this money to get people more needed homecare and long-term care rather than being used to maintain the status quo.
New money must drive real systematic reform.
You need to lead and explore with the provinces new ideas like possible universal long-term care insurance (similar to CPP) or other innovative financing strategies that maximize individual autonomy and choice. One idea could be personal support budgets which are popular in Europe and allow those in need a source of funds to buy homecare and other supports in the community rather than being forced into (costly) public institutions.
Minister Philpott, we need new models of thinking about how we provide essential medicines and health services to Canadians. The same-old-same-old thinking will no longer do.
Colleen M. Flood is a Professor, Director of the Centre for Health Law, Policy & Ethics, and a University of Ottawa Research Chair in Health Law & Policy.
