Tackling health care wrong way round, again

VICTORIA - The premiers' proposal for a national, federally funded pharmacare plan highlights what's wrong with the way we approach health care.
There's a certain tactical cleverness to the idea, hatched -- apparently with little preparation -- at meetings last week.
The premiers were trying to figure out how to approach next month's televised health care summit with Prime Minister Paul Martin, who had already struck his own pose with an empty campaign promise to cut waiting lists.
The premiers needed a response.
Fundamentally, they want more money from Ottawa. But that demand is wearing thin, not least because the public recognizes that provincial and federal governments tap the same pool of taxpayers.
So the premiers came up with a twist. The federal government should create a national pharmacare program, they decided, and come up with the required $7 billion to $12 billion. (The range indicates just how well this has been thought through.) And, of course, the premiers still want Ottawa to come up with $5 billion a year in extra health transfer payments.
Don't expect any fast action.
The provinces can't even say what sort of plan they want Ottawa to provide. Provincial pharmacare plans now vary widely. P.E.I. covers 30 per cent of total prescription drug costs, with the rest paid by private insurers or individuals; Manitoba's plan covers 53 per cent of all prescription drug costs. Working out a coherent, nationally acceptable model would be a huge task.
The federal government has no interest in taking on all responsibility for the fastest-growing component of health care costs.
And the public recognizes that this proposal does nothing to address the real issues The premiers' rhetoric is about rising costs, greater effectiveness and sustainability. But their pharmacare plan doesn't tackle those tough issues. It simply takes the status quo and shuffles the financial arrangements around.
A real national pharmacare strategy would be useful.
Prescription drugs are taking an increasing share of health care spending, with little evidence on whether the money buys useful results.
In B.C., prescription drug spending was $360 per person in 2003, about $145 less than the national average, according to the Canadian Institute for Health Information. But there's little evidence as to why we spend less, or whether it's a good thing.
Perhaps reference-based pricing is keeping costs down; perhaps we're simply healthier; or perhaps we're under-prescribing and as a result more people are inding up in hospital. We don't know.
A national strategy, based on the best information available, could improve the assessment and approval process for new drugs and provide better ways of managing costs (including more effective bargaining with the drug companies.) When that is done -- the important work -- the question of who pays can be resolved.
It's difficult work. Deciding not to pay for the latest, more costly drug variations brings pressure from patients who believe they can improve their lives, and drug companies that believe they can improve their bottom lines. But it's the only way to real reform.
So far, once you get past the rhetoric, the talk is all about who pays. Even the advocates of two-tier care acknowledge it doesn't reduce costs or increase effectiveness. The health care expense is the same; the difference is whether we pay collectively or allow people to pay individually for speedier care.
We're not in any sort of health care sustainability crisis. Cost increases are worrying, but Canadian health care spending as a percentage of GDP was unchanged between 1991 and 2001. A federal finance department review released this year projected that even without changes health spending would remain easily manageable until 2040 and beyond.
That means we have time to make the difficult decisions about the kind of health care system we want and are prepared to pay for.
Instead, our politicians are still bogged down on debates about whether the taxes we pay to Ottawa or the taxes we pay to Victoria should be allocated to health care costs.
And that's a debate that has very little to do with better patient care.
- From the Vancouver Sun