By Nav Persaud
The MPs mulling options for publicly funding medications will likely take their sweet time. There is no rush for them, because they already have the type of publicly funded access to medications that is being contemplated for other Canadians.
I am glad that our elected leaders have access to life-saving medications like insulin that was discovered in Canada and treatments for HIV-AIDS that extend life-expectancy by decades. It would be absurd to allow our leaders to die preventable deaths while holding elected office.
But it is actually absurd that most taxi drivers or daycare workers, for example, must either pay for medications or suffer. The consequences of untreated diabetes include heart attacks, strokes and death. Are we prepared to allow people who work as food servers, or as artists, or small business owners to die from treatable conditions?
The health of our elected leaders is crucial, but the lives and limbs of everyone else are important, too.
While we should celebrate the fact that Parliament is more diverse than it used to be, the House is still very different from the country. Twenty-six per cent of MPs are women — less than the number of low-income families headed by a woman in our country (34 per cent) and, of course, about half of the number it should be. We don't have a clear tally of the self-reported ethnicities of MPs, but you can decide for yourself where you are more likely to encounter a racialized person: on Parliament Hill or behind the counter of a fast food restaurant (or in another low-wage job).
Canadians overwhelmingly reject the idea that your access to medications should depend on your job.
Prominent examples illustrate that new Canadians can make it big in this country, but that's not true for immigrants who get cut down in their prime by a stroke that could have been prevented by high blood pressure treatments.
It's possible the publicly funded medicine plans for lawmakers may delay the needed policy changes. MPs and other lawmakers are insulated from our frayed patchwork system where some people have public or private plans, but others do not.
Studies in the United States have shown that lawmakers who have children in private schools are less likely to vote for laws that support public schools. Canadian lawmakers may be slow to support publicly funded medication access for all Canadians because they would not be affected by the change — their coverage is already great.
Over the last 40 years, multiple reports have recommended public funding of medications. The recent witnesses who appeared before the parliamentary committee repeated overwhelming arguments for including medications in our publicly funded system. According to surveys, Canadians overwhelmingly reject the idea that your access to medications should depend on your job.
People understandably worry about taxes going up if medications are publicly funded. The fact is we are already paying more than $1,000 per person in Canada — or a total of $30 billion per year — on medications. Government spending represents 40 per cent of that whopping amount, and the rest is insurance fees and out-of-pocket charges.
We should be able to publicly fund the most important essential medicines for every person in Canada for the amount we are paying right now. Bulk purchasing should reduce prices per pill the way it has in countries that are smaller than Canada like Sweden and New Zealand. We would not need to pay for both public and private administrative systems for medications, and the drug budget would not end up as profit for insurance companies.
We could also better promote the appropriate use of medicines.
Insurance companies advertise their large medication lists as though a wider selection is better. But less can be more when it comes to medications. Some studies have demonstrated that doctors make better prescribing decisions when they choose from a shorter list of medicines. Doctors cannot keep track thousands of drugs; they tend to prescribe a relatively small number out of habit. But the medications you get should not be determined by your doctor's habits — or whether she was influenced by an advertisement in a medical journal for a new drug.
The World Health Organization has created a model list of essential medicines that more than 100 countries have adapted to their own circumstances. We could do the same in Canada, and that list of essential medicines could serve as the basis for an equitable publicly funded medication policy.
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There are two ways to level the playing field between lawmakers and everyone else. We could publicly fund essential medications for everyone in Canada just like we publicly fund essential health care services, such as seeing a doctor or having an X-ray.
Or we could give lawmakers the same medication coverage plans as factory workers and see if that speeds up their deliberations about publicly funding medications.
Nav Persaud is an expert advisor with EvidenceNetwork.ca, a physician and scientist in Toronto and an assistant professor at the University of Toronto.
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