Free pharmacare — if you’re younger than 25

Is the new OHIP+ program really a step in the right direction?

Free pharmacare — if you’re younger than 25

If you were to ask random passersby for examples of distinctly Canadian things, you would be sure to collect an eclectic mish-mash of responses. These would likely be topped by maple syrup and hockey, perhaps with an honourable mention of colourful money and the CN Tower. Among these answers would likely be our universal healthcare system.

Given that nearly all developed nations, with the noticeable exception of the US, have adopted some form of free, accessible, universal healthcare, it may be considered odd that Canadians take such pride in a system that is not unique to them.

Statistics Canada reported in its 2013 General Social Survey that our health care system was our second greatest source of national pride, tied with Canada’s armed forces, with 64 per cent of Canadians polled reporting being proud of it.

Yet, despite the lavish praise, Canada’s national health care system lacks what many systems in other developed countries have: a subsidized prescription drug program.

Approximately one in 10 Canadians are forced to forego prescribed medication due to financial difficulties. Such difficulties are one of the many issues that the Government of Ontario chose to tackle in its 2017 budget with the introduction of the new OHIP+ program.

Having come into effect on January 1 of this year, OHIP+ provides more than 4,400 medications — that were only partially covered by the existing Ontario Drug Benefit plan — free of charge to anyone under the age of 25 in Ontario with a health card number.

“Young people aged 19-24 are less likely to have access to prescription drug coverage or the financial means to pay out-of-pocket due to higher unemployment and lower incomes,” wrote David Jensen from the Ministry of Health and Long Term Care’s Communications and Marketing Division. “The unemployment rate for youth (aged 15-24) in Ontario is almost three times higher than the unemployment rate for adults over the age of 25.”

Dr. Danielle Martin of U of T’s Institute of Health Policy, Management, and Evaluation and the university’s School of Public Policy and Governance sees OHIP+ as a step forward for the province.

“The introduction of OHIP+ is an amazing accomplishment for young people and their families in Ontario. Doctors often see families in our offices who cannot afford to pay for their prescription medicines, and sometimes those medicines are lifesaving or critical to a child or youth’s quality of life,” explained Martin.

Martin is one of the authors of the Pharmacare 2020 report, which calls for universal national coverage of some medications, and she has defended single-payer health care systems before the US Senate.

She made it clear, though, that this program is just the first step. “Covering prescription medicines for people up to age 25 is a critical step on the road to universal pharmacare in Canada, and it will make a big difference for a lot of people. Now we just need to close the gap between ages 25 and 65.”

Painting OHIP+ as the best step toward a universal pharmacare program is not the most accurate depiction. A recent Parliamentary Budget Officer report shows that introducing a fully universal program right off the bat would in fact be cheaper than OHIP+ in the long-term.

This has prompted some criticism of OHIP+. U of T’s Dr. Jessica Ross is among its critics, stating that “OHIP+ is a small step forward, but not a smart one” in an opinion piece published by the Toronto Star. Instead, Ross supports the adoption of free pharmacare for Ontarians of all ages.

There are also concerns about how the province will pay for OHIP+ — with a $465 million price tag, the expansion will not come cheap.

Despite being included in what the Liberal Party describes as a balanced budget, the $465 million figure is dubious, as a breakdown is not included in the budget document itself. This caused Ontario New Democratic Party leader Andrea Horwath to postulate that the expansion was a last-minute addition to the budget.

Regardless, the reception among some U of T students has been warm. “OHIP+ is a net positive for students everywhere,” said UTSU Vice-President Internal Daman Singh. “We expect it to complement the UTSU plan, and we don’t foresee any negative impact.”

The more cynical among us may wonder about the timing of the expansion. It is not out of line to think that the introduction of OHIP+, in conjunction with the minimum wage hike and recently improved OSAP benefits, is a play by the Liberals to woo young voters before the upcoming provincial election this summer.

How effective is this move? Only time — and the ballot boxes — will tell.

An international student’s perspective on the Canadian healthcare system

International healthcare debates can put benefits, drawbacks of Canada’s approach in perspective

An international student’s perspective on the Canadian healthcare system

It is common for strangers in a foreign land to feel disinclined to critique its customs and practices. Sharing my experience with the Canadian healthcare system here makes me an exception to the rule.

Discussions about healthcare in Canada often focus predominantly on the strengths of the current system, particularly when compared to complementary systems around the world. As the debate around healthcare rages on in the United States, many references are made to the successful Canadian alternative. Nevertheless, significant evidence suggests that the system is not as flawless as it is made to appear.

In August 2016, I rushed to the emergency room at Mount Sinai Hospital. As a result of a freak accident, I had gotten a papercut in my eye. I found a receptionist behind a desk and a couple of doctors in the hallway, all of whom seemed utterly unaffected by my red eye and tearful pleas for urgent help. The fact that I waited for two and a half hours to receive medical attention was an unexpected surprise — I had heard many people speak highly of the Canadian healthcare system in the past.

Dr. Andreas Laupacis, Executive Director of the Li Ka Shing Knowledge Institute at St. Michael’s Hospital, wrote an article in the Toronto Star that accurately sums up my experience. Laupacis argues that the staff within the medical system have become so accustomed to the endless waiting line within and outside the ER that they have become desensitized to its heartbreaking impact on patients.  

Unaffected staff seem to be the just the tip of the iceberg that plagues the Canadian healthcare system. It is also extremely difficult to book an appointment the day a medical problem occurs, or even on the day after. Furthermore, timely access to specialists for patients seems like a luxury. The problem is further compounded because long-term medical care facilities, such as hospitals and nursing homes, are overburdened, while home care options for patients are limited. This creates a vicious cycle — patients who require a lower degree of care cannot leave the healthcare system, while others in need cannot enter it.

As illustrated by my experience, and those of many others, the Canadian system faces some serious problems that need to be addressed. At the same time, if we are to engage in a balanced, productive debate about healthcare reform, it is also important to acknowledge what Canada is doing right.

Notably, I cannot help but admire the principle of universal, equal access to medical care. When compared to the developing world, Canada’s system becomes even more pronounced. In my home country, India, for example, an underfunded and inadequately staffed public healthcare system makes access to proper medical care extremely difficult for most people.

There are also some things that the United States can learn from Canada. In the context of the present debate on healthcare accessibility, the best example is the principle of universal coverage. The Patient Protection and Affordable Care Act, more commonly known as “Obamacare,” reflects this principle to a degree, given that the act expanded the scope of Medicaid to adults who could not afford adequate healthcare and made universal health insurance mandatory. However, The Republican Party, who currently hold a majority in both the House of Representatives and Senate, want to overturn this legislation on the grounds that it hinders job creation and burdens too many business enterprises.

This also raises several questions about how public healthcare should be managed, the most of important of which was whether it should be publicly or privately insured. In the US, as in India, private insurance companies dominate the healthcare sector.  To remedy this, Obamacare made it illegal for private insurance providers to deny coverage to those insured based on pre-existing terms and conditions included in policy documents.

Though many people in Canada also have private health insurance, most Canadians are not dependent on their employers for the healthcare benefits and security they need, unlike their American counterparts. It is incredible to me that the medical costs of Canadian citizens and permanent residents are covered by taxes paid to the government. This means that the average Canadian pays less than the average, insured American for the healthcare they receive. Even international students attending Canadian post-secondary institutions in Ontario are covered by the University Health Insurance Plan.

Moreover, the federal government subsidizes the cost of several non-prescription medical drugs. The flip side of this is that prescription drugs in the country are exorbitantly priced,  making them inaccessible for many people. The CBC estimates that Canadians wasted approximately $15 billion — of $81 billion spent — on prescription drugs in the last five years.

The divergences in healthcare regulation strategies adopted by Canada, the US, and India shed light on the fundamental question of how to make access to healthcare simultaneously efficient and low-cost. There is little difference between Canada and the US in this regard: a study conducted by the Commonwealth Fund placed the Canadian healthcare system ninth out of the 11 developed countries surveyed, while the American system ranked 11th.

This indicates that both systems yield inefficient results, despite being driven by different economic principles. Furthermore, the case of uninsured prescription drugs shows that economic barriers can sometimes make healthcare just as inaccessible in Canada as it is in the US.

Considering Canada in international context is beneficial, for there is much that Canada can learn from ongoing healthcare debates. For one, the American example shows us that policy changes in healthcare cannot be made suddenly, which is something the Canadian government must realize when it modifies the existing system.

Ultimately, the Canadian healthcare system is a mixed bag of benefits and drawbacks — all of which must be acknowledged if we are truly committed to improving our system. When we have conversations about healthcare in Canada, we should adopt a balanced perspective or risk disregarding the areas that are most in need of reform.

Rohit Khanna, writing for The Walrus, observes that “Healthcare becomes the embodiment of a nation,” and therefore it too, must be looked after. The alternative is painful, hazardous disillusionment.  

 

Sonali Gill is an incoming fourth-year student at St. Michael’s College studying Criminology and International Relations.