The choice of treatment

Marc-André Gagnon's proposal to save upwards of $10 billion per year through a national prescription drug purchasing program makes for a compelling enough idea on its face. But it only looks all the stronger when compared to the right-wing answer.

Here's what Gagnon proposes:

The report, being released Monday in Ottawa, argues that Canada's jumbled assortment of public and private plans and wildly varying drug policies across jurisdictions is inefficient, costly and inequitable.

But, above all, it says Canada pays too much for drugs – between 16 and 40 per cent more than other industrialized countries – in a bid to attract pharmaceutical investment.

In fact, the vast majority of the purported savings – $10.2-billion – would come from adopting a drug-purchasing policy based on market competition and the assumption prices would drop 37 per cent. That would likely provoke a backlash from the pharmaceutical industry and may be politically unpalatable, researchers concede. However, in a number of other scenarios presented in the study, Prof. Gagnon shows, even without purchasing drugs at that lower price, a national program would still deliver net savings of ranging from $2.6-billion to $4.5-billion.

Now, astute readers may ask why a sane government wouldn't conclude that it's well worth the political cost to rein in prescription drug costs by paying only for the drugs themselves, rather than also gratuitously throwing money at big pharma in the hope of generating some undefinable indirect benefits. And one would expect such an argument to resonate just as much among conservative pundits as progressive ones.

Instead, Tasha Kheiriddin takes a rather different approach, making a truly stunning argument that we'd be better off if only we'd pay more for the same products. For Kheiriddin, any attempt to lower drug costs is to be discouraged, with half-baked theories and "studies" presented to justify using higher-cost generic drugs over lower-cost ones and brand-name medications over cheaper generics. One would have to wonder how much better health might be bestowed upon us by the market gods if only we'd freely sacrifice a few hundred million more dollars to our corporate overlords - except that thanks to the Harper Cons, that very strategy has been tried and has failed.

Of course, that leads to Kheiriddin's own endgame of shilling for privatization on the theory that the ideal health-care system is one where the wealthy can pay their way to the front of the line.

But there's another more direct solution to Kheiriddin's own problems (albeit one that I'm sure she'd reject out of hand). If there's some reason to be concerned about the quality of generic drugs as currently imported or manufactured due to the incentives on private operators to cut corners and costs, then isn't the obvious answer to have the public sector - which would otherwise absorb the costs of any theoretical subpar drugs - step in to produce truly equivalent products?

Naturally, I'd see that combined with a national purchasing plan to create economies of scale as the best possible outcome. But I'd be more than willing to see Gagnon's plan put in place on its own first to see if the private sector can actually provide reasonable prices - as long as the focus is on actually improving access to drugs, rather than enriching big pharma and providing excuses to sell off our health-care system.