When Canada collectively chose Tommy Douglas, the father of medicare, as “The Greatest Canadian” in the CBC’s 2004 series of the same name, it was a telling testament to how much that commitment to universal health care has shaped our identity as Canadians. However, it’s been over thirty years since the 1984 Canada Health Act enshrined Douglas’ vision of universal access to health care services as law for all Canadians. Maybe it’s time to take a second look at it.

One of the biggest sticking points in Canadian health care is equitable and affordable access to medication. Though the Canada Health Act guarantees free access to medications administered in a hospital, Canadians are dependent on provincial government plans or private insurance to gain access to drugs prescribed for use outside of a hospital setting. Tommy Douglas knew this was a problem we would eventually need to address and, as an aging population and expensive new drugs are putting ever greater strain on the health care system, eventually is now.

A pan-Canadian partnership

“Drug coverage was not mandated as part of universal health care, and that’s the genesis of the problem we have,” says Louise Binder, a Health Policy Consultant with the Save Your Skin Foundation. “Unfortunately, it’s not going to be resolved by reopening the legislation and creating a federal mandate. Nobody really has the appetite for that. There are, thankfully, other ways that we can solve this problem. But they will require a profound pan-Canadian partnership.”

Such a partnership would ideally include not just federal and provincial governments but also patient support and advocacy groups, private insurers, and pharmaceutical companies. For that conversation, there is an appetite. “We have a watershed moment right now where research is generating excitement and hope for new life-saving and life-altering medications, but it comes at a time when health care has become so expensive that sustainability is the overarching issue for everyone,” says Pamela Fralick, President of Innovative Medicines Canada, a pharmaceutical industry association. “We have a system governing access to medication that’s 30 years old. The internet didn’t exist when this framework was developed. It has served us well, but now we as a society have new ideas and new information available to us. It’s time to take a look at it and see if we can make it better.”

Once that conversation begins, it has the potential to reach well beyond the issue of access to medication, and to touch on the many other aspects of our health care superstructure that could also use renovation and reinforcement. It would allow us to take a step back and get a good look at whether the system is patient-centred in the ways it should be, and whether good outcomes for those receiving care are being properly optimized and incentivized.

Opportunities to learn

Canada is not the only developed country struggling with health care issues. Perhaps one of the most powerful tools at our disposal for charting positive change is to learn from other nations around the world fighting the same fight, particularly in Europe. Belgium, for example, recently launched a Pact for the Future, in which the government is working closely with pharmaceutical industry associations to streamline clinical trials, improve transparency, and stimulate research. The Pact is set to substantially lower costs for patients and to reduce pharmaceutical companies’ tax burden, all while bringing innovative new drugs to market more quickly than ever before.

If we are to learn one thing from this example, it’s that the biggest gains come when all the stakeholders work together with the common goal of what’s best for the patient. That is what we need to replicate in Canada.

“We have great leaders in health, but we still have a challenge with leadership,” says Fralick. “It’s all about getting the right people in the room to solve the problems together. We all have the same goal, there’s no debate on that.”