Two Canadian think tanks weighed in this week on the same issue – the state of provincial drug plans for seniors – but came to dramatically different conclusions.

A C.D. Howe Institute study concluded that age-based drug plans, which pay for medications for those over 65, will face huge cost pressures as the ranks of seniors increase dramatically in the coming years. Currently a majority of the provinces have these kinds of plans. A better alternative, the report says, is to base coverage on income, so those with the least resources – whatever their age – will get their drugs paid for.

The Institute for Research on Public Policy's report, on the other hand, says that replacing age-based drug benefits with those based on income – as British Columbia and some other provinces have done – is a mistake. The deductibles that are a feature of income-base plans can hurt many seniors and add costs to the system, it says. The IRPP study favours full and universal coverage of drug costs. Such plans, it says, could be financed with small income tax hikes. And dramatic savings could be achieved if the provinces and territories create a central agency to buy drugs, thus generating huge discounts from bulk purchases.

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These studies, along with others that have analyzed Canada's drug insurance issues, are a valuable contribution to the debate, even if they come with disparate recommendations. This is one case where Canada's fractured national medical structure is an advantage, in that we can examine experiences with different models in each province, to see what's working and what isn't.

It's important to keep in mind that two of the central goals for our health care system are universality and achieving the best possible outcomes for patients. It makes no sense to divorce pharmaceutical treatment from the principle of universality. More and more health care is pharmaceutical care, and Canada is the only developed country with universal health insurance that doesn't provide full coverage for medications.

It is also crucial to ensure the necessary drugs are available to all and are taken when prescribed, so that sick people don't become a further burden on health care system. It's not acceptable that some Canadians do not fill needed prescriptions because they cannot afford them. Of course costs have to be taken into account, but let's have a full debate and fix the system. Canada should be striving to make our various provincial health care systems not just more affordable, but also stronger, more comprehensive and better.