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“Pharmacare Now” was the title of the health committee report. Would it have been if the NDP had not lately indicated it would be part of its platform in 2019, and if Liberal election strategy did not depend on keeping NDP-leaners in the big red tent?

The idea, of course, has been somewhere on the Liberal wish list for decades. But if past Liberal prime ministers have declined to implement it — and if this one hesitates before committing to it — it may be because it is also fraught with political risk.

That there is a genuine problem to be solved should not be in doubt, as the committee’s report ably summarizes. Canada spends more on prescription drugs, through a chaotic mix of public, private and individual payers, than nearly every other country on earth: $34 billion annually, or roughly $1,000 per capita — a third higher than the OECD average, and twice what countries like Denmark and the Netherlands pay.

Yet an estimated 10 per cent of our people have no drug insurance — two to three times the rate in comparable countries — while another 10 per cent are classed as under-insured, meaning their drug costs exceed the limits of their plans, forcing them to pay out of pocket.

The problem is especially acute for the working poor, the self-employed, and those in part-time or short-term employment, without access either to the public plans available to those on social assistance or employer-provided insurance. The poorest one-fifth of households spend more than one per cent of their incomes on drugs, on average; those with chronic illnesses can pay more than five or even 10 per cent. Unsurprisingly, many are forced to skimp on their drug purchases, often with consequences for their health, and subsequent higher costs to the health care system: as much as $9 billion annually, according to one study.

With so many plans (there are more than 70 public plans, and thousands of private ones) and such wide differences in the range of drugs they cover, it is easy to see how some people, and some drugs, might fall into the cracks. And with less than 43 per cent of the market, the collective purchasing initiative among the provinces, lately joined by the federal government, known as the pan-Canadian Pharmaceutical Alliance, has achieved only limited success in negotiating price reductions with manufacturers.