Monday, May 25, 2015

The Debate About the Debates

“Pick your battles” is a wise adage for life, especially in the intensely competitive and adversarial arena that is politics. That is why we have a certain tolerance and even admiration for leaders who display this wisdom in their campaign strategies.

But what if that campaign seems never-ending,  and the battles avoided include major issues of the day and time- worn avenues of democratic accountability?  I am referring of course to the prime minister’s recent decision to not attend the traditional debates put on by the consortium of Canada’s major broadcasting networks.  These debates have become known as “the” debates and one the key focal points of the election campaign: in 2011 the first English-language debate drew 10 million viewers.  The only problem, from Mr. Harper’s perspective, is that he can’t control them. And that is why he prefers to have a Google/Globe and Mail debate on the economy in Calgary and a Munk debate on national security in Toronto instead. Smaller, more fragmented audiences looking at debates focusing on his preferred agenda, in his preferred context, suits him better.

By pulling out of the traditional consortium debates, the government has cleverly conflated two issues: one is that the idea of a broadcasting consortium effectively monopolizing and determining the debate format is no longer acceptable; the other is that it is acceptable for the government to unilaterally change the rules 5 months before an election. The government pretends that the former consideration legitimates the latter; it does not. All it suggests is that we should supplement the broadcasters’ debate with others, and then agree after the election to establish a Debates Commission to set the rules for the following election. 

Perhaps the prime minister’s audacity wouldn’t seem so bad if it weren’t part of an even larger pattern of audacity that has characterized his entire tenure in power. We don’t have First Ministers’ conferences anymore, even though healthcare reform and battling climate change are of immense concern to Canadians and require a very high level of federal-provincial coordination. We don’t have wide open press conferences anymore either.  Instead, we now have personal attack ads between elections, prorogations of parliament whenever a government is in danger of losing a vote of confidence, and omnibus budget implementation bills as the primary vehicle for unpopular measures that are neither budgetary nor about mere implementation.  All of this has become simply routine.

If Mr. Harper is rewarded with another majority and becomes the most successful Conservative PM of modern times, his behavior will become the template for Conservatives, the unspoken political playbook for all politicians, and the 'new normal' for all young and immigrant Canadians, and even for a large number of older Canadians who don't bother to remember the honour system that once was.  Is this the role model we want for politics in the future?

Friday, May 15, 2015

Why Are Drug Prices High?

Canadians now spend $34 billion per year on pharmaceuticals. That is almost a thousand dollars for every man, woman and child--- considerably more than most citizens of other OECD countries spend on comparable or better drug plans. In New Zealand, for example, a national drug formulary aggressively pursues the most cost effective drugs and negotiates the best obtainable prices.  Even countries such as France, Italy and Spain spend less than Canadians do for the same basket of drugs.  According to a recent study conducted by several experts on drug policy published in the Canadian Medical Association Journal, Canadians could save $8 billion dollars per year on prescription drugs  (well over 20% of our total costs) if we had a single–payer system of pharmacare.  More people would be covered—thereby making drug policy more consistent with the basic principle of universal medicare-- and administrative costs would be lower.  Economies would be realized through three different mechanisms: the benefits of bulk purchasing; the negotiation of lower prices; and the substitution of generic drugs for more expensive brands.  So why hasn’t it happened?

It almost did. In 2004, B.C. ‘s Liberal premier Gordon Campbell, Alberta’s Conservative premier Ralph Klein, and Saskatchewan NDP premier Lorne Calvert all agreed that the federal government was more able than the provinces to finance a national pharmaceutical plan. All of the other premiers readily agreed (with Quebec premier Jean Charest of course insisting on the right of Quebec to opt out and run its own parallel plan). Unfortunately,  the new Liberal prime minister, Paul Martin , had too much on his plate and too little time to deliver it. The death blow came when Stephen Harper’s Conservative government was elected in 2006, and began its policy of implementing targeted tax cuts rather than “expensive” social programs. But what if the “expensive social program” actually saved billions per year by lowering drug costs? Let’s just say that Stephen Harper did not enter politics to save medicare, but rather something closer to the opposite.

The Conservatives’ role in driving up drug prices was not just due to this act of omission, but also to a considerable act of commission that came a few years later with the negotiation of the Canada-European Trade Agreement  (CETA).  Canada needs to encourage investment in research, development and manufacturing, but that neither explains nor justifies our history of higher prices.  Remember when Brian Mulroney first  angered seniors by improving patent protection for drugs and making generic drugs more expensive, way back in 1987? At that time, the pharmaceutical industry promised to spend 10% of sales revenues on R&D in exchange for higher prices. What happened? Research spending has been well below 10% since 2002.  How can we be confident that drug companies will serve consumers any better under CETA?