History has taught us that health policy decisions are not only emotional, but very political. Changes to public policy are frequently made in response to the concerns raised by any number of constituents and “special interest groups”, and governments are disinclined to take bold steps to reform the health system, as the measure of ‘bold’ is often decided by popularity polls.
Take the U.S. as an example of the politics of health. Many experts have labeled U.S. healthcare reform a convoluted and complex piece of legislation that really does little to fix the significant issues facing the American health system. Yes, the legislation does provide access to healthcare for many uninsured Americans, but it does relatively little to address the spiraling cost of healthcare. How did the US get to this point? In a word, politics. Opponents to healthcare reform made it very difficult for the President to pass the extensive healthcare reform package that he wanted.
The Canadian experience
Closer to home, the Alberta government developed a comprehensive pharmaceutical strategy to address the rising cost of prescription drugs and to introduce an expanded role for pharmacists in the delivery of healthcare. An important pillar of this strategy was to revise Alberta’s seniors’ drug plan through the introduction of premiums, revised co-payments and to make the provincial program second payer to any plan provided by an employer.
Seniors’ groups in the province were outraged and the government has recently announced these changes will be delayed indefinitely to allow time for further review. It may be entirely coincidental that the government decided to defer these changes at a time when their popularity with the voters is relatively low, but the optics would suggest otherwise. The politics of health undoubtedly had a significant role in the government’s decision.
The Ontario government seems more willing to take on pharmacy in a very public battle to reduce the cost of prescription drugs in that province through an aggressive generic drug pricing strategy. Pharmacy has rallied and launched an impressive public relations campaign to win the hearts and minds of Ontario voters. The government relented—albeit briefly—and delayed its announcement to allow it more time to consider pharmacy’s submissions. In this case, however, it managed to push its reforms through.
None of this is particularly new, as healthcare decisions have always been political. But the stakes are higher now, and the need for healthcare reform will increase exponentially in future years. The shoe has to drop, and soon.
Should I care?
So as sponsors of employee benefit plans, why should you care? You should care—and plenty—for the following reasons:
• We simply can not afford our current healthcare system. Many provinces have done long-term projections on the cost of healthcare, and the prognosis is not good. A study on Alberta’s healthcare system estimates that unchecked, healthcare costs will double by 2020 from $12.9 billion (2009-10 estimates) to $25 billion. The role of employers and employee benefit plans will undoubtedly change and you may have very little say in the matter.
• Governments will be forced to make difficult choices regarding access to and the funding of future care. We have seen evidence that the needs of working (and retired) Canadians with access employer provided benefit coverage may be considered as secondary to those on social assistance, seniors (without other coverage) and individuals with high medical needs, etc.
• Governments are committed to changing the healthcare delivery model to better access under-utilized resources to reduce costs, improve efficiencies and hopefully improve health outcomes. Pharmacists, for example, are enjoying expanded scope of practice in many provinces including prescribing and an increased role in medication management. Within the context of the overall health system, these changes make a lot of sense.