Health
National pharmacare – might it be a pig in a poke?

From the Macdonald Laurier Institute
By Nigel Rawson and John Adams for Inside Policy
No Canadian should have to choose between paying for medicines and paying for rent or food. National pharmacare has been proposed as a remedy to this situation.
“When will Canada have national pharmacare?” asks the author of a recent article in the British Medical Journal (BMJ). Better questions are: will Canadian pharmacare be the system many Canadians hope for? Or, might it turn out to be skimpy coverage akin to minimum wage laws?
In its 2024 budget document, the federal government proposed providing $1.5 billion over five years to support the launch of national pharmacare for “universal, single-payer coverage for a number of contraception and diabetes medications.” This has been hailed as a “big day for pharmacare” by some labour unions, patients and others, including the author of the BMJ article who said that national pharmacare should be expanded to cover all medication needs beginning with the most commonly-prescribed, clinically-important “essential medicines.”
In its budget, the government stated “coverage of contraceptives will mean that nine million women in Canada will have better access to contraception” and “improving access to diabetes medications will help improve the health of 3.7 million Canadians with diabetes.” Why not salute such affable, motherhood and apple pie, sentiments? The devil is in the details.
The plan does not cover new drugs for diabetes, such as Ozempic, Rybelsus, Wegovy, Mounjaro or Zepbound, all based on innovative GLP-1 agonists, where evidence is building for cardiovascular and weight loss benefits. This limited rollout seems based on cheap, older medicines, which can be less effective for some with diabetes.
The federal government has also consistently under-estimated the cost of national proposals such as pharmacare – not to mention other promises. In their 2019 election platform, the Liberals promised $6 billion for national pharmacare (the NDP promised $10 billion). Keen analysis shows that even these expansive amounts would be woefully inadequate to fund a full national pharmacare plan. This makes the $300 million a year actually proposed by the Liberals’ look like the skimpy window-dressing that it is.
National pharmacare, based on the most comprehensive existing public drug plan (Quebec’s), would cost much more. In 2017, using optimistic assumptions, the Parliamentary Budget Officer (PBO) estimated the cost for a national plan based on Quebec’s experience to be $19.3 billion a year. With more appropriate assumptions, the Canadian Health Policy Institute estimated $26.2 billion. In June 2019, the federal government’s own Advisory Council on the Implementation of National Pharmacare put the cost at $40 billion, while a few months later, the tax consulting company RSM Canada projected $48.3 to $52.5 billion per year. Five years later, costs no doubt have soared.
Even with these staggering cost a program based on matching Quebec’s drug plan at the national level would fail to provide anywhere near the level of coverage already provided to the almost two-thirds of Canadians who have private drug insurance, including many in unionized jobs. Are they willing to sacrifice their superior coverage, especially of innovative brand-name medicines, for a program covering only “essential medicines”? Put another way, are Canadians and their unions prepared to settle for the equivalent of a minimum wage or minimum benefits?
The PBO has estimated the cost of coverage of a range of contraceptives and diabetes medicines as $1.9 billion over five years, which is more than the $1.5 billion provided in the budget. However, this figure is based on an assumption that the new program would only cover Canadians who currently do not have public or private drug plan insurance, those who currently do not fill their prescriptions due to cost related reasons, and the out-of-pocket part of prescription costs for Canadians who have public or private drug plan coverage. This is major guesswork because existing public and private drug plans may see the new federal program as an opportunity to reduce their costs by requiring their beneficiaries to use the new program. If this occurs, the national pharmacare costs to the federal government, even for the limited role out of diabetes and contraceptives, would soar to an estimated $5.7 billion, according to the PBO.
Our governments are not known for accurate estimates of the costs of new programs. One has only to remember the Phoenix pay system and the ArriveCAN costs. In 2017, the Government of Ontario estimated $465 million per year to extend drug coverage to every resident under the age of 25 years. What happened? Introduced in 2018, prescriptions rose by 290% and drug expenditure increased to $839 million – almost double the guesstimate. In 2019, the provincial government back peddled and modified the program to cover only people not already insured by a private plan.
Although we believe governments should facilitate access to necessary medicines for Canadians who cannot afford their medicines, this does not require national pharmacare and a growing bureaucracy. Exempting lower-income Canadians from copayments and premiums required by provincial programs, as British Columbia has done, and removing the requirement to pay for all drugs up to a deductible would allow these Canadians access sooner, more simply, and more effectively.
Moreover, it isn’t just lower-income Canadians who want help with unmet medicine needs. Canadians who need access to drugs for diseases that are difficult to treat and can cost hundreds of thousands of dollars per year also require assistance. Few Canadians whether they have low, medium or high incomes can afford these prices without government or private insurance. Private insurers often refuse to cover these drugs.
The Liberals provided a separate $1.5 billion over three years for drugs for rare disorders, but no province or territory has signed a bilateral agreement with the federal government for these drugs and no patient has received benefit through this program. Even if they did, the $500 million per year would not go far towards the actual costs. There is at least a zero missing in the federal contribution, as the projected cost of public spending on rare disease medicines by 2025 is more than threefold what Ottawa has budgeted.
Expensive drugs for cancer and rare disorders are just as essential as basic medicines for cardiovascular diseases, diabetes, birth control, and many other common conditions. If a costly medicine will allow a person with a life-shortening disease to live longer or one with a disorder that will be severely disabling left untreated to have an improved quality of life and be a productive taxpayer, it too should be regarded as essential.
The Liberals and NDP are working to stampede the bill to introduce the pharmacare program (Bill C-64) through the legislative process. This includes inviting witnesses over the first long weekend of summer, when many Canadians are away, to appear before the parliamentary Standing Committee on Health three days later.
Too much is unknown about what will be covered (will newer drugs be covered or only older, cheaper medicines?), who will be eligible for coverage (all appropriate Canadians regardless of existing coverage or only those with no present coverage?), and what the real cost will be, including whether a new program focusing on older, cheaper drugs will deter drug developers from launching novel medicines for unmet needs in Canada.
This Bill as it stands is such a power grab that, if passed, the federal Health Minister never has to come back to Parliament for review, oversight or another tranche of legal authority, it would empower the Cabinet to make rules and regulations without parliamentary scrutiny.
A lot is at stake for Canadians, especially for patients and their doctors. Prescription medicines are of critical importance to treating many diseases. National pharmacare must not only allow low-income residents to access purported “essential medicines” but also ensure that patients who need specialized drugs, especially higher-cost innovative cell and genetic therapies that may be the only effective treatment for their disorder, are not ignored. Canadians should be careful what they wish for. They may receive less than they anticipate, and, in fact, many Canadians may be worse off despite the increase in public spending. Time to look under the hood and kick the tires.
Nigel Rawson is a senior fellow with the Macdonald-Laurier Institute.
John Adams is co-founder and CEO of Canadian PKU and Allied Disorders Inc., a senior fellow with the Macdonald-Laurier Institute and volunteer board chair of Best Medicines Coalition.
Business
Canadians continue to experience long waits for MRIs and CT scans

From the Fraser Institute
Canada reported 10.6 MRI machines per million population, ranking us 27th out of 31 universal health-care countries and far behind fifth-ranked Germany (32.5 machines per million population). We see a similar story with CT scanners where second-ranked Australia (78.5 units per million) far outpaces Canada (14.6 units per million population)
Canada’s health-care system is in dire straits. We face an access crisis in primary care, regular rural emergency room closures, and some of the longest waits for non-emergency surgery in more than 30 years. Indeed, the median wait between referral to a specialist by a general practitioner and receipt of treatment was 30 weeks in 2024, the longest on record.
But beyond medical and surgical treatments, Canadians also face significant waits for key diagnostic services.
In 2024, the latest year of available data, patients could expect a 16.2-week wait for an MRI (more than three weeks longer than what they waited in 2023) and an 8.1-week wait for a CT scan (a week and half longer than in 2023).
Of course, these machines are crucial in the diagnosis and monitoring of many different illnesses. As a result, long waits for these machines can result in delays in diagnosis and the advancing of illness that can impact decisions around treatment and potential outcomes.
But why are there delays for this type of basic diagnostic care?
One explanation is that Canada has lower availability of these machines compared to other high-income universal health-care systems.
For example, using the latest available data from 2022 and after adjusting for population age, Canada reported 10.6 MRI machines per million population, ranking us 27th out of 31 universal health-care countries and far behind fifth-ranked Germany (32.5 machines per million population). We see a similar story with CT scanners where second-ranked Australia (78.5 units per million) far outpaces Canada (14.6 units per million population), which ranked 28th of 31.
These data also underscore the wider dissatisfaction among Canadians about how our governments steward our health-care systems. According to a recent Navigator poll, 73 per cent of Canadians want major health-care reform.
In the end, poor access to diagnostic imaging technology can prevent the appropriate triaging of patients and create further delays for scheduled care. Improving access to diagnostic imaging should help reduce delays for care overall and improve the lives of patients and their families.
Economy
Human population set to decline for the first time since the Black Death

From LifeSiteNews
By Steven Mosher of the Population Research Institute
The world’s population is not only not exploding, it’s on the cusp of collapsing.
The collapse in birth rates that began in post-war Europe has, in the decades since, spread to every single corner of the globe.
Many nations are already feeling this death spiral, filling more coffins than cradles each year.
Just this past year, Japan lost nearly a million people. Poland lost 130,000.
However, the big story comes from China, home to one-sixth of the world’s population.
The decades-long devastation wrought by the one-child policy has sent that country, for centuries the pacesetter in population, into absolute decline.
China finally admitted that its population was shrinking, but demographers — including myself — believe that the numbers have been falling for almost a decade.
The Chinese government’s official population figure of 1.44 billion also greatly exaggerates its overall numbers, some analysts say by as much as 130 million people.
India, the country that has now overtaken China in population, is still growing, but not for long.
The average Indian woman was having only two children over her reproductive lifetime, the Indian government reported in 2021, well below the 2.25 or so needed to sustain the current population.
The same story is being repeated all over the world, as birthrates in Latin America, the Middle East, and even Africa are not just falling — they are collapsing.
The current total fertility of Tunisian women, for example, is estimated at 1.93.
The result of all these empty wombs is that humanity just passed a major milestone, although not one we should celebrate.
For the first time in the 60,000 or so years that human beings first arrived on the planet, we are not having enough babies to replace ourselves. No wonder Donald Trump has suggested providing free IVF to all Americans “because we want more babies,” he says.
Because of ever-lengthening life spans, the population will continue to grow until mid-century. But when this demographic momentum ends—and it will end—we will reach a second grim milestone on humanity’s downward trajectory:
For the first time since the Black Death in the Middle Ages, human numbers will decline.
The 14th century bubonic plague was the worst pandemic in human history. It killed off half the population of Europe and perhaps a third of the population of the Middle East.
But even as the plague was filling mass graves, the survivors kept filling cradles. And because the birth rate remained high the global population recovered although it took a century or so.
This time around, we may not be so fortunate. All the factors that influence fertility, from marriage rates to urbanization to education levels, are pushing births downward.
Now you may be excused for not knowing about the current birth dearth.
After all, powerful international agencies like the UN Population Fund and the World Bank have done their best to keep it out of the public eye.
Moreover, these agencies, set up during the height of the hysteria over “overpopulation” in the 1960s, like to overestimate births in one country and pad population numbers in another.
For example, the UN, in its annual World Population Prospects, claims that 705,000 babies were born in Colombia last year, when the country’s own government pegs the number at just 510,000.
This is not a rounding error.
Neither is the UN’s claim that Indian women are still averaging 2.25 children, defying the country’s own published statistics, which show that it is now below 2.0.
All this number fudging allows the UN to claim that the global total fertility rate last year was at 2.25, still above replacement
It’s even wrong about replacement rate fertility, which it says is 2.1 children per women.
It’s wrong because in many countries sex-selection abortion skews the sex ratio strongly in favor of boys.
To make up for the tens of millions of unborn baby girls missing in China, India and other Asian countries, those countries need more need 2.2 or even 2.3 children on average.
The UN exaggerates human numbers for the same reason that the Biden-Harris administration exaggerated employment numbers: for financial gain and political survival.
There are billions of dollars at stake, funding that is fueled by a dark fear of mushrooming human numbers.
The population control movement does not intend to go quietly to its grave, even as it continues to dig humanity’s own, so it feeds this fear.
But the world’s population is not only not exploding, it’s on the cusp of collapsing. Which is why it’s time to end the war on population.
This article was originally published on www.pop.org on September 3rd, 2024, before being reprinted in the John Paul II Academy for Human Life and the Family’s Academy Review in November 2024. Edited and republished here with permission.
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