"If the Liberals are re-elected in May, they could start playing tougher with municipalities standing in the way of their power plans."
Michael Smyth, Vancouver Province, January 30, 2005

The concluding sentence of Mike Smyth's Sunday column was in the context of what the Campbell government might to deal with the decision of the Squamish Lillooet Regional District's decision to kill the Ashlu dam project. Mike may not have intended it, but his comment is equally valid for dozens of other public policy issues. What can be expected after the next election given what Campbell did after the last one? Who expected tax cuts weighted in favour of high income earners? Who expected the sale of BC Rail, expanded gambling or chaos in the Ministry of Children and Family Development?

One of the surprises in the past four years came on May 1, 2003, with the "re-structuring of Pharmacare". The new "Fair Pharmacare" helped some low income people but it shifted over $100 million in costs onto sick seniors. The rules of "Fair Pharmacare" are very complex; they differ for each family. For example, seniors who previously faced maximum user fees of $25 per prescription, to a total of $275 per year, now receive no government help until they have paid their annual deductible. If an elderly family has an income of $40,000 per year their deductible is $400. They must pay the full cost of their prescriptions until they reach $400, after which they must pay 25% of the costs until their costs exceed $800.

The "service plan" for the Ministry of Health shows that costs for Pharmacare are expected to rise from $830.4 million in 2004-05 to $926.6 million in 2005-06, and to $1,025.3 million in 2006-07. That means that even after shifting over $100 million in costs on to sick seniors through increased deductibles and user fees, costs are expected to continue to rise at double digit growth rates. That is not sustainable.

The problem of unsustainable growth in Pharmacare costs can be solved by either offloading more costs onto those who are prescribed drugs (primarly seniors), or by taking on "big pharma" on its campaign to influence the prescribing habits of physicians. Drug companies spend tens of thousands of dollars per year on each physician in Canada in order to influence what prescriptions they write. Many of those prescriptions are unnecessary, or worse, bad for the patient's health. Costs could be shifted or controlled by improving prescribing habits. In 2001 the Campbell gang campaigned on the side of big pharma by opposing reference base pricing. In 2005 expect them to deliver for the drug companies again.

Expect deductibles and user fees to go up if the Campbell government gets re-elected. For example, an elderly family with an income of $40,000 per year, might see their deductible rise from $400 to $600, and they might find that they pay the full cost of their prescriptions until they exceed $600, after which they must pay 25% of the costs until their costs exceed $1,000 (now $800).

Campbell needs to tell British Columbians what he will do with Pharmacare after the election. Double digit cost increases are not sustainable. Will he solve the problem on the backs of sick seniors, or by taking on the pharmaceutical industry and its campaign to influence doctors?