41.

　　What to do? Both the Romanow commission and the Kirby committee on health care----to say nothing of reports from other experts----recommended the creation of a national drug agency. Instead of each province having its own list of approved drugs, bureaucracy, procedures and limited bargaining power, all would pool resources, work with Ottawa, and create a national institution.

　　42.

　　But “national” doesn’t have to mean that. “National” could mean interprovincial----provinces combining efforts to create one body. Either way, one benefit of a “national” organization would be to negotiate better prices, if possible, with drug manufacturers. Instead of having one province-or a series of hospitals within a province----negotiate a price for a given drug on the provincial list, the national agency would negotiate on behalf of all provinces. Rather than, say, Quebec, negotiating on behalf of seven million people, the national agency would negotiate on behalf of 31 million people. Basic economics suggests the greater the potential consumers, the higher the likelihood of a better price.

　　43.

　　A small step has been taken in the direction of a national agency with the creation of the Canadian Co-coordinating Office for Health Technology Assessment, funded by Ottawa and the provinces. Under it, a Common Drug Review recommends to provincial lists which new drugs should be included. Predictably and regrettably Quebec refused to join.

　　A few premiers are suspicious of any federal-provincial deal-making. They (particularly Quebec and Alberta) just want Ottawa to fork over additional billions with few, if any, strings attached. That’s one reason why the idea of a national list hasn’t gone anywhere while drug costs keep rising fast.

　　44.

　　Premiers love to quote Mr. Romanow’s report selectively, especially the parts about more federal money perhaps they should read what he had to say about drugs: “A national drug agency would provide governments more influence on pharmaceutical companies in order to constrain the ever-increasing cost of drugs.”

　　45.

　　So when the premiers gather in Niagara Falls to assemble their usual complaint list, they should also get cracking about something in their jurisdiction that would help their budgets and patients.

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