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Rather than moving toward a countrywide public monopoly, Canada's provinces should follow the lead of Quebec, which in 1997 implemented a reform that made drug insurance coverage in the province universal, but that relies on a range of insurers, public and private. The costs of the Quebec system have risen since its implementation, but this is largely because Quebec has resisted the temptation to ration access to innovative drugs. Indeed, among Canadian provinces, Quebec provides the most generous coverage by far. Whereas on average 23 per cent of all drugs approved by Health Canada between 2004 and 2012 were reimbursable by Canada's provincial public plans as of December 2013, the proportion in Quebec was 38 per cent.

A national plan, it is argued, would provide the public insurer with greater negotiating power, allowing it to obtain price concessions from pharmaceutical companies. But the savings would largely come from increased rationing rather than from greater efficiency. In the United Kingdom, there has been one policy after another since the 1990s aimed at controlling spending. Patients continue to suffer the consequences of a lack of access to many proven drugs. Likely as a result of such restrictions, despite screening rates that are among the highest in the world, English patients have lower survival rates for various cancers than most other industrialized countries. In New Zealand, another country frequently held up as a model, patients' access to innovative drugs is just as restricted, if not more so. Of all the drugs approved in the country from 2009 to 2014, barely 13 per cent were reimbursable by the public insurance plan, the worst result among 20 countries evaluated.

It is also important to note that while Quebec spends more on drugs, this goes hand in hand with lower overall costs in the public health care system compared to other provinces, as more accessible pharmaceutical therapies have likely replaced other kinds of more expensive medical care, like hospital surgeries. Quebec's mixed universal plan is not perfect, but it does provide coverage to all residents. And only 4.4 per cent of Quebecers say they had to forgo taking their medicines or skip a dose for financial reasons - less than the residents of all other Canadian provinces, and less than the residents of many other countries, too. If one is concerned with universal access to the latest drugs, that's a far better model to follow. Yanick Labrie is an economist at the Montreal Economic Institute (www.iedm.org)

However, according to a recent study in the Canadian Medical Association Journal, a universal public drug plan, one facilitated by the federal government and run by the provinces, would be cost-saving. Such a plan could provide coverage for all Canadians, ensuring access to the prescription drugs they need, while saving Canadians $7.3 billion a year - a 32 per cent reduction in total drug expenditures.

Individuals and businesses would save $8.2 billion while government expenditures would increase by $1 billion, which is considerably less than 1 per cent of current government expenditures on health care. The cost to governments could be even less because these figures don't account for the potential savings from reduced use of publicly-funded hospital and physician services resulting from improved access to safe, effective and appropriate medications. Let's stop for a minute and imagine: a social program that improves health and saves Canadians several times the added cost to the public purse. What's not to like?

A national pharmacare plan would yield substantial benefits for municipalities such as Hamilton. Approximately two-thirds of municipal employees in Canada, including those in Hamilton, receive supplemental health care insurance through their employer. In Hamilton, prescription drug coverage represents over half the cost of employee health benefits. Cities across Canada spend more than $500 million each year on drug plans. Imagine what it would mean to have that money available for other municipal priorities. Council's recent support of a national pharmacare plan clearly makes good economic sense. Hamilton has joined other cities across the country in its call for such a plan. Organizations and individuals are adding their voices through the Campaign for National Drug Coverage (www.campaign4nationaldrugcoverage). It's time to add prescription drugs to Canadian medicare. Dr. Brian Hutchison, Professor Emeritus of Family Medicine and Clinical Epidemiology and Biostatistics at McMaster University, is a retired family physician and is on the board of directors of Canadian Doctors for Medicare.

It is hard to estimate the economic cost - lost productivity, costly treatments if illnesses are allowed to get worse, or even premature death - of such a high level of non-compliance. But studies show the highest compliance rates are for drugs for erectile dysfunction, contraception, and pain relief that have nothing do with saving lives. But if these drag down the average non-compliance rate, then prescriptions for other ailments, including serious ones, must be dragging it back up. A third reason to consider universal Pharmacare is a more easier-to-measure economic loss. Green leader Elizabeth May's plan sounded too good to be true as she outlined it - annual cost of $300 million a year for the feds to set up a national Pharmacare agency in return for savings to the health-care system of up to $11 billion a year.

But these estimated savings aren't something dreamed up in the party's backrooms - they are drawn from a recent scholarly analysis by UBC health economist Steven Morgan, a leading researcher in the field. The issue, Morgan told me in an interview, is that the whole system is fundamentally flawed and inefficient. Despite recent agreements by the provinces to co-operate on drug purchases - an approach Morgan thinks is worthwhile, but not nearly enough - neither the governments nor the dozens of private insurers have enough clout with drug companies to negotiate best prices. Not to mention the millions of uninsured who have no negotiating power at all.

As well, governments spend $3 billion a year on employees' health insurance premiums, Morgan said, and businesses pay several times that - money that would be saved if we had universal Pharmacare. May didn't pitch her plan simply as something a Green government would implement if her party is elected - a long-shot by any measure. Rather, she called on other parties to work together on this. This isn't likely to happen in the toxic partisan environment of federal politics, especially during an election. But given the Angus Reid poll's finding that 39 per cent of Canadians strongly support and 48 per cent moderately support adding prescription drugs to the universal medicare program (B.C.'s numbers are 44 per cent and 47 per cent), it's an issue other parties ignore at their peril.

Some Canadian-made generic drugs are twice the price in Canada compared with the U.S., U.K. and elsewhere. Retail pharmacies continue to get substantial rebates on generics, at our expense. In some cases, this accounts for up to 20 per cent of a store's revenues. Access to medications is more difficult for lowincome families and the underinsured. One-third of prescriptions are never filled, often related to household income and cost. As physicians, we do not prescribe as appropriately as we could and should. We do a shameful job of inflicting polypharmacy on seniors, particularly the frail elderly.

As patients, we have high and often unrealistic expectations of pharmaceuticals, and we consume too many. Ours is an overmedicated society. It's time to change the channel on pharmaceuticals. Universal pharmacare for Albertans and Canadians is both possible and necessary. Provinces need to act collectively and co-operate. Designed properly, with advantages such as joint policies, bulk acquisition and improved purchasing power, it can be affordable. Ontario has recently announced its intentions to move on this, and Alberta should join. Ultimately, federal participation is required for a truly national strategy, as was the case in the creation of medicare. This is a prime issue, sooner or later relevant and important to all Canadians, and should be seen as such in the upcoming federal election.

It can be anticipated that those with vested interests will say we cannot afford, and do not need, universal pharmacare. Those who care about a high-performing, equitable, patient-centred health system say we cannot afford to do without it. Health care faces a tough financial future. The time has never been better to expand public coverage for medically necessary pharmaceuticals, making appropriate, affordable, cost-effective medications available to all.

Dr. Tom Noseworthy, formerly of Edmonton, is professor of community health sciences at the Cumming School of Medicine O'Brien Institute for Public Health at the University of Calgary.

Across Canada, about 20,000 patients undergo nuclear imaging procedures every week and the field of nuclear medicine is growing around the world.

Most Canadians don't realize it, but this country has been an international leader, the world's largest single supplier of medical isotopes used in nuclear imaging, for more than 50 years.

But all of that is about to end. Buried deep in the federal budget bill, now winding its way toward approval, is something called the Nordion and Theratronics Divestiture Authorization Act.

In a few short sentences that amendment removes all foreign ownership restrictions on Canada's medical isotope processor, Nordion, paving the way for the former Crown corporation to be sold to a U.S. firm.

The buyer, Sterigenics, is ready and waiting with an offer on the table. Shareholders will vote on May 27.

That OECD warning triggered flashbacks for those Canadian nuclear medicine specialists who lived through the white knuckle crisis in 2009 when a leak shut down Chalk River for 15 months at the same time as an isotope-supplying Dutch reactor went down for repair.

In the political chaos that followed, Prime Minister Stephen Harper announced Canada would be getting out of the isotope business by 2016.

As analysts Ake Blomqvist and Colin Busby note in a new C.D. Howe Institute study, "Many other countries, in Europe and elsewhere, also have systems that cost much less than the American one and that, arguably, are at least as equitable as Canada's, if not more so." Yet, "No other country is modelling their health-financing system around the Canadian example," they add. "None of them seem to think that a monopoly approach to paying for most health services is the best way to achieve equity and efficiency goals."

Many of these restrictions do not flow from the Canada Health Act, but rather from provincial laws. For example, Victoria, not Ottawa, prohibits doctors who opt out of the Medicare system from getting any payments from public funds, or doctors who work within the public system from billing patients over and above what the government pays. These restrictions, the study argues, impose big costs. To illustrate this, it focuses on how health care is paid for in four countries - the U.K., Australia, Switzerland and the Netherlands - whose health systems are considered to be among the world's best.

"Their guiding principles are similar to those within the Canadian health care system. All endorse universal public coverage and access for a defined core set of services, the belief that costs should be borne by society at large ... and high standards of care." In all these countries, public spending covers a significantly smaller percentage of hospital and doctor-related costs than in Canada, leaving the balance to be paid by private insurance for those who have it. (The range is from 65-85 per cent for hospital costs, compared to 92 per cent in Canada, and 60-90 per cent for doctors fees, compared with 99 per cent in Canada.)

But their governments also cover 45-67 per cent of drug and other outpatient medical costs, compared with 35 per cent in Canada. The authors consider, and ultimately dismiss, the view that any deviation from Canada's single-payer system would result in higher costs - an often-cited factor when sky-high U.S. health costs are dissected, but not an issue in countries that have a more carefully balanced mix of public and private funders.

Nor do they buy the argument that the public sector would lose out if privately paid health services were allowed to compete for doctors and patients. Indeed, other countries have found that competition can improve service and lower costs. The bottom line is that Canada's health care system only looks as good as many of us like to think it is when we compare it to the American system. And other countries have figured out better ways to fully respect the same vaunted principles Canada aspires to while providing more or better care at comparable cost. We could learn from them.

In Sweden, the pharmacy sector was a government monopoly from 1971 to 2009. Consequently, it was among the countries with the lowest number of pharmacies by population, with barely one outlet per 10,000 inhabitants, about a third as many as in most Canadian provinces. State pharmacies offered very limited opening hours: from 10 a.m. to 6 p.m. Monday through Friday, and from 10 a.m. to 2 p.m. on Saturday. Not a single pharmacy was open on Sunday, and many closed down completely for the summer. Sweden has since profoundly liberalized this sector and the number of pharmacies has skyrocketed as a result, increasing more in the following four years than in the previous 30. In addition to the hundreds that were privatized, 374 new private pharmacies entered the market, thereby improving access for the inhabitants of all regions. The effectiveness and accessibility of the health services provided by the private sector result primarily from the market mechanisms that govern them, namely entrepreneurship, competition and patients' freedom of choice. We should not be surprised to find that these mechanisms are largely absent in the public healthcare system. Yet it is these mechanisms that ensure that patients remain at the centre of care-providers' concerns. We should keep that in mind when thinking of how to reform our ailing public system. Yanick Labrie is an economist at the Montreal Economic Institute (Iedm.org) and author of The Other Health Care System: Four Areas Where the Private Sector Answers Patients' Needs.