Abstract

The Canadian debate surrounding pharmacare follows some strange rules. On the one hand, there is a strong and widely shared belief that drugs ought to be among the benefits of the public health system, along with the other core services - hospitals and physicians. On the other hand, it is hard not to see the many obstacles to such a project, including the costs associated with drug consumption and the indifference of a large part of the population, which seems to be coming to terms with the fragmentary coverage it already has. Champions prepared to defend the cause of a universal and public system are but a few, and the sour experience of the National Forum on Health (1994-97), which proposed nothing short of comprehensive public coverage, is there as a reminder that a frontal attack is pointless - it looks too expensive, too complicated, too difficult. As did the Greek kings outside Troy, when Ulysses suggested to them that they build a wooden horse, the experts endlessly debate the stratagem that will make it possible to create a public system, without arousing the suspicions of the policy-makers or even the population. The lead paper by Morgan and Willison is no exception: once again, the idea is to achieve pharmacare without alerting potential opponents.