Seniors' pharmacare program changes misleading, says Graham Steele

Political communication is an art, and last week the McNeil government painted a Picasso.

The news release issued last Thursday on changes to the seniors' pharmacareprogram was a textbook example of how to direct, or misdirect, public attention.

Because of the sensitivity of the topic,you can be sure these changes were massaged at the highest levels of the political apparatus.

To understand the artistry of what the government did, you first have to know how seniors' pharmacare works.

Seniors' pharmacare is a major government program, with a budget this year of $166 million. It's insurance for 120,000 seniors against the cost of medication. It's also a big public subsidy.

If you're in the program, your total cost is a combination of two things: your premiumand your co-pay.

The premium is an annual fee. Currently the maximum premium is $424. About half of the seniors enrolled in the program pay no premium because of their modest income.

The co-pay is the amount paid at the pharmacy counter. A seniors' pharmacare member currently pays 30 per cent of a drug's cost, up to an annual maximum of $382.

Once the member hits the maximum co-pay (and it doesn't take a lot of medication, or expensive medication, to hit the maximum) the province pays the full cost for the rest of the year.

Maximum premium up

The essence of the changes announced last Thursday are that the maximum premium is going up, and the co-pay is going down. The maximum premium will jump from $424 to $1,200.

The co-pay is dropping from 30 per cent to 20 per cent. The maximum co-pay stays the same at $382.

The impact on any individual senior will depend on their income, and their specific medication needs, in the year ahead.

The fact that the impact on any individual senior can't be predicted precisely leaves plenty of room for artistry in the way the information is communicated.

Misleading impression

The news release on seniors' pharmacare is a carefully-crafted and highly political document.

There is not one sentence in it that is untrue, and yet the overall impression is, in my view, misleading.

The headline is "Lower seniors' pharmacareco-pays beginApril 1," followed by a lead paragraph saying "Nova Scotians enrolled in the program will soon pay less each time they pick up a prescription."

That sentence is true, but it leaves out two important qualifications.

First, the change in co-pay won't matter to anyone who takes enough medication to hit the ceiling anyway. They will pay slightly less each time they fill a prescription, but their total annual cost is the same.

It also leaves out the other part of the equation: the premium. The total cost of seniors' pharmacare will be going up for many seniors. But how many?

No clouds allowed

You may look in vain in the news release, or any of the department's supporting information on its website, for an answer to that question.

This sunny ways news release won't allow any clouds.

We're told that 47,500 seniors will be exempt from premium; 12,000 seniors will see their premium drop to zero for the first time; 29,000 seniors will qualify for a reduced annual premium. Good news.

But nowhere is it stated how many will pay more.

The answer, which I obtained only by inquiring at the Department of Health and Wellness, is 33 per cent. In other words, 40,000 seniors will pay a higher premium, starting April 1.

No debate

This is, by any measure, a major policy change.

Frankly, the changes strike me as reasonable, or at least defensible. A more rigorously income-tested approach to an important, expensive program like seniors' pharmacare is good public policy.

But there has been no debate in the legislature, no discussion paper, no public consultation.

Some households will take a substantial hit. If the same thing had been done via taxation, there would have been an uproar.

As an ex-politician, I can admire the way public reaction was managed.

As a citizen, though, I want to shout from the rooftops: "Don't you see what they just did there?"

Net revenue generator

The other important question is how much all of these changes will cost, or, as I suspect, how much extra revenue the changes will generate.

I asked the Department of Health and Wellness twice for the expected budgetary impact. The department declined twice to provide a figure.

It is inconceivable that the government would undertake a major overhaul of a sensitive program without having a very good idea of the dollars involved.

Their refusal to provide a figure only reinforces my suspicion that the changes are a net revenue generator for the government.

But that story that these changes are being driven by revenue considerationsdoesn't fit the overall good-news framing.

So it got left out.

Textbook.