Canada loves its single-payer healthcare system. In 2009, a poll commissioned by the Canadian Medical Association revealed that 86 percent of Canadians favoured “public solutions” for improving medicare. In 2013, another set of polling data conducted by Nanos Research found that “more than six in ten Canadians would be open to paying higher taxes if it meant health homecare costs or drug costs would be covered.” CBC viewers, after all, crowned Tommy Douglas—the leading figure behind the birth of medicare—the “greatest Canadian.”

Praise for Canada’s healthcare system is not only a national phenomenon. United States Senator Bernie Sanders, who reinvigorated the American progressive movement, spoke highly of our system. Sanders has crossed the border on numerous occasions to purchase cheaper pharmaceutical drugs, once taking a group of people with diabetes on a bus from Detroit to Windsor to get insulin at a Canadian pharmacy.

“We will do also what the Canadians do,” he said on the trip. “They look around the world and they see what other countries are paying for various types of prescription drugs, and that is what they charge here in Canada.”

In 2014, Dr. Danielle Martin—Assistant Professor and Vice President of Medical Affairs and Health System Solutions at Women’s College Hospital in Toronto—found herself at the junction of Canadian and American sentiment when she was asked by Sanders to present a strong case for our health care system before a partisan US Senate committee. In her testimony, which has since gone viral, Martin explained to skeptical American politicians that commonly listed issues with Canadian medicare—long wait times for elective procedures, for example—are not due to our single-payer program, but in spite of it.

In 2017, Dr. Martin published Better Now: Six Big Ideas to Improve Health Care for All Canadians, which presented, among five other broad proposals, calls to expand healthcare to cover the costs of pharmaceutical drugs. To many, the idea is common sense. If a patient cannot afford the necessary drug for their treatment, the likelihood of their recovery is slim. In other words, the Canada Health Act, which claims “to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers,” would have failed them.

There is absolutely no logical or moral reason to exclude pharmaceuticals from our healthcare plan. They are, like any other evidence-based tool, fundamental to modern medicine. Yet, in Canada, provincial and territorial pharmaceutical drug plans only extend to provide “coverage for those most in need, based on age, income, and medical condition.” Many are still left without coverage.

According to a 2017 federal report, Canadians spent roughly $4.7 billion on out-of-pocket pharmaceutical expenses. Data analysis from 2007 found that “9.6% … of Canadians who had received a prescription in the past year” did not adhere to it due to cost. To our government’s embarrassment, McMaster University Professor Katherine Boothe reminds us that “Canada is the only country with a broad public health system that does not include universal, nationwide coverage for pharmaceuticals.”

The history of this political failure is full of shortsighted back-and-forths. In the early 1960s, the Royal Commission on Health Services called for a “comprehensive, universal Health Services Programme for the Canadian people.” Yet, as professor Boothe concludes:

its recommendations for pharmaceutical coverage were not adopted or indeed seriously considered, and this can be explained by the entrenched ideas among federal elites that health policy development should proceed incrementally and that pharmaceutical insurance posed special challenges with regards to affordability.

There is, however, an economic interest in upholding a barrier between the conceptual realms of medicine and pharmacology, and it all comes down to private profits. In simple terms, the pharmaceutical industry and private insurance companies do not want pharmacare. Why? Because, if implemented, the policy would deleteriously affect the bottom of line of drug makers, even though data demonstrates that pharmacare would likely save average Canadians money.

Last year, several pharmaceutical companies “filed a complaint in a Canadian court challenging the constitutionality of new Canadian regulations meant to lower patented drug prices” ahead of October’s federal elections.

Unfortunately, these “interest groups” have protected themselves inside the belly of a figurative elephant in the room. As Martin notes in her book, “these economic powerhouses exert tremendous political influence” on our democracy. “Their current business model,” argues Steven Lewis, “owes much of its success to me-too drugs, mischievous litigation to extend the life of patents, massive marketing campaigns, excess utilization, and price maximization.” No wonder, then, that political proposals to expand pharmaceutical coverage have been lukewarm at best.

Being the elephant in the room works well for these “interest groups,” as they remain relatively free from serious public scrutiny. However, this collective silence is impoverishing working Canadians, putting their health at risk, and limiting their freedom from the debilitating burdens of illness. The tepid language of policymakers, advisory committees, and bureaucrats shrouds the greed which motivates these companies to privilege profits at the expense of Canadian patients.

But it wasn’t always like this. Canadian political sentiment has quickly forgotten that medicare was not implemented by a series of bureaucratic paper-pushing—it was inspired, motivated, and fought for primarily by workers and farmer’s unions, represented by a burgeoning political organization called the New Democratic Party (formerly the Co-operative Commonwealth Federation), which, at the time, upheld principle over public relations. The history of medicare, now widely cherished, was not a polite affair.

An essay published in Canadian Dimension accurately summarizes the resistance carried out by capitalist and professional classes against medicare, which was infamously epitomized in the Saskatchewan doctors’ strike of July 1-23, 1962, a movement “based on outrageous lies about the intent of medicare, racial slurs, red-baiting, acts of violence and threats of blood in the streets.” The strikers’ moral weakness apexed in Red Scare fear mongering, a popular tactic at the time; history, however, has exposed their reactionary politics as popular betrayal.

Contemporary resistance to pharmacare is not so different. For instance, a 2019 article published by the Fraser Institute entitled “Pharmacare plan will likely limit drug access and hurt patients,” makes the fraudulent claim that “a national pharmacare program in Canada could halt pharmaceutical innovation” without any listed references. Contrary to this claim, a 2014 annual report prepared by the Patented Medicine Prices Review Board states that “the percentage of [research and development]-to-sales by pharmaceutical patentees in Canada has been falling since the late 1990s and has been under the agreed-upon target of 10% since 2003.” There is indeed no causal link between high drug prices and increases in innovation.

The Fraser Institute, to no one’s surprise, is a right-wing think tank funded, in part, by the pharmaceutical industry. So, to properly frame the issue, let us call these “interest groups” what they actually are: capitalists. Further, let us call their interests what they actually are: power.

If we want medicare reform, we need to be confrontational. We need to speak truth to power. And we need to expect and prepare for aggressive resistance. The same principle applies to the fight for universal dental care and other similar reforms to strengthen the saftey net.

Endless proposals and reports in support of expanding medicare are routinely prepared by policymakers and presented to governmental bodies. Several advocacy groups focusing on expanding medical coverage, such as Canadian Doctors for Medicare, already do useful work in this regard, and the NDP’s current platform includes a proposal to implement universal pharmacare. But these policies are pragmatically useless without the backing of public mobilization.

Data and statistics will keep piling up on the desks of indifferent bureaucrats, functioning, in a sense, like political sedatives. We cannot allow the passive decorum of Canadian political sentiment to temper our latent power—justice only emerges by means of popular revolt.

Resisting capitalist interests will not be an easy task, but the fight to expand medicare must be led by working people—not policymakers.

Emmanuel Adams is a writer and journalist, as well as a community-involved activist and medical student at McGill University. Emmanuel holds a BA in English Literature and Philosophy from McGill University.