Canada's premiers ( the leaders of provincial governments), if they have any breath left after complaining about Ottawa at their late July annual meeting, might spare a moment to do something, to reduce health-care costs. They're all groaning about soaring health budgets, the fastest-growing component of which are pharmaceutical costs. 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 31 million people. Basic economies 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-ordinating 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 nationalist 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.