The health minister and health critic spoke cordially of their ability to compromise, by which I mean come to an agreement about which neither is particularly enthusiastic
The marriage of convenience between the Liberals and NDP is based on a simple transaction: Jagmeet Singh has agreed to prop up Justin Trudeau’s ailing government in exchange for the prime minister’s tepid backing for the NDP leader’s policy priorities.
The half-hearted nature of that support was apparent when Health Minister Mark Holland unveiled Bill C-64, the new pharmacare legislation, at a community health centre in Ottawa on Thursday.
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Holland was accompanied by the NDP’s health critic, Don Davies. Both are decent men and spoke cordially of their ability to compromise, by which I mean come to an agreement about which neither is particularly enthusiastic.
The first, and perhaps only, fruit of this collaboration was the announcement that Canadians will soon be able to get contraceptive and diabetes medication at a pharmacy without paying out of pocket. At least they will if their province signs up for the deal. Alberta and Quebec have already indicated that they have exclusive jurisdiction over health and will opt out of the program, while claiming full compensation. Alberta Health Minister Adriana LaGrange called the deal a “hastily arranged, politically motivated program,” a not-unreasonable precis given Singh had given Trudeau a March 1 deadline for the legislation.
Holland said contraceptive medications were chosen because birth control gives women control over their own future and their own bodies. And diabetes causes so many complications that cost should not be one of them, he said.
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Pharmacare has long been a fixation for New Democrats, to the point where the Liberals thought it was a good electoral wheeze to purloin it from the NDP and add it to their own platform.
In government, their enthusiasm waned. Former finance minister Bill Morneau noted in his book Where To From Here that a universal, single-payer system, such as the one advocated by the Hoskins advisory committee in 2019, would be extremely expensive — an additional $15 billion a year). Morneau also noted it would be difficult to implement because it would face opposition from the half of Canadians who are happy with their own employee-based private insurance coverage, and from many of the provinces, who would prefer no-strings attached cash injections. He thought implementing pharmacare would swallow up an inordinate amount of government time negotiating with businesses, insurance companies and the provinces, and instead suggested a “fill the gaps” approach for people without public or private insurance, which could be achieved for a relatively modest $3 billion per year.
His successor, Chrystia Freeland, may be more sympathetic to the universal pharmacare concept but she has found the demands on the public purse mean that she does not have a spare $15 billion lying around to spend on a solution in search of a problem.
The New Democrats, for reasons best known to themselves, continue to prioritize pharmacare over other more pressing health issues, such as surgical wait times, senior care or mental health services.
At their fall policy convention, their rank-and-file membership voted to withdraw their support for the confidence-and-supply agreement keeping Trudeau in power unless he commits to a universal, comprehensive and entirely public pharma program.
Bill C-64 does exactly that, but it makes no spending commitments and is transparently an attempt by the Liberals to do as little as possible while keeping the NDP onside.
Davies, the NDP health critic, described C-64 as “a structural foundation” for future expansion because it enshrines in legislation two building blocks: it obliges the minister, within a year of royal assent, to draw up a list of essential medicines that would form the basis of a national formulary of drugs; and, in the same time period, to develop a national bulk-buying strategy to drive down the price of drugs in negotiations with pharma companies.
Davies is an experienced union negotiator and no naïf. He is taking a patient approach that relies on the NDP increasing its leverage at the next election.
“I’m the middle child, which I think was critical” to reaching an agreement, he joked.
But Holland’s appraisal was more candid: “This is a pilot.” He gave a ballpark financial cost of around $1.5 billion to roll out free contraceptive and diabetes medication. “This is an opportunity to evaluate this model in the real world and see how it works,” he said. “Until now, most of this has been in the theatre of the mind.”
Holland talked about incrementalism and prudence — concepts that are alien to most New Democrats.
He even held out the fantastical prospect that the data may reveal that the government saves more than it spends, thanks to reduced hospital visits and lower drug costs.
Not to cast aspersions, but if that statement were a government bond, it would be rated as “extremely speculative.”
The Conservatives have already signalled their hostility towards a universal, single-payer pharma plan, pointing out that most Canadians have existing coverage through their workplace or provincial social services.
It may well be that the national pharmacare strategy goes this far, and no further.
That would be no great mischief. A recent study by the Montreal Economic Institute suggested that many Canadians would have less access to drugs under a single-payer national plan than they do now.
It said 24.5 million Canadians (65 per cent of the population) are covered under private plans. Most of those people live in the biggest provinces — Ontario, Quebec, B.C. and Alberta — and with more coverage than the most generous public plan provided by Quebec’s Régie de l’assurance maladie du Québec (RAMQ). Most experts have suggested a federal list of drugs would be similar to Quebec’s, which would mean more than 20-million Canadians would experience a reduction in the quality of their drug coverage under a pharmacare plan, the MEI said.
In that event, it suggested the most practical solution would be to plug the gaps in the provincial systems and cover the up to 3.8-million Canadians who are either ineligible or not signed up for existing public or private systems.
But practical solutions, like small dreams, have no power to move the hearts of New Democrats. Hence, the facade of historic legislation to sugarcoat a relatively modest drug giveaway.
National Post
jivison@criffel.ca
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