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Pharmacare: How far is far enough for Canadian voters?

Healthcare is a perennial top 5 issue for most Canadian voters. It’s never far from being top of mind during any federal or provincial campaign. Election 2019 will likely be no different.

But this time around, the likely political focus will not be on the proverbial debates around wait times and long-term care—although these and other health issues could also emerge in the coming weeks.

In our view, now that the federal election writs have been issued and that the campaign is revving up in earnest, major parties' positions on enhancing drug coverage for Canadians—specifically, where they stand regarding the issue of national pharmacare—will likely advance to the top of the list as a key area of attempted political delineation.

This is, however, merely the next major phase of a debate, which has taken up significant political and policy bandwidth in Ottawa and provincial capitals for years. Simply put: this is anything but a new pan-Canadian discussion.

Previous federal-provincial-territorial (FPT) health accords, for example, have included steps to move in this direction. The 2004 Health Accord signed by then-Prime Minister Paul Martin and his provincial premier counterparts stands out as a signature attempt to move in the direction of a more fulsome national pharmacare program.

But nothing stuck. Progress was piecemeal between federal, provincial and territorial governments. And funding disagreements among the levels of government held back any significant changes at a national level. In recent years, the momentum has shifted. The Trudeau government, seeing movement in public opinion numbers and an inherent political opportunity, has slowly positioned itself to incorporate at least some variant of pharmacare as a major platform commitment in the 2019 federal election.

To do so, they enlisted former Ontario Minister of Health Eric Hoskins to lead a committee to generate recommendations that would serve as both the foundation to the eventual policy, but also the political commitments that would precede it. The Hoskins report laid out the following recommendations:

  • A national pharmacare program that operates much the same as our current single-payer medicare system;
  • A stepwise implementation of this plan in partnership with provinces and territories;
  • Low co-payments for patients to reduce barriers to access, and;
  • A strategy to improve access to expensive drugs for rare diseases.

Any “deeper” political foray into this policy domain will come with a high price tag. The Hoskins report was relatively blunt on these and other key considerations.

For the New Democratic Party (NDP) however, it seems unlikely that they will accept any proposal from the Liberal Party as sufficient. The NDP has long campaigned on a comprehensive pharmacare program and would be loath to once again see the Liberal Party absorb, and accomplish, one of its more cherished policies. As was expected, the NDP announced right out of the starting gate that it is committed to pharmacare for all, thus positioning itself as the party with the best—and most uncompromised—pharmacare option.

The equation for the Conservative Party is likely going to be quite different. The party has been relatively quiet on this front, and the issue is not expected to be a core element of its platform. At most, even a commitment to “fill the gaps” in current patient needs is not a foregone conclusion; their current party policy calls for 20-year patent protections while ensuring “no one loses their life-savings because of unexpected health problems or as the result of the costs of prescription drugs”. A targeted tax cut to deal with more of a middle-class “affordability” appeal is likely a more tempting political lane to occupy for Scheer and the CPC team.

The Liberals’ plan will likely be more nuanced. After having triggered the Hoskins report—and already committing to core pharmacare steps in Budget 2019—we envision the party likely waiting to outline specifics on next steps until the direction of the election debate is clear. They will be looking to appeal to the same “progressive” voters as the NDP and Green Party. But the party also knows that fully committing to a comprehensive national pharmacare program comes with a mammoth price point if they secure a second mandate.

The nuance in the eventual Liberal pharmacare plan was put into plain sight on September 5th when Justin Trudeau revealed that the Liberal Party would not force provinces to adopt pharmacare if they do not want it. While the first instinct is to perhaps wonder why that would be the case, it does mirror the implementation of our national health care system, which was adopted piecemeal by the provinces over time. Furthermore, it lets Trudeau better position himself with the Government of Québec, who are active defenders of what they believe to be a provincial issue.

Irrespective of the particular commitment in question by the major parties—and the financial commitments promised—expect drug coverage for Canadians to play a prominent role in this campaign. Canadians will subsequently decide whether this issue becomes a true “vote mover” on election day.