If ‘pharmacare’ means ‘give us billions,’ the provinces are interested

Posted on July 17, 2019 in Health Debates

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NationalPost.com – Opinion
Kelly McParland

The premiers are in unison that if Ottawa wants to hand them $15 billion, no strings attached, they’re willing to accept the cheques and do with it what they please

For a time, it appeared possible Canada’s premiers might end their latest get-together without finding something new to fight about with Ottawa.

Alberta’s Jason Kenney complained about pipeline issues; Quebec’s François Legault declared Quebecers would rather face civil servants wearing crucifixes than let a pipeline cross their sacred territory; Manitoba’s Brian Pallister said Quebec’s fixation on crucifixes and the like is “dangerous” and “unCanadian.” Then they all held a final sit-down and announced that — if you ignored all the things they’d just been complaining about — Canadian unity is strong, give or take parts of Alberta.

Liberals in Ottawa must have been astonished: was it possible Justin Trudeau’s troops would be allowed to spend the rest of the summer peacefully handing out government cheques just coincidentally before an election is called?

Of course, it was not to be. Premiers’ gatherings are not called so they can fight among themselves, they’re called so they can complain about Ottawa. And, in the end, they did indeed find a point of contention on which they could all agree: pharmacare.

Some weeks back, the federal government was handed a report urging it to introduce a universal, single-payer drug program. “Universal, single-payer” means everyone gets it, and the government pays. The proposal, from a commission headed by Dr. Eric Hoskins, was expected to cost about $15 billion a year once fully implemented. Given how rarely governments get cost estimates right, the real tab is anyone’s guess. Kevin Page, the former parliamentary budget officer, calculates it would be closer to $20 billion a year.

The premiers are all for pharmacare, and why wouldn’t they be? Freeing people of the cost of their meds is one humdinger of an election bauble, and both the Liberals and NDP are expected to roll out plans when the election race officially begins.

But, this being Canada, the premiers are fully capable of supporting a plan while simultaneously building roadblocks against it. And so they did: while they agree it would be great if Canada had a national drug plan, they want it to be under their control, designed according to standards developed in each individual province, with only the money coming from Ottawa.

“My main focus would be to encourage any federal party to respect provincial jurisdiction in the delivery of health services,” said Kenney. “We’re the ones closest to our citizens, we know what their needs are. And that applies to any additional federal funding for pharmaceuticals.”

They also want to be able to opt out, while keeping the money as if they’d remained within the plan. They didn’t say what they’d do with the money: that would be up to each province. A statement by the premiers indicated Quebec has already decided it wants nothing to do with a federal plan and will stick with its own, though of course it would want a cut of the money Ottawa doles out to other provinces.

So, in short, the premiers are in unison that if Ottawa wants to hand them $15 billion or so, no strings attached, they’re willing to accept the cheques and do with it what they please. And who says it’s hard to get consensus in Canada?

Goofy as it may sound, it’s not impossible Trudeau’s Liberals — if they survive the election — could live with something that fits the demands of the provincial and territorial leaders. The carbon tax introduced — and in some cases imposed — by Ottawa operates by setting criteria for carbon emissions and letting the provinces organize their own means of meeting them. Theoretically, a pharmacare program could work in similar fashion, with the feds setting a baseline while leaving each province free to decide how to meet it.

But there’s a key difference: the carbon tax doesn’t dangle billions of dollars before the eyes of revenue-hungry premiers. In those provinces that refused to design their own plan, the revenue is rebated to taxpayers. And there’s no opt-out clause in the carbon tax; provinces can’t get out of it no matter how much they complain, as Saskatchewan and Ontario learned in launching unsuccessful court challenges.

We’re the ones closest to our citizens, we know what their needs are. And that applies to any additional federal funding for pharmaceuticals

Apart from the joy of arguing, there are real reasons the provinces would be wary of signing on to a drug regime designed and operated from Ottawa. As doubters were quick to note, the Liberals have been promising pharmacare in one form or another for more than 20 years. Meanwhile, some provinces have introduced their own plans; B.C. Premier John Horgan boasted that his province has “a very comprehensive pharmacare program” already. The provinces have also cut costs by organizing a purchasing alliance to negotiate better deals on drugs.

Apart from those concerns, you would have a hard time finding a provincial politician with much faith in Ottawa’s reliability as a long-term financial partner. The share of federal funding for health care “has declined significantly” over the years, the premiers complained. Nova Scotia Premier Stephen McNeil — one of only two Liberal premiers left in Canada — noted that federal coverage of health-care costs has fallen from 25 per cent to as low as 18 per cent. As Conservative leader Andrew Scheer noted: “I don’t think anybody thinks that when the Liberals announce multi-billion-dollar spending programs that they’re going to save any money.”

He’s probably right, but pharmacare’s on the horizon, and provincial leaders will be loath to get in the way if Canadians decide they want it. Once it’s in place, they can go back to attacking Ottawa over the details.

Kelly McParland: If ‘pharmacare’ means ‘give us billions,’ the provinces are interested

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