In 1969, the Rolling Stones released the song “You Can’t Always get What You Want.” The lyrics and music swing from optimism to despair to pragmatism. This storyline can be easily applied to the public policy debate around a national pharmacare program.

Over the past 60 years we have seen major initiatives calling for the introduction of a national pharmacare program, including two Royal Commissions (Hall 1964 and Romanow 2002) and a National Forum on Health (Chrétien 1996).

All three initiatives made a strong case for a universal single payer program, but nothing major was done. In every case we moved from optimism to despair.

The result has been a patchwork of provincial-based programs, providing partial or complete coverage only for certain groups. Canada is the only country with a universal health care system that does not include prescription drugs outside hospitals. Also, Canadians pay the third highest patented drug prices among the OECD countries.

The latest effort by the government of Canada was to create an Advisory Council on the Implementation of National Pharmacare with Dr. Eric Hoskins acting as the chair.

Hoskins’ final report once again makes a strong case for a universal, single-payer pharmacare program. But, given the fiscal context and the difficult relationship between the federal government and some provinces, will we see the same outcome as in the past (i.e., despair)?

We have a federal election in about four months. It is time for a meaningful debate on how to implement a pharmacare program. We need a system that would lower drug costs, increase coverage and provide equal access across the country. A national pharmacare program seems to be the way to achieve these goals.

Implementing a national single-payer pharmacare program represents a major institutional change. Hoskins’ advisory council proposes an incremental approach but does not address some of the key implementation challenges.

The upcoming election debate on this issue should address key implementation issues including:

  • Identifying the goalposts and the mechanism for achieving the desired outcome.
  • The role of the federal government, subnational governments and the private sector.
  • Who pays for the incremental costs and how will it be financed.
  • The mechanism to get buy-ins from all subnational governments. A universal system only works if all subnational governments participate in it.

It seems that after so many studies and reports we know what we need but we have not figured out how to achieve it.

It is time to focus on the latter.

Political parties should come forward with an implementation strategy and plan for a national pharmacare program in their 2019 federal election platforms.

Mostafa Askari (chief economist), Jan Kurman (research assistant) and Kevin Page (President and CEO) are with the Institute of Fiscal Studies and Democracy, University of Ottawa.