Social Policy in Ontario

As governments across the country rise for the summer, and as federal political parties prepare for the election this fall, we have some “quiet” time to reflect on the type of future that we envision for our communities. Importantly, this is a time to think about what public policies we need for the future we want.

Despite the strength of our economy, a number of measures reflect the pressures that individuals and families across Canada are experiencing. For example, four in ten Canadiansreport living paycheque to paycheque, almost half of Canadian households lack savings to keep them out of poverty for more than three months, 1.7 million Canadians report living in inadequate or insecure housing, and 1 in 10 Canadians cannot afford to take the medications they need.

The public policies we decide to implement to respond to these pressures could either amplify these problems, or change the trajectory of the trends we are seeing. We need to think carefully about what public policies we need.

The public systems that we developed decades ago—such as public health care, Employment Insurance, and social assistance—were reflective of the political, economic, and social realities of that time. The social contract between governments, employers, and the general public often meant that many benefits that helped secure and stabilize the lives of working-age adults were negotiated between employers and employees. Public programs often focused on those outside of the labour market (e.g., programs for seniors), or provided stop-gap support to those in between jobs in their working-age years.

Given how vastly different our economy and labour market look today, we need to be innovative in the way we approach and respond to public policy problems so our solutions are reflective of our current and anticipated realities.

As we think about the future of our public systems, we need to think about how new or strengthened initiatives interact with programs that already exist, about the values they impart, and about the tough decisions we expect elected officials to make. These tough decisions require an honest conversation about priorities, trade-offs, and consequences. And they require paying attention to the basic human rights and dignities that should be afforded to all people in Canada.

For example, there is a heated debate in Canada about the appropriate public policy response, if any, to ensure all Canadians have access to affordable prescription medications.

For some, a universal, publicly-funded pharmacare program is unnecessary. They argue that a program that fills the “gap” for the 20 per cent of Canadians who report being uninsured or underinsured would help achieve the goal of comprehensive pharmacare coverage. Furthermore, such an approach would not disturb the current “ecosystem” that Canada has in its over 100,000 private plans and 100 public plans, and would prevent shifting billions of dollars in private/employer spending to the public purse.

Others call for a move to a universal, publicly-funded pharmacare program—as echoed in the Advisory Council on the Implementation of National Pharmacare. Such a move would not only help complete the formation of Canada’s public healthcare system, but, from a social policy perspective, would also help ensure that all Canadians continue to have access to medicines that they need.

So how do we decide which path to pursue?

While the debate is often focused on those without adequate access to prescription drug coverage, our public policy response must be rooted in an understanding of our economic and social contexts.

A publicly-funded and universal pharmacare program would be forward-looking and reflective of our economic and social realities because it would include the 60 per cent of Canadianscovered by employer-sponsored or private health plans.

It is this segment of the population that is at the crux of the changing relationship between employers, employees, the government, and the broader public.

Some estimates show that between 2017 and 2025, Canadian employers will face upwards of a 130 per cent increase in the cost of their health benefit plans. Although some of these plans might cover new medicines not covered by a national drug formulary, with cost-pressures like these, employers will determine how best to limit this cost growth. This could lead to even greater inconsistency in prescription drug coverage that Canadians have.

Layer on concerns about increasing precarity in the labour market and the retreat of some employers in providing workplace benefits, and it becomes clear that a fill-in-the-gaps approach to pharmacare would be an inadequate response to the economic and social changes we are experiencing.

A publicly-funded pharmacare program would be forward-looking as it recognizes that the employer-employee relationship is changing rapidly, that the costs employers face are increasing significantly, and that a universal program can help respond to these pressures (e.g., through gains in bulk-purchasing).

In the long run, a universal pharmacare program may be collectively more cost-effective. But the shifting cost on the public purse (estimated at $15.3 billion per year by 2027) means we would have tough choices to make. An investment in pharmacare to help prepare us for the future may come at the cost of another public program or decisions to increase public revenues — but that’s a choice we have to make if we want to build systems that can endure.

Ultimately, good public policy requires balancing social, economic, fiscal and political considerations. We can get clarity on the best path to pursue if we decide that future public policies prioritize and articulate the dignities and rights that we think all Canadians should be afforded by virtue of being a human being, and not because of where we work. By doing this, we have an opportunity to build a strengthened and modern social architecture.

This would also mark a significant change in the way that social policy is developed in Canada. It would set us on a path that helps us build the future that we want, one that works not just for today, but hopefully for tomorrow as well.

Prioritizing fundamental human rights can help us find the clarity we need for good public policy