When this campaign began, it seemed that universal pharmacare would be a central plank in Prime Minister Justin Trudeau’s bid for re-election.
Polls showed the idea of expanding medicare to cover all necessary pharmaceutical drugs for all Canadians was overwhelmingly popular.
As well, universal pharmacare made good financial sense. The non-partisan Parliamentary Budget Officer has calculated that ultimately it would save Canadians more than $4 billion a year.
The Liberals weren’t shy about hinting that they planned to endorse universal pharmacare.
Last year, the Liberal-dominated Commons health committee recommended that Ottawa create such a program.
This year, an advisory panel created by the Trudeau government and headed by former Ontario health minister Eric Hoskins made the same pitch.
The New Democrats were worried enough about the Liberals outflanking them on the left that they put out their own universal pharmacare proposals in April.
The NDP need not have worried. Trudeau finally revealed his pharmacare plank on Monday. And it is a singularly unimpressive.
First, it is disturbingly vague. It is not clear whether Trudeau is promising a universal program, as advocated by the Hoskins panel, or a more limited version designed to fill in gaps in existing drug coverage, as favoured by Conservative Leader Andrew Scheer and Liberal Finance Minister Bill Morneau.
Background documents released by the Liberals promise only that they would negotiate with the provinces and territories “to seek a mandate to design and implement universal pharmacare.”
The Liberals don’t say what they would do if the provinces and territories fail to give them such a mandate.
They say they would be “guided by” the recommendations of the Hoskins panel. But they don’t explicitly endorse them.
That panel called on Ottawa to move ahead with legislation to create a national, universal pharmacare plan even if not all provinces were onside. That’s the strategy a previous Liberal government used to bring medicare to Canada in 1968, over the opposition of provincial governments in Ontario, Alberta and Quebec. And it worked.
The Hoskins panel also set out an ambitious timeline, calling for the coverage of essential medicines by 2022 and of all necessary drugs by 2027. Monday’s announcement by Trudeau makes no mention of timelines.
Second, the Liberal announcement provides only the scantiest estimates of costs. It says that all of its health care promises — including more money for mental health and better access to family physicians as well as pharmacare — will cost the federal treasury $6 billion over the next four years.
If that’s the scale of their financial commitment to health care in total, then the Liberals don’t plan to accomplish much on the pharmacare front. Both the Hoskins panel and the parliamentary budget officer estimate that, while universal pharmacare would save money for Canadians overall by substantially lowering the price of drugs, it would cost the federal government plenty.
The Parliamentary Budget Officer estimates that once universal pharmacare is fully in place, it will shift about $20 billion in costs from provinces, individuals and companies to Ottawa.
The debate over universality is an old one. In the 1960s, the cabinet of Liberal prime minister Lester Pearson was split over whether medicare should be available to every Canadian or only to those who couldn’t afford private health insurance.
The universalists won that debate within Pearson’s Liberal Party and gave us medicare as we know it. In Justin Trudeau’s Liberal Party, those advocating for universal pharmacare appear to have been less successful.
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