Why we may not get public pharmacare any time soon

ANALYSIS: A committee headed by a prominent Ontario Liberal has recommended that Ottawa move ahead with full public pharmacare. But that can’t happen before the next election — and, after October, provinces may stand in the way
By John Michael McGrath - Published on June 13, 2019
Eric Hoskins
A panel chaired by Eric Hoskins released a report in Ottawa on Wednesday calling for full national public pharmacare. (Sean Kilpatrick/CP)

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Eric Hoskins has made the most of the gig he bailed on Kathleen Wynne for. Hoskins was the minister of health and long-term care under the former Liberal premier until he left provincial politics abruptly in February 2018 to take a job advising the federal government on creating a national pharmacare system. And, as Steve Paikin reported back then, in this context, “abruptly” meant “in such as way as to irritate a bunch of his fellow Liberals.”

Despite some early signs that the panel he chaired wouldn’t produce sufficiently ambitious recommendations, the final report, released Wednesday, calls for full national public pharmacare with cheap co-pays. The system it envisions would be bankrolled by Ottawa and be up and running by 2022.

Only eight things stand in the way: the next federal election and the seven conservative provincial governments currently in power, all of which are generally skeptical of major government expansions, especially those led by Justin Trudeau.

Ontario’s current minister of health and long-term care, Christine Elliott, certainly hasn’t jumped on the pharmacare bandwagon just yet. Hayley Chazan, Elliott’s spokesperson, told TVO.org via email that the minister will be reviewing Hoskins’s work: “We will measure all recommendations against their impact on the sustainability of our public health care system while keeping in mind the lessons learned with OHIP+ — mainly, the fact that many young Ontarians ended up with worse coverage than offered by their private insurance plans.” (Whether young Ontarians were actually worse off under the Liberals’ OHIP+, which offered free prescription drugs to those under 25, is a matter for debate.)

The Ford government’s apparent reservations are important to note, because national public pharmacare is not going to happen without provincial participation. More potentially bad news for the program: the Legault government, in Quebec, has warned the federal Liberals against trying to “dictate” provincial health policies, and the Hoskins panel explicitly states that Quebec’s current policies should not be used as a model for a national system.

Only two years ago, pharmacare advocate and University of British Columbia researcher Steve Morgan said (in an interview with TVO.org) that the election of an NDP government in B.C. had set the stage for an alliance of progressive, pro-pharmacare provinces to press their case with the federal government. As B.C., Alberta, and Ontario make up a major demographic and economic slice of the country, they’d be hard for any prime minister to ignore.

Today, only that NDP government in Victoria remains in power. Whoever wins the next federal election in October will face a number of conservative governments, many of which came to power only in the past year, meaning they have long mandates ahead of them.

It would be one thing if Hoskins and his panel had unearthed some new idea or broken new policy ground. But the final report expressly acknowledges that they haven’t: the arguments for pharmacare haven’t changed in 50 years — they’ve simply become more urgent. Instead of taking action, though, the federal Liberals spent a year performatively “consulting” to get the answer they wanted.

All of which is just a long way of saying that multiple federal political parties (the Liberals, the NDP, and the Greens, at a minimum) will likely spend a lot of time and energy over the next several months arguing why they, and not their rivals, should be the ones to cash the cheque that Hoskins has written. But nothing that happens in Canada’s 43rd general election can change the fact that it’s the provinces that are responsible for delivering health care in Canada’s federal system — and the current political prospects for pharmacare in the provincial legislatures are dim.

If the federal Liberals ever had a window to make real national progress on pharmacare, it’s now closed. Try again in the 2020s.

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