Pharmacare: Are the Liberals serious about it this time?

All the evidence points to a need and significant savings, but no government has been willing to take on the challenge so far

The federal Liberals are flirting with pharmacare again. Maybe this time they are serious.

Providing Canadians with pharmacare — a single, universal, publicly funded prescription drug program — should be a no-brainer. Study after study shows it would be cheaper, fairer and more effective than the grab bag of private and public insurance schemes that characterize the current Canadian system.

And yet no federal government has been willing to tackle the project.

Before the 1997 election, Jean Chretien’s Liberal government famously promised to move on pharmacare, establishing the National Forum on Health to look into the idea.

But when the forum reported, the government simply dismissed its recommendations.

Given that track record, it is easy to be skeptical about the surprise decision by Justin Trudeau’s Liberal government to reprise pharmacare.

This week, the government hired former Ontario health minister Eric Hoskins to head an advisory council on how to establish a pharmacare system. The council is to report before the 2019 federal election.

If the Trudeau government is serious, then Hoskins is a wise choice. A physician himself, he’s been a fierce advocate for national pharmacare. As Ontario health minister, he oversaw the implementation of a mini-pharmacare scheme to provide drug coverage for those under 25.

While limited in scope, the Ontario scheme is well-designed. Like medicare, it is universal, covering all regardless of income. Again, like medicare, it involves no user fees or copayments. Young people are covered for 100 per cent of their eligible prescription drug costs.

Although it is relatively cheap (young people tend to be healthy), it does provide a base upon which to build a full-scale pharmacare system.

In designing a truly comprehensive national pharmacare program, Hoskins will face three problems. The first is cost. Although studies show that pharmacare is cheaper overall, it does off-load more of the cost on governments.

A report last fall by the Parliamentary Budget Office calculated that Canadians pay about $24 billion a year for pharmaceuticals. A federally funded national pharmacare program would save about $4 billion. But it would also shift the remaining $20 billion from those who currently pay (employers, individuals, provincial governments) to Ottawa.

And Ottawa is usually wary of that. The second problem has to do with federal-provincial relations. The provinces, which all offer drug programs to the elderly and poor, are in favour of a national pharmacare program that sees Ottawa picking up more of their costs.

But at the same time, they are jealous of their prerogatives and fearful that Ottawa might yet again stiff them for the cost of an ambitious national social program.

Quebec, for instance, already requires its citizens to have drug coverage either through private plans or the provincial public system. It’s a less efficient way to provide drug coverage than a single-pay, pharmacare system, but it is popular with the province’s private insurers.

The third problem is that pharmacare cost savings depend largely on the bulk buying of drugs. In effect a single, national pharmacare system would have enough market power to substantially bargain down drug company prices.

The drug companies don’t like that. Traditionally, they have threatened to stop manufacturing drugs in jurisdictions that engage aggressively in bulk buying.

All of this means Hoskins will have his hands full.

Still, if the Liberals are serious (a big if ) his appointment is a welcome development. The New Democrats offered a rudimentary, nonuniversal form of pharmacare before the last general election. They are talking about pharmacare again.

But maybe we’ll get lucky this time. Maybe next year we’ll elect a government that delivers this sensible yet long overdue health-care program.

Providing Canadians with pharmacare should be a no-brainer. And yet no federal government has been willing to tackle the project.