Pharmacare must happen even if some provincial governments say no

Sometimes, the federal government must go ahead with policies in the national interest despite provincial opposition. Urgently needed, bold action on climate change is an obvious example. Trying to herd provinces and territories into consensus on such an issue is a recipe for inaction, which is a recipe for disaster.

This is also true in health care, as history has taught us.

In the early 1940s, the federal government proposed a comprehensive, national health insurance system akin to what would become the British NHS later that decade. However, some provincial premiers wanted none of it.

Several premiers asserted health care is their jurisdiction, so the federal government should keep out of it — except for sending money their way. Conservative premiers added that they preferred a limited government role in health care. The federal government gave in to opposition. There would be no NHS-like health-care system for Canada following the war.

Eventually, Canada did achieve universal, public insurance for select health-care services: hospital and medical care, in particular. That “Canadian Medicare” system has benefited residents in every province and territory and has become a source of national pride.

But it is often overlooked that Canadian Medicare came into being not because of provincial support but despite provincial opposition. Yes, some premiers — like Saskatchewan’s Tommy Douglas — embraced universal, public health insurance even before the federal government did. Nevertheless, some premiers wanted public health insurance to be limited, covering only the elderly and the poor — which was the model the U.S. would embrace as its standard.

Luckily for Canadians, Lester B. Pearson’s minority Parliament did not give in to conservative premiers. Prime Minster Pearson and Health Minister Allan MacEachen passed the ambitious Medical Care Act in 1966 with the support of the NDP. The act provided considerable federal funding — 50 per cent of program costs — to provinces that met national standards for universal, public health insurance programs. The Medical Care Act offered a lot of money, but with strings clearly attached. Provincial premiers hate that kind of thing for reasons that have less to do with the well-being of provincial residents than they have to do with the power of provincial premiers.

But the scale of the federal funding offered in the Medical Care Act not only helped all provinces to be able to afford to implement Canadian Medicare, it also ensured that even reluctant provinces would participate. Within a few years, all provincial governments embraced the idea or were replaced by provincial governments that did.

A similar process is now underway concerning pharmacare.

Since the 1960s, five national commissions have recommended that prescription drugs be included in Canada’s universal, public health insurance system because that is the most equitable and affordable way to ensure equitable access to necessary medicines for all Canadians. Trudeau’s minority parliament can (finally!) implement such a national pharmacare program. It can do so with the support of the NDP.

But, as recently as this week, premiers say they want more healthcare money without strings. Some premiers appear to prefer that Canadians purchase their drug coverage from private insurers.

Does this mean national pharmacare is already dead? Not at all.

In the end, it will not matter if Ford, Kenney or any other provincial premier doesn’t want universal pharmacare at this moment or if they prefer U.S.-style prescription drug insurance for Canada.

Prime Minister Trudeau and Health Minister Patty Hajdu will need to outline a principled, evidence-based national pharmacare standard. It has to be something that is practical and that Canadians can get behind — and they have just that in the final report of Trudeau’s Advisory Council on the Implementation of National Pharmacare. Then, the federal government needs to put significant funding on the table ... only for provinces that comply with the national pharmacare standard.

If Trudeau’s government does this, provincial governments come around or get replaced by provincial governments that will. Simply put, naysaying premiers were not elected because they opposed national pharmacare in the last round of provincial elections, but their opponents might be elected because of their support for it in the next election.

That is how we got Canadian Medicare in the 1960s. That is how we will get national pharmacare now, even if some premiers protest at the outset.

Steve Morgan is a professor in the University of British Columbia School of Population and Public Health and founder of Pharmacare 2020, a campaign supported by more than 1,300 academic experts in health care and public policy. Twitter: @SteveUBC