Why keep so quiet on pharmacare?
When NDP Leader Thomas Mulcair announced his plans for a national pharmacare plan last week, he was uncharacteristically low-key.
He didn’t promise a medicare-style plan that would allow the sick to receive necessary prescriptions free of charge. He didn’t give a target date for implementing his plan.
He didn’t explain how his proposed universal scheme would fit in with existing private drug plans that are offered by many employers.
He didn’t even use the word pharmacare. His pledge was sandwiched in after a televised leaders debate, on a day when reporters were more concerned with Conservative Leader Stephen Harper’s use of the term “old stock” to describe some Canadians.
All of which is a shame. Because if the New Democrats are serious about this, their pharmacare scheme could be one of the most important health-care initiatives in decades.
Pharmacare is the great idea that never quite gets off the ground. Jean Chrétien’s Liberals talked about it but never acted. In 1975, Saskatchewan’s NDP government sent up a provincial pharmacare scheme. In 1993, another Saskatchewan NDP government cancelled it in order to pay down the province’s deficit.
Yet study after study shows that a national universal pharmacare scheme would save money.
A recent study in the Canadian Medical Association Journal calculates that universal pharmacare would cost governments an extra $1 billion a year but would save Canadians, as a whole, $7.3 billion.
The savings come from the ability of a national plan to bargain for better prices with the drug giants and pool risk over a large population, as well as the cheaper administration costs that come from replacing multiple private insurers with one single-pay system.
To the NDP’s credit, the party seems to understand this. Indeed, background material provided to journalists cites the CMAJ study.
Still, the proposal announced last Friday seems unusually woolly. Mulcair does talk of bulk-buying as a way to reduce drug prices. And he does pledge to have Ottawa spend $2.6 billion over four years.
But would the NDP plan cover all Canadians or just those who currently don’t have private drug insurance? I put those questions to the New Democrats. On the one hand they said their scheme would be universal (that is, it would cover everyone). On the other they said they wouldn’t meddle with existing private plans.
All of this matters according to Danielle Martin, a Toronto family physician and one of the authors of the CMAJ pharmacare study. She points out that if the plan doesn’t cover all Canadians — that is, if it doesn’t replace existing private plans — it won’t achieve the savings associated with a single-pay system.
Marc-André Gagnon, a Carleton University public policy professor and another co-author of the CMAJ study, says the NDP’s language around its proposal seems deliberately fuzzy — perhaps to aid in any future negotiations with the provinces.
Certainly, the new fiscally conservative NDP is moving cautiously. It doesn’t say whether its plan would require those buying drugs to pay part of the cost out-of-pocket. That, it says, will be decided in negotiations with the province. It suggests that the plan might operate differently in different provinces. That, too, is up for negotiation. Quebec, for instance, requires employers who offer any kind of benefits to their workers to also provide drug coverage. Any Quebecers not covered by these private schemes can get prescription drugs through the province’s public drug plan.
The $2.6 billion spent over four years would come from the extra funds the NDP plans to deliver to the provinces by reversing Harper’s proposed health-care cuts.
That money would be used to get the scheme going and start phasing in better coverage. Annual costs to the federal treasury once the scheme is up and running are estimated at $1.5 billion.
It’s not clear what the provinces would have to pony up. But they would not be expected to spend more on drugs than they already do.
In short, the devilish details remain vague. Still, it’s worth noting that neither Justin Trudeau’s Liberals nor Harper’s Conservatives had come up with anything at all on this front. “It’s the most comprehensive kick at the can we’ve seen,” says Martin. “I’m thrilled they’re bringing it to the table.” Thomas Walkom’s column appears Wednesday, Thursday and Saturday.