Don’t get too excited about pharmacare
NDP Leader Jagmeet Singh describes it as “historic.” Prime Minister Justin Trudeau talks about “moving forward with national, single-payer pharmacare.”
But for those who view the Liberals’ new legislation as the baby steps toward a plan that covers all — regardless of income or status — with life-saving medicines, the bill should come with a warning label: “Don’t get your hopes up.”
This is not a pharmacare plan. It’s an experiment. Framed another way, the government might call it a pilot. A pilot program whose results are unlikely to be known before the next federal election campaign, and may be quickly shelved after, if Pierre Poilievre becomes prime minister.
It’s not that Health Minister Mark Holland hasn’t been clear. “Don Davies, the NDP health critic, really got caught on single payer, universal as the only way to go. And I am a little bit — I’m a lot more open,” Holland told me on the Star’s “It’s Political” podcast. Holland wants to see all Canadians covered for the medicine they need, but said he’s also concerned with being “really prudent and careful with taxpayers dollars, and taking the most efficient route to get there.”
If you hear that sound, it’s a sigh of relief from those in the pharmaceutical industry, the health insurance industry, and even local pharmacists who fear a single-payer system will significantly impact their bottom lines.
What the Liberals and NDP crafted last week is a political compromise, one that gives Singh some form of cover to support the Grits’ upcoming budget next month.
It does not, in fact, respect the red line NDP delegates expressly stated last fall. They unanimously told Singh in October that continued support for the party’s confidence and supply agreement — a deal forged in 2022 that sees NDP MPs support the government until June 2025 in exchange for the establishment of a new public dental care program and actions on many unfulfilled Liberal promises — should be contingent on a “comprehensive and entirely public pharmacare program.”
What was tabled on Feb. 29 is not a “comprehensive” pharmacare program. It will provide provinces cash in exchange for offering residents free contraception and diabetes medication. Two categories of drugs that could serve as a motivator in the next federal election with, for example, young women heading to the polls fearing their free birth control may be taken away.
But the details of the bill suggest it may be difficult — if not impossible — to move beyond free coverage of those two drugs.
For one thing, the vision of the bill is not about laying the foundation for a universal public system.
For Holland, the bill represents a way out of an impasse. The NDP insists a single-payer system is the way to go, and that it will save governments money and lead to better health outcomes, while Holland appears to believe a fill-in-the-gap model, where the government covers those without private coverage — or perhaps even picks up the tab for those with private coverage but with copays or ceiling caps — would allow more people to be covered for more drugs more quickly.
What Davies and Holland negotiated is a plan to evaluate both models. They’ll compare the cost, the savings, and public health outcomes of delivering free contraception and free diabetes medication vs. the federal government’s fill-inthe-gap model which has been used in Prince Edward Island for the past three years.
“What I said to Don to sort of try to get us through this impasse is, ‘OK, if you’re right, then you shouldn’t be afraid of the scrutiny, right?’ That if this is the best model, if going universal single payer is the right model, then it will bear itself out in evidence when we put that model into the real world,” said Holland. “You should only fear something if his position isn’t, in fact, rooted in evidence.”
But will the baby-step universal public system really have much of a chance to be tested in the real world? Beyond debating whether it is actually fair to judge the viability of a universal public system based solely on two categories of medications — most of which are already available in cheaper generic form — political timelines suggest there is practically no chance this can happen before the next election, even if we assume the campaign will occur at the latest possible moment in October 2025.
Why? The legislation tasks an unnamed committee to make recommendations within a year after the Pharmacare Act has obtained royal assent — meaning after it has passed all the legislative hurdles of debate and committee studies in both the House of Commons and the Senate. Could that even happen before the next election? “I don’t know,” is Holland’s answer. Hitting a critical mass of evidence could take a long time, he argued, but he believes it’s important in ensuring the best outcomes for patients and taxpayers.
“For me, you’ve got to know how much it’s going to cost. You’ve got to know how you’re going to pay for it. You’ve got to be able to see, in real world, how these models are working,” he said. “That data has to be clear, and it can’t involve leaps of logic, or it can’t involve hopeful or wishful thinking. It’s got to really be able to be demonstrated in evidence. I know that’s frustrating, because it means that it doesn’t move as fast as some would like.”
Or it may mean the Liberals don’t move at all … until their election platform is revealed.