NDP Leader Jagmeet Singh shakes hands with NDP MP Lori Idlout as other caucus members embrace, after their news conference on drug coverage for Canadians, in the Foyer of the House of Commons on Parliament Hill in Ottawa, on Feb. 29.Justin Tang/The Canadian Press
The Liberal-NDP agreement on national, universal, single-payer pharmacare has a peculiar quirk: It was struck even though the two parties don’t agree on national, universal, single-payer pharmacare.
The package unveiled Thursday gives Ottawa the authority to pay for a pilot program that would launch single-payer pharmacare for two classes of drugs, for birth control and diabetes, as long as provinces sign on.
That could be a big thing for folks who are struggling to afford those drugs – and as a test of the idea that Ottawa should buy those drugs for all patients under universal public insurance.
What is not in this deal is an agreement between the Liberals and the NDP that that idea is the future of pharmacare.
It is not in the “framework legislation” on national pharmacare that had to be delivered under the terms of the Liberal-NDP supply and confidence agreement. In fact, there wasn’t any framework in it at all, and when it came to drawing up a blueprint for full national pharmacare, there was diddly squat.
It called for the creation of a committee of experts to make recommendations on options for a universal, single-payer program, but not for such a program. The government has to create a national formulary for covered drugs but there’s no indication that they would be covered.
The Health Minister, the bill states, must then “initiate discussions” to “work toward” pharmacare. What kind of pharmacare? When? The bill does not stipulate.
NDP Leader Jagmeet Singh’s assertion that he would only accept legislation that rules out a fill-in-the-gaps partial pharmacare turned out to be hollow.
What it does do, in one simple clause, is allow for a pilot program for the kind of universal, single-payer system that the NDP wants, but for only two classes of drugs. It’s a long way from full pharmacare. But the compromise was made more in practice than in principle.
Health Minister Mark Holland and NDP health critic Don Davies shook hands and lauded themselves for a step forward on pharmacare, even if they never agreed on what kind.
The choices of drugs in this pilot make a statement. Diabetes, if untreated, can lead to other serious conditions, so it lends itself to the argument that spending on medication saves other health costs. Covering birth control also makes a statement about a woman’s control of her body.
Politically, the Liberals and NDP are daring Pierre Poilievre’s Conservatives to vote against the plan to make those widely used drugs free for all.
Still, it was strange to hear Mr. Holland say that no one should oppose full, free coverage of these two types of drugs – and then say that he’s not sure that is the way pharmacare should work for other drugs.
Mr. Holland wouldn’t even provide a cost estimate for the program – maybe $1.5-billion, he said – because there are still too many uncertainties. The government materials did not provide figures, let alone estimate how much of the budget would go to pay for medications currently provided under private and employer insurance.
The pilot itself has a lot of hurdles to overcome, starting with the fact that it requires agreement from provinces. Mr. Holland suggested that he didn’t expect it to be fully implemented till next year.
At least two provinces, Quebec and Alberta, have said they want to opt out and take the cash instead – which would obviously undercut the goal of a national pharmacare program that uses federal-government bulk buying to lower costs.
Mr. Singh has said Quebec should be able to do that, but not Alberta, while Mr. Holland danced around the question, expressing optimism that all provinces will want to join, but suggesting that the government has no intention of offering cash to provinces who don’t take part.
If it gets through all those hurdles, then the pilot program really could offer the thing that both Mr. Holland and Mr. Davies touted: a practical test of universal, single-payer pharmacare.
It would provide an opportunity for the public to judge if it is wise to shift the cost burden from private insurance to public taxpayers, if the single-payer model really does save money.
That’s a real-life test drive of NDP policy that marks a big win for the party. The Liberals are willing to pay the cost to keep their parliamentary alliance with the NDP alive – even if they don’t necessarily believe in the principle.