In March, Prime Minister Carney promised pharmacare 'for everyone who needs it,' but there was no new money for it in his government's recent budget.Ryan Remiorz/The Canadian Press
Can you mourn something that never existed? Like the idea of a happy marriage when you knew all along you settled for the first person who accepted your advances? Or the daydream of a life of luxury and indulgence, which feels possible while you’re holding a lottery ticket, but vanishes as soon as the numbers are called? What about the notion of universal drug coverage for all Canadians, which has been under consideration for decades – an official recommendation as far back as the first report from the Royal Commission on Health Services, published in 1964 – and appeared, at least to some, as though it might become a reality under the Justin Trudeau administration?
Prime Minister Mark Carney hasn’t called time of death for pharmacare yet. But everyone can see it’s only being kept alive by machines, still referred to in the present tense because anything else would be too painful.
Perhaps Mr. Carney is reluctant to admit to another election bait-and-switch, akin to how “elbows up” during the campaign became kiss-the-ring afterward. Back in March, Mr. Carney promised “dental care and pharmacare for everyone who needs it,” and in September, reiterated his intention to sign deals with the provinces and territories that have yet to ink deals with Ottawa. But there was no new money for pharmacare in the recent budget, and Health Minister Marjorie Michel is now being coy about whether her government intends to heed the recommendations from the final report from the committee of experts on pharmacare.
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The committee recommended, among other things, that the federal government should fully fund a list of essential medicines, thereby avoiding the “drawbacks of bilateral agreements.” (Which are evident by looking at the rollout of the Canada-Wide Early Learning and Child Care system in various provinces, for example.) Ms. Michel appeared to dismiss that recommendation last week, saying, “We need to make sure that we build the strongest partnership possible with the provinces and territories to improve the health of Canadians.” She also pointed out that the recommendations from the committee are “non-binding for the government.”
That is perhaps a kinder way of saying: Thanks but no thanks; we’re not interested. Not now, anyway.
Pharmacare as proposed and quasi-implemented by the Justin Trudeau government always seemed more of a political tool to maintain the support of the NDP under the supply-and-confidence agreement than it was a realistic framework for universal drug coverage. Programs for prescription drug coverage are already a mess of overlapping benefits and bureaucracy. In Ontario, for example, OHIP+ covers thousands of prescription drugs for residents under 25; the Ontario Drug Benefit covers prescriptions for those over 65; the Trillium Drug Program covers some drugs for residents based on household income; hospitals cover drugs for in-patients; and employer-paid insurance covers drugs for others. The Trudeau pharmacare plan would add yet another tentacle by, as a start, providing coverage for diabetes medication and birth control.
Ontario hasn’t yet signed a deal with Ottawa, but PEI, B.C., Yukon and Manitoba did, which ate up 60 per cent of the $1.5-billion that the government allocated over five years to fund the program. That means this initial phase will cost significantly more than first anticipated, though, as mentioned, there was no new money for pharmacare in the budget (the committee estimated that if the federal government covered the entire cost of essential medicines, meaning a centralized program without bilateral agreements, it would cost in the range of $6-billion to $10-billion).
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It might not be the worst thing if Mr. Carney adds pharmacare to the Trudeau-era trash pile – pharmacare as conceived and laid out by the former Liberal government, that is. Our health care system doesn’t need new tentacles, new bureaucracy or new overlapping benefits.
What it needs is an overhaul, a fundamental rethink and perhaps a fundamental reorganization. Alberta is attempting to shake up the status quo by allowing doctors performing elective surgeries to work in a hybrid parallel-and-private system for the first time, which is a baby step toward more significant reform. It’s also a recognition that our system as it currently functions isn’t working. Indeed, most other countries that provide universal health care also provide coverage for pharmaceuticals, either through national programs or mandatory insurance. We are the outlier, yet we insist on trying to build on a broken system.
The first step for the Carney government, if it is inclined to pursue change on this file, is to admit that Mr. Trudeau’s version of pharmacare is dead. The dream for those of us fantasizing about Dutch- or Japanese-style health care in Canada (and also clutching our lottery tickets and imagining life on a yacht) is that Mr. Carney will do so while acknowledging that the Canada Health Act needs a rewrite, and pledging to explore new options that could provide better health care, at less cost. That might be as likely as me spending 2026 on a yacht. But hey, my dream’s not dead until they call the numbers.