Three of Canada’s major political parties are promising to introduce universal pharmacare, but they differ on how specific their plans are and on how fast they say they will move.

The Liberals announced Monday that they would implement a program “so that all Canadians have the drug coverage they need at an affordable price.”

The New Democratic Party and the Green Party have each already included universal pharmacare in their platforms.

The Conservatives, in contrast, have said they would increase health spending, but that many Canadians are already covered by drug insurance plans, so they would focus on filling gaps in coverage rather than providing universal care.

Liberal leader Justin Trudeau committed to spend $6 billion over the next four years if re-elected. He characterized it as a “down payment” that along with pharmacare would go towards making sure every Canadian has access to a family doctor and to improve mental health services.

The promise builds on a report for the federal government from the Advisory Council on the Implementation of National Pharmacare that was released in June. Chaired by former Ontario Health Minister Eric Hoskins, it mapped how to introduce a national pharmacare program by 2027 at an estimated annual cost of $15.3 billion.

Jane Philpott, who served as the Liberal government’s health minister starting in 2015 but who is now running as an independent in Markham-Stouffville after parting with the party over the SNC-Lavalin affair, criticized the Liberals’ promise for being vague and underfunded.

“We’ve been studying this for decades now,” she said in an interview with CTV. “There is a huge appetite among Canadians to have universal, public, single-payer pharmacare. It’s been well proven to be the right thing to do, but the announcement... falls short of the specifics that are necessary to know that if you vote for a Liberal government, that that’s what you’ll get.”

The Liberals have given no timelines for implementation, Philpott said. And while $6 billion sounds like a lot, it won’t go far. “They fall short of what the Hoskins report recommended and what the Parliamentary Budget Officer has recommended.”

In a press release, the Conservatives said, “Trudeau’s Liberals promised pharmacare in 1997 and 2004. They broke their promise then, and Justin Trudeau will do it again. Trudeau cannot be trusted, and he is not as advertised.”

NDP leader Jagmeet Singh has also been saying that Trudeau and the Liberals can’t be trusted on pharmacare. When The Tyee asked him in August how the NDP plan differs from the Liberals’ plan, he said, “They’re just talking about it. They haven’t actually released a plan. So that’s one key difference.”

The NDP has been proposing exactly the kind of universal, single-payer, publicly funded and comprehensive pharmacare system that the Hoskins report endorsed, Singh said, adding they would go faster than Hoskins recommended.

“Our plan is to get it done by 2020,” Singh said. “We believe there’s no reason to wait. The report said it can be done in eight years. Other parties are talking about doing it by 2030. We’re saying we’re going to do it by 2020, in one year.”

The Liberal party responded to a request for an interview by referring The Tyee to Hoskins.

Hoskins said it’s very positive that three of the four leading parties have committed to universal pharmacare and that to him, the agreement on the destination is more important than differences they may have on how best to proceed.

“Any political party or leader that speaks in favour of pharmacare, that is far more important to me than the specific details of how they’ll go about it,” he said. “I think all of us need to be prepared for some flexibility.”

The issue is complicated and will require many steps, including negotiations with the provinces and territories as well as drug companies, he said, adding that when medicare was first introduced 50 years ago it took five years before all the provinces and territories agreed to join the program.

“Provinces and territories need to have confidence that this is going to work for them,” Hoskins said. That means knowing the funding will be reliable going forward rather than part of the Canada Health Transfer that the federal government can reduce unilaterally.

Drugs have become the second biggest health care cost after hospitals, and we spend more on them as a country than we do on doctors, he said. Canadians have been waiting for universal drug coverage for some 60 years, and it’s worth taking the time to get it right, he said.

And while Hoskins acknowledged that Trudeau’s funding commitment was shy of what his report estimated was needed, he said, “I accept the characterization that this is a ‘down payment.’”

As for questions about the vagueness of the Liberal commitment, Hoskins said, “If they’re re-elected, they’re going to have to answer those questions very, very soon.”

By creating the council he chaired, letting it do its work independently, beginning work on a national formulary, starting the Canadian Drug Agency, and committing money for expensive drugs for rare diseases, the government had demonstrated it’s serious about the issue, he said.

“Their past behaviour gives me confidence in their future behaviour,” he said.

The NDP’s Singh said introducing a universal, single payer, publicly funded, comprehensive system could be done relatively quickly by building on existing provincial, territorial and federal systems.

“There’s already a buying mechanism that exists, but they’re just separate buyers,” Singh said. “Each province has multiple buyers; the federal government has a buyer... If we put that together and use our combined buying power, we can negotiate better prices, like when you buy bulk it’s a lot cheaper.”

It makes no sense to have people end up in a hospital bed that costs $1,000 a day because they can’t afford a pill. “It’s just offensive to me,” he said. “Then the idea of telling people to wait years, maybe 10 years.”

Someone spending $3,000 a year on medicine, which is not unusual, would pay $30,000 while waiting for the Liberals to put their plan into place, Singh said. “We’re saying that’s wrong. We don’t want people to spend $30,000. We want to get it done in one year.”

Singh said there was one story about the need for pharmacare that has stuck with him. “It’s engraved in my mind because it was a young kid, he was about 10 years old.”

The youth was part of a lobby group that met with Singh and during the visit described to him how his chronic illness required injections to keep him alive.

In Singh’s telling, when the youth saw his reaction, he said, “Don’t worry about me, I can handle this, I know what to do. I’ve learned how to take my medication, my injections. I’m just worried about how much all my medication costs my mom and dad.”

“He’s a 10-year-old kid, and he’s worried about feeling like he’s a burden to his family,” Singh said. “That to me really speaks to what we cannot allow to continue. That kid should not feel like a burden.”

It makes no sense to have a health system that provides a diagnosis, but not what you need to be treated, he said. “I want to say to that kid, ‘Yeah, you do matter, and you should not feel like a burden, and I’m going to make sure you don’t feel like a burden by bringing in a universal pharmacare for all program.’”

He said he expected premiers and territorial leaders would want to join a program like the NDP is proposing where the federal government covers any incremental costs and the provinces won’t have to pay any more than they already do. “I can’t imagine even the most conservative premier saying ‘no’ to covering everyone in their province.”

Hoskins was hesitant to criticize the NDP’s timeline for introducing universal pharmacare, saying he applauds the party for putting it in their platform, but that it was clear from his work as chair on the advisory council that the issue was too complex to be done quickly.

“If we thought we could do it all in a year, we would have recommended that,” he said. “I think it’s incredibly challenging to do that in as short a time frame as the NDP has laid out.”

The Green party’s platform says, “The Green Party supports the recommendations of the Parliamentary Committee on Health to expand the Canada Health Act to include prescription drugs dispensed outside of a hospital. Universal Pharmacare is the best way to accomplish both life-saving and cost-cutting goals.”

Nobody was available from the Green party for an interview on the topic.

Nor did the Conservative party respond to requests for comment.

During the Maclean’s-Citytv debate, Conservative Leader Andrew Scheer said 95 per cent of Canadians already have prescription drug coverage and “a government should be focused on those people who fall through the cracks” and instead concentrate on filling the gaps.

Hoskins said that a significant number of people who may have some insurance still face unaffordable costs for drugs, noting that studies have shown that about 20 per cent of Canadians opt not to fill prescriptions because they can’t afford to.

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“What [the advisory council] found in a year [of work] is we couldn’t identify ‘the gaps,’” Hoskins said. “How do you identify that person with private insurance who can’t afford it?”

Nor would “filling the gaps” deliver the savings that a universal pharmacare program would, since the country wouldn’t get the benefits of having a single purchaser able to negotiate better prices with pharmaceutical companies, he said. It would leave intact the expensive and unsustainable system the country has now, he added.

A universal pharmacare program, on the other hand, would both reduce health care costs, including by reducing the number of visits to emergency rooms by 400,000 a year, and keep more people able to participate in the economy, Hoskins said. “This investment will keep people healthier, so they are able to work... I think it will strengthen the economy.”

With three parties in support and the work of the past couple years, Canada is closer now to introducing universal pharmacare than it has ever been, Hoskins said. “This is kind of our best chance.”

Election day is Oct. 21, with advance polls opening starting Oct. 11.

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