The federal government is moving ahead with the largest expansion to the country’s health care system in decades, with plans to cover the cost of dental care for lower income Canadians and the first steps toward creating a national pharmacare program outlined in Thursday’s federal budget.
But there was no mention of several key promises the Liberals campaigned on last year, such as $3.2-billion to support the hiring of 7,500 new doctors and nurses and a commitment to increase the minimum wage of personal support workers to at least $25 an hour. And while the Liberals promised to spend $6-billion to address wait lists, the budget only committed $2-billion.
Finance Minister Chrystia Freeland said in a news conference that the government remains committed to its platform promises and there will be more to come in future budgets.
“This is something that we need to work hard together with the provinces and territories to get right,” Ms. Freeland said. “It’s a complicated challenge.”
She said Canada spends more than peer countries on health and has worse outcomes overall, which suggests a smarter approach to health spending is needed.
“Canada’s biggest challenge isn’t that we don’t spend enough on health care,” Ms. Freeland said.
But it’s unclear how the government intends to improve health outcomes. In a statement, the Lung Health Foundation said it wanted to see the federal government put conditions on health transfers to ensure provinces meet health care improvements, but the budget didn’t include any of those details.
The budget detailed priorities designed to address some of the problems caused or worsened by the ongoing pandemic, including funding for research into the long-term impacts of COVID-19, and an expansion of student loan forgiveness programs to incentivize doctors and nurses to work in rural and remote areas.
But the budget did not include any new spending to address chronic problems with the country’s long-term care system, many of which were exposed during the early waves of COVID-19, when thousands of seniors became ill and died. And while the government is committing $100-million over three years toward opioid harm reduction, treatment and prevention, experts say it’s not enough.
“I would say the crisis probably demands much more than $100 million,” said Margaret Eaton, national CEO of the Canadian Mental Health Association. “People are desperate for support and there are very few programs that are out there that are evidence-based and effective.”
The commitment to a dental coverage program for lower income Canadians and to a national pharmacare program to cover the cost of prescription drugs are integral parts of a confidence-and-supply agreement between the Liberals and NDP, under which the New Democrats pledge to support the government as long as its priorities are acted on.
Health experts have for years been calling on the federal government to extend health coverage to dental care, prescription drugs and a host of other expenditures to help lower income Canadians, people without private insurance and other vulnerable groups.
According to the budget, the government will spend $5.3-billion over the next five years on a new dental coverage plan, which will roll out later this year starting with children under the age of 12. Families who earn less than $90,000 a year will be eligible for coverage and those that earn less than $70,000 will not have to make any flat fee co-payments at dental visits. Next year, coverage will extend to people under 18, seniors and people with disabilities. The program will be fully implemented by 2025 and the government says it will spend $1.7-billion on the program annually once it’s fully up and running.
Michel Breau, the Canadian Dental Association’s head of advocacy and governance, said the commitment to dental coverage will benefit many lower income and vulnerable individuals. He said the association wants the program to work with existing provincial health plans instead of creating an entirely new system.
The budget had few details about the implementation of pharmacare beyond saying the government wants to have a bill passed by the end of next year followed by the creation of a list of essential medicines that should be covered and a bulk purchasing plan.
Steve Morgan, a pharmacare expert and professor at the University of British Columbia’s School of Population and Public Health, said it’s unclear whether the federal government is actually serious about implementing a national drug coverage plan. Without one, millions of Canadians will continue to struggle to afford medications or skip taking them altogether, all while the country spends far too much on drugs, Dr. Morgan said.
“There is nothing that actually says a [pharmacare] plan will happen,” he said. “We will spend somewhere in the range of $5- to $7-billion more on prescriptions this year than it would have cost if we had a national pharmacare program.”
The Canadian Centre for Policy Alternatives senior economist David Macdonald said in a statement the budget represents a “huge missed opportunity” to invest in pharmacare, an overhaul of long-term care and a better health care system.
The Canada Health Transfer to provinces and territories will be $45.2-billion in 2022-23, which the government says is an increase, but falls far short of what provinces and territories have been requesting. Canada’s premiers have been lobbying for the federal government to increase its contribution to health care costs to 35 per cent from 22 per cent.
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