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Politics Health care and an aging Canada: Four things to know before you vote

ELECTION PRIMER

HEALTH CARE: FOUR THINGS TO KNOW BEFORE YOU VOTE

KEVIN VAN PAASSEN/THE GLOBE AND MAIL

Doctors, health advocates and the provinces fear that caring for Canada's aging population will be a big challenge in the years to come. What are the major parties' prescriptions for change? Here's a primer

Canada is the only developed country that has universal health insurance without universal prescription drug coverage.

Some drug treatment is publicly paid for in Canada, but private drug plans and patients cover the lion's share of a national prescription drug bill estimated at $29-billion a year. In July, an Angus Reid Institute study of 1,556 Canadians found one in five spent $500 or more a year on prescriptions and, under the financial strain, 23 per cent decided to avoid refilling or renewing their prescriptions or made them last longer by missing doses or splitting pills. That figure is even higher in British Columbia, at 29 per cent.

The same Angus Reid Institute poll found 91 per cent supported the idea of a national pharmacare program. Canada's political leaders disagree about whether such a plan is affordable or how it could be managed effectively.

  • NDP: A New Democrat government, if elected, would work with the provinces toward bringing Canadians universal prescription drug coverage, party Leader Tom Mulcair says. On Sept. 18, Mr. Mulcair promised $2.6-billion over four years for the plan, though the party is not calling its pledge a national pharmacare program. Mr. Mulcair has also criticized the Trans-Pacific Partnership trade deal, saying it will harm Canadians’ access to less expensive generic drugs.
  • Liberals: The party’s platform says a Liberal government under Leader Justin Trudeau would “improve access to necessary prescription medications” and help provinces to buy less expensive drugs in bulk to pass savings on to patients.
  • Conservatives: The Conservative platform does not mention pharmacare. Conservative Leader Stephen Harper has stressed that health care is a provincial responsibility.

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As of July 1, 2015, Canada had more seniors than children aged 14 or under.

Baby boomers are quickly outnumbering actual babies: By Statistics Canada's latest estimates, seniors will make up one-fifth of the Canadian population by 2024. Provinces, eager to keep the ballooning costs of treating elderly patients under control, have shifted more services out of hospitals and into patients' homes, creating a patchwork of underfunded support networks for seniors and patients with dementia and chronic illnesses. During the election campaign, the Canadian Medical Association has been pressing the federal government to make sweeping changes to deal with seniors' costly health-care needs.

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  • Liberals: Mr. Trudeau says a Liberal government would spend $3-billion over four years to improve home-care services, and invest $190-million to expand the compassionate-care benefit to give paid time off to Canadians who look after seriously ill family members.
  • NDP: On Sept. 13, Mr. Mulcair announced a $1.8-billion plan over four years to expand home care, nursing beds and palliative care for seniors. The NDP would also implement a $40-million strategy to diagnose, treat and research the causes of Alzheimer’s disease and dementia, Mr. Mulcair says. The NDP would also expand the compassionate-care benefit.
  • Conservatives: Last year, the Conservative government also announced a $31.5-million plan on dementia involving partnerships with private and public-sector groups.

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Legal, physician-assisted suicide is supported by 77 per cent of Canadians, according to a recent Forum Research poll.

Political parties may see it as a hot-button issue too hot to touch, but public opinion polls suggest a dramatic shift in Canadians' attitudes to physician-assisted death. Asked by Forum Research if they supported or opposed legal, physician-assisted suicide for terminally ill patients, a majority of Canadians said yes, regardless of their party affiliation.

Parliament has until February to craft new legislation on assisted dying after a Supreme Court ruling in the case of Kathleen Carter upheld a Canadian's right to end their own life with doctors' help under certain circumstances. At first, the government suggested they'd seek more time or even invoke the Charter's notwithstanding clause to overrule the court. Then the government appointed a consultative panel on the issue – two of whose members were government witnesses opposed to physician-assisted death in the earlier B.C. Supreme Court's hearing on the Carter case – but its powers to consult were suspended until after the election, and now time is running out.

  • Conservatives: The Conservative government has been reluctant to respond to the top court’s ruling, saying they intend to study it first. Their platform calls for more research into improving palliative care.
  • Liberals: Mr. Trudeau has said a Liberal government would appoint an all-party special committee to come up with recommendations for assisted-dying laws.
  • NDP: Mr. Mulcair says an NDP government would act on the court’s ruling “swiftly, with balance, respect and sensitivity,” allowing a free vote in Parliament on any new assisted-dying legislation but also making palliative care a priority.

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When medicare was introduced in 1957, Ottawa paid for half of the provinces' health-care costs. That's decreased over the decades, and now it's only about 20 per cent.

Federal Finance Minister Jim Flaherty, is shown before a provincial, territorial and federal finance ministers meeting in Victoria on Dec. 19, 2011.

Federal Finance Minister Jim Flaherty, is shown before a provincial, territorial and federal finance ministers meeting in Victoria on Dec. 19, 2011.

GEOFF HOWE/THE CANADIAN PRESS

In 2011, the late Jim Flaherty, then the federal finance minister, offered the provinces a surprising take-it-or-leave-it deal: A 10-year plan overhauling how Ottawa gives out money for health care. Whereas the 2004 health accord from Paul Martin's Liberal government gave provinces annual increases of 6 per cent for health transfers, the Conservatives' plan would link the increases to economic growth, with a minimum guaranteed increase of 3 per cent, from 2017 until 2024. The new deal had other features that some provinces liked (a move to per-capita funding, for instance, meant Alberta got more money than it had before), but other provinces have ended up with millions less than they would have under the old system.

Complaining of a "fiscal imbalance" between provinces, premiers have been pressing for years to get more help dealing with their aging populations' health-care needs. A Conference Board of Canada report commissioned by the CMA estimates it would cost Ottawa $1.6-billion next year in additional transfers to help provinces keep up with health-care costs for the elderly.

  • Conservatives: Under the Conservative government’s 2011 health-care deal, increases to health transfers will be tied to economic growth – specifically growth in the nominal gross domestic product, which measures real GDP plus inflation – after 2016-17.
  • NDP: Mr. Mulcair says an NDP government would use any budget surpluses to preserve the 6-per-cent annual increase in health-care transfers.
  • Liberals: In his letter to the premiers, Mr. Trudeau promised a Liberal government would aim to craft a new health-care funding agreement after a meeting between the provinces and Ottawa.

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With reports from Globe staff and The Canadian Press


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