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We’ve just had a federal election, a conference of provincial and territorial premiers and a Speech from the Throne, a trifecta for policy wonks.

Has the flood of political rhetoric and promises in recent weeks left us any closer to a national pharmacare program – or any reforms in health care, for that matter? By all appearances, the answer is no.

In academic and political health circles, pharmacare has become the Holy Grail and appears just as elusive.

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“Pharmacare is the key missing piece of universal health care in this country,” according to the Throne Speech of the new minority Liberal government. “The government will take steps to introduce and implement national pharmacare so that Canadians have the drug coverage they need.”

One would be hard-pressed to imagine a more vague promise, especially when it involves an issue that has been discussed for at least half a century.

The Liberal election platform was no more precise: $6-billion over four years as a down payment on bolstering pharmacare, expanding mental-health services and improving access to family doctors.

In contrast, the New Democratic Party had pledged to $43.1-billion over four years for a national pharmacare program, and the Green Party had said its pharmacare plan would cost $27-billion in the first year alone. (The Conservative Party and Bloc Québécois made no specific promises on pharmacare.)

There is a theory out there that the NDP can use its leverage in a minority government to force the Liberals to implement a national pharmacare program, but it’s delusional to think the Liberals will act anything other than slowly.

While the purported savings are compelling, shifting spending from private drug plans to the public treasury is much less so.

Not to mention that the provinces are, at best, lukewarm about the idea.

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At the Council of the Federation meeting in Mississauga last week, their disinterest was palpable.

“Don’t start broadening health care when you can’t get it right now,” said Manitoba Premier Brian Pallister. The Premiers of British Columbia, Saskatchewan, Alberta and Quebec sang from the same hymn book: “We have pharmacare now.”

That’s a reminder that pharmacare means ensuring that everyone has affordable access to essential medications. It doesn’t necessarily mean drug coverage must be provided by a centralized, government-run program, even though that was the recommendation of the Advisory Council on the Implementation of National Pharmacare.

If Ottawa wants to embrace the approach, it has to be willing to spend, and spend big – $15.3-billion annually by the time the program is up and running, according to the report from Dr. Eric Hoskins.

The clear message the premiers delivered was, “If you plan to go that route, show us the money.” Nothing but nothing is more predictable in Canadian politics than the provinces taking a Jerry Maguire-esque stance.

But in their final communiqué, their thinly-veiled message was that pharmacare is well down their list of spending priorities: “Premiers also discussed national pharmacare and emphasized that any program must be developed in partnership with provinces and territories.” Yawn.

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What they did ask for is an increase in the Canada Health Transfer, the money Ottawa allocates to the provinces and territories for health spending. Currently, the federal transfer is about $40-billion and increases by 3 per cent each year.

The premiers want the escalator to increase to 5.2 per cent before they even consider pharmacare.

They may well get that, given that health spending is increasing at about 4 per cent annually, and that’s likely to increase with the aging population and the new technologies coming down the pipe.

The premiers also said that, if a national pharmacare program is proposed, there must be an opt-out clause. Of course, that’s a non-starter. Pharmacare has to be an opt-in program, meaning you don’t get any money unless you get on board.

That’s how medicare began, way back in 1957, when Ottawa offered to pay 50 per cent of the provinces’ hospital costs. What we often forget is that it took 15 years before the final province, Quebec, signed on in 1972.

As frustrating as it is, go-slow is the Canadian way. Parliament buildings are currently being renovated, a project expected to last at least a decade.

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The pilgrimage toward national pharmacare will probably take as long. Along the way, we need to keep building, filling in the gaps and getting drug coverage to those who don’t have it, brick-by-brick, till it’s done.

About 20 per cent of Canadians, or more than 7.5 million people, are estimated to be either uninsured or underinsured for prescription drug costs. A national pharmacare plan would address that, and aim to save billions of dollars. Globe health reporter Kelly Grant explains.

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