Liberals and NDP negotiate pharmacare now to fight over it later

If you ask Liberals about the pharmacare commitments they made in their deal with the NDP, they tend to emphasize that they promised very little.

The supply-and-confidence agreement the two parties struck in 2022 calls for progress toward a national pharmacare program – but not actual pharmacare.

The Liberals and NDP were supposed to pass framework legislation for a future pharmacare program by the end of 2023, but both agreed to an extension till March.

There are two tricky aspects to the negotiations. One is that the two parties have very different ideas of what national pharmacare should be, and so they’re trying to draft legislation for two vastly different programs.

The other is that the NDP insists on a starter version of pharmacare – with federal coverage for a handful or drugs – right away.

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There will be a deal. Both Prime Minister Justin Trudeau and NDP Leader Jagmeet Singh want to keep their supply-and-confidence agreement, which ensures the survival of the Liberal government and the current Parliament till 2025. Neither is doing very well in the polls. Neither wants the risk of an election any time soon.

But the odd thing is that both also know their joint work on pharmacare will eventually end up with their parties on separate sides. Both expect they’ll be fighting over it in the next election campaign.

The NDP vision is the full deal: universal national pharmacare with the government as bulk buyer and single payer for a wide list of prescription drugs.

The Liberal model is a more limited fill-the-gaps program for a narrower list of drugs for those who don’t have other insurance coverage – closer to Prince Edward Island’s pharmacare.

Drafting legislation that can be used for both is possible, and that’s all the supply-and-confidence agreement calls for. But politically, that’s not enough for the NDP.

They want to be able to show there are some concrete things coming out of their arrangement with the Liberals, so they are insisting the legislation be accompanied by coverage of a small number of widely-used drugs, such as diabetes medications.

The New Democrats know that there won’t be national pharmacare before the next election slated for the fall of 2025. But they don’t want to go into the campaign telling voters that the pharmacare arrangements at the heart of their multiyear deal to support the Liberals didn’t provide any actual drug coverage.

“There has to be tangible relief from drug costs for Canadians in order for this entire effort to have political payoff,” said long-time NDP strategist Brad Lavigne, now a partner with Counsel Public Affairs, in an interview.

Both parties are motivated negotiators. The Liberals are far behind the Conservatives in polls, so they are willing to make a deal. The NDP isn’t doing so well, either, so they won’t push their demands too far.

But this isn’t two parties working together toward a shared plan for pharmacare. By the time the next election campaign arrives, the Liberals and the NDP will be on opposite sides.

In fact, we can expect three visions of pharmacare on offer: the Conservatives will presumably advocate for the current system of mostly private drug insurance; the NDP will campaign for full universal pharmacare; and the Liberals will call for something in between.

Historically, the Liberals have often liked to position themselves that way, between their opponents like Goldilocks – in this case arguing that the Conservatives proposal is too little and the NDP’s too much.

Health Minister Mark Holland told reporters last fall that the government can’t afford to pay $40-billion or $45-billion on pharmacare – pumping up the sticker shock.

The sums are for universal pharmacare are indeed enormous, but not quite as enormous as Mr. Holland suggests. The Parliamentary Budget Officer estimated that full universal pharmacare would cost $33.2-billion it total in 2024-25, but that would be $11.2-billion more than existing levels of provincial and federal spending.

So far, polls suggest more Canadians support a limited public drug-insurance program over universal pharmacare. But that is a debate between the Liberals and the NDP that isn’t likely to come to a head until the 2025 election – a vote that right now, neither party seems likely to win.