Justin Trudeau’s national pharmacare promise is to negotiate hard to create something sometime soonish.
Wait – it’s not quite that precise. The need for a program to help folks pay for medicine is great, Mr. Trudeau indicated in Hamilton Monday, but just what is needed has to be worked out. He can’t say whether it will be universal or a top-up to private insurance. The language he employed suggests it will be a big, universal program, but he wouldn’t actually say so. And, crucially, he didn’t commit to any sum to pay for it.
The key reason Mr. Trudeau gives for all that vagueness is not entirely without merit: Pharmacare would have to be negotiated with the provinces – after all, health care is a provincial jurisdiction.
But it is easy to see that he was being vague for a couple of other reasons. The first is that he didn’t want to be nailed down on how many billions pharmacare would cost. The second is that he wanted to set up pharmacare as a battle with Ontario Premier Doug Ford.
If you are just tuning in now, Mr. Ford is the bogeyman the Liberals really want to run against. Mr. Trudeau talks about Mr. Ford cutting public services and insists Conservative Leader Andrew Scheer will be just like him. On Monday, the Liberal Leader didn’t want to talk about pharmacare as much as he wanted to talk about who – himself or Mr. Scheer – should negotiate it with Mr. Ford.
“Who do you want negotiating with Doug Ford?” he said. “That’s the question people have to ask themselves.”
There was certainly no doubt that’s what Mr. Trudeau wants people to ask. He repeated the line over and over, undaunted by questions about pharmacare.
Will his pharmacare be a universal public plan that replaces employer-funded private insurance? Mr. Trudeau said the Liberals “believe” in universal pharmacare, but said he can’t just drop it on the provinces. That’s why, he said, the question is who do you want to negotiate with Mr. Ford.
That’s not the question. The question of who would do the negotiating is not as important as what the negotiations would be about. And Mr. Trudeau wouldn’t really say what that would be.
Another question – how much? – is pretty important for an election promise, too. A report issued by Parliamentary Budget Officer Yves Giroux two years ago estimated the net public cost of a universal pharmacare system would have been $19.3-billion in 2016 – $7.3-billion more than the provinces were already paying. The amounts will have risen since. Details matter, but Ottawa would have to chip in $5-billion to $10-billion a year to have a hope at universal pharmacare. The NDP says its proposal would cost the feds $10-billion a year.
The amount Ottawa puts in changes the tenor of any negotiations with the provinces, too. If Ottawa covers some of the costs the provinces are already paying, they would be more willing to make a deal.
Mr. Trudeau’s Liberals clearly know it takes a commitment of money to get provinces to talk about new health-care services. In fact, he promised that, if re-elected, a Liberal government would spend $6-billion in its next mandate to help provide more family doctors and set new standards for mental-health care. Both require working with the provinces, too, but at least the Liberals put a promise of money on the table.
When it came to pharmacare, they let a lot slide off the table. If Mr. Trudeau was promising a universal plan, that would be a big deal. But is he? It wasn’t clear that he was.
It is reasonable to leave a little wiggle room in a proposal for negotiating. And time. The NDP’s insistence that it would work out a complex, national cost-sharing deal with the provinces and have it in place next year is the promise of a party that doesn’t expect to be in power. But at least we know what they have in mind. Mr. Trudeau, so focused on Mr. Ford, never really talked about his pharmacare plan.
Our Morning Update and Evening Update newsletters are written by Globe editors, giving you a concise summary of the day’s most important headlines. Sign up today.