The new federal pharmacare bill has been posted.
I was curious to see how far left the NDP had managed to push the Liberals, and to guess how long it might plausibly be before Canadians start getting even contraception and insulin paid for, much less any other drugs required to live a happy and healthy life.
Having now read the bill, my bet is “years from now, possibly never.” First, there are all the uncertainties and delays to overcome in the legislative process before this bill becomes law. But even assuming it passes, the bill pretty much just creates more work for other people (the Minister of Health, the provinces / territories / Indigenous peoples, the Canadian Drug Agency, the “Committee of Experts”).
The big news provision is s. 6(1), which says no province or territory is getting any money until after it negotiates an agreement with the Minister:
The Minister may, if the Minister has entered into an agreement with a province or territory to do so, make payments to the province or territory in order to increase any existing public pharmacare coverage — and to provide universal, single-payer, first-dollar coverage — for specific prescription drugs and related products intended for contraception or the treatment of diabetes.
Looks to me like it’d be pretty easy for a province to “opt-out” of this scheme, by simply not entering into an agreement with the feds (or perhaps by not having “any existing public pharmacare coverage” in the first place). Maybe some provinces will get an agreement for payments before the election that is likely to result in a health minister who will refuse to negotiate this.
In relation to the creation of “a list of essential prescription drugs and related products,” there is section 8(1), which is a weird combination of precise and vague:
The Minister must, after discussions with the provinces and territories, request that the Canadian Drug Agency prepare, no later than the first anniversary of the day on which this Act receives royal assent, a list of essential prescription drugs and related products to inform the development of a national formulary that will establish the scope of prescription drugs and related products to which Canadians should have access under national universal pharmacare.
The Minister is going to have to those discussions with the provinces and territories very quickly if the Canadian Drug Agency is expected to prepare this list within a year of royal assent. … Unless the Canadian Drug Agency already has a list of “essential prescription drugs and related products” and the discussions with the provinces and territories are a sham.
Regardless, this list of essential prescription drugs is nowhere close to binding law. It will simply “inform the development of a national formulary that will establish the scope of prescription drugs and related products to which Canadians should have access under national universal pharmacare.” When would Canadians have actual access? Given where our governments seem to be heading, I’m guessing never.
If you think I am being pessimistic, I invite you to read subsection 8(2):
The Minister must, after the list referred to in subsection (1) has been prepared, initiate discussions based on the list with provinces, territories, Indigenous peoples and other partners and stakeholders with the aim of continuing to work toward the implementation of national universal pharmacare.
The government doesn’t even bother establishing a timeline for the Minister to “initiate” these discussions. There’s certainly no timeline to conclude them and actually implement national universal pharmacare. Just a vague obligation to talk to stakeholders “with the aim of continuing to work” towards implementation.
Section 9 imposes another challenging timeline on the Canadian Drug Agency, to develop “a national bulk purchasing strategy for prescription drugs and related products” (“in collaboration with partners and stakeholders” and “within a year of royal assent,” but again only after the Minister holds discussions with the provinces and territories). Unlike the “list of essential prescription drugs,” the “national bulk purchasing strategy” doesn’t get a subsection imposing even the wishy-washiest of obligations on the Minister. It’s almost like the government already doesn’t intend to do anything with it.
There’s other fancy-sounding language in the bill too, including a whole string of whereases, a “purpose” section chock-full of buzzwords, lofty principles, and allusions to advice, reports and recommendations. None of this means the actual implementation of national universal pharmacare.
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As Dale Smith is wont to repeat, at the end of the day none of this happens without the agreement of the provinces (and so far that means only PEI), so at best the federal gov’t can just push on a string.* Now, they can push with large wads of cash, but we know that even that’s sometimes not enough to induce provinces to surrender what they see as their core area of business (whether or not they’re shitting the bed in that area of business). Especially since the provinces can and do routinely whine for federal money without any such conditions, so why stop now, I guess?
* Well, the fed gov’t can also make announcements and pat itself on the back, but that’s not really doing anything, right?
I think the feds can be more daring, constitutionally and legislatively. They can *lead.* If the provinces don’t want federal funding for pharmacare, they’re free to say no and then the feds can point the finger.
My issue is unmerited bragging and downplayed timelines. The Minister should at minimum have been called out for saying “hopefully this year” while admitting *in the same article* it’s not in the upcoming federal budget.
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