Federal Interventionism in Health Policy: Back to the Future?

Canada’s “Fathers of Confederation” were men of their time, which is why, among other things, “health” was not seen as a primary responsibility for governments, and certainly not the Dominion government (Maioni and Smith 2003). This is not surprising, given that at the time, medical care was not particularly effective nor sought after, and health and social matters were of a local nature, to be addressed by family, charity, and religious communities.  How surprised these men would have been to learn that, a century and a half after Confederation, health care had become such a powerful political symbol, a salient electoral issue, and a lightning rod for federal-provincial tension. It is little wonder, then, that health care was again a top-of-mind issue for Canadian voters, and for political candidates, in the 2015 election campaign and more recently in the pre-election budget (Morneau 2019).

The Liberal party of Canada, which has long had a crucial role in the politics of health care, indeed made health-related promises a leitmotif of their electoral campaign. In analysing those promises and the extent to which they were realised, broadly speaking, we find that the Trudeau government’s actions in health policy have demonstrated a return to a more interventionist stance by the federal government, one that involves a more deliberate steering of provincial health and social services delivery through spending and performance assessment. This marks a significant shift from previous Conservative governments (Kates 2014). In even starker contrast, the Liberal government’s rhetoric appears to seek to extend the purview of the Canada Health Act to the new areas of home care and mental health such as the Liberal government’s proposal to spend $50 million over five years to support a national dementia strategy.

And in an even bolder move, Pharmacare (i.e. a publicly-funded universal program for prescription drugs) will likely be on the next electoral platform’s agenda. While it was not explicitly discussed in the 2015 party’s platform, the Liberals did campaign on a promise to improve access to necessary prescription medications (Liberal Party of Canada 2015). Furthermore, the last two budgets of this government spelled out concrete investments, suggesting the Liberal government has moved past considerations of desirability and feasibility, and is deliberately and purposefully progressing towards policy formulation. As such, Budget 2018 announced the creation of an Advisory Council on the Implementation of National Pharmacare. While the Council’s report was only due in late spring 2019, an interim report was released within days of Budget 2019 (Hoskins 2019). This interim report provided the foundational principles for the investments announced on March 19, 2019, namely the creation of a new Canadian Drug Agency, a pan-Canadian formulary and a national strategy for high-cost drugs for rare diseases (Morneau 2019). The stated goals of these initiatives are to harmonize coverage nationally and increase cost-efficiency of coverage through economies of scale and bargaining power.

Thus, it appears the government will present a national pharmacare strategy as an electoral promise in the 2019 campaign. Considering the support from influential lobby groups and the work accomplished to date in laying out the policy options, they would then be in a good position to fulfill these promises should they win a second mandate. The Canada Health Act has long embodied the federal role in health care. In both its promises and its realizations, this Liberal government has flexed its muscle to expand the scope of publicly insured services across the provinces and lead the way in providing better coverage of some of the same services for the populations under its responsibility. However, while bolstering its financial commitment to medicare is a necessary step forward, it is not likely to be a sufficient condition to ensure the kind of lasting structural impact on Canadian’s access to care that a more formal expansion of the definition of insured services would achieve.

REFERENCES

Advisory Council on the Implementation of National Pharmacare. 2018. “National Pharmacare Online Consultation | Let’s Talk Health.” September 17, 2018. https://www.letstalkhealth.ca/pharmacare.

Casey, Bill. 2018. “Pharmacare Now: Prescription Medicine Coverage for All Canadians – Report of the Standing Committee on Health.” House of Commons, Canada.

Hoskins, Eric. 2019. “Interim Report of the Advisory Council on the Implementation of National Pharmacare.” Advisory Council on the Implementation of National Pharmacare. https://www.canada.ca/content/dam/hc-sc/documents/corporate/about-health-canada/public-engagement/external-advisory-bodies/implementation-national-pharmacare/interim-report/interim-report.pdf.

Kates, David. 2014. “As Accord Expires, Ottawa Takes a Back Seat on Health Care Policy.” O.Canada.Com, May 16, 2014, sec. Health. https://o.canada.com/health-2/as-accord-expires-ottawa-takes-a-back-seat-on-health-care-policy.

Liberal Party of Canada. 2015. “Liberal Election Campaign Platform: Real Change – a New Plan for a Strong Middle Class.” https://www.liberal.ca/wp-content/uploads/2015/10/New-plan-for-a-strong-middle-class.pdf.

Maioni, Antonia, and Miriam Smith. 2003. “Health Care and Canadian Federalism.” In New Trends in Canadian Federalism, edited by François Rocher and Miriam Smith, Second edition, 295–312. Peterborough: Broadview Press.

Morneau, William. 2017. “Building a Strong Middle Class: Budget 2017.” Government of Canada. https://www.budget.gc.ca/2017/docs/plan/budget-2017-en.pdf.

———. 2019. “Investing in the Middle Class to Grow Canada’s Economy: Budget 2019.” Government of Canada. https://budget.gc.ca/2019/docs/plan/budget-2019-en.pdf.

Office of the Parliamentary Budget Officer. 2017. “Federal Cost of a National Pharmacare Program.” Government of Canada. http://www.pbo-dpb.gc.ca/web/default/files/Documents/Reports/2017/Pharmacare/Pharmacare_EN_2017_11_07.pdf.