Drug insurance | How to pass the pill?

There is a scent of the end of the reign in Ottawa.

On one side of the political arena, Pierre Polievre’s conservatives, ahead by a good 15 points in the polls, are enjoying the setbacks ofArriveCAN which show to what extent the public service has lost control of the management of IT systems.

On the other hand, Jagmeet Singh’s New Democrats are threatening to tear up their agreement to support Justin Trudeau’s minority government if the Liberals do not table a bill as promised laying the foundations for a national insurance plan. medication before 1^er March.

But this project seems riskier than ever. If we had difficulty delivering a $60 million application to control travelers’ information during the pandemic, imagine what bureaucratic madness we could find ourselves in with the creation of an otherwise complex system.

The negotiation window seems very slim to produce a bill by 1^er March, especially since Parliament does not sit next week. But that doesn’t mean voters will be called to the polls any time soon.

The NDP alone cannot bring about the fall of the government. The three opposition parties would have to band together against the Liberals to force an election.

Still, the New Democrats are playing a dangerous game by raising their voices. By tearing up their agreement, they would increase the chances of a mishap that would derail the government.

But Jagmeet Singh himself is stuck: his activists are putting pressure on him to obtain significant gains, like other New Democratic leaders before him. In the 1960s, it was Tommy Douglas who pushed the minority government of Lester B. Pearson to create health insurance, the Pension Plan and other measures that form the bedrock of modern Canada.

Except that the NDP must face the facts. It’s not the 1960s anymore. And Jagmeet Singh has limited negotiating power.

By tearing up the agreement with the Liberals, the NDP would condemn itself to sharing the balance of power with the Bloc Québécois. Ultimately, this would risk precipitating elections that could lead to a majority Conservative government.

With the keys to Parliament, Pierre Poilievre could put aside achievements dear to the New Democrats.

Is this what they want?

Isn’t there a compromise that would make things easier?

We agree that all Canadians should have access to the medications they need without putting their financial health at risk. Currently, 2% of Canadians are uninsured and 10% are underinsured.

This week, the NDP showed itself open to a phased approach that would cover contraceptive products and diabetes treatments for free, to begin with. But why these two categories and not others?

If we absolutely want to nationalize a part of the industry, it would be more useful to centralize the coverage of exceptional drugs, to distribute across all Canadians their astronomical costs which are causing the collapse of private plans (treatments at half a price). million per patient are no longer so rare).

This would be a great step forward that the NDP could be proud of.

For the rest, there is no point turning the current ecosystem upside down.

Instead of creating a new single-payer plan from scratch, Ottawa could simply make drug insurance compulsory for everyone, as is already the case in Quebec, by providing uniform conditions that would allow the less fortunate not to be choked by the amounts to be paid¹.

But the NDP, supported by the unions, wants medications to be 100% free. And that the system is managed 100% by the public. Exit private insurers which cover approximately half of the population in Quebec.

This raises all kinds of issues.

Financial: the additional bill for a national plan could cost the public $13.4 billion annually, according to the Parliamentary Budget Officer. Even if Ottawa committed to compensating the provinces, which would be responsible for developing the system, they would be right to be reluctant to take the burden on their shoulders, knowing only too well that in the long term, federal funding could melt. They’ve already had it done to them with health insurance.

Constitutional: health is a provincial responsibility, let’s not forget that. And we don’t need another federal-provincial quarrel. Already Quebec refuses to sign the agreement on health transfers because Ottawa persists in wanting to impose its conditions on it².

IT: supporters of a national regime argue that centralization would make it possible to save money. Oh yes ? That’s what the Harper government said when it launched the Phoenix payroll management system. Not only were the $70 million savings never realized, but eight years later, billions were sunk into a computer system that caused incredible harm to public servants.

If the past is a guide to the future, we must not underestimate the side effects of nationalizing drug insurance.

1. Read the editorial “National drug insurance for Christmas? No need ! »

2. Read the editorial “Health transfers: what is Ottawa getting involved in?” »