Though health care is delivered by the provinces and territories, Canada’s federal government has a crucial role in terms of funding levels, setting health care priorities, and making sure that access and availability is equal across the country.
The federal government also provides health care services directly to certain people, including to members of the Canadian Forces, some Indigenous communities, veterans, and inmates held in federal prisons.
“This is a bold plan. It’s going to take some courage,” Singh said during his announcement of the proposal. “It’s going to take us standing up to pharmaceutical industries and insurance companies who don’t want us to bring this plan in. But we know this plan will work.”
The NDP platform’s “new deal for health care that includes pharmacare for everyone” makes reference to the origins of Canada’s universal health care regime, which can be traced back to former Saskatchewan premier and NDP leader Tommy Douglas.
It also states that many still struggle with issues around inaccessibility and unaffordability when it comes to health care, particularly the costs of prescription medications that aren’t covered through public plans or employers.
A 2017 report by the Conference Board of Canada found that 4.1 million Canadians are not enrolled in either a public or private prescription drug insurance plan, but that they may be eligible. And nearly two-thirds of Canadian households paid out-of-pocket for at least a portion of their prescription drug purchases in 2015.
If the NDP forms government, the party promises to implement its pharmacare plan by late 2020 with an annual federal investment of $10 billion. On top of that, the party promises to include dental care in the Canada Health Act.
Singh said the party would extend full publicly funded dental care to households making less than $70,000 per year starting in 2020. The plan would partially cover dentistry for households making between $70,000 and $90,000. The parliamentary budget office costed the first year at $560 million and just under $1.9 billion as more people received dental care.
These costs would then hover around $825 million and $850 million in later years as the program becomes more established.
The NDP platform also pledges to tackle wait times for health care and to improve access to primary care across the country, and “recruit and retain the doctors, nurses, and other health professionals Canadians need.” Details on these measures are scant, especially as these types of health care specifics are under the jurisdiction of the provinces and territories.
The party also states that mental health care should be available at no cost for people who need it, and everyone should have access to regular eye care and hearing care. However, those pledges are not fleshed out and haven’t been costed.
On the issue of long-term care for aging Canadians, the party says there are inconsistent standards across Canada, such as understaffing at residential homes. The Conference Board of Canada found that the demand for long-term care beds was at 263,000 people in 2016. And in Ontario alone, the waitlist for long-term care was at 32,000 people in 2017.
To respond to this, the NDP says it will develop and amend the Canada Health Act national care standards specifically to account for home care and long-term care.
The party states that Canadians struggling with infertility should have access to the procedures they need, but does not state what those are, how they would be funded, or when.
On the issue of reproductive health, the party also pledges to ensure equal access to abortion services.
An NDP government would also “step up and regulate” natural health products under new legislation.
Though the Conservatives have not yet released their full platform, leader Andrew Scheer has said that his party would budget $1.5 billion for new medical imaging equipment, specifically to replace old MRI and CT machines. Scheer said these improvements would reduce wait times for those tests, particularly for aging Canadians.
“This investment will help our health care providers to deliver quality services with the most up-to-date technology, giving patients quicker access to reliable, potentially life-saving tests,” he said in a statement.
Scheer has also said his party would maintain and increase long-term health care payments from the federal government to the provinces and territories under the Canada Health transfer.
The party has also been skeptical of universal pharmacare. In response to a report from the Liberal government’s advisory council on national pharmacare released in June that recommended a universal, single-payer pharmacare plan funded by the government, Scheer said that Canadians would likely not be impressed by the cost of the plan.
“I don’t believe anybody thinks that when Liberals announce multi-billion dollar spending programs that they’re going to save money,” Scheer told reporters at the time. He added that his government would reduce the cost of prescription drugs and address “gaps” that make them inaccessible for people who can’t afford them.
Earlier this year, Scheer said a federal government under the Conservatives would balance the budget within five years.
The Liberal platform released this week states that the previous Liberal government committed billions to health care.
If re-elected, the party pledges it will “move forward with more accessible care, shorter wait times, and better health outcomes.”
Specifically, the party promises to ensure that every Canadian has access to a primary health care provider, “set clear national standards for access to mental health services,” and improve home care and palliative care.
Again, because the specifics of health care services are delivered through the provinces and territories, it’s unclear how, exactly, the Liberals plan to do this. And health experts say that while the goal of increasing access to primary care is necessary, the steps to do so are complex and require overhauling the system of primary care itself.
Another major hurdle in access to primary care is that the vast majority of family doctors and health professionals are located in urban centres, so specific measures need to be pursued to address access in more rural areas.
To fund these promises, Liberal Leader Justin Trudeau has said his government would provide an additional $6 billion in funding over the next four years tied to negotiations with the provinces and territories.
The Liberal platform also states the government would “take the critical steps” to implement national universal pharmacare, although there is no specific timeline for when this would happen.
The platform does not provide a specific cost, but Trudeau has said his party would adhere to a pharmacare report conducted by former Ontario health minister Eric Hoskins, who estimated the cost would run at $15.3 billion a year by 2027.
The platform does not make any promises related to dental care like those of the NDP and the Green Party.
The Liberals also make a specific promise to double the Child Disability Benefit, a tax-free monthly benefit for caregivers who care for children with certain conditions such as learning and speech disabilities, autism, among others. It’s a type of promise that appears to take direct aim at the cuts and overhauls to the autism program under Ontario Premier Doug Ford, who comes up repeatedly in speeches by Trudeau and other Liberal candidates.
The party’s own costing suggests that promise would cost $391 million in 2020-2021 and go up to $548 million by 2022-2023.
On sexual and reproductive health, the Liberals promise to make family planning and sexual and reproductive health care “more accessible and affordable,” but don’t say how or when. A Global News investigation earlier this year found that hundreds of Canadian women are being sent to the U.S. for abortion-related services that they cannot access in their home province, and the Globe and Mail recently found that access to the abortion pill is patchy across Canada due to doctors being unwilling to prescribe it.
The Liberals are also promising to create Canada’s first National Institute for Women’s Health Research to bring experts together to tackle gaps in research and care — taking an intersectional approach that includes “race, ability, indigeneity and more.”
The platform confirms that a re-elected Liberal government will amend the Criminal Code to ban conversion therapy and work with provincial and territorial governments to “eliminate” the practice altogether. However, there’s no timeline for this commitment.
One of the first promises in the Liberal platform section on “Building a Better Future With Indigenous Peoples” includes a promise that the government will provide access to the “high-quality, culturally relevant health care and mental health services they need.” This would include co-developing specific Indigenous Health legislation.
When it comes to health care for veterans, the costed portion of the platform says a Liberal government would spend an additional $53 million for mental health and wellness services, an amount that would increase to $105 million in the following years.
The promises in the Green Party platform fittingly are woven with concerns about climate change and the environment — including the party’s health care commitments.
There’s a specific section on Reducing Ecological and Health risks that promises to tackle the “series health threats” posed by pollution and toxic chemicals. This includes passing legislation to give Canadians the “right to a healthy environment” and setting targets for reducing the use of pesticides in agriculture through programs that help farmers move toward “organic and regenerative farming.”
The Greens are also the only party promising to pass legislation to create an “adverse effects reporting database” for healthcare professionals to track the health impacts of pesticides and other chemicals.
It’s also the only party pledging to exempt cannabidiol or CBD extract from the restricted section of the Prescriptions List, and allowing hemp growers to produce it as a natural health product.
Other Green Party health care promises are more conventional, including ensuring everyone has access to a family doctor — also without specifying how that will be done or when — and devoting “sufficient resources” for maternal and infant care and mental health services.
The party also pledges to rework the Canada Health Act to “prioritize expansion of” mental health and rehabilitation services and reduce wait times.
The party is also promising that, if elected, it would promote primary health care that is “sensitive to issues of social justice, equity and cultural appropriateness.”
Like the NDP and Liberals, the Greens are making their own pledge to expand single-payer medicare to include pharmacare for everyone. Like the NDP, it’s promising free dental care for low-income Canadians. The plan does not specify whether that would include households that make between $70,000 to $90,000 like the NDP plan.
The Parliamentary Budget Officer costed the Green Party’s pharmacare promise at $26.7 billion in the first year, rising up to $31.3 billion by 2024-2025, making it one of the most costly aspects of the platform.
In response to the PBO’s assessment, Green Leader Elizabeth May said she was surprised by the price tag.
“The big ticket items — pharmacare — turns out to be a cost,” she told reporters. “But it’s essential. We have to do it.”
The Greens are also focusing on the way that climate change impacts mental health, specifically promising to “reorient Health Canada’s mandate” toward the health risks of climate change. The party would also encourage medical associations to train health professionals to “understand and engage with climate change related health threats.”
The Greens, like the NDP, make specific promises to provide health services for LGBTQ2 people who want them, including gender-affirming health services such as “hormones, blockers, and surgery.”
On health care for Indigenous Peoples, the Greens promise to formally include traditional healing and mental wellness and home and community care programs.
And the Greens are the only party so far to make a platform promise to amend the Liberal government’s Medical Assistance in Dying legislation, which required that patients’ deaths to be “reasonably foreseeable,” something that a Quebec judge recently struck down as unconstitutional. The Greens promise to ensure that everyone “has the choice of dying with dignity.”