If there are two words that define the relationship any democratically elected government has with its voters, they are public trust. Government is about so many things.
But its very legitimacy is bounded up in the trust citizens have for the officials they democratically elect. And government is a unique entity that has unique responsibilities to deliver important services, the most important one being health care.
Under the Canadian system, there is only one insurer, only one guarantor of health-care delivery, and that’s the government. Even though the administration of this public trust is done by provincial governments, none of it is possible without health-care policy and funding from the federal government.
When Canadians are asked to name the most important element of the Canadian safety net, health care is the one most mentioned. Nothing else comes close. And this is why, in election after election, there may be many water cooler issues, but none is ever more important than health care.
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The economy, affordability, climate change and immigration are, according to Ipsos, the key issues in this election. But every single one of them lines up behind health care.
Some 35 per cent of Canadians name health care as their top issue, followed by affordability and the cost of living at 27 per cent, climate change at 25 per cent and the economy at 24 per cent.
No party that seeks the support of Canadians ever campaigns against the key principle of our health-care system: universality. Every resident of this country must have equal access to health-care services. All governments deliver the same guarantee. But in this campaign, not all of the main parties are campaigning for a new public trust that most health-care analysts believe will eventually be a feature of the Canadian health-care system — universal pharmacare.
Just under 90 per cent agree that all Canadians should have equal access to prescription medicines, paid for by a government program.
“I think Canadians, because they love our universal health-care system, it can make sense for them that we also have drugs covered under that system,” says Manuel Arango, director of policy advocacy and engagement for the Heart and Stroke Foundation of Canada.
But while there is no doubt that a government-guaranteed prescription drug plan is a popular idea, not all political parties are supporting its implementation.
The Liberals say they are for it and will commit to spending at least $6 billion in its first year of implementation. They are very vague about how it will be rolled out and precisely which prescription drugs would be guaranteed under the system.
Many drugs for rare diseases might not get the government seal of approval. Those highly expensive drugs — drugs that are unaffordable to the vast majority of Canadians — are controversial, and they could very well remain that way for a long time.
The NDP is talking about $10 billion guaranteed in the first year and, in a political bidding war with the Liberals, will always talk about a much more generous program.
Elizabeth May’s Greens have been talking about pharmacare for almost as many years as they have been discussing the environment. In a fully costed program reviewed by the Parliamentary Budget Officer, the Green program for pharmacare would cost $26.7 billion in its first year of implementation.
May says she didn’t expect the cost to be as high as that but calls it an essential service and says: “We have to do it.”
There is only one Canadian political party that is not trying to position itself as the party of universal pharmacare: the Conservatives. Andrew Scheer doesn’t feel any pressure on the issue. He is on record saying he doesn’t think the Liberals are committed to this.
“What people know is this proposal is designed by a member of former Ontario premier Kathleen Wynne’s failed government,” Scheer said.
Scheer is referring to former Ontario health minister Eric Hoskins, chair of the federal government’s advisory council, which came up with the pharmacare plan the Trudeau Liberals are running on.
When this subject comes up during the pre-election debates, there is no doubt the Conservative leader will remind the country of the enormous debt built up by successive Ontario provincial governments and suggest the Trudeau team wants to follow the same path.
The Conservatives will connect universal pharmacare to their general argument that the Liberals are fiscally irresponsible. That could, in the end, be a risky strategy to pursue at a time when most Canadians favour such a program … and those who are most enthusiastic about it are those who always turn out for elections: the elderly.
Charles Adler hosts Charles Adler Tonight on Global News Radio and is a columnist for Global News.