It is surely the most noteworthy new program in this year’s provincial budget: Finance Minister Charles Sousa is introducing a new, universal pharmacare plan for all Ontarians 24 years of age or younger.
While the mere fact of the commitment captured plenty of attention, the Liberals didn’t appear to have many of the details worked out, including (astonishingly) the cost of the program, which Sousa estimated for reporters when asked, but appears nowhere in the budget papers themselves.
That got some critics wondering whether the plan was a last minute addition to the budget, included only because the NDP unveiled its own pharmacare plan the previous week at its annual convention. In a rather suspicious coincidence, the Liberals’ plan costs almost the same as the NDP’s: $465 million compared to $475.
There are a couple of major differences between the two proposals. The NDP effort would cover fewer drugs but more people. The government’s plan includes about 35 times as many drugs as the NDP proposal — 4,400 versus 125 — but only covers young Ontarians. Obviously, honourable people can disagree about spending priorities. But presumably some of the most important questions facing the Liberals ought to be: Which plan does the most good for the least amount of money? And which plan directs help to those who need it most?
Ontario already has many different pharmacare plans designed to help specific demographics. The province covers meds for those on social assistance through Ontario Works or the Ontario Disability Support Program. It pays the lion’s share of the costs of the Ontario Drug Benefit plan for seniors (minus some modest deductibles and co-payments). There’s also the Trillium plan, for drugs that cost a lot relative to an individual’s income (which arises in many catastrophic illnesses, as well as with chronic conditions that require expensive medications). There are, additionally, specialized drug plans including ones for cancer patients, those with metabolic diseases, high risk infants, and people who suffer from age-related macular degeneration (an eye condition).
And then there are the public and private sector workplace drug plans, under which many Ontario employees have their children covered.
Add ‘em all up, and those drug plans cover the vast majority of the population under age 25. In other words, the Liberals’ pharmacare announcement may make for great political optics — covering all young people is an appealing sales pitch. But a closer look suggests the plan won’t give as much bang for its buck as it may initially seem.
Ironically, while the Liberals claim they’re aiming to help the most vulnerable Ontarians, we don’t know if their plan will do that, even in the relevant age group. We don’t have details about how the program will work logistically, and so we don’t know whether it will be set up to accommodate the homeless, for instance, or those without bank accounts — people who don’t have fixed addresses or who can’t easily be reimbursed for drug costs.
There is also a question of principle: The Liberals need to explain why it makes sense to offer free meds to children who are already covered while poorer, older Ontarians won’t be. (When asked this precise question on budget day, Sousa rejected the premise of the query, saying that universal access is a Canadian and a provincial value, and that people should have publicly funded health care regardless of income — framing the government’s pharmacare plan as the first step in the expansion of universal health care more broadly.)
It’s these questions — and the fact that there’s no mention of the cost of the Liberals’ plan in the budget — that fuel the suspicion on the part of both opposition parties that the government worked out its pharmacare idea on the back of an envelope, and shoehorned it at the last minute into the finance minister’s budget speech (but not the detailed budget breakdowns themselves). Experts at the budget lockup last week were unable to explain how they arrived at the program’s $465 million price tag, further lending credence to the idea this plan was developed on the fly.
Having said that, the politics of doing something for kids may be irresistible to Ontarians, and pollsters will surely be on the lookout to see whether the premier’s (and her party’s) popularity improves in the immediate aftermath of the budget.
Another potential political windfall for the Liberals could be what their plan does to the Progressive Conservatives’ efforts on this issue. The Tories, so far, have not said what their own drug plan might look like, deciding to wait for the outcome of a grassroots policy-development process getting underway in November. On budget day leader Patrick Brown said the party would not hinder access to meds, but offered no specifics. He also mused that the notion of offering free meds to the children of millionaires doesn’t make much sense. But if the Liberal plan does kick in as of January 2018, as planned, it may box him in: should he win the election six months later and become premier, he will be in the tough spot of contemplating whether to end an existing entitlement, which people will have benefited from for six months at that point.
All of which means: this story is a long way from over.
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