“This Is Some Kind of Business Agreement”

The Liberal-NDP pact, termed a supply-and-confidence agreement (not a coalition, as the NDP holds no cabinet seats), has put Singh in an uneasy bind as an opposition figure. His criticisms of the government on issues such as housing, climate, and foreign policy don’t carry much weight due to his having agreed to support the government to prevent its collapse.

Although Singh maintains the right under the agreement’s terms to walk away if the NDP is unsatisfied with its results — and he’s repeatedly threatened to do so — the results so far have been lackluster. “This isn’t politics. This is garbage. This is some kind of business agreement,” said Alanna Johnston, a Toronto delegate to the 2023 NDP convention.

Consider the dental care initiative, for instance, which addresses another significant gap in Canadian public health care. The program, agreed upon by the NDP in March 2022, is already a means-tested mess. By the time it’s fully rolled out, it will provide coverage to Canadians who aren’t already privately insured and have an annual household income of less than C$90,000. But only those who earn less than $70,000 will receive full coverage. Those making $70,000 to $79,999 will still have to pay 40 percent of the cost, while those making $80,000 to $89,999 will pay 60 percent.

If you earn $90,001, tough luck. A January report from the Canadian Centre for Policy Alternatives found that this framework will exclude 4.4 million uninsured Canadians from receiving dental coverage. Economist David Macdonald noted that a family of four with a $90,000 household income isn’t particularly wealthy. “But making more than that precludes those families from receiving federal dental care coverage,” he told the Canadian Press.

The Liberals have proven fickle when it comes to deadlines. Under the terms of the Liberal-NDP deal, the dental care program, despite its flaws, was supposed to be fully implemented before the end of this year. However, the Liberals now say the program’s gradual rollout will continue into 2025. Buried near the end of the CBC story reporting the delay is the fact that the program was contracted out to the private insurance company Sun Life — it will not even be a public program in any meaningful sense of the word.

Perhaps these deficiencies were why the NDP emphasized that the pharmacare aspect of their deal had to be a universal, single-payer program. To ensure it remained “entirely public,” Singh agreed to allow the Liberals to breeze past their end-of-2023 deadline for introducing the Pharmacare Act.

Singh touted the inclusion of diabetes and contraception medication coverage in the act as a big win. But the limited coverage offered by the act highlights how much ground still must be covered to achieve a comprehensive pharmacare program — if, indeed, we ever even get there.

Provincial Intransigence

Days after the February 23 announcement that the federal Liberals and NDP reached a deal on pharmacare, the right-wing provincial governments in Quebec and Alberta announced they wanted no part in the program. Nationalist Quebec governments have long opted out of federal programs, including the Canada Pension Plan, in favor of creating their own versions with their allocated funding.

The Alberta government, which has veered increasingly close to Quebec-style separatism under Premier Danielle Smith, has suggested there’s no need for a federal pharmacare program because provinces already have their own subsidies for medications in place. Alberta health minister Adriana LaGrange has made clear she would gladly take the feds’ money to bolster the province’s existing programs.

Alberta’s existing subsidies provide a glimpse into why means-tested patchworks, such as the federal dental care program, are wholly inadequate. The primary medication subsidy in Alberta, the Alberta Adult Health Benefit, is even more miserly than the federal dental coverage initiative, providing coverage for some medications only to those with a household income of less than $36,634 a year.

The Alberta government also subsidizes premiums for Alberta Blue Cross insurance, but to qualify for a discount, applicants must have a household income of less than $39,250 a year. People on Blue Cross plans are still required to pay 30 percent of the cost, up to $25 per medication. Even if the Alberta government uses federal funds to expand eligibility and reduce copays, this falls far short of a universal program.

According to University of Calgary endocrinologist Dr David Campbell, the federal program could save someone with type 2 diabetes $1,100 per year on medication costs if they already receive provincial subsidies, or $2,000 a year if they don’t. Dr Campbell notes that could lead to reduced overall health care costs, as individuals who are unable to afford their diabetes medications are 55 percent more likely to require hospitalization than those who can afford them.

Will These Programs Withstand a Conservative Government?

Fully subsidizing these medications in a single-payer system is no doubt a good start. But given that the provinces are tasked with delivering health care, their obstinance could be a significant roadblock. Even more concerning is the likely prospect of Conservative leader Pierre Poilievre becoming the next prime minister.

While he’s thus far refrained from taking a clear position on the Pharmacare Act itself, he has expressed sympathy for Quebec and Alberta wanting to opt out. Poilievre’s opposition to the milquetoast federal dental care framework doesn’t exactly inspire confidence, nor does his constant bloviation about excessive federal government spending.

A Poilievre government would have a much easier time taking a wrecking ball to the means-tested dental care subsidy — which he can convincingly argue is a subsidy to insurance companies — than opposing single-payer coverage for diabetes and contraception medications. However, the limited scope of pharmacare coverage thus far makes it easier to backtrack on than a comprehensive, more robust plan.

This is the cost of the federal NDP’s cautious incrementalism and their willingness to play ball with the notoriously duplicitous Liberals. The NDP had the opportunity to force the Liberals to implement bold, progressive changes that would have been more resilient against dismantling by a future Conservative government. However, this could only have been achieved outside the lopsided supply-and-confidence agreement. Instead, the party opted to play second fiddle to the Liberals, raising the risk of their legislative accomplishments getting lost in the wind.