Early in November, the NDP used one of its opposition days in the House of Commons to propose two new taxes: a one percent levy on all accumulated family wealth over $20 million, and an excess profit tax on big corporations that have profiteered from the pandemic.
It was a non-binding resolution, meaning, if it passed, parliamentarians would merely be signaling they liked the idea. Tangible action would have to come later, in the form of budgetary legislation.
Despite the purely symbolic nature of the motion, the other parties with official status in the House — the Bloc Québécois, which likes, at times, to fancy itself as progressive; the Conservatives, who are allergic to the very word tax; and the governing Liberals, who after coming second in the popular vote in the last election claimed they, nonetheless, form a progressive majority when their vote is combined with that of the New Democrats and Greens — all voted nay.
Only the three Green MPs supported the NDP.
The Parliamentary Budget Office estimates the wealth tax alone would bring in $5.6 billion this year. And when he spoke to the motion in the House, NDP finance critic Peter Julian pointed out that COVID-19 has increased the concentration of wealth in Canada.
“Billionaires added $37 billion to their profits,” Julian said, “and the banking sector, with incredible federal largesse, increased its profits, as well.”
Step two: pharmacare
New Democrats did not propose these new taxes just to knock the wealthy down a peg.
They had specific ideas as to how the additional revenues should be used, including a guaranteed livable income, a national right-to-housing program, and expanded health care, meaning national dental care and public pharmacare.
On Wednesday, November 18, the NDP decided to push further with one part of that overall plan.
Peter Julian introduced a private member’s bill to create a national prescription drug benefit for all Canadians, in conjunction with the provinces. Health care is, constitutionally, a provincial responsibility.
Julian’s new measure is a bill, not a motion, meaning that if it were passed, it would become law.
As an overarching objective, the bill states that it is “the policy of the Government of Canada to facilitate access to prescription drugs without financial or other barriers in order to protect and promote the physical and mental well-being of Canadians.”
To make that happen, the bill proposes a series of measures similar to those the federal government took when it enacted legislation, in the 1960s, to create the national public health insurance system — modeled on the Saskatchewan NDP government’s pioneering program.
In the 1980s, there was significant erosion of the public system. Some provinces, for instance, allowed doctors to double-dip: they could take the fee paid by the public insurance plan and, in addition, charge patients an additional amount.
We called that practice extra billing, and I experienced it in 1981 as I lay on a gurney at the Ottawa General Hospital suffering from a severely inflamed appendix. An anesthesiologist explained that they had an effective closed shop at the hospital – no anesthesiologists would be permitted to practise there unless they extra-billed. I was in no shape to make an argument on principle, and agreed to pay.
In 1984, then health minister Monique Bégin shepherded the landmark Canada Health Act through Parliament, which put an end to extra billing and other similar practices, and established some basic principles for public health insurance throughout the country. Among those were universality, meaning the insurance had to cover everybody, and portability, which guaranteed seamless coverage for Canadians who moved from one province or territory to another.
Peter Julian’s pharmacare bill would incorporate the 1960s’ and Canada Health Act’s principles into a universal drug benefit plan. The federal government would make cash contributions to the provinces to support the plan, as long as the provinces abided by these basic principles.
Prescription drugs were not crucial in 1960s
Canada’s medical insurance system, as it exists now, is largely based on a 1960s notion of what constituted basic, necessary health services.
Back then, our idea of essential services focused, primarily, on hospitalization, doctors’ consultations and surgery. Costly pharmaceutical drugs, such as those to treat cancer, diabetes, or vascular and heart disease, were nowhere as commonplace in the 1960s as they are now.
Other countries with universal systems similar to Canada’s might not cover every single doctor’s visit, as does ours, but a good many are more comprehensive, especially when it comes to live-saving medication. After all, what is the use of giving patients unfettered access to doctors, who, more often than not, prescribe drug treatments, but not making those treatments available to all?
Some provinces offer some drug coverage to some groups, such as seniors. But the NDP has long argued that it is long past time that Canada got with the program and included not only a doctor’s examination but the medicines that doctor prescribes in the public health insurance system.
The Liberals have supported this idea, in principle, for a while; but have been very timid about moving too far and too fast.
In 2018, the current Trudeau government set up an advisory council on the implementation of national pharmacare, headed by former Ontario health minister Dr. Eric Hoskins. In 2019 that council recommended almost exactly what Peter Julian proposes in his bill.
They put it this way:
“The council recommends the federal government work with provincial and territorial governments to establish a universal, single-payer, public system of prescription drug coverage in Canada.”
The council proposed the five principles enunciated in the Canada Health Act be applied to a new pharmacare program. Those principles would guarantee equal access, based on medical need, via a system that was publicly funded and administered and fully portable throughout the country.
In their report, council members noted that one in five Canadians either do not have prescription drug insurance or only have inadequate insurance. They reported that many Canadians fail to take prescribed medicines because of cost, that at least a million Canadians cut back on food or home heating to pay for their medication, and that an equal number have to borrow money to pay for prescriptions.
The needs are real, and as Peter Julian and his NDP colleagues emphasize, a universal drug plan would bring significant economic benefits, in the form of increased productivity and fewer hospitalizations caused by failure to take prescribed medications.
The COVID-19 crisis has, naturally, absorbed all of governments’ attention since this past March. But those who want to, at long last, see federal action on a big missing piece of the Canadian health-care puzzle argue that, in fact, the impact of COVID-19 underscores the need to move now.
It would be a pity if partisan considerations — such as fear of allowing New Democrats to get at least part of the credit for any new prescription-drug initiative — were to prevent the governing Liberals from voting for Julian’s bill, and then acting on it.
Karl Nerenberg has been a journalist and filmmaker for more than 25 years. He is rabble’s politics reporter.