While every federal election campaign is unique, one of the things you can always count on is voters ranking health care at the top of their priority list. The 2019 election campaign will be no different. And while climate change is a growing concern for many, indeed the top concern for Canadians aged 19-34, health care has yet to be knocked from its perch atop Canadians’ priority list.

However, while health care is perpetually ranked as a top voter concern, it has arguably never been the “ballot box” question in a federal election. Will 2019 be the year that health care becomes THE issue that will decide how people vote? The NDP (New Democratic Party) are hoping so, the Liberals (Liberal Party of Canada) are worried it might be and the Conservatives (Conservative Party of Canada) are betting against it.

Health care commitments have always formed a central part of the NDP’s campaign platforms, but the Party is doubling down on the issue in 2019, promising something for virtually everyone in the country. In addition to committing to a universal public pharmacare program by 2020, the NDP has also promised universal coverage of dental, mental health, fertility, vision and hearing care. It has also promised to stop the privatization of health services and user fees, create a plan to recruit and retain doctors, nurses and other health professionals, prevent the sale of blood products and ensure equal access to abortion. The NDP has also committed to developing national strategies for seniors, autism and suicide, they would declare the opioid epidemic a public health emergency and make investments in health care infrastructure in Indigenous communities.

There is no answer yet to the question of how they would pay for these commitments, but it is clear that the NDP is betting heavily on health as a ballot box question in this year’s campaign. In doing so, the NDP may have changed how the Liberals approach their signature health commitment – a universal pharmacare program.

Unlike the NDP, the Liberals and Conservatives have not yet released their policy platforms so we don’t know what might be promised by the two parties. What we do know is that a national pharmacare program will be the centrepiece of the Liberal platform commitments in health. But what type of pharmacare program will the Liberals promise? A public, single-payer (federally-funded) pharmacare program as the NDP has promised and as was recommended by the Hoskins advisory panel, or a “fill the gap” model that would ensure coverage for those who don’t have public or private insurance and those that are underinsured?

The debate within the Liberal party over the best model for a national pharmacare program is years old, but many stakeholders and observers believed that the “fill the gap” model would prevail. However, it is increasingly likely that the Liberals will propose a public, single-payer model to keep pace with the NDP, given the political imperative of attracting every possible left-leaning vote in a very competitive election race. It seems the Liberals are worried that health care and pharmacare could indeed become a ballot box question in this election and that, more than anything, may be influencing their policy decision on the pharmacare model question.

The Conservative Party, on the other hand, is betting heavily that history will repeat itself and that health care, while a top concern of voters, will not decide how people vote. Instead, Conservatives believe that “pocketbook” and cost of living issues will be more determinative and their platform will reflect that conviction. Health care is not considered a strength for the Conservatives (although their record is arguably better than most people think) and so on health, the Conservatives will aim to reassure people, rather than win them over. To wit, Conservative Leader Andrew Scheer is promising the Premiers that he would increase health transfers and a social transfer by at least three per cent every year should he become Prime Minister, in an attempt to blunt some of the criticism and “fear-mongering” that the Conservative camp is anticipating. While they may make other health commitments – on pharmacare, the Conservatives have argued that a “fill the gap” approach is the best option – it is clear that the Conservative Party is wagering heavily that other concerns will trump health care in the 2019 election.

In the end, all three parties may have it right on the question of health care. The Conservatives know that the votes they are seeking to attract won’t be moved by health care commitments and are accordingly focused elsewhere. The NDP and Liberals know that they are in a fight for the left-leaning undecided voter, who ranks healthcare as a top priority and are jockeying for position on the health care file. In the 2019 election, the outcome of that battle may mean the difference between a majority and minority government for the Liberals and survival for the NDP.