SoVote

Context: House Hansard - 321 - May/30/24

May/30/24 8:31:01 p.m.
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Mr. Speaker, that is a little rich from a member who has supported he most costly government in the history of our country at every step of the way. He approved the $61-billion budget that the government announced just recently. At every step of the way, the member has done the bidding of his Liberal coalition. He has covered up scandal after scandal. The member also knows that I stand up for my riding of Cariboo—Prince George and I stand up for British Columbians each and every day because, God only knows, the British Columbians from the NDP do not.

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Mr. Peter Julian

May/30/24 8:31:54 p.m.
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Mr. Speaker, I will come back on that. Of course, the NDP members got dental care for British Columbians. They are getting pharmacare for British Columbians, affordable housing and anti-scab legislation, all of the things that the Conservative caucus had been unable to do. The reality is that Conservative MPs just have not worked very hard. We are not asking that member, who I know is devoted to public service, and the rest of his colleagues to actually lift a finger to deliver pharmacare for their constituents. All we are asking them is to stop standing in the way, stop forcing these meaningless debates like tonight's, with deleting all clauses of the bill, and let the NDP work on behalf of their constituents, so that all British Columbians and all Canadians—

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Caucus

The Deputy Speaker

May/30/24 8:32:37 p.m.
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I will interrupt the member, just so we have time for the hon. member for Cariboo—Prince George.

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Mr. Todd Doherty

May/30/24 8:32:41 p.m.
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Mr. Speaker, there were 43 amendments. Only an NDP member would say that they worked hard for two years and came up with a four-page document. We had 43 amendments, and for five and a half hours we had to listen to a filibuster, as we are tonight.

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Mr. Angelo Iacono (Alfred-Pellan, Lib.)

May/30/24 8:33:16 p.m.
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Mr. Speaker, I am pleased to rise today to participate in this important debate. The legislation before us contains the four principles of accessibility, affordability, appropriateness and universality. Today, I will speak to the principle of appropriateness, which relates to the appropriate prescribing and use of medicines. I will outline the importance of achieving a pan-Canadian strategy on the appropriate use of drugs, which is a key feature of this legislation. Notably, the World Health Organization defines “appropriate use” as follows: “patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community.” Prescription drugs play a critical role in the day-to-day for Canadians. Every year, over 750 million prescriptions are filled by 18 million people in Canada. It is estimated that in any given month, 55% of adults and 23% of children and youth will take at least one prescription medication. Getting the right medication at the right time can be life-changing. Whether it is receiving a prescription for an inhaler to help an asthmatic patient breathe better or anti-hypertensive medication to bring down blood pressure and decrease the risk of heart attack or stroke, medications have the power to restore health and improve a person's quality of life. However, getting the wrong medication at the wrong time can cause significant unintended harms. In fact, adverse drug events are a leading cause of unplanned hospital visits, contributing to over two million emergency department visits and 700,000 hospital admissions in Canada every year. Examples of appropriate use and action include an informed conversation between a patient and their health care provider on the best treatment to improve their health, opting to stop a medication that was once helpful and is now causing more harm than good, or a public awareness campaign on how to use antibiotics wisely. Unfortunately, a growing body of evidence suggests that inappropriate prescribing and use happen more often than they should. Consider that 21% of adults in Canada between the ages of 40 and 79 are currently taking more than five prescription medications at a time. This is called polypharmacy and it can increase a person's risk of falls by 75%, among other impacts. Consider the story heard from a clinician about a patient who was taking over 25 different medications, the combined effects of which were taking a serious toll on their health and quality of life. This clinician stressed to us the significant time and effort required to support the patient and caregiver to slowly discontinue the inappropriate medications. A striking takeaway from this conversation was that this case was far from an anomaly in their practice. Inappropriate prescribing can threaten patient safety and lead to negative health, social and financial impacts. Other significant examples, such as increased antibiotic resistance due to overuse that threatens patient safety, the risks of addiction and overdose from opioid misuse, and many problems and injuries related to the long-term use of sleeping pills, show this issue is widespread. It is estimated that approximately 1.9 million Canadian seniors regularly use at least one inappropriate medication, which can lead to dizziness, memory problems, hospitalization and even death. The cost of these inappropriate prescriptions is over $419 million per year, and it rises to over $1.4 billion if the costs of hospital visits and the impacts of other harms are included. Appropriate use was established as a shared priority among federal, provincial and territorial governments. Jurisdictions, health organizations and even local providers have implemented a variety of initiatives and programs to address the issue at hand. There is good work happening across the country, but those doing this important work have called for a unified approach so we can increase its impact and reach. While there are several pockets of excellence addressing appropriate use, persistent gaps and challenges exist. Inconsistent reach, overlapping efforts and even duplication have limited the scale-up and spread of promising approaches across the health care system, which limits our ability to make these benefits available to people across the country. Without a devoted strategy to better connect our siloed work and improve collaboration, we risk stretching our already limited health system resources, and we will miss an opportunity to serve patients with the highest quality of care. Other countries around the world have shown us that addressing appropriate use works and makes a difference in the health and safety of their citizens. Countries such as Australia, the U.K. and the Netherlands have developed a coordinated solution that addresses appropriate use at multiple levels and works to ensure that everyone, including patients, prescribers and the public, is motivated to make the necessary changes. In doing so, they have managed to improve prescribing and use behaviours while reducing the harms and health system costs of inappropriate care. Developing and implementing a pan-Canadian strategy that builds on this learning would help expand the impact and reach of successful appropriate use programs to better serve prescribers, patients, and diverse communities across the country. To date, efforts to improve appropriate use, detect and respond to patient safety issues as they arise have been hampered by the uneven ability of prescribing data. This has significantly limited the supports available to patients and prescribers to make the best decisions regarding their care. Support to enhance the collection of and access to prescribing data will need to underpin any strategy. Addressing appropriate use of prescription drugs also presents a unique opportunity to tackle some of the most topical challenges facing our health system, such as appropriate therapies for mental health; access to safe, long-term care; and optimizing primary care. The prescribing of antipsychotics in long-term care is a prime example where, at any given time, it is estimated that nearly one in four long-term care residents was receiving an antipsychotic drug while having no clinical reason for its use. These medications put patients at increased risk of falls, fractures and even strokes. Ultimately, healthier patients and fewer adverse drug events puts less stress on our health professionals and health care system. Patients, health care providers and partners all agree that now is the time to act, and a pan-Canadian appropriate use strategy would bring the vision into reality. This means directing efforts towards implementing widespread programs and initiatives, collaborating closely to make meaningful change, ensuring that health policy promotes positive actions and bolstering evaluation of programs so we can scale and spread those programs that we know would make a difference. We are already getting started. Last spring, the Canadian drug agency transition office established an appropriate use advisory committee, comprising organizations, prescribers, patients, insurers and health system partners, to provide guidance and advice for the development of a pan-Canadian appropriate use strategy. The committee will soon issue its final report. It is also working closely with key partners, including Choosing Wisely Canada and the Canadian Medication Appropriateness and Deprescribing Network to better coordinate existing efforts to further enhance its impact. New health challenges continue to emerge, and the need for a coordinated appropriate use strategy to enhance quality of care, improve patient health and promote the judicious and equitable use of health care resources has become even more critical. Members can see that this strategy, guided by the CDA, would be an important element of moving forward with national pharmacare. Addressing appropriate use on a national scale would confront these challenges, knitting together our existing patchwork of programs to provide much-needed support for patients and prescribers while improving safety and outcomes, ultimately reducing the cost of burdens caused by inappropriate care. We look forward to working closely with patients, prescribers, health partners and jurisdictions in making the program a reality.

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Mr. Stephen Ellis (Cumberland—Colchester, CPC)

May/30/24 8:42:47 p.m.
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Mr. Speaker, with respect to all Canadians such as physicians, nurse practitioners and pharmacists who are listening and who are out there prescribing medications this evening, I find it fascinating that the member would be suggesting that their appropriateness is actually inappropriate and that we need the government now to tell physicians what to prescribe. Think about someone with hypertension, sitting in their family doctor's office if they are fortunate enough not to be one of the seven million people without a family doctor. What is the family doctor going to do? Are they going to call the “1-800-who-cares” phone number provided by the people who cannot even get them a passport, and wait on hold while they say which medication should be prescribed? I find that to be an absolutely terrifying prospect for Canada's incredibly well-trained frontline prescribers in this country who have the independent ability to make those decisions, the best decisions on behalf of the patients, many of whom they have known for an incredibly long time. Maybe the member could answer this: Would they now be setting up a 1-800 number for doctors to ask which medication should be prescribed? Perhaps, as I mentioned, they could call it “1-800-who-cares”.

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Mr. Angelo Iacono

May/30/24 8:44:10 p.m.
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Mr. Speaker, I would like to start off by first saying hello to my 10-year-old boy, who is watching. I know it is past his bedtime, but his mommy has given him an opportunity to hear daddy speak. Second, I would like to say that is not what I said in my speech. Maybe the member should consult a hearing doctor. Why am I not surprised by the question from my Conservative colleague? Pharmacare, for example, is about access to contraceptives for women, which is clearly not within the priorities of the opposition party. My colleague opposite and his party have shown every woman in Canada that when it comes to contraception, they are on their own. Canadians are listening, and by now they know that when it comes to health care, they cannot trust the Conservatives, just like when the member said, making fun of the 1-800 number, “Who cares?"

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Ms. Lori Idlout (Nunavut, NDP)

May/30/24 8:45:11 p.m.
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Uqaqtittiji, it has been disappointing to listen to the debate and how partisan it has been. I wonder whether the member can remind us of what the bill would do. As this is just the beginning of getting universal pharmacare started, what would the legislation do to ensure that more work is done to improve on it as time goes on?

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Mr. Angelo Iacono

May/30/24 8:45:54 p.m.
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Mr. Speaker, we know very well where the members of the official opposition stands on the bill. Obviously they are against it. They do not care, and it is very easy for them to be critical about it. I thank my colleague for the tremendous work they did in shaping the bill with the government. We both understand how important it is. For example, contraceptive drugs were chosen as part of the next step in universal pharmacare specifically because contraception improves the equality of all women when they are able to receive proper care for their needs. It reduces the risk of unintended pregnancies and improves reproductive rights. Also, the bill would help all diabetic patients access proper care and be well treated.

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Mr. Yasir Naqvi (Parliamentary Secretary to the Minister of Health, Lib.)

May/30/24 8:47:02 p.m.
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Re: Bill C-64

Mr. Speaker, I think throughout the debate on Bill C-64, whether at second reading stage or at committee, we have seen nothing but fearmongering on the part of the Conservatives, for a simple reason: They do not support the bill. They do not want Canadians to have pharmacare. In fact, they support a private health care system. That is why they have chosen every which way to put up blockades against the bill by inventing stuff. We heard the member opposite, the health critic for the official opposition, throughout the committee process make things up while witnesses kept telling him that was not the case. He is still repeating the same mistruths. I want to ask the member, who gave an excellent speech, this: How does he feel the legislation, if passed by Parliament, would help his constituents get the medications they so deserve and need?

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Mr. Angelo Iacono

May/30/24 8:48:00 p.m.
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Mr. Speaker, through our bilateral health agreements with the provinces and territories for the Canadian dental care plan and now pharmacare, we are delivering on the promise that every Canadian deserves better health care. Thanks to this plan, nine million women and gender-diverse Canadians across the country will be able to access the contraception and reproductive autonomy they deserve. In addition, it will help 3.7 million Canadians living with diabetes get the medication and resources they need. Canadians should never have to choose between their health and their—

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The Deputy Speaker

May/30/24 8:48:55 p.m.
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Give a foot; take a mile. I should know better. I wish your son good night. I am sure he was happy to see his dad working tonight. Resuming debate, the hon. member for Edmonton Manning.

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Mr. Ziad Aboultaif (Edmonton Manning, CPC)

May/30/24 8:49:15 p.m.
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Re: Bill C-64

Mr. Speaker, I am proud to stand on behalf of the people of Edmonton Manning tonight. When a bill is brought before Committee, I expect that during the study done there that committee members would be able to make amendments that would improve the legislation. Sadly, that has not happened with Bill C-64, the pharmacare act, which is probably because the legislation is so flawed that nothing can fix it. The only proper fix is to bury it. I wish that tonight we were debating the merits of a proposed national pharmacare program. Many Canadians would like to see such a thing, although they might not be so enthusiastic once they saw the price tag. The only resemblance the bill before us has to pharmacare is in the name. If we had asked Canadians what they expected to receive from the NDP-Liberal coalition besides ever-increasing taxes, high inflation, sky-high crime rates and housing shortages, they would probably have said, “Well, at least they have promised pharmacare.” If we had asked what that meant, they would have said, “free prescription drugs for everyone: drugs to treat heart disease or cancer, life-saving drugs and maybe penicillin to treat any number of less serious illnesses”. Instead, what the government is offering is a pledge to consider funding contraceptives and diabetes drugs. It is not a pharmacare plan; it is an empty promise. It is not what anyone was expecting, but it is no surprise. It is not as if the Liberals really want a national pharmacare program. If they did, they would not have needed the NDP to push them into creating the bill before us. The Liberals' plan is empty and it is pretty simple. They want to delay as much as possible to convince the NDP that a plan is coming and that therefore the incompetent government must be propped up. I have to give the Liberals credit for their political skill in this matter. They have the NDP so completely fooled that the government faces no chance of defeat no matter the scandals and no matter how much Liberal polices are hurting Canadians. The NDP is blindly accepting a Liberal promise, apparently unwilling to admit that they have been fooled. I think it is safe to predict that when Canadians go to the polls, whether it is in October 2025 or earlier, the NDP will not be able to point to a functioning pharmacare program, not even the limited one that the bill calls for. However, the promise will have accomplished its purpose: keeping an undeserving government in power. It is the Canadian electorate that will hold both the NDP and the Liberals accountable for their actions. It is the Canadian people who will elect a Conservative government that actually cares about serving them and does not just care about political power. The bill is being shoved through in haste by a government that is so desperate for approval. The Minister of Health is assuring Canadians that the pharmacare plan should not jeopardize the drug coverage that millions of Canadians have through private insurers. I am sure he is well-intentioned when he makes that statement; he may even believe his words, but good intentions are not reality. The CEO of the Canadian Life and Health Insurance Association says that the bill could indeed cause disruption for those who have existing drug plans. Either he is right or the minister is right; it cannot be both. Given the Liberal track record, I suspect the minister is indulging in some wishful thinking, which is not surprising from a government that thinks budgets magically balance themselves, something that has not happened under the current Prime Minister. By using time allocation, the government is rushing the bill through the House without opportunity for proper scrutiny, which is no surprise. Despite having had two years to figure out how they were going to implement their deal with the NDP, the Liberals put together the legislation at the last minute. It is window dressing, designed not to define pharmacare, but to keep the government in office for a few more months to deny Canadians what they want most, which is an end to Liberal overspending and incompetence. The proposed bill is a promise, and Canadians know what happens when Liberals make promises. They have made promises in the past nine years. The reality is that, when the Liberals make a promise, things always seem to get worse. They promised affordable housing, and housing costs have doubled under their watch. They promised that the carbon tax would not cost us anything, and we find now that 60% of families are paying more than they collect. The Liberals promised that taxes would go down, and taxes have gone up. They promised safe streets, and then delivered crime, chaos, drugs and disorder. It is no wonder Canadians are afraid things will get worse when the Liberals promise pharmacare. If the government were serious about helping Canadians, it would have gone about things differently. It would have consulted with the insurance industry, found out what the private insurance sector was offering and what the non-profit sector was providing, examined existing provincial coverage, and discovered if there were gaps that needed to be addressed. Instead, the Liberals decided to rush blindly ahead. Canadians know the government is not worth the cost. That has been proven time and time again over the past nine years. Is this pharmacare program worth the cost? An honest answer is that nobody knows because the minister cannot tell us how much it will cost. Any numbers he tosses around are more wishful thinking than reality. Canadians are struggling and looking to the federal government for help. Inflation eats away at their paycheques. Every trip to the grocery store, it seems the prices are going up. Liberals' catch-and-release bail policies are turning violent offenders loose to commit yet more crimes. Despite an ever-increasing carbon tax, the government has no plan to balance its books. The Liberals apparently have no desire to fix the problems created by their wasteful spending. They believe that water runs downhill but never reaches the bottom. They know they will not be in government when the bill for this mismanagement comes due. Food Banks Canada's 2024 poverty report card shows that almost 50% of Canadians feel financially worse off compared to last year, while 25% of Canadians are experiencing food insecurity. The cost of living has become so high that food banks have seen a 50% increase in visits since 2021. As a direct consequence of the government's inflationary spending and taxes, millions of Canadians are struggling to keep their heads above water, yet the Liberals ask us to take on faith that they know how to set up and run a pharmacare program without turning it into a disaster. This is the government that spent more than $50 million on an app that was supposed to cost $80,000, and it cannot tell us how or when that cost overrun happened, or who is responsible. Why should Canadians trust it to run anything? The good news is that this is not a serious piece of legislation. As I said, the Liberals have no idea what they are doing and no real intention to institute a pharmacare program. Bill C-64 is a public relations exercise with which they hope to fool the NDP and Canadians into thinking they are doing something to help people. Given the Liberals track record, I doubt many Canadians will be fooled.

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Mr. Yasir Naqvi (Parliamentary Secretary to the Minister of Health, Lib.)

May/30/24 8:58:52 p.m.
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Mr. Speaker, I respect the member opposite a lot. I listened to his speech quite diligently, and I am a bit perplexed because, on one hand, he spoke about and advocated for private health care insurance. He talked about how Canadians should just get private insurance for medicine if they do not have any, but then he went on to talk about affordability and the high use of food banks. I hope the member can explain to all of us how he wants to ensure affordable fees against a pharmacare system that is going to save hundreds of dollars for Canadians who do not have private health care insurance so that they can afford to buy good, nutritious food for themselves. I would love to hear that explanation.

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Mr. Ziad Aboultaif

May/30/24 8:59:44 p.m.
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Mr. Speaker, with respect to the hon. member, who I do respect a lot, I did not suggest what he just said. What I was saying is, if there is a gap in the system, the gaps can be filled in many different ways, and we need to solve the problem rather than giving a big promise that we know is not going to be delivered upon. That is the fundamental issue. There is no way I can speak in the House and not mention the difficulties Canadians are going through these days. There are the increased use of food banks, higher mortgage payments, high taxes and all the inflation issues Canadians have to deal with. It is a stop at the perfect time and position to be able to address that and remind ourselves about the disaster the Liberal government and the Liberal-NDP coalition have put Canadians through.

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Mr. Peter Julian (New Westminster—Burnaby, NDP)

May/30/24 9:00:35 p.m.
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Mr. Speaker, Conservatives, in a bizarre way, seem obsessed with the size of the bill. It is just a few pages, they say. There is another bill that Canadians hold dear, and it is called the Canada Health Act. It is just a few pages, but it puts in place our universal health care that, in poll after poll, 80% of Canadians see as our most cherished institution. The dental care plan the NDP pushed out, which Conservatives refused to support and in fact tried to block at every turn, has now helped hundreds of seniors in the member's riding. Now we have pharmacare, which would help about 18,000 people in this riding with diabetes and 25,000 who are looking for contraception. The reality is that the next election will be a health care election. Conservatives are very badly placed because all they have done is obstruct and block rather than offering anything at all. Why is my colleague blocking legislation that would help 18,000 of his constituents who have diabetes, and who are sometimes paying up to $1,000 a month, and 25,000 people who are looking for support for contraception?

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Mr. Ziad Aboultaif

May/30/24 9:01:57 p.m.
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Mr. Speaker, with the thinking mode the NDP member is in this evening, there is no way we can have a reasonable conversation. As well, his suggestion about the 18,000 people in my riding is as if I do not know my riding or the people who live in Edmonton Manning. The member chose to be fooled by the Liberals, but we are not fooled, and Canadians will not be.

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Mr. Colin Carrie (Oshawa, CPC)

May/30/24 9:02:34 p.m.
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Mr. Speaker, I cannot believe how easy it is to fool the NDP. We heard the NDP member stand up to talk about universal pharmacare. We have this bill in front of us, and it is covering two important things, which are contraception and medication for diabetes, but it is being promoted as universal pharmacare. What does my colleague from Edmonton think Canadians are going to think about this? Again, this is another promise that is not being fulfilled, but the way it is being presented is really deceptive. What does he think Canadians are going to think about that?

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Mr. Ziad Aboultaif

May/30/24 9:03:17 p.m.
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Mr. Speaker, unfortunately, the NDP is gathering, as a price for this, a one-week extension of the election so its leader can collect his full pension. That is what they are getting in return, and it does not matter what Canadians get, as long as the NDP leader—

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The Deputy Speaker

May/30/24 9:03:39 p.m.
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There is a point of order from the hon. member for New Westminster—Burnaby.

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