SoVote

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

May/30/24 10:22:34 p.m.
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Mr. Speaker, the Liberals always talk about providing coverage for the 1.1 million people, which is important, but they would take away some of the better coverage that 27 million people have. That is fake compassion and the lie of the left.

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Mr. Marcus Powlowski (Thunder Bay—Rainy River, Lib.)

May/30/24 10:22:58 p.m.
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Mr. Speaker, I am pleased to rise to speak to this issue and this bill, finally. As others have already pointed out, Canada is the only country with a universal health care system that does not provide some sort of universal drug coverage. Under the British, Australian, New Zealand, French and Belgian systems, basically to some degree or another, people's medications are paid for by the government and they do not have to pay for them. Having said that, admittedly, in some countries there is copay. This is an important bill. It is the first step in creating a national pharmacare system, and this I truly support. However, I did not always feel this way. As somebody who has long-practised in the health care system, I was a bit worried, because with the health care system as it presently is, we are struggling to pay for it. It occurred to me that what the government ought to be doing in health care is making sure that this sucker stays on the road. Certainly, I had a bit of trepidation with the idea that we were going to add another cost like pharmacare. However, having thought about it and having sat through committee meetings where we talked to experts, I have changed my mind because I think that a national pharmacare system would save the health care system money, not increase costs. The current system, as we have it, which is a patchwork of private and public plans, is really inefficient. Multiple studies and recommendations since the 1960s have all basically said that. In fact, one study from the Canadian Medical Association Journal in 2017 concluded that we in Canada pay 50% more for our drugs than people do in 10 other wealthy countries that have national pharmacare programs. In addition, the inefficiency of our pharmaceutical system is demonstrated by the fact that we in Canada pay the second most for drugs of any people in the world. The Americans pay more, but other than that, we pay more for drugs than anyone else. The inefficiency of our system comes from the fact that we provide pharmacare in Canada like the United States does. We, like the United States, have a patchwork system of private and public providers, and the private providers are often set up through employers. At times, these are non-profits, but for the most part they are for-profit companies. Similarly, there are public systems and public plans, and there are multiple public plans. For example, in Ontario, there is the Ontario drug benefit plan for those over 65, there is a Trillium plan for higher-cost medications and there is OHIP+. Basically, we pay for our medications in Canada like Americans pay for all parts of their health care system, but our system for paying for medications, like the U.S. health care system, is really inefficient. Americans pay twice as much for health care as Canadians do. On average, Americans pay $12,000 per person for health care, and in Canada we pay $6,000 for health care per person, and they have worse outcomes than we do. For example, they have a lower life expectancy than we do in Canada. I studied health law and policy both in Boston and at Georgetown University in Washington, D.C., and learned a bit about the health care system. I was certainly impressed by the inefficiency of the American health care system. They have private hospitals, private health care providers and private insurance companies, and each of these organizations has administrators who basically spend half of their time scheming on how they can decrease costs and increase profits. They have to pay for these administrators. Similarly, they have to pay the CEOs and the higher-up executives, who all bring in the big bucks, for working in those positions. On top of that, and most of all, a lot of money goes to the shareholders of corporations, which are legally obliged to financially benefit shareholders. All this money comes out of the health care system, money that ought to be going toward trying to improve the health care of Americans. Similarly, in Canada, we currently have 1,100 private and public plans according to a Lancet 2024 study, although according to the Hoskins report, we have 100,000 private plans. If instead of having all these plans, we just had one plan, then surely there would be tremendous savings coming from economies of scale. We would not need 1,100 organizations with 1,100 sets of administrators administering their own plans. We would not need hundreds of CEOs siphoning money that would otherwise go to health care, and there would be no profits going to shareholders rather than going to health care. There would be all sorts of savings from economies of scale and increased bargaining power. For example, if someone went to a provider or manufacturer of drugs and bought 10 million pills rather than 10,000 pills, I am sure they would get those pills at a cheaper cost, so there are savings there. Also, shipping costs are lower when buying in bulk, and there are fewer inspections needed. When we add up all these savings, how much do they add up to? Well, according to the 2019 Hoskins report, with national pharmacare by 2027, which is when it would come into effect, total spending on prescription drugs would be $5 billion lower than it would be without national pharmacare. That is money we could use in the health care system for other things. That means more money to afford expensive cancer therapies, more money to address the long waiting times for either surgeries or diagnostic tests and more money to do research and try to find new cures for things like cancer, ALS, etc. However, it is not just about saving money in the system. It is also about helping Canadians who struggle to meet the high costs of medications. According to the Hoskins report, between 5% and 20% of Canadians are either uninsured or under-insured, which amounts to two million to eight million people. Furthermore, one in five households reported that a family member in the past year had not taken a prescribed medicine due to its high costs, another three million Canadians said they were not able to afford one or more of their prescription drugs in the past year and almost one million Canadians borrowed money in order to pay for prescription drugs. For all these reasons, I support this legislation and moving to the next step toward a national pharmacare system. I also welcome that we will be able to provide diabetic medications and contraception to people as one of the next steps in getting to a national pharmacare system.

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Mr. Stephen Ellis (Cumberland—Colchester, CPC)

May/30/24 10:31:07 p.m.
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Mr. Speaker, my colleague from Thunder Bay—Rainy River is always thoughtful here and mindful of the shortfalls of things the government puts forward. There are a couple of things, though, to think about. At the health committee, we had two of Canada's experts, Drs. Morgan and Gagnon, and as the member well knows, they had no input into but much criticism about this bill. It related to the fact that it would not create a national, universal, single-payer, first-dollar pharmacare system. I heard them say that and I know the member across heard them say that as well. The other criticism we heard clearly is that the newly formed Canadian drug agency will have absolutely no oversight, especially from the point of view of an Auditor General's audit, with respect to its activities. We know on behalf of Canadians that at the current time, the time from application to approval for a drug in Canada is one of the longest among the OECD countries. I would appreciate my hon. colleague's comments with respect to those two things.

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Mr. Marcus Powlowski

May/30/24 10:32:12 p.m.
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Mr. Speaker, this is a step toward universal health care. Yes, it does not bring us to that point yet, but it is a step. With respect to the committee that is going to be involved in this, I thought the member was going to ask me about the fact that those two people were not consulted in the process. That is too bad. However, I agree with the member that how we do this is really important. If we have an efficient system and an efficient bureaucracy, this can save Canadians money. If we create a gigantic bureaucracy that costs a whole ton of money, more than the private system, then it will not end up benefiting Canadians. It is really crucial who we put on that committee and the steps we take in subsequent days, weeks and years.

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Ms. Heather McPherson (Edmonton Strathcona, NDP)

May/30/24 10:33:10 p.m.
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Mr. Speaker, I have worked with the member very closely on a number of files, and I know him to be a very honourable member of this place. He referenced the Hoskins report many times, and of course this is the report that was commissioned by the government to look at this. It found that $5 billion of savings would be available if we were to put in a national pharmacare program. Like the member, I recognize that this is not a full pharmacare program. This is a framework on which we could build a pharmacare program. Could the member comment on the medications or drugs that he thinks should be next in the pharmacare program now that we have dedicated this particular step to diabetes medication and devices and to contraceptives?

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Mr. Marcus Powlowski

May/30/24 10:34:00 p.m.
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Mr. Speaker, the member's question is very pertinent. I have some background in this. Once upon a time, years ago, I worked in a tiny country in the South Pacific, Vanuatu, on its essential drug list, which was its first essential drug list. The WHO is trying to do this with a lot of countries. Similarly in Canada, this act calls for the creation of an essential drug list. On that essential drug list, we would have the input of physicians and other specialists from across Canada to determine what the priority drugs are that a government finance system ought to supply its citizenry. That is an important question, and it is one of the next steps. I, like her, realize that this does not bring us to a national pharmacare system, but it is an important step on the way to that.

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

May/30/24 10:35:03 p.m.
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Mr. Speaker, I appreciate being recognized again. It is a great honour for me to work with the hon. member for Thunder Bay—Rainy River on the HESA committee. Given his medical and legal background, I find him quite beneficial to me for my understanding of a lot of health care issues. One of the things we heard a lot about at committee is the impact of this framework legislation on private health insurance. There was a lot of fearmongering on the Conservatives' part that somehow it would disappear. Could the hon. member for Thunder Bay—Rainy River comment and give us his views on what impact this bill would have on private health insurance?

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Insurance

Mr. Marcus Powlowski

May/30/24 10:35:50 p.m.
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Mr. Speaker, I welcome the very perceptive question by the member from Ottawa. This is a very important point. We heard from a lot of people, and there was a lot of concern about having a basic system. What if we needed more expensive medications for certain things? Would we be getting rid of private drug plans? That is not necessarily the case. There will be a public plan, but I think there would still be the option, if people wanted, to pay additional money for a private plan that would cover all the things that are not currently insured, as there is for other kinds of health care at the moment.

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The Speaker

May/30/24 10:36:25 p.m.
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Before I go to the member for Nunavut, who will be joining us virtually, I want to let members know that I have tried to provide members with about 40 seconds to ask and answer questions so that we can do the full rotation. It is really important that we all try to keep to that so that everybody can participate. I am also providing some flexibility, because questions are interesting and I want to hear as complete an answer as possible, as I am certain a person who asks a question would like that. The hon. member for Nunavut.

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Ms. Lori Idlout (Nunavut, NDP)

May/30/24 10:36:59 p.m.
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Re: Bill C-64

Uqaqtittiji, before I begin my speech, I will take this opportunity to congratulate Sharon DeSousa, who just became the first racialized national president at the Public Service Alliance of Canada. I first met her when the Iqaluit Housing Authority Inuit workers had their 136 days of striking to advance the rights of workers, not just for Iqalummiut, but also abroad. I am excited about Sharon's election. I will get to my speech. As the member of Parliament for Nunavut, Bill C-64, an act respecting pharmacare, put me in a bit of a personal dilemma. I wondered if I should support a bill that would do too little for the majority of my constituents. Through my speech this evening, I will share how I came to support the importance of this bill. As an Inuk from Nunavut, I continue to see the impacts of what happens when the federal government purposefully underinvests in indigenous peoples. The lack of investing in housing means that people live in overcrowded housing conditions. Many live in mouldy homes. These conditions create poorer health outcomes and deep-rooted social issues, such as increased violence, substance abuse and the continuation of intergenerational trauma being passed on to our children and our grandchildren. Having lived through these hurdles, I am always analyzing bills and debates with sensitivity to how all too common my experience is for indigenous peoples in Canada. I know all too well what it means to suffer. I hope when Canadians hear me, that they do their part to act on reconciliation with indigenous peoples. When I became the member of Parliament for Nunavut, I learned to act on solidarity. Before I was an MP, it was just a word. I wholeheartedly thank my colleague and friend, the member of Parliament for Hamilton Centre. This is what I am doing in supporting this bill. I am compelled to act knowing this bill, when it is passed, will help so many Canadians. It will help women and gender-diverse people access contraceptives. It will help many Canadians pay for diabetes medication. On another note, I must express my view regarding the Bloc's position on this bill. Its main concern seems to be that of jurisdiction and telling the government to stay out of its jurisdiction. I do hope its members reconsider their position because, regardless of jurisdiction, this bill can help more Canadians. This bill sets a foundation to create a universal single-payer system across Canada. This reminds me of Jordan's principle. I take this opportunity to honour the family of Jordan River Anderson, who this program is importantly named after. Jordan died a preventable death. He died while different jurisdictions were fighting over not having jurisdiction to cover his expenses and care. Because of Jordan's principle, care for first nations and Inuit has improved. While the Liberal government's responses take too long and it allows funding to lapse, Jordan's principle has made significant impacts for Inuit and first nations. Bill C-64 is an opportunity to model Jordan's principle so women and gender-diverse people have immediate access to contraceptives and people with diabetes can stop stressing about their finances knowing they can rely on this program for diabetes medication. I must share my criticism of the bill. I am dismayed to see that, once again, when it comes to indigenous peoples, we are forced to wait. While I appreciate that Bill C-64 would require the Minister of Health to initiate discussions based on essential medicines lists with provinces, territories and indigenous peoples, this work must start immediately. While first nations and Inuit have the non-insured health benefits program to have services such as dental care, eye care and mental health services paid for, much of the investments in Nunavut go toward medical travel because of the lack of health care in Nunavut. Children are flown thousands of kilometres to access basic care and dental care. This program funds millions of dollars to the airline industry. Ensuring pharmacare improves on the NIHB program will be very important in making sure that Nunavummiut, northerners and indigenous peoples see better care closer to home. The pharmacare bill must avoid the pitfalls that we have seen in NIHB. I remember, for example, my colleague and friend, the MP for Algoma—Manitoulin—Kapuskasing, bringing to me a witness when the indigenous and northern affairs committee studied the non-insured health benefits program. She brought forward a pharmacist, Rudy Malak, who struggled to get paid for providing eligible people the drugs covered under the non-insured health benefits program. The proposed act must ensure that pharmacists would be paid immediately without worrying about closing their doors because the federal government may take too long to pay its bills. I conclude by reminding everyone that, when it comes to helping Canadians, we must do so with a foundation of removing barriers for people. As much as I am conflicted about the bill, I must practise what the MP for Hamilton Centre taught me about acting in solidarity, knowing that the passage of the bill will help so many Canadians.

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Mr. Kevin Lamoureux (Parliamentary Secretary to the Leader of the Government in the House of Commons, Lib.)

May/30/24 10:44:20 p.m.
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Mr. Speaker, I appreciate the member's general attitude in recognizing the importance of the legislation to the degree in which it would assist millions of Canadians in all regions of the country. I am wondering if she could expand on why it is so important that Liberals, New Democrats, Bloc members and Conservatives should be behind this bill to help so many of our constituents.

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Importance

Ms. Lori Idlout

May/30/24 10:44:53 p.m.
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Uqaqtittiji, as I said earlier, having empathy is really important, but acting on that empathy is even more important. When I hear about so many Canadians possibly having amputations because they cannot afford diabetes medication, I feel we all have to do our part to make sure that we act when we can, and it is our duty as parliamentarians to make sure that all Canadians get the drugs and the care that they need, so we can keep making sure that Canada is a better place to live in.

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Ms. Rachel Blaney (North Island—Powell River, NDP)

May/30/24 10:45:45 p.m.
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Mr. Speaker, when we are in this place, we have to wrestle with really hard pieces of legislation that benefit some but not all, and I am afraid that in this place, historically, up until today, indigenous people are left out of so much decision-making, and their needs are extensively not met, again and again. I am just wondering if the member could talk about what she sees as being needed right now to start including indigenous people in a more meaningful way so that we can start to repair the harm that has been done, specifically in this place.

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Ms. Lori Idlout

May/30/24 10:46:31 p.m.
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Uqaqtittiji, that is such an important question because one of the answers is what indigenous peoples have been saying all along, and we hear it in some responses, such as co-development, but we have to really make sure that, when it comes everything from laws to program development policies to decisions regarding lands and the health and education of indigenous peoples, we have to be at the table helping to make those decisions, not just because of a legal duty to consult, but demanding it because of reconciliation. We have to make sure that we have more indigenous peoples become parliamentarians, and we have to make sure that there is more participation that does not prevent us from helping to make decisions on these matters.

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Ms. Lindsay Mathyssen (London—Fanshawe, NDP)

May/30/24 10:47:37 p.m.
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Mr. Speaker, my hon. colleague talked about Jordan's principle, and I would really love for her to expand on the importance of that within her own community and on the dangers that we see with the government stepping back from the commitment to ensure that the needs of first nations, Inuit and Métis are placed in priority over money and squabbling between jurisdictions.

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Ms. Lori Idlout

May/30/24 10:48:12 p.m.
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Uqaqtittiji, Jordan's principle is such an important story to always remember because the implementation of it allows payments to be made up front and for the jurisdictions to discuss who ends up paying for it in the end. We have an opportunity with the pharmacare act for women and gender-diverse people to get their contraceptives immediately, without having to worry about whether it is going to be the provinces or the federal government who pays for it, as well as for people to get their diabetes medication. I know this kind of system can work because we see it in Jordan's principle, especially when we have discovered, through that program, the atrocities indigenous children are forced to experience and that treatment will happen immediately. We need that same kind of foundation through this pharmacare program.

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Ms. Julie Dzerowicz (Davenport, Lib.)

May/30/24 10:49:40 p.m.
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Re: Bill C-64

Mr. Speaker, it is a real pleasure for me to stand once again today to speak to this very important bill. Bill C-64 is an act respecting pharmacare. The bill contains three key sections. One, it would establish a framework toward a national universal pharmacare in Canada for certain prescription drugs and related products. Two, it provides that the Canadian drug agency work toward the development of a national formulary to develop a national bulk-purchasing strategy and support the publication of a pan-Canadian strategy regarding the appropriate use of prescription medications. The third section is that, within 30 days of hopefully this bill receiving royal assent, the minister would establish a committee of experts to make recommendations regarding the operation and financing of national, universal, single-payer pharmacare. The bill, along with other investments made by our government, would help millions of Canadians who are struggling to pay for their prescription drugs. Since this bill was introduced, we have heard many facts about access and affordability of prescription drugs within Canada. We know that Statistics Canada data from 2021 has indicated that one in five Canadians reported not having enough insurance to cover the cost of prescription medication in the previous 12 months. We know that having no prescription insurance coverage was associated with higher out-of-pocket spending and higher non-adherence to prescriptions because of cost. We know that this results in some Canadians having to choose between paying for these medications or for other basic necessities, like food and housing. This is why we have consistently made commitments toward national pharmacare and have focused efforts on the key areas of accessibility, affordability and appropriate use of medications. Let me start with the pharmacare act, which references the foundational principles of access, affordability, appropriate use and universality. We have heard a lot about these four principles this evening, but it is important to continue this conversation. Bill C-64 recognizes the critical importance of working with provinces and territories, which are responsible for the administration of health care. It also outlines our intent to work with these partners to provide universal, single-payer coverage for a number of contraception and diabetes medications. This legislation is an important step forward to improve health equity, affordability and outcomes, and has the potential of long-term savings to the health care system. In our most recent budget, budget 2024, we announced $1.5 billion over seven years to support the launch of national pharmacare and coverage for contraception and diabetes medications. I would like to highlight the potential impact the two drug classes for which we are seeking to provide coverage under this legislation would have on Canadians. We have heard of stories or know of someone in our constituency who is struggling to access diabetes medications or supplies due to lack of insurance coverage through their work, or of an individual who has limited insurance coverage so they cannot choose the form of contraception that is better suited for her. For example, let us talk about a part-time, uninsured worker who has type 1 diabetes and is also of reproductive age. For this individual to manage her diabetes, it would cost her up to $18,000 every year, leaving her potentially unable to afford the $500 upfront cost of her preferred method of contraception, a hormonal IUD. With the introduction of this legislation, this individual would save money on costs associated with managing her diabetes and would be able to access a hormonal IUD at no cost, with no out-of-pocket expenses, once the legislation is implemented in her province. Studies have demonstrated that publicly funded, no-cost universal contraception can result in public cost savings. Evidence from the University of British Columbia estimated that no-cost contraception has the potential to save the B.C. health care system approximately $27 million per year. Since April 1, 2023, B.C. is the only province in Canada to provide universal free contraceptives to all residents under the B.C. pharmacare program. In the first eight months of this program, more than 188,000 people received free contraceptives. That is wonderful. With respect to diabetes, it is a complex disease that can be treated with safe and effective medications. One in four Canadians with diabetes has reported not following their treatment plan due to costs. Improving access to diabetes medications would help improve the health of some of the 3.7 million Canadians living with diabetes and reduce the risk of serious, life-changing health complications, such as blindness or amputations. Beyond helping people with managing their diabetes and living healthier lives, we also know that, if left untreated or poorly managed, diabetes can lead to high and unnecessary costs on the health care system due to diabetes and its complications, including heart attack, stroke and kidney failure. The full cost of diabetes to the health care system could exceed almost $40 billion by 2028, as estimated by Diabetes Canada. The bill demonstrates the Government of Canada's commitment to consulting widely on the way forward and working with provinces, territories, indigenous peoples, and other partners and stakeholders to improve the accessibility, affordability and appropriate use of pharmaceutical products by reducing financial barriers and contributing to physical and mental health and well-being. Beyond our recent work under Bill C-64, I would like to highlight one or two initiatives, depending on my time, that the government has also put in place to support our efforts towards national pharmacare. On a national level, our government has launched the first-ever national strategy for drugs for rare diseases in March 2023, with an investment of up to $1.5 billion over three years. As part of the overall $1.5-billion investment, our government will make available up to $1.4 billion over three years to willing provinces and territories through bilateral agreements. This funding would help provinces and territories improve access to new and emerging drugs for Canadians with rare diseases, as well as support enhanced access to existing drugs, early diagnosis and screening for rare diseases. I would also like to highlight another initiative under way, which involves the excellent work by P.E.I. through a $35-million federal investment. Under this initiative, P.E.I. is working to improve the affordable access of prescription drugs, while at the same time informing the advancement of national universal pharmacare. The work accomplished by P.E.I. has been remarkable. Since December of last year, P.E.I. has expanded access to over 100 medications to treat a variety of conditions, including heart disease, pulmonary arterial hypertension, multiple sclerosis, psoriasis and cancer. In addition, effective June 1, 2023, P.E.I. reduced copays to $5 for almost 60% of medications regularly used by island residents. I am pleased to share that through this initiative, P.E.I. residents have saved over $2.8 million in out-of-pocket expenses as of March of this year. Finally, on December 18, 2023, the Government of Canada announced the creation of Canada's drug agency, with an investment of $89.5 million over five years, beginning this year. Built from the existing Canadian Agency for Drugs and Technologies in Health, and in partnership with provinces and territories, the CDA will provide the dedicated leadership and coordination needed to make Canada's drug system more sustainable and better prepared for the future, helping Canadians achieve better health outcomes. I am pleased to share that as of May 1, CADTH has been officially launched as Canada's drug agency. In closing, we can see the extraordinary amount of work that has been and will continue to be dedicated to our commitments related to national pharmacare that focuses on accessibility, affordability and appropriate use of medications. Bill C-64 represents the next phase of helping Canadians receive the medications they need, and we look forward to working with all parliamentarians to ensure its successful passing.

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Mr. Tom Kmiec (Calgary Shepard, CPC)

May/30/24 10:59:00 p.m.
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Mr. Speaker, the member did mention rare diseases, and I cannot pass up the opportunity to clarify a couple of things. It is only mentioned once, in clause 5 of the legislation. To all my constituents back home, and all the rare disease organizations and patients across the country, not a single person will have their rare disease drugs paid for by this legislation, not a single one. It is not in the legislation. The 2023 announcement that the government just made is a reannouncement of its 2019 announcement. Some hon. members: Oh, oh! Mr. Tom Kmiec: Mr. Speaker, the NDP caucus is heckling me once again. I know the New Democrats get really upset when I raise this. The government is the one that actually cancelled the original rare disease strategy in 2016, and at the time, the head of the organization called it “the kiss of death” for rare disease patients. Does that member agree?

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Ms. Julie Dzerowicz

May/30/24 10:59:52 p.m.
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Re: Bill C-64

Mr. Speaker, Bill C-64 would establish the framework of a national universal pharmacare program here in Canada. It is phase one of the proposed program, which would include prescription drugs and free coverage for contraceptives and diabetes medication, and we are hoping to expand the program. As well, there are additional elements that would complement the national pharmacare program, which is our national strategy for drugs for rare diseases. Again, it is starting with a $1.5-billion investment over three years. I believe our intention is that we will be expanding it in the years to come.

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Ms. Nathalie Sinclair-Desgagné (Terrebonne, BQ)

May/30/24 11:00:41 p.m.
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Mr. Speaker, my question is simple, but at the same time I think it is rather complex because I have never gotten a clear answer from the federal government. Why does the government think that it is better placed to understand the needs of Quebeckers than the Government of Quebec, which administers a pharmacare program that has been around for many years?

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