Hon. Pat Duncan: Honourable senators, I rise to speak at second reading of Bill C-64, An Act respecting pharmacare. I am deeply appreciative of your time in light of the hour and of the particular date in our legislative calendar. Mindful that it’s our desire to refer Bill C-64 to committee for further study, I rise to share with you a personal perspective with the intent that this story of my region will provide some insights and some questions for the committee’s study.

You are aware that I served as the Yukon premier from 2000 until 2002. At that time, it was also customary for the premier to serve as the finance minister. It was also a time of intense negotiations and discussions about health care costs, especially in the Yukon case, because the Martin government had reduced the Canada Health and Social Transfers quite significantly. In the Yukon’s case, that was especially significant for a small territorial budget of less than $1 billion.

My term also included Team Canada Trade Missions trips with then-Prime Minister Chrétien. For colleagues who may have forgotten, Team Canada trips were trade missions organized by the Prime Minister that included all provincial and territorial premiers, as well as business and community leaders. Relationships are built when leaders break bread together and share a common purpose of promoting our great country.

There are two specific actions that could be attributed to the premiers and the Prime Minister travelling together that relate to our discussions today. One was that Prime Minister Chrétien tasked Roy Romanow with the Commission on the Future of Health Care in Canada. One of the key recommendations from the Romanow commission was to introduce a limited pharmacare program to cover high-price drug treatments. Another recommendation was that:

Canada Health Infoway should continue to take the lead on this initiative and be responsible for developing a pan-Canadian electronic health record framework built upon provincial systems, including ensuring the interoperability of current electronic health information systems and addressing issues such as security standards and harmonizing privacy policies.

The premise underlying Canada Health Infoway was the concern expressed by Prime Minister Chrétien that when physicians were treating a former colleague of his in a hospital in British Columbia, they should have been able to access all of his health information via his provincial health care record.

Honourable senators, I continued to serve until 2006 as a member of the Yukon legislature following the defeat of our government. My retirement as a legislator began a career in the public service in health care administration. You might say I’d been well inoculated during discussions surrounding health care. I was often heard to say, “Wow, I wish I’d known then what I know now.”

My tasks as the manager of health care registration included the administration of what had been discussed on those Team Canada missions some years previously: the challenges of interprovincial reciprocal billing; ensuring Canadians maintain their health care registration when moving between provinces; and how Canadians longed for a health care card that would provide health care providers with as much information as possible, no matter where they received treatment in the country, and still protect their privacy.

My responsibilities also included claims — the payment of physicians who operated on a fee-for-service basis — which gives me a particular view on the current debate regarding the capital gains tax and how the fee-for-service structure with physicians has shaped and continues to shape medical care in this country. Over the summer months, I look forward to reading former health minister Jane Philpott’s recently released book Health for All: A Doctor’s Prescription for a Healthier Canada.

My duties included managing medical travel. Honourable senators will be aware that Canadians from remote communities are flown to major centres to receive health care treatment. For those who are referred medically out of the Yukon, travel is paid for by the Yukon government, whether by medevac plane or commercial aircraft.

The Romanow commission also called for a rural and remote access fund to provide timely access to care in rural and remote areas. During my term as premier, at my first Western Premiers’ Conference, the first conference hosted by then-Manitoba premier Gary Doer, he stated that Canada must recognize they are the fourteenth province at the table. Canada is responsible for health care costs for Indigenous peoples; the Canadian Armed Forces; and, in some instances, federal government employees, such as the RCMP.

In the context of medical travel at that Western Premiers’ Conference, Premier Doer was talking about the high costs of bringing patients from the North to the South for dialysis. What medical travel meant for me as the manager of registration claims for the Yukon government was that I would regularly be dealing with Canada when the Yukon paid for travel — for example, a one-way $15,000 flight for a status First Nations person — that Non-Insured Health Benefits should have been paying for.

So when medical travel forms a good portion of the health care budget, every $15,000 bill that you can submit to another government — in this case, the Yukon government submitting it to the Government of Canada — is critical.

I am sharing this example and story to highlight for senators the responsibilities that Canada has in health care delivery in our country, which must be included in the discussions of any program that is to be made available to all Canadians. Canada’s responsibility includes being more than the legislative lead and a primary funder in this discussion.

Most importantly, my manager responsibilities also included working closely with the manager of the extended health care benefits and Pharmacare program for the Yukon health care system. That program provided then, as it does today, pharmaceutical drugs for persons over the age of 65 and persons married to someone over the age of 65. Submissions are made to a drug plan — if you have one — and the government pays the balance. If a senior citizen does not have a drug plan, they do not go without physician-prescribed drugs in the Yukon. They are paid for by Yukon health care. If you are a First Nations citizen, Non-Insured Health Benefits pay for those drugs.

Honourable senators, I have to share a story with you, again from my experience working in the health care department. At that time, Avastin, a drug for bladder cancer, was being used off-label to treat macular degeneration. We had an individual come in who could access Avastin through non-insured health benefits, but not the Yukon extended health benefits because our formularies were different.

Yukon ultimately matched the non-insured health benefits formulary. But the formulary, administration and slow approval of drugs for First Nations children are some of the reasons why tragedy occurred in Manitoba, and why we have the program Jordan’s Principle.

Also, the stated purpose of Bill C-64 is “. . . to support the development of a national formulary . . .” This will be challenging. We have all borne witness to the stories in the news, most recently one from British Columbia concerning a specific drug to treat multiple sclerosis. It was approved in Alberta, but the client in British Columbia was unable to access it due to the cost. I don’t know of a provincial or territorial legislator or official who has not dealt with questions from constituents regarding access to drugs.

A framework for drugs for rare diseases poses extraordinary costs for smaller jurisdictions, and these concerns must be recognized. Also, the Western provinces have been discussing and/or negotiating a collaborative purchase of drugs for some years, as the larger provinces have done individually. Acting together, as one country, we will be better served in our discussions with pharmaceutical companies.

A final note about the extended benefits program in the Yukon — if you have a chronic disease or a disability, you are most likely able to receive help with your costs. For example, if your health care practitioner recommends prescription drugs or medical surgical supplies to treat diabetes, support is provided through the Chronic Disease and Disability Benefits Program. The list of chronic diseases is comprehensive, and so is the assistance.

Bill C-64 is a legislative framework to plan for national programs similar to what the Yukon already has in place. Senator Pate has described Bill C-64 as:

. . . a plan to work with all provinces and territories willing to provide universal single-payer coverage of necessary medicines, starting with a number of contraceptive —

— medications, which are not currently covered in the Yukon —

— and diabetes medications. . . .

— which are covered.

You’ve heard me state on many occasions that federalism is challenging work. I believe we have all stated that the devil is in the details. I appreciate that the details and actual administration of implementing legislation are, in the eyes of some, not necessarily the purview or responsibility of this august chamber.

However, just as we must be assured that all legislation adheres with the Charter and our goals of reconciliation, I’m of the view that in providing our sober second thought to legislation, we also have a responsibility to ensure that the legislation can meet the stated goals. In this situation, a plan for pharmacare in Canada as intended by Bill C-64 can be achieved. The importance of this bill has been eloquently stated by others, including the medical professionals among us. I agree with them.

The committee that will study this bill should consider how a plan that is to be developed between Canada and all the provinces and territories will deliver a pharmacare program for Canadians.

I have shared with you today that this is not a new debate or discussion. I have used only one of the many studies and reports that have recommended a national pharmacare program. I’ve referenced the Romanow Commission.

I have also shared with you my experience in the Yukon, both front line and political. I have shared this purposely as we refer this bill to committee. I will borrow a quote from the June 13, 2024, report of the Standing Senate Committee on National Finance, which stated:

Finally, your committee notes that Bill C-69 contains many measures whose successful implementation requires close collaboration with provincial and territorial governments . . . .

Bill C-64 will require close collaboration with provinces and territories. In relaying this example, I hope I have convinced my colleagues to pay close attention in their study of this bill to the experiences of the territories and provinces, and to recognize Canada’s responsibilities.

Ultimately, I hope the committee will conclude — perhaps with observations, after reviewing all the evidence from the many reports, commissions and speeches recommending a national pharmacare program — that bill will be enacted and the program will come to be.

In the languages of the Yukon First Nations, shä̀w níthän, mahsi’cho, gùnáłchîsh. Thank you.