Hon. Jean-Guy Dagenais, Deputy Chair of the Standing Senate Committee on National Security, Defence and Veterans Affairs, presented the following report:

Tuesday, June 18, 2024

The Standing Senate Committee on National Security, Defence and Veterans Affairs has the honour to present its

TENTH REPORT

Your committee, to which was referred Bill C-70, An Act respecting countering foreign interference, has, in obedience to the order of reference of Monday, June 17, 2024, examined the said bill and now reports the same without amendment but with certain observations, which are appended to this report.

Respectfully submitted,

JEAN-GUY DAGENAIS

Deputy Chair

(For text of observations, see today’s Journals of the Senate, p. 2949.)

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.

Some Hon. Senators: Hear, hear.

(On motion of Senator Martin, debate adjourned.)

On the Order:

Resuming debate on the motion of the Honourable Senator Pate, seconded by the Honourable Senator McBean, for the second reading of Bill C-64, An Act respecting pharmacare.

Hon. Judith G. Seidman: Honourable senators, I rise today as the opposition critic to speak at second reading to Bill C-64, An Act respecting pharmacare. I want to thank Senator Pate, the sponsor of Bill C-64, and Senators Osler, Moodie, Simons, Bernard and Duncan for their insights on this important piece of legislation.

I will now look at the bill.

Colleagues, Bill C-64 seems to propose two distinct policies. On the one hand, Bill C-64 proposes national universal pharmacare and sets out the essential principles that the Minister of Health is to consider when working toward the implementation of this policy.

On the other hand, the bill codifies a structure and processes which oblige the Minister of Health to make payments to those provinces with which the federal government has made bilateral agreements in order to increase any existing public pharmacare coverage for specific prescription drugs and related products intended for contraception or the treatment of diabetes. It’s a tale of two policies.

Colleagues, I will consider some of the issues that confront us in Bill C-64, both in the proposal for national universal pharmacare and the incremental plan for drugs and products intended solely for contraception or the treatment of diabetes. I will also consider three overarching, structural concerns which I believe should be examined at committee.

The national universal pharmacare framework proposed in Bill C-64 seems to express principles in keeping with the policy envisioned by A Prescription for Canada: Achieving Pharmacare for All, the final report of the Advisory Council on the Implementation of National Pharmacare.

The advisory council was launched in June 2018 and chaired by Dr. Eric Hoskins. Its final report, published in June 2019 and often referred to as “the Hoskins Report,” proposed “. . . the government enact national pharmacare through new legislation embodying the five fundamental principles in the Canada Health Act. . . .”

In keeping with the Hoskins Report, commitments have been made for foundational elements, including the Canadian Drug Agency, the National Formularly and the National Strategy for Drugs for Rare Diseases.

In 2021, the federal government invested $35 million with Prince Edward Island for the Improving Affordable Access to Prescription Drugs Program as a kind of pilot study for fill-in-the-gap coverage.

In 2022, a multidisciplinary national panel convened by the Canadian Agency for Drugs and Technologies in Health, or CADTH, at the request of Health Canada, recommended a framework for developing a national formulary and a sample list of drugs.

In March 2023, the National Strategy for Drugs for Rare Diseases was launched with an investment of up to $1.5 billion over three years to increase access to and the affordability of drugs for rare diseases.

In December 2023, the Canadian Drug Agency was created with an investment of $89.5 million over five years starting in 2024-25.

Bill C-64, the government asserts, is the next step toward national universal pharmacare. However, there are considerable weaknesses to this particular proposal for national universal pharmacare. As my colleagues often hear me emphasize around proposed legislation, there may be serious unintended consequences. Let’s explore that.

First, the national universal pharmacare policy envisioned by Bill C-64 infringes on provincial jurisdiction and complicates or interferes with programs the provinces and territories already have in place.

As we understand, in Canada, provincial and territorial governments are responsible for the management, organization and delivery of health care services for their residents. Quebec — which requires that all residents who do not have private drug insurance must enrol in the province’s premium-based public plan — is the only province to have achieved universal drug coverage. Given this, Quebec’s government objects to Bill C-64.

In February, the office of Christian Dubé, Quebec’s Minister of Health and Social Services, told The Canadian Press:

The Quebec government has repeatedly pointed out that health is an exclusive Quebec jurisdiction. If the Government of Canada goes ahead with this drug insurance project, the Government of Quebec will demand the right to opt out with full compensation . . . .

Quebec is not alone in this objection. The Government of Alberta has expressed similar sentiments.

All provincial and territorial governments offer prescription drug coverage programs, albeit of different types, for their residents. Let me provide just an overview of some of the public programs across Canada which cover prescription drugs, medical devices and supplies. Some are based on income, some are based on age, and some add specific disease entities, which require expensive medications.

Alberta has a plan that covers adults from low-income households with high ongoing prescription needs or who are pregnant; children in low-income households; residents who are 65 years of age and older; and the Non-Group Coverage program — administered by Alberta Blue Cross — which charges monthly premiums and is available to all Albertans.

British Columbia has a plan that covers residents receiving income assistance; residents of licensed residential care facilities; and Fair PharmaCare, which helps B.C. families pay for prescription drugs. Fair PharmaCare is based on income — the less a family earns, the more assistance they receive.

Manitoba’s Pharmacare program provides income-tested benefits for residents whose prescription costs are high.

New Brunswick has a plan that covers residents over 65 years of age; those in a nursing home; children in the province’s care; social development clients; and a plan that provides income-tested benefits for residents who do not have private insurance.

Newfoundland and Labrador has a plan that covers low-income individuals and families; and residents over 65 years of age who receive Old Age Security and the Guaranteed Income Supplement.

The Northwest Territories has a plan that covers eligible residents 60 years of age and older and residents diagnosed with specific diseases, and a plan that covers Indigenous Métis residents.

Nova Scotia has a plan that covers all residents without any other drug plan, or who have excessive drug costs.

Nunavut has a plan that covers seniors and residents diagnosed with certain illnesses, and residents receiving income support.

Ontario has plans that cover residents over 65 years of age; residents receiving social assistance; residents in long-term or special homes; residents receiving home care; and residents with high prescription drug costs — based on income — who do not have private coverage or another provincial plan. And Ontario has a plan that covers more than 5,000 drugs at no cost for anyone 24 years of age or younger who is not covered by a private plan.

Prince Edward Island has a plan that covers low-income families; residents 65 years of age and older; residents under age 65 who do not have drug insurance; and residents who need assistance to pay for drugs and supplies for a range of specific medical conditions. Further, in 2021, P.E.I. entered into a partnership with the federal government for a pilot program that reduced co-pays for eligible medications to $5 — including medications for cardiovascular disease, diabetes and mental health — for residents covered under certain programs.

In Quebec, the Public Prescription Drug Insurance Plan covers all residents who are not covered by a private plan.

Saskatchewan has a plan that covers all residents except those on federal programs.

The Yukon has a plan that covers residents over age 65 and children from low-income families, and that provides benefits for Yukon residents who have a chronic disease or a serious functional disability. Our colleague Senator Duncan has very well described their plan in much more detail.

Depending on program design, national universal pharmacare could simplify the complex array of programs in place across Canada. But there is institutional knowledge regarding program delivery in each of our provinces and territories, and there are tailored programs in place to meet the needs of our communities. Quebec, for instance, has almost 30 years of experience with its program.

Furthermore, most Canadians do have existing drug coverage. Statistics vary depending on the source you reference. As the Advisory Council on the Implementation of National Pharmacare notes in the Hoskins report:

Our research turned up different estimates of how many Canadians are uninsured or underinsured: some studies put the number of uninsured at 5 per cent of Canadians . . . . Other surveys tell us closer to 20 per cent of Canadians . . . are either uninsured or underinsured . . . .

Those who don’t have existing drug coverage may be eligible for a program in which they are not enrolled. In a 2022 pan-Canadian analysis of prescription drug insurance coverage, The Conference Board of Canada estimates that more than 97% of Canadians are eligible for some form of prescription drug coverage. That leaves a 2.8% gap of Canadians who are not eligible for coverage. In addition, The Conference Board of Canada notes that approximately 10% of Canadians are not enrolled in a public or private plan for which they are eligible.

Second, the national universal pharmacare policy contemplated by Bill C-64 may have a negative impact on pharmacists’ practice. In testimony to the Standing Committee on Health in the other place, pharmacists expressed concerns about a national universal pharmacare plan. Joelle Walker from the Canadian Pharmacists Association highlighted the administrative burden involved in switching patients from one plan to another:

. . . the potential for significant disruption can’t be overstated. . . . changing drug plans can be very disruptive for plan members and for pharmacists.

The reality is that public drug plans across Canada are far less comprehensive than private plans, which means that if the legislation shifts patients from their private plans to a public plan, pharmacists and physicians will likely have to spend a considerable amount of time switching patients to new therapies, especially if their drug is no longer covered under a public plan; filling out paperwork to get special exemptions; and communicating these changes to patients.

Benoit Morin, President of the Association québécoise des pharmaciens propriétaires, told the Standing Committee on Health that under a public single-payer principle, dispensing fees would be a single amount negotiated for covered drugs. He explained that this would have a significant impact on Quebec proprietor pharmacists because dispensing fees are higher for drugs covered by private plans, including the private component of Quebec’s Public Prescription Drug Insurance Plan.

Here’s the importance of that point. He said:

The current funding of Quebec pharmacies relies mainly on professional fees associated with the dispensing and monitoring of prescription drugs. Variations in those fees can influence pharmacies’ ability to provide services to patients. . . .

It is precisely the flexibility of the present mixed public-private model that enables Quebec pharmacies to develop, operate in all regions and provide a host of services to patients. . . . Without that flexibility, the financial health of the pharmacy network would be undermined, and the impact would be even greater in remote regions.

Mr. Morin also noted:

Some 371 pharmacies shut down when a universal plan was introduced in New Zealand.

We’re afraid that, if there’s no mixed system in Quebec, pharmacies will find it hard to be profitable, which will result in closures and force them to set up in major centres rather than rural areas.

The federal government has a pattern of not consulting pharmacists on policies which will directly impact both them and the Canadians whom they serve. In a press release issued after Bill C-64 was tabled in the other place, the association lamented that there were no pharmacists on the 2018 Hoskins Advisory Council on the Implementation of National Pharmacare.

The care that Canadians receive at pharmacies is irreplaceable. According to research conducted for the Canadian Pharmacists Association by Abacus Data in September 2023, 37% of Canadians visit a pharmacy at least once a month, and 23% speak with a pharmacist at least once a month.

Pharmacists’ scope of practice varies across the country, but, depending on jurisdiction, pharmacists can prescribe medications, make therapeutic substitutions and change drug dosages, formulations, regimens, et cetera. In all provinces and in the Yukon, pharmacists can inject drugs and vaccines. In Alberta and Quebec, pharmacists can even order and interpret lab tests.

Pharmacists’ scope of practice continues to grow. As more and more Canadians report not having a family doctor, a majority of those surveyed by Abacus agreed that expanding the range of services offered at pharmacies — including walk-in clinics for common ailments, vaccinations, testing and lab services, chronic disease management and prescribing contraception — would enhance access to and quality of health care.

Such ambitions could be realized in a context in which local pharmacies can thrive. In an op-ed in The Hill Times, Sandra Hanna, a community pharmacist and pharmacy owner in Guelph and the Chief Executive Officer of the Neighbourhood Pharmacy Association of Canada, notes that:

Over the past few years, pharmacies and their teams have played an increasingly important role as primary health-care providers, particularly in rural and remote regions. . . .

She warns, however, that a single-payer pharmacare program would cost the pharmacy sector $1 billion annually, which is equal to cutting approximately 20 million pharmacist hours.

Currently, Canadians have excellent access to pharmacies. According to Organisation for Economic Co-operation and Development, or OECD, data, in 2021, Canada had 30 pharmacies per 100,000 population, more pharmacies than the OECD average. Can we, in our current health care ecosystem, afford to jeopardize the success of our pharmacies and pharmacists? This is a potential unintended consequence that we should examine at committee.

Third, the national universal pharmacare policy contemplated by Bill C-64 could erode access to drugs and exacerbate drug shortages. The Standing Committee on Health, or HESA, heard from several stakeholders who were concerned that, depending on the ultimate contents of a national formulary, the national universal pharmacare plan proposed in Bill C-64 may worsen drug availability.

Angelique Berg, the President and Chief Executive Officer at the Canadian Association for Pharmacy Distribution Management, told the committee:

. . . Because they run so efficiently, reduced funding means that distributors have few options left but to reduce services. Some examples are that they could stop carrying money-losing products . . . reduce safety stock . . . or reduce delivery frequency to high-cost regions . . . .

. . . When the government awards a contract to a single manufacturer, that firm effectively becomes a monopoly, so competitors have little incentive to stay in the market. Concentrated marked power increases the risk of limited supply, and therein lies our concern.

The Canadian Pharmacists Association shared Ms. Berg’s concern about drug shortages. Ms. Walker said:

One thing that we’ve noted is that the number of available medications in each drug class can decrease significantly, depending on how many companies are in the market, and we are most vulnerable to drug shortages if only one or two manufacturers are producing a particular drug.

Let’s say that there’s a national disaster in one country that’s producing some of the API, and the one company there can’t produce that drug, and the other companies aren’t able to readily increase their production. . . . there’s a really complicated ecosystem that this pharmacare approach needs to also recognize.

The Montreal Economic Institute has also flagged concerns that if national universal pharmacare was implemented in Canada, drug distribution could be interrupted. They write:

. . . if certain drugs are no longer covered by an insurance plan, it is very likely that pharmaceutical companies will stop distributing them in Canada. The variety of medications in circulation in this country is therefore at risk of shrinking, preventing previously covered patients from having access to these drugs, even if they were disposed to pay for them out of their own pocket.

Drug shortages are not uncommon in Canada. In December 2018, I asked the Leader of the Government in the Senate about a Canada-wide shortage of the antidepressant Wellbutrin. In February 2020, I asked about a shortage of tamoxifen, a drug used as part of hormone therapy to treat breast cancer. In June 2020, I asked about shortages of thyroid drugs, inhalers, blood pressure medication and glaucoma eye drops. In November 2022, I asked about a shortage of pediatric amoxicillin.

Pharmacists already navigate drug shortages in Canada. Committee hearings should carefully consider the unintended consequences of fewer available medications in Canada.

Hon. Judith G. Seidman: Honourable senators, I will continue to address some of the issues that confront us in this plan and the possible unintended consequences.

The fourth issue I bring to your attention is the national universal pharmacare policy contemplated by Bill C-64. It has no mechanism for exceptions to be made to allow a patient to access a drug that is not on the formulary.

This concern was raised at the House of Commons Standing Committee on Health by John Adams, Chair of the Board of Directors of the Best Medicines Coalition. The Best Medicines Coalition represents 30 patient organizations from Parkinson’s, arthritis, hemophilia and blindness to cancers and other complicated and rare diseases.

He told the House of Commons Health Committee:

. . . not every patient responds in the same way to the same drug. We need some variety and some choice. Quebec has a mechanism where a doctor can apply to a truly independent scientific review committee that is outside of the health bureaucracy for a drug that the doctor knows the patient needs . . . .

It would be a great improvement for national pharmacare, as a concept, to always have that safety valve for the exceptional patient.

Committee hearings should examine the merits and potential mechanisms for exceptions to the formulary.

Fifth, costs for a national universal pharmacare program, as outlined in the principles of Bill C-64, could balloon.

In its report on Bill C-64, published on May 15, the Office of the Parliamentary Budget Officer:

. . . assumes that any medications that are currently covered by provincial and territorial governments, as well as private insurance providers will remain covered on the same terms.

They state, and the language is really important, “. . . The aim of the program is to expand and enhance, rather than replace . . . .”

This assumption informed the PBO’s estimate that universal national pharmacare will increase federal program spending by $1.9 billion over five years.

In my briefing with department officials, I was assured that the government, in its bilateral agreements with the provinces, will negotiate to ensure that the provinces maintain their own current public plan coverage for diabetes and contraception. However, there is no way for the federal government to guarantee that private drug plans will maintain their coverage.

If private drug plans were to cease providing coverage for diabetes and contraception drugs and devices, according to the PBO public program spending would more than double. Instead of costing $1.9 billion over five years, the program would be projected to cost $4.4 billion over five years.

Honourable senators, aside from the stated “universality” principles, the actual propositions in Bill C-64 oblige the Minister of Health to make payments to provinces and territories with which the federal government has made bilateral agreements to provide coverage for specific prescription drugs and related products intended for contraception or the treatment of diabetes.

Clause 6(1) of the bill specifies that the payments are intended to “. . . increase any existing public pharmacare coverage . . . .” The wording of this clause informed the assumptions made in the PBO’s report on Bill C-64.

The wording of clause 6(1) seems to indicate that the coverage for specific prescription drugs and related products intended for contraception or the treatment of diabetes would fill gaps in existing coverage.

This seems to contradict other clauses in the bill. Is it confusing? Indeed it is. As Stephen Frank, the President and Chief Executive Officer of the Canadian Life and Health Insurance Association, told the House of Commons Health Committee:

. . . in Canada there are 27 million Canadians with private drug coverage. It’s very broad coverage, much broader even than that of the best public system available across Canada, and they value that coverage greatly—90% of them value their coverage to a high amount or to a great amount—so they want to protect it and they are very strongly opposed to having it put at risk. Overwhelmingly, if you ask them what their preferred approach is and you give them a choice, they would like government to target their efforts to where the need is.

Colleagues, should we displace the existing coverage that 90% of Canadians value?

Confusion remains regarding how private insurance and this new public plan would be coordinated at the pharmacy counter. If a patient has existing private coverage for 80% of the cost of a medication, will the public plan cover the remaining 20%? Or will 100% of the cost shift to the public plan, thereby shifting costs from the private insurer to taxpayers?

In my briefing with department officials, when asked, they replied that these “back office” details had not yet been worked through. In its study, committee hearings should pursue answers to these foundational questions.

Coverage for specific prescription drugs and related products intended for contraception or the treatment of diabetes will not be administered centrally by the federal government, unlike the new dental benefit. Instead, the new coverage will be administered by the provinces and territories in accordance with forthcoming bilateral agreements.

Bilateral agreements entail myriad challenges. For instance, in March 2023, the government announced an investment, as I already said, of up to $1.5 billion over three years in support of the National Strategy for Drugs for Rare Diseases, which is supposedly part of this plan. This is meant to help increase access to, and affordability of, promising and effective drugs for rare diseases.

It has been more than one year, and those bilateral agreements have not been signed and, as a result, that money has yet to help Canadians with rare diseases.

Dr. Durhane Wong-Rieger, the President and Chief Executive Officer of the Canadian Organization for Rare Disorders, or CORD, told the House of Commons Health Committee:

. . . we’ve seen that the majority of that money, $1.4 billion out of $1.5 billion, is to be allocated through bilateral agreements. . . .

What we know is that, well over a year later, none of these agreements have been put in place. We don’t even know if there have been discussions around them. Whether it’s just bureaucracy, whether it’s just the cumbersome nature of the process, whether it’s really hard to get provinces to agree, I don’t know. However, this is not the way it’s needed to be.

Dr. Wong-Rieger wondered whether other medications would suffer the same tardiness in rollout as the drugs for rare diseases. Committee hearings would benefit from CORD’s lessons learned.

We have heard over the years how very difficult it is for the federal government to get comprehensive and comparable data from the provinces, even if data reporting is a requirement of a bilateral agreement.

For example, late last year when the Social Affairs Committee was studying Bill C-35, An Act respecting early learning and child care in Canada, we heard from Gordon Cleveland, who is the chair of the National Advisory Council on Early Learning and Child Care’s Data Indicators and Research Working Group. He told us:

. . . . the trouble is that the provinces and territories, in many cases — either haven’t been able to —

— improve data collection —

— or it’s not high enough of a priority. They are not reporting in the way the agreements foresaw. They’re not providing information in as timely a way as we thought they would, and even when they do, there will be major problems of lack of comparability.

If, as the minister has indicated, coverage for specific prescription drugs and related products intended for contraception or the treatment of diabetes is to be a pilot project for more universal coverage, then we will need excellent data for evaluation purposes. Colleagues, committee hearings should consider whether bilateral agreements can facilitate such data collection by including data-specific requirements.

The Government of Canada will be launching discussions with provinces and territories based on the list of diabetes drugs attached to a backgrounder published on Health Canada’s website on February 29, 2024. In that backgrounder, the government also announced its intention to establish a fund to enable work with provincial and territorial partners to support Canadians’ access to supplies that diabetics require to manage and monitor their condition and administer their medication, such as syringes and glucose test strips.

Many stakeholders have weighed in on the list provided in the backgrounder. The Association québécoise des pharmaciens propriétaires noted:

If you compare Quebec’s formulary to the one being proposed, even though it’s not final, you can see that several millions of diabetes-related prescriptions would be lost. . . . we manage stock shortages every day in community pharmacies. . . . We really need to ensure that this formulary at least covers Quebec’s formulary, even though the Quebec one is generous.

Broad coverage is needed for diabetes. . . . This wide range of covered drugs is essential in maintaining the health of Canadians.

Furthermore, the proposed fund for medical supplies for diabetics is, at this point, no more than a commitment. It is not included in Bill C-64. Mike Bleskie, an advocate with Type 1 diabetes, told the House of Commons Health Committee that his out-of-pocket costs stand at about $450 per month, mostly from his continuous glucose monitor, which is not covered in Ontario, and his insulin pump supplies. Bill C-64 would not help diabetics with those expenses.

Committee hearings should include the potential consequences of such a limited formulary and should study the formularies of different jurisdictions, both within Canada and internationally.

Colleagues, there are three other overarching problems with Bill C-64 that should be examined at committee. The first is the lack of oversight of the newly created Canadian Drug Agency, or CDA.

Bill C-64 envisions a broad and important role for the Canadian Drug Agency. Part 7 of Bill C-64 explains that the CDA will advise the minister on the clinical effectiveness and cost effectiveness of prescription drugs and related products compared to other treatment options; the prescription drugs and related products that should be included in prescription drug coverage plans in Canada and the conditions of that coverage; the collection and analysis of data on prescription drugs and related products; information and recommendations to be provided to health care practitioners and patients on the appropriate use of prescription drugs and related products; and improvements to be made to the pharmaceutical system, including through greater coordination between health system partners, patients and other stakeholders. It’s a big list.

The Canadian Drug Agency, or CDA, will prepare the national formulary that will inform the Minister of Health’s discussions with the provinces, territories, Indigenous peoples and other partners and stakeholders regarding national universal pharmacare. The CDA will also develop a national bulk purchasing strategy for prescription drugs and related products.

The problem, honourable senators, is that the Canadian Drug Agency was established at the direction of the Minister of Health, not by legislation. Serious questions should be asked as to whether, instead, the CDA should be subject to parliamentary oversight, the Access to Information Act, Auditor General scrutiny and interventions by a patient ombudsperson.

In his testimony at Standing Committee on Health, or HESA, John Adams of Best Medicines Coalition elaborated:

This bill gives the minister substantial new powers. It could be improved by building in various forms of transparency and accountability . . . .

. . . I think it defers too much to the black box called the Canadian drug agency and doesn’t put transparency or accountability mechanisms around what could become a very important role in system reform. . . .

The second overarching problem is that although the CDA will advise the minister on the creation of the national formulary, decisions regarding which drugs will be included will ultimately be made by the minister. This is an extraordinary power.

In her testimony before HESA, Linda Silas, the President of the Canadian Federation of Nurses Unions, said:

. . . when I met the minister yesterday, I said that it wasn’t really up to him to decide what was on the formulary, which diabetic drug, and that a group of experts should deal with it. . . .

Committee hearings should consider whether it is appropriate for the minister on the advice of an agency that is not overseen by Parliament — to decide what drugs and devices will be listed on the national formulary.

The third overarching problem with Bill C-64 is its lack of definitions. This concern was raised by many members of Parliament and stakeholders during HESA’s study.

Clause 6(1) of the bill tasks the minister with making payments to provinces or territories:

. . . in order to increase any existing public pharmacare coverage — and to provide universal, single-payer, first-dollar coverage — for specific prescription drugs and related products intended for contraception or the treatment of diabetes.

But the bill does not define “universal,” “single-payer” or “first dollar.” This has led to unnecessary confusion. Committee hearings should include the consideration of amendments to the bill to introduce definitions.

According to the Canada Health Act:

In order to satisfy the criterion respecting universality, the health care insurance plan of a province must entitle one hundred per cent of the insured persons of the province to the insured health services provided for by the plan on uniform terms and conditions.

This is how Canadians have understood the term “universal” since 1985.

Although Canadians may have an intuition as to what “single-payer” means, the term must be defined. As a 2017 article in the Journal of General Internal Medicine notes:

Single-payer systems are heterogeneous. Acknowledgment of what is considered as single-payer and the characteristics that are variable is important for nuanced policy discussions on specific reform proposals.

The government should be asked to provide a precise definition of “single-payer” so that the term can be defined in Bill C-64.

The term “first dollar” has also caused confusion. At HESA, Michelle Boudreau, the Associate Assistant Deputy Minister in the Strategic Policy Branch of Health Canada, explained that:

. . . “First dollar” means that as soon as an insurable event occurs — in this case, having a prescription filled — the insurance would apply: That is, the coverage would apply before any other payments.

Similarly, the Canadian Medical Association defines “first dollar coverage” as, “Health services covered 100% by public insurance, with no charges to patients seeking care.” This would seem to indicate that there will not be coordination of benefits when a patient has private insurance.

If public coverage will apply before private coverage, the government has underfunded its program:

Budget 2024 proposes to provide $1.5 billion over five years, starting in 2024-25, to Health Canada to support the launch of the National Pharmacare Plan.

The Parliamentary Budget Officer, or PBO, meanwhile:

. . . estimates that the first phase of national universal pharmacare will increase federal program spending by $1.9 billion over five years. . . .

We must remember, however, that the PBO’s estimate:

. . . assumes that any medications that are currently covered by provincial and territorial governments, as well as private insurance providers will remain covered on the same terms.

If medications for contraception and diabetes that are currently covered by private insurance providers are instead covered by the public plan, the PBO estimates that this phase of pharmacare will cost $4.4 billion. There would therefore be a $2.9 billion dollar budget shortfall.

The government must explain what precisely is meant by “first dollar,” and the committee should consider amending the bill to include this definition.

The Hoskins report says:

. . . Canada is the only country in the world with universal health care that does not provide universal coverage for prescription drugs. . . .

However, colleagues, universal coverage need not mean single-payer coverage. We can endorse universal coverage without endorsing a system funded exclusively by the federal government.

In conclusion, honourable senators, when Bill C-64 is sent to committee, there is much to consider — even as for the very essence of what is being proposed in this legislation. Is it indeed a universal system, as we understand the concept, or is it a fill-in-the-gap system? There seems to be confusion even about these very principles.

Colleagues, Canadians are counting on us.

Thank you for your attention. I look forward to study at committee.

The Hon. the Speaker: Honourable senators, the question is as follows: It was moved by the Honourable Senator Yussuff, seconded by the Honourable Senator Boehm:

That Bill C-50, An Act respecting accountability, transparency and engagement to support the creation of sustainable jobs for workers and economic growth in a net-zero economy, be read the third time.

Motion agreed to and bill read third time and passed on the following division:

On the Order:

Resuming debate on the motion of the Honourable Senator Pate, seconded by the Honourable Senator McBean, for the second reading of Bill C-64, An Act respecting pharmacare.

Hon. Donald Neil Plett (Leader of the Opposition): Honourable colleagues, I was not planning on speaking on this bill because I was quite convinced that our critic, Senator Seidman, would do a remarkable job, and she indeed did that just now. However, Senator Simons drew me into this debate last week during her speech on this topic. Quite frankly, colleagues, I would have preferred not to dignify the senator’s comments with a response, but I feel compelled to correct the record as she twisted my words and my position on something that carries very deep significance to me.

Since I am already on my feet, I will take the opportunity to share some of my thoughts on this newest piece of bad legislation coming from this NDP-Liberal government.

In her speech on June 12, Senator Simons quoted me quoting The Washington Post article about the fact that the Taliban had banned birth control in Afghanistan. For the record, I am going to repeat the quote from The Washington Post as it was powerful, and I stand by my words in their entirety. This was the quote:

Because of their diminishing educational and economic prospects, women and girls are increasingly forced into early marriage, with families resorting to selling their elementary-school-aged daughters to put food on the table. As many as 9 of every 10 of these child brides will experience gender-based violence, and many will be placed at further risk because of Taliban-imposed obstacles to health-care access. Today in Afghanistan, one woman dies every two hours during childbirth, and birth control has been banned. These conditions exacerbate the grave humanitarian crisis in a country full of war widows.

Colleagues, all of this behaviour is despicable and reprehensible. It is cruel and dehumanizing. It should not be.

Yet, in an incredible display of intellectual dishonesty, Senator Simons twisted this quotation and misrepresented my position when she stated the following:

. . . I think it is far more revolutionary that this plan will cover birth control, including the pill, the patch, the implant and the IUD, as well as emergency “morning-after pills” such as Plan B.

In the Senate just last week, Senator Don Plett himself spoke with considerable passion on the need for access to contraception. He quoted a Washington Post piece which explained that one of the ways the Taliban was oppressing woman in Afghanistan was by banning birth control.

I had not realized that the Leader of the Opposition in the Senate was such an outspoken and stalwart advocate for reproductive choice for women. However, I am grateful that he raised his voice — and loudly — to support a woman’s right to control her own body and fertility.

Colleagues, everyone who has been here for longer than one week knows my personal convictions on the sanctity of life — that it extends from conception to natural death. Having said that, I am also respectful of other people’s right to their convictions and opinions, including those of Senator Simons’.

Yet, in an incredible display of disrespect, Senator Simons used a quotation from my speech — where I was denouncing the vile actions of the Taliban towards women and girls in Afghanistan — to suggest that I was supportive of terminating a pregnancy by utilizing what is commonly known as morning-after pills.

For a former journalist, this either displays a shocking level of ignorance about the parameters of one of the most contentious public policy debates in the last century or reveals an alarming lack of concern for an honest representation of facts. Either way, it is troubling.

However, there is one interesting thing about Senator Simons’ speech. As usual, she will be supporting Justin Trudeau, against the wishes of the Alberta government. However, on this bill, at least we know where she stands from the start of the debate. We will not have to listen to her long speeches about why she is unsure about which way to vote and watch the drama unfold as she gnashes her teeth, feigning anxiety and uncertainty about whether she will support the people of Alberta, before finally voting with Justin Trudeau.

You may recall that in her speech, Senator Simons attacked the Alberta government for its decision to refuse to participate in the NDP-Liberal pharmacare plan. She even concocted a conspiracy theory that to be opposed to Bill C-64 somehow aligns you with some right-wing ideology about women.

I am sure that would be news to the Quebec National Assembly, which unanimously voted to denounce Bill C-64. We have a number of Quebec senators. I’m wondering how they will vote on Bill C-64.

Once again, we can see from some politicians around here that the “Ottawa knows best” approach is alive and well. They are ready to use any argument, even a far-fetched one, to attack the provinces that are ready to defend their rights: “You don’t agree with the federal government invading your jurisdiction? It is because you hate women.”

Senator Simons is a good example of those NDP-Liberal politicians who are so quick to use the parts of the Constitution that they cherish, such as the Charter of Rights and Freedoms, but are quick to dismiss other parts, such as sections 91 and 92 of the British North America Act on the separation of powers.

Any first-year law student will tell you that health care is a provincial matter, that it is an exclusive jurisdiction of the provinces.

So why is the Trudeau government getting involved in this? Did any of the provinces ask for this? No, not one of them did. They all said they would prefer more money for health care. Did a majority of Canadians ask for this? No. They also want more money for health care.

We all know the answer: It is the NDP that wanted pharmacare. With their sagging polling numbers, they needed a spark — something, anything.

And Justin Trudeau was ready to do exactly that — anything — to keep power, even the things that the Liberal Party has fought against for years. This NDP-Liberal coalition and their supporters have decided to throw the Constitution on the side, once again, and create a new program in an area that is exclusively provincial jurisdiction.

Of course, the provinces don’t want that. They know full well how this movie will go: The federal government will impose conditions, promising to pay for the program. Then, when costs balloon, it will no longer cover its share and will leave the provinces holding the buck. This is the same thing it did with health care and the same thing it is already starting to do with child care.

This idea that the federal government has to get involved in provincial jurisdictions is the biggest threat not only to the federal treasury but to the unity of our federation. However, the superiority complex of the NDP-Liberals vis-à-vis the provinces knows no bounds. The leader of the NDP wrote to Quebec’s health minister, asking for a meeting so that he could school him about the benefits of a pharmacare system. He did that, even though Quebec has a system where everyone has been insured since 1996.

Peter Julian said in his speech in the House of Commons on April 16, 2024, “It is no secret that Quebec’s current system is not working. People are falling through the cracks.” This is a politician from British Columbia, House leader of a party with one elected member in Quebec who has decided he knows what’s best for Quebecers.

Senator Simons is in good company when she pretends that she knows better than the Alberta government what is good for Albertans. I find it strange that the same people who say that senators should not oppose legislation adopted by the House of Commons because it was adopted by elected officials don’t have any problem opposing legislation voted through by elected officials in their own provinces. We can see this attitude that provincial governments and elected members are somehow inferior to their Ottawa counterparts.

They are not. Our federation is not constructed that way. Provinces are the masters in their own jurisdictions, such as health, which includes pharmacare. If there is a place in Ottawa where that constitutional reality should be not only understood but defended, it is here in the Senate.

Both Quebec and Alberta have indicated that they will not participate in any plan, and should the NDP-Liberal program be implemented, they expect full compensation.

I find it worrisome that the Trudeau government refuses to confirm that any province that refuses to take part in their scheme would be fully compensated.

I want to remind you, colleagues, that our role as senators includes the protection of provincial rights. I hope that all senators will keep that in mind when they make up their minds on Bill C-64. There is no place for simplistic arguments and conspiracy theories in our analysis of the positions of the various stakeholders.

This bill is about to be sent to committee. I hope that our Social Affairs Committee will shed some light on each of the provinces’ positions on the bill and on the Trudeau government’s commitment to accept giving full compensation in case of opting out, and that members of the committee will respect their duty as defenders of provincial rights.

I also hope we will get answers on this question: What is the federal government trying to achieve with Bill C-64? Because as I said, no one except the NDP wanted this bill. So why introduce it, other than just to make Jagmeet Singh happy and keep him onside? One theory is that there is no other reason. This is what I would call “the theory of the nothing burger.”

A lot of people have claimed this is not a pharmacare plan; it is only a plan to have conversations with the provinces about the federal government covering some of the cost for some medications for diabetes and some contraceptives. In other words, this bill is a PR exercise. It would be the legislative equivalent of the health minister inviting his provincial and territorial counterparts for a conference to discuss an issue with the knowledge that something may or may not happen.

Considering the political circumstances surrounding the birth of this legislation, I think these skeptics may be right. You have two parties with bad polling numbers trying to come up with an idea, any idea, to move the needle. They don’t have the money to fund a big program, but they have to show something sexy enough to make people believe something will change. But they must be careful — too much change would scare people. So they come up with a bill so vague that it does not mean anything, but it means everything. They hope that the radicals will see the promised revolution, while everyone else stays asleep, thinking that nothing will happen to them.

The brains behind this PR stunt thought they could add a kicker: the idea of including contraceptives is clearly designed for women, who are leaving the Justin train in droves.

So, this was the plan: introduce a bill that does not commit you to anything other than to more talks with the provinces, don’t budget anything yet, prepare a list of what would be covered but with the caveat that this may change. The government put that list on Canada.ca, which creates hope for Canadians. Canadians will say, “Well, these are the medications that are going to be covered.” But then some people will ask, “Well, why not this? Why not that?”

For example, senators will know that Ozempic is not on the list. The government’s answer to this is, “Hey, this is not the final list.” According to the theory of the nothing burger, the Liberals would dance around the issue until the next election, blaming the provincial Conservative governments for the delay. This way, they don’t touch the plans that the large majority of Canadians use, and they will use the issue for their election platform in 2025.

This bill would be another of those “Seinfeld” bills that the Trudeau government is so fond of — a bill about nothing, a nothing burger. Or it may be more than this — and this is where it becomes dangerous. This is the theory of the Trojan Horse.

The NDP-Liberal deal said that the two parties would be “continuing progress towards a universal national pharmacare program by passing a Canada Pharmacare Act . . . .” So, the ultimate goal would be this universal program. Liberal MP Chandra Arya said in his speech in the House that Bill C-64 is “. . . a new chapter in our social contract” — nothing less. So maybe it is a big thing, but what exactly?

Over 97% of Canadians are already eligible for some form of prescription drug coverage, so there are about 1.1 million Canadians without any coverage for pharmacare. Why didn’t the government focus on offering coverage to those 1.1 million Canadians?

Compare this to the over 27 million Canadians who rely on privately administered workplace plans. Are they to scrap their plans altogether? What happens to those 27 million Canadians who already have a plan?

As usual, the Trudeau government is speaking from both sides of its mouth. Parliamentary Secretary Mark Gerretsen said:

This is about accepting, realizing and coming to the conclusion that we all deserve the exact same level of coverage, regardless of who we are, where we work or what our income is.

So for him, there would no longer be any private plan — we would all have the same coverage. But wait: Minister Holland, from the same government, said:

. . . the 70% to 80% or so of Canadians who have private insurance can be at least somewhat reassured that they would not lose private coverage.

But wait again. The government designated sponsor of the bill in the Senate, Senator Kim Pate, issued a press release saying that Bill C-64 reflects a step-by-step process and that:

Incremental expansion of coverage from contraceptive and diabetes medication toward a full public, universal pharmacare system will require the buying power of a single-payer system purchasing medications for 40 million Canadians through processes that are evidence-based and publicly accountable. . . .

So, it is clear for the sponsor — the ultimate goal is to strip the 27 million Canadians who have private plans of their coverage. Let me read again from the press release:

“We start by insisting that access to pharmacare does not vary from one person to the next,” said Senate sponsor of Bill C-64, Kim Pate. “Pharmacare must remedy Canada’s patchwork of literally thousands of independent private and public drug plans. It must be a cohesive system that brings together and ensures Canada’s purchasing power when negotiating prices and supply guarantees with multinational pharmaceutical companies. It must support individual households and employers by relieving them of the costs of drug coverage.”

Earlier this month, the co-leader of the NDP-Liberal coalition said:

We believe in a universal single-payer program. We included that language in the bill. This bill isn’t perfect, but this bill does lay the foundation.

Let me then quote The Hill Times of June 8:

“The [bill’s] language is fatally flawed because of its ambiguity,” said Dr. Steve Morgan, a professor at the University of British Columbia and a well-known pharmacare expert who has advocated for a single-payer program for many years. “[Pharmaceuticals are] a critical and massive component in the health-care system, and yet this legislation doesn’t define terms such as what does ‘single payer’ mean? What does ‘universal’ mean? What does ‘first dollar’ mean? What does ‘public’ mean?”

None of those terms are defined in the legislation, which is an outcome of the supply-and-confidence agreement between the Liberals and the New Democratic Party. Instead, definitions are limited to the following: “Indigenous Peoples,” “Minister,” “pharmacare,” and “pharmaceutical product.”

Why did the government come up with such vague legislation? Why do some supporters say this is the first step of a complete overhaul of how medicine is distributed in Canada, while the minister keeps on telling us, “Move on; nothing to see here”?

You would think that facing such uncertainty about the impact of such an important bill as Bill C-64, the government would have clarified its intentions during House committee proceedings, but, no, it refused amendments to clarify what would happen to private coverage. Isn’t it strange — a government that insists that the program should be universal but refuses to define the term?

I hope that when the bill comes back for third reading, this will be clarified. Otherwise, we will have to conclude that Bill C-64 is indeed a Trojan Horse, and that the ultimate goal of the government is what Senator Pate and Jagmeet Singh stated: to get rid of all private coverage to the benefit of one single government-run program.

If that is the plan, the government should have the courage to say so. If Mark Holland wants to annul all the collective agreements whereby unions and their members obtained superior coverage for drugs, then he should have the courage to say so. I fully hope that Senator Yussuff would see to it that he does.

The Liberals should also have the courage to tell us the cost of their pharmacare plan. As usual, the Trudeau government is gaslighting Canadians on the costs of its measures. Mark Holland said:

We can’t afford this to be a massively expensive program. We’re not in a time where the fiscal framework can absorb massive costs. And so that absolutely is a consideration . . . .

In October 2023, the Parliamentary Budget Officer said that a single-payer universal drug plan would cost federal and provincial governments $11.2 billion in the first year and $13.4 billion in five years. So what is it? Is $11 billion no longer considered a massive cost to this government, or is Minister Holland hiding the truth? Once again, this is a question for our committee.

Finally, I hope the committee will clarify what coverage Canadians will have once we have a single national program. On March 3, expert Emmanuelle Faubert wrote in the National Post that if coverage similar to Quebec’s public drug insurance plan were to be extended across the country, the coverage quality of 21.5 million Canadians would be jeopardized if a government monopoly were to be imposed, and a loss of coverage could mean a loss of access to drugs.

I remind you that even the supporters of Bill C-64 admit that the Quebec model is too expensive. Our committee and our Senate should take a careful look at what happened in New Zealand, where drugs are no longer available due to the constraints of the public plan. Is this what would be in store for Canadians with Bill C-64: more money, less choice and inferior coverage? Is that what is in this Trojan Horse?

In conclusion, colleagues, we have in front of us a badly written bill for which the objectives remain unclear. Is this a “nothingburger” or is this a Trojan Horse that will reduce the existing coverage that 21 million to 27 million Canadians enjoy today? We don’t know. The government, in their usual format, rushed this bill in the House, with the committee having only 10 hours of witness testimony and the minister saying one thing one day and something contrary another day.

Canadians are fed up with their health care system. Why should we impose a similar single-payer pharmacare system with lack of choice, rationing of care and worse outcomes? Former president Ronald Reagan famously said, “. . . the nine most terrifying words in the English language are: I’m from the Government, and I’m here to help.” I would say that just as terrifying are the words, “I’m Justin Trudeau, and I’m going to set up a new program to replace what you have now.”

We need to know where the government is going with this, and the committee has a lot of work to do on this bill. I would imagine that Senator Pate will have the same interest as me in clarifying what Bill C-64 is all about because — so far — this is what we have with Bill C-64: We don’t know what will be covered. We don’t know who will be covered. We don’t know how coverage will be delivered. We don’t know how much this will cost. Yet the government wants us to just rush this through.

We don’t know the impact on the 97% of Canadians who already have pharmacare. I sincerely hope our Senate committee will obtain the answers from the government. I don’t think Canadians have any more faith in Justin Trudeau and his incompetent ministers. The “trust me” message from Minister Holland on this bill is not acceptable.

Thank you.

Some Hon. Senators: Agreed.

An Hon. Senator: On division.

(Motion agreed to and bill read second time, on division.)

The Hon. the Speaker: Honourable senators, when shall this bill be read the third time?

(On motion of Senator Pate, bill referred to the Standing Senate Committee on Social Affairs, Science and Technology.)

Leave having been given to revert to Government Business, Bills, Third Reading, Order No. 2:

On the Order:

Resuming debate on the motion of the Honourable Senator Moncion, seconded by the Honourable Senator McBean, for the third reading of Bill C-59, An Act to implement certain provisions of the fall economic statement tabled in Parliament on November 21, 2023 and certain provisions of the budget tabled in Parliament on March 28, 2023.