Madam Speaker, after what I have heard, I would like to begin my speech by commenting briefly on the answer given by the Conservative health critic, with whom I serve on the Standing Committee on Health. In his answer, he spoke strictly about the jurisdictions of Quebec and the provinces and made no mention of what kind of additional funding the Conservatives would provide for health transfers. If I understood him correctly, basically, the only real option Quebeckers have is the Bloc Québécois.
On one hand, we have the Liberal Party, which says that it will give the provinces money but only on its own terms and while infringing on their jurisdictions. The Liberals are duplicating programs and efforts. On the other hand, we have the Conservative Party, which says that it will not bother the provinces and will respect their jurisdictions but it will not give them a single cent more. That is the choice facing Canadian voters, except in Quebec, where they can vote for the Bloc Québécois.
I will begin my speech with a brief comment, and I hope that the Minister of Health will listen carefully to what I am saying. He always talks about the great discussions that he has with the Quebec health minister. I will come back to that a little later.
I want to begin by saying that in June 2019, the Quebec national state, through its National Assembly, with a single voice and across party lines, responded to this desire to implement coast-to-coast pharmacare. The National Assembly and the national state of the people of Quebec have not changed their position on this issue. The motion that was adopted the day after the Hoskins report reads as follows:
THAT it reaffirm the Government of Québec's exclusive jurisdiction over health;
THAT it also reaffirm that Québec has had its own general prescription insurance plan for 20 years;
I should point out that it has now been nearly 28 years.
THAT it indicate to the federal government that Québec refuses to adhere to a pan-Canadian pharmacare plan;
THAT it ask the Government of Québec to maintain its prescription drug insurance plan and that it demand full financial compensation from the federal government if a project for a pan-Canadian pharmacare plan is officially tabled.
That is what is going on right now. This motion was moved in June 2019. The House passed a motion twice on recognizing Quebec as a nation. When we respect a nation as a national state, by allegedly giving it more than mere token recognition, then the least we can do is avoid the kind of heavy-handed approach taken by the current federal Liberal minister of health. We have to sit down respectfully with the people who administer a plan, which is not perfect.
In fact, I imagine that if the federal government was being stingy with the health transfers, it was because it wanted to funnel some of the money into pharmacare and dental insurance. We will talk about that later. In this case, the government should have come and sat down to see who has the expertise, learn how the Quebec system operates and arrange to provide the full compensation that Quebec is calling for, with no strings attached. In that regard, we need to stop all the speculation around what Quebec wants to do with the money.
Quebec’s health minister was very clear when he said, “we have no problem adding this money to the drug insurance program. But it has to be without conditions. It is not up to them to decide what the best drug coverage is for Quebeckers”.
His intention seems pretty clear. There is respect for Quebec symbolically. They call Quebec a nation to avoid looking foolish. When it comes down to it, though, this must not have any legislative consequences, period. The debate could end here if full compensation were offered. The bill provides for a list to be prepared. Earlier I asked the minister if he knew the list of drugs covered in Quebec, but he did not wish to answer my question. Do members know how many drugs are covered by Quebec’s drug insurance plan? The answer is 8,000. I wanted to bring this 792-page list, but I found it a bit heavy.
These sorcerers' apprentices would have us believe they will arrange all this in no time at all. They will create the Canadian drug agency while in Quebec, there is already infrastructure. Ottawa has so much money that they are going to create another structure. There will be a duplication of structures. Is the Institut national d'excellence en santé et en services sociaux, or INESSS, not doing its job properly? It has been 28 years since Quebec has been making decisions, analyzing all the elements at a molecular level and determining whether these elements, many of which are innovative, are to be reimbursed. They are included in the list. Whether we are talking about the public part or the private part of this mixed plan, everyone has access to the same drugs.
This would have been a great opportunity to respect the Quebec nation. The Quebec national state and all its parties are asking for the same thing. The leader of the NDP, that progressive party, is lecturing us. He is completely out to lunch, though, when he says that the health problem in Quebec has to do with the fact that the government has not invested enough in health care. The Government of Quebec increased its budget by 50%. It has enacted reforms to try to do more with less. It implemented a number of reforms and a lot of structural modifications in an effort to achieve greater health efficiencies.
We have a partner that has not been putting enough money on the table. Then, a few years later, this same partner has the nerve to say that Quebec does not know how to manage its own health care system and tries to explain how it should be done. The first thing that partner should do is hand over the money. That would be a good starting point. Quebec's current resistance to all this federal interference should not be that hard to grasp. It is easy for the Prime Minister to say that he does not care about jurisdictions. The Prime Minister does not care about the Constitution. Well, let him reopen the Constitution, then. We will see if he really does not care. The government likes to lecture everyone else, but cannot even take care of its own people. That is the federal government. I will come back to that.
One might think this bill was well-intentioned, but the road to hell is paved with good intentions and the devil is in the details. I asked only one question: How many prescription drugs will be covered by the national public pharmacare program with a single universal payer? Will Quebec's list be used? Will Quebec have to take any prescription drugs off its list? Will INESSS be made redundant, or will it be able to continue doing its good work? Why is a Canadian agency being created to supersede the process we have in Quebec? We are not getting any answers to these questions. However, the minister claims he has maintained a very good dialogue with Quebec. I gave an example. I think the minister is having a dialogue of the deaf, where he listens only to himself and not the other party.
It seems to me that it was quite clear when Quebec's health minister, Christian Dubé, said, “we have no problem adding this money to the drug insurance program. But it has to be without conditions”. He then added the following:
The government is not only refusing to give us the money we asked for in health transfers, but it also wants to interfere in an area under Quebec's jurisdiction. The federal government knows full well that this is a provincial jurisdiction. We have had our own pharmacare program since 1997. That is almost 30 years. We also cover the widest range of prescription drugs of all the Canadian provinces.
The federal health minister just told us that he has very good conversations with him, even though the Premier of Quebec felt it necessary to hold a press conference to tell the federal Liberal government—which is in a coalition with the NDP and was not so centralist before the NDP got involved—to mind its own business. The minister just told us this morning that they have very good conversations, but when we stand up in question period, we are told that we are trying to pick a fight. All we are saying is that the federal government should mind its own business. We are only relaying the message from the National Assembly of Quebec, not from a single party but from all parties, on pharmacare.
The reason Ottawa has money in the first place is because of the fiscal imbalance. Well, we are going to enhance our own program. I challenge anyone here this morning to prove they could do a more competent job managing our program than those who are doing it right now in Quebec City. I challenge anyone willing to make that claim to go make their case to those managing the program and prove that they have the competence. I am talking not only about provincial competence in the jurisdictional sense, but also about incompetence. In that respect, I have a short list I will return to later.
Bill C-64 has put the cart before the horse, as the saying goes. Today, rather than sitting down, holding a summit, talking to people, looking at what was being done and coming up with something of substance, the government announced an intention of putting something in place. However, it did not talk to anyone, it is not open to anything without conditions, and it is saying that Quebec must march to the beat of Ottawa's drum.
This is not well intentioned; this is a political deal to stay in power until October 2025. That is what this bill is really about. That is what is behind it, because no one could be this keen to jump into as sensitive and critical a field as pharmacare.
Drugs in 2024 are not like they used to be in 1996 or 1997. We are not talking about codeine or Tylenol. We are talking about innovative molecules that often give rise to treatments that could potentially allow patients to avoid surgeries and transplants. A case in point is Trikafta for cystic fibrosis. Patients can take two pills and a glass of water a day, instead of being hospitalized for 280 or 320 days a year, instead of having to get a lung transplant. This drug needs to be covered. How will the list be compiled, and how can we trust the federal government, which starts things but then walks away?
After all, this is the government that pilfered from the EI fund and from workers and that never did the right thing by returning the money. This is the government that dumped the federal deficit on the provinces and cut health transfers in the mid-1990s. Jean Chrétien travelled the world, boasting to the G7 countries that all he had to do to balance his budget was cut health transfers and that the best part was that people were protesting in front of the Quebec National Assembly, not in front of the Parliament of Canada. That is what the federal government is like.
It is creating a program now, but how many years will it be before the government disengages because it got the math wrong, it is unable to manage the program properly, and the infrastructure is cumbersome and redundant, when the money should be on the ground, going directly to patients as quickly as possible?
The minister delivered a very nice speech, saying the governments get along really well, the principles are sound, the Quebec government wants to co-operate. In reality, the Quebec government's response was to ask Ottawa to mind its own business.
The federal government is not even capable of handling its own affairs properly. Think about the whole F-35 saga or the lack of investment in defence. Think about Phoenix, the borders, passports, asylum seekers. The national emergency stockpile was empty when the pandemic hit. The Global Public Health Intelligence Network had been dismantled and was ineffective at the start of the pandemic. The federal government should mind its own business and clean up its own house before lecturing us.
It lectures the provinces about health care management, but it is the worst employer for federal health employees. Communities under the federal government's jurisdiction are neglected. The funding Ottawa provides for public health care is insufficient, to be sure, but the federal government treats its employees worse than the provinces do. How it can then lecture anyone, I just do not know.
The bill seeks to put in place principles, and then, based on these principles, a list will be compiled. After this list is compiled, an agency and then a committee will be established. The government is so clueless about where it wants to go with this that it is tabling a bill to create a committee that will make recommendations for rolling out pharmacare. Bravo.
The Bloc Québécois is not opposed to state pharmacare. It already exists in Quebec. It is far from perfect, there are positives and negatives, but it does guarantee minimum coverage. What we are calling for is what the National Assembly has always demanded: the right to opt out with full compensation. Given how long Quebec has been administering pharmacare, if there was a real need elsewhere, I imagine others would have followed suit. However, that was not the case. We are going to ensure that no one is ever allowed to dismantle our system or reduce our coverage.
Medication is currently free for people aged 18 and under. The system is not perfect, of course, and there are certain fees involved. However, if we had the money, we could increase free coverage without compromising on the list of drugs we cover.
Does the federal government really know how much it is going to cost to make everything free from the first dollar invested? I am not sure these sorcerers' apprentices really know what they are doing. Based on the reaction of the National Assembly and the Quebec government, I am certain the federal government has never sat down with them to have a serious conversation about it. Quebec's example and expertise are not going to be on the agenda as the government implements its system.
