Bill C-64

Pharmacare Act

An Act respecting pharmacare

This enactment sets out the principles that the Minister of Health is to consider when working towards the implementation of national universal pharmacare and obliges the Minister to make payments, in certain circumstances, in relation to the coverage of certain prescription drugs and related products. It also sets out certain powers and obligations of the Minister — including in relation to the preparation of a list to inform the development of a national formulary and in relation to the development of a national bulk purchasing strategy — and requires the Minister to publish a pan-Canadian strategy regarding the appropriate use of prescription drugs and related products. Finally, it provides for the establishment of a committee of experts to make certain recommendations.

Pharmacare Act

[Adam van Koeverden, Liberal, Milton, ON]

Thank you, Madam Speaker. There is not only heckling but also unnecessary interruption.

I will use my remaining time to talk about diabetes and those living with diabetes. Diabetes is a disease with no cure. There is a treatment, and it is thanks to Canadian science, which is something that our government supports. Canadian scientist Frederick Banting and his team came up with an interim solution, I suppose we could call it; it is a treatment for diabetes that allows diabetics to live. Without it, diabetics would not have the opportunity to live fulfilling lives, but we still need to fight for a cure. Before we get there, we should also ensure that we reduce inequality and inequities in the populations impacted by diabetes.

There is a really interesting infographic from the Public Health Agency of Canada. Anybody who is watching this debate might be interested in how diabetes and inequality intersect in Canada. I was actually very surprised to learn that diabetes and employment status are related; there is a positive correlation between them. When people are employed, they are less likely to suffer from diabetes and live with diabetes. When people are permanently unable to work, they are more likely to have diabetes, which means that they naturally have a lower income. It is the same for education level, surprisingly. Almost 10% of those individuals with less than a high school education will have diabetes or prediabetes throughout their life; for university graduates, that goes down to between 3.5% and 6.1%. There is also a positive relationship within income quintiles. All five income quintiles are associated with a positive relationship. As income goes up, people are less likely to have diabetes. Therefore, providing folks living with diabetes with free access to medication, to insulin and to supports for managing their illness is also an affordability measure that would make a difference for a lot of Canadians.

Diabetes also affects people disproportionately in different categories. There are complex social and environmental behavioural factors that result in inequalities in the burden of diabetes between certain populations in Canada. The prevalence of diabetes is 2.3% higher among South Asian Canadians, and it is 2.1% higher among Black adults.

For indigenous adults, the prevalence of diabetes is similarly staggering, at 1.9% higher for first nations Canadians living off reserve. Inequities experienced by first nations, Inuit and Métis populations are a direct result of colonial policies and practices that included massive forced relocation, loss of lands, creation of the reserve system, banning of indigenous languages and cultural practices, and the creation of the harmful residential school system. Unaddressed intergenerational trauma adds to the ongoing challenges faced by indigenous peoples, and providing them with a reliable and affordable treatment for diabetes would support affordability.

This would also reduce the number of times people with diabetes have to access health care as a result of their illness. People with diabetes are more at risk of all sorts of life-changing health crises, such as a heart attack or stroke, kidney failure, blindness and amputation. At this very moment, there are about 3.7 million Canadians, or 9.4% of our population, who have been diagnosed and have to manage their condition for their entire life. If members can believe it, in 2015, 25% of Canadians with diabetes indicated that they followed their treatments to a T, but they were affected by cost; in some cases, those Canadians were rationing medications to save money. Therefore, a quarter of the people who are following their treatments are affected by cost. There are other Canadians who are undiagnosed, and there are Canadians who are not following their treatments. We need to make sure that they live a healthy and fulfilled life, and one way to do that is to ensure that they have access to this vital medication.

About one out of three people is living with diabetes or prediabetes today in Canada, and rates of diabetes are ever rising. It is estimated that, by 2028, over 13 million Canadians, or 32% of the population, will have diabetes or prediabetes. Through Bill C-64 and the work of the national framework for diabetes, we can improve aspects of preventative care as well. We can do this through information sharing and knowledge transfer, while also ensuring that those living with diabetes have access to insulin and other diabetes medications.

This is a cost-saving endeavour. The Conservatives have continually referred to this as a spending program, as if it would not be invested directly in the health of Canadians. Not only would it be invested in their long-term health outcomes, but it would also be invested directly in their affordability. It would support affordability, and, as I pointed out, that is something that is positively correlated with other risk factors.

We introduced the national framework for diabetes in 2022 to align multisectoral efforts to reduce the impact of diabetes in Canada. The framework comprises about six interdependent and interconnected components that represent the range of areas where opportunities to advance efforts on diabetes could and will be beneficial.

Bill C-64 would support people living with diabetes, whether through improving access to the medications they need or giving them the tools they need to have a better quality of life in Canada. We are here for Canadians. Our plan to provide universal coverage for contraception and diabetes medications would be transformative, and I still have faith that the Conservatives will see the light and recognize that this is a very popular and worthwhile endeavour.

We should all get behind national pharmacare for Canadians.

[Adam van Koeverden, Liberal, Parliamentary Secretary to the Minister of Environment and Climate Change and to the Minister of Sport and Physical Activity]

Madam Speaker, it is an honour to rise this evening to discuss the bill before us, Bill C-64, an act respecting pharmacare. We can all agree, or I hope we can all agree, that Canadians should have access to the right medicines at an affordable price regardless of where they live in our country. That is precisely what Bill C-64 would do. It represents the first phase toward a national pharmacare plan, starting with the provision of universal single-payer coverage for contraception and diabetes medications. This legislation is an important step forward to improve health equity, affordability and outcomes and has the potential of long-term savings to the health care system and for all Canadians who use it.

In budget 2024, we announced $1.5 billion over five years to support the launch of national pharmacare and coverage for contraception and diabetes medications. The single most important barrier to access to contraception in Canada is cost. For example, the typical cost for select contraceptives in our country for an uninsured Canadian woman is up to $25 per unit, or $300 per year, for oral birth control pills and up to $500 per unit for a hormonal IUD, which is effective for five years.

It occurs to me that if oil and gas companies were going to start selling diabetes medications, insulin or contraceptives, the Conservatives might be all for it. It seems like they are the only group, the only organization, and the only affordability measures the Conservatives can come up with are supports for oil and gas.

However, Canadians have lots of expenses, and one of the main expenses associated with inequality and inequities in our society is their medications. We are here to help. Some populations are disproportionately affected by the lack of coverage. Women, people with low incomes and young people, all of whom are more likely to work in part-time or contract positions and thereby not have access to a drug plan, often lack access to private coverage. One study found that women from lower-income households are more likely to use less effective contraceptive methods or no contraceptive method at all as a result of their lower-income situation.

Bill C-64 would ensure that Canadians have access to a comprehensive suite of options when it comes to contraceptive drugs and devices, because improved access to contraception improves equality. This means that every woman in Canada would have the ability to choose the contraceptive that is best for her, regardless of her ability to pay. This would contribute to her right to have bodily autonomy, which is what this government fully supports.

Sexual and reproductive health is a priority for this government. This is reflected in Bill C-64, as I have mentioned, but it goes beyond that in other significant federal initiatives. Our government is committed to improving the sexual and reproductive health outcomes for all Canadians, and this includes helping to ensure access to a comprehensive suite of contraceptive drugs and devices for everyone. By working with provinces and territories and guided by the principles within Bill C-64, we can make this a reality.

The proposed Bill C-64 lays the groundwork for that process, and through it, with collaboration with provinces and territories, we are helping to fight for affordability for all Canadians. By passing this legislation, collectively, we can all continue to build on the momentum we have already achieved.

I looked into this. Pharmacare in Canada is deeply popular with people who vote for all parties. It is almost 90%, in fact. This is something I expect all members of Parliament to get behind. It is something a lot of Canadians support, regardless of party.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Madam Speaker, I believe there is at least one province, possibly even more, that has acted on the issue of contraceptives. We will find, as I said, that there are different policies in different provinces, and so forth.

What is really important to recognize is that Bill C-64 would help an estimated nine million people in dealing with contraceptives. When we think about diabetes medications, we are talking about over 3.5 million people. That is a lot of good reasons to get behind this legislation and ensure there are some standards across the nation.

The House resumed consideration of the motion that Bill C-64, An Act respecting pharmacare, be read the third time and passed.

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the Leader of the Government in the House of Commons]

Madam Speaker, I will be splitting my time with the member for Milton.

I want to address what I would suggest is the ultimate potential assault on health care by the Conservative-Reform Party of Canada. For the record, to be very clear, one needs to look at what the member for Abbotsford said today, which has been repeated in many different ways by different members. I have often talked about the hidden Conservative-Reform agenda.

I personally see health care as an important issue going into the next federal election, and my intention is to point out the contrast. When I say that the Conservative Party has crazy policies, we should think about them saying that the federal government has no constitutional role. One would think they were separatists, like the Bloc. They believe the federal government should just be an ATM machine, hand over the cash and say nothing about health care because the federal government has no role to play. Both the Conservatives and the Bloc believe that there is no role for the federal government to play in health care.

Then, they say that it is a constitutional God-given right that provinces are the only ones that have anything to do with health care. That is absolutely wrong. I would ask members to cite a Supreme Court of Canada decision that says that the Canada Health Act is in violation of the Constitution. I would like members to tell me which premier or which province took the government to the Supreme Court and had a favourable ruling on that issue. The simple answer is that it has not happened. That is why the Conservative spin of misinformation continues to flow, and that is most unfortunate.

Unlike the Conservative Party, Liberals understand and value the important role that the federal government in Ottawa plays. In terms of the pharmacare program, it is interesting to hear from different opposition members, the Conservatives and the Bloc, as they have that unholy alliance on Bill C-64 for different reasons. We have well over 100 policies on pharmacare, depending on what province people are in or which company they work for. There are many different types of policies facing the pharmacare issue.

The idea of a national pharmacare program is nothing new. The Prime Minister is moving the issue forward. That is what Bill C-64 is all about. It recognizes there is a need for the national government to work, where it can, with provinces, to develop a national pharmacare program that has similarities in all regions of the country. The way I see it, there are two areas where we are focusing a great deal of attention today. I see it as a step forward. I believe that provinces will continue to look at what is being proposed and will come on board.

The arguments I hear from the Conservative Party today are the types of arguments one would have heard generations ago regarding health care when public health was brought in. Those are the types of arguments of deniers. I suspect we will never hear the Conservative Party saying they are going to get rid of the Canada Health Act. Maybe a good opposition day motion would be what people have to say about the Canada Health Act and whether they support it or not.

[Warren Steinley, Conservative, Regina—Lewvan, SK]

Madam Speaker, I do like the little cute condescension from the NDP: “when he reads the bill”. The bill, Bill C-64, is four pages. I did read the bill. It is really cute when they have that passive-aggressive tone. It is adorable.

If they sign on and if they do take the universal single-payer coverage, what are his constituents going to say when their coverage is less than what they had before?

What is he going to say to 27 million Canadians who are losing better coverage because they are going to add coverage that is not as good as what they have right now? They would have a lot of explaining to do to their constituents when they try to take away the coverage they have right now and give them less coverage.

[Taylor Bachrach, NDP, Skeena—Bulkley Valley, BC]

Madam Speaker, the member for Regina—Lewvan was quite adamant that health care delivery is the purview of the provinces. I think that when he reads the bill, Bill C-64, he will be delighted to find that, in the pharmacare proposal that we are debating today, the delivery of pharmacare is delivered by the provinces.

The other thing I think he will be quite delighted with is the fact that provinces will have the ability to sign on or not to sign on with the pharmacare plan that is being debated. I think the only challenge he is going to have is that, when the Province of Manitoba and the Province of British Columbia sign on and when their residents start receiving free contraception and free diabetes medication and devices, the residents of his province, his constituents, are going to start asking why they are not able to tap into the benefits of universal pharmacare.

I would just ask him what he is going to say to them in those situations.

[Warren Steinley, Conservative, Regina—Lewvan, SK]

Madam Speaker, it is pleasure to rise to speak to Bill C-64 for a second time. I spoke at second reading of this bill on Thursday evening, and I am happy to speak to third reading of the pharmacare pamphlet.

I would like to repeat some of my remarks made during my speech at second reading. I have asked, time and time again, for any of the NDP-Liberal costly coalition members to tell me how many provincial ministers asked for a pharmacare bill at a federal-provincial-territorial meeting. Not one of the Liberal ministers, Liberal members or NDP members actually answered me. Quite frankly, they did not want to say out loud that the answer is zero. This was not at the top of a wish list for any of the provincial health ministers.

I have been talking with our health minister in Saskatchewan. He still has no details about what this pharmacare pamphlet would look like or how it would affect the people of Saskatchewan. The biggest fear at the provincial level is that coverage would lessen in Saskatchewan. They have done a good job of building health care back up in Saskatchewan after the nineties, when the NDP ruined health care in Saskatchewan, which I will get to later in my speech. The provincial health ministers are asking, “Where are the details?”

We have talked about how the federal Liberal government continues to bring in bills without any consultation. We have seen it in agriculture, in oil and gas, and even with the budget. At the agriculture committee on Thursday, I asked the agriculture minister about who he consulted in the ag sector when it came to increasing the capital gains tax exemption from a half to two-thirds. I have not gotten a straight answer from a lot of the Liberal ministers at committee, but to that minister's credit, he said that he did not even know that it was in the budget. A senior minister in the government did not know what was going to be in budget 2024.

I have had the honour of serving in the Government of Saskatchewan, and I know there is quite a process to get a budget approved. It goes through Treasury Board finalization, then through cabinet finalization, then through caucus finalization, and then back to cabinet for a final sign-off.

My colleague, the member for Abbotsford, who gave a great speech, was in government, and I think he probably saw most of what was going to be in the budget before it came out. When a senior minister who has been here for a long time, some might say too long of a time, admitted that senior ranking Liberals did not see the budget before it came out, I was dumbfounded. It was unbelievable.

It does not surprise me, then, that this bill was brought forward with very little consultation with anyone. We all know this was signed off on, on the back of a napkin, to placate the junior NDP partners, so they would prop up the corrupt government for years, or at least until the member for Burnaby South gets his pension. We know what this is about, and it is to ensure that the NDP-Liberal costly coalition stays in power. This is the price Canadians are going to pay.

Right now, 27 million Canadians are anxious about losing some of the health coverage they have right now as they have health coverage that they want to keep. I will admit that 1.1 million Canadians are under-insured or do not have insurance. Why does the government not focus on that? We could have had something rolled out that supplemented the provincial government programs. Instead, the costly Liberal coalition government always wants to be the one that rides in on the white horse, saying, “We are going to save you. We have a national plan.”

We have a national day care plan. A friend of mine is now number 300 on the wait-list in Regina, which is not that big of a city. The government has made day care spots less available in my city of Regina, Saskatchewan.

The federal government has a dental plan that no dentist wants to sign off on. I have a letter from the Saskatchewan Dental Hygienists' Association, where 99% of dental assistants and dental hygienists are female, and there was not one consultation with any of those stakeholder groups about what they should do or if they thought the dental care plan was a good idea. Once again, there was no consultation. This is a recurring theme.

We have a national lunch program for which the Liberals did not do any consultations with any school boards. In Regina, there are a lot of great corporate citizens who donate a lot of money to lunch programs. When we got together as a group and talked about this, I asked if anyone knew how many lunch programs were in our city. The Regina Food Bank covers some programs. Mosaic Market covers some programs. Nutrien covers some programs. If we put all those programs together, we could do a lot of good and almost get to where we need to so all kids could have food when they go to school.

There was no consultation on that either. The Liberals just come in on their white horses and think they are saviours. It is almost like someone over there has a God complex, one might say. They always want to be the one walking in and saving people, but they do not work with anyone else across the country.

Let us get to the pharmacare program. Once again, it is a pharmacare program, with no consultation, that no one asked for at a provincial level. My friend for Winnipeg North talked about how health care is not within provincial jurisdiction, but it is. Health care delivery is within provincial jurisdiction. He knows that, as he is a former MLA. Money transfers come from the federal government, but the day-to-day operational delivery of health care is one hundred per cent a provincial jurisdiction. He knows that.

It is interesting for the Liberals to bring in a national program, or a pamphlet, really, that covers two things, and then act like they are the conquering heroes. Who asked for this at a provincial level? I hope my friend from Winnipeg North will ask me a couple questions about that.

There is one more thing when it comes to health care in our country. The biggest threat to health care in Canada is whenever there is a provincial NDP government. The NDP in Saskatchewan devastated health care. When it was in government, it closed 52 hospitals in my province. It closed 1,200 long-term care beds in Saskatchewan during the nineties. It fired 1,000 nurses, hundreds of doctors, and rural Saskatchewan was divided.

The NDP is the pioneer of our two-tiered health care systems. In Saskatchewan, there is much different health care if someone is in rural Saskatchewan compared to urban Saskatchewan. The NDP went so far as to close the Plains Health Centre hospital in Regina. It was one of the best hospitals in the city and was the newest hospital. The NDP closed it because it was servicing too many rural Saskatchewanians. It was unbelievable.

We now have a government in B.C., an NDP provincial government, that is pioneering a pharmacare program, but it has it backward. It is giving B.C. residents free drugs that are killing them, instead of having a plan in place to give residents affordable drugs that would be life-saving. That is what B.C. is doing right now.

Instead of putting money toward life-saving drugs, the Liberals want a safe supply, which I do not think exists. They continue to spend taxpayers' dollars in British Columbia to give drugs to people who are killing themselves with those drugs. That is so opposite to what a government should be doing. The Liberals want to come in like they are champions of pharmacare. They should talk to some of their B.C. cousins about what is going on in that province. They should take some of the money they are spending putting illicit hard drugs on the street, and maybe supplement that with some programs that would give drugs to people that would help save their lives instead of end their lives.

I would end with one more conversation about how consultation is so disregarded by the government. Obviously, the NDP are going to vote for this terrible piece of legislation. The Liberals will vote for it.

One thing I would say to members is to please consult with the health ministers of the provincial governments because Saskatchewan is doing a great job. It has diabetes coverage for everyone up to age 25. We have a $25 cap on senior drugs, a program that helps seniors make sure they get the medication they need.

Provinces are in charge of the delivery of the health care system. Please let them keep that in their domain, and do the proper thing and consult with the health ministers in this country.

[Francesco Sorbara, Liberal, Vaughan—Woodbridge, ON]

Madam Speaker, I was just saying how important contraceptives are to nearly nine million women in this beautiful country we live in, nearly one-quarter of the Canadian population.

Contraception, also known as birth control, is used to prevent pregnancy, whether it is required for family planning, medical treatment or overall reproductive health. Improved access to contraception improves equality, reduces the risk of unintended pregnancies and improves reproductive rights.

The single most important barrier to accessing contraception in Canada is cost. For example, the typical cost for select contraceptives for an uninsured Canadian woman is up to $25 per unit, or $300 per year, for oral birth control pills, and up to $500 per unit for a hormonal IUD, which is effective for five years.

Some populations are disproportionately affected by the lack of coverage. Women, people with low incomes and young people, all of whom are more likely to work in part-time or contract positions, often lack access to private coverage. One study found that women from lower-income households are more likely to use less effective contraceptive methods or no contraceptive method at all. Although most drug plans list a range of contraceptive products, unfortunately only a fraction of Canadians are eligible for prescription birth control at low or no cost through a public drug plan.

Bill C-64 would ensure that Canadians have access to a comprehensive suite of contraceptive drugs and devices, because improved access to contraception improves health equality. This means that every woman would have the ability to choose a contraceptive that is best for her, regardless of her ability to pay. This would contribute to her right to have bodily autonomy, which is what this government fully and fundamentally supports.

In addition, ensuring access to a comprehensive suite of contraceptive drugs and devices at no cost to the patient can lead to savings for the health care system. British Columbia implemented this policy at the provincial level last April, and studies from the University of British Columbia suggest that no-cost contraception has the potential to save the B.C. health care system approximately $27 million per year. In the first eight months of that policy being in place, more than 188,000 women have received free contraceptives.

Sexual and reproductive health is a priority for this government. This is reflected in Bill C-64 but, as I have mentioned, it also goes beyond that to other significant federal initiatives. As part of budget 2021 and budget 2023, the Government of Canada has continued to demonstrate its commitment to improving access to sexual and reproductive health care support, information and services for Canadians who face the greatest barriers to access; and to generating knowledge about sexual and reproductive health for health care providers.

Since 2021, the sexual and reproductive health fund has committed $36.1 million to community organizations to help make access to abortion, gender-affirming care and other sexual and reproductive health care information and services more accessible for underserved populations. An additional $16.7 million has been provided to the Province of Quebec.

Budget 2023 renewed the sexual and reproductive health fund until 2026-27. This initiative has funded 21 projects and is currently funding 11. The sexual and reproductive health fund is providing $5.1 million to the University of British Columbia contraception and abortion research team for a 25-month project from March 17, 2023, to March 31, 2025, entitled the “Contraception and abortion research team access project, advancing access to abortion for under-served populations through tools for health professionals and people seeking care”.

As a segment of the project centres on contraception, the project has partnered with the Canadian Pharmacists Association to develop educational resources that support pharmacists prescribing contraception and assist pharmacists in understanding and tailoring their approach for indigenous and racialized populations, including youth and other underserved populations.

With the support of the University of Toronto youth wellness lab, the project will also engage with family planning professionals, for example pharmacists, family physicians, obstetricians, gynecologists, nurses, midwives and social workers, to optimally design affirming and judgment-free services and contraception information care by, with, and for youth. Additionally, the medical expense tax credit has been included to include more costs related to the use of reproductive technologies, making conception more affordable.

In conclusion, our government is committed to improving the sexual and reproductive health of all Canadians. This includes helping to ensure access to a comprehensive suite of contraceptive drugs and devices for all Canadians. By working with provinces and territories, and guided by the principles within Bill C-64, we can make this a reality.

As we move forward, Liberals will continue to work with the provinces and territories, indigenous peoples and other stakeholders to ensure we get this right. The proposed Bill C-64 lays the groundwork for that process and would guide our collaboration. By passing this legislation, we could continue to build on the momentum we have already achieved. We are well on our way and I look forward to working with all parliamentarians to realize the next phase of Canadian health care.

Whether it is dental care; the Canada child benefit; $10 day care and the national learning strategy; helping the almost 3.7 million individuals who have diabetes; or providing dental care for seniors, and now moving into another segment of the population, which I believe is individuals with disabilities, we are going to be there and have the backs of Canadians today and into the future.

[Francesco Sorbara, Liberal, Vaughan—Woodbridge, ON]

Madam Speaker, it is always a pleasure to rise in the House. Happy Monday. I hope that we and our respective families are doing well. Before I begin, I wish to say that I will be sharing my time with the member for Winnipeg Centre this evening.

I am happy to speak today regarding Bill C-64, an act respecting pharmacare. It is another step for our government to make life more affordable for Canadians and provide the services that they need at this point in our term, and something that I am very proud of as a member of Parliament.

Before I get into my formal remarks, this weekend I was reminded of the work we are doing in helping Canadians, including the wonderful residents that I have the privilege of representing in Vaughan—Woodbridge. Close to my constituency office is one of the regional roads in the city of Vaughan in York Region, Weston Road. Along Weston Road, there are three signs that are placed up by our local dentists, all accepting the Canadian dental care program. Much like what is contained in the contents of Bill C-64, an act respecting pharmacare, here we have another foundational piece that is assisting Canadians in my riding and across the country. We know that over two million seniors have been approved for the dental care plan, and that over 120,000 have actually visited dentists. I have had many conversations with the seniors in my riding over the weekend who have used the plan and are very happy about it.

Along that vein, we are introducing a bill on pharmacare that will again help Canadians, 3.7 million of them, who have diabetes. We know that diabetes costs our health care system north of $30 billion a year. There are real savings in doing what we are doing and also taking preventative steps and providing contraceptives for Canadians.

This bill sets out the principles that will guide our government's efforts to improve the accessibility and affordability of prescription medicines and support their appropriate use. It also underscores the importance of working together with provinces and territories to make national pharmacare a reality for Canadians. We can all agree that Canadians should have access to the right medicines at an affordable price regardless of where they live.

That is what Bill C-64 does. It represents the first phase toward a national pharmacare, starting with the provision of universal single-payer coverage for a number of contraception and diabetes medications. This legislation is an important step forward to improve health equity, affordability and outcomes and has the potential of long-term savings to the health care system.

In budget 2024, we announced $1.5 billion over five years to support the launch of national pharmacare and coverage for contraception and diabetes medications. I will highlight how important this is to Canadians and, specifically, how important access to contraceptives is to almost nine million women—

[Brad Redekopp, Conservative, Saskatoon West, SK]

Madam Speaker, Liberals like to wrap themselves in the Canadian flag and proclaim themselves the great deliverers of health care in our country. It gets better. Allow me to read from former Liberal prime minister Paul Martin's 2004 election platform, which he infamously called a “fix for a generation”: “The priorities of a Liberal government begin with publicly funded, universally available health care. There is simply no other issue of such vital significance to Canadians. Liberals are proud of their founding role in making medicare a national priority.”

That sounded pretty good. It continues on, stating, “The objective of a Liberal government will be to agree with provinces and territories on a national pharmaceuticals strategy by 2006.” I would say that was a fail. That was former Liberal prime minister Paul Martin's 2004 election platform: a “fix for a generation”. Needless to say, national pharmacare did not happen in 2006. In fact, it is a full 20 years, a full generation, later, and we have a health care system that has fallen apart under the current NDP-Liberal government in Ottawa. Having broken our publicly accessible universal primary care system, we now have a Liberal Prime Minister who is setting his eyes on taking a wrecking ball to yet another part of our health care system. Why? In this backward town we call Ottawa, where common sense goes to die, Liberal logic says that if it is not broken, they need to break it.

What are the NDP-Liberals breaking today? It is the systematic dismantling of Canadians' access to their prescription drugs and treatments that are vital to their health. Just like 20 years ago, when that former Liberal prime minister brought disaster after disaster to primary health care, breaking it for a generation, if we follow our current NDP-Liberal Prime Minister down this path, our prescription drug system will forever be broken for generations to come. Rather than calling this a “fix for a generation”, I would say the fix is in.

It is against this backdrop of our broken primary health care system that Canadians need to take a good, hard look at this legislation. Bill C-64, the so-called pharmacare bill in front of us today, is not what the NDP or the Liberals are advertising. It is neither the implementation of universal prescription drug coverage, nor will it improve the options for the two items it promises to cover: contraception and diabetes medications. Instead, it goes out of its way to destroy Canadians' already pre-existing insurance coverage, provincial drug plans and freedom of choice in medication when pursuing treatments.

First, let us talk about federal-provincial relations. It is interventionist NDP-Liberal governments that use their control over the purse strings to force provinces into impossible decisions on patient care. Every time a premier tries to improve health care in their jurisdiction, the Liberal Prime Minister of the day will threaten to cut off health care funding to the province. Let us say a province wants to establish a few clinics offering MRIs outside of a hospital. To the Liberals, this is a mortal sin, and it cannot be allowed.

Earlier this year, the federal Liberal Minister of Health fined my home province of Saskatchewan $1 million for allowing MRI clinics to operate in 2021. This was an innovative idea that increased the number of MRIs performed at a lower cost. It was brilliant, but not so fast. The NDP-Liberal government saw that as a mortal threat and fined the province. As these clinics are still functioning because they are common sense, we can expect the fines to continue. How ridiculous is that? The answer is as simple as it is sad. They actually do not want the system to get better. They do not want better outcomes for people. The NDP and the Liberals learned long ago that as long as the health care system is broken, they can campaign in elections as the great protectors and saviours of the system. Canadians are not going to fall for that again. Remember, this whole thing depends on the federal government convincing the provinces to go along with this scheme, something we already know the Liberals are not good at doing.

Is this bill not doing something good? There is a second important thing to understand. This so-called pharmacare legislation will not bring universal prescription drug coverage to Canadians. Subsection 8(2) of the legislation, Bill C-64, under the heading “Discussions” says:

The Minister must...initiate discussions...with the aim of continuing to work toward the implementation of national universal pharmacare.

Let us break that down. What does the legislation require the minister to do? He must initiate discussions. That is fair enough. What do those discussions do? They have the aim of continuing to work towards a goal. Is that the big reveal? The minister is required to talk to some people to work towards an ideal. That sounds like every scam artist running a Ponzi scheme. Schmooze as many people as possible, and sell them on an idea that is nothing more than smoke and mirrors. This legislation is literally that: smoke and mirrors, conning Canadians into thinking there is a pot of prescription drug gold at the end of the rainbow.

It is not prescription drug gold at the end of this legislation. In fact, every single Canadian would be just that much poorer if and when this gets implemented because it is a direct attack on Canadians' private health insurance and drug coverage. Did members know that, according to The Globe and Mail, there are 102 government drug programs operating today, along with 113,000 private insurance programs? Statistics Canada reports that 79% of Canadians currently have health insurance that includes drug coverage.

The completely independent Parliamentary Budget Officer analyzed how much it would cost Canadian taxpayers if universal pharmacare were implemented. Their analysis is that pharmacare would cost about $40 billion every year. More importantly, that would be about $13 billion more than is being spent today. Let us keep in mind that pharmacare would replace existing public and private drug plans. Generally, private health care plans have better coverage than public ones. That would leave most people worse off. Therefore, overnight, four out of five Canadians would lose the prescription drug coverage they have through their employer, union, school, spouse, parent or provincial government plan.

The federal government is paying for it, which means we are paying for it through increased taxes. Either way we look at this, it would result in a multi-billion dollar spending increase paid for by us. Those who would really benefit from this are private companies who provide insurance to their employees because today the companies are paying for private drug insurance. Once this program kicks in, they could cancel those programs because the government would be paying for it. That would save those companies significant dollars. Essentially, it would be a transfer of dollars from the federal government directly to those companies, which is paid for by us.

Of course, the NDP-Liberals always love increasing taxes on unsuspecting Canadians. The other thing they love doing is limiting our choices to fit their narrow world view. There are two classes of drugs that the NDP-Liberals choose to cover in this so-called pharmacare bill: contraception and diabetes medications.

Let us talk about diabetes. Most people know that insulin is a shot given to diabetics to control their blood sugar levels, as needed. However, do people know that metformin is a prescription diabetes pill that is taken once or twice daily to help the body control its blood sugar properly, reducing the need for insulin? Do people know that metformin is prescribed commonly as a treatment for people before they have diabetes? With a daily treatment of metformin, that person may never develop diabetes, and that daily metformin is a dirt-cheap alternative to very expensive insulin. It keeps pre-diabetics from developing the disease, and it costs pennies, compared to insulin. Metformin is not covered.

What about Ozempic? We have all heard of Ozempic as the wonder weight-loss drug, but that is simply a side effect of being a diabetes drug that acts on the pancreas to control blood sugar. We also know that the best way to avoid type 2 diabetes is to be a healthy weight and to not be obese. Ozempic does that, but Ozempic is among the most expensive drugs on the market at about $75 a dose. Ozempic and metformin are used to prevent the disease of diabetes. Does that mean the NDP-Liberals are purposely going to deny treatment to those folks to prevent them from developing diabetes and are going to wait until they get the full-blown disease? How is that fair? Should that not be a decision for the patient and the doctor, and not for some bureaucrat in Ottawa?

Innovative Medicines did a comparison of the access of drugs covered by private insurance versus those in public plans. The results are as shocking as they are sad. In Canada, private insurance covers twice as many drugs as provincial plans do. The bottom line is that this bill, Bill C-64, proposes to take away people's private drug plan. That is what single-payer means. The result is that private companies and anyone else currently providing drug coverage in a benefit plan would cancel those plans and would force Canadians onto the government plan. Canadians would be stuck with a slimmed-down plan and would be forced to pay out-of-pocket for the rest.

After nine years, it is clear that this NDP-Liberal government simply is not worth the cost to Canadians' health. It has broken our primary health care system, and now with this so-called pharmacare legislation, it is setting out to break prescription drug coverage for 80% of Canadians who already have private insurance.

Conservatives will not stand idly by while the NDP-Liberals systematically break our country. If we form government, we would undertake the task to fix the immense damage this costly coalition has done. We would axe the tax. We would build the homes. We would fix the budget, and we would stop the crime. Let us bring it home.

[Kelly McCauley, Conservative, Edmonton West, AB]

Madam Speaker, I will be sharing my time with my colleague from Saskatoon West, or as we fondly know him, the member from Saskatoon West Edmonton Mall.

I rise on Bill C-64, which is officially called an act respecting pharmacare. I have two other names for it. One is the proper Liberal name of the bill, which is “fake news to satisfy the gullible NDP caucus act,” and then the longer title is the NDP “I hope no one notices we said we would force an election unless we got a comprehensive and entirely public pharmacare program but sold out for little act.” I am being a bit sarcastic here, but this is the truth.

The government has repeatedly stood in the House and said it is extensive pharmacare, but it is not. It is two items. The NDP members have constantly stood up with their colleagues across the way in the senior partnership, or the radical wing of the NDP, and said it is comprehensive pharmacare that is single pay. Despite what they would have one believe, it would just cover two items.

It does potentially cover diabetes drugs and birth control, but we do not know the details. What it would not do is cover the chronic diseases Canadians are suffering from most. The top ones are hypertension, osteoarthritis, mood and anxiety disorders, osteoporosis, asthma, obstructive pulmonary disease, ischemic heart disease, cancer, dementia and, rounding out the top list, diabetes. Only one item would be covered out of the major chronic issues that are diseases or afflictions hurting Canadians. Where is the coverage for those? It is nowhere to be found, which is why the government and other people in the House should not be calling it a pharmacare act.

The Liberals can name it a potential pharmacare act down the road, but they should not be misleading Canadians into believing that this is a pharmacare act. I asked where the coverage was for hypertension. Eight million Canadians suffer from this. Four million Canadians have osteoarthritis, two million have osteoporosis, and four million are suffering from asthma. How many of them would be covered by this so-called pharmacare act? The answer is zero. Two million Canadians are suffering from obstructive pulmonary disease. Not one would be covered. On ischemic heart disease, 2.4 million Canadians are suffering from this. Not one would be covered under this plan. Forty per cent of Canadians will be diagnosed with cancer in their lifetime, with 250,000 new cases every year. Not one would be covered under this so-called pharmacare act. For dementia, 750,000 people are affected, and not one would be covered. Where is the coverage?

I want to get back to my admittedly snarky comments about the NDP. I want to quote the National Post, which reads, “NDP members drew a line in the sand by passing an emergency resolution at their policy convention in Hamilton...that says the party should withdraw its support if the Liberals do not commit to ‘a universal, comprehensive and entirely public pharmacare program.’”

If one looks up the word “comprehensive”, the definition is, “complete, including all or nearly all aspects of something”. Is this all or nearly all aspects of pharmaceuticals? No, of course it is not. Anne McGrath, the New Democratic Party's national director, “said getting a bill that has teeth will be her party's biggest priority as parliamentarians return to the House of Commons”.

Canada has about 9,000 approved pharmaceutical drugs. The bill would cover maybe 200, so where are the other 8,800? Anne McGrath further stated, “Weak legislation is not going to be acceptable to New Democrats”. Maybe 200 for diabetes and birth control out of 9,000 seems to be acceptable.

She said, “It has to be strong. It has to have teeth. And I feel like that resolution gave [the NDP leader] and the caucus a lot of bargaining power. It gives them a lot of strength.” I wonder when my colleagues in the NDP are going to be withdrawing their support. They probably will not.

One issue I brought up in an earlier question is that a large majority of Canadians are covered, but some are slipping through the cracks. Some are not covered, and some are only partially covered, but they are covered by the province. Alberta, for example, covers most of the items brought up. Essentially, B.C., Quebec and Ontario do as well. Pretty much every province, except one or two in Atlantic Canada, covers diabetes or birth control for low-income Canadians. However, they are not covering the other items of importance, such as hypertension and some of the others.

The initial phase of this is going to cost about a billion and a half dollars. That money could be better used, by either giving it to the provinces for rounding out the services or, better yet, focusing on Canadians afflicted with rare diseases. A couple of families came to my office. Their young children were suffering from SMA, spinal muscular atrophy. It is a horrible disease. Generally, it is a death sentence by the time the child is two years of age. At about the time the children of these two families in Edmonton were diagnosed, a new drug had come out; it is called Spinraza. I have to give points to the pharmaceutical companies for how they come up with these names. Spinraza does not cure the disease, but it extends life to about 18 years old. Children would not have a great quality of life, but they could live to their late teens.

When Spinraza came on the market, Rachel Notley's NDP was in power in Alberta. We went to the local MLAs in the NDP to see if we could speed up coverage for the drug in Alberta; however, the NDP refused to look at this. The same NDP that says it is a line in the sand that it will force an election over refused to help this family. When the provincial United Conservatives were elected, Tyler Shandro was the health minister. He was much maligned, and I am sure a lot of it was probably deserved. However, he managed to get Spinraza approved for the family within two weeks. It is a very expensive drug.

Along came a better drug called Zolgensma. I truly believe it is a miracle drug. With Spinraza, children would spend about a month a year in intensive care, getting spinal taps and everything, for their treatment. Instead of that, Zolgensma is one shot in the arm. It seeks out the bad gene and copy-pastes the good gene over, basically stopping the disease in its track and giving the children a chance at a strong life. It would be about $45 million a year to treat everyone afflicted with this, everyone born every year in Canada. This is where the government should spend this money. It should focus on that.

It should not be spending money to replace programs that already exist. About 60% of Canadians have a program delivered through work. Instead of subsidizing that 60%, it should look after people like this in need. These two families had to fundraise for this drug. Ryan Reynolds, who was in Deadpool, helped fundraise for these two families. Luckily enough, a corporate benefactor came through and provided for everyone in Canada. This is an example where that billion and a half dollars could be better spent.

Another couple in my riding had a child suffering from PKU, which is a rare inherited disorder. It causes a buildup in amino acid in the body and prevents it from metabolizing protein. Children cannot have protein. It costs $5,000 a month out-of-pocket. The government should look after covering this.

Twenty-seven million Canadians already have coverage through work. This Liberal single-payer plan is going to subsidize either the companies that are already paying for this or big pharma. It is funny that big pharma just got an extra tax for too much profit through the Liberal government, a temporary Canada recovery dividend to attack big pharma, which it is now going to subsidize. It could also subsidize companies directly, including Loblaws. At the same time as it is demonizing Loblaws in the House, it will end up subsidizing it. Therefore, I do not support the act as it is. There are better ways to do it than the way the Liberals and NDP are doing it.

[Mark Gerretsen, Liberal, Kingston and the Islands, ON]

Mr. Speaker, it is an honour to rise to speak to such an important piece of legislation, our national pharmacare bill, Bill C-64, which was introduced by the member for Ajax, the minister responsible for health care. In my opinion, this particular legislation is a long time coming. When health care, what Canadians have become accustomed to in Canada, was first introduced many decades ago, I think that there was always an expectation that Canada would follow suit with a pharmacare piece of legislation.

Indeed, it is my understanding that Canada is the only country in the world that has a health care plan that does not also have a pharmacare plan. I think that it is incredibly important that this piece of legislation is here. I have been listening to the debate over the last number of weeks regarding this particular bill, and I have found it quite interesting what I have heard in the House about it.

For starters, I want to say that it is a piece of legislation that I see as a starting point. It is a point at which we can start to implement a national pharmacare plan, in particular to help some of the most vulnerable Canadians get access to medications they need. I will address that point in more detail in a moment. More importantly, this is a starting point in the sense that we will start by having two major medications that Canadians use, medications for diabetes and contraceptives for individuals who require them.

I say that because I know that almost four million people in Canada are currently using medications for diabetes. This piece of legislation, even though it is only a starting point covering two specific medications, would certainly have an impact on so many people in our country. With the portion that is just for diabetes, that is nearly four million people on its own.

Bill C-64 would establish a framework, and that is the important thing. It is a framework toward a national universal pharmacare plan in Canada for certain prescription drugs and related products, including free coverage of contraception and diabetes medication, as I have already mentioned. The bill would also provide that the Canadian drug agency work toward the development of a national formula to develop a national bulk purchasing strategy and support the publication of a pan-Canadian strategy regarding the appropriate use of prescription medications.

I think that the part regarding the bulk purchasing strategy is so incredibly important because this is where Canadians would see the benefit of having a national pharmacare plan. The idea that we can, as a whole country, purchase medications in bulk would give us that purchasing power that I think is needed to be able to make the purchases at a fair price, a price point that we as Canadians will ultimately be paying for through our taxes.

Finally, the last part of the bill is that, within 30 days of receiving royal assent, the minister would need to establish a committee of experts to make recommendations regarding the operation and financing of national universal single-payer pharmacare. The committee would be required to provide its report of recommendations to the minister no later than one year after the bill receives royal assent.

As I indicated earlier, when one talks about a program that is this big and this complex, it is important to have that proper oversight and to have a committee of experts making recommendations to the government on how to proceed. When we talk about the number of people who would be impacted by this, I find the conversation in the House to be really interesting, and this is something I alluded to a few moments ago, because it would be a benefit that everybody would be covered under the program. The reason why I say that is that I think it is very easy to make comments, such as I have heard from Conservatives in particular, that so many people are already covered. There are already people who are covered under their private plans. I think about 80% of people are covered in one way or another.

However, not everybody is covered in the exact same way. For starters, at least 20% of people are not covered under any plan, and these would be the most vulnerable because these are people who would have to go to the drug store to pay for their medication out of pocket. On the other end of the spectrum, there are a lot of people who are fully covered, and there are some really good plans out there. There are some really good employers. There are some really good institutions that provide plans to their employees and family members that are going to cover a lot, up to, in many cases, 100% of the cost of medication. Then, there is everything in between concerning what the coverage is and how much coverage there is. This is why it is so important that we talk about universal coverage. Sure, 80% of people might have some degree of coverage, but not everybody is covered the exact same way. I think it is extremely important that everybody has the same basic universal coverage.

When we look at the way we are treated when we go into hospitals, everybody is treated the exact same way. At least, it is supposed to be this way, and it could be argued that provinces are setting up things differently. If we go into a hospital emergency room, we will see triage. The hospital will determine the critical nature of a person's visit, how quickly a person needs to be dealt with, and everybody is treated the exact same way. Most importantly, when we are done and when we leave the hospital, we just go home. There is no one asking for a credit card or a billing address. We have the luxury of having a health care system that covers everybody, which does not ask people to pay when they are in, quite frankly, what would be their most vulnerable state.

I think one of the problems with my generation, and generations after mine and a few before, would be that the idea of having to pay for medical care seems almost foreign. It certainly does to me. I never think to myself, “Wow, I should go get this checked out, but what's it going to cost me to do that?” That is never something that enters my mind.

Members can just imagine that, if I were living in the United States, for example, there would be a lot of people who actually have to make that choice. They say, “Well, I should get checked out, but what is it going to cost me to do that?” This is one of those luxuries that we have with a single universal health care system such that we have here in Canada. It is not something that enters our mind because I think we believe, as a society, that there is a certain onus to take care of each other when it comes to our health care, which is what our health care system provides, notwithstanding the fact that we could get particular about what different provinces are attempting to do now. However, that is the reality of the situation.

When we talk about pharmacare and the drugs that we also need to be healthy, we have to ask ourselves why they are not treated the exact same way. What I see with the bill before us is an attempt to move in that direction.

There are two very important, or at least very popular, medications that a lot of Canadians use to start with. This comes from the same premise that, when somebody needs to take care of diabetes, for example, or somebody wants access to contraceptive medication, they should not have to filter into the equation of the decision whether they would have to pay for it, for starters, as 20% of the population would, or how much of it they would have to pay for. They should not have to ask, “Do I have to pay for a portion of it? Does my coverage only cover 60%, and so I have to pay 40%? Does that make it worthwhile to do this?” Canadians should not have to think that perhaps they could go against their doctor's advice and not get the medication because they think they will be fine.

These questions should not be asked by Canadians. There are a lot of seniors out there who rely on a lot of medications who should not have to say, “I have to make a decision between getting the medication I need or buying food.” They should not be making those choices, and they should not be saying that maybe they will only take half the dosage they have been prescribed because at least then they are still taking something but are not spending as much.

When we talk about health care and pharmacare, it is my position that it should be treated in the same way that we talk about health care and accessing care in terms of going to see a physician or going to the hospital. That is why I think the pharmacare bill is so important, because, as I said, it certainly does not cover every drug. It actually covers only two very important and widely used drugs, but it sets the framework for how things can evolve from here.

One of the things I find really interesting, when we are having this discussion about universality and the fact that it is just two pieces of very important medication, is what I have been hearing from Conservatives to this point. They are getting upset over the fact that it would not cover a lot and a lot of people would not be covered. They are basically saying that more should be invested. I have heard the member from Battle River—Crowfoot talking about how we are not doing enough. Nonetheless, they will still vote against the bill.

I cannot help but wonder why they are saying we need to do more, but then are against the idea fundamentally. I do not know whether Conservatives are doing what we have seen them do a number of times before, which is to start by talking about a piece of legislation and trying to critique it all day long, only to then vote in favour of it when the time comes, or whether they have a plan for universal pharmacare that is even more ambitious than this one. I find myself somewhere in between, trying to figure out what they are really trying to get at with this.

At the end of the day, we know that this is something that would help Canadians. We know, and I strongly believe, that the concept of having a universal pharmacare system, in the long run to cover many more drugs, is certainly my goal. That would be to the great benefit of all Canadians.

The legislation is a huge step forward in delivering better health care to Canadians. As I said, it lays out the plan for universal single-payer coverage for contraception and for diabetes medication. This would mean nine million women and gender-diverse Canadians all across the country could get access to the contraception and reproductive autonomy that they deserve.

Notwithstanding the fact that lately we have heard some Conservatives start to talk and to reopen discussions about reproductive autonomy from decades ago, the reality is that we believe that when somebody makes choices about what to do with their body, in particular when it comes to reproductive aspects, they should be able to make those choices. A woman should be able to make those choices. In my opinion, the government should be there to support them in making whatever choice they think is the best for them as an individual.

Although the piece of legislation before us, as I previously said, would not cover every medication, or a lot more medication as I would ultimately like to see, it certainly would be a starting point, a place to begin. It would be a place to lay the groundwork. It would be a place to engage the experts to provide feedback as to how we could move forward. It would allow us to start somewhere significant, given the number of Canadians it would affect, and then from there, to grow.

I am really looking forward to the day when we can say that our pharmacare and the medications that Canadians depend on so much will be treated in the exact same manner that we see in the rest of our health care system, in particular when we go to visit a doctor or we have to go to an emergency room, as I described earlier.

I really hope Conservatives vote in favour of this at the end of the day, despite some of what I have been hearing. This is a great opportunity to show the country that the bill is not something we will make political and that it is something that truly would benefit many Canadians. It would help the 20% or so of people who might not have some degree of coverage. It would equalize the very well-off people with some of the most vulnerable in our communities by saying it does not matter what one's socio-economic status is and it does not matter what one's income level is. We respect the fact that all Canadians should have access to the medications they need so badly, and that their doctors, through our health care system, could provide it to them.

The House resumed consideration of the motion that Bill C-64, An Act respecting pharmacare, be read the third time and passed.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

Mr. Speaker, I want to acknowledge that today is the fifth anniversary of the National Inquiry of Missing and Murdered Indigenous Women and Girls, Two-Spirit and Gender-Diverse People. We need to acknowledge today that the government is failing to address the genocide against indigenous people, and that is failing both indigenous people and all Canadians. I certainly hope that the government prioritizes those calls for justice, knowing that to date we have only achieved two of the 231 calls for justice.

Today we are here to speak about Bill C-64. Today is, as my leader, the member for Burnaby South mentioned, historic. It is not just historic because of pharmacare. I do want give a shout-out to the Edmonton Oilers, who are now going to the Stanley Cup finals as of yesterday. It was a very big day.

I also want to start by saying how grateful I am to our leader. Our leader, the member for Burnaby South, has been a strong advocate for pharmacare for years. Instead of just being an advocate, he rolled up his sleeves, got to work, worked with the Liberals and he forced the Liberals, against all their historic votes, to put this framework in place.

I am so grateful to be a New Democrat today. I am so grateful to work with such a strong leader. I am also extraordinarily grateful to all the advocates who have done so much for decades to move this forward.

I want to start by talking a little about one of my constituents, Pat. He came into my office, and he had a challenge. We are really proud of health care in Canada. Canadians should be proud of our public health care system. However, when Pat came into my office and talked to my team and I, he told us that he had been able to see a doctor and he had been referred to a specialist. The specialist was able to give him treatment. The problem was that the medication for his treatment cost $400, and he did not have that $400. While our health care system is a point of pride, thanks to the health care system that Tommy Douglas developed, Pat was able to get part way there, but he was unable to get the treatment that would actually help him. It was never supposed to be this way.

When Tommy Douglas envisioned our health care system, pharmacare was always supposed to be part of that system. We know that Canada is the only country that has a medicare program that does not include pharmacare. It does not make any sense that we will treat Canadians to a certain point, but that we will not get them over the finish line without access to medication.

Today is an opportunity to make pharmacare a reality for millions of Canadians and to lay the groundwork to create a fully universal pharmacare system for all Canadians. It is truly historic.

Pat is not alone. A few months ago, I sat and listened to Albertans share their challenges and experiences at a pharmacare round table in Edmonton. One after another, Edmontonians stood up and they talked about how the lack of prescription coverage had affected their lives, how they had to juggle their bills and how they had to worry about groceries, utilities and rent, on top of their prescriptions. They had to make choices about which of those things they can afford.

As members of Parliament, sitting in this place, every one of us has a health care plan that covers our medication. However, for so many Canadians who do not have that access, this is game-changing. This is the difference between paying their rent and taking care of their health at the same time.

It was not just lower-income Canadians who were speaking out for pharmacare. Business leaders and health care professionals were all speaking about how important pharmacare was for them and why they wanted the government to move fast on this.

I spoke to a paramedic who shared his experience providing emergency care and transportation to hospital for people who could not afford their prescriptions, people who would be doing well if they had taken their medications appropriately, if they had not thought about cutting their pills in half, if they had not thought about taking a pill every second day. Those decisions that people are making are impacting their health, which in the long run have large costs on our health care system as well.

Doctors are so frustrated that their patients are not getting better because they cannot afford the treatment. Small business owners, despite paying more than minimum wage, can not possibly pay their employees enough in order to afford their medications.

A couple months ago, I sent out a mailer on pharmacare, as we all do in this place. I wanted to know what people in Edmonton thought about pharmacare. The response from constituents in Edmonton Strathcona was overwhelming. Ninety three per cent of people indicated that they were in favour of a universal pharmacare program and only 5% indicated that they were unsure or opposed. This mirrors national polls that put support for implementing a national pharmacare program to provide equal access to prescription drugs for everyone in Canada at 87%.

Last year, an Alberta-wide poll found that 74% of Albertans supported universal pharmacare. As the president of the polling company noted, the overwhelming support in Alberta for a federal program like this was surprising. He said, “Getting three-quarters of a population to agree with any piece of public policy these days, it is a bit astounding. It's very popular in Alberta.” He added that approval of the idea largely crossed all demographics and all regions of the province. Canadians understand and they know that we must care for one another. We must take care of each other, and universal pharmacare is a promise to take care of each other.

This legislation is not the end point; it is just the beginning but a very important beginning. We need the bill to create the mechanism for a full-fledged universal pharmacare system that covers all Canadians. No matter how young or how old, no matter where they live and no matter how they make their living, all Canadians have the right to prescription drug coverage, and this legislation is critical in getting it for them. The legislation is always going to be critical, but, right now, with coverage for contraceptives and diabetes medication, these two classes of drugs would impact millions of Canadians.

For example, nearly four million Canadians are affected with diabetes, a disease that impacts every aspect of their lives. In my province of Alberta, individuals with diabetes have had to fight the provincial government repeatedly to ensure they get the care they need and deserve. The bill would means that people living with diabetes may finally be able to put those battles aside and finally have hope for their future. By treating diabetes with devices and supplies on the same terms as the prescription medication, this legislation would save diabetics hundreds, if not thousands, of dollars each year.

With regard to contraceptives, we know the impact of contraception on women across the country and how vitally important this is. Manpreet Gill, the president of the Edmonton Zone Medical Staff Association and associate professor in the division of General Clinical Medicine at the University of Alberta, has written about the importance of contraceptive coverage to health and especially health care in Alberta. Dr. Gill states:

The cost of hormonal therapy (including for birth control) and intrauterine devices (IUDs) is a barrier for Albertan women to receive medically necessary care....

It also perpetuates unfairness in the system, resulting in unplanned and unwanted pregnancies. Universally available contraception would reduce the number of abortions, reduce economic stress on young and poor women and improve child and maternal health. It is estimated that 40 per cent of pregnancies in Canada are unplanned and it seems obvious that those who cannot afford contraception cannot afford to have a child.

The current patchwork system in Alberta is blatantly unfair. First, it is obvious that birth-control costs are primarily borne by women while men bear no such equivalent costs....

Secondly, while it is true that private plans cover birth control, it is worth considering two facts that this reveals. One, birth control reduces the costs to a private health plan, that’s why it is offered, and two, those that most [have that] need [are unable to] access...it.

As a woman, as a mother and as a mother of a daughter, I want my daughter, and every daughter in our country, every daughter in this world, to have access to the entire range of reproductive health care, including contraceptives. A system that provides access to some, those who can afford care, while denying access to others is not a system that I can support. Reproductive health care is health care, period.

Finally, I want to thank all the advocates across Canada who have worked so hard and so long to create this legislation. I want to thank Chris and the powerful advocates at Friends of Medicare in Alberta, who have worked not months, not years, but decades for this universal pharmacare. I want to thank the Canadian Labour Congress, the Alberta Federation of Labour and all the labour leaders, organizers and members across Canada who have put the needs of all Canadians, regardless of union membership, at the forefront of their campaigns for pharmacare.

We are here today because of the hard work of so many Canadians and so many leaders in our country. I continue to be delighted and honoured to work with all those leaders to ensure we get this over the finish line.

[Peter Julian, NDP, New Westminster—Burnaby, BC]

Mr. Speaker, the Bloc Québécois appears not to be answering the question. A vast coalition of two million Quebeckers told the Bloc Québécois to vote in favour of Bill C-64. Its members are critical of Quebec's existing plan.

I am quoting them because it is important. I am referring to the Union des consommateurs, the Fédération interprofessionalle de la santé du Québec, the Centrale des syndicats démocratiques, the Confédération des syndicats nationaux and the Fédération des travailleurs et travailleuses du Québec, which, on behalf of two million Quebeckers, are calling on Bloc Québécois members, who are members for Quebec after all, to listen to them and take action by passing Bill C‑64, which the NDP introduced in Parliament.

Let us be clear. I am quoting a coalition that the Bloc Québécois seems unwilling to listen to.

We are asking the federal government not to give in to the provinces and territories that are asking for an unconditional right to opt out with full financial compensation.

This coalition is saying that we need to pass Bill C‑64 and we need these negotiations.

Why does the Bloc Québécois insist on blocking this bill and refuse to listen to Quebeckers who want it to pass?

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Speaker, as my colleague has clearly demonstrated, Bill C‑64 is much more the expression of an election agreement than of a bill. Why? That would be because a bill of this scope would have required prior coordination, at least with the nation that put a system in place 30 years ago.

Here in the House, the Quebec nation has been symbolically recognized on two occasions, but the moment that that has a legislative impact, it is out of the question. The National Assembly unanimously agreed that it wanted the right to opt out with full compensation to improve its plan. What is so hard to understand about that? My colleague clearly demonstrated that.

The worst part is that, in addition to the first phase of the bill, the government intends to implement something with no accountability. Has anyone ever seen a Canadian prime minister lose their seat in an election because of health care? It has never happened. Why? Because health care has never been their jurisdiction. In Quebec, however, governments have fallen over health care.

The government wants to meddle in the affairs of others, and with no political accountability, to boot. What does my colleague think about that?

[Peter Julian, NDP, New Westminster—Burnaby, BC]

Mr. Speaker, I am quite fond of the member, but she just said that we need to listen to Quebeckers.

However, as the Bloc Québécois members should know, the largest coalition in Quebec's history, namely two million people under the umbrella of all the central labour unions, the Centrale des syndicats du Québec, the Centrale des syndicats démocratiques, the Confédération des syndicats nationaux, the Fédération des travailleurs et travailleuses du Québec, the Union des consommateurs and all the allied groups around the Fédération de la santé et des services sociaux, is calling for us to pass this bill, Bill C‑64.

The coalition members have been very critical of the current program in Quebec, including the fact that there are user fees for the drugs and many people are not covered. There are a lot of problems with the current situation. This broad coalition that the Bloc Québécois seems to refuse to listen to, says the following:

We are asking the federal government not to give in to the provinces and territories, which are asking for an unconditional right to opt out with full financial compensation.

The coalition members want to have the NDP's public, universal pharmacare program.

I have a very simple question. Why is the Bloc Québécois refusing to listen to Quebeckers?

[Marilène Gill, Bloc, Manicouagan, QC]

Mr. Speaker, I have risen three times today because I was so eager to speak.

I am pleased to speak today at third reading of Bill C-64. We have been debating this bill for a long time. Clause-by-clause study took place last week, but we do need to wind up the debate at some point.

Before continuing with my speech, I would ask my colleagues to respect my right to speak and not talk over me.

First, to make things clear, if they are not already, the Bloc Québécois's position has not changed one iota: We are against Bill C-64.

I would like to remind my colleagues of the purpose of the bill. Obviously, a bill can have several different purposes, depending on which side we are on. Sometimes it may seem like a bill has a noble goal, but that may not be the case.

I would like to talk about something that is totally obvious to me but that people tend to forget when we get into these debates. Bill C‑64 addresses one of the 27 items in the agreement that the Liberals reached with the NDP in 2022 to stay in power by forming a sort of coalition with the NDP. This may have been in the NDP's best interests, although maybe it will want to argue that point.

I would like to remind the House of the wording of the second item in this agreement: “Continuing progress towards a universal national pharmacare program by passing a Canada Pharmacare Act by the end of 2023”.

They want to “continu[e] progress”. We often hear similar phrases in the House, phrases like continuing to move forward, continuing progress or continuing to do something. That is all very vague, in my opinion. I would imagine that pretty much anything we do is progress, even the bill we are currently discussing. Perhaps that covers the disagreement there was between the Liberals and the NDP on this issue.

As members know, the Liberals dragged their feet on introducing this bill. This bill was in the works for years. They were talking about it in 2022. It was introduced on February 29. They could not agree on the cost of the measure. Of course we would like to see a pharmacare act, but perhaps not at all costs, if my colleagues will pardon the pun.

This bill was introduced on February 29, at the very last minute, to save the agreement and to save the Liberals. I might add that it was also to save the NDP. I must say that I did not hold my breath at the time.

A moment ago, I talked about the purpose of the bill. I think that this bill was introduced purely for the purpose of garnering votes. It could have been introduced sooner, but there was an agreement. The NDP would not want to bring the government down. That is why I was not surprised when the bill was introduced this year, one year away from the election, just before the budget.

I also get the feeling that it may have been because the government is short on ideas. I have spoken many times about the government's lack of vision. It has been eight, almost nine, years since the government came to power. It will have been 10 years by the time the election comes around.

I have noticed that the House is copying the debates taking place south of the border. Take the debates over contraceptives and diabetes medication. It is not that I am not happy to see my colleagues across the aisle and next to me tackling the official opposition, to use a soccer term, here in the House over a woman's right to do what she wants with her own body. I was not unhappy about that. However, it is being done for the purpose of gaining votes. There is one party in the House that wants to limit women's rights. This may resonate with some people, even me, but it should not be done for that purpose alone.

In fact, maybe it was entirely arbitrary. The government did not know what to do, what to propose. It desperately wanted pharmacare, but it had no idea what it really wanted to do, so it thought about what could help it win votes. It figured that it could take certain debates from the U.S. bipartisan system and copy them here to pit the good guys against the bad guys.

In short, I am not saying that these billions of dollars that will be spent by the government are a form of pre-election advertising, but that is what it looks like. Again, Quebeckers and Canadians need to be aware of the partisan agenda hidden behind this bill. There is a hidden objective.

I think it takes a certain kind of courage to oppose a bill that seems virtuous. That is what we are being told: If we do not vote in favour of the bill, it is because we are against it. I, of course, am 100% in favour of a woman's right to choose and all methods of contraception. I am a member of the Bloc Québécois. I speak on behalf of Quebec. I am not against the provinces' positions. I do not mind if they decide that the federal government can interfere in their jurisdictions. That is their choice, and I respect it. At the same time, that is not what I want for Quebec. That is why the Bloc Québécois proposed the following amendment in committee:

Despite subsections (1) and (2), a province or territory may elect not to participate in national universal pharmacare, in which case that province or territory remains unconditionally entitled to receive payments in order to maintain the accessibility and affordability of the prescription drugs and related products already covered by its public pharmacare.

Our amendment concerns the ability to opt out with full compensation from the pharmacare program. It was not debated because we could not debate it in committee during clause-by-clause study of the bill. It was not rejected either. I would say that what happened is even worse: It was ruled inadmissible. I wish I could avoid talking about the reasons the committee chair ruled the amendment inadmissible, but I think it is important to go over them because this is just another clear demonstration of bad faith, in my opinion, and the federal government's disregard for the jurisdictions of the provinces and Quebec.

It was argued that the amendment required a royal recommendation, which is false. What we were told is that it will generate additional costs and that, since we are an opposition party, it requires a royal recommendation. I hate to say it, but that is absolutely false. The amendment did not require a royal recommendation, because the funds had already been committed by the government. The Bloc Québécois's amendment was therefore legitimate and admissible.

This is not the only time that government members have made arguments that do not hold water and that are merely a pretext to interfere in Quebec's jurisdiction. The government did the same thing in the case of Bill C-35, which deals with the child care program. As far as I am concerned, this is not only a sign of disrespect toward Quebec, it is basically an insult, because over the decades, Quebec has built a social safety net that is the envy of North America. We have pharmacare, as well as dental coverage for young people. We have free education and early childhood centres. We have made some huge social advances.

In this case, the federal government is digging in its heels and refusing to allow Quebec to opt out unconditionally with full compensation. As I see it, Ottawa is refusing to recognize Quebec's decades of leadership in this area. The same thing happened with child care centres and Bill C‑35. What is more, the federal government is doing all this without having jurisdiction over this area or having any expertise in care and social services. Quebec is being denied something we have every right to request by a government that lacks both expertise and jurisdiction. The government has no compunction about turning us down, but at the same time, it has to follow our example with a view to “continuing progress”, as they put it so eloquently. I have no problem with the federal government continuing progress, but I do not want this progress to come at Quebec's expense.

As I said before, Quebec already has a public pharmacare plan for part of the population that the government introduced nearly 30 years ago. I need to repeat this because I think some people have trouble hearing it. This is not the case with everyone, but in the House, it is true of nearly the majority. As far as Canada is concerned, it is trying to catch up. It is behind by 30 years, so now it is encroaching on our jurisdiction. It may be more. We also have a private plan offered by employers, to which workers contribute as well. No one in Quebec lacks pharmacare coverage. People need to stop spreading falsehoods.

The choice was made by Quebeckers. It was not Ottawa that made this choice, it was Quebec. Our plan is also paid for by Quebeckers. The federal government did not give a red cent for this plan. We know what is right for us. We do not need someone else to tell us. We are capable of taking care of ourselves. We do not need paternalistic Ottawa trying to manage a pharmacare plan in Quebec without expertise, without legitimacy and without experience.

I keep thinking that what the Bloc Québécois is asking from the federal government is simple and it makes sense. We are asking the federal government to take care of its own responsibilities, such as foreign affairs, defence and fisheries. It seems to me that the federal government has enough responsibilities. It has more than enough things to take care of.

Perhaps that is not sexy enough for the government. I should ask that question. Is that sexy enough for the government? Health and education are the two areas that affect people the most. Of course, health is a matter of major importance. We talk about the things we care about. If we are not alive, then nothing else matters, obviously. Health is important. These are the two budget items that are most important for Quebec.

The government knows that, for years now, its health transfers have been insufficient. They are shrinking down to nothing. It knows all that. If the government reduces the transfers, the burden will fall heavily on Quebec and the provinces. Who gets the blame when there is a shortage of care and services? Quebec and the provinces, obviously.

Jean Chrétien understood this well. He bragged to the G7 that all he had to do to balance the budget was reduce health transfers. He said that Canadians would look for someone to blame, but that they would not blame the federal government, because health is under Quebec's and the provinces' jurisdiction. They are the ones who would be cutting health care and education. For him, it was simple: Canadians would take it out on the provinces. The federal government would be able to achieve a balanced budget, and no one would hold anything against it. The provinces would pay the price, both literally and figuratively.

It always comes down to this, unfortunately, but as a separatist, I have no other choice. I am a separatist and I am pragmatic. It always comes down to the fiscal imbalance. The federal government collects more money than it needs to fulfill its responsibilities, while the provinces and Quebec are not collecting enough to manage their own jurisdictions. They are short of money, which gives the federal government an opening to spend money on things under Quebec's and the provinces' jursidiction.

It is unbelievable. It is like the federal government is stealing from the provinces and Quebec. It is strangling them. If they meet certain conditions, it will back off and let them breathe again.

We would not thank anyone who is strangling us for stopping. We understand that interference is always done with a purpose. I mentioned this earlier, but it is still the same thing with the government and its minions.

The federal government swoops in like a saviour, slapping its flag on cheques, which it tosses around like confetti, and the cavalry of government members run around, trumpets blaring, trying to solve the problems it created itself. In fact, the more I think about it, the more I like that image. It has definite educational value. However, although we may be laughing over it, it is a hard fact.

While the government is gaily running around, it has forgotten why it was elected. Perhaps it does not know. Perhaps it has forgotten. When a government has no vision, it may take a peek in the neighbour's yard, looking for direction.

Again, interfering in areas of provincial and Quebec jurisdiction has a purpose for them. In fact, the purpose is twofold in this case: one, to keep the government in power, and two, to prepare for the next election.

Until we gain independence, Quebeckers will have to fight to make sure this government respects us, respects our expertise and experience and gives us what is ours, meaning our money and, of course, control over our own jurisdictions. It will also have to respect the fact that we have our own pharmacare program.

Quebeckers are capable of discussing amongst ourselves, at home, and improving our pharmacare plan with our experts, based on our experience and our wishes. It is not up to the federal government to tell Quebeckers what to do. We refuse to let our own tax money be used against us and at our expense.

One way to respect us is to vote down Bill C‑64. I may be a member of the Bloc Québécois, but I am not the only one who says so. The Quebec National Assembly has said it too. Christian Dubé, Quebec's health minister, pointed it out the day before the bill was introduced. We do not want this bill. We do not want the federal government to encroach on areas of Quebec's jurisdiction. I would remind the House that the National Assembly alone speaks for all Quebeckers.

In closing, I would therefore like to let the voices of Quebeckers be heard through the unanimous demands of the National Assembly for compensation to be paid to Quebec. That is what the Bloc Québécois has asked for, because the Bloc Québécois speaks on behalf of Quebeckers. The motion unanimously adopted by the National Assembly on June 14, 2019, reads as follows:

THAT the National Assembly acknowledge the federal report recommending the establishment of a pan-Canadian pharmacare plan;

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;

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 was back in 2019, so the Quebec government made its position clear quite some time ago. Today, I am still trying to be a voice for the National Assembly. I hoped that the federal government would respect Quebec's decision to refuse to join the federal plan, for example, in the motion put forward at the committee studying Bill C‑64. We respect the provinces that want to take part in the program set out in the bill, since coverage is rather inconsistent across Canada, but in Quebec, everyone is covered by a pharmacare program.

It is up to us to decide what we want to do next. It is not up to the federal government.

The House resumed consideration of the motion that Bill C-64, An Act respecting pharmacare, be read the third time and passed.

[Damien Kurek, Conservative, Battle River—Crowfoot, AB]

Mr. Speaker, it is interesting how calling out the failures of the NDP not only offends New Democrats, but offends Liberal members of Parliament. It truly is telling of the level of absurdity that this place has descended into, when simply calling out the failures of this so-called confidence and supply agreement, this coalition, this poorly negotiated agreement that has propped up one of the most corrupt governments in Canadian history, that NDP and Liberal members would become so offended when we bring forward some things, including talking about the history of those parties. I will be happy to address some of the failures specific to the Liberal Party here in short order, for that member specifically, but it seems like that they do not want to hear those things because they are simply offended that somebody would dare question their pre-eminence.

I will get into the substance of Bill C-64 in just a moment, because the context of it is so important. The Liberals, backed up by the New Democrats, do not want an opposition in this place. That is why the Liberals bought off the NDP. That is why we see so often that the Bloc Québécois are quick to go with them. They want an audience, not an opposition. This is a sad state of affairs. This place has a long democratic tradition, where we should be able to discuss the affairs of the nation and have meaningful debates. Whenever somebody suggests very valid points of criticism, such as those I brought forward to the previous Liberal member, like our concerns about the impact that Bill C-64 would have on the coverage of many Canadians, the government's response has been to ask us to trust it. Many Canadians over the last nine years have clearly communicated their concerns to me and many of my colleagues. I know that many Liberals are hearing the same thing. As I have travelled across the country, in airports or in communities that, in some cases, are represented by Liberals, I have heard from individuals saying they have lost trust not only in the Liberals, but also in the way that the Liberals, propped up by the NDP, have conducted themselves over the last number of years. There is an erosion of trust in our institutions.

For the government to ask us to trust it is not good enough, when there a real risk that 97% of Canadians, who do have some form of drug coverage currently, may be at risk of losing some of those benefits. That is a real concern for so many Canadians. In this circumstance, the government has promised much and has truly delivered very little. Government members will stand up and bluster about how great this is and whatnot, but when it comes to what Canadians actually need, they are failing to deliver.

A clear proof point on that front comes from the government's work with provinces. The Prime Minister was quick to brag about going around the provinces to deliver his agenda. However, when it comes to the history and the way that this federation was built, health care is provincial jurisdiction. Now, the federal government does play a role in the federal health transfer. We have seen on that front that there is a litany of failures. In fact, the Prime Minister promised to tear up the previous agreement that would have actually resulted in more funding dollars, because it was tagged to inflation, than the agreement that the Prime Minister went around the backs of different provinces to sign. He was quick to talk and puff up his chest, yet he has not met with premiers since those initial discussions, despite saying it was so important to meet with the premiers nearly a decade ago.

We have even seen how different provinces are treated differently. There are some provinces that the Prime Minister has been quick to suggest the government is happy to work with and other provinces that they may not like the party that those people in that province elected. It is not a conversation around whether they should or should not like a particular political party. The government is quick to dismiss any province that would bring forward legitimate concerns. When the government tries to go around the provinces, it ends up ultimately putting Canadians and the care that Canadians expect and deserve at risk.

There is no question that we need to address some of the challenges when it comes to health care. That is why Conservatives have been talking so significantly about some of these things, including making sure that Canadians have access to care, especially when there is a shortage of family doctors. There are so many doctors who are not eligible to work in Canada today because there is no clear process for recognition. The solution to that is very simple.

We need leadership that will bring the country together, to figure out that path forward so that what could be tens of thousands of doctors could actually get to work delivering the care for Canadians, following that Hippocratic oath that they took when they entered medical school. That would be good news for everybody because it would address a shortage. It would increase productivity. One of the challenges, and it is interesting because one does not hear the Liberals talk very much about this, is that we have a massive productivity challenge in our country. When one has wait-lists, when one has long processing times, and this is not limited to health care but includes permitting for houses, benefits, name it, if there is a delay, it has a negative effect on productivity. However, it is specifically impacting productivity on our national workforce when it comes to health care.

Canadians are being forced to wait. A constituent of mine waited three years for a hip replacement because they were in their 40s. Because of the processes and the hoops that they had to jump through, they had to stop working and there were family challenges associated with that. Again, these other parties do not want to hear some of this stuff, because they would rather simply stand on an empty promise than actually address the real challenges that are facing our constituents. When it comes to productivity, if we can address some of those things, we will see our national productivity increase, and we will provide more doctor and nurses. It makes sense that one has a nurse that is trained at an institution and has the training that is required to deliver the quality of care that is acceptable in this country.

The proposal that the Leader of the Opposition has brought forward, which he has called the blue seal plan, would give certainty in a process that currently has no certainty. That is just common sense. For somebody who is looking for opportunity, looking for a future, looking to build what used to be known as the Canadian dream, which has been so much eroded under these Liberals, there would be certainty.

A physician, a nurse or another health care provider could come to this country and have certainty. What the Leader of the Opposition has talked about is that within 60 days they would be given the thumbs-up or thumbs-down so they could get to work or at least know then, going forward, what upgrading and what training needed to be done so that they could deliver that care that, obviously, they want to give to Canadians.

It is truly a shame that there are so many talented immigrants in this country who are not able to do the work that they trained so hard to do. That is an absolute disgrace, yet, with some political will, some collaboration and working with provinces, as opposed to pitting them against each other like what the Liberal government does on a daily basis, we could see solutions and better outcomes for Canadians.

There are serious concerns that I hear about, and I know many of my colleagues do as well. Because of the potential impacts of the passing of this bill, there would be an erosion or outright dismantling of private drug plans. That includes publicly funded drug plans that are delivered by private companies, as everybody in this place, and all public servants, the 400,000 of them or so, are experiencing, as well as with provincial and other levels of government.

In this process, we have not heard clarity. The Liberals will say that they addressed that at committee. Yes, it was asked. The questions were asked, but the answers were not given in any way that would provide certainty.

What does this mean? The bill talks about being single-payer, which may be simply fanciful language from the Liberals to appease their coalition partners in the NDP and means nothing. I would suggest that this is just as bad, because it is abusing the democratic process and just speaks to the poor negotiating tactics of the leader from Burnaby South, but we will leave that, because I think I addressed that appropriately in the beginning of my speech. This could practically mean that private companies would then be changing the way that they deliver those specifics. It would put employee benefits at risk, including when somebody signs up for a job. When somebody signs a contract for work, the benefit package is a part of the compensation package.

The Liberals have not done their job or their homework in terms of making sure that all the i's are dotted and the t's are crossed, as the saying goes. What they are doing could put some of those things at risk and directly impact the ability of Canadians from coast to coast to coast to access the drugs they already have.

That could mean simple issues, such as the pharmacist saying, well, this certain drug is not covered, but this one is, or outright not being able to get it covered altogether. This can be a huge issue in some cases. Further, it could scrap coverage plans, and there is no question that it will force Canadians onto the government plan. We see this as well when it comes to the dental care plan.

We have yet another example where there is big talk but little in terms of actual deliverables for Canadians. In fact, it is interesting. When we listen to the Minister of Health, he talks about how many people have signed up for the program. Even last week, he said how many people had registered for potential appointments. The language he used was truly a cop-out.

If the government want to deliver health care for Canadians, then it should get to work and work with provinces to ensure that provincial plans can be complemented and whatnot. However, that is not what the Liberals did. They signed an agreement, seemingly on the back of a napkin, to keep the NDP happy. This does not fulfill the promises and the objectives that they so publicly brag about.

The result is a very real potential that, in terms of outcomes, Canadians will not be better off after the Liberals have tried to fix the problem. This is the case when it comes to drug coverage, as we are debating today; when it comes to dental care, as has been and will continue to be debated; and when it comes to so many of the other things that the Liberals have promised.

What is the solution? Well, first and foremost, we need leadership in this country that will bring provinces together to address the challenges we face in ensuring that Canadians can get the health care they need. That includes mental health care. This is incredibly relevant when it comes to this conversation because the Liberal Party promised that there would be a Canada mental health transfer, yet we are now several years into a mandate and that promise has not been delivered on. I guess it was not negotiated on the back of a napkin in this confidence and supply agreement.

This speaks to how little the Liberals care about ensuring that Canadians have access to the care they actually need. We need leadership in this country so we can make sure that every Canadian can, in fact, have those better health outcomes and that Canadians can, once again, start to trust the institutions that we have worked so hard to pay for over multiple generations in this country.

I look forward to being able to answer questions on this and ultimately ensure that we get answers for Canadians.

[Yasir Naqvi, Liberal, Ottawa Centre, ON]

Mr. Speaker, I want to thank the member for Don Valley East, who had the honour of serving in the provincial legislature. He will remember when we worked together to create OHIP+, which started providing universal access to pharmacare for young people, which was a game-changer. It was unfortunate that Doug Ford gutted that program.

The member for Don Valley East is absolutely right. Our number one job and responsibility to Canadians is to make sure that we make their lives easier, and the way we make their lives easier, whether it is affordable child care or seniors being able to access a dentist or dental hygienist to look after their oral care, is to have programs available to make their lives better. That is what we all hear at people's doors. Those are the kinds of things people are concerned with, and that is the job we have been given.

In particular, in this Parliament, as we come out of the once-in-a-lifetime pandemic that we all lived through, so many structures within our society have been shaken as a result of the pandemic that we have to do this extra work, whether it is through Bill C-64 bringing pharmacare into our country, through $10-a-day child care, a Canadian dental care program or the unprecedented investment that we are making in our public health care system to ensure that Canadians know that their government is actually paying particular attention to their day-to-day needs, and this is exactly what we are doing.

[Yasir Naqvi, Liberal, Parliamentary Secretary to the Minister of Health]

Mr. Speaker, it is my privilege today to begin the debate at third reading stage of Bill C-64, an act respecting pharmacare. The legislation, as people know, is a priority for the government. It would establish the fundamental principles for implementing a national pharmacare program in Canada. Additionally, it would outline our plan to work with participating provinces and territories to deliver universal single-payer coverage for various contraceptives and diabetes medications.

This is an important step toward a national universal pharmacare system, as well as a historic event in the evolution of health care in Canada.

The core principles outlined in the bill are accessibility, affordability, appropriateness and universality. Accessibility ensures that Canadians can access pharmaceuticals regardless of location or income, while affordability aims to minimize financial barriers.

Appropriate use prioritizes patient safety and health outcomes, while ensuring the sustainability of the health care system.

Last, the legislation would advocate for universal coverage across Canada. These principles would shape our collaborative efforts with provinces, territories and indigenous communities to establish national universal pharmacare.

Our government has repeatedly and consistently demonstrated our commitment to public health care. Budget 2023 announced $200 billion over 10 years to better support the health and well-being of Canadians with a strong and effective health care system. More recently, in budget 2024, we committed $1.5 billion over five years to launch the new national pharmacare plan. The plan would help provide support for Canadians seeking access to contraception and for those living with diabetes. Let me focus some of my time on contraception.

Canada has more than nine million women of child-bearing age, who account for nearly a quarter of our population. For many of them, access to safe and reliable contraception is essential.

It would grant them the autonomy to be intentional about their family planning and pursue their aspirations for the future. This may involve advancing their education or their careers, delaying starting a family until they feel prepared or choosing not to have children at all. Affordability has been recognized as the primary obstacle in accessing birth control. This can lead to individuals' not using it consistently and may discourage them from opting for the most reliable method available.

Consider oral contraceptives as an example. This type of birth control is priced at roughly $25 per month and carries a typical use failure rate of 9%. Compare this to IUDs, which cost up to $500 per year. Although IUDs are a higher initial investment, they provide coverage for five years and have a use failure rate as low as 0.2%. Women should be able to make the choice between different types of contraception, regardless of whether they can afford it.

Many Canadians are just simply not in a position to pay for these upfront investments. For example, a young, part-time worker who does not have drug coverage from their employer would struggle to pay for a $500 IUD. With limited income from sporadic employment, which is typical for many young adults, even the monthly prescription cost can present a significant financial burden. This is the reality for many Canadians, and it is a reality I have heard from some of my constituents in Ottawa Centre.

One study indicated that women and girls from lower-income families tend to use less-reliable contraceptive methods or opt out of using contraception altogether. This disparity emphasizes how socio-economic factors intersect with access to reproductive health care, identifying gaps in our health care system and perpetuating cycles of systemic inequality. Additional research has even shown us that providing contraception through public funding can actually result in public cost savings. The University of British Columbia estimates that implementing no-cost contraception has the possibility of saving the B.C. health care system around $27 million per year.

Recently, I had the opportunity to meet with Planned Parenthood Ottawa in my community of Ottawa Centre. Our conversation focused on a broad range of issues, but in particular we spoke of the impact Bill C-64 would have on the health of women here in our community. What became clear to me in that conversation was that contraception is not merely a matter of personal choice. It is an integral aspect of health care. It is a fundamental aspect of reproductive health, and it plays a pivotal role in advancing gender equality.

It was also made clear to me that, by ensuring affordable access to contraception, this legislation would advance gender equality. Preventing unintended pregnancies would enable more Canadians to participate in the economy, which would result in greater prosperity for all. This is crucial for building a more equitable society where everyone has the opportunity to thrive.

I want to thank Planned Parenthood Ottawa for the good work it does, day in and day out. I was really happy to speak to its representatives recently to let them know of a funding grant it is receiving to continue doing this important work in our community. I am thankful for them for meeting with me and for educating me further on the impact Bill C-64 would have on women here in our community and across the country.

Moving on to the impact on diabetes, we can apply the same cost-saving principle that I was speaking to in the case of contraception to medications that treat diabetes. Diabetes is one of the most prevalent chronic disease in Canada, impacting 3.7 million individuals at present. There are projections that this number will continue to grow.

Many of us know someone with diabetes and have seen the devastating effects it can have on a person's quality of life. While diabetes has no cure, treatments are available to control it.

These treatments are not always affordable or accessible to those who need them. We know that 25% of Canadians with diabetes have identified that the cost of their medications has impacted their ability to stick to their treatment plans. Neglecting proper management of this disease can result in devastating consequences.

When we made the announcement introducing Bill C-64, I was honoured to join the Minister of Health and many community advocates, who have been working in this area for some time, at the Centretown Community Health Centre, which is also located in my community of Ottawa Centre. Prior to the announcement, we met with some of the social workers, the primary health care practitioners and nurses who work at the Centretown Community Health Centre, which is a fabulous institution in my community. In fact, I used to serve on the board of the Centretown Community Health Centre some time ago.

When we met, we talked about the impact of this legislation. With regard to diabetes, we spoke to a specialist there who told us countless stories of individuals who she meets, and treats, who ration their diabetes medication. They are unable to afford the cost of their medication due to their current circumstances. It was made clear that, when diabetes is not properly managed, it can result in severe complications, such as heart attacks, strokes, blindness and even amputation.

In 2018, the total cost incurred by the health care system due to diabetes was estimated to be around $27 billion, a figure that we can expect to increase to $39 billion by 2028. These figures emphasize the urgent need for effective measures to mitigate the impact of diabetes and its associated costs on both individuals and the health care system as a whole. Independent of the legislation, the Government of Canada revealed its plan to collaborate with the provinces and territories to establish a diabetes devices fund. This initiative aims to guarantee that individuals with diabetes will have access to the essential medical devices and supplies they need to manage their treatment, including syringes, glucose-monitoring devices and insulin pumps.

This, along with the framework outlined in Bill C-64 for universal single-payer coverage for first line diabetes medications, would prevent any person living with diabetes in Canada from having to ration their medication or compromise their treatment. These actions will benefit all Canadians by helping diabetics control their disease, making it less costly to treat over time.

I want to address the concerns that pharmacare might affect private drug coverage, something that came up in the conversation when we were considering this bill at committee. Bill C-64 does not mention private drug insurance or regulate any of its activities. I want to be really clear about that. Our work with provinces and territories to offer universal single-payer coverage for contraception and diabetes medications would benefit all Canadians needing those drugs, regardless of their insurance status. Since the initiative is focused, benefits provided by private insurance are expected to remain unchanged. That choice remains in place.

As the two examples just mentioned show, the high cost of medication has become a pressing concern for too many people in Canada. For them, access to affordable medication is still a major challenge.

When medicare was first introduced in the 1960s, prescription medicines played a smaller role in the overall health care system. They were primarily administered in hospital settings, and those distributed beyond hospital confines were generally low in cost, but that is not the reality today.

Today, medicines are a vital and regular part of maintaining one's health. We know that roughly 1.1 million Canadians lack access to private or public drug insurance. That is approximately 2.8% of our population. In 2021, Statistics Canada found that one in five adults in Canada did not have the insurance they needed to cover the cost of the medication. In other words, 21% of adults in Canada face out-of-pocket drug costs that create a financial burden. This can lead people to forego their basic needs, such as food or heat, or even lead people to ration their medications or choose not to fill their prescriptions at all. Canadians should not have to choose between buying groceries and paying for medication. Being forced to make choices like these has serious consequences. Whether they are skipping meals or doses of medication, or opting to go without, sets off a chain reaction of adverse effects on the health of individuals and can heighten the strain on our health care and social support systems.

We can do better and we must do better. While it entails a financial commitment, the alternative, which is not investing in our pharmacare, would result in far more severe health and financial repercussions, as we can see with the two examples I presented earlier.

It is worth also noting that Canada has one of the highest per capita rates of prescription drug usage globally. Despite recent improvements, the elevated drug costs and the fragmented nature of drug coverage pose significant barriers for many individuals in Canada when it comes to accessing the prescription medications they need. In acknowledgement of these concerns, in December 2023, our government announced plans to advance the establishment of a Canadian drug agency, in short the CDA, with an investment of $89.5 million over five years, starting in 2024-25. The CDA will be built from the existing Canadian Agency for Drugs and Technologies in Health in partnership with provinces and territories. The Canadian Agency for Drugs and Technologies in Health publicly announced its transition to the CDA on May 1.

Canada's drug agency, or CDA, will play a central role in leading and coordinating initiatives designed to improve the sustainability and readiness of Canada's drug system for the future. Bill C‑64 sets out three main tasks for the CDA.

Initially, the agency would prepare a preliminary list of prescription drugs and related products to guide the establishment of a national formulary. This formulary would outline the range of prescription medications and associated products that Canadians should be able to access under the universal, national pharmacare.

Additionally, Bill C-64 would entrust the agency with formulating a national bulk purchasing strategy for prescription drugs and related products in co-operation with partners and stakeholders, including provinces and territories. This plan would explore methods to lower the cost of prescription drugs, which could help alleviate financial pressures for both individuals and the health care system. The agency would be required to finalize both the preliminary list and the strategy no later than the first anniversary of the day on which this act receives royal assent.

Last, the agency would aid in the publication of a pan-Canadian strategy concerning the appropriate utilization of prescription drugs and related products. This report would be released within one year of the bill receiving royal assent. Canada's drug agency would also be obligated to provide updates on the progress of implementing the strategy every three years.

As we know, national universal pharmacare cannot be accomplished without the contributions of the provinces, territories and indigenous peoples.

Given Canada's size and diversity, each province and territory has unique needs and specific challenges.

To establish a national pharmacare program that is both effective and fair, it is crucial to foster strong collaboration between the Government of Canada and all partners. Each stride toward national universal pharmacare will be made hand-in-hand with these partners. Future funding to support pharmacare will be allocated to provincial and territorial governments by way of bilateral agreements. This funding would supplement, rather than replace, existing provincial and territorial investments on public drug benefit programs.

In the immediate future, we will draw insights from ongoing initiatives as we persist in our efforts to enhance accessibility and affordability for all Canadians through a national pharmacare program.

Since August 2021, for example, our government has been working with the Government of Prince Edward Island to reduce drug costs for patients through the improving affordable access to prescription drugs initiative. Since then, P.E.I. has expanded access to over 100 additional medications on its roster of covered drugs, including treatments for cancer, heart disease, migraine and multiple sclerosis, just to name a few.

As of June 1, 2023, P.E.I. lowered copayment costs to $5 for nearly 60% of commonly prescribed medications for its residents. As a result of this initiative, within the first nine months alone, P.E.I. residents have saved over $2.8 million in out-of-pocket costs for over 330,000 prescriptions.

In addition to the progress being made on a regional level, I am happy to also share some of the work being done on a national level to support our pharmacare efforts. Bill C-64 builds on the work we have done to make drugs for rare diseases more accessible.

In March 2023, we launched Canada's first-ever national strategy for drugs for rare diseases. Supported by federal funding of up to $1.5 billion over three years, this strategy aims to enhance accessibility and affordability for medications for rare diseases, ensuring they are in reach for those who need them.

It marks the beginning of a national approach seeking to meet the need for drugs used in the treatment of rare diseases.

As my time is winding down, I want to say in conclusion that, in Canada, it is our belief that everyone should receive prompt access to the health care they need, when they need it, irrespective of financial needs. This principle is a core Canadian belief, and we are dedicated to defending it.

Bill C‑64 is a major step forward in our commitment to guaranteeing all Canadians access to affordable, high-quality drugs.

Our plan for universal coverage of contraception and diabetes medications would be life-changing for individuals, families, society and our health care system. While there is a lot of work ahead, we have already made substantial progress, from regulatory modernization to enhancing access to drugs for rare diseases, establishing Canada's drug agency and collaborating with the provinces and territories.

Passing this legislation would allow us to build on this momentum. We stand at the threshold of a new era in Canadian health care. We should seize this opportunity to invest in a stronger Canada.

I thank members for their attention.

I encourage all members of the House to vote in favour of Bill C-64.

[Dan Vandal, Liberal, for the Minister of Health]

moved that Bill C-64, An Act respecting pharmacare, be read the third time and passed.

[Dan Vandal, Liberal, Saint Boniface—Saint Vital, MB]

moved that Bill C-64, An Act respecting pharmacare, as amended, be concurred in at report stage.

[Patrick Weiler, Liberal, West Vancouver—Sunshine Coast—Sea to Sky Country, BC]

Mr. Speaker, I am very pleased to rise in the House to speak to Bill C‑64.

It is a great pleasure to join the debate today about the pharmacare legislation that is going to bring in the first steps of pharmacare in Canada, as well as to be the last person to give a speech before we actually vote on this important piece of legislation.

Quality health care, including access to prescription drugs, is vital to protecting and promoting the health and well-being of Canadians. Prescription medicines allow millions of Canadians to prevent and fight disease, manage chronic illness, ease pain and breathe better; in other words, they allow Canadians to live healthier and more productive lives. I must say, there are few issues that I hear more about than health care. It is a priority for my constituents.

With rising costs, some Canadians are facing difficult choices between paying for their prescriptions and covering essentials, such as food and heat. Nobody should be put in that circumstance. We need to ensure that prescription drugs are more accessible and affordable for Canadians, including those facing the greatest financial barriers to accessing medications. That is why our government has introduced the pharmacare act. The bill proposes foundational principles for national universal pharmacare and describes the government's intent to work with provinces and territories to provide Canadians with universal, single-payer, first-dollar coverage for a range of contraceptive and diabetes products.

When medicare was introduced in Canada in the 1960s, prescription drugs played a relatively limited role in health care. Most drugs outside of a hospital were inexpensive medicines for common conditions. However, in the intervening decades, the development of drugs has surged as pharmaceutical companies have pushed the science further in search of new treatments and cures. Prescription medicines are now an essential part of health care. As a share of overall health care costs, spending on prescribed drugs has risen from six per cent in 1975 to nearly 14% in 2022. This makes prescription drugs the second-largest area of health care spending in Canada, after hospital services.

Today, the landscape of prescription drugs available in Canada is robust and complex, with pharmaceutical companies launching dozens of new products every year. To support effective management, in government-run, public drug plans in Canada, as well as some privately run plans, a formulary is developed, which is a list of drugs and related products that are eligible for coverage under the drug plan. To develop the formularies, public plans consider both how well a drug works and whether these products offer good value for money relative to other treatment options. While there are over a hundred public plans in Canada, there is generally good alignment with regard to the list of drugs that are eligible for coverage across provinces and territories.

Many Canadians are only eligible for public drug coverage with high deductibles or premiums that provide little relief for more routine drug expenses, such as for prescribed contraception and diabetes medications. A national formulary would outline the scope of prescription drugs and related products that all Canadians should have affordable access to under national universal pharmacare.

In 2019, the advisory council on the implementation of national pharmacare, chaired by Dr. Eric Hoskins, recommended a national formulary service, one of the standards for national universal pharmacare. He proposed pharmacare coverage to be phased in, starting with a short list of essential medicines. In budget 2019, the government announced funding for a number of foundational steps towards national pharmacare, including the development of a national formulary. Back in 2022, the government announced continued progress towards this by introducing a pharmacare act and tasking the drug agency to develop a national formulary of essential medicines and a bulk purchasing plan. Preliminary work has already been completed, and a framework and process for developing a future national formulary was recommended.

The panel released its final report in 2022, including giving guiding principles for the formulary and a process for bringing it into place, as well as a sample list of commonly prescribed drugs and related products for three therapeutic areas with a high volume of drug use in Canada. These are cardiovascular disease, diabetes and mental illness. This list has been expanded by looking at equity-seeking groups to make sure that we are closing the gaps in access between different communities in Canada.

Actually, this foundational work is already having real-world impacts. In 2021, our government announced that it would work with the Province of Prince Edward Island on the improving affordable access to prescription drugs initiative. Under this initiative, P.E.I. is receiving funding to add new drugs to its list of publicly covered drugs and to lower the out-of-pocket costs for island residents.

I just want to say that, with the legislation, P.E.I. residents have already saved $2 million in out-of-pocket costs on more than 230,000 prescriptions, and the savings continue. Our government remains firmly committed to taking the next steps in pharmacare, and the legislation today is going to help us do that by providing coverage for contraception and diabetes medicine. This is part of our overall approach to support the provinces to improve health care in Canada, including with a new deal we signed with all the provinces last year to provide better care, as well as making it easier to get access to such things as a medical practitioner in rural areas, including where I live, by providing student loan forgiveness for people to operate there.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Mr. Speaker, I am pleased to have another opportunity to address Bill C-64, an act respecting pharmacare. It is an act with respect to pharmacare, and yet it would cover only diabetes and contraception. As a member of the Standing Committee on Health, I can say that the bill, which is really more of a pamphlet than a real piece of legislation, has been the main focus of committee for the last month or so, about as long as it took for the government to draft the legislation.

It is important to make sure that Canadians know what the pamphlet really is and, more importantly, what it is not, since many people are under the impression that Bill C-64 would mean free medications for all Canadians. This is absolutely not the case. Despite what the NDP-Liberal coalition is claiming, the pamphlet would do very little to improve the lives of the majority of Canadians, and overall it could have more negative impacts than positive.

One huge issue that I have with Bill C-64 is the way that it was rammed through Parliament so quickly. Typically when legislation comes to committee, we are given ample time to hear from witnesses and to read all the briefs, submissions and recommendations from stakeholders on the legislation. This is extremely important, as there are many groups that have valuable insight and input on issues as major as pharmacare. We on this side of the House believe that they all deserve to be heard and considered, yet due to closure on what Canadians think should be a piece of legislation intervening in provincial domains, it was rushed through.

When it comes to matters that would potentially affect a huge portion of the population, due consideration must be given to the opinions of experts. This is not an issue that should be handled by “Ottawa knows best”, which the Liberal-NDP coalition so often does. The Liberals think they know better than the professionals who are said to be the most impacted by the pharmacare pamphlet, so they are fine with pushing the weak legislation through. Why is that? It is because they want to be able to tell Canadians that they gave them universal pharmacare, even though that is blatant misinformation because what the bill would provide is anything but universal.

There were 10 hours of committee time to hear from witnesses with respect to Bill C-64, which was not nearly enough time to cover all the industries, organizations and individuals who would be affected by the poor piece of legislation before us. My inbox was inundated with emails from groups that were pleading with the government to have a chance to give their input at committee. However, because the NDP-Liberals were so desperate to ram Bill C-64 through Parliament, their voices were not heard.

It astounds me that the costly coalition is trying to tout the pamphlet as being historic and groundbreaking, when the Liberals neglected to listen to the very people who would be most impacted by the shoddy work of the file. Many groups who were fortunate enough to appear at committee said they were not consulted by the NDP-Liberals before or during the development of the pharmacare pamphlet. In what world is this acceptable?

It is not just the medical field that the NDP-Liberal coalition failed to consult in advance. One of the biggest industries that would have to deal with all of the changes caused by Bill C-64 is the insurance industry. We were fortunate to be able to hear from some industry representatives on the matter at committee. Mr. Stephen Frank, president and chief executive officer of the Canadian Life and Health Insurance Association, made some important observations.

Mr Frank said, “The Minister of Health has stated that people who have an existing drug plan are going to continue to enjoy the access they have to their drugs. If that's the minister's intent it's not...clear from this bill. As many of the questions reinforced today, its text is ambiguous, it repeatedly calls for universal, single-payer, pharmacare in Canada with no mention of workplace benefit plans. Read in its entirety the bill could result in practical, and even legal, barriers to our ability to provide Canadians with the drug benefits that they currently have.

“For the majority of Canadians, therefore, this plan, as it's currently written, risks disrupting existing prescription drug coverage paid for by employers, limiting choice, and using scarce federal resources to simply replace existing coverage while leaving a huge gap for uninsured Canadians who rely on other medications beyond diabetic drugs and contraceptives.”

There are a number of different drug insurance plans out there: government-sponsored plans, employer-sponsored plans, association-sponsored plans and private plans. The Conference Board of Canada found that 36.8 million Canadians, or 97.2%, are eligible for some form of prescription drug coverage. The Canadian Chamber of Commerce indicates that the uninsured population is 1.1 million, or 2.8%, and 3.8 million are eligible but not enrolled. That is basically 4.9 million, a little over roughly 10% of the population, yet Statistics Canada in 2019 indicated that 86.2% of Canadians are covered by at least one type of drug insurance.

When an issue as important as access to medications and prescriptions comes up, it is the minister's job to ensure that all policies are clear and comprehensive and that all possible implications have been considered. Obviously, this is not being done with Bill C-64.

Another witness who appeared at committee and had concerns about the clarity of this bill was Carolyne Eagan, the principal representative for the Smart Health Benefits Coalition. She stated, “thousands of our advisers have received thousands of phone calls and engaged discussion with the misperception that people can go ahead and cancel their plan and essentially replace it by the free plan, not knowing what is on that list of coverage and who it's intended for.

“My own mother, who's turning 80 this year, got her letter. She was completely confused and figured she would cancel her plan and have free coverage with everything included. Luckily, I'm in the business and could explain it to her.

“It is a risk and there's a great risk of employers and Canadians thinking they would lose access to a longer list of medications where their health is stable on the treatment plan that they have been prescribed. Losing that access puts everything at risk. It puts the sustainability and health of Canadians and families, and our workforce and productivity, at great risk.”

This is alarming to say the very least. How many seniors in this country are going to lose their private insurance plan because the NDP-Liberal coalition failed to be clear about what the pamphlet would actually do and cover? How many seniors might have already cancelled their plan? What will stop employers from cancelling the benefit plan they offer and telling their employees to use universal pharmacare, which covers medication for only two things?

These are the questions that were asked at committee, yet the minister was unable to answer. Even more alarming is that only 44% of new drugs launched globally are distributed in Canada, and only 20% of them are covered by public plans. According to a study by Innovative Medicines Canada, which, by the way, asked to present at committee and was denied.

The fact of the matter is that the minister came to committee and gave blatant misinformation to Canadians, telling them that everything is going to be okay and that they must just trust him. After nine years of the Prime Minister's ruining our country, it is absurd that he is expecting public trust. The NDP-Liberal coalition has broken promise after promise, and somehow the minister thinks that he deserves or is entitled to something as sacred as the trust of Canadians.

One of the briefs that was received at committee was sent by Chris MacLeod, a 54-year-old lawyer who has cystic fibrosis. This disease is one that hits home very personally, and I am grateful to Mr. MacLeod for sharing his experiences with public drug plans in this country. He stated that unfortunately Bill C-64 looks like it could be another major barrier to access for patients, especially those with rare diseases, and that notably, the federal government's attempt to force substandard public formulary coverage on everyone across the country could prove to be a disaster, with potentially deadly consequences.

People who live with diseases like cystic fibrosis do not deserve to have their life made even more difficult because of incompetence with respect to the bill. The bottom line is that most Canadians already have solid drug plans that they are happy with and they do not want to have them replaced.

[Julie Dzerowicz, Liberal, Davenport, ON]

Mr. Speaker, Bill C-64 would establish the framework of a national universal pharmacare program here in Canada. It is phase one of the proposed program, which would include prescription drugs and free coverage for contraceptives and diabetes medication, and we are hoping to expand the program.

As well, there are additional elements that would complement the national pharmacare program, which is our national strategy for drugs for rare diseases. Again, it is starting with a $1.5-billion investment over three years. I believe our intention is that we will be expanding it in the years to come.

[Julie Dzerowicz, Liberal, Davenport, ON]

Mr. Speaker, it is a real pleasure for me to stand once again today to speak to this very important bill. Bill C-64 is an act respecting pharmacare.

The bill contains three key sections. One, it would establish a framework toward a national universal pharmacare in Canada for certain prescription drugs and related products. Two, it provides that the Canadian drug agency work toward the development of a national formulary to develop a national bulk-purchasing strategy and support the publication of a pan-Canadian strategy regarding the appropriate use of prescription medications. The third section is that, within 30 days of hopefully this bill receiving royal assent, the minister would establish a committee of experts to make recommendations regarding the operation and financing of national, universal, single-payer pharmacare.

The bill, along with other investments made by our government, would help millions of Canadians who are struggling to pay for their prescription drugs. Since this bill was introduced, we have heard many facts about access and affordability of prescription drugs within Canada. We know that Statistics Canada data from 2021 has indicated that one in five Canadians reported not having enough insurance to cover the cost of prescription medication in the previous 12 months.

We know that having no prescription insurance coverage was associated with higher out-of-pocket spending and higher non-adherence to prescriptions because of cost. We know that this results in some Canadians having to choose between paying for these medications or for other basic necessities, like food and housing. This is why we have consistently made commitments toward national pharmacare and have focused efforts on the key areas of accessibility, affordability and appropriate use of medications.

Let me start with the pharmacare act, which references the foundational principles of access, affordability, appropriate use and universality. We have heard a lot about these four principles this evening, but it is important to continue this conversation. Bill C-64 recognizes the critical importance of working with provinces and territories, which are responsible for the administration of health care. It also outlines our intent to work with these partners to provide universal, single-payer coverage for a number of contraception and diabetes medications.

This legislation is an important step forward to improve health equity, affordability and outcomes, and has the potential of long-term savings to the health care system. In our most recent budget, budget 2024, we announced $1.5 billion over seven years to support the launch of national pharmacare and coverage for contraception and diabetes medications. I would like to highlight the potential impact the two drug classes for which we are seeking to provide coverage under this legislation would have on Canadians.

We have heard of stories or know of someone in our constituency who is struggling to access diabetes medications or supplies due to lack of insurance coverage through their work, or of an individual who has limited insurance coverage so they cannot choose the form of contraception that is better suited for her.

For example, let us talk about a part-time, uninsured worker who has type 1 diabetes and is also of reproductive age. For this individual to manage her diabetes, it would cost her up to $18,000 every year, leaving her potentially unable to afford the $500 upfront cost of her preferred method of contraception, a hormonal IUD. With the introduction of this legislation, this individual would save money on costs associated with managing her diabetes and would be able to access a hormonal IUD at no cost, with no out-of-pocket expenses, once the legislation is implemented in her province.

Studies have demonstrated that publicly funded, no-cost universal contraception can result in public cost savings. Evidence from the University of British Columbia estimated that no-cost contraception has the potential to save the B.C. health care system approximately $27 million per year. Since April 1, 2023, B.C. is the only province in Canada to provide universal free contraceptives to all residents under the B.C. pharmacare program. In the first eight months of this program, more than 188,000 people received free contraceptives. That is wonderful.

With respect to diabetes, it is a complex disease that can be treated with safe and effective medications. One in four Canadians with diabetes has reported not following their treatment plan due to costs. Improving access to diabetes medications would help improve the health of some of the 3.7 million Canadians living with diabetes and reduce the risk of serious, life-changing health complications, such as blindness or amputations.

Beyond helping people with managing their diabetes and living healthier lives, we also know that, if left untreated or poorly managed, diabetes can lead to high and unnecessary costs on the health care system due to diabetes and its complications, including heart attack, stroke and kidney failure. The full cost of diabetes to the health care system could exceed almost $40 billion by 2028, as estimated by Diabetes Canada.

The bill demonstrates the Government of Canada's commitment to consulting widely on the way forward and working with provinces, territories, indigenous peoples, and other partners and stakeholders to improve the accessibility, affordability and appropriate use of pharmaceutical products by reducing financial barriers and contributing to physical and mental health and well-being.

Beyond our recent work under Bill C-64, I would like to highlight one or two initiatives, depending on my time, that the government has also put in place to support our efforts towards national pharmacare.

On a national level, our government has launched the first-ever national strategy for drugs for rare diseases in March 2023, with an investment of up to $1.5 billion over three years. As part of the overall $1.5-billion investment, our government will make available up to $1.4 billion over three years to willing provinces and territories through bilateral agreements. This funding would help provinces and territories improve access to new and emerging drugs for Canadians with rare diseases, as well as support enhanced access to existing drugs, early diagnosis and screening for rare diseases.

I would also like to highlight another initiative under way, which involves the excellent work by P.E.I. through a $35-million federal investment. Under this initiative, P.E.I. is working to improve the affordable access of prescription drugs, while at the same time informing the advancement of national universal pharmacare.

The work accomplished by P.E.I. has been remarkable. Since December of last year, P.E.I. has expanded access to over 100 medications to treat a variety of conditions, including heart disease, pulmonary arterial hypertension, multiple sclerosis, psoriasis and cancer. In addition, effective June 1, 2023, P.E.I. reduced copays to $5 for almost 60% of medications regularly used by island residents. I am pleased to share that through this initiative, P.E.I. residents have saved over $2.8 million in out-of-pocket expenses as of March of this year.

Finally, on December 18, 2023, the Government of Canada announced the creation of Canada's drug agency, with an investment of $89.5 million over five years, beginning this year. Built from the existing Canadian Agency for Drugs and Technologies in Health, and in partnership with provinces and territories, the CDA will provide the dedicated leadership and coordination needed to make Canada's drug system more sustainable and better prepared for the future, helping Canadians achieve better health outcomes. I am pleased to share that as of May 1, CADTH has been officially launched as Canada's drug agency.

In closing, we can see the extraordinary amount of work that has been and will continue to be dedicated to our commitments related to national pharmacare that focuses on accessibility, affordability and appropriate use of medications.

Bill C-64 represents the next phase of helping Canadians receive the medications they need, and we look forward to working with all parliamentarians to ensure its successful passing.

[Lori Idlout, NDP, Nunavut, NU]

Uqaqtittiji, before I begin my speech, I will take this opportunity to congratulate Sharon DeSousa, who just became the first racialized national president at the Public Service Alliance of Canada. I first met her when the Iqaluit Housing Authority Inuit workers had their 136 days of striking to advance the rights of workers, not just for Iqalummiut, but also abroad. I am excited about Sharon's election.

I will get to my speech. As the member of Parliament for Nunavut, Bill C-64, an act respecting pharmacare, put me in a bit of a personal dilemma. I wondered if I should support a bill that would do too little for the majority of my constituents. Through my speech this evening, I will share how I came to support the importance of this bill.

As an Inuk from Nunavut, I continue to see the impacts of what happens when the federal government purposefully underinvests in indigenous peoples. The lack of investing in housing means that people live in overcrowded housing conditions. Many live in mouldy homes. These conditions create poorer health outcomes and deep-rooted social issues, such as increased violence, substance abuse and the continuation of intergenerational trauma being passed on to our children and our grandchildren.

Having lived through these hurdles, I am always analyzing bills and debates with sensitivity to how all too common my experience is for indigenous peoples in Canada. I know all too well what it means to suffer. I hope when Canadians hear me, that they do their part to act on reconciliation with indigenous peoples.

When I became the member of Parliament for Nunavut, I learned to act on solidarity. Before I was an MP, it was just a word. I wholeheartedly thank my colleague and friend, the member of Parliament for Hamilton Centre. This is what I am doing in supporting this bill. I am compelled to act knowing this bill, when it is passed, will help so many Canadians. It will help women and gender-diverse people access contraceptives. It will help many Canadians pay for diabetes medication.

On another note, I must express my view regarding the Bloc's position on this bill. Its main concern seems to be that of jurisdiction and telling the government to stay out of its jurisdiction. I do hope its members reconsider their position because, regardless of jurisdiction, this bill can help more Canadians. This bill sets a foundation to create a universal single-payer system across Canada.

This reminds me of Jordan's principle. I take this opportunity to honour the family of Jordan River Anderson, who this program is importantly named after. Jordan died a preventable death. He died while different jurisdictions were fighting over not having jurisdiction to cover his expenses and care. Because of Jordan's principle, care for first nations and Inuit has improved.

While the Liberal government's responses take too long and it allows funding to lapse, Jordan's principle has made significant impacts for Inuit and first nations. Bill C-64 is an opportunity to model Jordan's principle so women and gender-diverse people have immediate access to contraceptives and people with diabetes can stop stressing about their finances knowing they can rely on this program for diabetes medication.

I must share my criticism of the bill. I am dismayed to see that, once again, when it comes to indigenous peoples, we are forced to wait. While I appreciate that Bill C-64 would require the Minister of Health to initiate discussions based on essential medicines lists with provinces, territories and indigenous peoples, this work must start immediately.

While first nations and Inuit have the non-insured health benefits program to have services such as dental care, eye care and mental health services paid for, much of the investments in Nunavut go toward medical travel because of the lack of health care in Nunavut. Children are flown thousands of kilometres to access basic care and dental care. This program funds millions of dollars to the airline industry. Ensuring pharmacare improves on the NIHB program will be very important in making sure that Nunavummiut, northerners and indigenous peoples see better care closer to home.

The pharmacare bill must avoid the pitfalls that we have seen in NIHB. I remember, for example, my colleague and friend, the MP for Algoma—Manitoulin—Kapuskasing, bringing to me a witness when the indigenous and northern affairs committee studied the non-insured health benefits program. She brought forward a pharmacist, Rudy Malak, who struggled to get paid for providing eligible people the drugs covered under the non-insured health benefits program. The proposed act must ensure that pharmacists would be paid immediately without worrying about closing their doors because the federal government may take too long to pay its bills.

I conclude by reminding everyone that, when it comes to helping Canadians, we must do so with a foundation of removing barriers for people. As much as I am conflicted about the bill, I must practise what the MP for Hamilton Centre taught me about acting in solidarity, knowing that the passage of the bill will help so many Canadians.

[Warren Steinley, Conservative, Regina—Lewvan, SK]

Mr. Speaker, we are talking about Bill C-64. I think the provincial government has jurisdiction over health care and the federal government should butt out.

[Warren Steinley, Conservative, Regina—Lewvan, SK]

Mr. Speaker, after the NDP House leader, let us get this back on track and talk about the pharmacare bill, Bill C-64. I am pretty happy to take to my feet. I did have the opportunity to sit in committee for five hours a couple days ago and listen to some of the witnesses and some of the comments and concerns around the pharmacare bill, Bill C-64. I want to put some of my concerns on the record. I see the former health minister and I am looking forward to hearing him talk about it, if he is going to get to his feet.

A year ago, I asked the former health minister how many provincial health ministers at an FPT meeting had asked to bring forward a pharmacare bill. Was it on the top of their priority list? At that time, the minister did not have an answer for me. In committee, a couple of days ago, I had the opportunity to ask the current health minister that exact same question. I do believe that health is a provincial jurisdiction.

My question was whether they were able to name any health ministers who proactively came to the federal government to ask for this bill to be brought forward or whether there were other requests.

I know, in Saskatchewan, that we have a shortage of nurses. We have a shortage of doctors. There are a lot of issues, and I think many provinces do have concerns around doctor and nurse shortages. I think we are short 30,000 doctors right now in Canada. That is a pretty big deal. I think around seven million Canadians do not have access to a family physician.

I think that is something that health ministers probably brought forward at the FPT meetings. I believe that is something that we do need to look at: how we can support our provincial partners and have that conversation.

Once again, the current health minister did not answer my question about whether this was a priority at FPT meetings. Tonight, I was able to ask that question again to the member from Winnipeg North. I asked if he could name a health minister who brought this pharmacare bill forward as a priority for the provinces. I have never seen him play hockey but he was pretty good at skating around that question. He went full circle, but he never really came to the crux of my question as to whether a health minister had asked for this.

This is not partisan rhetoric. This is a legitimate question around public policy and the priorities of provincial governments. I heard from my colleague from Victoria. She talked about a child who needed diabetes care. I listened to her speech and when I asked her if she could tell me the age of full coverage in Saskatchewan, she could not. That is a very real concern of mine, the fact that they are bringing forward this legislation and that people voting for this bill do not know what the different coverages are out there in different provinces.

That is a legitimate problem. We should know where the coverages are across the provinces. In my home province of Saskatchewan, I have been texting with our health minister, I asked him if this was one of the things he brought forward and he said no, that they just came to them and said they were going to do this, take it or leave it. Then they asked for details. The minister said that they never gave them any details because they did not have any yet. It is surprising for a provincial health minister to not have any details on a pharmacare bill. A pamphlet, in my opinion, is not a bill, as it is four pages long. It covers diabetes and contraceptives, but there is little detail given to our provincial partners and that is a legitimate concern that we have to discuss.

They rammed this through. They bring in time allocation and then they just expect everything to be okay. We all know that this is just what the NDP asked for to keep the government in power for a little bit more time. This is part of the supply and confidence deal. They continue to tell falsehoods to Canadians. It is not coverage; two things are being covered.

For NDP members to bring up Tommy Douglas in the House is laughable. He would be embarrassed by the NDP and the situation it is in right now. He would probably be a Conservative right now. He would be completely embarrassed by what the NDP, the rump of the NDP, has become: a bunch of activists. I think it is very funny whenever they bring forward the name of Tommy Douglas, because he probably rolls over in his grave when that happens.

Being from Saskatchewan, I also had a time to be in government, with the Saskatchewan Party and former premier Wall, which takes me to another point. The NDP-Liberal government continues to bring in bills and then it says it is going to do consultation. I think that is a little bit backward. I remember being in Saskatchewan, and I was a member of the all-party traffic safety committee. We travelled around Saskatchewan for a couple weeks, in all corners, and took feedback from all of the stakeholders.

We consulted. We gathered feedback. Then we made legislation. Is that not a novel idea? Talk to people, ask what is going on, ask what works and what does not work, and then put forward legislation, instead of bringing forward legislation and then asking if it can work. Sometimes, I just find that some of the things the government does are quite backwards. The same thing happened with nuclear consultations. We started nuclear consultations in Saskatchewan in the first term of 2007 and continued to talk to people and consult before we even got to the point of even the discussion of small nuclear reactors. That was how long we actually consulted with the people of Saskatchewan. Can members imagine having that approach here in this House, to continue to talk to people, instead of ramming things through based on political ideology and what people think they need to stay in power?

Getting back to my point about diabetes, I have a cousin who plays for Regina Thunder. He was diagnosed with type 1 diabetes when he was two. That is why I am such a champion of diabetes care. His mother and father had to wake him up at night and prick his finger when he was a baby and when he was two or three years old. Then he would get insulin pills. Now he has tracking on his arm. He has a pump that is covered by the province of Saskatchewan. That is progress. That is how to listen to people and get things done. I think that is what we should take forward.

The NDP have talked about compassion. Where is their compassion for the 27 million Canadians who have insurance, but who are scared right now that they are going to have less coverage? I know 1.1 million Canadians are under-insured. We can take care of them.

Just imagine if one of the health ministers of the NDP-Liberal government went to a provincial-territorial meeting and asked how to get people insured under their provincial programs. What is the need out there? The Liberal government of the day wants to take credit for everything. There did not have to be a national program. Imagine if it had worked with its provincial partners and then supplemented their programs? Maybe the provinces would have needed extra money. I guarantee that it would not have cost $1 billion or $2 billion. This program is going to cost $2 billion.

There are several public policy reasons why this bill should not go forward in the form it is in. We should continue to work with our provincial partners. I would love for one of these ministers of health to answer how many provincial health ministers asked for this program to come forward. The same could be said for the dental plan.

Today is a pretty special day in my life. On May 30, 1944, my father, Ron Steinley, was born. I am not able to be home with him, but I want to wish him a very happy 80th birthday. He is in Swift Current, Saskatchewan. I am going to try and rip out there, maybe this week or next week, so we can take him out for supper. Happy birthday to my dad and all the best.

The House resumed consideration of Bill C-64, An Act respecting pharmacare, as reported (with amendments) from the committee, and of the motions in Group No. 1.

Motions in Amendment

[Peter Julian, NDP, New Westminster—Burnaby, BC]

Mr. Speaker, I always like listening to my colleague.

It seems to me that Bloc Québécois MPs should at least listen to Quebeckers. There are at least two million of them united in the largest coalition in Quebec. They are specifically asking that Bill C‑64 be passed by the federal government. They are very critical of the current pharmacare situation in Quebec. They talk about co-payments. They talk about all the problems that exist in Quebec. All the community and union organizations are asking the federal government not to give in to the provinces and territories that are asking for an unconditional right to opt out with full financial compensation. They are saying that because they want Bill C‑64 to pass.

Why is the Bloc Québécois not listening to Quebeckers?

[Nathalie Sinclair-Desgagné, Bloc, Terrebonne, QC]

Mr. Speaker, we are here to debate Bill C-64 at third reading. It will come as no surprise to anyone when I say that the Bloc Québécois will be voting against this bill. I am the last person from the Bloc Québécois who will be rising today to speak to this bill on pharmacare. We will soon be voting on it and we will see whether it passes.

What we have been saying repeatedly in the House is simple. What the Bloc Québécois wants is for the federal government to stop interfering in provincial jurisdictions. We want the money to be transferred to Quebec with no strings attached and we want full financial compensation. We want health transfers. That is what we want, and that is what we will continue to hammer home. I feel like I have to keep repeating myself in the House and that is not right. All the Bloc Québécois wants is to defend Quebeckers' rights and to simply get the money we send to the federal level back so that we can improve the pharmacare program that we already have in Quebec.

When this bill was being studied in committee, the Bloc Québécois proposed an important amendment. It read as follows:

(4) Despite subsections (1) and (2), a province or territory may elect not to participate in national universal pharmacare, in which case that province or territory remains unconditionally entitled to receive payments in order to maintain the accessibility and affordability of the prescription drugs and related products already covered by its public pharmacare.

I do not think this amendment was unreasonable. Its purpose was simply to uphold respect for jurisdictions. The committee chair rejected the amendment on the grounds that it was out of order. The reason will come as a surprise to many. The chair ruled that our amendment was out of order because, in his opinion, it would have required royal recommendation, which we obviously challenged. In committee, however, we can challenge a decision, but unfortunately, we cannot debate it. The committee therefore voted to uphold the chair's ruling.

I was rather shocked that the committee ruled our amendment inadmissible. The purpose of the amendment was simply to ensure that jurisdictions are respected and that Quebec be given the money that has already been budgeted and set out in the bill. Quebec is simply asking that its share be set aside and that the money be transferred to Quebec so that it can improve the system that already exists in Quebec. It is unbelievable that that was rejected. It makes no sense.

I think the opposite is what should require a royal recommendation. Anything that goes against the Canadian Constitution should require a royal recommendation. That is not the case here. Unfortunately, this bill goes against the very foundations of the Canadian Constitution. Let me explain.

It is rather ironic that it still takes a member of the separatist party to remind the House how the Canadian Constitution works, when the government never misses an opportunity to point out that the Constitution is untouchable and that all the issues related to it are not important to Canadians and Quebeckers or that Quebeckers do not care about jurisdictions. However, as surely as I stand in the House today, based on the polls we are seeing, I can say that Quebeckers want jurisdictions to be respected. Whenever Quebeckers are asked who they would prefer to manage services like education or health care, the vast majority of the time, the answer is the same: Quebec.

It is all the more ironic given that the Constitution I am talking about is the one that was imposed in secret by the father of the current Prime Minister, during the night of the long knives in 1982. That was a little refresher. Since then, the Liberal Party's tendency has grown stronger. Increasingly, English-speaking Canada wants Ottawa to be its real government, the one that manages the bulk of public services. Conversely, Quebec has made a different choice. Quebec wants to manage its own jurisdictions, its own health care system, its own education system, its own day cares and so on. That is the choice that Quebeckers are making and that is the clear choice that the Quebec National Assembly made when its members unanimously reiterated that jurisdictions must be respected.

Of course, pharmacare has a noble objective, that of giving every individual, every person who needs medical services or prescription drugs the ability to get those drugs for little or no cost. It is so noble that Quebec has already done it. Quebec already has its own pharmacare program. Taking care of people affected by the difficult economic conditions we are experiencing is very noble. The problem is that these measures are ill-suited to the different realities of Quebec and Canada's provinces.

Even with all the good faith in the world, this was inevitable. Health and housing are not federal matters. The House of Commons has no business getting involved in those areas. That is because Quebeckers believe that their real government is in Quebec City. As long as that is the case, the concept of fiscal imbalance will exist. My colleague from Mirabel is very familiar with the concept of fiscal imbalance. We will not stop talking about it in the House. By fiscal imbalance, I mean the fact that the provinces have insufficient financial resources in relation to their own powers, while the federal government normally has surpluses. It is hard to understand why it has these deficits given all the money it collects. Yes, it has services it is supposed to deliver, but they are not exactly high-quality services.

The responsibilities that fall under federal or provincial jurisdictions must be respected. More simply, as Bernard Landry used to say, “the needs are in the provinces but the means are in Ottawa”. Even if the federal government tries hard to deny its existence, the fiscal imbalance is a major problem that has been recognized for many years. As the population ages, the cost of Quebec's social programs is rising rapidly. The cost of pharmacare is obviously rising rapidly. It is up to the Quebec government, and the Quebec government alone, to determine where the funds for these programs should go and how to improve the pharmacare program that already exists.

Since Quebec is chronically underfunded, we might wonder, as we often do, if a Quebecker is worth less than a Canadian. The Government of Quebec is shouting itself hoarse asking for health transfers. What does the federal government have to say in response? It responds with even more intrusions into Quebec's jurisdiction. That is what we are seeing again today with pharmacare. Unfortunately, the reason Quebeckers prefer to have pharmacare and every area of Quebec's jurisdiction run by Quebec City, is that everything the federal government touches results in failure. Federal equals failure.

I have talked about ArriveCAN several times in the House. I have a question: How much does Tylenol cost when it is 7,500% higher than its cost, like the ArriveCAN app was? It is going to be expensive. That is what is happening with pharmacare. The pharmacare that the federal government is going to create is going to cost us a lot more because the only thing the federal government does is mismanage its programs, run them completely inefficiently, like it did with ArriveCAN.

Quebec's system may be imperfect, but it does not need interference or duplication of costs. It needs more money. That money is in the hands of the federal government. It is a mixed system, a system that works well between a “forgiver” and company contributions and individual payroll contributions. It is not perfect, but it works. It is based on an existing model in France. The federal government is modelling its plan after it. However, instead of simply saying that Quebec has the expertise and skills to run its own pharmacare, the federal government wants to duplicate it and make it less efficient. It is crazy and that is why the Bloc Québécois is against this type of bill and the pharmacare program proposed by the federal government.

I keep hearing my NDP colleagues remind us that the major unions, including the Fédération des travailleurs et travailleuses du Québec, have come out in favour of moving forward with pharmacare. Of course, they had their reasons, as I will explain today. The reason is noble, the objective is noble. Improving medical coverage and offering pharmacare to people with diabetes or people who use contraception is noble, but it is not a federal jurisdiction. It is up to Quebec to decide how to do that. It would cost Quebec less to improve its own pharmacare program than to have it managed by the federal government. A ton of evidence shows that the federal government has no idea how to manage its own programs. Does anyone need to be reminded about passports or ArriveCAN? No, I will not go there. It is too late, and if the truth be told, I am a little too tired for that.

In conclusion, once we recognize, first of all, the fiscal imbalance problem, which will continue for as long as Canada is governed by the current Canadian Constitution, and secondly, the need to take steps to help our fellow citizens, the House will have to ask itself some hard questions. When the federal system was set up, important needs came under federal jurisdiction, like participating in imperialist wars. Today, the real needs are in the provinces.

Let us be honest. Instead of voting on pharmacare tonight, why not vote to reopen the Canadian Constitution and finally put an end to this farce of separate jurisdictions?

Let us ask Quebeckers to vote again, put an end to jurisdictions, and declare Quebec's independence.

[Joanne Thompson, Liberal, St. John's East, NL]

Mr. Speaker, I am rising in the House today to speak to what our government is doing, and plans to do, to help millions of Canadians who are struggling to pay for their prescription drugs.

Statistics Canada has indicated that one in five Canadians reported not having insurance to cover the cost of prescription medications in the previous 12 months. We have heard, time and time again, that Canadians who do not have drug insurance coverage struggle to afford medications and are left to make extremely difficult decisions to choose between paying for these medications or other basic necessities of life, such as food and housing.

No Canadian should have to make this type of a decision. This is why we introduced Bill C-64, the pharmacare bill, and continue to work with all parliamentarians and colleagues to ensure its speedy adoption.

This bill is needed for so many reasons. It proposes the foundational principles for the first phase of national pharmacare in Canada. These principles of access, affordability and appropriate use and universality have guided, and will continue to guide, our government's efforts in moving towards national, universal pharmacare.

We have seen these principles reflected in the work that is already under way, including launching the national strategy for drugs for rare diseases and improving affordable access to prescription drugs, which is the initiative with Prince Edward Island. I would like to take a moment to highlight the impact that both of these initiatives would have on national pharmacare.

In March last year, the Government of Canada launched the first-ever national strategy for drugs for rare diseases with an investment of up to $1.5 billion over three years. As part of the overall $1.5 billion investment, the federal government will make available up to $1.4 billion over three years to provinces and territories through bilateral agreements.

This funding would help provinces and territories improve access to new and emerging drugs for Canadians with rare diseases, as well as support enhanced access to existing drugs, early diagnosis and screening for rare diseases. This would help ensure patients with rare diseases, including children, would have access to treatments as early as possible for a better quality of life.

With respect to Prince Edward Island, the Government of Canada established an agreement with P.E.I., in August 2021, to improve the affordable access to prescription drugs and inform the advancement of national universal pharmacare. The $35-million investment has allowed for P.E.I. to add new drugs to its provincial formulary and lower out-of-pocket costs for drugs covered under existing public plans for island residents.

As of March of this year, P.E.I. has expanded access to over 100 new medications to treat a variety of conditions, including heart disease, pulmonary artery hypertension, multiple sclerosis, psoriasis and cancer. In addition, effective June 1, 2023, P.E.I. reduced copays to $5 for almost 60% of medications regularly used by island residents. I am pleased to share that, through this initiative, within the first nine months alone, P.E.I. residents have saved over $2.8 million in out-of-pocket costs on more than 300,000 prescriptions.

These two initiatives highlight how the principles of access, affordability, appropriate use and universality are reflected in our government's work, but they also underscore the importance of working with provinces and territories. Provinces and territories are, and will continue to be, a key partner in ensuring that Canadians get the health care they need. Our government will continue to work with provinces and territories to help ensure that this goal is met.

Finally, I would like to highlight another key component of Bill C-64, and that is the Government of Canada's intent to work with provinces and territories to provide universal, single-payer coverage for a number of contraceptives, as well as diabetes medications and supports. Similar to other initiatives that we have put in place, our work to provide contraception and diabetes medications would be guided by the principles I mentioned earlier and will involve working closely with our provincial and territorial partners. The importance of this provision within the bill cannot be understated.

We have likely heard over the past few weeks, since the introduction of Bill C-64, Canadians sharing their stories of how this bill would help them, how they are currently suffering from diabetes and do not have the insurance coverage, so they have to pay for their insulin, syringes and test strips out of pocket. Similarly, we are hearing stories of young women who do not have the drug coverage needed to pay for contraception or are limited in the choice available to them because more effective contraception is financially out of reach.

We have been receiving, and I certainly have received, numerous letters from Canadians across the country expressing their full support for Bill C-64 and asking the same question of when these drugs would be available to them. There is definitely a need for both of these sets of essential drugs, and I applaud the work of my parliamentary colleagues in getting the bill one step closer to a reality for Canadians.

Bill C-64 would allow for nine million Canadians of reproductive age to have better access to contraception and reproductive autonomy. This will help reduce the risk of unintended pregnancies and improve an individual's ability to plan for the future. As I mentioned, cost is the single most important barrier to access to these medications. Bill C-64 would ensure that Canadians will have access to a comprehensive suite of contraceptive drugs and the devices that they need. Similarly, we know that there is no cure for diabetes, but it can be treated with safe and effective medications.

Due to cost, 25% of Canadians with diabetes have reported not following their treatment plan. Improving access to diabetes medication, as outlined in Bill C-64, will help improve the health of almost four million Canadians living with diabetes and reduce the risk of serious life-changing health complications, which can include amputations or blindness. That is what Bill C-64 would do. It would give Canadians access to medications to maintain their health and give them a choice to determine which medication is best for them. In addition, these efforts will help avoid additional costs to the health care system.

In closing, our government will continue to work toward a national pharmacare plan that focuses on the principles of accessibility, affordability, appropriate use and universality. We will do so in partnership with provinces and territories, and we will do so knowing that Canadians need this immediately to help them access the drugs they need to live a healthy life.

[Ziad Aboultaif, Conservative, Edmonton Manning, AB]

Mr. Speaker, I am proud to stand on behalf of the people of Edmonton Manning tonight.

When a bill is brought before Committee, I expect that during the study done there that committee members would be able to make amendments that would improve the legislation. Sadly, that has not happened with Bill C-64, the pharmacare act, which is probably because the legislation is so flawed that nothing can fix it. The only proper fix is to bury it.

I wish that tonight we were debating the merits of a proposed national pharmacare program. Many Canadians would like to see such a thing, although they might not be so enthusiastic once they saw the price tag. The only resemblance the bill before us has to pharmacare is in the name. If we had asked Canadians what they expected to receive from the NDP-Liberal coalition besides ever-increasing taxes, high inflation, sky-high crime rates and housing shortages, they would probably have said, “Well, at least they have promised pharmacare.”

If we had asked what that meant, they would have said, “free prescription drugs for everyone: drugs to treat heart disease or cancer, life-saving drugs and maybe penicillin to treat any number of less serious illnesses”. Instead, what the government is offering is a pledge to consider funding contraceptives and diabetes drugs. It is not a pharmacare plan; it is an empty promise. It is not what anyone was expecting, but it is no surprise. It is not as if the Liberals really want a national pharmacare program. If they did, they would not have needed the NDP to push them into creating the bill before us.

The Liberals' plan is empty and it is pretty simple. They want to delay as much as possible to convince the NDP that a plan is coming and that therefore the incompetent government must be propped up. I have to give the Liberals credit for their political skill in this matter. They have the NDP so completely fooled that the government faces no chance of defeat no matter the scandals and no matter how much Liberal polices are hurting Canadians. The NDP is blindly accepting a Liberal promise, apparently unwilling to admit that they have been fooled.

I think it is safe to predict that when Canadians go to the polls, whether it is in October 2025 or earlier, the NDP will not be able to point to a functioning pharmacare program, not even the limited one that the bill calls for. However, the promise will have accomplished its purpose: keeping an undeserving government in power. It is the Canadian electorate that will hold both the NDP and the Liberals accountable for their actions. It is the Canadian people who will elect a Conservative government that actually cares about serving them and does not just care about political power.

The bill is being shoved through in haste by a government that is so desperate for approval. The Minister of Health is assuring Canadians that the pharmacare plan should not jeopardize the drug coverage that millions of Canadians have through private insurers. I am sure he is well-intentioned when he makes that statement; he may even believe his words, but good intentions are not reality.

The CEO of the Canadian Life and Health Insurance Association says that the bill could indeed cause disruption for those who have existing drug plans. Either he is right or the minister is right; it cannot be both. Given the Liberal track record, I suspect the minister is indulging in some wishful thinking, which is not surprising from a government that thinks budgets magically balance themselves, something that has not happened under the current Prime Minister.

By using time allocation, the government is rushing the bill through the House without opportunity for proper scrutiny, which is no surprise. Despite having had two years to figure out how they were going to implement their deal with the NDP, the Liberals put together the legislation at the last minute.

It is window dressing, designed not to define pharmacare, but to keep the government in office for a few more months to deny Canadians what they want most, which is an end to Liberal overspending and incompetence.

The proposed bill is a promise, and Canadians know what happens when Liberals make promises. They have made promises in the past nine years. The reality is that, when the Liberals make a promise, things always seem to get worse. They promised affordable housing, and housing costs have doubled under their watch. They promised that the carbon tax would not cost us anything, and we find now that 60% of families are paying more than they collect. The Liberals promised that taxes would go down, and taxes have gone up. They promised safe streets, and then delivered crime, chaos, drugs and disorder. It is no wonder Canadians are afraid things will get worse when the Liberals promise pharmacare.

If the government were serious about helping Canadians, it would have gone about things differently. It would have consulted with the insurance industry, found out what the private insurance sector was offering and what the non-profit sector was providing, examined existing provincial coverage, and discovered if there were gaps that needed to be addressed. Instead, the Liberals decided to rush blindly ahead.

Canadians know the government is not worth the cost. That has been proven time and time again over the past nine years. Is this pharmacare program worth the cost? An honest answer is that nobody knows because the minister cannot tell us how much it will cost. Any numbers he tosses around are more wishful thinking than reality.

Canadians are struggling and looking to the federal government for help. Inflation eats away at their paycheques. Every trip to the grocery store, it seems the prices are going up. Liberals' catch-and-release bail policies are turning violent offenders loose to commit yet more crimes. Despite an ever-increasing carbon tax, the government has no plan to balance its books.

The Liberals apparently have no desire to fix the problems created by their wasteful spending. They believe that water runs downhill but never reaches the bottom. They know they will not be in government when the bill for this mismanagement comes due. Food Banks Canada's 2024 poverty report card shows that almost 50% of Canadians feel financially worse off compared to last year, while 25% of Canadians are experiencing food insecurity.

The cost of living has become so high that food banks have seen a 50% increase in visits since 2021. As a direct consequence of the government's inflationary spending and taxes, millions of Canadians are struggling to keep their heads above water, yet the Liberals ask us to take on faith that they know how to set up and run a pharmacare program without turning it into a disaster.

This is the government that spent more than $50 million on an app that was supposed to cost $80,000, and it cannot tell us how or when that cost overrun happened, or who is responsible. Why should Canadians trust it to run anything?

The good news is that this is not a serious piece of legislation. As I said, the Liberals have no idea what they are doing and no real intention to institute a pharmacare program. Bill C-64 is a public relations exercise with which they hope to fool the NDP and Canadians into thinking they are doing something to help people. Given the Liberals track record, I doubt many Canadians will be fooled.

[Yasir Naqvi, Liberal, Parliamentary Secretary to the Minister of Health]

Mr. Speaker, I think throughout the debate on Bill C-64, whether at second reading stage or at committee, we have seen nothing but fearmongering on the part of the Conservatives, for a simple reason: They do not support the bill. They do not want Canadians to have pharmacare. In fact, they support a private health care system. That is why they have chosen every which way to put up blockades against the bill by inventing stuff. We heard the member opposite, the health critic for the official opposition, throughout the committee process make things up while witnesses kept telling him that was not the case. He is still repeating the same mistruths.

I want to ask the member, who gave an excellent speech, this: How does he feel the legislation, if passed by Parliament, would help his constituents get the medications they so deserve and need?

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

The member heckles me and laughs at me right now from down at the far end.

Mr. Speaker, I have a great deal of respect for my colleague from New Westminster—Burnaby, and he is a fellow British Columbian. We have worked collaboratively before.

At every step of the way, we introduced common-sense amendments. If I may, I will read into the record snippets of a few: “universal, in respect of pharmacare, means providing uniform coverage to all residents of all provinces and territories, including Indigenous peoples.” That was one that was voted down by the Liberal-NDP coalition.

Another amendment was this: “payments to the province or territory in order to provide, to Canadians without access to any other prescription drug coverage plan, public pharmacare coverage for or to increase any existing public pharmacare coverage for and to provide universal, single-payer, first-dollar coverage for”. Does that sound like Conservatives are trying to block this piece of legislation? It does not. How about this? This one is very straightforward: “make progress on providing universal coverage of pharmaceutical”.

I offer that to the House because, at every step of the way and throughout the next couple of hours of this debate, we will hear interventions from our Liberal colleagues and our NDP colleagues that will say that Conservatives tried to block this piece of legislation every step of the way.

Those of us who have been tasked, on this side of the House, to work collaboratively with the other side in the health committee worked diligently to try to come up with an actual piece of legislation that was accurate and that provided the necessary tools and meat for such an important topic. We were shut down at every step of the way, primarily by our colleague from New Westminster—Burnaby, who was doing yeoman service for his Liberal coalition on the other side, as most of them sat silent.

I want to remind the House as well that all provinces have their own type of pharmacare and that 97.2% of Canadians have some form of coverage. This is a $2-billion cost, a program cost. Surely, for the one million or 1.1 million Canadians who are without coverage, we could have found a different way of doing this, a better way of doing this, that would not have put in jeopardy the plans that 27 million other Canadians have. We have spoken with insurers. We have spoken with businesses that offer private insurance to their employees, and they have questions: Who is going to pay? What happens to their employees? What happens to those who are insured by them? Insurers have concerns. Canadians have concerns.

Moreover, I will offer this. In last night's committee of the whole debate, a lot was said about this plan being universal pharmacare. We know that we have constituents who are phoning and saying that they are going to the pharmacy today and asking if they can get their medications paid for. The reality is this: No, they cannot.

This was confirmed by the Minister of Health last night when I asked him if Bill C-64 provides any government funding for those struggling or inflicted with cardiac issues. The answer was no. Does Bill C-64 provide any funding for those with ALS? The answer was no. Does Bill C-64 provide any government funding for those who are struggling with asthma? It does not. Does Bill C-64 provide any funding for any medications other than contraception or diabetes? His answer was no, that it does not.

This is not universal pharmacare. It provides the necessary and very important medications for those struggling or living with diabetes and it provides contraception. It does not offer what it is being billed as. That is exactly what we are telling the government.

Tell Canadians exactly what it is. Let us be honest with Canadians. This is not universal pharmacare. That is where we have problems with this bill.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Mr. Speaker, it is an honour to stand here and talk about what is being billed as universal pharmacare but what we know is not universal pharmacare.

Before I go down the path of our debate tonight, it is about 5:18 p.m. back home in British Columbia, which would mean that my granddaughter Ren is being picked up from our house. She watches every time I am on, and she always talks to the screen. I am going to say hi to my granddaughter Ren and tell her that papa loves her and will be home soon.

We are talking about Bill C-64 tonight. We are talking about a bill that is literally, for Canadians who are watching, four pages long. That is it. It is being billed as universal pharmacare. We have those who are in the audience to listen to this speech tonight at 8:19 p.m; it is a packed house in the gallery. Canadians at home are watching this important debate.

It is an important debate. There are over 27 million Canadians who are insured and have private plans. There are approximately 1.1 million Canadians who are under-insured or do not have plans. This has been said before by my esteemed colleague from Cumberland—Colchester, a former physician. He and I sit on the health committee. We work together in the best interests of Canadians and the constituents we represent.

When the government forced closure on Bill C-64 and started to ram it through the House, we rolled up our sleeves in good faith and submitted in excess of 43 amendments. These are amendments that the Conservatives and the other opposition parties were asked to submit without the opportunity to hear from the witnesses. Witnesses gave 10 hours of testimony. Surprisingly enough, the two most prominent experts in Canada with respect to pharmacare were not invited. We did not get a chance to hear from them.

There were 43 amendments that we tried to introduce in good faith. The government always says, with its NDP coalition partners, to trust it. We should just get the bill to committee, and we will do great work there. We will work collaboratively with all parties to make reasonable, needed amendments to these watered-down pieces of legislation. It does not work that way.

For five and a half hours, the member for New Westminster—Burnaby filibustered each and every one of the amendments. He says that it was Conservatives who had been blocking the bill the whole way.

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the Leader of the Government in the House of Commons]

Madam Speaker, we are talking about pharmacare and the member is talking about cutting the carbon tax.

Let me read a quote from Linda Silas: “Every day, nurses witness the profound impact of poor access to medications on their patients’ health.” She has addressed this to all members of Parliament. Further down she says, “Get it done for the sake of our patients, for the future of our health care system and for the well-being of our country. VOTE “YES” ON BILL C-64.” Linda happens to be the president of the Canadian Federation of Nurses Unions.

Could the member provide his thoughts on why the Conservative Party is going against our professional health care providers, who really want to see this legislation pass because they understand it?

[Jacques Gourde, Conservative, Lévis—Lotbinière, QC]

Mr. Speaker, it is a privilege to speak to Bill C-64, an act respecting pharmacare, which seeks to support the implementation of a national, universal pharmacare program.

I am always ready to champion a federalism that meets the needs of all Canadians, but there are a number of things that bother me about Bill C-64. Apart from the fact that it interferes in provincial jurisdictions, it was born of the Liberals' need to keep a minority government alive. That is why we are debating this bill tonight. Another thing that bothers me about Bill C-64 is that the Liberals are using the NDP like a lapdog, keeping it warm and cozy, only too happy to give in to the NDP's costly demands, while keeping it on a tight leash in a minority government that is on life support until the fall of 2025.

Since this bill does not respect provincial jurisdictions, it is obviously not legitimate. I have a hard time sorting out the reasons for this interference in provincial jurisdictions, which has become chronic over time, since the arrival of this Liberal government. I am even beginning to wonder whether the Bloc Québécois is not starting to rub off on the Liberal-NDP government in the House on other subjects.

One things is certain. Canadians are finding it increasingly difficult to identify with those who have become spokespeople for every issue instead of minding their own business. The Bloc Québécois is another example. On many issues, they are undermining the real well-being of Canadians, and especially Quebeckers, by playing provincial politics in the federal arena. They are confusing everyone.

In its current form, Bill C-64 would replace the private insurance system with a single insurance system. It would be a federal monopoly administered by a centralizing and incompetent Liberal government that has trouble managing its own departments and portfolios. For example, I am thinking about this government's inability to issue passports on time, which we experienced two years ago. I am not even sure what to say about the government's financial management, when it keeps spending borrowed money on the backs of future generations and dragging us towards a chronic and structural deficit. It is distressing to see a Liberal government that is incompetent across the board being supported by the NDP and, unfortunately, all too often by the Bloc Québécois as well.

Canadians are increasingly vulnerable, not because they lack access to medication in the provinces, but because they can no longer make ends meet. They have to make difficult choices between food and housing. Bill C-64 is just another idea where the expense is not worth the cost. Even more of taxpayers' money is being wasted in the expansion of the federal government, which is becoming increasingly intrusive and costly. Bill C-64 was born of noble intentions, but implementing it would create yet another inefficient and costly bureaucracy on top of the one that has been far too intrusive since 2015.

Currently, according to the brief submitted by Innovative Medicines Canada to the Standing Committee on Health, 97.2% of Canada's population benefits from access to prescription drug coverage through a public or private pharmacare plan. However, one in 10 Canadians are not enrolled in a government program that would cover the costs, even though they are entitled to it.

If we want to improve coverage, then we need to better inform Canadians. We do not need to destroy what is already in place to rebuild on a new foundation that has not been proven. The precursor pharmacare system in the province of Quebec, which was implemented 28 years ago, has been proven. The system is already practically universal. Common sense tells us that to improve coverage and access we just need to have targeted policies for the populations that do not have access. It is unnecessary to demolish what is already working, contrary to what the Liberals are currently proposing.

Monopolies of any kind have rarely served the interests of citizens. Replacing all the private drug plans entails major risks, including a reduction in the quality of service. As a result of competition, approximately twice as many new drugs are made available to patients on the private market in half the time.

Canadians appreciate this efficient system. Because it is a high-quality system, hospitals are less crowded, which in turn means lower costs. As I was saying earlier, this is yet another attempt by the Liberal government to interfere in provincial jurisdictions without consultation.

The health minister suggested that it would be absolutely out of the question for Quebec to give Ottawa free rein to create a pharmacare program in the province, unless it gives Quebec the right to opt out with full financial compensation, which the Prime Minister has no intention of doing. The same goes for Alberta.

The real reason behind this bill is that the Liberals have no choice but to bring forward this proposal because it is a condition of the NDP's support for the Liberal government and its survival, which has been at risk since its re-election. They outright ignore all the misgivings about the need for the bill and especially the costs associated with implementing it, as the Parliamentary Budget Officer told us. The survival of the costly coalition is at stake. They are trying once again to establish an even more centralist government, forgetting the country's federative nature and attempting to make it a unitary state.

The government should be more pragmatic and less ideological about this bill, otherwise all its efforts will be counterproductive. Instead of thinking about kickbacks to stay in power, the Liberal government should recognize the following facts. This is not a pharmacare plan. It is an empty promise that will not cover the vast majority of drugs used by Canadians.

After nine years of Liberal governance, the current Prime Minister has made a lot of promises. He promised affordable housing, and then he doubled the cost of housing. He promised that the carbon tax would cost nothing, and now we learn that 60% of families are paying more because of the carbon tax. He promised that taxes would be lowered but they went up. He promised safe streets, but ushered in crime, chaos, drugs and disorder.

This Liberal-NDP government cannot be trusted to deliver anything worthwhile to Canadians. In fact, the people have been betrayed, along with the working class too, to keep the Prime Minister in power while he doubles the cost of housing and quadruples the carbon tax.

Most Canadians already have prescription drug coverage. Many worry about losing the coverage they already have, coverage that works for them. There are also serious concerns about the cost of this proposal. The Parliamentary Budget Officer has said that it could cost tens of billions of dollars. Canadians cannot afford it at a time when they cannot even afford to pay their bills because of this Prime Minister. No Canadian wants a system that performs less well, offers less coverage, costs more and creates a massive new bureaucracy in Ottawa.

In closing, I want to reassure concerned voters who are not buying it. The common-sense Conservatives are going to abolish the carbon tax and bring down the prices of the basic goods that Canadians need. Canadians do not need legislation like this in these difficult times. What they need is an election as soon as possible to axe the tax, build the homes, fix the budget and stop the crime.

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Mr. Speaker, I will actually ask the member a question about the legislation. In Bill C-64, clause 6, “Payments”, it says very specifically that it is supposed “to provide universal, single-payer, first-dollar coverage”.

First-dollar coverage means that if a private insurance company today covers diabetic medication, it will not be able to do so if this legislation comes into force. In fact, it would be a crime. It would be illegal to do that, which means that there is a great potential for Canadians who are currently insured for their diabetes medication with a private insurer to lose it. They are actually the majority in this country.

How many Canadians would lose the coverage that they currently have because of this first-dollar coverage found in clause 6 of Bill C-64?

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the Leader of the Government in the House of Commons]

Madam Speaker, it is a pleasure to be able to rise and speak to this legislation today.

There are some aspects of public policy that I have had a great deal of interest in over the years, not only here in Ottawa, but also during the days I spent in the Manitoba legislature. Canadians have a justified expectation that provincial and federal governments will work together on the important issue of health care. It is part of our Canadian identity. In many ways, it is one of the biggest treasures we have as Canadians.

At the end of the day, when I look at this legislation, Bill C-64, I see it as a significant step forward in recognizing just how important it is, when we talk about health care, that medications need to be incorporated in a very real and tangible way into the discussions. I think of the number of people over the years who have ended up going to emergency services, had a premature death or were in situations where there were additional costs for health care. Imagine the number of different pharmacare programs that are scattered throughout the provinces. Even within a province, there are multiple different forms of pharmacare programs being provided. However, even with all of those hundred-plus national or provincial insurance programs that are out there, there are still many Canadians, hundreds of thousands, who have absolutely no insurance for prescribed medicines.

This policy that is sound and makes sense. Therefore, I am bewildered as to why, yet again, we see the official Reform Party across the way saying no to Canadians on what I believe is a significant step forward toward a national pharmacare program. It would start off with two medications, in two areas. I believe Canadians would overwhelmingly be in support of this. Whether it is people in Quebec, Manitoba, B.C. or Atlantic Canada, we will find resounding support for this initiative, and I would like to think that Conservatives, at some point in time, will open their eyes and have a better appreciation for the true benefits of this program.

This is not new for me. I have been talking about it in this House for many years. For the last half-dozen or so years, I have raised the issue. I have presented petitions on the issue. Whenever I had the opportunity to highlight the importance of pharmacare, I would often make reference to the importance of the federal government working with provincial governments across the country to encourage more participation in a truly national program. Interprovincial migration happens all the time. I have family members who live in different provinces. In fact, I have a brother who lives in B.C. and a sister who lives in Newfoundland and Labrador. The types of coverage vary. We all have opinions. Because this includes medication for people with diabetes and contraceptives for women, we would all benefit directly because we all have family members or know people who would benefit from that. I would personally love to see an add-on to it with respect to shingles.

I understand that in some provinces there is better coverage than in other provinces. That is one reason I would argue, as my daughter has in Manitoba, that we need to get provinces to come to the table in such a way that we could recognize the best pharmacare program that we could have, while expanding it to what it ideally could and should be into the future, with a higher sense of co-operation. I believe that is the answer. I think it was back in 2016 or 2017, I recall being on Keewatin Street in the north end of Winnipeg, asking people to sign a petition on the importance of national health care and on a national pharmacare program.

The NDP House leader made reference to a Quebec union and its thoughts about ensuring not only that this program sees the light of the day, but also that all politicians get behind it. There is a saying from the national nurses union that health care workers understand and they appreciate. If one goes into a hospital, one will find, at least in Manitoba, that one's medications are covered. When one leaves the hospital, depending on their situation and what kind of a plan they might have, they will get their medication. Many may not have a plan, so they will not get the medications, and often, the person returns to a hospital situation. I have talked to individuals, particularly seniors, who talk about medications versus food. That is a real discussion that takes place, sadly. From a personal point of view, the pharmacare program has been more important to me than the dental care program, and we have seen the success of the dental care program.

As a government, with the Prime Minister, we have seen how much Liberals value our health care system, our Canadian identity, virtually from the get-go with the buying of prescription medications to be circulated in order to support provinces, until not that long ago when we made a contribution of $198 billion over the next 10 years to support our health care system so that we can enhance programs such as staffing requirements, long-term care and mental health. Those are expectations our constituents have. That is the type of thing that we are delivering because we have seen agreement after agreement with provinces and Ottawa dealing with health care, and we recognize just how important the issue is. We continue to be able to work with the different jurisdictions.

I believe that when we think about issues like mental health, dental services, pharmaceuticals and long-term care, they are all things that I believe, through the Canada Health Act, we have a responsibility to show leadership for. I like to think that whether it is a territory or a province, there is a some semblance of what we could expect and that it would be of a similar nature. That is why we have transfer payments, equalization payments and so much more. That is why we have a government that not only understands it, but it brings in budgetary measures to support it and legislative measures like we are debating today on Bill C-64. The Conservative Party needs to wake up and understand what Canadians want. That is better quality health care, and Bill C-64 delivers just that. Conservatives should be voting in favour of it, not filibustering.

[Peter Julian, NDP, New Westminster—Burnaby, BC]

Madam Speaker, I am truly surprised that the Bloc Québécois refuses to listen to what Quebeckers are saying.

A large coalition, the largest in Quebec, made up of two million Quebeckers, major unions and community groups, said that Quebeckers applauded the federal government's Bill C‑64.

They said the following:

Never before have we come so close to implementing a real public, universal pharmacare program. The hybrid public-private system in place in Quebec creates a two-tiered system that is unsustainable and needs to be fixed.

While criticizing the system, they also said this:

We are asking the federal government not to give in to the provinces and territories, which are asking for an unconditional right to opt out with full financial compensation.

That is the message that Quebeckers are sending to the Bloc Québécois. It is a bit like dental care, where the largest percentage of people advocating for dental care are Quebeckers.

Why does the Bloc Québécois refuse to listen to Quebeckers?

[Jean-Denis Garon, Bloc, Mirabel, QC]

Madam Speaker, I would like to commend the members who may have the courage to sit late with us this evening.

Today we are debating Bill C‑64 to supposedly institute a national pharmacare program. I say supposedly because that is not what the bill does. Let us speak the truth. It is a bill mainly designed to playing politics, to the benefit of who knows who because by all accounts, the NDP is dropping in the polls.

What we are seeing today is a partial implementation of this system. The Liberal government, together with the NDP, is focusing on diabetes medication and contraceptives. What we are seeing today is a bit what the Conservatives have also been trying to do for a while now in this Parliament, to introduce American-style politics here in Canada's Parliament. We know that in the United States, in some states, the right-wing parties, the right-wing Republicans are attacking a woman's right to bodily autonomy. The Liberals are very afraid of the Conservatives, often with reason, because we know that there are a lot of people in the Conservative caucus who think that women do not have the right to control their own bodies. Essentially, the pharmacare plan is being used to Americanize Canadian politics.

Now, what this bill does is say that a national pharmacare program is needed. I want to point out that we are talking here about a federal national program, because we know that Quebec is a nation. The government is imposing a format. It is called first dollar coverage, which means that an individual must be insured and must have access to medication without having to spend a single penny. I understand that it would be ideal if many insurance plans, depending on the nature of the risk, were to say that, when a person is sick, they are not responsible for their situation. They did not do anything in particular to get sick, they are just unlucky and they should be insured and not have to spend a single penny. Society will be responsible for providing full insurance coverage.

However, Quebec already has an insurance program, a mixed insurance system. It is true that people have to pay a little. For example, for the public plan, when a person does not have a workplace plan or a private plan, they pay from $0 to $700 and change per year per person, depending on income. The contribution is geared to income. Most people have a plan through their employer that is negotiated as part of their collective agreement, so it is true that, in some cases, people pay a deductible for medication. They pay a certain amount, which is often very low, but everyone in Quebec is insured and the system already exists.

The money that is going to be used to meddle in Quebec's affairs in an area where the federal government is notoriously incompetent, namely health care, should be paid out to Quebec so that we can improve the system that already exists and help it evolve. There is a list of 8,000 drugs that are covered in Quebec. That seems to have piqued people's interest. The federal government knows it is going to be very expensive, so it is buying time. The Liberals know very well that this completely universal plan, where everything is covered, will never come to fruition before the Conservatives come to power. This plan deals with two health conditions. Do people realize how huge a gap there is between reality and rhetoric and how we could have taken this money and sent it to Quebec so that these funds could be managed based on Quebec's priorities?

Some of the debates we had were disgusting in many ways. We, in the Bloc, were told that by opposing Bill C‑64, we were opposing the well-being of the people in our own ridings, and that the only possible way to show concern for people's health, supposedly, was to support a bill that will not properly establish a universal pharmacare system for Quebeckers. That is going to be addressed through questions, if the Liberals ask any. They will tell us that we are against this or that, that we are against people's health, but that is absolutely untrue. We are in favour of insurance, but Quebec is ahead of the game, and we cannot totally upend the Quebec system just because at some point, 25 years down the road, the federal government and the NDP decided to wake up one Tuesday morning. We cannot do that.

One of the reasons the NDP included this kind of program in its coalition agreement with the Liberals, and one of the reasons the only NDP member from Quebec, the member for Rosemont—La Petite-Patrie, is fighting tooth and nail for Bill C‑64, is supposedly because the major unions support it. It is a delicate situation.

It is true that the cost of drugs has increased, as has the cost of health care services in general, as well as all health technologies. As a result, the cost of private group insurance has gone up. In many workplaces, employer and employee contributions have increased over the past few years. This can put pressure on people's ability to pay. This can put pressure on collective bargaining to get higher wages to deal with the cost of living. We recognize that. We know that is important.

The reason the unions might be united in supporting this federal legislation is not because Ottawa is capable, it is not because Ottawa is good, it is not because Ottawa is competent, it is because the money is in Ottawa; it is because there is a fundamental fiscal imbalance; it is because there are more revenues in Ottawa than the weight of responsibility on the federal government; it is because the provinces need money. The federal government is so determined not to transfer money unconditionally to the provinces that many people have at some point lost confidence in one day having a federal government that will act responsibly and transfer money unconditionally. At some point, the unions decided that they will support the minimum. They will support what they think is feasible in a context where the federal government's lack of respect for provincial jurisdictions and its contempt for Quebec have been institutionalized for decades. That is what is happening.

The member for Rosemont—La Petite-Patrie is grandstanding and saying that he has the support of the unions. The message that he should be sending to the unions is this. He should tell the unions that, with Ottawa running this program, they will get less value for their money. There will be fewer drugs and less coverage. The system will not be as effective. The government will be creating a redundant system. In the end, the workers are the ones who will pay. This measure is extremely anti-union.

The member for Rosemont—La Petite-Patrie should have acted more responsibly. He should have explained to the unions that we need to stand together and look to Quebec to get the transfers with no strings attached because Quebec is prepared to improve its system. That is what should be done.

I served on the Standing Committee on Health for several months. The ability to spend, the ability to put a knife to the provinces' throats, to make them accept conditions in exchange for money is in the NDP's DNA. I spent enough time in committee to know that.

The Bloc Québécois proposed a completely reasonable amendment. It asked for the right for Quebec to opt out with full compensation because Quebec already has all the necessary infrastructure. Quebec already has a system. Quebec is prepared to improve its system. It needs that money to continue this social development, which, as with day cares, means that, today, Quebec has a social policy—

[Yasir Naqvi, Liberal, Ottawa Centre, ON]

Madam Speaker, I want to thank the hon. member opposite for his advocacy on rare diseases and drug coverage. I have heard him speak before quite convincingly, and I thank him for the hard work he is doing.

The member is absolutely right. We have allocated $1.5 billion over three years, but that delivery will come through provinces and territories. We are doing the hard work to engage in bilateral agreements with provinces and territories so that we can flow that money through provinces and cover the cost of medication through bilateral agreements for rare diseases. That work is ongoing.

The work that we are doing through Bill C-64 on pharmacare is an add-on to that work. It complements the work that we are doing on rare diseases, and I look forward to continuing to work with the member opposite on this very important issue.

[Yasir Naqvi, Liberal, Parliamentary Secretary to the Minister of Health]

Madam Speaker, I am thankful for the opportunity to speak to a very important piece of legislation, Bill C-64, which deals with pharmacare and develops a framework for it. This bill, along with other investments made by our government, would help millions of Canadians who are struggling to pay for their prescription drugs. We had a very healthy process at HESA, the Standing Committee on Health. I want to thank all witnesses who appeared before the committee and those who sent written testimony because it really helped us understand the positive impact of this legislation.

This bill is a priority for our government. It establishes the fundamental principles for implementing a national pharmacare program in Canada. It also sets out our plan to work with the provinces and territories who so desire to propose universal single-payer coverage for a certain number of contraceptives and diabetes medications.

Since this bill was introduced, we have heard many facts about access to and affordability of prescription drugs within Canada. Statistics Canada's data from 2021 indicates that one in five Canadians has reported not having enough insurance to cover the cost of prescription medication in the previous 12 months. We know that having no prescription insurance coverage is associated with higher non-adherence to prescriptions because of cost. We also know that this results in some Canadians having to choose between paying for these medications and paying for other basic necessities, like food and housing.

This is why our government has consistently made commitments toward national pharmacare. Bill C-64 recognizes the critical importance of working with provinces and territories, which are responsible for the administration of health care. It also outlines our intent to work with these partners to provide universal single-payer coverage for a number of contraception and diabetes medications.

This legislation is an important step forward to improve health equity, affordability and outcomes and has the potential of long-term savings for the health care system. In budget 2024, we announced $1.5 billion over five years to support the launch of national pharmacare and coverage for contraception and diabetes medications. I would like to highlight the potential impact that these two drug classes, for which we are seeking to provide coverage under this legislation, would have on Canadians.

We have heard stories of people, or know someone, in our constituencies struggling to access diabetes medication or supplies due to a lack of insurance coverage through their work, or of an individual who has limited insurance coverage so they cannot choose the form of contraception that is best suited for them. For example, for a part-time uninsured worker who has type 1 diabetes and is also of reproductive age to manage her diabetes, it would cost up to $18,000 per year, leaving her unable to afford the $500 upfront cost of her preferred method of contraception, a hormonal IUD. With the introduction of this legislation, this individual would save money on costs associated with managing her diabetes and would be able to access a hormonal IUD at no cost, with no out-of-pocket expenses, once the legislation is implemented in her province.

Studies have demonstrated that publicly funded, no-cost universal contraception can result in public cost savings. Evidence from the University of British Columbia has estimated that no-cost contraception has the potential to save the B.C. health care system approximately $27 million per year. Since April 1, 2023, British Columbia is the only province in Canada to provide universal free contraceptives to all residents under the B.C. pharmacare program. In the first eight months of this program, more than 188,000 people received free contraceptives.

The same cost-cutting principle applies to diabetes medication.

Diabetes is one of the most widespread chronic diseases in Canada. Although there is no cure for diabetes, there are treatments to manage the disease.

One in four Canadians with diabetes has reported not following a treatment plan due to cost. Improving access to diabetes medications would help improve the health of some of the 3.7 million Canadians living with diabetes and would reduce the risk of serious life-changing health complications such as blindness and amputations. Beyond helping people with managing their diabetes and living healthier lives, if left untreated or poorly managed, diabetes can lead to high and unnecessary costs on the health care system due to its complications, including heart attacks, strokes and kidney failure. The full cost of diabetes to the health care system could exceed almost $40 billion by 2028, as estimated by Diabetes Canada.

The bill demonstrates the Government of Canada's commitment to consulting widely on the way forward and working with provinces, territories, indigenous peoples and other partners and stakeholders, including other political parties, to improve the accessibility, affordability and appropriate use of pharmaceutical products by reducing financial barriers and contributing to physical and mental health and well-being.

Beyond our recent work on Bill C-64, I would like to highlight some of the ongoing initiatives that this government has put in place to support our efforts toward national pharmacare.

On a national level, our government launched the first-ever national strategy for drugs for rare diseases in March 2023, with an investment of up to $1.5 billion over three years. As part of the overall $1.5-billion investment, our government will make available up to $1.4 billion over three years to willing provinces and territories through bilateral agreements.

The strategy marks the beginning of a national approach to meeting the need for drugs used to treat rare diseases.

This funding would help provinces and territories improve access to new and emerging drugs for Canadians with rare diseases and would support enhanced access to existing drugs, early diagnosis and screening for rare diseases.

I would also like to highlight another initiative under way, which involves the excellent work by Prince Edward Island through a $35-million federal investment. Under this initiative, P.E.I. is working to improve affordable access to prescription drugs, while at the same time informing the advancement of national universal pharmacare. The work accomplished by P.E.I. has been remarkable. Since December of last year, P.E.I. has expanded access to over 100 medications to treat a variety of conditions, including heart disease, pulmonary arterial hypertension, multiple sclerosis, psoriasis and cancer. In addition, effective June 1, 2023, P.E.I. reduced copays to five dollars for almost 60% of medications regularly used by island residents. I am pleased to share that through this initiative, P.E.I. residents have saved over $2.8 million in out-of-pocket costs as of March of this year.

Finally, on December 18, 2023, the Government of Canada announced the creation of Canada's drug agency, the CDA, with an investment of over $89.5 million over five years, starting in 2024-25. The CDA will provide the dedicated leadership and coordination needed to make Canada's drug system more sustainable and better prepared for the future, helping Canadians achieve better health outcomes. I am pleased to share that as of May 1, Canada's drug agency has officially launched.

In closing, members can see the extraordinary amount of hard work that has been dedicated to national pharmacare.

Bill C‑64 is a major step forward in our commitment to guaranteeing affordable, quality drugs for all Canadians. Our universal coverage plan for contraceptives and diabetes drugs will change the lives of individuals, families, society and our health care system.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Madam Speaker, it is interesting here in the House, the whole idea, whether the NDP-Liberal costly coalition likes it or not, of actually having a robust debate, especially when there are significant differences of opinion. Of course, that is why we are here tonight. We on this side of the House believe that legislation should be debated, and debated robustly, in spite of the fact of the trickery and antics used by the costly coalition to move closure on the bill.

On behalf of Canadians, I say that it has become fascinating to me that the notion that the House is spending other people's money has been lost, and this is a $2-billion bill where we would spend the money of taxpayers. I think we should do it with great caution. We should be prudent when we are doing it, and we should be doing things that we hear from taxpayers are important to them.

When we look across the country and hear about the things that are mentioned in the bill, we know that that is not happening. Therefore, when the hon. NDP member who is standing behind me says that what we are talking about is this or that, or some other foolish intervention, then what we end up with is just wasting more time. He has been here long enough to know the rules, or he should know the rules.

We know that when the bill was introduced there were only 10 hours of witness testimony and five hours of debate on clause-by-clause on it. Why is this important? When we begin to look at the pharmacare bill, we see that some of the amendments that were introduced originally were related to having Canadians understand that the bill really relates to only two classes of medications: contraception and medications and products for diabetes. That does not mean that those two classes are not important; they are. They involve important health states that often need the intervention of a prescription, but it means that the bill is no more than that at the current time.

It is interesting that the government, on canada.ca, puts out a list of medications that may or may not be covered by the bill, which creates hope for Canadians. Canadians will say, “Well, these are the medications that are going to be covered.” Many different groups come forward and ask, “Well, why not this and why not that?” Probably one of the most influential medications in the history of diabetes treatment besides insulin is Ozempic, but it is not on the list. People will say, “Well, why is it not on the list?” Then, of course, the government talks about the bill and says, “Well, that is not really the list; that is just a list. It is any old list.” Why did it publish it on its website, on canada.ca? Are those things important? Absolutely, they are.

When we talk about definitions, folks listening in at home will say that some of them are self-evident. They are not self-evident when we are dealing with $2 billion. For example, what is the definition of “universal”, “single-payer” and “first dollar”? Those definitions are incredibly important, so that 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.

That is the largest, most expansive and most distressing concern that we on this side of the House have. I would suggest that reassurances from the Minister of Health are just not enough for Canadians. To say, “Oh, trust me” is kind of akin to that old saying, “I'm from the government and I'm here to help”, which we all know is a difficult pill to swallow.

There was another interesting thing that, in our limited time, we did learn in committee. There were two experts. One was actually there in person and one was on Zoom, and they were both touted as Canada's experts on pharmacare. I was glad they were not in the same room, as we never know what might have happened, but that being said, the most fascinating thing was that, even though both of them are experts on pharmacare, neither one of them was actually consulted on the bill. They did not give any input whatsoever on how the bill should come to be, what should be in it or what should not be in it, and for me that is somewhat distressing.

Another somewhat distressing thing that is referenced in the bill is the committee of experts, the group that would be put forward to decide exactly which medications and which devices would be covered. Again, there are several amendments related to that. Things such as regional representation and professional representation were once again simply dismissed by the NDP-Liberal costly coalition. That creates significant problems for us on this side of the House, and it is exactly why we believe we need to be here this evening. When we know it is not a plan, not a blueprint, but is a plan perhaps to create a plan, that again creates distress on behalf of Canadians.

We know that people value the private coverage they are fortunate enough to have at this time, and we know that employers are happy to offer those benefits to their employees as a condition of their employment. Sadly, about a million people do not have coverage for medications. We on this side of the House believe there could be better ways to give them that than offering the pharmacare idea.

When we begin to look at the state of health care in this country at the current time, we know there are problems with the system we have. When one cannot access primary care, it is incredibly difficult to have a lab test done, to see a specialist or to have a diagnostic imaging test done. I say it is difficult because what happens is that people end up going to emergency rooms and urgent care centres to have some routine things done or even to have their prescriptions refilled. When we begin to look at that, in the words of former Canadian Medical Association president Dr. Katharine Smart a couple of years ago, the system is actually on the brink of collapse.

If anything, in the last couple of years we know that things have become even worse. There are now approximately seven million Canadians who do not have access to primary care, which means, as I mentioned, that they have to go to urgent care centres or emergency rooms, or go without care, which is the worst state of affairs.

Some of the other estimates would say we are 30,000 physicians short in this country. When we graduate about 3,200 every year, it seems almost an impossibility to make up the shortage. I always to try to help Canadians understand it. It is kind of like having a car that does not have any wheels on it, but wanting a new stereo in it, which is not terribly helpful. It is perhaps not a great analogy but it is something to try to help Canadians understand what is going on.

The other part is that we know that wait times in the system, if one is so fortunate enough to be able to access it, are the longest they have been in 30 years, three decades. If one is fortunate enough to have a family physician, the wait time for having specialist care is over 27 weeks, six months. We know that people on waiting lists are dying. Somewhere between 17,000 and 30,000 people are dying every year waiting for treatment in this country. The system itself is in absolutely poor shape and falling apart.

The difficulty we also see, again, is government members' being champions of photo ops. They talk about their dental program, which has significantly disappointed many Canadians. We now know that provincial dental associations are taking out ads warning people about the extra costs and the lack of ability to find a dentist.

Liberals promised a $4.5-billion Canada mental health transfer, which has never come to fruition at all. They promised affordable housing, and we know they are building less housing than before. They promised $10-a-day day care, and of course one cannot access it.

What we have is a government that is great at announcements and very bad at actually making anything happen. We know, on this side of the House, that Bill C-64 needs significant amendments and significant debate. On behalf of Canadians, we need to be incredibly cautious with how we are spending other people's money.

Speaker's Ruling

[The Assistant Deputy Speaker, NDP, Carol Hughes]

There are 13 motions in amendment standing on the Notice Paper for the report stage of Bill C-64.

Motion No. 7 will not be selected by the Chair as it requires a royal recommendation. Motion No. 13 will not be selected by the Chair as it could have been presented in committee.

All remaining motions have been examined, and the Chair is satisfied that they meet the guidelines expressed in the note to Standing Order 76.1(5) regarding the selection of motions in amendment at the report stage.

Motions Nos. 1 to 6 and 8 to 12 will be grouped for debate and voted upon according to the voting pattern available at the table.

I will now put Motions Nos. 1 to 6 and 8 to 12 to the House.

The House proceeded to the consideration of Bill C-64, An Act respecting pharmacare, as reported (with amendments) from the committee.

Business of the House

[Steven MacKinnon, Liberal, Leader of the Government in the House of Commons]

Mr. Speaker, my daily attempts to reach out to opposition members and improve the efficiency of the business of the House are always rebuffed out of hand. The Conservatives would rather filibuster, raise totally fake questions of privilege, and use all sorts of delay tactics in the House to prevent the government from passing measures that are going to help Canadians in their daily lives.

Despite it all, I will continue to reach out to opposition members to make sure that the business of the House takes place efficiently.

This evening, we will deal with report stage of Bill C-64 respecting pharmacare. Tomorrow, we will commence second reading of Bill C-65, the electoral participation act. On Monday, we will call Bill C-64 again, this time at third reading stage.

I would also like to inform the House that next Tuesday and Thursday shall be allotted days. On Wednesday, we will consider second reading of Bill C‑61, an act respecting water, source water, drinking water, wastewater and related infrastructure on first nation lands.

Next week, we will also give priority to Bill C‑20, an act establishing the public complaints and review commission and amending certain acts and statutory instruments, and Bill C‑40, the miscarriage of justice review commission act, also known as David and Joyce Milgaard's law.

Department of Health—Main Estimates, 2024-25

[Mark Holland, Liberal, Ajax, ON]

Madam Chair, first of all, for Dylan and Kim, I appreciate the member's advocacy. I cannot imagine how difficult that circumstance is, and that is exactly what we want to shut down. This is precisely why we are acting on pharmacare.

One very important question we have is about which model to use. We have a pilot in P.E.I. that is working very well, which is based on a fill-in-the-gaps model. The model that Bill C-64 is based on is a universal model. We are now looking at those two models in a real-world setting to see which one is best to use as a delivery mechanism for all drugs. We have a committee that will be looking at that over the next year, which will really paint that path forward.

These are very active matters of consideration, and this is one of the reasons it is so important that we establish that bedrock, which is the legislative foundation for pharmacare in Bill C-64, and take this action. In this way, we can make sure that we get to help families such as that of Dylan and Kim. That is envisioned in Bill C-64, and very much in my heart and in my mind as we are working on this.

[Mike Morrice, Green, Kitchener Centre, ON]

Madam Chair, I need to move to the next question.

My next question is on a concerning limitation in Bill C-64 brought to me by a senior in my community. The bill, of course, is designed to provide coverage for specific prescription drugs and products intended for contraception and the treatment of diabetes. My concern and that of this constituent is that critical equipment to administer medication and monitor blood sugar levels for people with diabetes, like real-time continuous glucose monitoring devices, is not included. Instead, the Health Canada website states, “the federal government is announcing its intention to establish a fund to support access to diabetes devices and supplies.”

Glucose monitoring devices cost between $2,000 and $6,000 per year and are a crucial part of diabetes management. While providing insulin is an important measure and the Greens support it wholeheartedly, I am concerned that this senior is still on the hook for hundreds of dollars a month for this essential tool in managing her diabetes, even with the passage, once we get there, of Bill C-64.

Will the minister commit to establishing this fund to ensure that glucose monitoring devices required by diabetics will be covered across the country, and if so, by when?

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Madam Chair, the question was regarding Bill C-64.

Can the Minister of Health tell us if Bill C-64 would provide for any government funding for any ailments other than diabetes?

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Madam Chair, would Bill C-64 provide for any government funding for any other rare diseases?

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Madam Chair, would Bill C-64 provide for government-funded asthma medications?

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Madam Chair, would Bill C-64 provide for government-funded ALS medications?

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Madam Chair, to the Minister of Health, would Bill C-64 provide for government-funded heart medications?

[Chris Bittle, Liberal, Parliamentary Secretary to the Minister of Housing]

Mr. Speaker, I will be speaking for a bit before I direct some questions to the ministers.

No Canadian should have to choose between paying for prescription drugs or putting food on the table. Unfortunately, many are still forced to make this impossible decision. It is why our government continues to work with provinces, territories and stakeholders to ensure that Canadians have better access to the drugs they need. Today, I will be providing an overview of some of the work by first highlighting our latest announcement, which presents a significant step forward towards national pharmacare.

On February 29, the Minister of Health introduced Bill C-64, an act respecting pharmacare, which proposes the foundational principles of the first phase of a national universal pharmacare plan in Canada. Bill C-64 describes our government's work with provinces and territories to provide universal single-payer coverage for a number of contraception and diabetes medications. In parallel to this, our government announced its plans to establish a fund to support Canada's access to supplies that people living with diabetes require to manage and monitor their condition and administer their medication, such as syringes and glucose test strips. These are impactful initiatives that can positively change the lives of millions of Canadians.

For example, coverage for contraceptives will mean that Canadians of reproductive age, which is nearly one-quarter of Canada's population, will have better access to contraception and reproductive autonomy. This access will improve equality, help reduce the risks of unintended pregnancies and improve a woman's ability to plan for the future.

Cost has been identified by Canadian contraceptive care providers as the single most important barrier to access these medications. Bill C-64 would ensure that Canadians will have access to a suite of contraceptive drugs and devices.

Similarly, one in four Canadians with diabetes have reported not following their treatment plan due to cost. Improving access to diabetes medication will help improve the health of almost four million Canadians living with diabetes and reduce the risk of serious life-changing health complications. These complications include permanent effects to the health and well-being of a person with diabetes, such as heart attack, stroke, kidney failure, blindness and amputation.

This bill also demonstrates our government's commitment to consulting widely on the way forward, including the need to work with provinces and territories, indigenous peoples and other partners and stakeholders. It includes four principles that the Minister of Health is to consider when collaborating with partners towards the implementation of national pharmacare. They are accessibility, affordability, appropriate use and universal coverage.

Bill C-64 would also provide that the new Canadian drug agency would work towards the development of a national formulary developing a national bulk purchasing strategy and supporting the publication of a pan-Canadian strategy regarding the appropriate use of prescription medications. It would also require the Minister of Health to establish a committee of experts to help make recommendations on the operation and financing of national, universal single-payer pharmacare in Canada. Together, these elements would inform the next key steps towards a national, universal pharmacare in Canada, building on the work already under way.

The work under way already includes the previously mentioned Canadian drug agency. The creation of the CDA was announced in December 2023 with an investment of over $89 million over five years. Built from the existing Canadian Agency for Drugs and Technologies in Health, and in partnership with provinces and territories, the CDA will provide the dedicated leadership and coordination needed to make Canada's drug system more sustainable and better prepared for the future in helping Canadians achieve better health outcomes. Engagement with provinces, territories, partners and stakeholders will continue to be an important part of the agency's path forward.

In addition, our government launched the first-ever national strategy for drugs for rare diseases, as announced in March 2023. This investment of up to $1.5 billion over three years will help increase access to and the affordability of drugs for rare diseases, with the aim of improving the health and quality of life of people living with rare diseases across the country. As part of this strategy, our government will create bilateral agreements with our provincial and territorial partners to make up $1.4 billion over three years, with a focus on improving access to new emerging drugs that treat rare diseases. We will also support better access to existing drugs and activities directed at improving screening and early diagnosis for rare diseases. The aim of these efforts is to help people living with rare diseases across Canada obtain earlier access to treatments and a chance at a better quality of life.

Our government is now working with provinces and territories on these bilateral agreements, starting with jointly determining a small set of new and emerging drugs that would be cost-shared and covered in a consistent way across the country for the benefit of Canadians living with rare diseases. I am also excited to share with members an update on the excellent progress we are making with the Government of Prince Edward Island to improve access to medication for island residents.

Similar to the work under way for the drugs for rare diseases strategy, our work with P.E.I. will also inform the advancement of national pharmacare. Under the improving affordable access to prescriptions drugs program with P.E.I., those who experience the most vulnerability, including uninsured island residents, seniors, and families with a high burden of medication costs, have seen immediate benefits, including improved access to medication and reduced copays.

Through this partnership, which includes a federal investment of $35 million, P.E.I. has expanded access to over 100 medications to treat a variety of conditions, including heart disease, cancer, and MS. Last June, P.E.I. also reduced copays to $5 for almost 60% of medications regularly used by island residents. Under their seniors' drug program, the family health benefit drug program, the generic drug program and the diabetes drug program, this program has led to island residents saving $2.5 million in out-of-pocket costs so far.

Speaking to our efforts more broadly, we continue to work on regulatory innovation, including agile licensing for drugs to better support drug oversight, both before and after the sale, due to the evolving market. These updated regulations will improve safety, support economic growth, and benefit both Canadians and industry.

In closing, no one should struggle with paying for the prescription drugs they need. Our government will continue to work with provinces, territories and stakeholders on the pharmacare initiatives I have outlined and continue to work with parliamentarians in passing Bill C-64. By working together, we can realize our goal of achieving national pharmacare, which will benefit all Canadians.

My first question is directed to the Minister of Health. Before I was elected to this place, I was the chair of the board of an incredible organization, Quest Community Health Centre. I know, as the Minister of Health knows, that community health centres look to what is missing in communities to fill a void. One of those things in St. Catharines and, of course, across the world, although we can only help in our little corner, was the lack of access to dental care. The staff at Quest, led by Coletta McGrath and Jenny Stranges, was incredible. They were able to build a team of volunteer dentists and hygienists who came in to provide care for those who had not had treatment in decades, who use the emergency room as their dental care. Some would say that they would be a burden on the system, but they were just trying to get pain relief.

I was able to get messages, as the chair, from people who were grateful for having received this service, who could smile again, who could go to job interviews, who could smile with their grandchildren. It is shocking that the Conservatives would deny this to Canadians

I was wondering if the Minister of Health could outline what the government is doing and what the progress of our dental care plan is. I do not need him to respond in the time allotted. I was hoping he could provide an update on the dental care plan.

Request for Office of Speaker to be Vacated—Motion That Debate Be Not Further Adjourned

[Peter Julian, NDP, New Westminster—Burnaby, BC]

Madam Speaker, my comments are definitely relevant because today's debate is derailing all the discussions on Bill C-64, which has just been tabled in the House at report stage.

Does my colleague think that there is a connection between the Conservative Party's and the Bloc Québécois's determination to block this bill and the fact that these two parties always want to debate the topic that we are debating today?

Health

[Sean Casey, Liberal, Charlottetown, PE]

Mr. Speaker, I have the honour to present, in both official languages, the 19th report of the Standing Committee on Health, which is in relation to Bill C-64.

The committee has studied the bill and decided to report the bill back to the House with amendments.

Because of the importance of this legislation and because of the programming motion that referred it to our committee, the level of effort given by the support team from the House of Commons and the Library of Parliament was absolutely commendable. I wish to sincerely thank them for our being able to present the report in such a timely fashion today.

[The Chair, Liberal, Sean Casey]

We'll have a recorded division on CPC-22, please.

(Amendment negatived: nays 6; yeas 5 [See Minutes of Proceedings])

CPC-22 is defeated.

The next amendment is BQ-1.

Bill C-64, An Act respecting pharmacare, authorizes the Minister of Health to make payments to a province or territory if an agreement has been entered into with that province or territory. The amendment provides for payments from the minister to the province or territory, even if no agreement has been entered into. House of Commons Procedure and Practice, third edition, page 772, states, “Since an amendment may not infringe upon the financial initiative of the Crown, it is inadmissible if it imposes a charge on the public treasury, or if it extends the objects or purposes or relaxes the conditions and qualifications specified in the royal recommendation.”

In the opinion of the chair, the amendment seeks to alter the terms and conditions of the royal recommendation and could impose a new charge on the public treasury. Therefore, I rule this amendment inadmissible.

[The Chair, Liberal, Sean Casey]

That brings us to CPC-20.

Bill C-64, an act respecting pharmacare, authorizes the Minister of Health to make payments to a province or territory, if an agreement has been entered into with that province or territory, in order to increase any existing public pharmacare coverage. The amendment seeks to broaden those payments to provide Canadians with public pharmacare coverage, which would have the effect of extending payments to a new group of Canadians not already covered by the royal recommendation.

As House of Commons Procedure and Practice, third edition, states on page 772:

Since an amendment may not infringe upon the financial initiative of the Crown, it is inadmissible if it imposes a charge on the public treasury, or if it extends the objects or purposes or relaxes the conditions and qualifications specified in the royal recommendation.

In the opinion of the chair, the amendment proposes a new scheme, which would impose a charge on the public treasury. I therefore rule this amendment inadmissible.

That brings us to CPC-21. This is going to sound familiar to you.

Bill C-64, an act respecting pharmacare, authorizes the Minister of Health to make payments to a province or territory if an agreement has been entered into with that province or territory. The amendment provides for payments from the minister to the province or territory, even if no agreement has been entered into.

As House of Commons Procedure and Practice, third edition, states on page 772:

Since an amendment may not infringe upon the financial initiative of the Crown, it is inadmissible if it imposes a charge on the public treasury, or if it extends the objects or purposes or relaxes the conditions and qualifications specified in the royal recommendation.

In the opinion of the chair, the amendment seeks to alter the terms and conditions of the royal recommendation and could impose a new charge on the public treasury. Therefore, I rule the amendment inadmissible.

That brings us to CPC-22. Shall CPC-22 carry?

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Thank you, Mr. Chair.

For over five hours we have had to listen to the multiple interventions of filibustering by our NDP colleague there. If you believe our colleague, he has the medication to make everything better. The NDP are the saving grace for our country, apparently. That's what Mr. Julian is saying, which I have to disagree with vehemently.

It's interesting. We're debating CPC-13, and the line is “make progress on providing universal coverage of pharmaceutical”. I believe we're probably the only party that's talking about providing universal coverage of pharmaceuticals, because Bill C-64, as we have talked about tonight, is truly only about providing access to contraception, as well as providing medication for those struggling with or living with diabetes.

It is a common-sense amendment. It's one of 43. Sadly, we only got to CPC-13 because of the interventions and the filibustering of our NDP colleague who, every chance he got, made sure.... He could not put any amendments forth to try to make this bill any better, which is deeply disappointing. I know him to be a decent man, but he sure likes to hear himself talk. I hope Canadians were paying attention to that.

There's no doubt that he will probably try to get a little bit of extra time in after I cede the floor, Mr. Chair. I'm imploring you to please.... We've had enough of his interventions. For over five hours we have had to listen to him. It's deeply disappointing, because we could have got to more of the CPC amendments. There are over 43.

I want it on the record that Conservatives rolled up their sleeves and got to work on this, while our NDP and Liberal colleagues said that they were not going to do it. All we have heard is rhetoric from our colleague down the way, who has tried to block any of the common-sense amendments that the CPC put forth in good faith.

They told Canadians in the House during debate just to trust them and they would get this bill: “Let's let Conservatives and the House pass this bill to get it to committee and we will do good work.”

Well, there was one party that came to work tonight—

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

With pleasure, Mr. Chair.

Here, once again, what we see is the original clause stating, “provide universal coverage of pharmaceutical products across Canada”. It's an aspirational goal; it's just not the truth. I think we've heard this resounding over and over and over again, and the reasoned argument that we have presented is that in Bill C-64, clause 4 will be amended by replacing line 30 on page 3 with the following “(d) make progress on providing universal coverage of pharmaceutical” products across Canada.

You know, Chair, I think it important again that this is about having Canadians understand that transparency and sunny ways are something that, at the current time, very sadly for Canadians, do not exist with this NDP-Liberal coalition government. What we are seeing is a lack of transparency.

They are spending money at the risk of insulting drunken sailors. To say that they are spending money “on behalf of Canadians” is in line with the problems that they have already created. We've heard the number of people who are living in food insecurity because of the spending of this NDP-Liberal costly coalition. Then what do they say? The statistic is that 26% of Canadians are going without food. Those are mostly parents who are going without food so that their children can eat. They're skipping meals, going to food banks, etc. They have food insecurity so that their children can eat.

What do we see now? We see that the government that created this problem is going to swoop in and save Canadian children by creating a national school food program. Well, let's be honest. If they hadn't created the problem in the first place, such that Canadians couldn't afford to feed themselves, they wouldn't have to create a national school food program.

This is like if I have a prosthetic business and I remove one of Mr. Doherty's legs, and then I sell him a prosthesis. It's not a funny analogy. It's something that's shared between Mr. Doherty and me. I apologize for being rather graphic, but it just makes no sense. It's like I rammed into his car when I have a car business, and I sell him a new one. I mean, I am creating a problem for him and then selling him the solution. Canadians who are no longer ready to be fleeced by the costly coalition know what lies at the heart of the spending addiction that this government has.

The cost of mortgages has doubled. The cost of rent has doubled. The number of homeless encampments is beyond imagination.

You know, it's always interesting to be in the House of Commons and listen to question period without answer. Folks ask, “Well, back when Pierre Poilievre was the minister of housing, how many houses did he build?” He didn't have to build houses, because there wasn't a housing crisis. The federal government didn't have to step in or didn't have to try to step in, as they have tried to do now, and they have failed miserably by building fewer houses and spending more money. The economy of the country worked in the way that it was imagined to work, such that people who are house builders were building houses. Permits were granted by municipal governments, and Canadians had money in their pockets that allowed them to afford to pay their mortgage. Interest rates were not out of control, while now they are rising the most rapidly that they have in the last 40 years.

In the economic situation that has been created by this costly coalition, they have the audacity to say that they will step in and solve your problem, even though it's a problem that they have created.

You can't afford your medications. What we heard some of the testimony talking about was that Canadians are choosing between eating and paying for their medications. Well, if the cost of food wasn't so high, then they could pay for their medications. If the leader of the NDP's brother were not a lobbyist for Metro, then maybe the cost of food would be less.

If we didn't have a carbon tax, the dreaded tax on everything.... I know that Canadians have heard this before, but it bears repeating. If you tax the farmer who grows the food and the trucker who ships the food, then the people, like all of us who buy the food, are going to have to pay more.

As we see that cascading effect, then we know that is where the problem lies. It's the spending addiction. It's the $10-a-day day care program, again, that can't be delivered. We know there are not spots out there for Canadian working families in which both people have to work because of the costly coalition and the cost of everything. They are unable to find a day care spot for $10 a day.

Again, they have the.... I can't even explain it. They have the anti-Midas touch. It's not that things turn to gold; it's that things turn to something else in a very different colour when they touch them, which again doesn't allow people to have appropriate access to the things they need in this country.

Allowing the costly coalition to create another costly program for two medications, two conditions, in this country would be a significant jeopardy. To go on and again suggest that this is more than what it is, which is what line 30 is suggesting with “providing universal coverage of pharmaceutical” products.... This is not doing any such thing.

I know that every other time we have brought this up, pointing out that all of the testimony was directed exactly towards contraceptive pills and devices and diabetic medications and devices, this costly coalition today has voted it down, because they do not want Canadians to know that what they are attempting to create here is very limited in scope and does not fulfill the needs of all Canadians.

Further to that—I'll say it again—this does not mean that Conservatives are against medications or against contraceptives or against the good health of Canadians. That is not what this means. What it means is that the way they are going about it, without transparency, without accountability and with the background of spending money foolishly on things like consultants.... We're seeing hundreds of millions of dollars being spent there that could be spent elsewhere. I clearly outlined previously the money that was wasted on the Medicago fiasco—half a billion dollars—and now we have the Novavax fiasco at another $130 million, with a recurring cost of $17 million to Canadians without anything at all to show for it—nothing.

It's not their money they're spending. It's our money. This is our money. What we're asking for is accountability and transparency, and we're telling the truth and pointing out that what is happening is not the way they're portraying it. This is about contraceptives and diabetes medications. That's what this is about. This is not a universal pharmacare program in which it doesn't matter where you go. You probably won't even have to show a card, if everything's free. You just have to have your prescription—boom, everything is free.

Nothing is free. There's no such thing as a free lunch. This is coming out of the pockets of every Canadian. With the amount of debt and the debt servicing costs that are happening now in this country, the debt servicing costs are more than $1 billion, with a “b”, every single week—every week—which, sadly, we know is more than the Canada health transfer. It is more than that because this Prime Minister of the costly coalition believed that interest rates would never go up. Of course, there's the infamous quote that budgets balance themselves.

We know that this costly coalition continues to have an ongoing deficit spending position, which was never the expectation of any government in the history of the free world. That's not their expectation.

Folks out there listening, think of it from your own perspective: If you're making $500 per week and you're spending $600 per week every single week, then it becomes very difficult—

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Thank you, Mr. Chair.

It's nice to have the floor after having to sit for almost four hours, listening to our NDP colleague filibuster every one of the CPC amendments. He likes to point fingers, and say the CPC are filibustering, but in reality we're the only party that put forth any amendments to this bill.

I will challenge Canadians that whenever a bill comes forward, it is the opposition's job to review pieces of legislation. As the government always says, “Let's not let perfection get in the way of progress.” It says, “Just trust us. Let's get it to committee, and we will work with all parties to make this bill better.”

The Conservatives rolled up their sleeves. If Canadians have been listening in for the last four hours, they will see that we have put forth some common-sense amendments, non-partisan amendments, that would make this bill clearer and more concise and would tell Canadians all about Bill C-64.

Unfortunately, after every discussion regarding the CPC amendments, our colleague from the NDP wants to filibuster. He goes on and on and on, and blames filibustering for four hours on Conservatives. I would assume... Well, pardon me; I won't say “assume”. You never want to assume anything. However, I would bet, Mr. Chair, that our colleague from the NDP will probably raise his hand and want to filibuster my intervention for the remaining minutes of this committee meeting.

What's sad is that the NDP had an opportunity, with its coalition, to really make something that would be beneficial for so many Canadians. Instead, it bowed down to its Liberal colleagues in the coalition. It's desperate to try and keep the Prime Minister in power, instead of fighting for Canadians and a true pharmacare program.

Mr. Julian spoke about his constituent who had cardiac issues. I spoke about my former constituents who succumbed to a terrible disease, ALS. There are millions of Canadians struggling because of the lack of access to a pharmacare program or affordable drugs. The NDP did not fight for a true pharmacare program; it settled on contraception and diabetes. Ultimately, we are left with a two-bill drug that really doesn't include any other Canadians who—

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Let's be very clear: The reason our colleague from the NDP is voting no is because he's been told by his coalition that this is the way they want it. This is the way that he is to vote with respect to any CPC amendment. It's the same old, same old that we hear time and again when it comes to legislation that we've been told time and again in the House...

The government tells you, “Just let it get to committee, and we'll work in good faith. Amendments will be taken in, and we'll work with great collaboration with all parties to get this bill right.” Look where we are today with a piece of legislation that really isn't... It's being called pharmacare. It really isn't pharmacare.

This is the line that we're talking about, so that Canadians are fully aware of what we're talking about here. It is page 3, subclause 4(a), and the last sentence reads “in a manner that is more consistent across Canada.” What is being proposed is “that is more consistent across Canada, in order to avoid a patchwork of care”.

The whole argument that we hear from our colleagues down the way is that there are millions of Canadians who do not have... There are some who do have care. They have programs and access to medications. There are some Canadians who don't. For me, that would be a patchwork of care that we're experiencing and that Canadians are experiencing. If you want to believe what our colleagues are saying, the government is trying... Bill C-64 is all about making sure we're eliminating the patchwork of care. Why not put that in the bill? It's no different from what we said earlier on.

We talk about the heart medication. We have cardiac patients and constituents who have cardiac issues. Our colleague from the NDP has brought up a number of times that his constituent faces $1,000 per month because of the patchwork of care that we have in our country, yet he still didn't negotiate, when he was sitting at the table with his coalition partners, to have cardiac medication in here.

There is another rare disease that was not mentioned here. I don't believe it was mentioned in any of the testimony either. It's ALS, and thousands of Canadians are afflicted with this horrible disease. I remember one of my constituents who was struck down at the age of 28. He was a soldier with our Canadian Armed Forces. “The best of the best”, his commanding officer said. At the age of 28, with his future right in his hands, Deane Gorsline was struck down with ALS. He lived the remainder of his life much like my former employee, Brett Wilson, who passed away last August, nine months after his dad Rick passed away from ALS as well.

After their diagnosis, both Rick Wilson and Deane Gorsline lived the remainder of their days fighting for Canadians who were struck with ALS. They were better people than I am. They turned their attention to ensuring that the next Canadians who would be diagnosed with ALS had access to those drugs that could prolong their lives, in the hope that they could walk back the impacts of that terrible disease.

We don't have a rare disease strategy in this country. When we talk about this national pharmacare plan, that's what our colleagues suggest Bill C-64is, and it does none of this. It doesn't provide greater access for those Canadians who are struggling with rare diseases such as ALS.

I think about that when we're talking about this bill. Due to the size of our country, and in some cases the comparatively small population of Canadians who are afflicted with certain diseases, Canadians struggle to have access. Pharmaceutical companies will not look at Canada in a favourable way to provide access for the small groups of Canadians who are afflicted with such illnesses as ALS. They are forced to lobby and forced to do whatever they can, even though their days are limited before this terrible disease takes over.

It is absolutely horrific to see and watch. I think about cancer patients within our country for whom this bill does nothing in terms of access to more medications and treatments. If it was a true pharmacare bill, we should have noted that. Maybe it would have been brought up. It's disappointing. This CPC-11 is a non-partisan amendment that simply clarifies, or adds to the line, and again, I'll read it out. After “in a manner that is more consistent across Canada”, it simply adds, “in order to avoid a patchwork of care”, which is exactly what we're talking about.

Mr. Julian's got his hand up, so he'll continue his NDP filibuster in the next little bit here, and he'll go on and on about how Conservatives are ragging the puck and filibustering this bill, but at every chance, he's on that speakers list, Mr. Chair, speaking as much as Conservatives members.

With that, Mr. Chair, I will cede the floor so that we can get to the vote on CPC-11, unless Mr. Julian wants to continue his filibuster.

[Peter Julian, NDP, New Westminster—Burnaby, BC]

Thank you, Mr. Chair.

I'll note that the Conservatives have allowed one amendment to be voted on in three hours. Thousands and thousands of dollars of committee time have been devoted to this study, and the Conservatives' filibuster blocking this legislation, as they have been blocking it since February 29, has meant that Canadian taxpayers, folks who are working hard trying to make ends meet, have seen thousands of their tax dollars going into a filibuster to block legislation that is going to help people.

I want to address the national bulk purchasing strategy, because it is true that Canadians pay more, and they pay more because of Conservative government decisions to extend patent protection. It was a beautiful sweetheart deal by a former Conservative government that extended patent protection so that Canadians pay unbelievably high drug prices. It was Conservatives who caused that, and instead of saying, “Gee, we're sorry, Canada. We apologize for everything we've done to wreck your access to medication”, we have Conservatives filibustering the next step, which is having a national bulk purchasing strategy that, through universal single-payer pharmacare, would allow us to bring the cost of those drugs down.

When New Zealand did the same thing, Mr. Chair—and I know you're aware of that—the cost of some drugs went down by 90%. Not only does this bill, Bill C-64, enhance Canadians' ability to access medication—diabetes medication and contraceptive medication and devices—but by putting in place a national bulk purchasing strategy, it also allows us to start what other countries have already found, which is, rather than paying massive prices and extending patent protection to the pharmaceutical industry with the huge costs that has entailed—it's made huge profits, and lobbyists are happy—having a national drug purchasing policy that will allow us to follow the lead of countries like New Zealand that have reduced the cost by 90%.

What this Conservative amendment, CPC-9, proposes to do is stop that, freeze it in place and not allow the bill to move further so that we can have in place a national drug purchasing strategy that goes beyond diabetes and contraceptives. I oppose this.

It's been three hours. Conservatives have allowed one amendment to come to a vote. I wish they would stop doing this, as it's not in the interest of their constituents or of any Canadians for them to continue as they have since February 29 in blocking this legislation.

[Daniel MacDonald]

The pan-Canadian Pharmaceutical Alliance acts on behalf of all of its members, all provinces and territories in Canada, and, in doing, so coordinates the purchase for their public drug plans, and, indeed, some federal drug plans are a part of that as well. It has the ability to conduct those price negotiations.

Bill C-64 authorizes the minister to seek advice from Canada's drug agency in its position as having expertise in the field to guide the development of advice to support that future conversation among decision-makers about how there might be improvements that could be realized. It doesn't commit that they would be adopted. It merely supports the development of advice to support a conversation.

[Daniel MacDonald]

There are two parts there. First, this does not create a new role for Canada's drug agency in the realm of price negotiations. I want to be very clear about that.

The bill sets up a future conversation about the future of pharmacare. Now, as part of that, the bill sets out that the minister may request advice from Canada's drug agency on two elements to develop expert advice to support that conversation.

One of those two pieces is to guide the development of advice on where Canada might go in terms of realizing improvements in its price negotiation strategy today. The reason for that is that previous advice by expert panels—I'm referring specifically to Hoskins—on how pharmacare might work have always pointed to the savings that would be realized from coordinated, negotiated drug acquisition. That's the element that Bill C-64 refers to: the development of the advice or further understanding about how and where that might work. It is not intended to be a reference to the existing activities of the pan-Canadian Pharmaceutical Alliance at all.

[Daniel MacDonald]

Not at all. What the national bulk purchasing section of Bill C-64 refers to is—I'm just seeking a term here—more improvements in the existing price negotiation steps that are taken in the pharmaceutical management system in Canada today: Where might improvements be sought? How might that be affected?

It's intended to be an expert-guided conversation, and Canada's drug agency is suited to guide that conversation, but it is not intended to be in any way a replacement for the pCPA. I just want to be clear about that.

[Daniel MacDonald]

That sounds better.

No, that is not at all what I was suggesting. I was simply stating two parts of the response to the question.

The first is the existing coordination of price negotiation that provinces and territories have set up through the existing pan-Canadian Pharmaceutical Alliance, and I was simply distinguishing that from the advice the minister, under Bill C-64, would be seeking from Canada's drug agency to suggest a future development or a move forward. My remark was not intended in any way to suggest there would be a replacement of existing activities; it was just about supporting the discussion among provinces, territories, indigenous peoples and other partners and stakeholders about where to go next and what improvements might be made.

[Daniel MacDonald]

With respect to what Bill C-64 commits to, which is the generation of advice, upon request, to the minister, that would not be being continued, because it doesn't exist yet.

Request for Office of Speaker to be Vacated

[Lindsay Mathyssen, NDP, London—Fanshawe, ON]

Madam Speaker, it is a pretty critical point in the legislative agenda that has come up.

I agree with the Bloc Québécois member and her argument that there are many bills we would like to discuss.

I appreciate that this is a critical time right now. We have a lot of legislation that we need to discuss in the House, legislation that our constituents have sent us to this place to get through. It is serious things that are so important, such as Bill C-49, Bill C-59, Bill C-70 and Bill C-64. We have two opposition day motions just this week. We are trying to deliver the help that Canadians so desperately need, including through legislation like the fall economic statement, which the official opposition has filibustered at committee for months and which is something that would deliver a great deal of support in terms of housing.

Something I am particularly proud of as a part of that piece of legislation is actually the removal of the HST on psychotherapy and counselling services. It is something that would help those who are working within that profession, and something that I actually had a conversation about just yesterday with a psychotherapist who asked me when we would be getting the legislation passed. I said we are working on it and trying to make sure it goes through. The person I spoke to needs the fairness for the removal of the federal tax to occur. She spoke to me about how important it was for her clients to have equality within the services that are provided to them. We know, of course, that we are in a mental health crisis and that every bit of assistance helps in that regard. That is one piece of legislation that the official opposition has filibustered at the committee.

There are, of course, amendments to the Newfoundland and Labrador and Nova Scotia accord act that we need to get through. There is the foreign interference act, which is of course becoming more and more important as we move through this parliamentary session.

I do not know how many times New Democrats have to talk about how incredibly important pharmacare is. We certainly know that the official opposition does not believe that. I think about the millions of Canadians who rely upon that piece of legislation to help them afford the medications they need, diabetics in this country, and I believe there are 3.7 million of them, who need the legislation to go through so they would not have to worry about the cost of their diabetes medications and devices. So many constituents have written to me thanking me for moving that forward.

Those are the key pieces of law that we need to get moving in the House. Yes, we are sitting until midnight most nights to do that. New Democrats believe in that absolutely because it is for people that it is important. There is an opposition party determined to delay every single one of the bills. Time again, the Conservatives have obfuscated, filibustered, screamed and yelled in outrage and then attempted to delay and stall all of that progress, all of those supports. I find it unacceptable.

The fact is that what the Conservatives are now calling out, in terms of their outrage, is that the Speaker seems to have been caught up in supposed partisan activity that clearly was not of his doing. He did everything he was supposed to do, ran through the permissions that he was supposed to get, and yet mistakes were made. The partisanship that the Conservatives are so outraged about actually fuels their own partisanship fire of trying to find yet some other thing that they can hold on to, so much so that it will delay again all of the incredible supports that we need to get to people.

I see this every day, whether I am at the procedure and House affairs committee or here in the House. The Conservatives are desperate to cling on to anything they can, and destroy whatever we are trying to do in the process, to show that this place does not work, because that fits into their communication strategy. I am sorry, but I am not going to allow something to fit into their communication strategy to disrupt what needs to happen for my constituents.

The member across the way for Winnipeg North did quote the letter, but I want to mention it again. We are here, in this case, over a tweet that was sent out by the Liberal Party without having consulted the Speaker. The letter is very clear. It is from the national director of the Liberal Party, apologizing very clearly to the Speaker. It states, “The Liberal Party of Canada unequivocally apologizes to you for this mistake, and we take full responsibility.”

Was there a mistake made? Absolutely. Is it horribly unfortunate? Absolutely. Are we punishing the right person in this instance? No. Should there be more vigilance on this issue? Absolutely, of course. However, calling for the Speaker's resignation is clawing to the communication strategy that benefits one group. It does not benefit the entire House. I do not agree with that. We on this side of the House do not agree with that.

We have to work on the legislation that the people have sent us to work on. We have a very important job, and I have no time for all of the bickering and squabbling. Canadians need this place to work. They need us to get to work. We can make this all about ourselves or we can make it about them. Canadians deserve that. New Democrats want to help deliver the supports they need. The work is urgent, and the official opposition just wants to delay. That is all I have to say on this matter.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thanks very much, Chair, and thanks to my colleague.

You know, it's interesting. I had been hopeful after my colleague Mr. Doherty and I started off this round with a couple of short, rational comments for accepting the amendment we had proposed. It was, without much in the way of partisan rhetoric, simply to point out realistically that this bill does not talk about other medications. I guess I should be aghast, but probably not now, that a four-page bill, if you take out the preamble, is what this NDP-Liberal coalition thinks a pharmacare bill should look like after 10 hours of witness testimony.

The other part of that interesting witness testimony was having Dr. Morgan and Dr. Gagnon here. Everybody heard their testimony. As interesting as it may have been, the two of them, thankfully, were not in the same room. One was virtual and one was here, but they were both billed as Canada's leading experts on pharmacare. We know that neither one of them had any input into this bill. They had none. It was zero. These were two Canadian experts on pharmacare, who touted the incredible benefits of pharmacare, of what it could be, and what it should be, etc., and what we hear is that they had zero input.

People around the table may think that's normal, and that this is not how a government works. They wouldn't reach out to Canada's leading experts on pharmacare. No, what would they do? Quite frankly, I have no idea what they did. I would suspect that they dreamt up this pharmacare pamphlet of four pages somehow in-house. Sadly, people are going into pharmacies now and asking for their free medications.

We know that this bill does not exist. We also know that there is no possibility anywhere in the near future of this coming into being, in the sense that there is an incredible bureaucratic framework that now exists to continue the creation of the Canada drug agency and the phase-out of the CADTH and the creation of this heretofore unknown council of experts, or whatever the bureaucratic name is. We don't know where they're coming from or who they are.

Maybe two of Canada's leading experts in pharmacare will be on that council of experts. However, again, that council of experts is not there to make this bill better; it is to actually decide which diabetes and contraceptive medications will be on a formulary. The formulary doesn't exist, even though, as I mentioned previously, two lists came out that say these are the medications that will likely be within the scope of the pharmacare pamphlet. That is not transparency.

Those are not sunny ways. That is not allowing Canadians in any way, shape, or form to begin to have an understanding of Bill C-64.

The government may have aspirational goals, which is fine. Everybody should have goals for themselves that they set and re-evaluate, but to pretend that this is anything but an idea... As one of my colleagues once said, “This is out there telling Canadians you have built a house for them that you're going to give to them for free, when realistically you haven't yet consulted with the architect.” Here it is, “We've built your house, but we really have no plan.”

We're now going to have arguments from the NDP-Liberal coalition, suggesting this is a fully completed house, and this will be a comprehensive plan when it's all done. Sadly, on behalf of Canadians, we would implore the acceptance of the amendment, because we know the truth: There is no transparency here and there are no sunny ways here.

The other difficulty, of course, is our NDP colleague talking about the last 17 years. Well, it's fascinating that the ghost of Stephen Harper lives deep in the heads of the NDP-Liberal coalition, rent-free forever.

I wish I had a nickel for every time I heard them mention Mr. Harper's name. It's in a disparaging way, of course, even though we know the average rents since the Harper government left have doubled and the average mortgage payments have doubled. The inflationary cost of interest rates has literally put Canadians in the poorhouse, if there were such a thing.

It's fascinating to me that the NDP part of the NDP-Liberal costly coalition wants to go on and talk about how difficult things have been for the last 17 years. Canadians know that now, more than ever, there's no chance for the NDP to ever form any government in this country. Sadly, the late Jack Layton probably took them as close to the promised land as they're ever going to get. Certainly with the way things are going, the promises they're making, the difficult coalition and the hole they've dug for themselves, I would suggest they're going to be like Moses: They're going to see the promised land, but they're never, ever going to get there.

When we talk about the cost of things and how difficult it is for Canadians, again, this government really is quite fascinating in the sense that it has this strange idea that after it's created a problem for Canadians, it wants to bill itself as the saviour to come in and free Canadians from the bondage it has created. We know its fiscal irresponsibility is one part of that.

Looking at the government's fiscal irresponsibility, I would challenge Canadians out there today to think about the money it spent on vaccine factories in this country.

First, we had the vaccine partnership with the Mitsubishi Tanabe group, which came here with a plant-based vaccine. Because it was based on the nicotine plant, the World Health Organization said it would be very difficult to use it. Also, because Philip Morris International, a major tobacco player, was involved with the development and ownership of that company, the World Health Organization said that in no way, shape or form could that vaccine potentially be used on the world market. That was because of the association with Philip Morris International.

What happened after that? Well, in this fiscal irresponsibility, as I'm pointing out, Philip Morris got out of the whole Medicago-Mitsubishi Tanabe partnership. The Canadian government continued, while working, strangely enough—and I'll come back to this, because I think it's germane and important—in the face of the national microbiology lab scandal, when two scientists were released from the national microbiology—

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

It's hard for me to chime in after I've missed the majority of the debate and discussion on this bill, but let's call it for what it is. It is being billed as pharmacare, but it really is not pharmacare.

A national pharmacare program implies that Canadians will be able to receive any drugs they are looking for. Further to what Dr. Ellis said, this piece of legislation really deals with just two main areas of concern: contraception and diabetes. They are two very important topics and issues that Canadians face and are dealing with.

If you've read the common-sense amendments that have been put forth by our Conservative colleagues, they say we call it what it is. Let's not mislead Canadians. I think it's important that we, here at this committee.... I've said this all along: We do some of our best work in Parliament at committees, but it calls for common sense from all of us. The work we do here will be reported to the House, and then at that point, Canadians will know what Bill C-64 entails.

I don't think there's any requirement for us to bill this as anything other than what it does: It's a funding framework for certain prescription drugs and related products intended for contraception, for the treatment of diabetes, and to support....

It's not just this bill, but others. We struggle in this House at times to get common sense to come into play. This is just a common-sense amendment that our colleague Dr. Ellis has put forth.

I support CPC-7.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Sure. Thanks, Chair.

I move that Bill C-64, in clause 3, be amended by replacing lines 1 to 3 on page 3 with the following:

“3 The purpose of this Act is to create a funding framework for certain prescription drugs and related products intended for contraception or the treatment of diabetes, and to support”

It continues on from there.

[The Chair, Liberal, Sean Casey]

I call this meeting to order.

Welcome to meeting number 118 of the House of Commons Standing Committee on Health.

Before we begin, I would like to ask all members and other in-person participants to consult the cards on the table for guidelines to prevent audio feedback incidents. Please take note of the following preventative measures in place to protect the health and safety of all participants, including the interpreters. Use only a black approved earpiece. The former grey earpieces must no longer be used. Keep your earpiece away from all microphones at all times. When you're not using your earpiece, place it face down on the sticker placed on the table for this purpose. Thank you all for your co-operation.

Pursuant to the order of reference adopted by the House of Commons on Wednesday, May 22, 2024, the committee is commencing its clause-by-clause consideration of Bill C-64, an act respecting pharmacare. I'd like to provide members of the committee with a few comments on how the committee will proceed with clause-by-clause consideration of Bill C-64.

As the name indicates, this is an examination of all the clauses in the order in which they appear in the bill. I will call each clause successively, and each clause will be subject to debate and a vote. If there is an amendment to the clause in question, I will recognize the member proposing it, who may then explain it. I would like to remind committee members that pursuant to the order adopted by the House on Wednesday, May 22, all amendments had to be submitted to the clerk of the committee by 4 p.m. on Friday, May 24. As a result, the chair will allow only amendments submitted before that deadline to be moved and debated. In other words, only amendments contained in the distributed package of amendments will be considered. When no further members wish to intervene, the amendment will be voted on. Amendments will be considered in the order in which they appear in the package of amendments.

In addition to having to be properly drafted in a legal sense, amendments must also be procedurally admissible. The chair may be called upon to rule amendments inadmissible if they go against the principle of the bill or beyond the scope of the bill, both of which conditions were adopted by the House when it agreed to the bill at second reading, or if they offend the financial prerogative of the Crown.

Amendments have been given a number in the top right-hand corner to indicate which party submitted them. There is no need for a seconder to move an amendment. Once an amendment has been moved, you will need unanimous consent to withdraw it.

During debate on an amendment, members are permitted to move subamendments. Approval from the mover of the amendment is not required. Subamendments must be provided in writing. Only one subamendment may be considered at a time, and that subamendment cannot be amended. When a subamendment to an amendment is moved, it is voted on first. Then another subamendment may be moved or the committee may consider the main amendment and vote on it.

Finally, pursuant to the order adopted by the House, if the committee has not completed the clause-by-clause consideration of the bill by 8.30 p.m., all remaining amendments submitted to the committee shall be deemed moved. The chair shall put the question forthwith and successively without further debate on all remaining clauses and amendments submitted to the committee, as well as each and every question necessary to dispose of the clause-by-clause consideration of the bill, and the committee shall not adjourn the meeting until it has disposed of the bill.

I thank the members for their attention and wish everyone a productive clause-by-clause consideration of Bill C-64.

I would also like to take this opportunity to welcome our witnesses, who are available as experts regarding any questions that members might have related to the legislation. You will recognize them. From the Department of Health, we have Michelle Boudreau, associate assistant deputy minister, strategic policy branch, and Daniel MacDonald, director general, office of pharmaceuticals management strategies, strategic policy branch.

We will now move to clause-by-clause study. Pursuant to Standing Order 75(1), consideration of clause 1, the short title, and of the preamble is postponed.

The chair therefore calls clause 2. Since there are a few amendments to clause 2, the definitions clause, I would suggest, based on advice from the legislative clerks, that we postpone the study of clause 2 until the end. This will allow us to first consider and then make a decision on amendments that could have an impact on the definitions.

As a reminder, the definitions clause of a bill is not the place to propose a substantive amendment to a bill, unless other amendments have been adopted that would warrant amendments to the definitions clause.

For clarity, as an example, there is an amendment—CPC-2—that proposes to add a definition for “Indigenous governing body”, but as of right now, the words “Indigenous governing body” do not appear in the bill. Therefore, by postponing clause 2, we can determine whether or not to put those words in the bill. That would dictate whether or not it is appropriate to assign a definition in the legislation.

I'm asking for your consensus to postpone clause 2 until the end. Is that the will of the committee?

I see consensus. Thank you, colleagues. That will make things move more smoothly.

(On clause 3)

The first amendment for clause 3 is CPC-7. It is on page 7 of the package, and it stands in the name of Dr. Ellis.

Dr. Ellis, would you like to move CPC-7?

[Dr. Steven Morgan]

Yes, I'll be quick.

There are minor amendments to clauses 4 and 6 of Bill C-64 that would probably suffice to make sure that even though this is just like baby steps, the pilot project for implementing Hoskins' recommendations, if you make a couple of key amendments, you can genuinely say that this legislation is actually going to do what Hoskins said.

For instance, clause 4 of Bill C-64 reads, “The Minister is to consider the following principles”. I think the Conservative members of this committee pointed out that this is unusual language. It should say, “The Minister shall apply the following principles”. That's important language.

In proposed paragraph 4(d), it reads, “provide universal coverage of pharmaceutical”, but the Hoskins council was very clear that it should be universal single-payer, first-dollar public coverage. There's language there that could be improved and clarified.

As was discussed yesterday at this committee, this bill should define what is meant by “single-payer”, “first-dollar” and “public coverage”. Those are terms that are very clearly defined in the Canada Health Act, which would be the analogous act to Bill C-64 in terms of establishing principles that all provinces and territories should aspire to in delivering these things. There are a few changes there.

Similarly, in clause 6, where it talks about the kind of coverage that should be implemented, it should be very clear what we're talking about. As the Hoskins council recommended and as many other commissions have recommended, the program should be universal, single-payer, first-dollar and public. That word needs to be there.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you, Mr. Chair.

I thank all the witnesses for joining us today.

We're well into Friday afternoon. I know that it's past four o'clock, and most of the amendments have probably already been written down and passed on, but I want to emphasize the fact that this bill will go through clause-by-clause on Monday. It will be sent back to the House. We will have the opportunity to debate it, and then it will go to the Senate. That will present more opportunities for us to highlight areas where we could strengthen it.

I'm going to focus most of my questions on Dr. Morgan. I noticed that you were patiently waiting and that a number of times, you wanted to intervene. You were not given the opportunity, so I'm going to dedicate all my five minutes to you.

You were very complimentary about the Hoskins report. You also said that if certain elements are considered in the design, then this bill, Bill C-64, would be a good starting base for us to introduce pharmacare.

If I get up next week in the House and debate those areas on third reading, using Hoskins as a base and saying, “Hey, look, this is the reality of Bill C-64; this is the base in Hoskins, and these are the three areas I want to focus on to make sure this bill is strong”, what would those three areas be?

You have all the time you want before the chair stops you.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Morgan.

Thank you, Mrs. Roberts.

The last round of questions for our examination of Bill C-64 will come from Mr. Jowhari for the next five minutes.

[Anna Roberts, Conservative, King—Vaughan, ON]

I'm sorry to cut you off, but I do have limited time.

My concern is that Bill C-64, in its current state, does not give specific enough information to ensure that this plan will benefit Canadians. Unless I misunderstood you, that's what I took from your statement.

[John Adams]

We hear many concerns and criticisms of the version of the model proposed in Bill C-64, and I've heard additional criticisms from my fellow panellists today. We're hearing mixed messages about whether this is such a good idea or not, as proposed.

As the parent of two sons and two daughters, I care about sexual reproduction and sexual health all the way around. Also, as I used to be prediabetic and am no longer, I care about medicines for diabetes. The drug that turned me from a prediabetic into a non-diabetic is not on the list as proposed by the Minister of Health at the moment. Those are specific examples. There's a great deal of uncertainty.

Also, in previous government initiatives at the federal, provincial, territorial and indigenous levels, there have been unanticipated or unintended consequences. Therefore, you should make haste slowly. I think the bill is a useful start, but this legislation is in need of improvement and has many opportunities to be improved.

[Maxime Blanchette-Joncas, Bloc, Rimouski-Neigette—Témiscouata—Les Basques, QC]

Thank you, Mr. Adams.

I'm glad you acknowledged that distinction, which, as you know, goes beyond pharmacare. We could definitely conduct another study on that subject alone, but I'm not sure it would be in the Standing Committee on Health. But we'll have that discussion at a later date.

Mr. Adams, you say in your brief that no patients in Canada should lose the drug coverage they currently have with a private plan as a result of the reforms and programs under Bill C-64 and that the changes made must not leave patients in a worse situation than before the reforms were introduced.

Would you please explain your concerns to us?

[Yasir Naqvi, Liberal, Ottawa Centre, ON]

I want to come to Dr. Norman. Thank you for being here and bringing the perspective of Action Canada to this conversation.

On the same theme of cost savings in the health care system, can you talk about what kind of impact we can see from having universal access to contraceptives, which is contemplated in Bill C-64?

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you very much.

Dr. Morgan, I'll turn to you. The other thing is that often we've heard in the last couple of days testimony related to the length of time it takes a medication to get on formularies on behalf of Canadians, often thousands of days. We have Health Canada, PMPRB, CDA, CADTH and pCPA, etc. It would appear to me that it would also have been a good idea in this Bill C-64 to add some oversight of those agencies, specifically the newly formed CDA.

Do you think that would be of benefit here, or do you have some other ideas around the necessity to get drugs to market on behalf of Canadians?

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you for that.

Through you, Chair, to Dr. Gagnon, were you involved in the drafting of Bill C-64?

[Dr. Steven Morgan]

I was not directly involved in developing this piece of legislation or the bill at all.

I've worked with government and advised different people within the bureaucracy and government over many years, but I was not involved in drafting Bill C-64.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you very much, Chair.

Thank you to everyone for being here.

It's certainly with interest that we'll pursue this next round of questioning.

I don't want to start a fight between Dr. Gagnon and Dr. Morgan, because your bios both say that you're Canada's leading expert in pharmacare systems. It's a good thing you're not both in the room. It might be interesting.

That being said, I'll start with you, Dr. Morgan.

You've written 150 papers about pharmacare and how to implement it. I'm interested to know how much consultative time you spent with the government on this Bill C-64.

[John Adams, Board Chair, Best Medicines Coalition]

Mr. Chair and health committee members, thank you for the invitation to be a witness at these historic hearings regarding pharmacare for Canadians.

Our Best Medicines Coalition represents 30 patient organizations, from Parkinson's, arthritis, hemophilia and blindness to cancers and other complicated and rare diseases. Together, we represent the interests of millions of patients and their caregivers.

I'm happy to have moral support from JK Harris of the Canadian Breast Cancer Network and one of our member organizations, who's here today. Thank you very much, JK, for being here.

BMC's aims are simple.

Number one is to fix the postal code lottery by ensuring all patients have access to the medically necessary medicines they need and ensure patients are meaningful participants in the development and oversight of pharmacare policies.

We at BMC recognize that Canada is the only developed nation with a universal health insurance system that does not include universal coverage for prescription drugs used outside of hospitals. This gap results in disparities within and among provinces, territories and indigenous jurisdictions where individual programs provide varying levels of drug coverage. This is what we call the postal code lottery.

As a result, one in 10 Canadians reportedly do not take their prescribed medications due to out-of-pocket costs. This highlights significant inequities in access to necessary medications. Up to 7.5 million citizens—one in five Canadians—don't have prescription drug insurance, have inadequate insurance to cover their medication needs or do not enrol when eligible.

Cost and coverage aren't the only problems.

Here's the bad news for anyone in the Ottawa bubble: Sixty-four per cent of Canadians believe that the federal government is not transparent enough about its health care policies. This lack of transparency erodes public trust and hinders the effective implementation and uptake of health initiatives.

Then there's data. Inconsistent reporting and lack of transparency in health data hinder the measurement of performance and outcomes, decrease opportunities for identifying gaps in data and services, and impede the capacity of the health system to integrate patient voices.

There's also a lack of representation of patient voices within governments and government-funded organizations in generating and implementing drug policy. One result is a health care system that is less responsive to patient needs. This can potentially compromise the quality of care and lead to a disconnect between patient expectations and the care provided.

In addition, existing complicated patient pathways cause significant stress and anxiety for patients and their caregivers, potentially exacerbating health conditions and leading to worse health outcomes. Thirty per cent of Canadians experience difficulties in navigating the existing health care system, leading to significant delays in receiving necessary medical attention. Changes in pharmacare must not create new barriers to innovations to address the unmet needs of patients.

The involvement of patients should be done with more than an expedited and truncated consultation on such a foundational expansion of the social safety net of Canadians. Patients should be built into the programs and the structure, not just with an occasional consultation. For example, patients—and that's plural—should be on the board of the Canadian drug agency.

We have eight friendly recommendations for amendments to the bill. I'm right at the clock, so if somebody could do us a courtesy, we'd love to have those eight submitted. They're in our written submission.

I want to highlight two key points of patient interests.

First, create a chief patient officer at Health Canada. Second, create a patient ombudsman who reports directly to Parliament. Only MPs and senators can make this ombudsman role come to life.

The chief patient officer at Health Canada would work within the organization. It should be someone with lived experience whose role gives them authority to ensure that the patient experience and expertise is recognized and used to drive reform and improve patient outcomes. This person should further be supported by an advisory committee with diverse patient representation, which this legislation doesn't quite contemplate yet.

The patient ombudsman would work outside the organization and report independently to Parliament. Besides reporting on any failures to uphold the act and regulations, this ombudsman would also assess barriers and concerns as expressed by patients when it comes to accessing medications and would recommend changes.

These amendments to Bill C-64 would enable and reinforce transparency and accountability. It's not enough for any government to say that they want universal access to medications. Bill C-64 should speak to the role patients must take in improving equitable access to medications.

With your questions, I'd be pleased to go into detail on all eight of the proposed amendments we suggest to better support patients.

The Best Medicines Coalition calls on Parliament to do its best for Canada's patients. On behalf of all patients, nothing about us without us.

Thank you.

[Dr. Wendy Norman]

Thank you.

I'll just say, then, that adolescents and people whose insurance is held by a parent or a coercive partner are in a particularly difficult situation and much less likely to access coverage if they need it.

There are few investments in health that have the potential to offer both health system savings and improved equity and health equity for children and families. Bill C-64 would support improved health for people throughout Canada.

I apologize, Mr. Chair, for going over the time.

[Dr. Wendy Norman, Public Health Agency of Canada Chair, Family Planning Research, Action Canada for Sexual Health and Rights]

Thank you, Honourable Mr. Chair and members of the committee. Thank you for the opportunity to speak today to your study of Bill C-64.

I am a family doctor and a UBC professor, and I have had the honour to serve for the past decade with the Public Health Agency of Canada as the chair for Canada for family planning research. I'm the co-chair on Statistics Canada's expert committee for sexual and reproductive health. I have worked with Health Canada to advance several of the programs within the sexual and reproductive health themes over these past several years, and as a long-time collaborator with Action Canada for Sexual Health and Rights.

There are two points I hope to bring expertise and experience to and highlight for you today. The first is that universal access to free contraception to prevent unintended pregnancy will support immediate, lifelong and intergenerational impacts for individuals and families, and society as a whole, that improve health and health equity throughout Canada.

Secondly, our modelling in Canada and examples in practice across the globe indicate that universal, comprehensive, single-payer, first-dollar coverage of contraception is required to address the needs of people at risk of unintended pregnancy. In Canada, 40% of pregnancies are unintended, and contrary to what you might expect, most unintended pregnancies result in unplanned births. The devastation of facing an unintended pregnancy and managing whatever outcome can have lifelong and intergenerational consequences not only for that pregnant person and their partner, but for the unplanned children and the children and other relatives already in the home.

The most comprehensive, most effective contraceptive methods have the highest upfront costs. The least expensive contraception has the highest rates of unintended pregnancy. In the case of longer-acting contraception, such as implants and intrauterine devices, which are our most effective methods, the cost can be over $400 up front. For many, this need for contraception conflicts with the money they need for rent or food. Due to their much higher effectiveness to prevent unintended pregnancy, however, those same “most expensive” methods have the lowest overall cost for government.

More effective contraceptive methods offer families a better and safer start for their planned and appropriately spaced children, while supporting family members to pursue advanced education, to better their opportunities, to contribute to the workforce and our economy, and to service their communities. In contrast, people unable to afford to manage their own fertility face lower educational achievements, lower household income and higher exposure to intimate partner violence. Their children, in turn, suffer lower rates of food safety, adequate shelter and graduation from high school.

Through a Canadian Institutes of Health Research-funded, UBC-led study from 2015 to 2019, the Government of B.C., Action Canada and a wide range of our collaborators modelled the cost effectiveness for prescription coverage in B.C. We found that among people who experienced unintended pregnancy and sought abortion, only about 30% had access to any form of subsidy for contraception, and the contraception cost was the factor most related to those subsequent unintended pregnancies.

For over two years, we worked with the B.C. government on variations of patchwork contraception coverage and compared them to comprehensive coverage through the modelling process. We looked at all kinds of models to address specific gaps. In every case, as soon as we moved from universal, comprehensive, first-dollar, single-payer systems, the rates of unintended pregnancy went up and the overall health system costs went up.

With a model of universal coverage, the B.C. government most effectively reduces unintended pregnancy while lowering overall health system costs by over five dollars for each resident of the province each year.

Evidence from health systems around the world indicate that a universal, first-payer prescription subsidy, rather than partial, fill-the-gap coverage is required to support health equity. Analysis after the institution of the U.S. Affordable Care Act determined a savings of over seven dollars for each dollar invested in contraception and contraception counselling. Similarly, Public Health England has found it's saving nine pounds for each pound it spends on universal prescription contraception.

An important factor here is that contraception is a stigmatized prescription. This is particularly true among equity-deserving populations and those in our society who face the most intersectional barriers. Our study found that reproductive-aged people, and particularly women at the ages of highest fertility, are the least likely to have stable, full-time jobs providing prescription benefits.

In fact, in analyzing the impact of the new B.C. policy for free contraception, we found that prior to its institution, 40% of those who bought contraception had to pay out of pocket completely, and another 20% had private coverage that required copayments. This isn't even looking at all of the people who weren't able to access contraception at all because of cost. Once B.C. implemented their policy, these out-of-pocket costs decreased to less than 10% of those accessing contraception.

We know that among those—

[Dr. Steven Morgan, Professor, School of Population and Public Health, University of British Columbia, As an Individual]

Thank you.

I'm an economist and professor of health care policy who has studied pharmacare systems for 30 years. I have published over 150 peer-reviewed research papers on related topics, and I serve on the World Health Organization's technical advisory group on pricing policies for medicines. I have no financial ties to commercial interests in this sector, and I have no have financial ties to health professionals, unions or other groups who also take an active interest in this file.

I am here simply because I wish to help Canada develop the institutional capacity necessary to fairly and efficiently provide access to necessary medicines in a very complex sector that involves some of the world's most powerful corporate interests and very serious, truly global challenges regarding the reasonableness and transparency of pricing.

I want to start by saying that we do not need another study of whether or how Canada should implement a national pharmacare program. These questions have been thoroughly investigated by four separate inquiries since the mid-1990s. All of these inquiries have recommended that carefully selected, medically necessary prescription drugs be included in Canada's universal single-payer public health insurance system.

The latest of these studies, the June 2019 report of the advisory council on the implementation of national pharmacare, was conducted by a council of experts from across the country and chaired by Ontario's former health minister, Dr. Eric Hoskins.

The Hoskins council, as it is known, consulted with provinces and territories. It consulted with first nations. It consulted with patients, health professionals and other stakeholders in the sector. It consulted with Canadians from coast to coast. It concluded with a detailed and feasible plan for implementing a universal single-payer public pharmacare program that would save Canadians billions of dollars every year while improving access to medicines from coast to coast and reducing strains on our health care system.

The foundations of Bill C-64 are backed by thorough discussion and analysis. I believe Bill C-64 can, if the government actually wishes to do so, move us toward the fair and efficient pharmacare system that has been recommended by commissions time and time again.

However, as it is written, Bill C-64 will not do this. This is because it does not make absolutely clear what type of pharmacare program the bill would establish. This ambiguity in Bill C-64 allowed the Parliamentary Budget Officer to conclude that the system that would be created would be a fill-the-gaps pharmacare system involving a patchwork of literally thousands of private and public drug plans. Indeed, even the Minister of Health testified yesterday that he would create such a program with the powers that Bill C-64 would give him.

This would be disastrous for Canada because patchwork pharmacare systems inject needless and costly inefficiencies into the system. They impose significant inequitable financial burdens on individual households and employers, they diminish a country's purchasing power on the global market for pharmaceuticals and they isolate the management of medicines from other key components of the health care system.

It would be especially problematic to have for-profit insurers involved in the core of a national pharmacare system. This is something that only the United States permits. It is problematic because insurers can actually profit from higher drug prices through higher administrative fees charged to plan sponsors. They can also profit by pocketing secret price rebates that they can and do negotiate with drug manufacturers and pharmacies.

If the first stage of national pharmacare is allowed to be a fill-the-gaps program involving a mix of private, public, for-profit and not-for-profit insurers, subsequent stages of national pharmacare will almost certainly be locked into that model too.

If, contrary to the recommendations of its own advisory council on the topic, the government wishes to implement a fill-the-gaps system, then it can leave Bill C-64 as it is, because that is what this legislation will deliver. In this case, the NDP should understand that their supply and confidence agreement has been broken.

If, on the other hand, the government does indeed wish to implement the recommendations of its own advisory council on this topic, then it must amend Bill C-64 to set out crystal clear standards for a national program that will prove that Canadians are, in fact, stronger together. That is what Canadians deserve, but as the bill is currently written, that is not what Bill C-64 will deliver.

Thank you.

[The Chair, Liberal, Sean Casey]

I call the meeting back to order and welcome our final panel of witnesses.

In accordance with our routine motion, I'm informing the committee that all remote participants have completed the required connection tests in advance of the meeting.

Joining us for this panel as individuals are Dr. Marc-André Gagnon, associate professor at the school of public policy and administration at Carleton University, and Dr. Steven Morgan, professor at the University of British Columbia, who is appearing by video conference. On behalf of Action Canada for Sexual Health and Rights is Dr. Wendy Norman, Public Health Agency of Canada chair of family planning and research. From the Best Medicines Coalition, John Adams is the board chair.

We're going to invite you to offer opening statements of five minutes in length.

Before we do, I will remind everyone that if they want to submit amendments for Bill C-64, the deadline is in 25 minutes, as was pointed out at the start of the meeting.

We're going to proceed now with opening statements in the order listed on the notice of meeting, so we're going to start with Dr. Gagnon for five minutes.

Welcome to the committee, Dr. Gagnon. You have the floor.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Chair.

My question goes to JDRF.

Yesterday we heard from Heart and Stroke that more than 600 people in Canada die every year from ischemic heart disease because they cannot afford their medication. We also heard testimony from a type 1 diabetes patient, Mr. Bleskie, who said that insulin is not a luxury; it's a necessity. We also heard that they have to pay $1,600 a year per patient, so there is a lot of savings from this legislation.

Ms. Diniz, from our work on the framework, we know how important this legislation in front of us is to all patients and their families.

What are you hearing from the young type 1 diabetes patients and their parents? What expectations do they have from the committee when it comes to Bill C-64? Can you explain that?

[Brendan Hanley, Liberal, Yukon, YT]

I will quickly go to you, Mr. Williams.

You have a very interesting background from your experience with Innovation Canada, with Research Canada and with a political career.

I don't have time to go over the preamble but, in this bill, we talk about supporting modernization of the health care system with drug data and improving coordination. We talk about the national strategy for rare diseases.

Is there room for improving collaboration and innovation within the context of Bill C-64? Do you see that there is potential there?

[Brendan Hanley, Liberal, Yukon, YT]

Thank you.

Ms. Eagan, I was intrigued by your comment in your opening remarks about updating the Canada Health Act. Then you mentioned the importance of, for instance, coverage for outpatient cancer therapies. We know how big of an issue that is. Have you done any analysis on what it would actually take to update it? Can you tell me a bit more about what your vision is?

I know that's outside of the scope of Bill C-64, but I am intrigued.

[Brendan Hanley, Liberal, Yukon, YT]

Thanks very much for everyone's testimony and for the range of expertise and expert opinion we have today. It's really welcome.

I've heard some, maybe, disparaging comments on the dental program. I just want to point out, on that note, that 100,000 Canadians have been served so far by the Canadian dental program, many for the first time. To me, this is a model of success, early success, of a great program. I think there are some things we can emulate with the proposed Bill C-64.

Mr. VanGorder, I want to go back to you. Thanks for appearing. I'm mesmerized by your backdrop, I must say. You wrote an editorial about pharmacare, and you talked about the successful collaboration between the federal government and P.E.I. in 2021. I wonder if you want to just comment briefly on that, on how that was a successful federal-provincial collaboration.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Bill C-64, except for diabetes medication and contraception, does not create a single-payer system. We don't know what the national pharmacare system is going to look like at the moment. It won't necessarily by the sounds of it be a single-payer system.

However, Ms. Eagan, in response to the idea of a single-payer system, you said this was wasteful because all Canadians would have to pay for it with taxes—which is true—but that, right now, many Canadians get it as a benefit from their employer.

It's not like that's free. That's part of your pay. You get paid a certain amount of money, but you get some benefits. It's a cost to the employer, and if the employer doesn't have to pay that cost presumably you would get more in your salary. If the government can have a system that is cheaper to run—and there is some indication that with a government-run system, a non-profit system, because of economies of scale, government could provide that system more cheaply than the employer could—that would be a net benefit to Canadians.

Would that not be the case?

[Peter Julian, NDP, New Westminster—Burnaby, BC]

Thank you, Mr. Chair.

Thanks to all the witnesses for being here.

Your remarks are interesting. You're giving us good information.

I'd like to go to you, Mr. Morin and Ms. Pelletier.

Pharmacists will definitely play a major role in the future of drug insurance.

Yesterday a large group of nearly two million Quebeckers, including members of the Centrale des syndicats démocratiques, the CSD, the Confédération des syndicats nationaux, the CSN, the Fédération des travailleurs et travailleuses du Québec, the FTQ, the Union des consommateurs, the Fédération interprofessionnelle de la santé du Québec and many other organizations, had this to say about the present situation in Quebec:

…the current Quebec drug insurance program can in no way guarantee all Quebeckers reasonable and fair access to drugs…“The various fees charged to drug purchasers are in fact copayments that have a deterrent effect: People skip doses or deprive themselves of certain drugs because they can't afford to buy them”…Furthermore, rising drug costs also put increasing pressure on private plans, leading workplaces to abandon their insurance and thus lose all their coverage.

These groups are calling for parliamentarians to pass Bill C-64.

You've obviously raised the matter of the formulary of drugs that will be covered. That aspect will be negotiated with the Quebec government. Other countries are fortunate to have universal, public drug coverage without any pharmacy closures.

Do you think it's important to ensure universal access to drugs that keep people alive and in good health, while being careful to negotiate repayment and to pay attention to how pharmacists are affected by this universal public system?

Is that the message you want to send today?

[Russell Williams]

At our meeting with the minister, those words were very reassuring because, when you take a look at the bill, there are a number of interpretations, which we heard about today, that cause a great deal of concern—excitement in some areas and concern in other areas—so the clarity from the minister is important. We did also talk about how the list that the government tabled is certainly not all-inclusive and doesn't reflect the clinical practice guidelines that Diabetes Canada creates with experts, and he assured us that this is a minimum list and one they'll start to work on. We supplied the committee members with a comparison between the clinical practice guidelines and the Bill C-64 list, as well as the NIHB list, which is a list of the government.

Ultimately, the care and management of diabetes is not one-size-fits-all. It's very individually focused, as you know. We have to make sure we build a program that will, on one hand, not just seem that there's a certain level of coverage but will actually be effective coverage for people with diabetes.

[Russell Williams, Senior Vice-President, Mission, Diabetes Canada]

Thank you very much, Mr. Chair and members of the committee.

Diabetes Canada has long advocated at the federal, provincial and territorial levels for improved access to medications, devices and services for the over four million people with diabetes. The goal of Diabetes Canada is to improve the quality of life for people living with diabetes.

Diabetes Canada applauds the government's intention to include diabetes medications and devices in the initial scope of the pharmacare plan. In fact, we see this as another step in building from the diabetes framework that was tabled last year.

Thank you, MP Sidhu, for your leadership in that.

However, there is an urgent and pressing need for those who are uninsured and under-insured. With broad consultation and careful implementation, this could represent a significant step toward reducing barriers. Providing comprehensive coverage and patient choice, continued improvement of care and a robust consultation system are our three key recommendations.

We recognize that there are significant gaps in coverage for some people living with diabetes. Our belief is that any public coverage should focus on addressing those gaps. As a first principle, we believe that government should focus on the uninsured and under-insured individuals, but the approach to diabetes management must also be comprehensive and align with Diabetes Canada's clinical practice guidelines. These guidelines are created by the country's experts and are one of the foundations on which physicians make informed decisions about patient care.

Unfortunately, the formulary that was tabled along with the law by the government is not aligned with the clinical practice guidelines or the NIHB program. It is limited in scope, excluding several key newer treatments while including older and outdated treatments.

We have produced a comparison of the proposed formulary of the CPGs and NIHB program. This document demonstrates that for many uninsured and under-insured individuals living with diabetes in Canada, most of the commonly prescribed medications would not be covered by the proposed plan. This is why filling the gap to focus on the uninsured and under-insured individuals to start with is so critical.

We met with the minister yesterday and he confirmed, though, that this list will grow and will move forward in terms of greater coverage.

We have to remember what we're talking about here, too. Let me underline the human reality. I know you all feel this. We're talking about the most vulnerable.

On our 1-800 line, which is open to all Canadians, we get a number of calls regularly from senior citizens who are choosing between rationing their drugs or going without. We get calls from people who are not taking the right amount of their medication because they can't afford it. Recently, we were getting calls about people concerned about their private insurance and whether they'd lose it during the transition to this law.

Again, we were assured by the minister, when we met with him yesterday, that people would not be shifted off their private insurance. These are two of the fundamental questions we had.

A further recommendation was the adoption of our principle of continued improvement and access.

Our CPGs have shown and new data continually indicates improvements to services, care and products. A pharmacare system must incorporate the principle of ensuring that new techniques and products that are more effective get incorporated into that plan when they become available. The system should actually welcome diverse approaches and creativity, including private insurance, while seeking universal coverage. Every province and territory has a distinct approach to its public formularies and pharmacare should be no different.

We already heard that Quebec's hybrid model is an interesting example and a good example to consider.

It's a universal plan, but it's mixed, both public and private.

We must ensure that all individuals do not lose access to drugs that they already have covered by private plans and are not included in the formulary. Unfortunately, we've seen examples of that issue in the past. Therefore, we are calling for a “do no harm” inclusion in the law to safeguard existing access to medications and ensure that persons living with diabetes can continue to access the latest treatments in care.

With these recommendations in mind, we believe that Bill C-64 needs a process of evaluation and practical analysis to ensure we set up the most effective system and ensure it's not just a debate about ideas, but a practical analysis for the effective system to improve access to medicines for people with diabetes.

We call for a more robust and transparent consultation process in the next steps of this law with people, patients, people with lived experience, health care providers, drug plan managers, researchers, provinces, territories and the indigenous communities.

We encourage parliamentarians to carefully ensure that this emerging national pharmacare delivers on its promise of improving access and ensures that no one gets left behind.

We appreciate the opportunity to share our ideas and are certainly open to questions.

Thank you very much.

[Jessica Diniz, President and Chief Executive Officer, JDRF Canada]

Thank you, Mr. Chair. I'm honoured to be here.

Good afternoon, members of the committee. My name is Jessica Diniz, and I'm the president and CEO of JDRF Canada.

JDRF is the world's largest charity focused on accelerating research to cure, prevent and treat type 1 diabetes and its complications, as well as helping to make life better every day for the people who live with it. We also advocate on behalf of the 300,000 Canadians living with type 1 diabetes, representing their voices on critical issues such as national pharmacare.

JDRF supports the goal of making access to medications and devices for treating and managing type 1 diabetes equitable and affordable for all Canadians. Patient choice needs to be a priority.

Type 1 diabetes is a lifelong autoimmune disease in which a person's immune system destroys insulin-producing cells in the pancreas, making them dependent on daily injections of insulin to survive. I just want to underscore that they require insulin to stay alive. I just want to make sure that is very clear.

Managing diabetes represents a significant financial burden for Canadians impacted by the disease, and many treatments and devices remain out of reach for some Canadians. We thank the government for bringing diabetes and the high cost to manage the disease into focus through coverage under Bill C-64.

While we align with the intention of Bill C-64 to provide fulsome, barrier-free access to treatments and devices for those living with diabetes, we'd like to raise a couple of recommendations to ensure that Bill C-64 meets the needs of all Canadians living with type 1 diabetes.

First, national pharmacare should not preclude anyone from using existing private and public insurance coverage to access insulin, whether they are listed on the national formulary or not. Bill C-64 should include a provision that clearly articulates this principle.

Second, based on consultations with health care providers and those living with type 1 diabetes, we'd like to see the list of insulins on the formulary be expanded to include more advanced insulins that help better treat the disease. It's a very limited list, including insulins that are rarely used and prescribed. It's important that physicians have therapeutic options to address the wide variation in individual patient responses to and tolerance of any particular drug, and that patients can access these, as one insulin may work well for one person and not for another. I think this is a very important point. By expanding the choice of medicines, you increase the number of treatment options available to help eliminate side effects, reduce complications and improve health outcomes.

We also have two areas of caution on how this program is implemented that we'd like to raise. Number one is changes in insurance coverage. The bill also creates a risk whereby the existence of the national formulary may motivate private insurers not to cover brand name insulins because some of the generic equivalents would now be available through the national pharmacare program. If this happens, the consequence could be the automatic substitution of a different insulin, which can impact health outcomes.

Another concern, number two, is stakeholder engagement and consultation. This will be critical to ensuring the implementation of a national pharmacare program that best meets the needs of Canadians living with type 1 diabetes.

JDRF is supportive of legislation that improves access to medications and devices for Canadians living with type 1 diabetes. We ask the government to provide clarity on this legislation to ensure it lives up to its intentions of equity and affordable access to medications and devices, and considers the input of various stakeholder groups that must have a voice now in how national pharmacare is rolled out.

It's critical to get the implementation of this legislation right to ensure it delivers on its promise, not only for those living with type 1 diabetes but for all Canadians who will benefit from this program in the future.

Thank you very much.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

We've heard from the Canadian Association for Pharmacy Distribution Management and the Canadian Organization for Rare Disorders. I think both of them sounded a note of caution about Bill C-64 being potentially a threat to access to drugs for rare diseases. Perhaps I'm not so surprised about that coming from Ms. Berg, but I am a little from Dr. Wong-Rieger.

Certainly, this bill does not create a single-payer system. We don't know as yet what national pharmacare would look like. Potentially, though, it would be a single-payer system.

I would have thought, particularly for Dr. Wong-Rieger, that there would be benefits with a single-payer system. I would have thought it would be more efficient. There are certainly cost savings to be had. There are certainly economies of scale in having one system. Right now, we have all these different providers. Each of these providers has its own management, and each of these managers and CEOs takes a bit of that money. This is money, in an employer-employee drug plan, that would probably otherwise be going to the employee. Instead it goes to the profits of the company providing the plans.

If you were to have one big plan administered by the government, you get economies of scale. There would be no money being siphoned off for profits, and there wouldn't be these many bureaucracies dealing with these different plans. There would be savings. In addition, if you buy 10 million pills at one time, you're going to get a better deal from a manufacturer than if you buy 100,000. If there was more money overall in Canada to buy drugs for everyone, wouldn't we then be able to afford drugs for rare diseases, which are often expensive?

Also, Ms. Berg, you were talking about shortages. Wouldn't we have money to provide for an emergency stockpile of medications, so we wouldn't have those shortages?

Perhaps I'll start with you, Dr. Wong-Rieger.

[Peter Julian, NDP, New Westminster—Burnaby, BC]

Thank you very much, Mr. Chair.

Thank you to our witnesses.

Ms. Silas, there is no doubt that Canada's nurses are the folk heroes of the pharmacare act. You'll recall three years and three months ago, we were working together on the Canada pharmacare act. It was a bill I sponsored on behalf of the NDP.

Canada's nurses did an extraordinary job. Some 120,000 Canadians wrote to Liberal and Conservative MPs to tell them to pass this legislation. We were all profoundly disappointed, as were most Canadians who supported pharmacare, that the bill went down to defeat with both Liberal and Conservative MPs voting against it.

Now, three years and three months later, you're testifying on behalf of the pharmacare act, which is extraordinary. You've sent a message to all parliamentarians. You wrote:

Passing this bill will help patients with diabetes and women who face the impossible choice between buying groceries and filling their prescriptions. This is not just a health care issue; it is a matter of fairness, equity and access. Investing in pharmacare will save lives, reduce overall health care costs and enable people in Canada to lead healthier, more productive lives.

We need you—

You are speaking to all parliamentarians:

—to act quickly and decisively. Your job is to protect and help build a public health care system that works for all people. Nurses across the country are doing their part, so put aside partisanship and let us make Pharmacare a reality.

That is an extraordinarily important message you're sending to all parliamentarians and to members of this committee.

I'd like you to tell us: What have Canada's nurses seen on the front lines with the lack of pharmacare, the lack of medication being available and people struggling to pay for their medications? What are some of the stories and the things that Canada's nurses have seen with the current system that lobbyists say are fine, but that Canadians want to see fundamentally changed?

[Linda Silas]

We all remember the 2019 report from Eric Hoskins. Dr. Hoskins and I were planning the pharmacare party, and then COVID hit.

I have to join you in congratulations to Dr. Wong-Rieger. I've been on many panels with Durhane. When I read the brief on Bill C-64, I was as excited to see rare diseases there, because 20 years ago, we weren't talking about it.

I believe that bureaucratic rules and obstacles shouldn't stop us from doing the right thing. We are improving health and we are improving the lives of Canadians with this bill. It's a door open, and we need to move on it.

[Dr. Durhane Wong-Rieger, President and Chief Executive Officer, Canadian Organization for Rare Disorders]

Thank you very much, honourable chair and members of the health committee.

Thank you for the opportunity to speak to you today. My name is Durhane Wong-Rieger, and I am the president and CEO of the Canadian Organization for Rare Disorders. I'm here to discuss Bill C-64 and, in part, its implications for the rare disease community in Canada.

I'd like to start, though, with a few facts that paint a bleak picture for Canadians with rare diseases. You may know that rare diseases affect over three million Canadians, the majority of whom are children. While most rare diseases affect children, we also know there are a significant number of adult-onset rare conditions that are being diagnosed.

Among the 7,000 known rare diseases, only 5% have an effective drug therapy. Unfortunately, one in three rare disease patients in Canada cannot access their treatments. In fact, only 60% of the treatments for rare disorders are made available in Canada, and most get approved up to six years later than they do in the U.S. or in Europe.

Even after the treatments are approved in Canada, many patients continue to face immense hurdles and delays in accessing new treatments due to the challenges related to the evaluation and funding of these medicines. When there are effective, available therapies, access can often be very challenging for patients. As you may know, they vary from one province to the other. As a result of these challenges, many patients experience an avoidable decline in functionality, and certainly many experience early death.

In an effort to respond to these challenges, on March 22, 2023, the federal government announced measures in support of Canada's first-ever rare disease drug strategy, including, at this time, a $1.4-billion investment for provinces and territories to improve access and affordability of rare disease medicines. This money had already been promised half a decade ago as part of budget 2019.

However, it's now been over a year since the funding announcement, and not a single penny has been spent to help fund rare disease drugs. While CORD supports efforts to improve access to medicine for all Canadians who need them, we're also concerned that the federal government has taken on another major commitment to fund a national pharmacare program when it hasn't even delivered on this promise to fund rare disease treatments—a promise that, as we said, was made over five years ago.

Notably, clause 5 of today's Bill C-64 would commit the government to long-term funding, beginning with products for rare diseases. We have to say it's unconscionable and unethical, and certainly really challenging for patients, to introduce a program designed to transform and save lives, and then fail to execute on it.

Moreover, given the lack of promised progress on rare diseases, what does that say in terms of the prospects for success of this pharmacare legislation? We need to see the prioritization for rare diseases in action. It was a promise made. When it comes to improving medicine access and affordability, CORD strongly believes that rare diseases represent the area with the greatest unmet need in Canada.

The federal government should focus first on rolling out the promised funding for rare disease treatments before undertaking another major pharmacare plan.

However, with respect to the bill itself, CORD has a number of comments. The predetermined categories, lists of medicines and proposed single-payer approach all risk limiting treatment options and potentially bringing everyone's level of coverage down to the lowest-common denominator. This is a concern.

Additionally, Bill C-64 outlines specific timelines for its key components, yet the rare disease drug strategy lacks a detailed implementation plan and time frame. The rare disease drug strategy must also be afforded clear timelines, publicly accountable milestones and opportunities for patient and clinical input. This is not in the current rollout.

Lastly, the formation of expert committees, as stated under Bill C-64, must ensure genuine advisory roles. CORD's experience with the current rare disease drug strategy implementation advisory group has highlighted significant issues with transparency, communication and accountability. Effective implementation of national pharmacare requires these committees to provide meaningful input, rather than service mere formalities.

I'd like to close by noting that Canada has an opportunity to become a leader in providing access to cutting-edge therapies that significantly impact patients' lives. We must aim high, ensuring that our national pharmacare program and the rare disease drug strategy deliver the best possible outcomes for patients with rare and common diseases alike.

Thank you very much for your attention. I'm open to any questions you may have.

[Linda Silas, President, Canadian Federation of Nurses Unions]

Thank you, Chair.

As mentioned, my name is Linda Silas and I'm the president of the Canadian Federation of Nurses Unions. As a nurse, I don't have to do what Angelique did and explain what we do. CFNU is the largest nursing organization in Canada. We represent over 250,000 unionized nurses and nursing students working everywhere, including in home care, long-term care, community care and acute care.

I'm so honoured to finally speak to you today on a bill that has been considered a leading priority for nurses for many years. It is a step towards a universal pharmacare program. CFNU has commissioned numerous studies and polls over the years to help build the case for the overwhelming merits of a public, single-payer pharmacare program in the country. You will be hearing from Dr. Marc-André Gagnon later on today, who was the author of one of our first reports.

There are many reasons why nurses support a public, single-payer pharmacare program: the positive health outcomes it would bring to our patients, the equitable access it would provide everyone in Canada, and the capacity it would free up in our health care system through avoidable hospital room visits and costs related to non-adherence to prescription drugs.

The latter point is the critical point I want to talk about today: the health human resources crisis. Each quarter, we witness the number of nursing vacancies rise to record heights across the country. Sadly, nurses are still working in our crippling system. We see patients unable to access their medications. They really should be at home, but they need to stay in our waiting rooms and hospital beds just to take their medications.

Members of Parliament, you have the power to change this today. We are thrilled to see Bill C-64 move ahead in the direction Canada's nurses have long advocated for. It is in sync with the recommendation of every major government study and commission on the matter, including the advisory council on the implementation of national pharmacare of 2019.

Ensuring universal access to contraceptives and diabetic medication and supply through a single-payer public system is a hugely significant improvement to our universal public health care system. It marks a fundamental step towards a truly comprehensive and universal national pharmacare program. Every day, nurses see first-hand the consequences of failing to provide equitable coverage for birth control and diabetic medication to our patients, from unwanted pregnancies to individuals who lack access to diabetic medications and supplies. They end up in our hospitals. This includes children and working Canadians. Patients divide their pills or go without them to buy food. This has to stop.

Canada's nurses have been lobbying parliamentarians like you for 30-plus years to move toward a universal national pharmacare program. Yes, it has to be single-payer and public, because that's what the evidence says is the best way to be fiscally responsible with our public dollars. That's what Canadians expect of us—to not have our health care services stop at a visit to the doctor or nurse practitioner.

Sadly, we are seeing many voices out there in support of the status quo. They say that Canadians are adequately covered by the patchwork system in place, and that a fill-in-the-gaps approach is the best way.

Nurses are motivated by the great care we can provide in this country. We say the best way to do that is through a universal public approach to prescription drugs. We urge you to follow 20 to 30 years of evidence, push ahead the passing of this bill and continue on the path of implementing a comprehensive, universal, national and public single-payer pharmacare program.

I stand proudly with all of you who will vote yes on Bill C-64.

Thank you.

[Angelique Berg, President and Chief Executive Officer, Canadian Association for Pharmacy Distribution Management]

Thank you, Mr. Chair and members of the committee. Thank you for your attention today.

I'm Angelique Berg, president and CEO at CAPDM, the Canadian Association for Pharmacy Distribution Management.

CAPDM is the nation's trade association for wholesale distributors that channel over 90% of the medicines our country consumes. With their trading partners, distributors form our efficient, accurate and reliable supply chain that ensures physical access to medicines, so naturally we support the aim of Bill C-64. We support both affordability and access in balance and not at the expense of one or the other.

Importantly, we recognize the enormous challenges that government and our citizenry face: slowed economic growth, regulatory overburden, health care system insufficiency and a growing percentage of the population over 65. I mention these to tell you that we're aware of the broader context, and we stand with you in navigating solutions where we can be of value.

To appreciate our comments relative to Bill C-64, I'll provide some basics about the supply chain because we rarely think about how our medicines get to us, just so long as they do.

The supply chain begins with manufacturers, who sell to distributors, who then sell to pharmacies and hospitals. Purchases flow the opposite way: from pharmacies, who buy from distributors, who buy from manufacturers. Rounding out that supply chain are service providers to this core supply chain, like third party logistics firms and transportation companies. The majority of Canada's pharmacy supply chain stakeholders are CAPDM members.

Distributors streamline orders and deliveries for 15,000 product SKUs between hundreds of manufacturers and over 12,000 points of dispensing over nine million square kilometres, creating efficiencies that save the country over $1 billion annually. Their safety stock also provides a short-term shortages buffer against drug shortages. The sector has over 30 distribution centres, all of which comply with at least three overarching acts, up to seven different Health Canada licences and very high technology to meet the conditions of all of those. The sector has roughly 20,000 employees—experts in inventory turnover and the secure and complex handling of all medications—and they are the backbone of our pharmacy supply chain.

Our market is challenging. It's a controlled market where funding is limited, yet operating and regulatory costs are not. Distribution is largely funded as a factor of the listed drug prices: The lower the price, the less funding is available to get medications to Canadians.

Costs have increased at least 2.5 times faster than volumes in the last five to 10 years, with market forces and increasing regulation. The gap is estimated at over $100 million annually, and distributors have so far absorbed that through eliminating expenses to stay in business and with only minimal impact to Canadians.

Assuming that it is striving for lower drug prices, we see that Bill C-64 has the potential to erode physical access and to exacerbate drug shortages. 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, which would be those of the lowest cost; reduce safety stock, which eliminates the buffer against shortages; or reduce delivery frequency to high-cost regions or eliminate them altogether.

CAPDM members are understandably concerned about some of Bill C-64, generally about reduced drug pricing and specifically about a restrictive national formulary, which was addressed in last evening's panel, and bulk purchasing. Evidence suggests that these types of policies limit suppliers. 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.

We recommend that this policy change be approached with caution, that further regulatory burden be avoided and that time be taken for consultation with all supply chain actors to uncover potentially unintended consequences so that Bill C-64's aims can be successful.

We don't have all the answers—we dearly wish that we did—but we're most willing to collaborate with government to find them in order to ensure safe, secure and timely physical access to medicines for all Canadians, and that's why we exist.

Thank you on behalf of the CAPDM board of directors, and I welcome your questions.

[The Chair, Liberal, Sean Casey]

I call this meeting to order.

Welcome to meeting number 117 of the House of Commons Standing Committee on Health.

Before we begin, I would like to ask all members and other in-person participants to consult the cards on the table for guidelines to prevent audio feedback incidents.

Please take note of the following preventative measures in place to protect the health and safety of all participants, including the interpreters. Please use only the black, approved earpiece. The former gray earpieces may no longer be used. Keep the earpiece away from all microphones at all times, and when you are not using your earpiece, place it face down on the sticker placed on the table for this purpose. Thank you for your co-operation.

In accordance with our routine motion, I'm informing the committee that all remote participants have completed the required connection tests in advance of the meeting. As a result of those connection tests, one connection was unsatisfactory to participate in the meeting, so we have a smaller witness panel than is contained in the notice of motion. Jessica Diniz from JDRF will not be with us on this panel. I have taken the executive decision of adding her to one of the later panels today, provided that we can come up with the right technology so that she can fully participate.

Pursuant to the order of reference adopted by the House of Commons on May 22, 2024, the committee is commencing its study of Bill C-64, an act respecting pharmacare.

As indicated in the memo that was sent out a couple of days ago, I would like to remind members that amendments to Bill C-64 must be submitted to the clerk of the committee by four o'clock today. It's important for members to note that, pursuant to the order adopted by the House on May 22, 2024, the 4 p.m. deadline to submit amendments is firm. This means that any amendments submitted to the clerk after the deadline and any amendments moved from the floor during clause-by-clause consideration of the bill will not be considered by the committee.

Without further ado, I would like to welcome our panel of witnesses and thank them for their patience as we attempted to overcome our technical difficulties.

We have with us today from the Canadian Association for Pharmacy Distribution Management, Angelique Berg, president and chief executive officer, appearing by video conference. In the room with us representing the Canadian Federation of Nurses Unions, we have Linda Silas, president. Also online for the Canadian Organization for Rare Disorders, we have Durhane Wong-Rieger, president and CEO.

Welcome to all of those who have joined us to help us out with Bill C-64. We are going to start with opening statements in the order that appears on the notice of meeting, so we are going to start with the Canadian Association for Pharmacy Distribution Management.

Ms. Berg, welcome to the committee. You have the floor.

Health

[Yasir Naqvi, Liberal, Parliamentary Secretary to the Minister of Health]

Mr. Speaker, that is a very thoughtful question. Of course, our number-one priority is to protect Canadians and to make sure they have all the necessary medications available to them. That is why we are actually bringing in pharmacare legislation, Bill C-64. I really hope the member opposite will support that bill because it would allow Canadians to have access to, initially, diabetes medications and contraceptives.

In relation to the particular medication the member is speaking of, I look forward to looking into it and working with him so that I can give him a more precise answer on the approval process for that particular medication.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Great. Thank you for that.

One thing that is not captured in Bill C-64 and that Canadians have relied on now for many years is the expanded scope of practice in the professional life of pharmacists. Is that something that you think should be captured in this bill?

[Peter Julian, NDP, New Westminster—Burnaby, BC]

Thank you, Mr. Chair.

Thank you to the witnesses for their input, which is extremely useful.

Quebec's current drug insurance plan, a hybrid public-private system, has come up a number of times. Recently, a major coalition representing two million Quebeckers called on Parliament to pass Bill C‑64.

The coalition is made up of all the major unions in Quebec, from the Fédération de la santé et des services sociaux and provincial groups to the Union des consommateurs. In its brief, the coalition states that the current pharmacare program in Quebec has failed to ensure that everyone has reasonable and equitable access to drugs. It also states that the various charges people have to pay for prescription drugs are actually user fees that serve to deter people, causing them to skip doses or go without their medications because they can't afford them. Higher drug costs are putting more strain on private plans, and as a result, workplaces are terminating their insurance plans and workers are losing all their coverage.

Quebec's system is broken, and these organizations are asking us to pass the bill quickly.

Under hybrid systems, many people can't afford to get the drugs they need. When it comes to women having control over their own reproductive health, Dr. Francoeur, what does it mean to have a universal, as opposed to a hybrid, system?

[Joelle Walker]

We think Bill C‑64 is a bit vague when it comes to the coverage of certain drugs under private plans. We need clearer information on that. Today, the minister suggested that they would continue to be covered, but the current bill makes no mention of that. It really needs to be laid out.

[Dr. Diane Francoeur, Chief Executive Officer, Society of Obstetricians and Gynaecologists of Canada]

Thank you, Mr. Chair and members of the committee.

My name is Dr. Diane Francoeur. I am a practising obstetrician and gynecologist, as well as the chief executive officer of The Society of Obstetricians and Gynaecologists of Canada.

I am here today to discuss the aspect of Bill C-64 that proposes to offer universal coverage of a full range of contraceptives for Canadian women. Specifically, I wish to highlight why this measure is important and long overdue; why it's not just a women's issue or a nice-to-have measure but a necessary economic policy that benefits all of society; and why we hope that you, as legislators, will ensure that coverage of all forms of birth control is included in the final bill and that the bill passes without any undue delay.

Today, somewhere in Canada, a woman will have to choose between buying groceries, paying her electrical bill, filling up her gas tank or paying for her birth control. It's no secret that the rising costs of almost all goods and services have become a significant burden for many Canadians. However, nine million women of childbearing age in Canada bear the additional cost of preventing unintended pregnancy, a basic need that often flies under the radar but that is no less fundamental to the way of life of millions of Canadian women.

Contraception allows women to plan their lives, their families and their pregnancies. They are more likely to finish school. They participate more fully in the workforce. They enjoy more economic stability and they have healthy pregnancies when they do choose to have children.

Canadian women spend, on average, 30 years of their lives shouldering the associated cost of trying to avoid a pregnancy, but financial barriers can limit birth control options for many women, as you so rightly said.

Canada currently has a patchwork of coverage for contraceptives, which varies according to income and where you live. This forces some women to choose the cheapest method, and not necessarily the most effective or best method for their bodies. In some cases, they may not be able to afford any birth control at all. This can result in an unintended pregnancy. I see this every week in my practice.

We can do better than that for Canadian women. Approximately 40% of pregnancies in Canada are still unintended. This doesn't impact only women and their families, but also the economy. The direct cost of unintended pregnancies in Canada is estimated to be at least $320 million per year, a figure that doesn't include the downstream cost to society or to parents. The B.C. modelling indicates that the health system will save $5 for every dollar it invests in contraception every year.

We urge you, as legislators, to ensure that Bill C-64 passes smoothly and without undue delay.

To fully implement the commitments in this bill, Ottawa will need to negotiate agreements with the provinces and territories, which will take time. Any parliamentary holdup would only force women to wait longer for this much-needed assistance. Already, my patients, my neighbours and my nurses with whom I practice every day have been asking me when this coverage will become available, because it's never soon enough for those in difficult economic situations.

We also urge you to ensure that the final version of the bill and any budget measures attached to it include coverage of a full range of contraceptives, including the pill, the patch, the ring, the IUDs, the shot and the implant. By ensuring that all options are available, nine million women in Canada will no longer be forced to make decisions about their family planning based on their income.

Thank you.

[Manuel Arango, Vice-President, Policy and Advocacy, Heart and Stroke Foundation of Canada]

Thank you very much.

Heart and Stroke applauds the Government of Canada and Parliament for introducing Bill C-64, which will lay the groundwork for equal access to life-saving drugs for all.

People in Canada appreciate our universal health care system, but the reality is that Canada is the only country with medicare that does not include prescription drugs as part of its universal health care program. The current patchwork of public and private plans in Canada has created fragmented drug access, leaving millions struggling to afford their prescription medications. I don't think there's any disagreement with this.

While many people in Canada have some form of drug coverage, it is often insufficient and poses affordability issues. The 2019 Hoskins report indicated very clearly that 7.5 million people in Canada had either no coverage or insufficient drug coverage.

As well, the 2021 survey on access to health care and pharmaceuticals during the pandemic found, once again, that one in five people did not have insurance to cover any of the cost of their prescription medications in the previous year.

Furthermore, a poll commissioned by the Heart and Stroke Foundation and the Canadian Cancer Society in 2024 found that one in five people in Canada do not have sufficient prescription drug coverage. One in four had to make difficult choices to afford prescription drugs, such as cutting back on groceries; delaying paying rent, mortgage or utility bills; and incurring debt. The same poll also found that one person in 10 in Canada who had been diagnosed with a chronic health condition was more likely to visit the ER due to a worsening health issue because they were not able to afford their prescription medications.

A study in 2016 also found that 16% of people in Canada went without medication for heart disease, cholesterol and high blood pressure because of cost.

With the introduction of this bill, the foundation is being laid for the first phase of national universal pharmacare through single-purchaser coverage of diabetes and contraceptive medications. This will ultimately provide equal drug coverage for all people in Canada, regardless of their gender, race, geography, age or ability to pay.

We do feel that this needs to be expanded in the future to cover drugs for heart disease and stroke. The reality is that millions of people in Canada live with heart disease and rely on daily prescription medicines to help keep them alive and to manage their conditions at home. In fact, in 2022, 105 million prescriptions were dispensed for cardiovascular diseases, making it the second-highest disease category for prescriptions.

Universal coverage of essential medicines will reduce pressure on the health system by cutting costs, because treating a condition such as high blood pressure, which is a leading risk factor for stroke, is more cost-effective for our health care system than the specialized care required to save a life after a stroke.

The Heart and Stroke Foundation has made a number of recommendations for amendments in its submission, but I would like to highlight one today. It pertains to subclause 8(1), regarding a national formulary.

We recommend that a definition be inserted here for “essential medicines”. In particular, essential prescription drugs should initially be defined as those included in the CLEAN meds trial. That's one way to define essential medicines.

We feel that the government must take quick action to close the gap in coverage that leaves out essential medicines for chronic diseases, including heart disease and stroke, that affect many in Canada. We also recommend that the minister prioritize the signing of bilateral agreements with provinces and territories in tandem with the progression of the bill and to pass this bill before the House adjourns for the summer.

Finally, I would like to address some other key points and misinformation about pharmacare. The reality is that the federal government, as a single drug purchaser, would be able to negotiate much lower prices compared to the myriad private and public plans. This would have a significant deflationary impact on the average drug price.

We heard comments earlier on about bulk purchasing. It's very well known in the world of business procurement that a company that buys 100,000 widgets from a manufacturer is going to get a much better price per widget than is a company that buys five widgets per year from the manufacturer. The reality of bulk purchasing and the fact that it leads to lower prices is well known throughout the world. In New Zealand and Australia, with respect to drug purchasing, or even just in general if you look at Costco, bulk purchasing leads to lower prices.

Another point is the notion that coverage is going to be decreased through a national pharmacare program. In fact, it's going to be the opposite. We're going to get enhanced coverage. The reality is that we have 7.5 million people who have no coverage or inadequate coverage. The objective is to increase coverage for those people. It's just not a reality that we're going to get reduced coverage. If the government, the federal payer, is covering a diabetes generic drug, whether that's in the private plan, the public plan or the federal plan, it doesn't matter: It's going to be covered one of those three ways. I don't foresee a reduction in potential coverage. It's the opposite. We're aiming for the opposite.

To conclude, the Heart and Stroke Foundation applauds the federal government and Parliament for the introduction of this legislation and for proposing an affordable plan that will give 7.5 million uninsured and under-insured people access to prescription drugs for diabetes and contraception. We really hope that in the future this can be increased and expanded. As my colleague mentioned, I think we do want an expansion of this formulary in the future, but this is a good start.

Thank you very much.

[Joelle Walker, Vice-President, Public and Professional Affairs, Canadian Pharmacists Association]

Mr. Chair and members of the committee, thank you.

We are pleased to have the opportunity to share our views on Bill C‑64.

I will be giving my opening remarks in English, but I would be glad to answer questions in either English or French.

Our testimony tonight is really aimed at providing the committee with a very practical perspective on what could happen at the pharmacy counter as changes are contemplated and considered as part of the legislation. My testimony will focus on three points.

The first is around the role of pharmacists in pharmacare. As anyone who has used a prescription drug will know, the pharmacist is the last person the patient will see before they get their medications. While the act of dispensing is complex, pharmacists do a lot more than simply fill prescriptions and sell medications; they provide critical care and counselling that are integral to the effective use of medications. Their daily interactions with patients place them in a unique position to understand their needs, educate them on proper medication use and advise on potential drug interactions. Pharmacare really should not be just about the cost of the drugs, but also the care that goes along with them.

Pharmacists also play a significant role in drug plan management and navigation, and that's not often seen by many patients. Every day, they submit millions of claims on behalf of their patients, they spend time on the phone with insurance plans and they help patients identify alternative treatment options that are covered by their plans. For this reason, it's essential that we have a pharmacist on the government's proposed committee of experts.

The second point I'd like to make is around how best to target medication coverage. Contraceptive and diabetes medications are two very important drug classes, and there's no doubt about that. There's also no doubt that there are too many people in Canada who don't have access to these drugs for cost-related reasons.

However, the focus of Bill C-64, which aims to provide free contraceptive and diabetes medications to all Canadians, irrespective of their existing coverage, could warrant reconsideration. The intent of reducing the burden of these drugs is the right one, but our view is that the projected cost of over a billion dollars could provide even more comprehensive coverage if directed toward expanding coverage for a broader range of medications for those who currently lack adequate coverage, rather than replacing coverage for those with existing drug plans. We believe such an approach would be more feasible, fit better with the needs of provinces and limit disruptions, all while ensuring universal coverage for all.

That brings me to my third and last point. While change is sorely needed to ensure universal pharmacare, the potential for significant disruption can't be overstated. As members of this committee can likely attest from the recent changes to the PSHCP, or Public Service Health Care Plan, changing drug plans can be very disruptive for plan members and for pharmacists. Switching patients from a private drug plan to a public drug plan can be equally disruptive, so changes must be implemented carefully to avoid confusion and reduce administrative burden.

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.

In conclusion, I'd like to provide a personal example. I'm on a birth control pill that is not on the current list proposed by the federal government, and it took me three years to find the pill that worked for me and didn't have side effects that I would have had to live with daily as a woman.

This raised some very real questions for me when I looked at the intent of the bill. Will my employer continue to cover contraceptives if that's not covered? I'll certainly lobby for it, but it's definitely a question in my mind. Will my pharmacy continue to stock products that aren't broadly covered? If there are exemptions, will my pharmacist have to apply for that exemption on my behalf, as they often do with many drug plans?

I hope this gives you a sense of frontline issues that could arise.

I thank you and welcome your questions.

[Steven Staples]

Thank you for the question.

Who is it fine for? That is what we have to talk about. Is it fine for Canadians?

Clearly, we hear that people in Quebec are not happy with the system they have. Talk to one of the leading health economists, Steve Morgan from the University of British Columbia. He ran the numbers. He says that Quebeckers are paying for drug medication in one of the highest-cost jurisdictions in the world. In fact, per capita, they're only topped by the United States. They pay more than Switzerland. In fact, if that system in Quebec were translated to other provinces, costs would actually increase because of the problems in the system.

I take the word of experts and health economists who looked at the Quebec model very closely. Listen to what people are saying. Is that the system we want to have for the rest of the country, or do we want to go with the kind of single-payer national universal system envisioned in Bill C-64?

[Yves Giroux]

The numbers that Lisa mentioned are the expenditures that are currently being covered by public, private and out-of-pocket expenditures. For the drugs under Bill C-64— contraceptives and diabetes—it's about $5.7 billion. Assuming that all these expenditures would be covered by the federal government, that's how much it would cost.

Then we don't make any assumptions as to whether provinces would continue. We assume they would continue, because there's no sign that they will withdraw, but if they were to withdraw their coverage, then the federal price would go up, obviously.

[Yves Giroux]

Possibly. Based on our understanding of Bill C‑64 and the technical documents included with the first portion, there's a list of drugs that will be covered. There may be other types of contraceptives or diabetes drugs, but they wouldn't be covered. There may also be a behavioural effect such as substitution. In other words, people would be encouraged to use or obtain prescriptions for drugs that are covered, rather than drugs that aren't covered.

[Maxime Blanchette-Joncas, Bloc, Rimouski-Neigette—Témiscouata—Les Basques, QC]

Thank you, Mr. Chair.

I'll continue with questions for Mr. Giroux.

Mr. Giroux, I have here your analysis report on Bill C‑64. Under the heading “Sources of Uncertainty”, which is quite striking, it states the following: “The estimate has high uncertainty and is contingent on the number of drugs listed for coverage. Drug expenditures have several cost drivers and the projections are highly sensitive to the projected growth rate of those cost drivers….” You also mention “behavioural effects such as substitution from the drugs not listed on the formulary to the drugs [currently] on the formulary.”

I have a simple question for you. Could the number of drugs covered decrease after pharmacare is implemented?

[Steven Staples]

Thank you very much.

Mr. Julian, I share your concern. When I hear witnesses say that the system's working very well, I ask, “For whom is it working very well?” We just heard from Mike Bleskie. It doesn't sound like the system's working very well for him. It seems to be working for industry and for insurance companies, but it's not working well for all Canadians. That's why this pharmacare act is so important. We must get Bill C-64 through.

Also, we heard that the Canada Health Act, in the view of industry, creates uncertainty. I would differ. I think the Canada Health Act is very important. For 40 years, it's made a guarantee that Canadians, when they need medical care, will get it, not based on who they work for, what insurance program they have or how much money they have, but because they need it. I'm very passionate that the CHA creates certainty for Canadians, and we want that system. We don't want a U.S. system.

When I hear frontline workers talk, and they do.... We had 100 frontline health care workers come here in February. They met with many members of this committee, and I express my gratitude for all of you who took time out to meet them at a very busy time. These are people who are working with all kinds of issues in their hospitals and in their health care environments, but they took time to come to Ottawa to talk about the importance of pharmacare with all the challenges that they face in the health care system.

Do you know why? What I hear them say is that filled prescriptions mean empty emergency rooms. They know that if people are getting their medications, if they're not cutting their meds, if they're not making choices today on whether to take their medicine or not, they don't end up presenting themselves with far worse conditions in the emergency wards. That's where a lot of cost savings can come in that we're not hearing about.

Of course there are cost savings for individuals. Of course there are cost savings through bulk purchasing; we can get those prices down to the median of OECD countries because they're so high, but there are also savings in the health care system.

St. Michael's Hospital did a study. It took 700 patients who had trouble economically in paying for their medication, and these patients went out into the world after they were diagnosed. The hospital mailed free medication to half of them. The other half it just let fend for themselves, based on that system that we were talking about a minute ago, however that system works out. Well, they found that those people who had free medication provided to them did far better. They recovered faster. In fact, they could even put a number on it; every patient who received free medication saved the system $1,600 per year. That's an important factor in looking at how we can save money in a national universal single-payer program.

[Peter Julian, NDP, New Westminster—Burnaby, BC]

Thanks very much, Mr. Chair.

I mentioned earlier that this is a historic moment and a historic hearing, and I cited a number of important organizations.

I want to give a shout-out to Canadian Labour Congress president Bea Bruske. They submitted a memo to this committee saying, “The [Canadian Labour Congress] calls for the speedy passage of Bill C-64, an act respecting pharmacare, before the House of Commons and the Senate adjourn for the summer, so that millions of Canadians can access contraception and diabetes drug and device coverage, giving them some relief from the high cost of living.” I would note that Elizabeth Kwan from the CLC is here in the room today.

I also want to give a shout-out to the Canadian Health Coalition and thank Mr. Staples for being here.

Mr. Staples, we've heard from one party in the House of Commons—the Conservatives—and a number of lobbyists that the system we have in pharmacare now works well in Canada. You deal with frontline workers, such as nurses. Is it true that everything is fine when it comes to access to medication?

My second question to you is about the issue of a pharmacare program. Is it true that a pharmacare program will help save health care dollars?

[Maxime Blanchette-Joncas, Bloc, Rimouski-Neigette—Témiscouata—Les Basques, QC]

Thank you, Mr. Chair.

I would like to welcome the witnesses taking part in the second part of this meeting.

My first questions are for the Parliamentary Budget Officer, Yves Giroux.

Mr. Giroux, I have looked carefully at your May 15 note on Bill C‑64, which states the following: “The PBO estimates that the first phase of national universal pharmacare will increase federal program spending by $1.9 billion over five years. This 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.” This includes the Quebec program.

If I understand this analysis correctly, the $1.9 billion will benefit provinces that don't have a drug coverage program. Provinces like Quebec, which already have a drug coverage program, will receive less money.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you very much for that.

Through the chair to Monsieur Giroux, thank you for being here and thank you for your analysis.

We know that federal government spending is ballooning out of control. That does not mean that pharmacare is not important. We've heard now from Mr. Keon that there are not going to be any savings here, so this will continue to be an expense to the federal government and, of course, to taxpayers.

We don't have that much time, but maybe you could outline that expense, which is going to be a recurring expense to taxpayers, with respect to Bill C-64.

[Yves Giroux, Parliamentary Budget Officer, Office of the Parliamentary Budget Officer]

Good afternoon, Mr. Chair and members of the committee.

We are pleased to be here today to discuss our analysis of Bill C-64, an act respecting pharmacare.

With me today I have Lisa Barkova, our lead analyst on pharmacare.

If memory serves, this is the first time that I'm appearing before the House of Commons Standing Committee on Health as a parliamentary budget officer, but this is not the first time that the office has responded to requests from the committee regarding pharmacare. In fact, in response to requests from this committee, in September 2017 my predecessor produced an estimate of the cost to the federal government of implementing a national pharmacare program.

Furthermore, following requests from parliamentarians, my office prepared an updated cost estimate of a single-payer universal drug program in October 2023.

Recently, on May 15, 2024, we published a cost estimate for Bill C‑64, which you're studying today.

As the first phase of a national universal pharmacare program, Bill C‑64 proposes to provide universal first‑dollar coverage for a variety of contraceptive drugs and for the treatment of diabetes.

The purpose of the program is to enhance and expand the coverage provided by provincial and territorial plans, not to replace it.

We estimate that, if implemented, Bill C‑64 would increase government spending by $1.9 billion over five years. This 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.

Ms. Barkova and I look forward to answering all your questions regarding our analysis of Bill C‑64 or other work done by my office.

Thank you.

[Stephen Frank, President and Chief Executive Officer, Canadian Life and Health Insurance Association]

Good afternoon. It's a pleasure to be here.

My name is Stephen Frank, and I'm pleased to be here today in my role as president and CEO of the Canadian Life and Health Insurance Association. An important part of my job is representing the 27 million Canadians who are covered by workplace and other health benefit plans.

Canada's life and health insurers believe that all Canadians should be able to access the drugs they have been prescribed. To achieve this, we know that both public and privately-funded plans are a necessity. Unfortunately, Bill C-64 falls short of its goal to ensure that all Canadians have access to the medications they need. It puts what's working well today at risk.

Workplace benefit plans are an essential pillar of the Canadian health care system. In the most recent year, Canada's life and health insurers paid for over 35% of prescription drug spending in the country. Our plans cover more drugs than even the most generous public plan.

In fact, 85% of Canadians say that their health insurance plan saves them money. They don't want to see their plan disrupted. Given the choice, they would overwhelmingly prefer that the government focus on providing coverage to Canadians who don't have it.

On behalf of the majority of Canadians who already have drug coverage, I ask members what this proposal will mean for the average Canadian family. Despite much of the discussion about this bill by various stakeholders, it goes further than contemplating a new pharmacare program for diabetes and contraceptive drugs: It requires the federal government to begin the rollout of a broad pharmacare program for an essential medicines list no later than 12 months after the bill gets royal assent. There are material and many unknown risks to disrupting existing programs for millions of Canadians.

The Minister of Health has stated that people who have an existing drug plan are going to continue to enjoy the access they have to their drugs. If that's the minister's intent, it's not at all clear from this bill. As many of the questions reinforced today, its text is ambiguous. It repeatedly calls for universal single-payer pharmacare in Canada with no mention of workplace benefit plans. Read in its entirety, the bill could result in practical and even legal barriers to our ability to provide Canadians with the drug benefits that they currently have.

For the majority of Canadians, therefore, this plan, as it's currently written, risks disrupting existing prescription drug coverage paid for by employers, limiting choice and using scarce federal resources to simply replace existing coverage, while leaving a huge gap for uninsured Canadians who rely on other medications beyond diabetic drugs and contraceptives.

There is a better way.

For example, using the $1.5 billion that has been allocated to this program to target those without coverage would allow the government to provide thousands of medications to several hundred thousand Canadians who currently lack drug plans. In other words, we could, as a country, use scarce federal dollars wisely to make a profound impact on the lives of those who do not have drug plans, while protecting the benefits that are currently working so well for the vast majority.

In conclusion, we believe that this legislation needs to be significantly amended to focus on ensuring universal drug coverage for all Canadians by addressing any gaps in the drug insurance that currently exists and to be clear with Canadians about what exactly we're trying to do.

I look forward to your questions. Thank you.

[Mike Bleskie, Advocate, Type 1 Diabetes, Canadian Health Coalition]

Through you, Mr. Chair, I thank you for the opportunity to be here.

My name is Mike Bleskie, and I have been a type 1 diabetic for 19 years. I'm also a gig worker in my 30s. As such, like many, I don't have private health insurance, and I either cannot qualify or cannot afford to pay for a plan myself.

Although Ontario's benefits cover a portion of my personal expenses, my out-of-pocket costs stand at about $450 a month, mostly from my continuous glucose monitor, which is not covered in Ontario, and my pump supplies. That leaves me with hard decisions about the cost of food and rent at the beginning of every single month. It also leads to situations in which I'm forced to consider rationing my supplies, which can lead to health complications.

My experience talking to nurses, doctors and other diabetics across Canada tells me that I am far from alone. Insulin is not a luxury for us; it is a basic necessity for every single type 1 diabetic. Without the proper treatment, we are exposed to complications like debilitating nerve pain, amputation and permanent blindness. A universal single-payer pharmacare system is the only policy that guarantees that every type 1 diabetic in Canada, regardless of their economic circumstance, can access live-sustaining therapy when they need it. Policies that attempt to fill gaps only leave more gaps that need to be filled later, such as what we have seen in Ontario with OHIP+ .

I urge this committee to support this bill promptly so that we can get insulin into the hands of diabetics as soon as possible. I'm also asking this committee to ensure that syringes, pen needles, pump cannulas and continuous glucose monitors are fully covered as part of the diabetic supply fund contained in Bill C-64, as these items represent the biggest expenses to most diabetics and, in many cases, are not part of public coverage in most provinces.

I appreciate your time, and we welcome your questions.

[Steven Staples, National Director, Policy and Advocacy, Canadian Health Coalition]

Thank you, Mr. Casey. It's a pleasure to be back here.

Dear members of the committee, my name is Steve Staples. I'm the director of policy and advocacy for the Canadian Health Coalition.

Our organization was founded in 1979. Our members work to defend and improve our public health care system. We comprise citizens, frontline health care workers' unions, community groups, students and public health care experts.

Members of the Canadian Health Coalition welcome the introduction of the pharmacare act, Bill C-64. This landmark legislation is an important first step in continuing progress toward a universal national pharmacare program.

Canada is the only country in the developed world that has a universal health care system that does not include universal coverage for prescription drugs outside of hospitals. Pharmacare is needed urgently to improve the lives of those living in Canada. As we have heard, one in five people reported to Statistics Canada that they do not have access to prescription drug coverage. Importantly, low-wage workers, immigrants and racialized people are hit the hardest.

In addition, the overall cost of drugs to the health system must be reduced. According to the PBO, prices for prescription drugs in Canada are roughly 25% higher than the median for OECD countries, and a single-payer pharmacare system with the power of bulk purchasing is the best route to negotiate lower prices from pharmaceutical manufacturers.

Canadian Health Coalition members heartily endorse the recommendations of the 2019 national advisory council on the implementation of national pharmacare led by Dr. Eric Hoskins, which was referenced earlier.

A nationwide program to achieve public coverage for contraception and diabetes medicine and related equipment, delivered by a single-payer approach through provincial health systems, is a historic step in the direction recommended by Hoskins in his report on pharmacare, but there are many more steps to achieve universal coverage of a national formulary of medicines.

We urge the government to ensure that the legislation adheres to a single-payer, national universal public delivery in partnership with provinces and territories, along with adequate funding and accountability measures, in accordance with the principles of the Canada Health Act.

I would like to share the remainder of my time with my colleague, Mike Bleskie.

[Jim Keon, President, Canadian Generic Pharmaceutical Association]

Thank you, Mr. Chair.

The Canadian Generic Pharmaceutical Association and its Biosimilars Canada division would like to thank the committee members for this opportunity to contribute to the study of Bill C‑64, An Act respecting pharmacare.

Making medicines more affordable and accessible is the key value proposition of generic and biosimilar medicines, which today are used to fill more than three-quarters of all prescriptions in Canada. Expanding the use of generics and biosimilars helps drug plans to fund innovative treatments for patients and contributes to the overall sustainability of drug plans.

Not surprisingly, maximizing the use of these cost-efficient treatments to help fund pharmacare was a key recommendation of the pharmacare advisory council report in 2019.

We have provided a brief to members and will focus our remarks today on three main areas: the medications to be covered for patients under the proposed pharmacare regime, guiding principles for bilateral agreements, and bulk purchasing, which has not been defined.

On the list of drugs, expanding access to ensure all Canadians can benefit from the life-saving and life-altering medicines they need is an important objective. However, the list of diabetes and contraceptive medications in the February 29 pharmacare announcement is not comprehensive. There are important gaps that need to be addressed. We have highlighted these in our brief.

The current non-comprehensive approach also raises patient equity concerns, as it could lead to suboptimal prescribing of the medicines that are made available to the public for free and lead to suboptimal health outcomes for patients.

We are also concerned that the non-comprehensive approach may provide a disincentive for public drug plan formularies to continue their coverage of a broad range of prescription medicines and provide a disincentive to expand coverage to include new drugs in the future. These same concerns apply to drug plans provided by Canadian employers.

We recommend that all diabetes drugs and contraceptives that are currently reimbursed by public drug programs in Canada be covered if pharmacare is implemented. This principle should also apply to medicines added in the future.

On guiding principles, under Bill C-64 the federal government must negotiate and enter into bilateral agreements with individual provinces and territories. An important guiding principle for drug formulary management that is already employed by public drug programs in Canada is to reimburse for only the low-cost alternative product of a pharmaceutical active substance.

In order to help ensure the sustainability of the plan, Bill C-64 should be amended to clarify that only generic and biosimilar medicines will be reimbursed once they are authorized for sale by Health Canada and enter the Canadian market. This principle should be included in all bilateral pharmacare agreements.

On bulk purchasing, “bulk purchasing” is not defined in Bill C-64. It is not clear what this means. It is important to recognize that Canadian governments already combine their purchasing power to negotiate internationally competitive drug prices for Canadians. They do this through the pan-Canadian Pharmaceutical Alliance, or pCPA.

It is critical that the pharmacare regime respect the existing pharmaceutical pricing infrastructure to ensure stability of the Canadian drug supply. This will ensure that Canadians continue to benefit from access to both cost-saving generic and biosimilar medicines and the innovative new medicines Canadians need.

Prices for generic medicines are controlled through the pCPA tiered pricing framework. This provides a stable and predictable environment for generic manufacturers to continue to provide existing medicines for Canadians and make the investments to launch new cost-saving drugs.

According to pCPA, joint efforts between pCPA and CGPA have resulted in savings of more than $4 billion to participating drug plans over the past 10 years. These savings will continue to grow through a new three-year agreement between CGPA and pCPA that came into force on October 1 of last year.

The pCPA also negotiates prices for biosimilar medicines that are set to be significantly lower than the list price for the original biologic drugs. The expanded use of biosimilars has saved public drug plans hundreds of millions of dollars that have been reinvested into coverage for innovative new therapies and the overall sustainability of drug programs.

We recommend that governments continue to exercise their power to collectively negotiate drug prices in Canada through the pCPA.

In closing, thank you again for inviting the CGPA and its Biosimilars Canada division to appear as witnesses on Bill C-64. Jody and I would be pleased to answer any questions you may have.

Thank you.

[Majid Jowhari, Liberal, Richmond Hill, ON]

You talked about portability. Can you explain what that is? It's not included in pharmacare under Bill C-64.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Okay. There is a list, and the list is available. Thank you.

I want to go back to clause 4 of the bill, which states that the minister must, when working with the pharmacare partners to implement national universal pharmacare, consider principles relating to the accessibility, affordability, appropriate use and universal coverage of pharmaceutical products across Canada. The minister must also consider the Canada Health Act.

Can you explain the similarity that exists between the principles outlined in clause 4 of Bill C-64 and the criteria set out in the Canada Health Act?

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you, Mr. Chair.

Thank you to the officials for the hard work you've done on this and for coming here today.

Unfortunately, I'm going to follow on the same theme as my colleague Dr. Powlowski, who has led us down this path.

In clause 2 of Bill C-64, pharmacare is defined to mean “a program that provides coverage of prescription drugs and related products.‍” I understand “prescription drugs”. “Related products”, however, are not defined. I think that may leave a lot of room for interpretation.

What does “related products” mean in the context of Bill C-64?

[Peter Julian, NDP, New Westminster—Burnaby, BC]

Thank you.

I'd just like to make sure that you received the statement issued a few hours ago by nine Quebec labour and community groups calling for the adoption of Bill C‑64. Did you receive it? If not, I can provide it to you. The Union des consommateurs, the Centrale des syndicats démocratiques and the Confédération des syndicats nationaux, to name a few, were very clear. There's a consensus in Quebec in favour of the bill.

I come back to the issue of the approval process of Health Canada. I think my Conservative colleague cut you off, but it's important for members of the committee to understand. Is it a 300-day period for approval, through Health Canada, from the application date to availability for consumers? I just want to understand what you were saying.

[Peter Julian, NDP, New Westminster—Burnaby, BC]

I'm pleased to have the opportunity to speak now, Mr. Chair, because I have an announcement to make. My Bloc Québécois colleague seems to be suggesting the opposite of what nine major organizations in Quebec stated just a few hours ago. These organizations include the Union des consommateurs, the Centrale des syndicats démocratiques, the Coalition solidarité santé, the Confédération des syndicats nationaux, the Fédération interprofessionnelle de la santé du Québec, the Fédération des travailleurs et travailleuses du Québec, the Table des regroupements provinciaux d'organismes communautaires et bénévoles, to name just a few.

These organizations, which represent over two million Quebeckers, are saying that they applaud Bill C‑64 introduced by the federal government: “Never have we been so close to establishing truly public and universal pharmacare. Quebec's hybrid public‑private program is creating an unsustainable two‑tiered system that must be corrected.”

In the brief they submitted today, these organizations point out that the current Quebec pharmacare program is far from guaranteeing everyone reasonable and equitable access to medication, as set out under Quebec's Act respecting prescription drug insurance. These organizations are saying that Bill C‑64 puts in place a framework leading to the creation of universal and public pharmacare. They stated the following: “We're calling on the federal government not to give in to the provinces and territories that are demanding the right to opt out unconditionally and with full financial compensation.”

Minister, given that this large coalition representing a significant proportion of the population of Quebec is saying that it supports Bill C‑64, should Quebec members of Parliament listen to it?

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Chair.

Thank you, Minister and your team, for being here with us.

The discussion is very important. It's historic legislation that aims to increase equitable access to contraceptives and diabetes medication.

Minister, as you know, important progress has been made in our country with the national framework to fight diabetes. As we discuss Bill C-64, can you update this committee on the progress in implementing the national framework for diabetes as well?

[The Chair, Liberal, Sean Casey]

I call this meeting to order.

Welcome to meeting number 116 of the House of Commons Standing Committee on Health.

Before we begin, I'd like to ask all members to consult the cards on the table for guidelines on preventing audio feedback incidents.

Please take note of the following preventive measures that are in place to protect the health and safety of all participants, including the interpreters: Please use only the black approved earpiece. The former grey earpieces must no longer be used. Please keep your earpiece away from all microphones at all times. When you're not using your earpiece, place it face down on the sticker on the table for this purpose. Thank you for your co-operation.

Pursuant to the order of reference adopted by the House of Commons last night, the committee is commencing its study of Bill C-64, an act respecting pharmacare.

As was indicated in the memo that was sent out this morning, I'd like to remind members that amendments to Bill C-64 must be submitted to the clerk of the committee by 4 p.m. Eastern Time tomorrow, Friday, May 24, 2024.

It's important for members to note that pursuant to the order adopted by the House yesterday, the 4 p.m. deadline to submit amendments is firm. This means that any amendments submitted to the clerk after the deadline and any amendments moved from the floor during clause-by-clause consideration of the bill will not be considered by the committee.

Colleagues, we also have a budget for the study of Bill C-64 that I propose to present to you after we hear from all the witnesses this evening.

Without further ado, I'd like to now welcome our first panel of witnesses.

We have with us the Honourable Mark Holland, Minister of Health. He's accompanied by officials from the Department of Health. They are Michelle Boudreau, associate assistant deputy minister, strategic policy branch, and Daniel MacDonald, director general, office of pharmaceutical management strategies, strategic policy branch.

Minister Holland will be with us for an hour, and the officials will stay on until five o'clock.

Without further ado, welcome to the committee, Minister. You can now go ahead with your opening statement for the next five minutes.

Fall Economic Statement Implementation Act, 2023

[Peter Julian, NDP, New Westminster—Burnaby, BC]

Mr. Speaker, I have a question for the member who just finished his speech. I would like to say at the outset that the number of Quebeckers already registered for the NDP's dental care program is in the hundreds of thousands. We also know that thousands of Quebeckers are getting their NDP dental care card every week. I think that is extremely important.

Pharmacare is another topic of discussion. All of the major unions in Quebec say that they view the NDP's pharmacare bill, Bill C‑64, in a very positive light. It is important to mention these two things. The NDP is the one proposing measures in the House to improve the daily lives of people across Canada. That is extremely important.

We are supportive of the fall economic statement, Bill C-59. I will talk about some of the measures the NDP has inserted into it, but I will start by saying that this is not an NDP budget.

Of all the governments in the country, the two most popular are the government of British Columbia and the government of Manitoba, and they are two NDP governments. They have both been very effective. The Manitoba NDP government is new, but it is extraordinarily popular. This is because the NDP really knows that the essence of good stewardship, of managing a democratic government, is ensuring that it is not the rich who are taken care of but, rather, regular folks. We have formed government provincially, of course, in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario and Nova Scotia. All those governments have been governments that have made a difference in the lives of people.

The simple reason the two most popular governments in the country right now are NDP governments is the financial statements that are issued by the federal ministry of finance. As members well know, the federal ministry of finance is not a hotbed of social democrats or democratic socialists, but it does publish the fiscal period returns. If members look through them, and I hope they do before the end of the evening, they will see that, over the last 40 years, the best governments, in terms of managing money, paying down debt, expanding education services, expanding housing services and expanding health care systems have been, systematically, over the last 40 years, NDP governments. That is why the two most popular governments in the country right now are NDP governments. It is because the NDP is not beholden to lobbyists.

The corporate Conservatives are run by lobbyists. Their national executive is run by lobbyists. There are lobbyists permeating the Conservative headquarters. The Conservative caucus and the campaign team are all lobbyists for the corporate sector. When the Conservatives were in government we could see how badly they performed. They do not understand the issue of stewardship. The infamous Harper tax haven treaties have bled over $30 billion, each and every year over the last 17 years, out of this country. That is $30 billion that could have been used for health care and housing. It could have been used for a variety of services for veterans, seniors and youth. It could have lowered post-secondary education costs. It could have made a big difference, but that was not what the Conservatives chose to do.

The Liberals, when they came to power, kept many of the tax breaks that had been given to the richest of Canadians, the wealthiest of Canadians, who have never paid their fair share, and the most profitable corporations. The NDP's approach is different, which is why the fiscal period returns to the federal ministry of finance show conclusively that the NDP and NDP governments are the best at managing money.

This is not an NDP budget, by any means. There are elements that the NDP forced into the budget that would make a difference in the lives of working people. The reason we are supporting it is the amendments we have achieved, in the same way that we brought dental care to Canadians. There are two million who have signed up already, including 100,000 seniors. There are many who are, for the first time in their lives, getting access to dental care, and this is just in the first two weeks of this new NDP program. NDP dental care is making a difference.

Earlier tonight, we moved the pharmacare bill to the health committee, which is where it should go. I am looking forward to those hearings over the next couple of days. People have been waiting for decades to have pharmacare added to our health care program and our health care strength in this country.

Mr. Speaker, you will recall in this House, as I am sure you have a great depth of historical memory, that 60 years ago in this House of Commons, just a few feet from this temporary house in the West Block, in Centre Block, Tommy Douglas, as the founding leader of the NDP, brought forward universal health care, which was viciously fought against by Conservatives at the time, who did not want to see people getting health care. However, it was a minority Parliament and Tommy Douglas was able to successfully deliver universal health care to Canadians.

Tommy Douglas always thought that we needed to make sure that health care was available from the tip of our heads right to the soles of our feet. He always envisaged that we would move to pharmacare, that we would move to dental care and that Canadians would have access to the full range of health care services that all other countries with universal health care enjoyed. Fortunately, we have the member for Burnaby South as our leader who feels the same way, and this has been a hallmark of NDP leaders over the decades. Every time there has been a minority Parliament, the NDP has stepped up as the worker bees of Parliament, as the adults in the room. We have gotten things done that have made a difference for Canadians, from universal health care to a whole range of other things like the Canada pension plan, employment insurance and all those things that make a difference in people's lives. All of them come thanks to the NDP, because that is our role in Parliament.

Therefore, when we look at the fall economic statement, we can see already that NDP stamp that makes a difference, but unlike the corporate Conservatives and the lobbyist Liberals, we do not believe in spending enormous amounts of money on the wealthy, on the pampered and on big corporations. We do not believe in funding massively the corporate sector. We believe in negotiating with the corporate sector. The reason we are pressing so hard for pharmacare is that countries that have universal pharmacare are able to have the bulk-purchasing negotiating power that forces down the price of drugs. New Zealand is a great example, where there is a reduction of 90% in the cost of certain medications because the New Zealand government was able to say to the pharmaceutical companies that if they wanted to come into that market, they would have to pay New Zealand's price. Currently, with the patchwork of plans that the corporate Conservatives and the lobbyist Liberals have put into place over decades, it is the pharmaceutical company executives who decide what the prices are, and that has to change.

The fall economic statement does contain some measures that we believe would make a difference. First off, we believe firmly in starting to adjust a taxation system that has become profoundly unjust and unequal. We have said that when we look at the infamous Harper tax haven treaties that cost us $30 billion a year, according to the Parliamentary Budget Officer, and we look at the range of other loopholes that exist, it is important to take steps to ensure that those loopholes are closed. The real taxation rate for Canada's largest corporations is single digits because of the loopholes. Because of the corporate executives' ability to write off and because of their ability to take money overseas where they do not have to pay taxes on it, their real taxation rate is in the single digits, less than 10%.

Why not ask Canadians what their taxation rate is? Middle-class Canadians pay their taxes expecting that they will get services and supports in return, but instead, under the Harper regime, we saw that the Conservatives slashed services to those taxpayers who had paid money into the federal government and they gave that money away. They gave it to tax havens. They gave it to the banks. Unbelievably, the Harper regime gave $160 billion to the banking sector so that the banks could prop up executive bonuses and corporate dividends.

The Conservatives have never apologized for that, and Liberals have never apologized for the $750 billion, again, in liquidity supports that they offered to the banking sector just a few years ago. It took 96 hours to provide $750 billion in liquidity supports. Between the two, the corporate coalition of Liberals and Conservatives, over the past 15 years, has given, unbelievably, in current dollars, over a trillion dollars in liquidity supports to the banking sector to prop up dividends and profits and executive bonuses.

We look at the health care problems that we are experiencing, the housing crisis and other problems that exist. We had, today, the member for Nunavut, who is an extraordinary member of Parliament, asking about day care that is not being adequately funded in Iqaluit, yet for Liberals and Conservatives, between them, giving a trillion dollars to the banking sector is no problem.

We can look at the tax havens over the last 15 years. That is half a trillion dollars. That is $30 billion a pop, according to the Parliamentary Budget Officer, given away to overseas tax havens without a penny of return to Canadians, yet we look at people with disabilities. Half of those who have to go to food banks to make ends meet, half of those who are sleeping outside in the parks and main streets of our country, are people with disabilities. They are not getting what they need in terms of support, but between Liberals and Conservatives, the corporate coalition, for 15 years, half a trillion dollars went to offshore tax havens.

We can look at oil and gas CEOs. Between both the Harper Conservatives and the current Liberal government, over the last 15 years, we have seen $100 billion given to oil and gas CEOs. There is a ton of money that goes to the wrong places in this country. That is why NDP MPs are here fighting on behalf of Canadians, delivering on pharmacare and affordable housing, finally. We had to push the Liberals hard on that over the last couple of years.

We are delivering on dental care, anti-scab legislation, a clean energy strategy and all those things, because, as worker bees in Parliament, we believe firmly that the investments need to happen with families and regular people right across this country, not the rich and the pampered. That is where the corporate Conservatives love to spend tons of money. That is where we have seen, sadly, the Liberal government spend tons of money. We believe that money needs to go to regular people.

When we look at this fall economic statement, there is a first step. Again, the NDP pushed hard for that. We finally will get an annual tax of 3% on types of digital services. This is earned by larger companies with more than $1.1 billion in revenue. This is an important step that we support. Again, is this an NDP budget? No. Does it take an important first step? Yes, it does.

As for the investments in housing, the apartment construction loan program, $15 billion, and the affordable housing fund over the next three years for non-profit and co-op and social housing, we support those as well. In fact, the member for Vancouver East fought hard and so did the member for Nunavut, to make a difference in terms of housing.

I do need to mention the anti-scab legislation for a moment and the work of my colleague from Rosemont—La Petite-Patrie, who did a remarkable job in making sure that, finally, replacement workers will be banned at the federal level, and Parliament will be called upon to get a final vote on that in the coming weeks. This is vitally important.

The NDP MPs work as a team. Our leader is the member from Burnaby South. We have made an enormous difference in this Parliament. We made an enormous difference in the last Parliament. We will recall, at the height of the COVID crisis, that it was the NDP that was pushing the government, fortunately in a Parliament where I think it is fair to say that all parties did work together, to invest more than $40 billion to ensure that people, families, people with disabilities, seniors and students were taken care of. Small businesses actually had the wherewithal to keep that shingle out as part of their small business by some rent relief.

All of those things came as a result of the NDP fighting hard on behalf of people. There have been two consecutive minority Parliaments where the NDP has made a difference.

Let me get to the crux of what is in Bill C-59 that we can support. The amendments that were brought originally by the member for Burnaby South, the leader of the NDP, would finally enhance the Competition Bureau. This is fundamentally important. We have had no consumer protection in this country. The corporate sector, the lobbyists, have really been paramount. We have seen, over the decades, how successive Liberal and Conservative governments have refused to do anything to enhance consumer protection.

The member for Burnaby South, the national leader of the NDP, brought forward enhancements to the Competition Act that would ensure that we can crack down on food price gouging and gas price gouging that we are seeing. It has happened with impunity because the Competition Bureau has not had the tools to take action against it. Members will recall that the member for Burnaby South tabled a bill in this regard. The NDP fought hard. We negotiated hard. We did our work as the worker bees in Parliament.

As a result of that, many of the enhancements to the Competition Act are now in this legislation. This is important because despite the protestations of the member for Carleton, who tries to pretend that putting a price on pollution has led to the difficulties and challenges around the rise in food prices, we know that most Canadians understand, unlike the member for Carleton, that it is actually food price gouging that has taken place. We are seeing massive profits in the grocery industry. We are seeing record CEO bonuses.

We have a Conservative Party that is absolutely inundated with lobbyists. Lobbyists run its national party and run its campaign team. This is no surprise because of all the corporate Conservatives have done. Their past track record is giving massive amounts of money to the corporate sector, without ever asking for anything in return. It is like they are not even trying to get any benefits for Canadians. They just hand it out. There were the infamous Harper tax haven treaties, $30 billion each and every year handed over to the wealthiest of Canadians in the corporate sector, and they never asked for a thing in return.

The role the NDP plays in Parliament is so important because the Competition Act amendments that we brought in would mean that we could start cracking down on the egregious food price gouging Canadians are experiencing when they go to the grocery store, and gas price gouging. Just a few weeks ago, my colleague from Courtenay—Alberni signalled this. I know my colleagues in British Columbia, like my colleague from South Okanagan—West Kootenay, can attest to this. The prices in British Columbia all of a sudden skyrocketed by 30¢ a litre. There was no explanation because the companies can do that now. They can do gas price gouging.

The companies do this when we have peak season in terms of travel in British Columbia. It is a beautiful province. We like to get around in British Columbia. The gas companies can gouge with impunity because the Conservatives have allowed them to do this and the Liberals have allowed them to do this. Finally, with these enhancements, the Competition Bureau and the Competition Act would be able to crack down on this gas price gouging that has inflicted so much pain on British Columbians and Canadians right across this country.

These are two important elements that are part of this bill, and it is why we are supporting it.

I wanted to give a shout-out to my colleague from London—Fanshawe. She presented a private member's bill waiving the GST on counselling and psychotherapy. The NDP has also put that into this bill. That would make a difference for all those who need counselling and psychotherapy. Those who have experience with mental illness, mental challenges and mental health know how important it is to be able to pay for those services. This is another innovation that would make a difference.

The NDP has achieved a lot to improve the bill, and we will support it.

Consideration of Government Business No. 39

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Madam Speaker, just to confirm, now that the motion has passed regarding Motion No. 39, I lose my unlimited time and I now have a 20-minute slot. Therefore, I will have to share my time with the member for Cumberland—Colchester, even though I would have enjoyed continuing to speak to an issue that I hold very dear to my heart, which is the approval of drugs for rare diseases in Canada and how patients can get access to them. Those two words actually only appear once in the legislation.

People with a rare disease are some of the most needy patients in Canada. As I said during the debate on Bill C-213 back in 2021, the hardest medication to get in Canada is the one that is not approved and not available because the manufacturer will say that Canada is too complicated, too difficult and it is not worth its time to try to get it onto our market. That is because of all the regulatory hurdles and steps that exist that make it very difficult for patients with rare diseases to get access to the drugs they need.

We saw this with cystic fibrosis drugs for patients who were trying to get access to Trikafta. It took many years from the time when it was available to patients in America to when it was available in Canada, and it was regulatory hurdles that made it much more difficult to do so.

Now that the government has passed this gag order on the gag order, it will direct the Standing Committee on Health on how it will consider the matter.

I want to draw the attention of the House to the debate on May 6, page 23051, where the Minister of Health responded to a question from the member for Berthier—Maskinongé about the timelines and why the Liberals were limiting debate. At the time, the minister said, “ there will be time for the committee to conduct a study.” I would put to members and constituents back home that a potential 10 hours of witness testimony at a committee is insufficient time to consider this pamphlet of a bill that the NDP-Liberal coalition is pretending is pharmacare. I have read the legislation in full, so I will comment on its contents as well.

The minister went on to say, “Yes, it is important to debate. However, there is plenty of time for debate in committee and during the rest of the House process. It is time to get on with it and move forward.” With this programming motion, the Liberals have essentially ordered the MPs on the committee to only consider it for a few more hours and then send it back here. In fact, after this bill has passed, there is now only one more day left for amendments to be considered. How can amendments be proposed without hearing from officials and witnesses who might bring forward amendments that would be of value to be considered by parliamentarians on that committee? It seems this is completely backward.

I want to comment on the issue of Conservatives delaying the bill, because this is a favourite talking point now of the Liberals and their colleagues in the NDP. I want the member for New Westminster—Burnaby to pay close attention to this. The bill was tabled on February 29. I would suggest that almost three and a half years into this mandate, this bill was not a priority of the government. Second of all, this bill was considered on April 16, May 6 and May 7, three days of consideration by the House of Commons. There were secret negotiations held between the Minister of Health, because he actually said it on the record, and whichever person on the NDP side who was negotiating so they could cobble together this particular piece of legislation.

I would put to members and my constituents back home, who deeply care about patients with rare diseases like I do, that there is nothing in this particular piece of legislation for them. It is not the job of the House of Commons or members of Parliament to simply ratify a secret deal reached between the Minister of Health and the NDP negotiator or negotiators. Our job is to debate, to bring forward ideas and potential amendments from expert witnesses, stakeholder groups and individuals back in our ridings who deeply care about this issue.

I will also mention that although Quebec has been mentioned several times, there is another province that has said openly it will not participate in this pamphlet of a pharmacare plan. It is Alberta, where I am from. Successive ministers of health have said they will not participate in it. One of the talking points I have heard is that we have a patchwork system right now in Canada. Saying “patchwork” is a way to kind of denigrate the hard work of the public servants in the different provinces in Canada who work for these public insurance plans. They are all over.

In fact, in Alberta, Blue Cross is available to anyone who wants it. There are lots of different public insurance plans. There are lots of public servants who work for them, and they work very hard to make sure they cover as many Albertans as possible. My province has said no and Quebec has said no, so we still have a patchwork. Even if this bill passes, even if it were to follow through on all the principles, the highfalutin language that I hear from the Liberals and the NDP on this, there will still be a patchwork in this country. We cannot force a province to participate.

As clause 6 of the pharmacare legislation clearly states, nobody's medication will be paid for. There are separate agreements that would have to be reached with each province. It says very clearly in subclause 6(1) of the pharmacare legislation, “in order to increase any existing public pharmacare coverage”. That would suggest that every single province has to either create or drastically expand a plan or successive series of plans that are single-payer, because that is one of the principles referred to again in that section.

If a province does not do that, it cannot negotiate a deal for future medication to be covered. No medication will get covered for either diabetes or contraceptives when this legislation passes. There will be none because no agreements have been signed yet. Alberta has said no, Quebec has said no, but the patchwork will continue.

I will move on to the legislation as I do want to mention this. Like I said before in a prior debate, there is a Yiddish proverb I used after listening to the minister's speech when he introduced Motion No. 39. He seems to think that pearls flow from his mouth because when I compared his speech at second reading on pharmacare, Bill C-64, and his speech on Motion No. 39, they were almost identical.

The minister actually used the exact same three anecdotes to make the case for why this plan is necessary. In the summary of the legislation, when the contents are reviewed, it gets into a lot of areas of provincial jurisdiction. This should be exclusive provincial jurisdiction. It is starting to interfere with how the provinces manage their public health care plans.

I will mention here that nobody with a rare disease will be covered by this piece of legislation. Nobody will be covered, whether someone has phenylketonuria, PKU, whether someone has cystinosis and needs Cystagon, or whether someone has MS, which is, I would say, the most common rare disease in Canada. None of their medication will be covered. If someone's kids have a rare disease, or a family like mine has Alport's syndrome, none of their medication will be covered by this piece of legislation.

The “Funding commitment” in clause 5 reads, “beginning with those for rare diseases. The funding for provinces and territories must be provided primarily through agreements with their respective governments. Then it goes on to talk about “payments” in clause 6 and completely contradicts clause 5 because it says, “for specific prescription drugs and related products intended for contraception or the treatment of diabetes.” In fact, there will be no payment plan for anything else. There cannot be because this legislation will not do any of those things. Nobody with a rare disease will be covered once this legislation passes.

I have been, I hope, consistent in this place about rare disease patients for the past nine years. That is the focus of my opposition to national pharmacare because it will not help them. Like I said, the hardest medications to get in Canada are the ones that are not approved in Canada. All the changes the government has done to the Canadian Agency for Drugs & Technologies in Health, CADTH, as well as all of the changes made to the Canadian Drug Agency, the PMPRB and the PCPA have been repetitive. The same mistakes are being repeated here.

The government says it is going to do bulk buying. Bulk buying is already done. It is done by the provinces through the PCPA. The government has an agreement for generics as well, which are not covered in this particular piece of legislation. There is no direct reference to generics. There is no direct reference to patented medication. It does not talk about those things. It takes years to get those drugs approved in Canada.

I would put to members and my constituents back home, who have emailed me because they are all so worried about this, that this is a pamphlet of legislation. The substance will be in the agreements that may come in the future. There are already two provinces that have backed out and other provinces are considering doing the same. Why is it that, since 2019, when the government announced it was going to fund drugs for rare diseases at $1.5 billion, it has done nothing? Not a single medication prescription has been filled for anyone I know with a rare disease in Canada. That money is just sitting there. The government has only started to put out RFPs to consider creating registries for rare disease patients. Registries, not medication. Most of the money remains unspent. The government has not done anything. That is the same thing that will happen here: a series of broken promises, unkept promises. The Liberals are being helped by the NDP to do this, giving people false hope.

I tell people who enter my office that the last thing I want to do is give false hope. I have two serious rare diseases in my family. Families who have rare diseases like mine cannot wait for the government to get its act together again.

Motion That Debate Be Not Further Adjourned

[Elizabeth May, Green, Saanich—Gulf Islands, BC]

Mr. Speaker, I am all in favour of the purpose of Bill C‑64, but I take issue with rushing through the work, because we must participate in the debates.

I really wish we had time. I understand the pressure, as things in this place seem to face so many obstacles. The concern of the government is that things will get bogged down

As the leader of the Green Party, we have been, in every platform for I cannot remember how many elections, calling for a universal single-payer pharmacare that actually means that Canada will properly be a country with universal health care. We are the only country in the world that has a nationalized health care system that does not provide for universal pharmacare.

The big pharma industry in this country, and globally, makes indecent levels of profits over drugs that it has not had to put investment in for research. There are a lot of issues to discuss with pharmacare. The Hoskins report scratched the surface of the ways we could, in this country, save billions of dollars for our health care system, but not with a piecemeal approach. I very much fear the piecemeal approach to what I support: absolutely, diabetes medications, absolutely, contraception available for free. However, I fear that we may be setting up a system where, because we do not see savings, we may even see an increase in costs.

Universal, single-payer pharmacare would save our health care system billions of dollars a year, and this is not it, not yet. I want to support getting the bill through, but I really object to seeing a constant loss of our opportunity to thoroughly debate issues because of the need to bring down le bâillon, toujours la guillotine.

Government Business No. 39—Proceedings on Bill C-64

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Madam Speaker, I listened attentively to what the health minister was saying, so I am glad to be the first person to rise on my side to maybe provide a rebuttal and also to reset the debate, because the debate is not directly about Bill C-64; it is about a programming motion.

When I listened to the minister's speech, I also had the time to compare it to his speech that he gave at second reading. The same three anecdotes he raised today were raised then. Two of the three are completely misleading, and one was a very personal experience of his that he raised, which is his right as a member and a minister.

However, this is about a programming motion that would guillotine debate in the House. It would order a committee of the House to basically consider a bill within 10 hours, a bill that would have profound impact on the structure of Canada's health care systems, plural because they are systems. Quebec has a different system than Alberta, than British Columbia, than Saskatchewan and than other provinces in Canada.

We know from much research that has already been done by CIHI, The Conference Board of Canada, Statistics Canada, and CLHIA, which is the life insurance trade association, that 97.2% of Canadians already have access or are eligible for access to an insurance benefit plan of some sort. I know that in my home province, we have Blue Cross, which is usually the insurer of last resort that provides a lot of the services that the minister talked about.

The worst part of all is that we would be programming a committee of the House to study what essentially amounts to a pamphlet of legislation. The minister talked about finding common ground and solutions. I have also heard other members of Parliament talk about how important committee work is to them. Now we would basically be guillotining and gag ordering a specific committee of the House, the Standing Committee on Health, to do its work in 10 hours.

That is why I asked a question for the health minister on why he felt the need to exclude himself from having to come to testify before the health committee. One would think that he would put himself before the members at committee and answer all of their questions on the reasoning behind C-64 and the wisdom of it, because it is not a national pharmacare plan. That is not what it would do. It would cover two very small areas of medicine.

I will note that in the minister's second reading speech about Bill C-64, he had all of one sentence devoted to rare disease drugs and rare disease patients, typically the source of the most expensive therapies, the most expensive drugs, on an individual basis, not on a broad basis. Typically most drug plans in the provinces, whether private or public, spend the most on things like the very basic medication for infections. Medications like amoxicillin or penicillin and variations thereof are the ones that are quite expensive because people get a lot of infections, so it it just a question of volume in those situations.

There is a lot of medication out there that is expensive because it is brand new; it is coming onto the market for the first time. Recently I learned about a new oncology drug that is going to be made available in the United States, but it is cutting-edge, specialized medicine made for the individual patient. The drug comes with a few tens of thousands of dollars of cost associated with its delivery. There will be some cancer centres in Canada that will not be able to have it available for patients, but it will be available to other patients in other parts of Canada. Oncology drugs would not be covered under the plan.

There would actually be nothing covered in the plan except for those two areas of medications, which are very specific ones as well. Like I said, there would be nothing for rare disease patients. The minister talked, in his original speech at second reading, though not today, about the $1.5 billion being devoted to rare disease drugs. That announcement was made in 2019, yet only now has some of the spending gone out, not to cover drug costs but to cover things like the creation of rare disease registries to get foundations, universities and private organizations to start up a rare disease registry specific to one individual drug.

There is often a problem in how the Liberals propose things. They say something, make claims, and then it takes years before anything actually happens. As an example, in 2019 there was an announcement. In 2024, still not a single rare disease drug has been covered by the $1.5 billion. It took five years of waiting. Rare disease patients cannot wait. In fact it was the Liberal government that cancelled the original rare disease strategy in 2016. At that time, the president of the Canadian Organizations for Rare Disorders, Durhane Wong-Rieger, said that it was the kiss of death for patients with rare diseases.

She is a literal ball of energy and an amazing woman, an amazing advocate for patients with rare diseases. This was in 2016. It took the government three years just to announce funding and five years after that to roll out a single dollar. Now the government wants to convince us that it needs to expedite Bill C-64 by programming and ordering the Standing Committee on Health to consider certain things but not others.

I will go through the programming motion, since the minister did not feel the need to even explain why this was necessary. He repeated, essentially, his second reading speech on why we need to expedite this so quickly. There were three days of debate in the House before there was a vote at the Senate and in the Standing Committee on Health. I looked at the work the Standing Committee on Health had done. It did not even have the chance to consider the bill. That is how quickly the government is now programming what is going on.

The first line of this programming motion is very simple: “the committee shall have the first priority for the use of House resources for the committee meetings”. It seems quite reasonable that it would be given first right to interpretation, rooms and catering services if the committee is expected to sit for hours and hours on end. I guess a programming motion would have to have that in it.

The second part is, “the committee shall meet between 3:30 p.m. and 8:30 p.m. on the two further sitting days following the adoption of this order to gather evidence from witnesses, provided that any meeting on a Friday may start at 12:00 p.m. for a duration of not more than five hours”. Essentially, that is saying there will be two more meetings of the Standing Committee on Health and 10 hours of testimony. There are countless members in the House who will say that, during consideration of a bill, witnesses will testify, explain an idea or perhaps a missing amendment or particular line in a bill between the French and the English, which happens on a fairly regular basis. They either do not match, do not make sense or there could be more added to a bill to clarify or constrain a bill. Ten hours is simply not enough for a bill that would have such a substantive impact.

According to the health minister, the Liberals are going to celebrate a bill with such a substantive and profound impact as some great achievement. I do not believe that. I believe this is a pamphlet. This is not national pharmacare. There is no spending associated with this bill. Every one of my constituents back home knows there is no spending associated with this bill. If the Liberals keep ramming the bill through at this pace and it passes through the Senate at some point in the future, not one single drug will be paid for through this legislation because there are no dollars associated with it. There is no, what we call, ministerial warrant from the Minister of Finance connected to this bill. There will be no medication paid for through this particular bill. That is why I do not understand why this programming motion is of such necessity when the committee has not even had a chance to consider it.

I understand perhaps it would be easier to tell Conservatives, members of the Bloc and independent members that they are slowing down the committee's work, that they are not allowing the committee to proceed with witness testimony or consider the contents of the bill, but that has not even happened yet. We have not even had a chance to invite witnesses to explain to us their views on the contents of the bill.

When the minister talks about finding common ground and solutions, he accuses the Conservatives of being against it. Of course we are against it. We voted against the bill, but that doesn't mean we cannot improve an F product and make it maybe an F+ product. I know that is not a grade in universities or colleges in Canada, but we can always make something terrible a little less terrible. This is essentially, like I said, a pamphlet. For me, it was easier to vote against it because I saw nothing for patients with rare diseases. That is not a surprise to anyone in this place.

I remember the original debate on an NDP private member's bill, which I believe was Bill C-340, if memory serves. It was on national pharmacare. At least the title was on national pharmacare, not the contents. It was put forward by the member for Vancouver Kingsway. He and I debated it for most of the day. I was all about access for patients with rare diseases, and I said that was why I could not vote for that bill at the time.

It is not a big surprise to many members of the House and members of the other place that I would be against a bill that has has a title of national pharmacare, but would not do anything for patients with rare diseases. Members know of a personal anecdote I have mentioned many times in the House. I have three living kids with a rare disease called Alport syndrome. One daughter passed away very young, at 39 days old, with a different rare disease. I always joke with my friends in the rare disease community that I am due. I should probably play the lottery as I would I have a decent chance of winning because both of those conditions are rare.

In the case of my living kids, it is a rare disease of the kidneys, CKD, a chronic kidney condition. In the case of my youngest daughter who passed away, she had Patau syndrome, which is a chromosomal condition and very, very rare.

If one knows a child with Down syndrome, one should hug them. They are very special little kids. My daughter had a condition that is considered much worse than Down's. Down's is survivable. There are a lot of very sweet kids who live with Down syndrome, and their families are made incredibly happy by them because they are sweet into the teen years, into their twenties, thirties and forties. One never has to go through those teenage years, as I am going through right now with one of my kids, where suddenly, as the dad, I know nothing and they know everything, which is okay. I will go through this three times in my life.

I will move on to the next part of the programming motion, which reads, “all amendments be submitted to the clerk of the committee by 4:00 p.m. on the second sitting day following the adoption of this order”.

We are quite fortunate there was unlimited time provided, I believe, for the first two speakers on a programming motion. Perhaps members are surprised I would rise on this, but I intend to use this time to explain why I do not like the programming motion and the defects with Bill C-64, and to remind the minister about what the summary of his own legislation says that it does, because it is the complete opposite of what the minister just explained to the House. It is the complete opposite from his second reading speech as well, so members can stay tuned for that part.

On these amendments, we are fortunate because we have a constituency week coming up. I can guarantee many of us will be sitting down and working with patient advocacy groups. We will be going to our stakeholder groups and meeting with our constituents. I have a few who have emailed me on this subject. I will be finding useful amendments to this bill that would improve it in my eyes and in the eyes of my constituents. We have the time.

Had we had a sitting week coming up, had there not been unlimited time for the first speaker on the official opposition side, we could have been rushed to provide amendments by 4 p.m. after the first day. That is an incredibly low amount of time considering this first came to the House February 29 and then the last vote was on April 16 before it was sent to the committee.

Doing a programming motion like this, or a gag order to the committee, is wrong. I do not agree with programming motions. I believe I voted against nearly all of them that ever came through the House. I believe the health minister was also the House leader at one point when Motion No. 16 was being moved through the House. There was also a previous one, and I believe it was a member for Waterloo who moved Motion No. 6, which would have programmed how committees work in the Standing Orders forevermore for the Houses.

I cannot base our opposition or our support for any particular motions and programming motions on good faith coming from that side because I simply do not believe the cabinet, the front-benchers. I do not believe them. There are many good-hearted backbenchers in the Liberal benches. They are easier to work with, I find, than those on the front bench. The front bench I just do not trust. I do not trust the front-benchers to do the right thing for Canadians. In fact, Canadians do not trust them. If we look at the polls, there is about a 20-point disparity, depending on which poll we consider, between what the government is polling at and what the official opposition is polling at.

I will move on to the next point, which reads, “amendments filed by independent members shall be deemed to have been proposed during the clause-by clause consideration of the bill”. I actually do not have a problem with that. Independent members should be treated like every other member of the House, especially during considerations of bills.

Now comes the next one, which gets gets quite technical:

the committee shall meet at 3:30 p.m., on the third sitting day following the adoption of this order to consider the bill at clause-by-clause, or 12:00 p.m. if on a Friday, and if the committee has not completed the clause-by-clause consideration of the bill by 8:30 p.m., or 5:00 p.m. if on a Friday, all remaining amendments submitted to the committee shall be deemed moved, the Chair shall put the question, forthwith and successively without further debate on all remaining clauses, amendments submitted to the committee as well as each and every question necessary to dispose of the clause-by-clause consideration of the bill, and the committee shall not adjourn the meeting until it has disposed of the bill...

This means that, once the 10 hours of testimony are done, once that particular portion of the committee's work is done, every single amendment has to be voted on immediately, with no debate for amendments. In those 10 hours, if witness testimony takes five or six or seven hours, we then have a few hours left over to consider and debate amendments. We could not even persuade the other side of the wisdom of the amendment. This is so profoundly wrong. I see this programming motion all the time when it comes to omnibus budget bills.

I will remind the House that the Liberal platforms in 2015 and 2019 promised not to do omnibus budget bills, yet they have done them repeatedly, over and over again. In fact, in Liberal budget 2023, they had section changes to clauses 500 to 504 on natural health products. That has nothing to do with the budget. There are no spending items related to it, but it was a regulatory expansion to apply rules for pharmaceuticals directly onto natural health products.

It caught a lot of people by surprise, including myself, that in a budget bill, which sometimes has hundreds of pages, one would do such a thing. They basically clip what they usually do at the finance committee, and now they have dropped it and ordered the Standing Committee on Health to do it in one particular way, in their way, their preferred way, with no debate on any amendments.

Why should one allow backbenchers from any of our political parties to freely consider the judgment and the argument being made by another member of another political party, individually or on behalf of their political movement, on the wisdom of a particular amendment to a government bill? I know, it would be shocking to even have that consideration.

It would be even more shocking for some members of the government benches to know that I have voted for government amendments at committee. I know. I hear “shame” from my side of the benches, but it happens. Sometimes they have a good idea. I am willing to consider good ideas. I am willing to. I have been on several committees over my time, from foreign affairs to finance to the Standing Joint Committee for the Scrutiny of Regulations. I am on the immigration committee and the Canada-China committee now, the select committee. I will vote for reasonable amendments. I will even talk to my own side to try to convince them if there is a reasonable, logical amendment that makes sense. Sometimes there is an argument made by a member of another party that actually makes sense. This section prevents that. There will be no debate on amendments. One is just supposed to vote on them.

Of course, what will happen is that there will be a question of having a recorded division on every single one of those votes. This means the committee will continue, likely, late into an evening, because it is basically programmed. To demonstrate that this is wrong and should not be done, I am fairly sure that there will be members of the committee who will want a recorded division on every single item so that we can go back to it later with our errors and mistakes and illogical situations that arise because two sections perhaps conflict with each other. This type of amendment process, clause by clause, is incredibly important, and we now will not be allowed to be given this opportunity.

The sixth portion of this guillotine gag order on the Standing Committee on Health says:

a member of the committee may report the bill to the House by depositing it with the Clerk of the House, who shall notify the House leaders of the recognized parties and independent members, and if the House stands adjourned, the report shall be deemed to have been duly presented to the House during the previous sitting for the purpose of Standing Order 76.1(1)

This is a fairly reasonable amendment that is often provided by members in other committees to make sure that, when reporting on a bill, the House leaders are informed, typically to go on the Notice Paper. I do not have a direct issue with this particular portion, apart from the fact that this is a programming motion, a gag order, that is going to guillotine a committee of the House without that committee even having had the chance to consider a bill.

The next section is section (b). It says:

not more than five hours shall be allotted to the consideration of the bill at report stage, and at the expiry of the time provided for the consideration of the said stage of the bill, or when no member rises to speak, whichever is earlier, any proceedings before the House shall be interrupted, and in turn every question necessary for the disposal of the said stage of the bill shall be put forthwith and successively, without further debate or amendment, and, if a recorded division is requested, the vote shall not be deferred...

It continues. There is another one, but I am going to stop right here. This essentially means that, when amendments come back from committee, they are sometimes ruled out of order. They cannot be considered at committee but they can be considered by the House because the House has control of its committees, and the House can decide whether certain amendments can be voted on. Those are typically then submitted to the Speaker.

This essentially says that this process will also be guillotined after five hours. I know they love gag orders. I know they love to guillotine debate. My hope is, too, that during this debate on the programming motion, they do not gag order the gag order. I would hate to see that. It would be like a double gagging of the orders of the House and really limiting debate.

They have done it before. They have done it on Bill C-7 and Bill C-14, the two medical assistance in dying bills. At different stages of those bill, they both programmed and then shut down debate on them. I have seen, plenty of times, allocation motions being moved by cabinet to force bills through the process on matters of conscience.

It is not as if they are technical bills where perhaps there is timeline the Liberals need to reach and where, for the proper administration of government, they can perhaps make an argument they can stand on, but for matters of conscience, to guillotine debate is wrong. In this particular case, I would say that this is not a matter of conscience. I think this is about administration of government services and what the contents of the bill are actually about versus what they are not about. When the Liberals impose a guillotine with time allocation and force the closure of debate, the major disadvantage to Canadians is that they cannot prepare themselves. They cannot organize themselves when they are opposed to particular ideas and when they want to ask questions like, “Why is my rare disease, my health condition or MS not covered in this bill? Why is diabetes covered?”

I know a lot of diabetics, and I am not picking on them directly. I am just asking a simple question. The most common rare disease is multiple sclerosis, or MS. A lot of people in my family have it, as well as friends, colleagues and co-workers. There are spouses of members on this side who have it. Therefore, why is that particular condition, and its medication, which is expensive medication, not in this particular piece of legislation?

It is a choice the government made, so why can we not debate that choice the government has made for those two particular conditions and the medications associated with them? If they are being covered, why not others? There are so many other types of medications, such as the most common ones: penicillin, amoxicillin and all the variations of the “-cillins”, because there are so many of them. Why are they not covered in this particular piece of legislation?

On this programming motion, should we put forward such an amendment to be considered at committee? If it is deemed non-votable at committee, why can it not be considered at report stage?

I guess I will only get through the programming motions, and I will have to come back later to finish talking about Bill C-64 and some of the things the minister said, as well as my concerns with the PMPRB, CADTH, pCPA and the entire architecture of drug approval in Canada.

The motion reads, “not more than one sitting day shall be allotted to the consideration of the bill at the third reading stage, and 15 minutes before the expiry of the time provided for Government Orders”, and it goes on like that, which basically means that there will be one day for final speeches, and then it will be done and sent to the other place. It is wrong to ram through a bill in this method, with bad faith being shown by the health minister, claiming that we were opposing it and not willing to consider things, when he has never bothered to listen.

[Mark Holland, Liberal, Ajax, ON]

Madam Speaker, through you to the Conservatives, they are against this bill and against providing contraceptive and diabetes medications. That is fair. They can be against it, but the House has an elected will. What we saw on the very first day that we attempted to put this bill before the House was obstruction and what we have seen with other bills is obstruction, not obstruction to continue a conversation, but obstruction because they do not want it.

I do not know how long we could have a debate about whether or not we should do it. What is the value of that debate to public discourse? We could talk about it until the cows come home, but Conservatives are against it. There is going to be an opportunity obviously at committee, at third reading and at report stage to have a lot more debate on the bill, Bill C-64, and to hear their single position, which is in opposition.

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Madam Speaker, I listened attentively to the health minister's speech. He talked about, at one point, finding common ground and finding solutions. He recited every single anecdote in this speech that he did in his second reading speech on the bill.

This bill, Bill C-64, only got three days of debate in the House, and it was then sent to committee. Now, we have a programming motion, so it is a guillotine or gag order attempting to be imposed on the House of Commons to order a committee of the House to dispense with the bill after something like 10 hours of consideration at committee. If we are talking about finding common ground and finding solutions, then we should allow the House and its committees to do their work instead of ramming things through.

I wonder if the minister could explain why, in the programming motion, he is not obliged to testify before the committee.

[Mark Holland, Liberal, Minister of Health]

moved:

That, notwithstanding any standing order, special order, or usual practice of the House, Bill C-64, An Act respecting pharmacare, shall be disposed of as follows:

(a) during the consideration of the bill by the Standing Committee on Health,

(i) the committee shall have the first priority for the use of House resources for the committee meetings,

(ii) the committee shall meet between 3:30 p.m. and 8:30 p.m. on the two further sitting days following the adoption of this order to gather evidence from witnesses, provided that any meeting on a Friday may start at 12:00 p.m. for a duration of not more than five hours,

(iii) all amendments be submitted to the clerk of the committee by 4:00 p.m. on the second sitting day following the adoption of this order,

(iv) amendments filed by independent members shall be deemed to have been proposed during the clause-by-clause consideration of the bill,

(v) the committee shall meet at 3:30 p.m., on the third sitting day following the adoption of this order to consider the bill at clause-by-clause, or 12:00 p.m. if on a Friday, and if the committee has not completed the clause-by-clause consideration of the bill by 8:30 p.m., or 5:00 p.m. if on a Friday, all remaining amendments submitted to the committee shall be deemed moved, the Chair shall put the question, forthwith and successively without further debate on all remaining clauses, amendments submitted to the committee as well as each and every question necessary to dispose of the clause-by-clause consideration of the bill, and the committee shall not adjourn the meeting until it has disposed of the bill,

(vi) a member of the committee may report the bill to the House by depositing it with the Clerk of the House, who shall notify the House leaders of the recognized parties and independent members, and if the House stands adjourned, the report shall be deemed to have been duly presented to the House during the previous sitting for the purpose of Standing Order 76.1(1);

(b) not more than five hours shall be allotted to the consideration of the bill at report stage, and at the expiry of the time provided for the consideration of the said stage of the bill, or when no member rises to speak, whichever is earlier, any proceedings before the House shall be interrupted, and in turn every question necessary for the disposal of the said stage of the bill shall be put forthwith and successively, without further debate or amendment, and, if a recorded division is requested, the vote shall not be deferred; and

(c) not more than one sitting day shall be allotted to the consideration of the bill at the third reading stage, and 15 minutes before the expiry of the time provided for Government Orders that day, or when no member rises to speak, whichever is earlier, any proceedings before the House shall be interrupted, and in turn every question necessary for the disposal of the said stage of the bill shall be put forthwith and successively, without further debate or amendment, and, if a recorded division is requested, the vote shall not be deferred. (Government Business No. 39)

Madam Speaker, it is my pleasure to rise to talk about Bill C-64, which is an opportunity for us to move forward with pharmacare in this country. In the first order, the bill represents the best of what Canadians should expect from the House, which is different parties working together to find common ground and solutions.

I will start by thanking the member for Vancouver Kingsway for his work in what were often challenging conversations and negotiations, but which led to an exceptionally important bill that is going to do incredible good across the country. As well, I want to thank the member for New Westminster—Burnaby, the House leader for the New Democratic Party, for his work as House leader and now as health critic. In all orders, when we are facing something as challenging as the protection of our public health system and making sure Canadians get the care they require, working in a non-partisan way to drive results is exceptionally important.

I will speak to what is at stake, say a bit about what we have been doing in health and then talk specifically to the legislation that is in front of us today.

It was a stark day for me yesterday because I had two very different kinds of conversations. One conversation was with somebody who was saying, in a roundabout way, that maybe it would not be so bad if our public health care system became private. It is important to focus on what that would mean for this country and why it is something that we should all be adamantly opposed to.

If we allow our system to become a private health care system, there would be a migration of dollars toward a private system and expertise, in which the private sector would take that which was easy and lucrative and leave that which was difficult or involved folks who did not have the means to be able to pay for those services. This would leave less money in a public system that would be dealing with the most expensive problems and the most intractable issues. Over time, we would then see more and more migration of that which was easier into the private system, which would mean that people who do not have the means could not afford the same kind of care.

In a very practical sense, that ends up in the following type of situation: I had an opportunity to be in the United States with my partner for a weekend, and we witnessed a man collapse. It was clearly a person with not a lot of means. He fell unconscious to the ground. We went to his side and called 911. When he became conscious, his first thought was not about his health or worrying about what had just happened to his physical body; his concern was how he was going to be able to afford what just happened to him. I thought about the phone call I made to 911 and whether this was what this man even wanted, because now he has to think of exorbitant health costs to get the care he needs.

Even those who do not fundamentally care about whether their fellow citizens, regardless of their financial circumstances, get the same level of care as everybody else in the country, even if we cannot compel people's morality to care about the circumstance of whether somebody in their own community gets the same level of medical care that they do, the reality is that when somebody does not go to a hospital to get checked for something that is minor, because they do not have money, then it becomes something major. We are then left with the existential question, when that person becomes so sick that they are on death's door, of whether we just let them die or whether we pay the exorbitant costs that we have allowed to accumulate through not having a system that took care of those problems in the first place.

For the prognosticators of doom about our health system, for those who push the idea that we should just allow it to deteriorate and not make the investments or say that it is too difficult, they have to be honest about the future they are painting for Canadians in this country and the type of health care system that they would be left with. It is one where only the affluent have the opportunity to get the care they need. We can imagine a world where nurses cannot afford the care and services they require, but the affluent they are serving do. I do not think that is a society we want to be in.

That is why the investments we are making in health care are so critically important. The federal government has come to the table with nearly $200 billion to invest in partnership with provincial and territorial governments over the next 10 years. In the same spirit as the legislation, the question was not asked about one's partisanship or one's jurisdiction, because I do not think Canadians are interested. They want to see answers and forward progress.

I really want to commend the health ministers across the country because, over the last 10 months, as I had an opportunity to work with them to negotiate the agreements we signed, it was a spirit of co-operation and putting the health of Canadians first. It does not matter whether it was Adriana LaGrange in Alberta, Tom Osborne in Newfoundland and Labrador, a Conservative and a Liberal, or Adrian Dix, a New Democratic health minister in B.C.; they understand we have an important job to do and that we need to focus on what unites us and how we make things better.

The results were incredibly detailed health agreements that not only put money into the system but also showed exactly how that federal money is going to be spent. Thus, Canadians can view where those dollars are going to go to improve their health system and issues such as the health workforce, where we make sure that we have the doctors and nurses Canadians need and that everybody has a relationship with a doctor in this country. In addition, this enables us to put common indicators across the country so people can see the progress their province is making.

We know what is measured is achieved, and for the first time in our health system, these agreements put common indicators across the country so we can see the progress occurring in our health system and see what those investments are doing on key indicators identified by CIHI, which is an independent agency dealing with health data.

However, in dealing with the urgency of the now, let us recognize that our health system has been enormously strained. Throughout one of the darkest periods in public health that, certainly, we have known in our lifetime, health care workers were asked to do Herculean amounts of work. They were asked to rise to an occasion and do more than I think any reasonable person could be expected to do, but they met that hour and did it. As in health systems all over the world, instead of being met with a break, they were met with even more work, with burnout, with all kinds of mental fatigue and mental health issues as a result of the pandemic, with a backlog of procedures and with a health system that was even more overwhelmed.

What was remarkable about that period of time, going back to the spirit of co-operation, is that we made extraordinary progress. This was when the health system was fully aligned in the darkest moments of the pandemic, everybody was given more agency to practise at top of scope, jurisdiction was of distant consideration and people's immediate urgent health needs were first. We are dealing with that, with these workforce agreements and the work we are doing bilaterally with provinces and territories, but it is not enough to deal with the crisis of now. We have already made such huge progress. On where we were a year ago versus where we are now, that progress is evident through our whole system, but we recognize we also have to be upstream.

That brings me to another conversation that I had yesterday. I had the opportunity to be with the member for Ottawa—Vanier at a denture clinic in Vanier. Here is another example of parliamentary co-operation, where two parties came together and recognized an essential need in this country, which is that some nine million Canadians do not have access to oral health care.

We have now seen more than 30,000 seniors, just in the first few days of this dental program, receive care for the first time. I have been able to see what that means, in many instances by going into clinics. I will talk about what I saw in that denture clinic in Vanier. A denturist was talking about a senior who had not had their dentures replaced in 40 years; they did not have the money. This senior had no teeth and used a black apparatus to crush food in their mouth. One can imagine the dignity and the spiritual change in that person when they came in and realized that, after 40 years, they were finally going to get teeth in their mouth. The denturist being able to describe that moment, the pride they had in being able to deliver that service and give that senior that dignity, was absolutely extraordinary.

I had an opportunity in my own riding, just a few days before that, in Ajax, to meet with a senior. I never had a chance to meet him before. His name is Wayne. He sometimes goes by “Moose”. He was talking about himself and his wife. He had a need for partial dentures, and he had other oral health problems, as did his wife, which they had been putting off. In terms of what it meant to him to feel seen and to be able to get those issues taken care of, the truth is that we know it is not just a matter of dignity. It is not just a question of what kind of country we want to live in. What about the cost?

I think of Wayne and his inability to pay for the medical care that he needed for oral health care. Left untreated, Wayne could very well end up in a hospital room with an unnecessary surgical procedure, placing his life at risk. Imagine the staggering cost of that.

Dental care is not about some kind of boutique political intervention. It is fundamentally about making sure that people get the preventative care they need. It is part of the overall action that we are taking as a government, not only dealing with the crisis of the now, but also casting our eyes into the future and asking how we can work together.

Clearly the Bloc Québécois members have concerns about the jurisdiction issue, which I completely understand. It is a concern for me too. However, in my opinion, this is not a question of jurisdiction. It is actually a question of co-operation. There was one question that dominated my conversations with Quebec's health minister, Christian Dubé: How can the Government of Canada and the Province of Quebec work together to improve our health care system?

There are plenty of opportunities for us to work together in a spirit of co-operation to improve our health care system. It is easy to pick quarrels, point out differences and raise the issue of jurisdiction. However, I believe that for Quebeckers, what really matters is their health and government action.

Dental care is a great example of that. In Quebec, the Minister of Heritage has done extraordinary work in her riding. Almost all the providers in her riding have signed up, meeting a lot of that misinformation that was coming from the Conservatives with true facts. The experiences of those providers have been extraordinary. That is an example of us working together.

I said to Minister Dubé in Quebec that if they want to administer the program, it is no problem. Our care is about the patients, not about the jurisdiction. Our only requirements, if a one wants to take it over, is that one has to have at least the same level of care, number one, and number two, we are not going to give more to administer the program than it costs us to administer it. If it costs one more, that is something one has to bear on one's shoulders or look internally at how one is operating one's system.

That is an example of making sure that we get the care now and that we fix the question of jurisdiction later. For somebody who has a dental emergency, for a senior who does not have teeth in their mouth, they do not care about jurisdiction. They care about care and about getting it done. That is what we are focused on.

Before I come to pharmacare, one of the other things we are doing is about school food. When I was at Heart and Stroke, I had the opportunity to lead the Ontario mission and to be the national director of children and youth. One thing that was shocking to me was that when a child has one healthy meal, it can totally change their health outcomes. It does it for a couple of reasons. First, just the act of eating fruits and vegetables and healthy food has a transformative effect on health and prevents chronic disease and illness. Second, how does one learn if one is hungry? Third, one actually gets to develop a taste for healthy food that lasts one's entire life. Therefore, this is an extraordinary investment that is going to make a massive difference.

We are also taking action on marketing to kids with front-of-pack labelling and taking action with the $500-million fund to develop capacity for mental health services on the ground in communities across the country. I could go on and on, but I only have a short period of time to talk about the thing that we are here to talk about. I see the member for Vancouver Kingsway, and I want to thank him for this.

When we talk about contraceptives, it is incredibly frustrating to me that, over the last number of days, we have seen a march and a protest here to try to take away women's rights and take away their right to choose. We have seen over 80 Conservative members, I believe is the number, who have been endorsed because of their belief that they should take away a woman's right to choose, and that is fine. I am pro-choice, and there are members who are not.

However, what I do not understand is if someone is against a woman's right to make a choice about her own body, how can they also be against giving her contraception? What choice is she left with? Let us look at that very specifically. If a woman today is in need of contraception and does not have the money for it, what are they supposed to do? Maybe they can find the money for oral contraception, but it has a failure rate of 9%. An IUD has a failure rate of 0.2%, but it costs $500 up front. For the women who do not have the money to pay for it up front, they are left with a less effective tool to be able to have control over their sexual and reproductive health.

How, in the one order, can we say to a woman that they are not allowed to choose or make a choice for their body, but in the other order, say that we are not going to help them get contraception to be able to make a choice about their body that way either? In other words, they get no choice. What conversation is being had about sexual health? If someone is against giving contraception to women and against them having a choice over their body, then they would at least talk about sexual health.

For women, it is extremely important to know that their body is something that they should always have autonomy over. Sex is something that should feel empowering and should make them feel like themselves. It is something they should never be coerced or pressured into. It is something that they should never feel ashamed of. It is something that should feel pleasurable.

Pharmacare Act

[The Speaker, Liberal, Greg Fergus]

It being 3:17 p.m., the House will now proceed to the taking of the deferred recorded division on the amendment of the hon. member for Cumberland—Colchester to the motion for second reading of Bill C‑64.

Call in the members.

The House resumed from May 6 consideration of the motion that Bill C-64, An Act respecting pharmacare, be read the second time and referred to a committee, and of the amendment.

Second reading

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Madam Speaker, debate on second reading of Bill C-64 took place tonight without quorum, which means that Bill C-64 will have been considered without the constitutional requirement of quorum. In the event that Bill C-64 receives royal assent, I trust that the fact—

[Ziad Aboultaif, Conservative, Edmonton Manning, AB]

Madam Speaker, Bill C-64 is a classic example of the legislation the Liberal government has brought before this Parliament. Once again, it has over-promised and under-delivered.

When the leader of the NDP sold his party's soul and coincidentally guaranteed that he would receive a pension for his efforts, many people thought he got too little for it. New Democrats did not even get 30 pieces of silver, as they betrayed their ideal and the Canadian people.

What has this betrayal cost Canadians? Inflation continues at record levels, fuelled by the carbon tax. Housing costs have doubled. Health care has vanished. Food bank use is at record levels. The immigration system is broken. Our military suffers from neglect, and foreign governments try to influence our elections. The Liberal response is to shrug. Canada has become a joke on the world stage.

What does the NDP receive for this blind support of the Prime Minister and his disastrous policies? It receives a promise to look at what it would take to establish a national pharmacare program. It is not even that, really.

Canadians thought a pharmacare plan would cover their drug costs. For the majority of the country, this was not a pressing issue. According to The Conference Board of Canada, 97% of Canadians are already eligible for some form of drug coverage, although the final report of the advisory council on the implementation of national pharmacare indicated that 20% of Canadians receive what could be termed inadequate coverage. In December of last year, a Leger poll indicated that only 18% of Canadians thought the establishment of a national pharmacare program was a health care priority.

It may come as a surprise to the Liberals and the NDP, but Canadians are worried about rising prices on everything, due in large part to the carbon tax. When people are worried about being able to feed their family, pay the rent or mortgage and put gas in their car so they can get to work, they do not spend much time thinking about a drug plan that does not cover the medications they need.

Canadians were hoping the Liberals could get it right. That turns out to have been a false hope. On this issue, as on many others, the Liberals are proving once again to have no idea what they are doing. The Liberal idea of pharmacare is restricted to just two types of medication. If one suffers from heart disease, one is out of luck. Heart disease is the second-leading cause of death in Canada, but medication for it would not be covered.

The Liberals' approach to pharmacare reminds me of their approach to Canadian liquid natural gas, or LNG. When the chancellor of Germany came to Canada looking to buy Canadian LNG, the Prime Minister told him there was no business case for such exports. That was a huge surprise to those companies looking to expand their markets.

Not only is there a business case for Canadian LNG, but there is a moral one as well. In the aftermath of the Russian invasion of Ukraine, countries are looking to replace Russian LNG and have turned to Canada, only to be told by the Canadian government that it does not want to sell Canadian LNG. The Prime Minister needs to learn that when there is a customer willing to buy the product, there is indeed a business case to support it. If Germany and Japan and Greece want to buy Canadian LNG, why would we not want to sell it to them?

A previous prime minister asked farmers, “Why should I sell your wheat?” This tells buyers there is not a business case to sell them the product they are asking for, while at the same time offering Canadians a pharmacare program they did not ask for, a plan so flawed it is unlikely to work.

This is the government that promised a firearms buyback program four years ago. So far, it has not managed to launch it, yet it wants Canadians to believe it has the skills necessary to design and implement a pharmacare program. Put simply, what is being offered is not pharmacare.

It is just another Liberal election gimmick, a promise they will campaign on in 2025, hoping that voters will not look at how many promises they have already broken. Anyone who has looked at the current state of drug coverage in Canada is concerned by this attempt to create additional bureaucracy. We already have some public drug plans; they do not seem to be as good as the private ones. Private drug insurance plans cover many more different medications than public plans do. The difference varies by province, but, on average, private coverage is 51% more extensive than its public counterpart is. In Quebec, the figure is 59.6%. Then there are the delays. Once a drug is approved by Health Canada, it takes an average of 226 days for a private insurer to approve the coverage. By contrast, it takes 732 days for approval by Health Canada, or a little over three times as long, for a public plan to add a drug to its list of covered treatments. These figures do not paint a rosy picture of the ability of public insurance to meet the Canadians' needs.

The marriage contract between the Liberals and the NDP required that the bill come before us last year. It did not. It took the Liberals two years to come up with the legislation, a bill that seems to have been put together without much thought, just to meet a deadline. Given how weak the bill is, I can only imagine what the first draft looked like. Maybe it was just one line, such as “We promise to look at establishing a pharmacare program in the hopes people will vote for us before we have to deliver.” Wait, is that not what Bill C-64 is?

After almost nine years of misgovernment, incompetence and mismanagement from the Liberal-NDP coalition, Canadians have lost all faith in the government's ability to discharge its responsibilities. What is the cost of this national pharmacare program? With two years to look into it, the Liberals either did not think to ask or are afraid to tell Canadians just how much more they want to raise taxes to pay for a plan that would benefit almost no one.

The bill is a public relations exercise by an utterly desperate government that is disliked by more and more Canadians every day. The inability of the Liberals to deliver on their promises is well known. Already, two provinces have opted out of this program. There is no indication that other provinces are interested. One would have thought that, in attempting to create a national program in an area of provincial jurisdiction, the Liberals would have consulted with the provinces. One might have expected that they would have hearings and consultations with stakeholders to see what exists now, what needs to be improved and the best way to do that. As far as I can tell, all they did was ask the NDP the minimum they could promise to keep the NDP's support.

Can the Minister of Health tell us what impact the bill will have on the 27 million Canadians who rely on privately administered workplace plans? If he is an honest man, he cannot, because he does not know. There was no consultation with the insurance industries when the bill was being drafted. Maybe he felt there was no need to check the facts. A promise had been made by the NDP, and the Liberals had to deliver. The needs and wishes for the Canadian people were not worthy of consideration. What is not worthy of consideration is this sad attempt at legislation; Canadians deserve much better than that.

[Brad Vis, Conservative, Mission—Matsqui—Fraser Canyon, BC]

Mr. Speaker, before I begin, I would just like to give a shout-out to the Abbotsford Rugby Football Club, which won the provincial championships over the weekend. The division 1 side has faced a lot of adversity. Our fields were flooded during the big flood in Abbotsford a few years ago. This team has really built back. Big congratulations go to Coach Chambers and all members of the squad on the game-winning kick by Mr. Rowell. Congratulations to all the boys for their accomplishments.

Now, I turn to Bill C-64, an act respecting pharmacare. As my colleague, the hon. member for Cumberland—Colchester, said in the House in April, the half-baked pharmacare plan being debated is truly about preserving the costly NDP-Liberal coalition.

In order to ensure that the coalition survives the next fixed election date, so many members can lock in their pensions, the NDP has agreed to a pharmacare plan that covers only two categories of drugs, while costing a billion and a half dollars and adding even more bureaucracy and gatekeepers to the already extremely bloated federal government.

There are 97.2% of Canadians who already qualify for some form of prescription drug coverage. It is important that we work to ensure that the 1.1 million Canadians without coverage can access pharmacare, but the proposed system would leave them woefully under-insured and no better off. In the context of British Columbia, we already have coverage for contraceptives through our provincial government.

What we have in front of us today is not a universal pharmacare system, as the NDP-Liberal government has been campaigning. It is a diabetes medication and contraceptive coverage system.

The member for Ottawa Centre just said in his speech that in 2028, diabetes alone will cost the medical system in Canada over $40 billion. Even the money put forward in this bill is only a drop in the bucket, and I wish the members of the NDP-Liberal government would come clean about misleading Canadians about what they are doing, because all of us have had constituents come to our offices and ask when the universal drug coverage will kick in. I am sorry to say that it will not; this is a PR exercise by this government, and it is shameful.

Canadians know how much a promise from the Prime Minister means, and it is not very much. This is the same Prime Minister who promised to balance the budget, or rather, that it would balance itself. This is the same Prime Minister who promised a $4.5-billion Canada mental health transfer that is yet to be delivered. This is the Prime Minister who promised British Columbians a universal day care system at $10 a day. Good luck trying to find that in our lifetime.

This is the same Prime Minister who promised that interest rates would stay low for a very long time, right before spending more money than any government in Canadian history and driving interest rates higher than they have been in decades. This is the same Prime Minister who has led to all of our GST payments, on every purchase we make in Canada, solely servicing the federal debt. Let that sink in. Every time we buy something, the taxes that we pay are only paying for the mistakes of the member for Papineau.

The only goal of this bill, as we all know, is to appease the NDP and avoid an election the government knows it would lose.

Speaking of the New Democrats, they really ought to be ashamed of themselves for even agreeing to this plan. For decades, they have campaigned on a single-payer pharmacare system, and now that they finally have a sliver of power in this Parliament, they fold and accept a half-baked plan that would cost taxpayers billions while failing to provide coverage for the vast majority of medications Canadians rely on, which the NDP promised to deliver. Shame on them.

The leader of the NDP loves to say that he will win the next election and often starts phrases with “when I am Prime Minister”. If he truly believed what he was saying, why does he continue to prop up that failed government, and why did he agree to this plan, which fails to cover the vast majority of drugs and treatments? If they are going to do it, they should go all in and take a risk. They are not willing to take a risk, because it is just about covering their own butts and getting their pensions.

The bill could have negative—

[Yasir Naqvi, Liberal, Ottawa Centre, ON]

Mr. Speaker, I want to first thank the member for Nunavut, along with the member for Bruce—Grey—Owen Sound, for joining me on Sunday in support of Christie Lake Camp, which is a worthy organization in Ottawa, in my community, raising $20,000 to support kids from priority neighbourhoods. I must say the member for Nunavut is an excellent basketball player, so it was a great afternoon.

I agree with the member that we need to catch up with many countries that allow for free contraception. It is about the autonomy of women. It is making sure that women are able to make decisions about their own lives. By passing Bill C-64, we will take the very important step of making sure that Canada really values women and gives them the autonomy they deserve as equal citizens.

[Yasir Naqvi, Liberal, Parliamentary Secretary to the Minister of Health]

Mr. Speaker, I am thankful for the opportunity to speak about Bill C-64 and about how this represents a historic milestone in the evolution of the Canadian health care system.

This bill and other investments made by our government will help millions of Canadians who are struggling to pay for their medication.

I was very thrilled when the Minister of Health, and many other incredible Canadians who have been advocating for a pharmacare program in Canada, joined in my community of Ottawa Centre, at the Centretown Community Health Centre, where, toward the end of February, we made the announcement on Bill C-64, on covering diabetes and contraception medication. One could see the excitement among people when that announcement was made in my community.

In fact, I have been working on this issue for over a decade now, during my time as a member of provincial Parliament in Ontario. I was part of a Liberal government that brought something that we called OHIP+. That “plus” covered medications for young people, and then, we were moving on to cover medications for seniors. It was really unfortunate that the Conservative government under Doug Ford cancelled that incredible program because it allowed for care for so many Ontarians.

However, I am thrilled that we are taking this important step here at the federal level.

In 2021, Statistics Canada found that one in five adults in Canada did not have the insurance they needed to cover their medication costs. This means that over 20% of adults in Canada face out-of-pocket drug costs that create a financial burden. This can lead to people sacrificing their basic needs, such as buying groceries or heating one's home, in order to afford their medications. It can also lead people to ration their medications, causing them worse health outcomes. This is not acceptable and I do not think that this is the kind of country any of us want to have.

Choices like whether to fill a prescription have serious consequences. Whether skipping meals or skipping doses, the decision to go without can create a cascade of negative impacts on a person's health and can increase the burden on our health and our social safety nets.

We can and we must do better. That is why we introduced Bill C‑64 and proposed this first step toward universal pharmacare.

Our commitment to address the accessibility and affordability of medication can be seen with the various initiatives we have implemented with respect to national pharmacare. In addition to the introduction of the pharmacare act, which includes a commitment to work with provinces and territories to ensure universal access to contraception and diabetes medications, we also established a partnership with P.E.I. to improve the affordability of prescription medications, implemented the first-ever national strategy for drugs for rare diseases and established a Canadian drug agency.

Let me start with the pharmacare act, which outlines a way forward toward national universal pharmacare in Canada. Bill C-64 recognizes the critical importance of working with the provinces and territories, which are responsible for the administration of health care. It also outlines our intent to work with these partners to provide universal, single-payer coverage for a number of contraception and diabetes medications.

This bill is an important step toward improving health equity, affordability and outcomes, and could help reduce health care system costs over the long term.

Coverage for contraceptives would mean that nine million Canadians of reproductive age would have better access to contraception, reducing the risk of unintended pregnancies and improving their ability to plan for the future. We are a government that has always and will always recognize that autonomy over one's body and the ability to control one's own sexual health is a matter of fundamental justice.

Contraception is a key component of individual autonomy. It is an essential component of reproductive health and contributes to advancing gender equality.

Cost has consistently been identified as the single most important barrier to accessing contraception and the cost is unevenly borne by women, people with low incomes and young people, all of whom are more likely to work in part-time or contract positions and often lack access to private coverage. Studies have demonstrated that publicly funded, no-cost universal access to contraception can lead to public cost savings. The University of British Columbia estimates that no-cost contraception has the potential to save the B.C. health care system approximately $27 million per year. Having safe, reliable birth control represents freedom and safety. However, these costs continue to be a barrier. With Bill C-64, we are taking action to remove the barrier.

The same cost reduction principle applies to diabetes medication. Diabetes is a complex disease that can be treated and managed with safe, effective medication.

However, one in four Canadians with diabetes have reported not following their treatment plan due to cost. Improving access to diabetes medications will help improve the health of 3.7 million Canadians living with diabetes and reduce the risk of serious, life-changing health complications, such as blindness or amputations.

Beyond helping people with managing their diabetes and living healthier lives, if left untreated or poorly managed, diabetes can lead to high and unnecessary costs to the health care system due to diabetes and its complications, including heart attack, stroke and kidney failure. The full cost of diabetes to the health care system could exceed almost $40 billion by 2028.

Independent of the legislation, we have announced that we will work with provinces and territories on a diabetes devices fund. This fund would ensure that people with diabetes have access to the medical devices and supplies they need, such as syringes, test strips, glucose monitoring devices and insulin pumps. This, combined with the framework outlined in Bill C-64 for universal single-payer coverage for first-line diabetes medications, will help ensure that no person with diabetes in Canada is forced to ration their medication or compromise their treatment.

I previously mentioned our excellent work with P.E.I. and how this $35-million investment is focused on improving affordable access to prescription drugs while at the same time informing the advancement of a national universal pharmacare. The work accomplished by Prince Edward Island has been outstanding. Since last year, P.E.I. has expanded access to over 100 medications to treat a variety of conditions, including heart disease, pulmonary arterial hypertension, multiple sclerosis and cancer, and is saving millions of dollars in out-of-pocket costs for P.E.I. residents.

On a national level, we launched the first-ever national strategy for drugs for rare diseases in March 2023, with an investment of up to $1.5 billion over three years.

As part of the overall investment of $1.5 billion, we are making up to $1.4 billion available to the provinces and territories over three years through bilateral agreements.

This funding will help to improve access to new and emerging drugs for Canadians with rare diseases as well as support enhanced access to existing drugs, early diagnosis and screening for rare diseases. This will help ensure patients with rare diseases have access to treatment as early as possible for a better quality of life.

I want to quickly mention that, in December of last year, we announced the creation of the Canadian drug agency, which will provide the dedicated leadership and coordination needed to help make Canada's drug system more sustainable and better prepared for the future.

This is an incredible opportunity for Canadians coast to coast to coast, working alongside provinces and territories, to allow for pharmacare, especially when it comes to contraception and diabetes. This is the beginning of building a more robust health care system that will work for all Canadians. I am excited to support this bill, and I encourage all my colleagues to do the same.

[Brenda Shanahan, Liberal, Châteauguay—Lacolle, QC]

Mr. Speaker, I have greatly appreciated the comments of my colleague from the NDP. It has been a very spirited debate here. We are talking about the provinces, the jurisdictions, and also about equality of care across the country. I think that is where the federal government comes in. That is where legislation like Bill C-64 comes in to ensure that there is equality of access to pharmacare, specifically in the areas of contraceptive care and diabetes.

I would like to hear my colleague's comments on that issue.

[Adam van Koeverden, Liberal, Parliamentary Secretary to the Minister of Environment and Climate Change and to the Minister of Sport and Physical Activity]

Mr. Speaker, reproductive and sexual rights are human rights. Our government recognizes that, and we stand by it as a matter of principle. Members of the Conservative Party caucus can stand in the House and say they are not interested in pursuing anti-abortion legislation that would infringe upon women's reproductive rights; however, sadly, that conviction is far from a universally held one in the caucus. In fact, the entire caucus has been designated as anti-choice by the Abortion Rights Coalition of Canada.

I am proud to say that, on this side, we are walking the walk. We are leading by example and putting forward Bill C-64, an act representing pharmacare, which would provide universal access to prescribed contraceptives to Canadians. In collaboration with provinces and territories, we will support universal coverage of contraceptive medications and devices so that nine million Canadians of reproductive age will have access to the contraception that they need and deserve. This will ensure that Canadian women can choose whether they are going to have children. It will give them greater control over their bodies and their futures.

Currently, Canada is one of the only countries in the world where access to health care is universal but access to contraceptives is not. Women therefore have a more limited range of options, and are more likely to experience unwanted pregnancies, which can impact their lives.

Access to safe, reliable birth control is essential. It gives women the freedom to plan their families and pursue their long-term goals and dreams. Unintended pregnancies, on the other hand, can cause a great number of negative health and economic impacts on families. At present, coverage for contraceptives varies across the country. Most Canadians rely on private drug insurance through their employer for their medication needs, and some populations are disproportionately affected by the lack of coverage.

Women, people with low incomes and young people, all of whom are more likely to work in part-time or contract positions, often lack access to private coverage, and only a fraction of Canadians are eligible for prescription birth control at low or no cost through a public drug plan. When a person pays out-of-pocket for their contraceptive needs, regardless of whether they have coverage, cost has been identified as the single most important barrier to accessing contraceptive medications or devices that they require.

One study showed that women from low-income households are more likely to use less effective contraceptives, or no contraceptives at all. Cost is a significant obstacle to gaining access to more effective forms of contraception.

For example, oral contraceptives cost approximately $25 per unit, or $300 per year. In comparison, intrauterine devices, or IUDs, are often more effective and last up to five years, but they have an upfront cost of approximately $500 per unit. IUDs are a much more effective method of contraception, since they have a low failure rate of 0.2%, compared with that of oral contraceptive pills, which is 9%. Furthermore, they do not require daily doses to remain effective, which is a long-standing challenge with the pill.

At this time, I would also point out that women can have the choice, but sometimes, it is not so much a matter of choice; it is a matter of how a woman's body reacts to these various interventions. It really should be a matter of choosing not based on cost, but based on what works best for them. If someone is a young woman in their twenties, working at a part-time job that does not offer private coverage, accessing an IUD or other contraceptive method can be a big cost when trying to manage other basic life expenses, such as rent or grocery bills.

As colleagues can see, this is the reality that many Canadians are currently facing and trying to manage. We have decided to intervene and help. Bill C-64 would address the lack of access by working with provinces and territories to provide universal coverage of contraceptive medications and devices, so Canadians can access the contraceptives they need. Furthermore, some provinces are already paving the way; this is similar to how Saskatchewan led the way by implementing universal health care in the 1960s. Last year, British Columbia became the first province to provide universal access to contraceptives to their residents. Recently, Manitoba also announced a commitment to implementing universal contraceptive coverage in their province. I would join my colleague in clapping.

There is a certain trend I see, with certain provinces offering these services to Canadians. What is that common trend? I think we can leave it to our imagination, but it tends to be parties that are left of centre, that are more progressive and that are willing to step in and help where people need it most. Studies from the United Kingdom show that universal access to contraceptives provided a return on investment in health and social services of nine to one for every investment in universal contraceptive access.

In the Canadian context, evidence from the University of British Columbia estimated that no-cost contraception has the potential to save the B.C. health care system approximately $27 million per year.

We commit to working with those provinces and the others in Canada to ensure that everyone in Canada has universal access to contraceptives.

This new coverage, to be delivered by provinces and territories that enter into a bilateral agreement with the Government of Canada, means that Canadians would be able to receive the contraceptives they choose, no matter where they live or how much they earn. In turn, Canadians will be healthier; they will be empowered to make important life decisions, and they will not have to opt for less-effective or less-desirable methods of contraception because of the cost of this essential medicine.

We will work with provinces and territories to provide Canadians with universal coverage for contraception. This is just the first phase of a national pharmacare plan, which can show how much of an impact universal coverage for contraception and, indeed, more than just contraception, will have on the lives of Canadians and further enshrine reproductive choice in Canada.

In closing, we look forward to working with all parliamentarians to pass the pharmacare act so that all Canadians can have reproductive choice and rights and get the contraception they need and deserve.

[Francesco Sorbara, Liberal, Vaughan—Woodbridge, ON]

Mr. Speaker, we know that almost four million Canadians have a form of diabetes, and we want to prevent their condition from deteriorating and their ending up in the hospital, which costs our hospital system even more. We want to prevent that, which is a big piece in Bill C-64.

Obviously, with contraceptives, we know that there are women out there who may not be able to afford the cost. We would be there to assist those individuals, especially the most vulnerable, in our country.

[Francesco Sorbara, Liberal, Vaughan—Woodbridge, ON]

Mr. Speaker, since 2015, when I was first elected to this most honourable House, my focus has been on helping and ensuring the success of the residents of my riding of Vaughan—Woodbridge and of all Canadians, and that is what we continue to do. We continue to implement policies that strengthen our social system, including what is contained in Bill C-64, specifically for folks with diabetes and individuals in need of contraceptives.

Obviously, the rare disease strategy is something near and dear to my heart as I have a nephew who suffers from a rare genetic disease. I understand the issues that my brother and sister-in-law go through in taking care of my nephew. The issue of expanding pharmacare, expanding our national system and strengthening our social safety net is very near and dear to my heart.

[Francesco Sorbara, Liberal, Vaughan—Woodbridge, ON]

Mr. Speaker, it is always a pleasure and an honour to rise in this most honourable of houses. This evening, I will be sharing my time with the hon. member for Milton.

Before beginning my formal remarks, I would say that, when I think of Bill C-64, an act respecting pharmacare, and the implementation of a piece of legislation that would obviously strengthen our health care system and the delivery of it, I would not be remiss to say that this is not only an excellent piece of legislation that would help Canadians, specifically those in need of contraceptives and the nearly 4 million Canadians dealing with diabetes, but also another sign of our government's strengthening of our social fabric and social system. It would build on other programs that we have implemented, including the Canada child benefit, which we know has lifted hundreds of thousands of children out of poverty and helps families every month. In my riding, nearly $80 million or $90 million a year arrives, tax-free and monthly. We know that the Canada workers benefit, which helps our working poor and those trying to make ends meet and get ahead, helps literally millions of Canadians. We introduced middle-income class tax cuts in 2015, raised the basic personal exemption amount and accelerated the pace. We know those are delivering $10 billion annually in tax relief to Canadians, as we speak.

More recently, the Canadian dental care program, which thousands of dentists have signed on for, is benefiting individuals in my riding of Vaughan—Woodbridge. In fact, in the heart of my riding at Weston Road and Rutherford Road, there is a big billboard, put up by one of the dentists in the community, stating that they welcome patients who are eligible and approved for the Canadian dental care program. This program is already helping thousands of residents in the riding of Vaughan—Woodbridge and in the city of Vaughan. The work that we are doing on Bill C-64 would continue to build on that work of helping Canadians to receive the services they need, which, in this case, is to improve health care.

With respect to health care, I was at the announcement with the Prime Minister and the Premier of Ontario, Doug Ford, when we announced a $3.1-billion bilateral agreement of health care funding for more nurses, more doctors and more health teams across the province of Ontario, a part of the $200 billion the federal government is committing to health care across this beautiful country.

I appreciate the opportunity to speak to the important work under way through Bill C-64 with regard to the Canadian drug agency, or CDA. The CDA is one of the key features contained in Bill C-64. On December 18, 2023, the Government of Canada announced the establishment of the CDA, which is to be built from the existing Canadian Agency for Drugs and Technologies in Health, in partnership with provinces and territories. The government committed $89.5 million over five years to establish the CDA, providing dedicated leadership and coordination to make Canada's drug system more sustainable and better prepared for the future. This investment would be in addition to the existing funding of $34 million per year to support CADTH's current work.

The CDA would build on CADTH's existing mandate and work, expanding to include new functions such as appropriate prescribing and use, data and analytics, and system coordination. Developing the CDA recognizes the organization's reputation of excellence, performance and results. It also ensures that we would be adding value to the system by building on what is already working with the CADTH.

Let me say a bit about how we got to this important milestone. Canada's pharmaceutical system evolves slowly over time, often responding to address new challenges as they developed. When medicare was first introduced in Canada in 1966, drugs used outside hospitals were primarily inexpensive medicines for common conditions. A growing number of specialized drugs are now helping to cure or manage a range of conditions, and rising rates of chronic disease have made prescription drugs a central part of our current health care system.

New pharmaceutical system organizations and functions have been created to manage the access and use of prescription drugs, but this has happened in an ad hoc and fragmented manner. Canada currently has over 100 public drug plans and 100,000 private drug plans, creating a patchwork of access and coverage for Canadians. Despite improvements in recent years, high prices and the patchwork of drug coverage leave many people in Canada facing barriers to access the prescription drugs they need when they need them.

Stakeholders in landmark reports have underscored the need for federal leadership in addressing these gaps. In recognition of concerns about the sustainability of the Canadian pharmaceutical system, budget 2019 provided $35 million over four years to establish the Canadian Drug Agency Transition Office, or CDATO, to provide dedicated capacity and leadership to work with provinces, territories and key partners on a vision, mandate and plan to establish the CDA. Since its establishment in 2021, the CDATO has conducted extensive engagement and analysis, holding over 400 meetings and round tables with a diverse range of stakeholders to understand the gaps and challenges in the pharmaceutical system and obtain advice on how to make improvements.

Extensive engagement has taken place with provinces, territories, patients, pan-Canadian health care organizations, health care professionals, industry insurers and international partners. Based on this engagement analysis, the CDA will build on CADTH's existing mandate and functions, expanding to include new work streams that better support patients and system sustainability, namely improving the appropriate prescribing and use of medications, increasing pan-Canadian data collection, expanding access to drug and treatment information, and reducing drug system duplication and lack of coordination.

Through our engagement, we learned that the appropriate prescribing and use of medications is a clear priority for many stakeholders. This is about ensuring that patients are prescribed the safest and most effective treatment for their outcomes and conditions. Each year, $419 million is spent on potentially harmful medications for seniors, and $1.4 billion is spent to treat harmful effects. However, there is no unified approach to guide and inform prescribers or patients on appropriate prescribing and use.

To date, we have launched an appropriate use of advisory committee involving patients, clinicians, experts and leading organizations in the field. The committee is advising on the development of a pan-Canadian appropriate prescribing and use strategy. Later this spring, the committee will issue its final report that will inform the work of the CDA to create and implement an appropriate prescribing and use program in collaboration with partners.

Stakeholders have also pointed to the need to improve pharmaceutical data and analytics to better understand the impact of drug treatments. However, there is limited ability to access, link or share drug data, which is siloed in different sources, such as hospitals, private drug plans, physicians' offices and jurisdictions. This fragmentation limits our ability to understand a drug or treatment's use pattern and effectiveness, including how it performs once it is being used by patients in the real world and how it compares to other available treatments.

We are working with several organizations in the health data field, such as CADTH, the Canadian Institute for Health Information, Canada Health Infoway, Health Data Research Network Canada and the pan-Canadian Pharmaceutical Alliance, to improve access to and use pharmaceutical data. Stakeholders also consistently emphasize the importance of incorporating patient equity and lived experience in the CDA's developments and operations. They noted that patient engagement in the pharmaceutical system is limited. Incorporating patient perspectives through engagement and governance were key recommendations for an organization that is transparent, accountable and meaningfully involves those who need it most, the patients.

We have also heard of significant challenges regarding system coordination. During the course of our engagements, most stakeholders highlighted at least one coordination-related issue that they face. Challenges include a lack of information sharing, confusion about roles or responsibilities or limitations to meaningful engagement. Our pharmaceutical ecosystem is managed by multiple organizations that have different purposes, priorities and areas of jurisdiction.

There is one organization mandated to convene players, focus the agenda, ensure efficiency and enhance collaboration. Because of this, there are both gaps and duplication in the system. Building from CADTH is a significant step in promoting system alignment. CADTH is a highly reputable organization with strong leadership and a shared federal, provincial, territorial governance model that works.

Through CDATO and CADTH's extensive partnerships and building on the work to date, we will build a CDA that is well positioned to convene key players and focus on promoting better outcomes for patients. We will develop an organization that has the capacity to adapt to the ever-changing pharmaceutical landscape. Our work to date reflects the significant input provided by stakeholders over the last three years. It also highlights a strong interest across the system to make meaningful improvements.

The CDA will support pharmaceutical system modernization in Canada and lay a strong foundation for future growth, including by providing the capacity to support the commitments outlined in Bill C-64, which is now before the House. The CDA will assume a leading role in the pharmaceutical system to ensure Canadians have better health outcomes and are well informed about the medications that they need now and into the future.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Madam Speaker, a Conservative heckles across the way, and she is consistent with other Conservative members who say it is a provincial responsibility. That is the attitude. We can remember, at the beginning, I said that the Bloc does not surprise me. I understand why Bloc members do not support it. It is a separatist party. It would just as soon Ottawa hand over the money, then Quebec would take the money and develop the programming.

In contrast, the Conservative Party thinks it is a provincial responsibility. People need to be aware, because it is the same as the member's off-the-cuff heckle. I would suggest that it is not just a provincial responsibility. If the member truly understood the Canada Health Act and, more importantly, her constituents, she would quickly realize that it is not just a provincial responsibility.

Even when I was in the Manitoba legislature, I argued and articulated that health care is not solely the responsibility of the Province of Manitoba. I like to think that, at the end of the day, all provinces have a responsibility to follow the Canada Health Act. When I talk to people about the pharmacare program and Bill C-64, it is a positive discussion. I have yet to hear anyone, outside the Conservative Party, tell me that Ottawa moving forward with respect to a national pharmacare program is a bad thing. I cannot recall anyone saying that we should not be doing this.

That might precipitate a few emails to me, but at the end of the day, I believe it is because people truly appreciate and understand the value.

That is why I said before the interruptions that one has to take a holistic approach to health care. Let us look at what has happened since 2015, when a new Prime Minister was elected and the agenda of health care started to change in a very positive way. It was not that long ago, and I referred to this earlier, that we actually had the Prime Minister in Winnipeg at a press conference at the Grace Hospital. My colleague would be very familiar with the Grace Hospital. At the end of the day, we had the premier of the province, the provincial minister of health, the Prime Minister and the federal Minister of Health. We talked about the future of health care and how the $198 billion over 10 years would have a positive impact not only for today but for tomorrow, thinking of generations ahead. We talked about how it would impact the province of Manitoba.

Let us think about the number of agreements that have been achieved by the government with the different provinces and territories and indigenous community leaders, all dealing directly or indirectly with the well-being and health of people. Something that was missing previously was the type of financial commitment, along with the sense of co-operation. Then we look at the type of national programs that we would bring in, which would make a difference.

People talk about the dental program as an example. Having a dental program ultimately helped literally thousands of children over the last year, including children who would not have been able to see a dentist or get some of the dental work that they received as a direct result of a national program. There are actually children in the province of Manitoba who end up going to emergency departments because their dental work has been neglected. Moving forward with a dental program is a good thing.

We just came out with the national food program, where we are delivering more nutritious food for children throughout the country. Hundreds of thousands of children will actually benefit from the program.

That is why I said that health care is a lot more than just a hospital facility. People need to look at everything from independent living and community living to what takes place in our schools. They need to think in terms of the medications; the bill is about getting people talking about medications and the important role they play in health care. Along with that, I would suggest that there is a general attitude that says we are committed to the Canada Health Act and to making sure that we continue to provide the type of progressive programs that would complement the health and well-being of Canadians. That is the way I see Bill C-64. It complements the Canada Health Act, and people should not fear it. They should accept it and look at ways in which we can improve upon it.

We often hear about the issue of bulk buying, as an example, and the hundreds of millions of dollars that have been saved in that area. I would suggest that we could do even more. I look forward to seeing the ongoing debate on this very important issue. I would hope that my Conservative friends, in particular, would revisit their positioning with the idea of getting behind the legislation and voting in favour of it.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Madam Speaker, I know it is not on the list. At the end of the day, some provinces, from what I understand, provide coverage for shingles vaccination for those 55 and over, or maybe 60 and over, whereas some provinces do not. However, I was suggesting, by bringing it up, that this is the type of discussion I would like to hear more about, but not in terms of how we keep Ottawa away from the issue of pharmacare or developing a national program. I do not think that is what our constituents want to hear. I believe they want to see consistency, where they can, in the different regions of our country.

I have presented many petitions in the House on the issue of pharmacare. I have consulted and talked about pharmacare at the door for years. I understand who has what kind of responsibility in health. As I said, I was a health care critic in the province of Manitoba.

However, I do not understand denying the opportunity for a federal government to participate in providing contraceptives or diabetes medications. I do not understand how opposition parties could oppose that, no matter what province they are from. Tell me a province, and I say that to all members, that provides any form of support for contraceptives today. I am not aware of any, but I could be wrong on that.

How could anyone say that the legislation would not be of benefit for all Canadians? It is a major part of the legislation. When we think of diabetes, we are not talking about a few hundred or a few thousand Canadians; we are talking about hundreds of thousands of Canadians who would be affected by Bill C-64.

What are opposition members afraid of? If they were truly listening to what people are saying in their communities, I would suggest that they should talk more about the issue of health care. I talk a great deal about health care in my riding. I understand why it is so important.

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the Leader of the Government in the House of Commons]

Madam Speaker, it has been interesting to listen to what members have to say about Bill C-64. In some areas, I am not surprised. In other areas, I am surprised. Let me provide a bit of an overview before I get into more detail.

When I think of pharmacare and the potential that pharmacare has for all Canadians, I think that we undervalue and underestimate the degree to which Canadians as a whole would support not only the concept, but also the implementation, of a true pharmacare program. This is not new for me. I have been talking about pharmacare for many years. I have been an advocate for it because I understand and believe in the benefits of a national program.

There is no province or territory in Canada that has absolutely free prescribed medications for its population. Everything depends on the province that one is in. It could be based on age or affordability, but there are all sorts of different variations. There is public sector participation and private sector participation. There is a wide spectrum, a smorg, of different ways that pharmaceuticals are being delivered in Canada. That is the reason I asked the Bloc member to provide more detail of the plan in Quebec. Someone will stand up to says it is free in Quebec, but this bill clearly demonstrates that it is not free.

Many would say that, if we have to pay a deductible or an annual premium, and if things are not in it that should be incorporated, it is not free. I am glad the member said that there is room for improvement. No matter what program we are talking about, there is always room for improvement. I suggest that the way we should be looking at the whole issue of pharmacare is to take a holistic approach to the expectations people have for health care in general.

I have said many times in the past how important health care is to all people in Canada, in all regions of our nation. That has not been lost on the government. The Bloc will say it does not want Ottawa to be involved, other than to hand out money. That particular attitude does not surprise me, and I will add further comments on that in a bit.

What really surprises me is the Conservative Party's approach to health care. It is demonstrated with Bill C-64. People need to be aware of this. At the end of the day, we value and treasure health care here in Canada. The Canada Health Act protects the integrity of the system in all regions. It is one of the reasons the federal government allocates the billions of dollars it does for federal transfer payments.

We have seen a national government and, in particular, a prime minister, our Prime Minister, who has taken a health care initiative, recognizing how important it is to Canadians. We are looking at ways to enhance it, to build a stronger health care system. Nationalized health care or the Canada Health Act are established, and many other countries today that have that form of legislation or that sort of delivery of health care have already incorporated a national pharmacare program.

One does not have to be a Liberal or a New Democrat to see the benefits of it. I used to be the health critic in the province of Manitoba, and I understand just how critical medicine actually is to our health care system.

We can think about it in the sense that, if a person gets sick and goes into a hospital, they receive medications in that emergency setting. I do not believe any province is actually charging for that. This is virtually universal now across Canada. It might be because of an ulcer issue, some sort of a bleed or any other need that might be there. If a person has to stay in a hospital facility for however long a time, the hospital staff does not say, “Well, here's a bandage. By the way, you're going to have to pay for that.” Or for medication, maybe a painkiller, they do not put out their hand, saying, “We want money before we inject the painkiller.”

However, the moment that person leaves the hospital, then it changes. This may not happen in every province, as some provinces might cover prescribed medications more than others, some might not charge as much, some will have a deductible and, as I said, some will have those annual premiums. What happens, generally speaking, is that the individual leaves the hospital and finds that now they are going to have to start paying for the medications.

I cannot tell members how many 55-plus facilities, personal care facilities or independent living facilities I have been to where they talk about the cost of medications, with diabetes being one of them. They will tell us, “Look, we cannot afford the medication.” As a result, I would suggest that there are many people who end up going back to hospitals because they are not getting the medications they require. This is because of decisions they have actually had to make in terms of buying and purchasing the medication versus food or possibly rent, or the amount of medications that are required and the bill that is associated with that. Those are the types of things that end up costing communities, society and the taxpayer a whole lot more when that individual ends up returning to the hospital because they were not taking the medications that were necessary in order to keep them out of the hospital facility.

The problem with the debate on the pharmacare issue is that I would have liked to hear more about, collectively as a House, seeing the value of this and that we want to move forward. This is what Bill 64 is doing; it is moving us forward on a very important issue. I would rather have seen everyone coming to an agreement that, yes, this is good stuff, we should be supporting it, and then adding value to that.

I think of Cardine, whom I met at a local restaurant on a Saturday. She was talking about the issue of the shingles vaccination and how this is something people should not necessarily have to pay for. I raised that with some of my colleagues.

[Bonita Zarrillo, NDP, Port Moody—Coquitlam, BC]

Madam Speaker, I really appreciated the speech by my colleague from Skeena—Bulkley Valley. He shared such amazing points today about the importance of looking after Canadians.

I am standing today, as a woman in Parliament, discussing one of the most important aspects of women's health and daily life: access to contraceptives. This health care measure is currently restricted by whether one can afford to access it or not. It should not be that way. Every time I enter this place, I am aware of how different my experiences are from the men who have not had to deal with regular menstrual cycles, painful periods, ovarian cysts, PMS and PMDD, endometriosis, menstrual migraines and unintended pregnancy. These are part of daily life when one has ovaries, starting in one's teens. Having ovaries requires management and affects everyday choices for school, work, recreation and more.

With that in mind, I am going to take a moment to read a poem by my daughter Coral. She is a writer and a poet. I wanted to share it because it shows how periods affect women, girls and non-binary people, from their very early teens. It is called Late Bloomer.

In the seventh grade, all my friends started menstruating,
but not me.
We would travel in a gossiping group to the school
washroom and I would listen as my
friends ripped tape inside stalls.
In high school, we had swimming in gym. I had a hard
time with a box of “easy applicators”.
I cried, one foot propped up on the toilet.
I lied on the ground, tried to raise my hips and contort my
body to be comfortable.
The garbage filled with failure. I surrendered to pads.
Diapers, my friends called them.
I would hide panic as girls exchanged tampons in cute
pink wrappers. Once a pad fell out of my bag, I snatched
it up, cheeks shame red.
I concealed pads far up sleeves and deep down in
pockets. On days I forgot a pad I settled for folded tissues
and tied my jacket around my waist.
Today, I borrowed a pad from a stranger.
Her cheeks weren't red and neither were mine. bloom,
bloom, bloom

“Bloom, bloom, bloom” is how I see this bill. It is time to blossom. It is a bill that sets in place a framework to consider the needs of women, girls and transgender people who menstruate.

My message to the men in power across the globe, including in Canada, who have spent their legislative time trying to control women and their bodies, while ignoring the enhancements that are there in basic health care, is to stop it, and let this bill bloom.

At a time when the possibility of gender equity remains elusive, what gives me hope is that in this bill, and currently in the tabled budget, the needs of women are starting to make their way onto the main stage, after 150 years. Affordable child care, free contraceptives, the red dress alert from my colleague, the member for Winnipeg Centre, a caregiving strategy and a sectoral table on care economy are all women's issues that the Conservatives and the Liberals have ignored for decades.

With that in mind, that is what causes me worry. The Conservatives in the House are rejecting these important advancements for women and, at the same time, are working against us by espousing that they would override women's charter rights on a whim. Conservatives are dangerous to women. If they ever had the power, they would immediately go after a woman's right to choose, just like what has happened in the United States. I never want to see that happen.

Not only would Bill C-64 help women as a framework for historic expansion of health care to single-payer pharmacare, but also the first rollout would give access to life-saving medication and devices for diabetics.

Linda, a resident in my riding, recently told me she estimates that, since she was diagnosed with diabetes over 40 years ago, she has spent over $120,000 on medication and devices to manage it. This is unfair. She has had to spend thousands of dollars a month just to stay alive. While I am on the topic of gender equity, Linda shared that she was 26 when she was diagnosed. She went to the doctor. She was single at the time, and the doctor said to just go find herself a husband, and she would be fine. This is what happens when someone cannot afford their medication or when society decides that women should not have economic empowerment and that they would not be able to afford their medication on their own.

Even with the loss of the life of a diabetic, if they do not get their medication, the Conservatives have decided to block the pharmacare bill. While they enjoy their MP taxpayer-funded health care and dental benefits, they deny them to others who need them. With the new pharmacare bill, New Democrats know that Canadians would have the access to medication that they need, not with a credit card, but with a health care card.

This would mean that close to 10 million Canadians would not have to suffer in pain and discomfort, would not have to put their health at risk and would not have to let their conditions get worse. This would no longer have to happen. The reason the Conservatives and the Liberals have let it happen in the past is profits from big pharma, as my colleague from Skeena—Bulkley Valley mentioned.

It is about trying to keep big pharma happy, not about trying to keep Canadians healthy. We need to do the work to keep Canadians healthy, to make sure we do preventative medicine and to release the burden of the expenses of contraceptives, diabetic medication and other medications as they come out. This is why we must pass the bill as quickly as possible. People are waiting on us, and the provinces are ready to come together and make life better for people.

The NDP has gotten this victory for Linda, for all women, and for people who use contraceptives and have not been able to get access to contraceptives. All those people will be able to get access very soon, and it would roll out to be even more. They would be able to keep the money in their pockets rather than in the pocket of some rich CEO.

I want to close and to double down on the fact that this is not the time to let our guard down as Canadians and as the NDP. This is not the time to let our guard down. Ideologies south of the border are coming up into Canada. There is a conversation in the House, and the Conservatives are trying to open a conversation about removing a woman's right to choose. They are using bills like this pharmacare bill around contraceptives to have that conversation. We cannot let it happen.

Also, for all Canadians, who are paying some of the highest drug prices in the world, this is not fair, and this is legislation. This is because of the Conservatives and the Liberals before, who have let big pharma take advantage of Canadians, gouge Canadians and made Canadians sicker because of their lack of compassion and their desire to control a woman's body.

[Taylor Bachrach, NDP, Skeena—Bulkley Valley, BC]

Madam Speaker, I thank my colleague for his timely intervention.

This is a proud and historic moment because Canada stands alone in the world as the only country with universal health care that does not have some form of universal coverage for prescription medication, and the case for this bill and the case for pharmacare are exceedingly strong.

One in five people in this country have zero or poor medication coverage. Nearly a million people cut their spending on things like groceries and heat so that they can afford medication, and one in five households have a member who did not take the medication they were prescribed because of the cost of that medication. This is something that profoundly affects the lives of the people we represent, and I am surprised, to be frank, that there is not unanimity in the House to try to expand our health care system in this way and to get people the help they so desperately need.

I will tell a really brief story. I held a meeting on pharmacare, which had attendance by nurses and health care folks in northwest B.C. and concerned citizens. One of the nurses told this story about patients she sees come into the hospital for a very routine procedure, a colonoscopy, which is something that many of us will be getting in order to detect what can be really life-threatening illnesses. I have not had one of these procedures yet, but I very much look forward to it.

In preparation for this procedure, people have to take a medication in advance that allows this procedure to take place. That medication, at the time, cost about $40. For many of us, the cost of a $40 prescription to get ready for an important procedure is something that is affordable. However, the nurse said she was surprised by the number of patients who came in for this scheduled procedure, went home with the prescription and never came back for the actual colonoscopy because they could not afford the $40 for the medication.

That is what we are talking about. What happens to those people? They are not getting a diagnostic procedure that could save their lives, and some of them, a percentage of them, are getting sick and ending up back in our hospitals and in our emergency rooms. They are having to have surgery and some of them are losing their lives all because they could not afford medication that was not covered under our health care system. That is shameful and it is something that we in the House can change. We can change it today by voting for Bill C-64.

Why would anyone oppose the bill before us? We have heard some of the arguments and, frankly, it is somewhat surprising. I was listening to the member for Red Deer—Lacombe extolling what he sees as all of the various problems with it. Then he got to the fact that it would cover diabetes medication and devices, and he said something like, “on the surface of it, that is a good thing”.

This bill would be incredibly positive for a lot of people, yet we see opposition. We also see a cynical critique of the legislation, and that critique goes like this: The Conservatives say that the NDP and the Liberals call this a pharmacare bill, but it is nothing of the sort. They say that it does not go nearly far enough, and Canadians who are expecting this wonderful vision of pharmacare are going to be disappointed.

When Canadians hear that, they are going to think that the Conservatives want something even better, that they want coverage that goes even further and that would help more people, but no. What the Conservatives are proposing is to get rid of this legislation altogether and not to improve it one iota. The Conservatives have brought forward an amendment to kill it outright. That is not contributing to the conversation. It is not going to make people's lives better in this country. With all due respect, it is a cynical critique of the bill before us.

It is also incredible that in the Conservatives' opposition to pharmacare, they are parroting many of the same lines coming from big pharma. We have heard that most people will be worse off under the pharmacare program. We heard from the Conservative leader that most people already have coverage through their employer, and we heard that this law is somehow going to prevent people from getting their own private insurance. It is incredible that Conservatives and big pharma are sort of harmonizing in the same beautiful key of total nonsense. It is incredibly frustrating because none of this, of course, is true. This is a program that is going to help millions of Canadians.

We hear that health care is a provincial jurisdiction, yet nothing could be further from the truth because it is shared jurisdiction. If we look at the Canada Health Act on the federal government's own website, it clearly lays out that, while the provinces are responsible for health care delivery, the federal government is responsible for setting national standards and, of course, for funding health care, in part, through federal transfers. Therefore, this is very much in the federal government's wheelhouse and something I believe the federal government has a moral and a practical responsibility to fulfill.

However, despite all of this opposition from Conservatives to pharmacare, we are here on this historic day to move this bill through the legislative process and make it a reality. This is a bill that, among other things, enshrines the step-by-step implementation of single-payer universal pharmacare in our country, for the very first time, in accordance with the principles of the Canada Health Act. It is a bill that forces the government to develop a list of essential medications within a year of this bill's passing into law. It is a bill that establishes an expert committee that is going to guide the implementation and the financing of pharmacare right across the country.

I am very pleased that not only will this bill lay the groundwork, the foundation, for universal pharmacare that covers a wide range of prescription medications, but it is starting in its first phase with two major classes of medications that are going to help a lot of folks who are struggling with the costs. People in the House know what those two classes of medications are.

First is contraception, which can cost people upwards of $200 a month, and disproportionately that cost is borne by women in our country. When it is not affordable for people, they are forced to make other choices, but sometimes they do not have choices. Ensuring that people have affordable contraception is going to improve the lives of so many people.

The other class of medications is diabetes medications and devices. Anyone who knows someone who lives with diabetes knows the incredible out-of-pocket costs that can come with managing the condition. Diabetes Canada approximates that the cost of type 1 diabetes is upwards of $18,000 a year, out of pocket, and for type 2 diabetes it is upwards of $10,000 per year, out of pocket. These are the out-of-pocket expenses that our constituents are paying. With the bill before us, as soon as agreements are struck with the provinces, this program is going to cover those costs for Canadians, and I could not be prouder for having been part of the process of making that a reality here in Canada.

I am going to leave it at that. I know that the constituents I represent want this bill. I know the health care professionals who work in our health care system recognize the importance and significance of this bill. I hope everyone in the House of Commons votes for this bill and passes it unanimously into law as quickly as possible.

[Taylor Bachrach, NDP, Skeena—Bulkley Valley, BC]

Madam Speaker, I will be splitting my time with the wonderful member for Port Moody—Coquitlam.

In this debate this evening, we can lose a bit of the context, and that context is the historic nature of the legislation before us. I am so proud to rise on behalf of the people of Skeena—Bulkley Valley and speak to Bill C-64, an act that will lay the groundwork for Canada's first national single-payer universal pharmacare system, a system that is going to help millions of Canadians, including many people in northwest British Columbia. The case for this bill is—

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Madam Speaker, I thank the House for the opportunity to speak on behalf of the people of Souris—Moose Mountain, and I appreciate the opportunity to speak to today's debate as we discuss Bill C-64, an act respecting pharmacare, and its amendment.

I think it is important to ensure that Canadians truly understand what the piece of legislation before us is and how it might affect them in the future. In fact if we read the amendment that has been put forward, we see that it states:

The House decline to give second reading to Bill C-64, An Act respecting pharmacare, since the Bill does nothing to address the health care crisis and will instead offer Canadians an inferior pharmacare plan that covers less, costs more and builds up a massive new bureaucracy that Canadians can't afford.

Unfortunately, much of what I am about to talk about in dealing with what the government has put forward is that we need to determine that it is going to be to the detriment of most Canadians, thanks to the NDP-Liberal government, which only continues to make life harder for those who are just trying to get by in difficult times like these. Bill C-64 is yet another example of an empty promise put forth by the Liberals in an attempt to please the NDP and maintain power in this country. There is virtually nothing for the vast majority of Canadians.

The document is a measly six pages long, much of which is preamble and definitions. I can almost guarantee that when Canadians were told that a pharmacare plan was coming, they were expecting a whole lot more than six pages that lack any of the necessary details like costs, timelines, formulary, which drugs are in and which drugs are out, and other relevant information. The reality is that the majority of Canadians, 79% of them, already have private health care insurance to cover their medications. Many of them are afraid of losing their plan.

The legislation, however, has become typical of the Liberal-NDP coalition government. Let us have a quote: “Bragging is not doing.” I wonder who said that. I will get back to it. After eight years of empty promises, brags, Canadians have lost trust in the so-called leadership of the Prime Minister. He promised affordable housing, yet housing costs has doubled across the country. Bragging is not doing; let us remember that.

The Prime Minister promised that the carbon tax would put more money in the pockets of taxpayers, yet 60% of Canadians are paying more because of that very tax. Bragging is not doing. In fact in 2019, his then environment minister promised Canadians that the carbon tax would not exceed $50 per tonne, stating that the price would not go up and that there is no secret agenda. However, after the election, the Liberals' hidden secret agenda came out, and the current carbon tax is at $80 per tonne and will be going up to a whopping $170 per tonne by 2030.

How are Canadians supposed to believe anything the government says when it breaks promise after promise, to the detriment of its own people? It does not take much to see that the sad little bill before us is simply a Liberal attempt to cater to the NDP, which has been propping the Liberals up and keeping them in power since the last election.

Since the pharmacare bill contains almost no details about how the program would actually work, I would like to touch on a similar plan that is about to be launched across Canada, more bragging, I hear. It is the Canadian dental care plan, which is set to start providing coverage. It is a great example of the Liberals' providing blatant misinformation to Canadians by omitting context.

They will tell us that the plan is a huge success because 1.6 million seniors have already signed up to participate. What they do not tell us is that Canada has only about 26,500 dentists practising in total, and fewer than 10% of them have enrolled in the new dental care plan, which also includes dental hygienists. There are eight dentists enrolled in New Brunswick. Ontario has 65 and Nova Scotia has six. P.E.I. has zero and Manitoba has seven. This is just to name a few of the provinces. Why is that? There is too much paperwork and signing of contracts, to name just some of their concerns.

Considering that Canada is already dealing with a massive shortage of doctors, the last thing taxpayers want to know and see, and have talked about many times, is the need to find yet another health care practitioner. That struggle is immense.

Another hugely alarming issue with the Canadian dental care plan that is also a major concern with pharmacare is the lack of consultation the government held with the important industry players. When it comes to the dental issue, the provincial associations stated that the federal Liberals started consulting them only in late November, just one month before the program was announced. One dentist stated that dentists were brought in at the eleventh hour. They asked why we started so late and whether we were rushing into a program that maybe we should be putting the brakes on.

Again, the lack of consultation has now become a hallmark of the NDP-Liberal government's agenda, as the Liberals also failed to consult with insurance industry stakeholders during the formulation of the pharmacare bill. If this is the Liberal track record on industry consultations that have the potential to greatly impact a key piece of legislation that would affect millions, then of course we need to be concerned that the same thing could happen with pharmacare.

Misinformation is also something that needs to be top of mind when dealing with the NDP-Liberal government. Initially, the government's dental care plan was pitched as being free, and yet now we know that is not so. The program covers only some types of dental care, and it does not adequately pay providers in line with the fees that are recommended by the provincial and territorial guidelines.

Will it be the same for pharmacare? One wonders. Canadians are going to be told not to worry, and then all of a sudden be required to pay for their medications despite the promises made by the government. Since the Liberals are completely inept at creating and implementing programs that actually work, this is unfortunately what Canadians have come to expect.

Since the pharmacare plan was first announced in February, physicians across the country have been vocal about the concerns they have with how the plan would actually work. Since the bill itself contains almost no information, there is worry that instead of filling the gaps left by public and private health care coverage, the bill could actually create more gaps, with more Canadians falling through the cracks.

There is also a lot of uncertainty over which drugs would make it onto the formulary. If there are extra steps involved in this, it would place an additional administrative burden on physicians, which is frankly the last thing Canada's health care system needs right now.

Furthermore, as we are all aware, wait times for health care in this country are longer than they ever have been. Currently, there is a median wait time of 27.7 weeks between getting a referral from a general practitioner and the receipt of treatment. This is an almost 200% increase in wait times since 1993.

We all know there are over six million Canadians without a family doctor, and we have overwhelmed emergency departments throughout Canada. Through ill-thought-out bills like the pharmacare one, the federal government would be burdening our physicians with even more paperwork and administration, instead of allowing them to provide the care that Canadians need. By increasing the administrative burden, there is also a concern that doctors, nurses and other health care providers would face greater instances of burnout, causing them to leave their professions altogether.

A very important part that the government continues to ignore is that the provision and administration of health care falls under provincial and territorial jurisdiction. It is not the job of the federal government to make decisions on issues like drug coverage, which the bill could certainly allow for. We need to respect the authority of the provinces and the territories to do what is best for their populations, as this is not a situation where Ottawa knows best.

One part of the bill that I personally take issue with is the fact that it would establish a committee of experts to make recommendations on pharmacare. The reason this concerns me is, yet again, the Liberals' track record when it comes to creating committees to create committees to create committees, ultimately doing nothing to address the issues they were created to address.

Ultimately, given that the pharmacare bill is so short on any details, we still do not know how big the committee would be and what the qualifications of the members would be. If the Liberals failed so drastically with something like just transition, which affected a small portion of Canada's population, how is anyone supposed to believe that they would handle this?

As an example, one year ago the Liberals pledged $1.4 billion for drugs for rare diseases, yet there is still no deal with the provinces. Therefore, once again, to quote the Prime Minister, “Bragging is not doing.” The NDP-Liberal coalition is all about brag and no action. Unfortunately, until the Liberals are out of office, Canadians will continue to pay the price of the Prime Minister's lack of leadership and his broken promises. It is time to end the bragging. It is time for a change, time to assist hard-working Canadians and time for a common-sense Conservative government.

[Blaine Calkins, Conservative, Red Deer—Lacombe, AB]

Madam Speaker, there is a joke going around that says, “It's not knowing that a politician can be bought; it's knowing how little they'll let themselves go for.” For a member of the NDP caucus right now thinking that this is the misery they are suffering in the polls, the misery they are suffering nationwide, which is the same misery Canadians are suffering, this is all they managed to get out of the supply and confidence arrangement with the government today.

It is not a pharmacare program. Health care is actually a provincial jurisdiction. It should be delivered by the provinces. The bill would simply be adding contraceptives and some diabetes measures into it. I guess, on the surface of it, that is a good thing, but to the tune of $1.5 billion. If viewers watching at home actually believe this is all it is going to cost them, I will remind them that the government bought a $7 billion pipeline and built it for about $40 billion. Therefore, if history is any predictor of the future when it comes to what things cost under a Liberal-NDP coalition, then they should be looking at least to that example if not more.

To us, as Conservatives, the issue is one of provincial jurisdiction. I come from Alberta, and this is a very important issue to our province and to our premier. This is just another intrusion into provincial jurisdiction. We think that, during these financial times, when Canadians are struggling to make ends meet, pouring more fuel on the inflationary fire is certainly not going to help. It is another financial albatross in the making, which Canadians cannot afford and are not willing to pay for.

It is not just me saying this, and it is not just Conservatives saying this. John Ivison eloquently stated in a piece that he published back on February 29, when the bill or this notion first came out, that this is “the woebegone child of a loveless Liberal-NDP marriage.” This is basically what we are dealing with.

It has become clear to me that the bill before us is basically the cost of keeping the NDP support for this Parliament under supply and confidence, and the coalition partners can take this until October 2025. It was supposed to be October 20, but it is going to be extended by another week to make sure that certain people here get the financial benefits they think they are entitled to. However, it just goes to show that there is only one serious opposition in the House, and that is the Conservative Party.

The NDP is not an opposition party but a willing accomplice to everything that the Liberal government has in its agenda. Its members have been witting partners in creating a massive inflationary deficit; setting restrictive policies towards, for example, lawful gun owners and natural health products, which they signed up for two years ago without even knowing they were going to vote in favour of that in Bill C-47 last year; impeding upon provincial jurisdiction time and time again, which is, of course, front and centre with this piece of legislation; continuing to cover up for the government's scandals, covering for it at committee and also here in the House of Commons; introducing soft-on-crime legislation or supporting that soft-on-crime legislation, which has turned our justice system into a revolving door; sending Canadians to food banks en masse, at a couple of million visitors, which is up over 300%; allowing housing prices to skyrocket; and neglecting our military to the point where our soldiers are basically relying on food donations while they are in Ottawa for training. I could continue, but I think members get the gist of what I am trying to say.

It is bad enough that NDP members backed budget after budget and shut down our work to hold the government to account at committee, but they are telling Canadians that they are doing their actual work as an opposition party. Well, they cannot have it both ways. They cannot be in opposition while they support everything that the government does. I do not buy it, and neither do Canadians.

A December 2023 Leger poll indicated that only 18% of Canadians listed the establishment of a national pharmacare program as a health care priority, and the promise was not included in the 2021 Liberal platform. Canadians did not vote for a party promising pharmacare, yet here we are, thanks to an NDP party that is keeping this weak and basically lame-duck government in office. It is no wonder that some provinces are already saying publicly that they are choosing to opt out.

Let it be known that the absence of the NDP as an opposition is also keenly felt in other areas. Just last year, as I was mentioning, the NDP-Liberal coalition passed Bill C-47.

I do not suppose anybody in the NDP was told, when they signed on to this supply and confidence agreement back in March 2022, that they would be asked to regulate natural health products in the same way as therapeutics, but they did it anyway. As a matter of fact, they made that commitment a year before the bill was passed, and it is going to basically shut down our supplements and natural health product industry when they are classified and rebranded as pharmaceutical drugs.

What did the New Democrats do when this came up for debate? They backed the budget instead of forcing the government to remove those four little clauses from Bill C-47, the budget implementation act. They had a chance. They could have flexed their muscles and said they were not going to support the budget implementation act unless the government removed them, but no such request was forthcoming, and the bill passed. It has caused unforeseen chaos in the natural health products and supplements industry across this country; consumers, of course, are rightly worried. In response, I had to table my own private member's bill, Bill C-368, to reverse these changes. This is just part and parcel.

New Democrats say one thing to Canadians but actually do another. Could anyone imagine such a thing as being the House leader of the NDP, for example, standing up and saying time and time again how much one does not like omnibus legislation, and yet gleefully passing Bill C-47. The NDP House leader has said this for the 18 years that he and I have been in the House together. However, he told the government that New Democrats would continue to pass every budget and every budget implementation act henceforth after March 2022. He cannot have it both ways. He cannot stand up and say New Democrats are going to hold the government to account while continuing to give it the keys to the house to do whatever it wants.

In the case of natural health product governance and regulations, New Democrats tell Canadians they are against omnibus legislation and that they are keeping the government accountable. However, as I said, they voted for Bill C-47, threw that industry into turmoil and then criticized me for giving them an off-ramp on the Bill C-368 debate last week. I was giving them a pathway to redemption, and all they could do was basically blame Stephen Harper for the mess that the country is in. I cannot even make this stuff up.

The most common questions I get from Canadians are these: When are we going to have an election? Who believes anything anybody in the NDP has to say anymore, when their actions are completely 180° opposite from what they say with their words?

It should also be highlighted that the bill was introduced with no public consultations whatsoever, which comes as no surprise to Conservatives. This piece of legislation has been pushed from a government with a terrible record on transparency. It is a government that regularly rushes massive changes with little regard for those people the changes may impact. It talks about the intended consequences, but it never fully understands the unintended consequences of the things it does, which is why we are in the mess we are in today.

The Conservative position on Bill C-64 is that the Liberals know this project is an expensive boondoggle. That is why they abandoned it in their 2019 election promise. Even former finance minister Bill Morneau noted in his book that a single-user system would cost an additional $15 billion a year. We cannot believe the $1.5 billion number, and that is why my colleagues here on the Conservative side and I will respect provincial jurisdiction and vote against this piece of legislation. We encourage New Democrats to change their ways before their party actually fades into oblivion forever.

[Blaine Calkins, Conservative, Red Deer—Lacombe, AB]

Madam Speaker, it is a pleasure for me today to speak to Bill C-64.

Before I go any further, I would like to let the Speaker know I will be splitting my time with my good friend and colleague from Souris—Moose Mountain.

The debate today is about Bill C-64, an act regarding pharmacare. At least everybody is being told that is what it is about. I would rather call it, I guess, the so-called pharmacare bill because I think that “the cost of keeping the Parliament going bill” is probably a name that has already been used.

This bill is very tepid. It is not a national pharmacare program. This is actually just a piece of legislation that is meant to check a box to keep a supply and confidence agreement in place.

To the NDP members, I cannot believe they actually think this is the pharmacare bill they envisioned. I have not met a program the NDP members would not want to nationalize, but they say it is a very sad day when one—

[Anju Dhillon, Liberal, Dorval—Lachine—LaSalle, QC]

Mr. Speaker, I am grateful for the opportunity today to speak to Bill C‑64, an act respecting pharmacare.

This bill represents the next phase of our government's commitment to a national universal pharmacare program. It proposes the foundational principles of national universal pharmacare and our intent to work with provinces and territories to provide universal single-payer coverage for many contraceptives as well as diabetes medications.

This is an important step forward in improving health equity, affordability and outcomes, and it could save the health care system money in the long term.

Public health care in Canada was built on the promise that no matter where one lives or what one earns, one will always be able to get the medical care one needs. Despite this promise, Canada is the only country in the world with universal health care that does not provide universal coverage for prescription drugs.

When medicare was first introduced, prescription drugs outside of hospitals cost less and played a smaller role in health care. Today, prescription drugs are an essential part of our health, helping to control chronic conditions, treat temporary ones, and aid in overall health and well-being.

One area that has seen significant changes is diabetes treatment. Over 100 years ago, thanks to a Canadian team of researchers, Frederick Banting, Charles Herbert Best, John J. R. Macleod and James Bertram Collip, insulin was discovered.

Since this monumental scientific discovery, there have been several advancements in diabetes treatment, from the introduction of fully synthetic human insulin to glucose monitors and insulin pumps. These breakthroughs have immensely improved the quality of life for people who have to live with diabetes, enhancing self-esteem, increasing social participation and improving the overall health and well-being of these individuals.

They have also come with higher costs, creating affordability challenges for Canadians affected by diabetes.

Outside of hospital, prescription drug coverage comes from a mix of private insurance, out-of-pocket cash payments and various provincial programs. While the majority of Canadians have access to some form of public or private insurance, about 2.8%, or 1.1 million Canadians, do not have access to private or public drug coverage.

Although most Canadians have some form of drug coverage, this does not mean that those with insurance have equal access to the prescription drugs they need. The existing patchwork system of private and public drug plans leaves millions of Canadians under-insured, and that means their out-of-pocket prescription drug costs create a financial burden that leaves them struggling to afford an essential part of health care.

In 2021, Statistics Canada found that more than one in five adults in Canada reported not having the insurance they needed to cover their prescription drug costs. Being under-insured can take many forms, for example, Canadians may have high deductibles, resulting in significant out-of-pocket costs before their insurance coverage even kicks in. They may reach the maximum annual or lifetime coverage limits for their insurance and have to pay out-of-pocket, or they may have to make co-payments, which are often 20% of the drug's cost on private plans and sometimes more on public plans.

All provinces have drug coverage to protect Canadians from catastrophic drug costs, but deductibles under these plans can range from 0% to 20% of net family income. In many cases, Canadians will never reach the deductible, leaving them without any support for their drug costs. This variability across the country creates a postal code lottery.

Let us consider the advancements in diabetes treatments. For a working-age Canadian with no private insurance, out-of-pocket costs vary widely. In some parts of the country, out-of-pocket costs for people living with type 1 diabetes can be higher than $18,000 per year out-of-pocket; for type 2 diabetes, they can be higher than $10,000 per year in out-of-pocket expenses. Even those with private insurance can face high co-pays or exceed annual plan maximums, resulting in high out-of-pocket costs.

Even for cases in which an individual is not accessing devices that cost thousands of dollars, they can face significant out-of-pocket costs. For example, we can consider a woman in her mid-twenties who is working a minimum wage job. An IUD, one of the most effective forms of birth control, can cost up to $500 with no insurance. Even with private insurance, a co-pay of 20% would be $100. While IUDs can last from three to 12 years and save money over the long term, the high upfront cost can make them inaccessible.

Under-insurance can be a particular concern for young adults who age out of their parents' private insurance but who do not have their own form of private coverage. Lower-income Canadians also make up a disproportionate share of the under-insured. While most provinces have put in place drug coverage for those accessing social assistance benefits, a gap still exists. Many lower-income households that do not qualify for social assistance continue to struggle with out-of-pocket prescription drug costs.

Employment factors contribute to differences in insurance coverage. People with low-paying jobs, such as entry-level, contract and part-time positions, often report less adequate drug insurance coverage. This may even discourage people from accessing social assistance benefits or from applying for jobs, because once hired, they may lose their public drug insurance coverage. However, many entry-level and part-time jobs do not offer drug benefits. One study found that only 27% of part-time employees reported receiving medical benefit coverage.

Under-insurance can have serious consequences. Many Canadians with high out-of-pocket costs report foregoing essential needs, such as food and heat, or not adhering to their prescription due to drug costs. Statistics Canada found that, in 2021, close to one in five Canadians spent $500 or more out-of-pocket for their prescription medication, and almost one in 10 reported not adhering to their prescription medication because of costs. This includes delaying filling prescriptions or skipping doses to contain costs.

When people do not take their prescription drugs the way they are supposed to, their health can suffer. This results in serious consequences for the individual and their household, and unnecessary costs to the health care system in the long run, as patients are more likely to visit an emergency room or to be admitted to hospital when they do not receive consistent treatment. For example, the full cost of diabetes to the health care system in 2018 was estimated to be around $27 billion and could exceed $39 billion by 2028.

I think we can all agree that no Canadian should be put in a position where they must choose between the prescription drugs they need for their health and well-being and putting food on the table. This is unacceptable, and it is why we are continuing our work to improve accessibility, affordability and appropriate use of prescription drugs as we move forward with national universal pharmacare.

[Darrell Samson, Liberal, Parliamentary Secretary to the Minister of Rural Economic Development and Minister responsible for the Atlantic Canada Opportunities Agency]

Mr. Speaker, I am thankful for the opportunity to speak to Bill C-64, an act respecting pharmacare. I am extremely excited to talk about this, because this is a very important program, another transformative initiative for Canadians. We are again supporting Canadians. We can think back to 1968, when we brought in medicare. We knew the Conservatives were against it then, and the Liberals brought it in; today, no one wants to get rid of medicare, because of its importance.

In this speech, I will be talking about the framework on pharmacare and also talking about diabetes and the three million people with diabetes, and how difficult it is for them. Also I will share some information about the pilot project we have been running in P.E.I., which has given us some information, as well as where we sit in the G20 when it comes to health care and drug care. Finally, I will talk about all those initiatives the Liberals have brought in, which are helping Canadians today and in the many years forward. It was the Liberal Party that brought those.

Let me start off by saying that this act is focused on certain drugs that we would bring forward, and related products.

Of course, my colleague will be joining me afterwards. I will be sharing my time with the member for Dorval—Lachine—LaSalle.

To continue, we are talking about certain drugs, such as contraceptives and diabetes medication. Again, as I said, there are over three million people with diabetes in Canada. Back in December 2023, we created the Canadian drug agency, and its focus is on three major areas. One is a formulary, which is putting up a list of all the drugs that would be included in this pharmacare program. Another is bulk purchasing. As some have mentioned already, we have already saved millions of dollars, and there are billions to be saved through that process, which will continue. Third, we will be publishing, of course, appropriate use of medication in Canada.

I also want to say that once this legislation is passed and receives royal assent, within 30 days the minister will appoint a committee of experts to make recommendations within a year, so that we can move on this as quickly as possible.

When I go to get some medication at the drug store, my pharmacist often tells me, “You have to do something for people with diabetes. The cost is unbelievable. Many Canadians are facing a cost they cannot afford to pay. You need to come forward with some type of initiative.” I am so pleased to be here today to talk about that.

In the last decade, we have seen a doubling of the number of people facing challenges with diabetes, which is extremely important. Today, 3.7 million people are living with this. If we do not do something to help them, 25% of those people have indicated that they cannot afford to pay for that medication. If we do not treat that disease, we know what some of the end products would be, and they are not very good. We are talking about blindness. We are talking about amputation. There are all kinds of challenges that come with that.

Just for insulin, for type 1 or type 2 diabetes, the cost can range anywhere between $900 and $3,000 or $4,000 a year, which is extremely high. The good news is that we are going to work with the provinces and territories and have a deal, so that they can have frontline services for these individuals.

Diabetes Canada said, “We are very pleased with the government's commitment to prioritize improved access to diabetes medications and devices. This monumental step demonstrates a genuine dedication from our political leaders to enhance the well-being of the over four million individuals living with diabetes in Canada.”

For example, last year in June we started a pilot project in P.E.I., and from that pilot project we have seen the medication costs drop by over 60%, helping the residents of P.E.I. In a very small province, they have already saved up to $2 million, out of pocket. That is extremely important, and when we talk about affordability, this is another step forward that our government is bringing to the table.

Where do we sit in the G20? Well, it is important. People ask why we are bringing this in. We are bringing this in because we probably should have brought it in before, but the time is now. We are the only country in the G20 that has health care insurance but yet does not include drugs. The U.K. has included some prescription drugs. Australia has a mixed formula of private and public. France has, of course, a health care system and is now paying significant portions toward drugs. There are other countries in the G20 that have some type of pharmacare, including Germany, Italy, Japan, South Korea, Argentina, Brazil, etc.

According to a CBC article, “the federal Advisory Council on the Implementation of National Pharmacare, led by Dr. Eric Hoskins, stressed how people's lives can suffer if they skip needed prescription drugs, and noted a Canada-wide program could eventually lead to system-wide savings of nearly $5 billion annually.” When they talk about how much it would cost, we could actually save up to $5 billion. I think that is also a very easy answer as to why we should move forward.

When I talk about our government, the values and ideology of the Liberal Party have always been to tighten up the gap, help the most vulnerable and make sure that all Canadians have opportunities to be successful. Let us look at some of the things that we brought forward: 1968, medicare; 1969, the Official Languages Act, making both languages the official languages of Canada; 1982, the Charter of Rights and Freedoms, which all Canadians should be very proud of. Some of the opposition members are hesitant today on some pieces of the charter and we will see where they go with that piece.

There is the new and improved universal child benefit. When the Conservatives had it, it was 30% to 40% less and it was taxable; now it is not. There is the new and improved CPP, in 2019, which went from $11,400 a year to almost $20,000 a year. Those are programs that are helping every Canadian. These are opportunities. This is what makes Canada great. This is why people want to move to Canada.

Let me speak about some more initiatives that we are bringing to the table. The national school food program would help over 400,000 young people. The new disability program would help over 600,000 people with disabilities, who we know comprise most of the individuals living in poverty. Those are major initiatives to help. We are also building the dental care program. Nine million Canadians would have access to the dental care program. These are big numbers. There are many Canadians who have challenges, and our government has been focused on how to support the individuals facing those challenges.

I am going to end with something that Canadians must listen carefully to. If the Conservatives ever came to power, what would they cut? They do not want to tell us. They say “a dollar for a dollar”, so if there is a deficit of $40 billion today, we know they are going to cut $40 billion tomorrow. That we already know; we just do not know which programs. Therefore, I am going to ask the Conservatives. Would they cut pharmacare? Would they cut dental? Would they cut the disability benefit for people with disabilities? Would they cut the school food program that we have been talking about for 20 years? Would they cut the CCB, which is helping young families? Would they cut the early learning and child care program? I do not know. I am sure the Conservatives do, and I would love for them to share that with Canadians.

[Dominique Vien, Conservative, Bellechasse—Les Etchemins—Lévis, QC]

Mr. Speaker, I rise to speak to Bill C-64, an act respecting pharmacare, to highlight two major concerns. The first is the federal government's intrusion into matters of provincial jurisdiction, and the second is budgetary concerns.

This neo-liberal initiative, which came from the Liberal-NDP coalition, raises serious concerns because of its impact on provincial jurisdictions. During its nine years in power, this Liberal government has not even been able to properly and competently manage its own files. How, then, do the Liberals think they can get away with interfering in provincial health care by imposing Bill C‑64 on the provinces, including Quebec, which has been offering Quebeckers its own pharmacare program since 1997, so for nearly 30 years?

Instead of continuing to overstep its boundaries by interfering in provincial affairs, the government should focus on matters within its jurisdiction, such as managing passports, fighting crime, fixing the immigration system, which it broke, and cutting inflationary taxes. These are just a few examples of areas where it needs to direct its attention and energy, instead of investing time and money in provincial matters.

A pharmacare program is not a program that should be set up at the federal level. That is a provincial responsibility. This arrogant, pretentious government wants to impose its science when it totally lacks the authority to manage this type of file.

Was this pharmacare program designed in close co-operation with all provinces, territories and indigenous peoples? Was it developed following a thorough review of what already exists in each of these areas of responsibility? Is it the result of thoughtful consultation with experts and stakeholders? We know the answer: Of course not.

We have here a shameful attempt by the Liberal government to stay in power thanks to the support of the NDP. The Journal de Montréal's Yasmine Abdelfadel writes, and I quote:

Make no mistake: Justin Trudeau has sold his soul to the NDP. The New Democrats are the ones who are really in power, the same New Democrats that did not have the support of the public in the last election.

This initiative seems well intentioned, but it is not. Because the Liberals only hold a minority, they found a dance partner, the NDP, which is keeping them in power in exchange for the implementation of various measures that the New Democrats care about, like dental care and pharmacare, the issue that is before us today.

Canadians did not vote for that or for the NDP. Only 17.7% of Canadians supported this far-left party in the last election.

Also, Radio-Canada notes that neither dental care nor pharmacare were part of the Liberals' election platforms.

Despite what they want us to believe, this pharmacare bill is therefore no reflection of the NDP-Liberal coalition's benevolence toward Canadians. It is mere political and electoral theatre. To suggest otherwise is to lie to Canadians.

Now, getting down to dollars and cents, this pharmacare plan, as proposed, would generate massive costs, a concern that seems to have been glossed over, if not completely ignored. In a report published on October 12, 2023, the Parliamentary Budget Officer wrote the following:

...we estimate the incremental cost to the public sector (that is federal and provincial governments combined) to be $11.2 billion in 2024-25, increasing to $13.4 billion in 2027-28.

I would remind the House that the Parliamentary Budget Officer thinks the total is going to reach $40 billion.

I find it hard to trust in the current government's ability not only to implement an effective pharmacare program, but also, and more importantly, to maintain it over the long term. A government that has proven repeatedly since 2015 that it cannot maintain a balanced budget and is fiscally incompetent does not exactly inspire confidence.

I think it is worth reminding the people watching at home that the national debt has doubled since the Liberals came to power in 2015. It now stands at $1.255 trillion. I also want to remind everyone that since we have to borrow money to pay for the Liberals' reckless spending—because they are spending money they do not have—we are also paying interest. The interest on this unbelievable debt is $54 billion. That is more than the total amount of health transfers to the provinces, and it is the equivalent of all the GST paid by Canadians. This money is being thrown away to pay for the creation of programs that already exist.

Access to medication is a major concern for Canadians, which is why it is imperative that we carefully examine the viability of such a program, so as to be absolutely certain that it will last over the the very long term. More than anything else, it is hard to justify creating such programs, which would require additional bureaucracy and uncontrolled spending, when the vast majority of Canadians, four out of five, or 80% according to Statistics Canada, already have drug coverage in their respective provinces, coverage that is even broader than what is proposed in Bill C‑64.

Here is what Quebec's health minister, Christian Dubé, had to say to La Presse:

Not only is the government refusing to give us the money we asked for in federal health transfers, but it wants to interfere in an area of Quebec jurisdiction. The federal government knows full well that this is an area of provincial jurisdiction. We've had our own drug insurance program since 1997. It's been nearly 30 years. We also probably have the broadest drug coverage of any Canadian province.

By the way, he also pointed out that 45% of Quebeckers are entitled to drug insurance coverage through the public plan and that 55% of Quebeckers have private insurance. Guess what? Fifty-five per cent plus 45% equals 100%.

The federal government has caused countless crises in Canada since coming to power. Canadians continue to be both witnesses and victims of this incompetence every day in things like immigration, passports—we are starting to see lineups again—the correctional system, the use of food banks or the lack of affordable housing across Canada. Do my colleagues know that since the Liberals came to power in 2015, the public service has grown by 40% and hired 100,000 public servants?

I am going to quote a sharp mind on the subject of bureaucracy. I would not bet that he is a Conservative. Listen to this:

Like a black hole, it can also absorb astronomical budgets without leading to an improvement to public services.

Look at the Phoenix pay system, the chaos in immigration management, the ArriveCAN saga, the passports saga, the airports saga, etc. Despite the huge amounts of money squandered on new programs administered by an armada of public servants and the gigantic debt it has run up, the [Liberal] government's incompetence at delivering effective services to the public continues to defy expectations.

That is a quote from Boucar Diouf.

I want to close by quoting Gérald Filion, an economics journalist who is very well respected in Quebec. In his opinion, the government is creating a lot of programs and economists are concerned about the impact that will have on Canada's credit rating. The creation of many expensive programs that must be maintained in the future means additional spending.

All of the provinces offer coverage, particularly Quebec. We therefore recommend that we not go forward with this bill because we cannot afford it right now with this government's reckless spending.

The House resumed from April 16 consideration of the motion that Bill C‑64, An Act respecting pharmacare, be read the second time and referred to a committee, and of the amendment.

Bill C‑64—Time Allocation Motion

[Elizabeth May, Green, Saanich—Gulf Islands, BC]

Mr. Speaker, the debate right now is on time allocation on Bill C-64, and I would put it to the Minister of Health that I would love for us to be having a debate on an actual proposal for pharmacare.

It has been since June 2019 that the former Ontario health minister, Dr. Eric Hoskins, gave the government and this country clear direction that we need a national pharmacare program. We are the only country in the world with a national health care program that does not automatically include the provision of needed prescription drugs. We know from the Hoskins report that, properly implemented, a full national pharmacare program will save this country $5 billion a year at least.

However, the bill is picking out only two things, which is what is so strange about this bill and why I object to the debate being closed before we can actually discuss it. Why are we only talking about reproductive health care and diabetes medication? What that may end up doing is giving those opposed to pharmacare evidence that it costs more than it is worth, when we need to prove to everyone concerned that national pharmacare will save our health care system money and ensure Canadians get the health care they need.

[Yves Perron, Bloc, Berthier—Maskinongé, QC]

Mr. Speaker, I was listening to the minister when he said to allow this House to do its work. Allowing the House do its work also means not limiting debate. I know the minister to be a reasonable man. Is he not embarrassed to be limiting debate?

Bill C‑64 includes some extremely important powers. There is a danger. No one will be surprised to learn that the Bloc Québécois is against encroachment, against jurisdictional overlap, against what will likely be a waste of public funds on administrative redundancy. I think it is important to take the time to debate this properly.

Is the minister not embarrassed to be limiting the time for debate?

[Steven MacKinnon, Liberal, Leader of the Government in the House of Commons]

moved:

That in relation to Bill C-64, An Act respecting pharmacare, not more than five further hours shall be allotted to the consideration at the second reading stage of the bill; and

That, at the expiry of the five hours provided for consideration at second reading stage of the said bill, any proceedings before the House shall be interrupted, if required for the purpose of this order, and, in turn, every question necessary for the disposal of the said stage of the bill shall be put forthwith and successively, without further debate or amendment.

Foreign Political Interference, Violence or Intimidation

[Peter Julian, NDP, New Westminster—Burnaby, BC]

Mr. Speaker, there have been discussions and I hope you will find unanimous consent for the following motion that, notwithstanding any standing order, special order or usual practice of the House, (a) the amendment to the motion at second reading for Bill C-64, an act respecting pharmacare, in the name of the MP for Cumberland—Colchester, be deemed withdrawn, and (b) Bill C-64, an act respecting pharmacare, be deemed read a second time and referred to the Standing Committee on Health.

Bill C‑64—Notice of Time Allocation Motion

[Steven Guilbeault, Liberal, Minister of Environment and Climate Change]

Mr. Speaker, an agreement could not be reached under the provisions of Standing Order 78(1) or 78(2) with respect to the second reading stage of Bill C-64, an act respecting pharmacare.

Under the provisions of Standing Order 78(3), I give notice that a minister of the Crown will propose at the next sitting a motion to allot a specific number of days or hours for the consideration and disposal of proceedings at the said stage.

Financial Statement of Minister of Finance

[Emmanuella Lambropoulos, Liberal, Saint-Laurent, QC]

Madam Speaker, it is my pleasure to contribute to this debate today in support of budget 2024.

The budget aims to make our country fairer for everyone, for all generations. As one of the younger MPs in this place, I have heard countless times from people my age and younger how difficult it is for them to visualize the future they had always imagined for themselves.

Millennials and gen Zs are the first generations who are not doing better than their parents. They grew up with a promise that they can do well in school, work hard, get a good job and live a great life. Today's economy is proving all of that to be difficult. Many did really well in school and have great jobs, yet they are still finding it difficult to make ends meet.

Many of my friends, my age and younger, still live with their parents because they cannot afford to buy their own place. At this point, rent is so expensive that it simply is not worth it. Young Canadians are having a hard time getting approved for a mortgage, and some are requiring their parents to act as guarantors. That is if they are lucky enough to come from a family who is well off enough to provide that signature.

This has to change. The backbone of our economy is our youth. They are our present and our future, and they deserve their hard work to pay off. They deserve at least the same opportunities as their parents and grandparents had in order to achieve a good life.

This is why our government put in place, in the last couple of years, the tax-free first home savings account to make it easier for Canadians to save for their first homes. Up to now, over 750,000 Canadians have opened an account to save money to put into a down payment faster, with the help of tax relief.

Budget 2024 proposes an additional support for Canadians to be able to afford a home faster. First off, we know that for homes to become more affordable we need to increase supply. Budget 2024 would include an additional investment of $15 billion in new loan funding for the apartment construction loan program, bringing the program's total to $55 billion since 2017. This new investment would help build more than 30,000 additional homes across the country.

Budget 2024 would also top up the housing accelerator fund to increase the supply of housing faster. This fund would work with municipalities to cut red tape and to fast-track the creation of at least 100,000 new homes across Canada. The investment in budget in 2024 is $400 million over four years and would help fast-track 12,000 new homes in three years.

Another measure that would be extended for an additional two years is the ban on foreign buyers of Canadian homes. People who are not Canadian citizens or permanent residents would continue to be prohibited from buying homes in Canada, as this practice has brought up the value of our homes.

While building new homes is a longer-term solution to bringing down the cost of housing, there are other ways that budget 2024 would aim to help young Canadians buy and keep their first homes. The budget proposes to enhance the Canadian mortgage charter in several ways. It would allow a five-year increase of the amortization period, allowing for a 30-year amortization for first-time homebuyers purchasing newly built homes and making it possible for more young Canadians to qualify for and afford their monthly mortgage payments.

For those who already have a mortgage and whose terms are coming to an end, renewing one's mortgage with today's rates seems quite daunting. However, the Canadian government will be working toward making permanent amortization relief available to protect homeowners who meet specific criteria. Eligible homeowners would be able to reduce their monthly mortgage payment to an amount they can afford for as long as they need to. This would give them an opportunity to stay in their homes for longer.

While housing is one of the most important points in budget 2024, I would like to turn to a few other great supports for Canadians that would be funded in this budget. I will not spend too much time talking about the national school food program because I have already spoken about it at length in this place. I could not be happier that this investment of $1 billion to help kids eat a healthy meal at school has seen the light of day. The only private member's bill I have ever had the opportunity to present in this place, in my time as an MP, was on this very program, because as a teacher, I know just how badly it is needed.

Budget 2024 proposes an investment of $1 billion over five years for the federal government to work with provinces, territories and indigenous partners to expand access to school food programs, with support beginning as early as the new school year. The program is expected to provide meals for more than 400,000 kids each year and is expected to save the average participating family with two children as much as $800 per year in grocery costs, with lower-income families benefiting the most.

Also incredibly important is that the federal government recently introduced legislation that would help make essential medications more accessible and affordable for Canadians, which is a landmark move toward building a national pharmacare program that is comprehensive, inclusive and fiscally sustainable. Bill C-64, the pharmacare act, describes the federal government's intent to work with provinces and territories to provide universal, single-payer coverage for a number of contraception and diabetes medications. Now, budget 2024 proposes to provide $1.5 billion over five years to help Canada support the launch of the national pharmacare program.

We also need more support for persons with disabilities who face significant barriers to financial security, Budget 2024 proposes funding of $6.1 billion over six years and $1.4 billion per ongoing year for a new Canada disability benefit, with payments to eligible Canadians, which would start in July 2025. The Canada disability benefit would establish an important support for persons with disabilities and would ensure a fairer chance for persons with disabilities. It would fill a gap in the federal government's social safety net and is intended to supplement, not to replace, existing provincial and territorial income support measures.

Another aspect I was thrilled to see in budget 2024 is continued mental health support for our young people. The budget proposes an investment of $500 million over five years, beginning in 2024-25, with the goal of reducing wait times and providing more options for youth in need of mental health care. The reason this is so important is that 32% of young people who seek mental health support are unable to access care because of the cost. Whether we are talking about mental health issues brought on by the pandemic or those brought on by the postpandemic economy, gen Z needs that extra help, and the government is here to provide it.

We know that Canada's success, now and tomorrow, depends on the success of its youngest generations, but too many young people feel as though the reward for hard work, which is a secure, prosperous, comfortable middle-class life, is out of reach. For students, even with increases in financial supports, many still need more help to cover rising costs. Budget 2024 announces the government's intention to extend, for an additional year, the increase in full-time Canada student grants from $3,000 to $4,200 per year and interest-free Canada student loans from $210 to $300 per week, in time for the new school year. With this change, Canada's student grants will have doubled in size since 2014.

Grants for part-time students, students with disabilities and students with dependents would also be increased proportionately. Increased grants would support 587,000 students, and increased interest-free loans would support 652,000 students, with a combined $7.3 billion for the upcoming academic year. However, since federal student grants and loans are intended to help cover the cost of shelter, the formula used to estimate students' housing costs has not bee updated since 1998.

Budget 2024 proposes to modernize the shelter allowances used by the Canada student financial assistance program when determining financial need. This new approach would provide additional student aid to approximately 79,000 students each year. The government would also incentivize post-secondary institutions to build more student housing, and would provide the low-cost financing needed so that more students could find an affordable place to call home.

To aid the transition from school to the work world, work-integrated learning opportunities, such as co-ops and internships, are a proven way for post-secondary students to gain the valuable skills, education and real-life experience necessary to get good-paying jobs in important and growing fields.

To create more work-integrated learning opportunities for post-secondary students, budget 2024 proposes to provide $207.6 million for the student work placement program, which has already created over 192,000 work opportunities for post-secondary students since 2017-18. Likewise, the government would invest to create more youth job opportunities to build their skills and to gain meaningful work experience, which will be critical to Canada's economic growth potential in the years to come.

To create 90,000 youth job placements and employment support opportunities, budget 2024 proposes to provide $351.2 million for the youth employment and skills strategy. This includes $200.5 million for Canada summer jobs, including in sectors facing critical labour shortages, and $150.7 million for the youth employment and skills strategy program.

We cannot ignore those younger Canadians who choose to work for themselves and to launch their own businesses, which is an important part of a growing economy. To empower young entrepreneurs, budget 2024 proposes to provide $60 million over five years for Futurpreneur Canada, a national not-for-profit organization that would provide young entrepreneurs with access to financing, mentorship and other business supports to help them launch and grow their businesses.

I can see that my time is up, so I would like to wrap up by saying once more that I support budget 2024.

[Ryan Turnbull, Liberal, Parliamentary Secretary to the Deputy Prime Minister and Minister of Finance and to the Minister of Innovation]

Madam Speaker, I am thankful for the opportunity to highlight some of the important actions in budget 2024 to ensure that Canada's social safety net works for every generation.

When our government was first elected in 2015, we recognized that the economy had changed. People needed more supports and supports of a new kind. The government got to work very quickly after 2015. We introduced the Canada child benefit, which has helped cut the child poverty rate by more than half. We reinforced the security and dignity of retirement income by strengthening the Canada pension plan and increasing old age security for seniors aged 75 and over.

We permanently eliminated interest on federal student and apprenticeship loans and made generational investments in early learning and child care with $10-a-day child care, cutting child care costs by at least half, giving families money back in their pockets and giving children the best start in life. That equates to thousands of dollars per year. The average family in my area pays about $1,800 per month for child care. If we think about cutting those fees in half, that is substantial savings for each family. These have been investments in people, unprecedented in the history of Canada. With budget 2024, we are making transformative investments that will continue levelling the playing field and lifting up every generation.

At the heart of Canada's social safety net is the promise of access to universal public health care. We have made a promise to each other as Canadians that if we get ill or injured or are born with complicated health issues, we do not need to go into debt just to get essential care. Here in Canada, no matter where one lives or what one earns, people should always be able to get the medical care they need. That is why last year the federal government announced our 10-year health care plan providing close to $200 billion to clear backlogs, improve primary care and cut wait times, delivering the health outcomes that Canadians need and deserve.

With budget 2024, we are introducing new measures that will strengthen Canada's social safety net to lift up every generation. That includes national pharmacare. It includes our landmark move toward building a comprehensive national pharmacare program. Bill C-64, the pharmacare act, proposes the foundational principles of national universal pharmacare in Canada and describes the federal government's intent to work with provinces and territories to provide universal single-payer coverage for most prescription contraceptives and many diabetes medications. The pharmacare act is a concrete step toward the vision of a national pharmacare program that is comprehensive, inclusive and fiscally sustainable today and for the next generation. With budget 2024, the government is proposing to provide $1.5 billion over five years to Health Canada to support the launch of the national pharmacare plan.

Another aspect of strengthening the social safety net is the Canada disability benefit. Last year, Parliament passed Bill C-22, the Canada Disability Benefit Act. This landmark legislation created the legal framework for a benefit for persons with disabilities. The benefit fills the gap in the federal government's robust social safety net between the Canada child benefit and old age security for persons with disabilities, and it is intended to supplement them, not replace them. That is very important. We are not replacing the provincial and territorial income support measures, but offering to top them up. We strongly urge the provinces and territories not to claw back those supports for people living with disabilities.

With budget 2024, we are making this benefit a reality by proposing funding of $6.1 billion over six years and $1.4 billion per year ongoing for the new Canada disability benefit, which would begin providing payments to eligible Canadians starting in July 2025. The Canada disability benefit would increase the financial well-being of low-income persons with disabilities between the ages of 18 and 64 by providing an income-tested maximum benefit of $2,400 per year. As proposed, the benefit is estimated to increase the financial well-being of over 600,000 low-income, working-age persons with disabilities. It is just a start. We know that those individuals who are living below the poverty line and who are living with a disability are going to need more support, and we are committed to increasing that in the future.

With respect to the new youth mental health fund, our government is also well aware that young Canadians are facing high levels of stress and mental health challenges, including depression and anxiety. Many of them are still in school or just starting their careers and are struggling with the cost of private mental health care. The rising cost of living has further exacerbated this issue. This is a top issue for my youth constituency council that has been meeting for years, and the youth on the council have often said it is important for them to have greater access to mental health care. That is exactly why we have set up the $500-million youth mental health fund, which will provide resourcing for five years to help younger Canadians access the mental health care they need.

Supporting children is another aspect, and this is something I feel very strongly about as a father of two young girls. We know that children are the future of Canada. They will become tomorrow's doctors, nurses, electricians, teachers, scientists and small business owners. Every child deserves the best start in life. Their success is certainly Canada's success. With budget 2024, the government is advancing progress through investments to strengthen and grow our Canada-wide early learning and child care system, save for an education later in life, have good health care and unlock the promise of Canada for the next generation.

This includes a decisive action to launch a new national school food program. This is something I advocated for well before I became a member of Parliament, and it was a pleasure to see us get over the finish line and get it included in this year's budget. That national school food program will help ensure that children have the food they need to get a fair start in life regardless of their family circumstance. The $1-billion commitment to the program is expected to provide meals for more than 400,000 kids each year.

We are also supporting millennials and gen Z, for whom we must restore a fair chance. If one stays in school and studies hard, one should be able to afford college, university or an apprenticeship. One should be able to graduate into a good job, put a roof over one's head and build a good middle-class life in this country. In budget 2024, the government is helping to restore generational fairness for millennials and gen Z by unlocking access to post-secondary education, including for the most vulnerable students and youth; investing in the skills of tomorrow; and creating new opportunities for younger Canadians to get the skills they need to get good-paying jobs. More specifically, with budget 2024 we are announcing the government's intention to extend for an additional year the increase in full-time Canada student grants from $3,000 to $4,200 per year and interest-free Canada student loans from $210 to $300 per week. The increased grants will support 587,000 students, and increased interest-free loans will support 652,000 students, with a combined $7.3 billion for the upcoming academic year.

We are also helping to lower costs for everyday Canadians. While I am proud of the social safety net support that our government has provided to Canadians since 2015, we are well aware too many Canadians today are feeling like their hard work is not quite paying off. I am here today to reassure Canadians that it does not have to be this way, and that our government is working hard to help Canadians keep more of their hard-earned dollars. To do this, we are taking action to hold to account those who are charging Canadians unnecessarily high prices, whether it is corporations charging junk fees or unnecessary banking fees. The budget will help better ensure that corporations are not taking advantage of Canadians, and it will make sure the economy is fair, affordable and set up to make it easier to get a good deal.

As Canadians, we take care of each other. It is the promise and the heart of who we are, and it goes back generations. From universal public health care to employment insurance and to strong, stable, funded pensions like the Canada pension plan, there has always been an agreement that we will take care of our neighbours when they have the need. It gave our workers stability and gave our businesses confidence that the right supports were in place where we live. This supports our economy and keeps people healthy, ready and well supported. It keeps the middle class strong.

[Adam van Koeverden, Liberal, Parliamentary Secretary to the Minister of Environment and Climate Change and to the Minister of Sport and Physical Activity]

Madam Speaker, it is always nice to see you in the chair, and today is no different.

I am very proud to have the opportunity today to speak to budget 2024, a budget with a special focus on Gen Z, one that aims to ensure a better future for all Canadians.

Budget 2024 ensures that Canada's social safety net will work for every generation. When our government was first elected in 2015, we recognized that the economy had changed. People needed more supports and supports of a new kind. The government got to work immediately.

We introduced the new Canada child benefit. We have helped cut child poverty by more than half in the last eight years with this measure. We reinforced the security and dignity of retirement by strengthening the CPP, increasing the old age security for seniors 75 and over, indexing it for inflation and making the CCB, in particular, tax-free. We then permanently eliminated interest on all federal student and apprenticeship loans for Canadians of student age. We also made generational investments in $10-a-day child care, which cut Canadian child care costs by at least half in every province and territory. That gave families more money back in their pockets, and it gives kids the best start in their lives.

When I walk the streets of Milton, I see a lot of strollers. There are a lot of young people per capita in Milton. Parents stop me all the time to say that they are saving a lot of money on child care costs, and they recognize that was a measure the federal government campaigned on and made happen.

With budget 2024, we are making more transformative investments that will continue to level the playing field and lift up every generation. Top of mind is universal public health care. We made a promise to Canadians that if they get ill or injured, or if they are born with complicated health issues, they do not need to go into debt just to get essential care. Unlike in other countries, we depend on our health care, not our credit card, to get the attention we require when we go to a doctor or a clinic. That is why, last year, the federal government announced our 10-year health care plan, providing close to $200 billion to clear backlogs, improve primary care, cut wait times and deliver the health outcomes that Canadians need and deserve.

With budget 2024, we are introducing new measures that would strengthen Canada's social safety net to lift up every generation. Chief among those is national pharmacare. This includes our landmark move towards building a comprehensive national pharmacare program. Bill C-64, the pharmacare act, proposes the foundational principles of national universal pharmacare in Canada. It describes the federal government's intent to work with provinces and territories to provide universal single-payer coverage for most prescription contraceptives and many diabetes medications.

This is something that I campaigned on and that I strongly believe in. Canada continues to be the only country in the world with socialized medicine without national pharmacare, but that is changing now because our government took action.

We are also very aware of the fact that mental health is health. Our government is aware that young Canadians are facing extremely high levels of stress and mental health challenges. That includes depression and anxiety. It is a tough time to be a millennial. Many of those young people are still in school or are just starting out in their careers, and they are struggling with the costs of private mental health care. The rising cost of living has further exacerbated these concerns. That is why our government remains committed to ensuring that future generations have access to basic mental health supports, so that they can have a healthy start to adulthood.

Budget 2024 also proposes to provide $500 million over five years for the creation of a new youth mental health fund, which will help younger Canadians access the mental health care they need.

We are also supporting children in an incremental way in budget 2024. We know that children are the future of Canada. Many of them are the leaders of today. They will become tomorrow's doctors, nurses, electricians, teachers, scientists and small business owners. Every child deserves the best start in life. Their success is truly Canada's success.

In budget 2024, our government is advancing progress through investments to strengthen and grow our Canada-wide early learning and child care system, save for an education later in life, have good health care and unlock the promise of Canada for the next generation.

Budget 2024 also includes taking decisive action to launch a new national school food program to help ensure that children have access to the food they need to get a fairer start in life, regardless of their family circumstances. The $1-billion program is expected to provide meals for over 400,000 children in schools every single year.

This is very personal for me. I benefited quite a lot from school food programs in my community. I was lucky. I grew up in a town that had lots of volunteers and great community-serving organizations, ones like Food for Life, Halton Food For Thought and Food4Kids in Halton Region. When kids needed a snack then or need a snack now, they can access a snack, but that is not true in every single school.

I am really proud of the fact that Brent Mansfield was here. Through the work that the Coalition for Healthy School Food did and the advocacy that all the food security organizations have done over the last decades, we are building Canada's first-ever national school food program. It would build on the work that great charities, such as Food for Life, Food For Thought, Food4Kids and many others, have been doing in their regions. It is important to note that this is all made possible through volunteer work and teachers taking on expenses themselves, sometimes bringing food from home, and sometimes taking time out of their curriculum to teach edible education and nutritional literacy. These are really important skills.

I am a big fan of Jamie Oliver. I saw on social media yesterday that he congratulated the mayor of London, in the U.K., for introducing more healthy school food for kids. I am a huge supporter and advocate for a national school food program, and I am thrilled that it is reflected in budget 2024.

We are also supporting millennials and gen Z. We must restore a fair chance for them. If they stay in school and study hard, they should be able to afford college, university or an apprenticeship. They should be able to graduate, get a good job, put a roof over their head and build a good middle-class life for them and their families. Budget 2024 would ensure the government's help to restore generational fairness for millennials and gen Z by removing the interest on Canada student loans; unlocking access to post-secondary education, including for the most vulnerable students and youth; investing in the skills of tomorrow; and creating new opportunities for younger Canadians to get the skills they need to get great jobs.

More specifically, in budget 2024, we are announcing the government's intention to extend for an additional year the increase in full-time Canada student grants from $3,000 to $4,200 per year and interest-free Canada student loans from $210 to $300 per week. The increased grants would support 587,000 students across Canada and increased interest-free loans would support 652,000 students with a combined $7.3 billion for the upcoming academic year. I cannot think of a better investment.

While I am proud of the social safety net that our government has provided Canadians since 2015 and certainly before that, we are aware that too many Canadians are not feeling as though their hard work is paying off. I am here today to reassure Canadians that it does not have to be that way. I am regularly heard in this House talking about co-op housing, and I am really glad that we are advancing on the promise to restore co-op housing in this country, to build more co-operative housing and to invest in more non-market housing solutions.

Our government is working hard to ensure that Canadians can keep more of their money. In many respects, this would ensure that they can invest in the economy; however, it is also about the well-being of families. We are taking action to hold to account those who are charging Canadians unnecessarily high prices, whether it is corporations charging junk fees or banks charging unnecessary banking fees. This budget would also better assure that corporations are not taking advantage of Canadians. It would make sure the economy is fair and affordable, as well as that everybody is set up to get a good deal. Budget 2024 would also build on these efforts and give people back control over their personal finances and banking choices, with action to cap banking fees and give better access to digital banking, lower-cost accounts and stronger consumer protection.

While the Conservatives continually prioritize the interests of wealthy CEOs and corporate lobbyists, particularly from the oil and gas sector, we will stay focused. We know that we work for Canadians here in the House, not the greedy corporate interests of the top 0.1% of earners. With some of the measures in budget 2024 that I have touched on today, we are ensuring that the support and advocacy continue.

Pharmacare Act

[Judy Sgro, Liberal, Humber River—Black Creek, ON]

Mr. Speaker, I want to thank the hon. member for his commitment to his community and the indigenous community, in particular.

Bill C-64 is one more way for us to talk about health care in Canada. We are certainly talking about the indigenous community, but we are also talking about all Canadians. The more opportunity we have to look at where we could improve the system, the better it is for all of us.

[Judy Sgro, Liberal, Humber River—Black Creek, ON]

Mr. Speaker, the member's first question was regarding a report. The member can rest assured that I will report the motion to the House at the first opportunity I have to do so.

On to the issue of Bill C-64, this is the beginning. It is a new program. We expect that there will be times for alterations as to how we do things. We will continue to work with the provinces on how we do the rollout of this plan. I think the best thing the member could do would be to work with all of us, and all of the parties in the House, to see that this legislation, Bill C-64, gets passed as soon as it can.

[Judy Sgro, Liberal, Humber River—Black Creek, ON]

Mr. Speaker, I was not sure I would get the opportunity to speak this afternoon, so I am glad to be able to join in debate on a very important bill, Bill C-64, an act respecting pharmacare.

Bill C-64 represents the next phase of our government's commitment to establishing a national universal pharmacare program. It proposes the foundational principles of the first phase of national universal pharmacare and our intent to work with provinces and territories to provide universal, single-payer coverage for a number of contraception and diabetes medications. This is an important step forward in improving health equity, affordability and outcomes, and it has the potential to provide long-term savings in our very endangered health care system.

Public health care in Canada was built on the promise that, no matter where one lives or what one earns, one will always be able to get the medical care one needs. Despite this promise, Canada is the only country in the world with universal health care that does not provide universal coverage for prescription drugs. In the bill, we talk specifically about contraception and the things needed for diabetes. They are very important aspects of this program.

When medicare was first introduced, prescription drugs outside of hospitals cost less and played a smaller role in health care. Today, prescription drugs are an essential part of our health, helping to control chronic conditions, treat temporary ones, and aid in overall health and well-being. We need to work harder to get those costs reduced.

One area that has seen significant change is diabetes treatment, as mentioned earlier by the minister and by other colleagues. Over 100 years ago, thanks to a Canadian team of researchers, Frederick Banting, Charles Herbert Best, John J.R. Macleod and James Bertram Collip, insulin was discovered. Since this monumental scientific discovery, there have been several advancements in diabetes treatment, from the introduction of fully synthetic human insulin to glucose monitors and insulin pumps.

These breakthroughs have improved quality of life immensely for people living with diabetes, whether it is by enhancing their self-esteem, increasing social participation, or improving overall health and well-being. Through hard work, one colleague in the House brought forward a program for a national diabetes strategy. These breakthroughs have come with higher costs, creating new affordability challenges for Canadians.

Outside of hospital, prescription drug coverage comes from a mix of private insurance, out-of-pocket cash payments and various provincial programs. While the majority of Canadians have access to some form of public or private insurance, about 2.8%, or 1.1 million Canadians, do not. We constantly hear just how expensive everything is in and around the diabetes forum on a monthly basis for an individual.

Although most Canadians have some form of drug coverage, as I mentioned, this does not mean that those with insurance have equal access to the prescription drugs they need. The existing patchwork system of private and public drug plans leaves millions of Canadians under-insured. That is, their out-of-pocket prescription drug costs create a financial burden that leaves them struggling to afford an essential part of health care.

In 2021, Statistics Canada found that more than one in every five adults in Canada reported not having the insurance they needed to cover their prescription costs. They had to decide whether they were going to fill their prescription or buy dinner.

Under-insurance can take many forms. For example, Canadians may have high deductibles, resulting in significant out-of-pocket costs before their insurance coverage even kicks in; they may reach the maximum annual or lifetime coverage limits for their insurance and have to pay out-of-pocket; or they may have high co-payments, which are often more than 20% of the drug's cost on private plans and sometimes more on public plans.

All provinces have drug coverage to protect Canadians from catastrophic drug costs, but deductibles under these plans can range from 0% to 20% of net family income. In many cases, Canadians will never reach the deductible, leaving them without any support for their drug costs. This variability across the country creates a postal code lottery.

We can again consider the advancements in diabetes treatments. For a working-age Canadian with no private insurance, out-of-pocket costs vary widely. In some parts of the country, out-of-pocket costs for people living with type 1 diabetes can be higher than $18,000 per year out-of-pocket; for type 2 diabetes, they can be higher than $10,000 per year in out-of-pocket expenses. Even those with private insurance can face high co-pays or exceed annual plan maximums, resulting in high out-of-pocket costs.

Even for cases in which an individual is not accessing devices that cost thousands of dollars, they can face significant out-of-pocket costs. For example, we can consider a woman in her mid-twenties who is working a minimum wage job. An IUD, one of the most effective forms of birth control, can cost up to $500 with no insurance. Even with private insurance, a co-pay of 20% would be $100. While IUDs can last from three to 12 years and save money over the long term, the high upfront cost can make them inaccessible.

Under-insurance can be a particular concern for young adults, who age out of their parents' private insurance but do not have their own form of private coverage. Lower-income Canadians also make up a disproportionate share of the under-insured. While most provinces have put drug coverage in place for those accessing social assistance benefits, a gap clearly persists. Many lower-income households that do not qualify for social assistance continue to struggle with out-of-pocket prescription drug costs.

Employment factors contribute to differences in insurance coverage. People with low-paying jobs, such as entry-level, contract and part-time positions, often report less adequate drug insurance coverage. This may even discourage people who are accessing social assistance benefits from applying for jobs: Once hired, they may lose their public drug coverage, but many entry-level and part-time jobs do not offer drug benefits. One study found that only 27% of part-time employees reported receiving medical benefit coverage.

Under-insurance can have serious consequences. Many Canadians with high out-of-pocket costs report forgoing essential needs, such as food and heat, or not adhering to their prescriptions because of the costs they have to pay. Statistics Canada also found that, in 2021, close to one in five Canadians spent $500 or more out-of-pocket for their prescription medication; almost one in 10 reported not adhering to their prescription medication because of costs. This includes delaying filling prescriptions or skipping doses in order to save money.

When people do not take their prescription drugs the way they are supposed to, their health can suffer, and this results in serious consequences for the individual and their household. It also results in unnecessary costs to the health care system, as patients are more likely to visit an emergency room and be admitted to hospital. For example, the full cost of diabetes to the health care system in 2018 was estimated to be around $27 billion, and it could exceed $39 billion by 2028.

I think we can all agree that no Canadian should be put in a position where they must choose between the prescription drugs they need for their health and well-being and putting food on the table. This is unacceptable, and it is why we are continuing our work to improve accessibility, affordability and appropriate use of prescription drugs as we move forward with national universal pharmacare.

I am thankful for the opportunity to speak to a very important bill, as we start the debate and move towards to the legislation passing in this House.

The House resumed consideration of the motion that Bill C-64, An Act respecting pharmacare, be read the second time and referred to a committee, and of the amendment.

[Mark Gerretsen, Liberal, Kingston and the Islands, ON]

Madam Speaker, it is a real pleasure to rise today to speak to a very important piece of legislation, Bill C-64. I will be sharing my time today with the hon. member for Humber River—Black Creek.

This is important legislation because, for decades, we have been talking about the need to bring in pharmacare. I look at this as the first step in bringing in pharmacare, which could cover a whole host of drugs and medicines that are very important for people. I would agree with the member for New Westminster—Burnaby, who was speaking earlier, that this is about preventative health care. This is about helping people before they get to the point when they would need to go to an emergency room. This is about getting people their very important medication.

When we have an issue like this that further builds on our health care system, which is a health care system that has developed over generations through, at times, very difficult partnerships and relationships with provinces, I am disheartened to see that, in the very first speech on this issue, when Conservatives stood, they brought in a motion to amend the bill. The amendment would basically substitute everything after the word “That” with “The House decline to give second reading”. That is all the Conservatives did.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Madam Speaker, it is an honour to rise today to speak to Bill C-64.

We have heard some doozies over the last day. Of course, today is budget day, so we will hear some more doozies about the billions upon billions that will be spent and heaped on the backs of taxpayers.

One of the reasons it is such a great honour to speak to Bill C-64 is that I get a chance to split my time with the newly minted Conservative member for Durham. Finally, we have a true blue Conservative in Durham, and I cannot wait to hear his speech. I believe it may be his maiden speech today. He is a great member of Parliament. If anybody has not heard his story, it is a true testament that a person can do anything they want if they set their mind to it and do not accept the barriers that life has placed before them. He is a cancer survivor. He was ruled illiterate in grade school and then went to Yale School of Law just seven years later. I am so honoured to share a bench and split my time with my colleague from Durham.

We are speaking about Bill C-64, which is yet another promise or plan of the Prime Minister's to hold onto whatever shreds of power he has. It is essentially a power grab, again. We will be talking a little about some of this announcement, as well some of the other failed announcements that the Prime Minister and his “speNDP” coalition have undertaken in the last four or five years.

From the onset, I will say that I believe that if a Canadian needs medication, we should be doing everything in our power to make sure they have access to the medications they need. However, this bill is not a pharmacare bill. It is a plan or a promise to work towards a bigger pharmacare system. Where did we hear that previously? Oh, that was with the dental care plan that we saw earlier, and now we are hearing that less than 10% of dentists across our country are signing up to it. It is a failed system. I will have more on that as we go further.

The Conference Board of Canada estimates that over 97% of Canadians are already eligible for some form of drug coverage. Over 27 million Canadians rely on privately administered workplace plans. I spoke with insurers who have no idea how this pharmacare plan would work. Are they to scrap their plans altogether? What happens to those 27 million Canadians who already have a plan?

Despite what the health minister said, that he has a great working relationship with Quebec, that was proven wrong time and time again. I believe it was the Quebec health minister who went public to say that there are no talks and that they do not agree with what the federal minister is saying regarding health care. We have seen this time and again with the Liberal government.

Going back to 2015, the member for Papineau campaigned on doing things differently. He campaigned on having the most open and transparent government in the history of our country. Wow. The one thing he has accomplished is having the most scandal-plagued government in the history of our country, and the NDP coalition is complicit in the cover-up of those scandals.

The pharmacare bill is just another in a long list of bills that allowed the Liberals to get in front of the cameras and say they are getting things done for Canadians, when they are really just trying to pull the wool over everyone's eyes.

Now, the Liberals and the NDP will stand up, pound their fists and say how bad Stephen Harper was in the dark years of Stephen Harper. Here is a news flash. The Liberals have been in power for nine years. If it was a priority for them, then they could have gotten it done. They had a majority, and now they have a majority with the NDP, so they could get things done if they really wanted to get things done.

Bill C-64 is nothing more than a photo op; that is it. It does not actually do anything concrete. It talks about, “to consider when working towards the implementation of national universal pharmacare”. In other words, it is just another broken election promise. Why does the government not work with pharmaceutical companies to bring down the cost of all drugs to Canadians? That is a novel idea, but nothing is mentioned in there. All we get are future promises and no plan. Let us really, truly be honest with Canadians. This is a not a pharmacare plan; it is an empty promise that will not even come close to covering every medication that Canadians use.

I spoke about promises. We have heard that Nova Scotia has a bit of plan. We heard that Quebec, obviously, has a plan and was not even consulted on how it has done it. My province of B.C. has the fair pharmacare plan. As a matter of fact, we have 12 plans under that one plan for British Columbians who have trouble accessing medication.

What the Liberals have proven time and again is that, after eight years, they neither trust nor respect Canadians. Apparently, they also think that Canadians are too foolish to see through the truth that is right before their eyes. The truth is that after eight long, miserable years, the NDP-Liberal government is simply not worth the cost. We say that time and time again. With this government, the choice is between costly programs and future promises, or should I say false promises, and Canadians know that NDP-Liberal promises never come true.

After eight long years of this Prime Minister, there have been so many broken promises. In 2015, he promised affordable housing, and then he doubled the mortgage, rent and down payment costs. It now takes 25 years to save for a down payment on the average home. In Vancouver, a person has to earn almost $250,000 just to afford a home. Most young Canadians believe that they will never be able to afford a home. That used to be the dream; now it is just a nightmare. He promised that the carbon tax would not cost us anything, and now we find out that over 60% of Canadians pay more because of that tax. He doubled the tax; actually, he raised it by 23% on April 1, which was an April Fools' Day joke on all of us.

I talked briefly about dental care, and I want to read something from a dental office in Prince George, which wrote that what has been put out to the public as far as the coverage is totally not true. The dental office said that the government has said to the public is that this is free dental, but that it's nowhere close to being free dental, unfortunately. That's why, they said, there's frustration from patients who are signing up and phoning around. Patients are saying that they have free dental now, and they, the dental offices, have to give them the bad news.

She continued by saying that there hasn't been a whole lot of information released to dentists, and the government won't give any more information until you register. It hasn't been totally honest and transparent with the dentists, and the dentists are leery of signing up. She said that it was confusing for them, because they haven't been getting all the facts, and that until the facts are better explained to dental offices, dentists and owners, they're not going to register for something if they don't know what they're getting involved in.

That is par for the course with this government. Its members stand before the public and the cameras, perhaps with a tissue to their eye; they put their hand on their heart and say that they truly care. However, the reality is that they are not doing the work. We have good people across the way who are actually waking up and seeing the failures and the lies of their front bench.

It is about time that this failed NDP-Liberal coalition moved out of the way so that the member for Carleton, Canada's future prime minister, can start righting the wrongs of the last eight years. It is going to be tough, but we have the team and we are ready to do it.

[Chandra Arya, Liberal, Nepean, ON]

Madam Speaker, I am going to share my time with the member for Kingston and the Islands.

Bill C-64, the pharmacare act, is a transformative shift in our national approach to health care. We are taking a decisive step towards not just improving health care but also fundamentally redefining what it means to be a part of this great nation.

Health care is a cornerstone of Canadian identity, rooted in the belief that access to medical care should be based on need, not ability to pay. However, until now, this promise has been incomplete, because it has not fully covered medications.

Bill C-64 would establish a framework towards national universal pharmacare in Canada for certain prescription drugs and related products, including free coverage for contraception and diabetes medication. This is more than policy; it is a new chapter in our social contract.

This comes after our Canadian dental care program. That program reduced the financial barrier to accessing oral health care services for up to nine million uninsured Canadian residents.

Let us consider the significance of this moment. Many of our citizens, particularly the chronically ill and the economically vulnerable, have had to choose between medication and other essentials of life. This choice, which no one should ever have to make, has led to deteriorating health conditions, increased hospitalizations and, tragically, premature deaths.

Bill C-64 would also mandate that the Canadian Drug Agency works towards the development of a national formulary, develop a national bulk purchasing strategy and support the publication of a pan-Canadian strategy regarding the appropriate use of prescription medications.

Several G7 countries have implemented national pharmacare programs that vary in structure but share the common goal of improving access to medications. In the United Kingdom, the National Health Service covers most prescription medications, with patients paying a fixed prescription charge or obtaining an exemption. It has made medications free for children, the elderly and low-income individuals.

France operates a co-payment system in which patients are reimbursed for a significant portion of their medication costs based on the medication's necessity and effectiveness. Some essential medications are covered at 100%.

Germany features a statutory health insurance system that covers the vast majority of the population. Prescriptions require a nominal co-pay that is capped annually.

Similarly, Italy's national health system provides medications at low or no cost, depending on the medication's classification and the patient's income level.

Japan has a system where patients pay a percentage of the costs for their prescriptions. This is adjusted based on income, age and chronic health status, ensuring that no one is denied access because of financial constraints.

These G7 countries demonstrate a commitment to ensuring that essential medications are affordable. This reduces the financial burden on individuals and promotes better health outcomes across the population.

The United States and Canada have distinct health care systems that reflect differing approaches to health care management and funding. The U.S. health care system is predominantly privatized; health insurance is primarily provided through private entities. It is supplemented by government programs, including Medicare and Medicaid, for specific groups such as the elderly and low-income individuals. This system often results in higher out-of-pocket costs for individuals, depending on their insurance plans.

In contrast, Canada's health care system is publicly funded. Funded through taxation, it provides universal coverage for all Canadian citizens and permanent residents. Health care services in Canada are delivered through a single-payer system, meaning that the government pays for care that is delivered by private entities. This model aims to ensure that access to health care does not depend on one's ability to pay.

While both systems aim to deliver high-quality medical care, the Canadian system is generally more focused on equitable access, whereas the U.S. system offers a wider range of provider choices and faster access to elective procedures, often at a higher cost to the consumer. The U.S. system also features higher health care spending per capita compared with Canada, which has managed to control costs more effectively through its single-payer system.

As a diabetic, I would like to touch on the transformative change that promises to reshape the lives of the more than 3.7 million Canadians living with diabetes.

Diabetes, a chronic and complex disease, poses one of the greatest health challenges in our nation, impacting an enormous swath of our population across every age, socio-economic status and community. The burden of diabetes is not only a personal struggle but also a national concern. The profound physical, emotional and financial strain of diabetes is well-documented. This disease, if not managed properly, can lead to devastating complications, such as blindness, kidney failure, heart disease and even amputations. However, despite the availability of effective treatments, a staggering one in four Canadians with diabetes has reported that, solely because of cost, they have not adhered to their prescribed medical regimen. This is not a failure in health management; it is a failure in our health policy.

The introduction of the pharmacare act is a beacon of hope. This legislation is a crucial step towards eliminating the financial barriers that too many Canadians face in accessing essential diabetes medications. By ensuring that no one is left out because they cannot afford their medicine, we would not only improve individual health outcomes but also enhance our nation's health security. The importance of this act for the diabetes community cannot be overstated. Improved access to necessary medications would mean better disease management and control, which would significantly reduce the risk of severe complications. This is a direct investment in the health of millions of people, and the ripple effects would be seen throughout our health care system. Fewer complications from diabetes mean reduced hospital admissions, fewer medical emergencies and a general decrease in the health care burden on our system. We are not just providing medication; we are restoring opportunities and enhancing the well-being of millions of Canadians.

I would say to all Canadians living with diabetes that this legislation is for them. It is a testament to our belief that, together, as a united nation, we can tackle the challenges of chronic disease with compassion and resolve. Let us move forward with the assurance that our government is committed to their health and well-being. Let us embrace this change, not just for those living with diabetes, but for us all, for a healthier, stronger Canada.

To conclude, Bill C-64 lays out our plan for universal, single-payer coverage for contraception and diabetes medications. Through our bilateral health agreements with the provinces and territories, the Canadian dental care plan and now pharmacare, we are delivering on the promise that every Canadian deserves better health care.

[Peter Julian, NDP, New Westminster—Burnaby, BC]

Madam Speaker, to begin, I will respond to my colleagues from the Bloc Québécois, because they do not seem to have read or listened to the Quebeckers who support this bill.

I will start by reading the statements issued by the Centrale des syndicats démocratiques, or CSD, the Confédération des syndicats nationaux, or CSN, the Centrale des syndicats du Québec, or CSQ, and the Fédération des travailleurs et travailleuses du Québec, or FTQ. These labour federations represent one million Quebeckers. When we factor in the families of these workers, these federations represent more than one-third of Quebec's population.

The labour federations said that they:

...welcome the introduction of a pharmacare bill by the federal government to lay the foundation for a future universal public pharmacare program. Several aspects of this bill are encouraging, including the fact that it takes into account the principles of the Canada Health Act (public administration, comprehensiveness, universality, portability and accessibility), maintains long-term federal funding, covers birth control and diabetes medication, and includes first dollar coverage.

I also want to quote the leaders of the labour federations. First, Luc Beauregard, secretary-treasurer of the CSQ, had this to say:

Quebeckers deserve better. They need a universal public pharmacare plan as soon as possible.

Next, Magali Picard, president of the FTQ, said this:

With the rising cost of living, many Quebeckers are struggling to make ends meet. Every year, more than one person in 10 goes without prescription drugs because they cannot afford them. That sort of situation should not be tolerated. Medication should be free, because no one chooses to be sick and to need medication.

I would like to mention that “[t]he labour federations believe that Quebec is misguided in calling for an unconditional right to opt out.”

Caroline Senneville, president of the CSN, had this to say:

We feel it would be unacceptable for Quebec to receive federal funds unconditionally in order to maintain a dysfunctional and unfair system...

Finally, Luc Vachon, president of the CSD, had this to say:

It is unacceptable for a person's health to depend on their income or to be up for negotiation. Quebec has its own system, but it discriminates against those with lower incomes. A real universal public system must guarantee everyone the right to easily access medication. There is a strong consensus in both Quebec and Canada on the implementation of a universal public pharmacare program, and the time has come to move beyond constitutional squabbling so that everyone has real access to affordable medication.

Again, the leaders of Quebec's largest labour federations have been clear. They represent more than one-third of Quebec's population.

We just heard the Bloc Québécois's arguments against this bill. I am asking them very nicely to listen to Quebeckers rather than assuming that they know what Quebeckers think. The Bloc Québécois does not like to hear that this bill represents what Quebeckers really want. The reality is that these are the voices in Quebec that the Bloc Québécois should be listening to.

It is no secret that Quebec's current system is not working. People are falling through the cracks. This bill, which the NDP pushed for and which is before the House because of the NDP, will make a difference in the lives of Quebeckers and Canadians across the country.

That is my message to my Bloc Québécois colleagues. It is difficult to be against Bill C-64 after hearing all those people who have looked at it and want us to move forward with it. They want us to help those who have trouble paying for their diabetes medication, as well as the low-income people who are falling through the cracks. It is something worth thinking about. I hope that my Bloc Québécois colleagues will hear these voices and act accordingly by voting in favour of the bill. They cannot just be reactionary like the Conservatives.

First, I want to about the impact of pharmacare. A little over three years ago, I brought forward, on behalf of the NDP caucus, the Canada pharmacare act. This would have made a difference in the lives of Canadians from coast to coast to coast. There were 120,000 Canadians who wrote to their members of Parliament, hundreds of them wrote to each Conservative MP and systematically the Conservatives and Liberals voted against that bill, which would have established, on the basis of the Canada Health Act and its five principles of universal health care, pharmacare in Canada.

For me, this is poetic justice. Three years later now, because of the NPD's pressure, the work of the leader of the NDP, my colleague from Burnaby South, our health critic at the time, the member of Parliament for Vancouver Kingsway, and the entire NDP caucus, using our weight and our pressure in a minority Parliament, we have actually achieved something that will make a significant difference in the lives of people.

The Conservatives have said that diabetes and contraception is only a start, which is very true, but the reality is that when we talk about diabetes medication, the cost of having diabetes, which is a profound health challenge, can be up to $900 a month. I cited a little earlier that a resident of Burnaby, B.C., Amber Malott, pays $900 a month.

Each and every Conservative MP has in their riding 17,000 people to 18,000 people who would be impacted by this significant move forward in Canadian health care. They would benefit from that. The ones who are paying anywhere from $100 a month to even $900 a month finally have that burden taken off them.

The Conservatives have signalled they want to gut it. They blocked the bill last week and refused to even have it brought to the floor of the House of Commons. They have indicated that they will try to block and destroy this legislation at every step. We have to ask the question, why? Is it just weird ideology, is it just their extremist leader or is it the fact that they have not even read the legislation and have not consulted their constituents? If they talked to 17,000 people or 18,000 people in each of their ridings, they would find those constituents saying that we need to adopt legislation, that they cannot continue to pay $200 a month, or $500 a month or $900 a month for medication, that they simply cannot afford to put food on the table or keep a roof over their heads and pay for this medication at the same time.

If the Conservatives consulted their constituents, they would hear overwhelmingly from those 17,000 people or 18,000 people that this would make a difference in their lives. I certainly will be going out to Conservative ridings and consulting their constituents, because they seem unwilling to do so. For them to block the bill and to say that they do not even want it discussed on the floor of the House of Commons indicates their extremism within—

[Luc Thériault, Bloc, Montcalm, QC]

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.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, the minister spoke about a lot of things. I feel he spoke very little about Bill C-64. However, when we talk to him about Quebec’s interests, he rises in the House and always says that the Bloc Québécois is looking for a fight. Quebec has been administering a mixed drug insurance plan for the past 28 years, but the minister never sat down with Quebec before making his announcement to see how Quebec manages this and how much it might cost.

Does the minister know how many prescription drugs are covered by Quebec’s drug insurance? Has he sat down with the health minister, who says that Quebec does have constitutional rights? When the minister says we are looking for a fight, he should add the word “constitutional”. It is as though we Bloc members have more respect for Canada’s Constitution than he does, despite his party having done all it could to prevent Quebec from signing the Constitution in 1982. Is he aware that the minister wants nothing to do with his pharmacare plan as proposed?

[Mark Holland, Liberal, Ajax, ON]

Yes, I want to thank parliamentary co-operation.

Madam Speaker, I would say to this place that this is what we were intended to do. When we were elected as members of Parliament, we are not here to shout things at each other, to belittle each other or to put each other down. We are here to listen to each other. The purpose of debate is to ensure that we take each other's ideas and that we find common ground. In this bill, Bill C-64, in pharmacare and in dental care, we are embodying exactly what I believe our constituents elected us to do.

Right now, we have 1.8 million seniors who, in many cases, have never had access to oral health care in their lives. I talked to a denturist who knew a senior who has not had new dentures for 50 years. They lost their dentures and had no money to replace them. The denturist talked about the dignity and the way that senior felt, knowing that they were going to get new teeth and that they could go out in the world, feeling that somebody cared about them. Let us think of the extraordinary nature of that.

When going to seniors homes and when talking to people who work with seniors, they ask if this is really going to happen. They talk about the dignity that comes from it. It is not only about that healthy smile or that they are not going to wind up in an emergency room for an avoidable procedure, but also about the dignity of saying that we care about them, that we see them and that their health matters.

We have one of the most extraordinary health care systems in the world, but it cannot be the best health care system in the world unless oral health is part of the equation. When we do not take care of oral health, when we are not there for oral health, then the costs, not just in terms of social justice but also in terms of health outcomes, are entirely unacceptable. I would submit that is not the country we want to live in.

I am also extraordinarily proud that, about two weeks ago, the Minister of Families, with many of us there, launched the national food program. When I was at the Heart and Stroke Foundation, I advocated for fiercely for that, knowing when a child goes to school hungry, it is impossible to learn, and when a child is denied nutrition, it has devastating effects on their health. It is so sad to say that the research shows just one healthy meal a day has a dramatic change on health outcomes for children. The other thing it does is to give kids a taste for what nutritious food is. They develop their palates, and for their whole lives, their nutrition and nutritional profile is changed.

An essential part of being upstream and avoiding illness and sickness is dental care, a national food program and, yes, action on pharmacare. This is a big task. We know that some 21% of Canadians are struggling to meet the financial burden of being able to afford their medicines. We took essential action on bulk purchasing, reducing the cost of medicine in this country by hundreds of millions of dollars, by working with provinces and territories to do bulk purchasing.

We are taking critical action in P.E.I., with a plan for Islanders, on a pilot basis, to improve affordable access to prescription drugs. Since June 1, 2023, we have been able to reduce copays to five dollars for almost 60% of medications regularly used by Islanders. P.E.I. residents have saved more than $2 million in out-of-pocket costs. This was a precursor to show us what could happen. Whether one goes to P.E.I. or other provinces, and I know that the member for Malpeque talks a lot about this, they will hear about the difference it is making in the lives of people, having medication taken off the table as a concern. It is absolutely huge.

We also launched, in March 2023, a national strategy for drugs for rare diseases, with an investment of $1.5 billion over three years because we know that drugs for rare diseases can be cripplingly expensive, yet they are absolutely vital to keep people alive.

I will give one quick story before I talk about the bill in front of us and about the action we are taking. I had an opportunity a few weekends ago to be in the United States with my partner. We watched someone in front of us collapse. That person was obviously not a person of means. As they came to and I called 911, the thing that person was worried about was not their health, but it was how much money they were going to have to spend. How much money did my call to 911 burden that person with?

We do not want to be in a place, with any element of health care, where somebody of limited financial means, through no fault of their own, is in a circumstance that they cannot afford care, or where nurses on the front lines, taking care of patients and investing their entire lives in trying to make things better, are not given the opportunity to get proper health care for themselves.

Why these drugs? Why did we start with diabetes medication and with universal contraceptives? Let me start with diabetes medication. I want to thank the member for Brampton South for her fantastic advocacy on diabetes specifically. There are 3.7 million Canadians, and it is a growing number, who have diabetes. When I had a conversation in Ottawa with 12-year-old Raina, she summed it up better than anybody else. She said that as a 12-year-old it is really hard in this world, and that no 12-year-old should have to worry about all the problems of the world and also how they are going to afford their medication. If 12-year-old Raina can get it, then this House can get it.

When a person does not have access to their diabetes medication, it means they risk heart attack, stroke, kidney failure, blindness and amputation. I was talking to Sarah in a diabetes clinic, who told me about patients who were reusing syringes because they could not afford them. The risk of blood-borne disease is terrible. That is not the country we should live in, so we all need to rise to this moment to say that for people with a precursor disease like diabetes, which is so indicative of whether they will have future chronic disease and illness, it is essential that we are there with medication for people.

On contraceptives, let me just give one example that illustrates the case. Oral contraceptives cost $25 a month and have a 9% failure rate. The IUD costs about $500, lasts five years and has a failure rate of 0.2%. What it means is that a person who does not have money ends up choosing the birth control option that is cheaper, which has a 9% fail rate and means they are more likely to wind up with an unwanted pregnancy or a sexually transmitted disease if they are not able to make the choices that give them autonomy over their own body and their reproductive health and future.

Therefore, it is absolutely essential, and not only for health. For example, in British Columbia, it has been demonstrated by UBC that it is saving more money with this initiative than it costs to roll it out. That is similar to what we are going to see in diabetes. This has such a powerful effect in prevention that it actually reduces costs overall.

The message it sends to women about their bodies and about their sexual and reproductive rights and autonomy is essential, which is that in this country, no matter where she is, a women will get what she needs to have control over her future and her body. That is a powerful statement, and it goes beyond just contraceptives as a drug.

As a very young person, when I was very, very young, I was exposed to sexual violence. That experience, in a family that did not talk about sex and did not have a conversation about what healthy sexual relationships were, had a devastating effect on my life, my self-esteem and my ability to stand up for myself at different moments in my life. It is difficult for somebody who does not have the information about their sexual health, who is not told that sex would never have anything to do with violence, that violence is about control and sex is about connection, that sex should always be consensual, should never be exploitive, should never involve violence and should always involve what a person wants for their body, that it should be pleasurable and it should make them feel like themselves.

As a health minister, it should not be in any way controversial for me to say those things to people. Whether a person is in a marriage or intersecting for the first time with somebody else sexually, they need to understand it is okay to be themselves and that as long as it conforms to those things, such as that sex should be pleasurable and that one should be empowered in one's body and have access to the reproductive medicines one needs to make choices about one's life, it is going to save lives, because the second-leading cause of death for young people is suicide. We lose about 500 kids every single year, and way too often it has to do with them not feeling comfortable in their own bodies. We have to end that.

In totality, looking at all of these actions, this is a new dawn for health, dealing with the crisis of now and also looking at prevention, so that we can build on what we started in the 1960s and ensure that all Canadians have access to the greatest health care system in the world.

[Mark Holland, Liberal, Minister of Health]

moved that Bill C-64, An Act respecting pharmacare, be read the second time and referred to a committee.

Mr. Speaker, it is my pleasure to rise.

I want to start by extending gratitude to the member for Vancouver Kingsway for his extraordinary work throughout this process. It was a long, hard discussion to find a place of meeting, but it is an example of what is possible when we, in this chamber, focus on getting things done and focus on working together, rather than focusing on what divides us. I think that sometimes we fundamentally misunderstand the purpose of democracy, which is to build consensus, to find points of commonality and to pull people together to find common ground; it is not to find differences or to sow division.

I also want to thank so many phenomenal colleagues on our side who have dedicated, in some cases, decades to fight for the moment when people are not forced to make a choice between the medication they need to stay healthy or the essential goods and services they need to stay alive, whether that be their rent or their food.

In the 1960s, we launched national medicare, but we forget how challenging that was. It was an incredibly turbulent period to actualize it and to bring it to reality. The dream had long existed, but to bring it to bear was extraordinarily difficult. However, at that moment in time, there were certain things left out, one of which was medicine. That was partially because, at that point in time, the number of medications available were very limited. They were typically prescribed in a hospital setting. They did not have the uses and abilities, and they were not as essential as they are today. Certainly, that dynamic has changed, and this means a new dawn for health.

I am going to talk specifically about pharmacare and the legislation therein, but before I do, I will paint a broader picture of the circumstances it faces.

Like all countries, everywhere in the world, the vast complexity of our health systems is overwhelming. We are driving down a highway at a 100 kilometres an hour, recognizing that we cannot slow down, and we have to change the engine while we are driving. Due to that difficulty, most health systems had not done the hard work of transformation, of really stepping back and looking upstream at how we deal with prevention and deal with reducing the amount of chronic disease and illness that exists within our system.

Then the pandemic hit, and in the pandemic, everywhere in the world, the strains and cracks in our health system were laid bare. Health care workers were asked to carry a burden that was impossibly large, working night and day to try to keep their communities safe, and carrying a load beyond imagining. However, in that moment, here in Canada and in a few places elsewhere in the world, we saw something I think quite remarkable happen, which was that in that chaos, there was one purpose in our system. Doctors, nurses and personal support care workers showed us the possibility of what happens when we move with one purpose, with one direction, and when we focus on people's health and nothing else. We could set aside egos, jurisdiction and turf, and we could make things happen. In an incredibly brief period of time, Canada's pandemic response was indeed one of the best in the world with one of the lowest death rates anywhere in the world. We had unbelievable support for the people working within the system and for one another for that period of time.

Then, challenges resumed. The pandemic began to recede. A war erupted in Europe. Global financial turmoil ensued. We forgot the lessons of the fruits of co-operation and of working together, and many of those divisions returned. Within our health system, we saw a workforce who had carried far too much and was dealing with burnout, yet still had the extraordinary weight of a system that needs to change. We saw, for the population, that health was a bit of a hot plate. People's experience of the pandemic was trauma, really, for everybody. It was especially so for health care workers, but nobody was saved from the traumatic experience of going through the pandemic.

I would say that it is the responsibility of not just this government, but also every government in this country to remember the incredible heroism of those who were working in the health workforce during those dark hours of the pandemic, and with that same spirit of co-operation and determination, to not focus on what divides us or what makes us different, but to focus on what can be done. That is no more important in any area than it is in health. Canadians do not care much about what political party someone is from. They do not care much about whose jurisdiction it is; they want to see results.

That is why the $200 billion that we put forward to invest in health care over the next 10 years was so critical. It required an agreement with every single province and every single territory to develop a plan to deal with the crisis of today, to tackle those issues within our health system around the workforce, the backlogs, the health data and the sharing of patient information, to deal with issues like administrative backlogs, things that are legacies that do not make sense, and to work with every province and territory, regardless of its stripe.

Whether it was Adriana LaGrange in Alberta, Adrian Dix in B.C, Michelle Thompson in Nova Scotia or Bruce Fitch in New Brunswick, and so forth, in every instance, that spirit of co-operation pervaded our negotiations. There was a profound understanding in those conversations that we have to be bigger than our partisanship and have to find commonality. As a result, we have had extraordinary agreements signed with all the provinces and territories, in a short period of time, to lay out the next number of years and to see what that health transformation will look like.

That spirit of co-operation was also seen in Charlottetown, where we were able to have an agreement on some things that are really essential: health data; looking toward interoperability and how our systems work together with a digital charter; reducing wait times for recognition of foreign credentials, taking it down to a 90-day service standard. We were also able to work later with the College of Physicians and Surgeons to take a process of credential recognition that is normally a couple of years and were able to get it down to a couple of months.

The other thing these agreements and conversations did, which I think is critically important for the future of our health system, was to establish common indicators, meaning that every province will have the same indicators for their health system, so that whether someone is a Quebecker in Quebec or a Manitoban in Manitoba, one can see how their health system is faring, not by anecdote but in data, and that can be compared against other provinces. Making sure those indicators are there is essential. It is so important that people feel that positive change, that they experience it in outcomes and that it is also measurable in data.

In our federation, as we are making changes and interventions, that ability to have data and to see how we are moving the needle is essential. What one measures, one achieves. For the first time in these health agreements, we have set these essential tools of measurement to be a key component of our health system.

We can then turn to dental care. There are some who say that this is just a boutique intervention, something that is a one-off, but it is actually part of a broader vision of health. Imagine that in this country there are nine million people today who do not have access to dental care. I want to thank my predecessor, the former minister of health, now the minister of procurement, the hon. member for Québec, for his extraordinary work to get us to this point in dental care. I want to thank the NDP and the member for Vancouver Kingsway for their work with our caucus in a common purpose to make sure that we pull together over health.

Business of the House

[Steven MacKinnon, Liberal, Leader of the Government in the House of Commons]

Mr. Speaker, I thank my good friend, with whom we have, of course, ongoing co-operation and good work.

I can assure the hon. member that we will continue today with the report stage of Bill C-50, the sustainable jobs act, despite the 20,000 automated, AI-generated robo-amendments that the Conservatives put up to obstruct this bill. We will take up third reading debate on that bill on Monday.

On Tuesday, we will commence second reading debate on Bill C-64, an act respecting pharmacare.

The budget presentation will take place later that afternoon, at 4 p.m., with the first day of debate on the budget taking place on Thursday of next week.

On Wednesday, we hope to resume debate on second reading of Bill C-61, an act respecting water, source water, drinking water, wastewater and related infrastructure on first nation lands.

Lastly, on Friday, we will resume debate on the motion in relation to the amendments made by the Senate to Bill C-29, an act to provide for the establishment of a national council for reconciliation.

I thank all members for their co-operation.

National Defence

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Mr. Speaker, I can tell the member that the Minister of Health was prepared today to deliver a very important speech on Bill C-64, on pharmacare, and members of the Conservative Party knew that.

I have introduced petition after petition on the importance of pharmacare for a number of years now. I have been advocating very strongly for it. As the House leader of the New Democratic Party has articulated, literally millions of Canadians are going to benefit from a national pharmacare program, and this is just another piece of legislation the Conservatives want to play games with. They have no intention of making life easier for Canadians. Their sole focus is on developing bumper stickers for the next election, which is very sad to see.

Pharmacare

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Speaker, federal pharmacare is not necessarily just around the corner.

Bill C-64 talks about a principle “to consider when working towards the implementation of national universal pharmacare”. In other words, it is basically just another election promise. Frankly, the NDP got bought off cheap.

If, after discussing a principle to consider when when working towards implementation, Ottawa actually were to someday end up with pharmacare, which Quebec already has, will Quebec be able to opt out with full compensation?

Pharmacare Act

[Mark Holland, Liberal, Minister of Health]

moved for leave to introduce Bill C-64, An Act respecting pharmacare.

(Motions deemed adopted, bill read the first time and printed)