Bill C-213 (Historical)

Canada Pharmacare Act

An Act to enact the Canada Pharmacare Act

This enactment enacts the Canada Pharmacare Act, which establishes criteria and conditions in respect of drug insurance plans established under the law of a province that must be met before a cash contribution may be made.

Royal Recommendation for Bill C-237

[Louis Plamondon, Bloc, Bécancour—Nicolet—Saurel, QC]

Madam Speaker, I appreciate your intervention.

Only the specific conditions of the Canada Health Act are affected. The Speaker has ruled on many occasions that playing within these standards does not generate or reallocate an expenditure and therefore does not require a royal recommendation.

In the 27 years since the start of the 35th Parliament, when bills began to be tracked in the LEGISinfo parliamentary module, no fewer than 31 private members' bills have proposed amendments to the Canada Health Act.

All of them added new conditions. Some required the province to develop new services in order to receive the Canada health transfer. Others imposed requirements on how health services had to be delivered in order to receive the transfer. Others prohibited access to the Canada health transfer for provinces that provide certain free services, in this case abortion. I will let the members guess which party recommended that.

The Chair did not require a royal recommendation for any of these bills, not one. Of course, not all of them were on the order of precedence, so the Chair did not have to rule on many of them. However, in some cases, the Chair did have to do so.

Take Bill C‑282, introduced during the 36th Parliament by the Liberal member for Ottawa—Vanier, the late Mauril Bélanger, a great defender of the rights of Franco-Ontarians. He introduced the bill in response to the crisis surrounding the Montfort Hospital, a francophone hospital in Ottawa that the Ontario government had tried to close.

The bill introduced a new condition in the Canada Health Act to set new language requirements for French-language services in the provinces and English-language services in Quebec. If the province did not meet these conditions, the minister could cut the transfer. The bill was placed on the order of precedence without the Chair indicating that it required a royal recommendation. It was subsequently debated.

If members consult the March 19, 2003, Hansard, they will see that the Parliamentary Secretary to the Minister of Health spoke on behalf of the Crown in the debate. He never made any mention of a royal recommendation. On the contrary, he asked members to refer the bill to the Standing Committee on Official Languages before second reading because “The federal government cannot and must not act unilaterally in a shared provincial jurisdiction. Any decision to broaden the scope of the Canada Health Act requires extensive consultations with the provinces”. In short, he asked the House not to pass the bill, even while recognizing that it had the right to do so.

I will give another example, that of Bill C-213, an act to enact the Canada pharmacare act, which was introduced by the member for New Westminster—Burnaby and voted on by the House at second reading on February 24, 2021. This bill basically creates a new transfer.

According to clause 4 of this bill, “The purpose of this Act is to establish criteria and conditions that must be met before a cash contribution may be made in respect of public drug insurance plans.” After setting out the specific conditions, the bill indicates that the minister “may” make a transfer to the provinces to fund a provincial drug program.

It is important to note that the bill does not set out a specific amount. I understand that it was specifically written that way so as to not generate any new spending and therefore not require royal recommendation. It worked. Even though the bill created a new transfer, even though it set out specific goals and conditions, it did not require royal recommendation because it did not generate any new spending.

If we apply the same logic to Bill C-237, we can come to only one conclusion. This bill does not require a royal recommendation.

Pharmacare

[Heather McPherson, NDP, Edmonton Strathcona, AB]

Madam Speaker, I asked a question some time ago and today, on Lou Gehrig Day, I want to share my discontent with the answer I received.

I owe my life to our public health care system. I simply would not be here today without it, so, like most Canadians, I cherish our public health care system. It is a system that is based on the principle of “access to health services without financial or other barriers”. However, our system has massive holes in it, holes that belie the principle, holes that force Canadians to choose between their health and their other basic needs.

It is time to fix the holes in our health care system. It is time to live up to the promise of access without financial barriers. It is time for a national pharmacare program so no Canadian should have to face the impossible choice between paying for groceries and filling a prescription, and yet that is exactly what happens for one in five families in Canada.

In my riding of Edmonton Strathcona, I listened to a woman describe cutting her pills in half, hoping for relief while hanging on to the few remaining pills she has left until the end of the month. One senior told me how she is sharing her medication with her husband, two trying to get by on the medicine for one. A young man in my riding urged me to get pharmacare passed, not because he needed prescription drug coverage for his own family, but because his daughter's friend was going without her medication due to cost. Too many Canadians know exactly what I am talking about, and when COVID-19 hit, even more became aware. Millions of Canadians who lost their employment also lost their prescription drug coverage, at least temporarily. They suddenly got a glimpse of what their neighbours experience on a daily basis. Our eyes are open. We know now how vulnerable we really are.

Canadians have been waiting nearly 60 years to get prescription medications included in our health care system. Twenty-three years ago, the Liberals first promised Canadians a national pharmacare program, and they have been repeating that promise ever since. We have had five public commissions on pharmacare, study after study, including the Liberals' own Hoskins report in 2019, all saying the same thing: Canadians need pharmacare and pharmacare will save Canadians money. I do not know what is more disappointing, 23 years of broken promises or the stubborn refusal to even acknowledge the reality of so many Canadians.

The Conservatives' position on pharmacare is one of the most cynical things I have ever heard. The Conservatives have said in this House that 98% of Canadians already have access to prescription drug coverage, so we do not need pharmacare, but what they are really saying is that 2% of Canadians live with pre-existing conditions that make them uninsurable, and everyone else who does not have a drug plan should just go out and buy one from a private insurance company. I have news for the Conservatives. The seven million Canadians who cannot afford to pay for their medications cannot afford to pay for private insurance either. Telling these Canadians that they have access to medications is a slap in the face. I mean, we all have access to a Lamborghini, right?

The cynical nonsense has to stop. In February, this House debated Bill C-213, sponsored by the NDP member for New Westminster—Burnaby, which would have created a national pharmacare act. In a survey conducted by the Angus Reid Institute, nearly nine in 10 Canadians support a national pharmacare program. Only big pharma and the insurance industry are opposed, and yet the government joined with the Conservatives to vote this bill down.

Canadians are done with excuses. The time is up. Canadians want and deserve a national universal pharmacare plan now.

Budget Implementation Act, 2021, No. 1

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Mr. Speaker, I appreciated the member mentioning child care in his speech. Child care has always been very important to me and to the constituents of Cowichan—Malahat—Langford. It is something I strongly campaigned on back in 2015.

My question is about the Liberal standard with respect to negotiating with the provinces. In Bill C-30, under division 34, we see that a legislative framework has been set up to get the early learning and child care system put into place, yet when the NDP came forward with a similar legislative framework in a version of Bill C-213 to set up pharmacare, the Liberals voted against it. Why was that?

Second, when can constituents in my riding and across Canada expect to see action on pharmacare, so that working families are no longer suffering under the huge burden of costs associated with unexpected pharmaceutical medications?

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Madam Speaker, it is great to see the Liberals supporting child care in this budget. It is something I ran on quite proudly back in 2015, and I agree with her that it would make a huge difference.

My question is regarding the Liberal standard for engaging with the provinces on these sorts of initiatives. This budget implementation act is setting up the legislative framework for the minister to engage with the provinces to get child care up and running.

However, when it came to Bill C-213, which was NDP legislation to set up a legislative framework for establishing a national pharmacare system, the Liberals voted against it. It seems as though the goal posts are shifting. Could the member clarify for the House what the Liberal standard is for engaging with provinces when trying to build up these national programs?

Finance

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Madam Speaker, I have to shake my head at the most recent intervention by the member for Kingston and the Islands complaining about the NDP when he conveniently forgets the fact that the Liberals had majority governments in 1993, 1997 and 2000. Why did they not use that time to get child care done?

The member for New Westminster—Burnaby has been in the House for a while and has been witness to things that would give a lot of people cynicism in politics. He saw Jack Layton's climate change bill killed in the Senate. He saw his most recent bill, Bill C-213, voted down by the Liberals who profess to have an interest in pharmacare.

When it comes to things such as tackling climate change, health care and poverty, our approach has always been that those investments are really important at the front end. They might seem costly, but they will have measurable impacts on people's lives at the back end. Those investments and dollars can have real, tangible results for people.

The member touched on some of those aspects in his speech, but could he expand a little more on how these investments are so important to addressing the very real and evident gaps that so many people in all of our ridings are facing daily?

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

Thanks very much, Mr. Chair.

I'd like to turn to Mr. Yussuff for a question.

I'd like to thank you for being such a strong advocate for public universal pharmacare. As well as the Canadian Labour Congress, we've had labour activists across the country who have really been fighting for public universal pharmacare. Particularly with this pandemic and the number of people who've lost their jobs, we're seeing an increasing number of people who have no medication plan at all. That's why the Canada pharmacare act that was brought forward in February—and endorsed by the CLC, as you know—was so important. Government voted that down. That would have structured pharmacare on the same basis as our universal health care.

The Hoskins report called for funding this year to negotiate with the provinces to set things in motion. There was no new funding available for pharmacare at all in this budget. Many people are saying that this is abandoning pharmacare and that pharmacare and child care could have been discussed and negotiated with the provinces together.

Could you outline the importance of having public universal pharmacare for workers and for the millions of Canadians who have no medication plan and who struggle to pay for their medication, particularly in a pandemic?

Financial Statement of Minister of Finance

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Mr. Speaker, I just got a phone call from the 1997 Liberal election platform, and it is still wondering when its pharmacare promise will come to be. I had to go all the way to page 238 to see only a half-page reference to a universal national pharmacare system.

How much longer will Canadians have to wait? The Liberals had an opportunity with their vote on Bill C-213 to set up a framework modelled on the Canada Health Act, but cynically voted against that opportunity. I am wondering how many more years Canadians will have to vote for this critical part of our health care system for it to be finally established.

Opposition Motion—Long-Term Care

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Mr. Speaker, I very much appreciate having this opportunity to participate in today's debate on behalf of the good people of Cowichan—Malahat—Langford. I have been listening to the debate throughout the day. It has certainly been, at times, very frustrating to listen to. We have taken this opportunity to identify a clear problem. We know the solutions that are out there, but we still seem plagued by the government's inertia to actually step up and do the right thing.

I want to start by expressing one very key point, which is that our parents and grandparents built this country. Whether they were born here or they immigrated here, this country is the way it is today, with all of its strengths, because of the work they put in. As they age, they deserve to live in comfort, dignity and safety. However, because of decades of cuts, underfunding and privatization, our continuing care system, our long-term care homes system, is broken.

This pandemic has very much revealed so many shortcomings in our society. It has shown the precariousness of work. It has shown where the gaps are in our social safety net. It has shown how vulnerable workers, those with the most to lose, are often at the front lines of the pandemic. They have most often been the ones at risk of both contracting COVID-19 and of bringing it home and spreading it to their loved ones. We really need to take a hard look at ourselves as a country and make some notes of what went wrong, and most important, how we can improve.

We have seen the cost of government inaction and neglect. We have seen the devastating loss of loved ones in long-term care centres across the country. In fact, it was so devastating that we actually had to send in the army to help out. The reports that emerged from those interventions were absolutely shocking. We had army medical staff finding residents who were dehydrated, who were starving, and who were left lying in their own feces and urine. There were residents who had fallen on the floor and could not get up, and some who had passed away in their beds with no one noticing. We have utterly failed to protect long-term care residents and workers through this pandemic, and it is absolutely a national disgrace. We owe our seniors so much more.

Today, New Democrats are using our one opposition day in this supply cycle to highlight the sorry state of our long-term care system and the fact that 82% of COVID deaths in Canada happened in long-term care, the highest proportion in the OECD. There have been over 12,000 long-term care resident and worker deaths in Canada since the beginning of the pandemic.

By acknowledging these incontrovertible facts, we are calling on the House today to take action. This is an opinion of the House. The House is calling on the government to take action. We want to see the transition of all for-profit models to non-profit models by the year 2030. We want to see our federal government working with the provinces and territories to stop licensing any new for-profit care facilities. We want to make sure that measures are in place to keep all existing beds open during that transition. We also want to see an additional $5 billion invested over the next four years in long-term care, and we want that funding tied to the principles of the Canada Health Act. We want to boost the number of not-for-profit homes.

There is a very clear precedent in what we are trying to do. In fact, our public health care system is based on this type of federal leadership. When we look at the for-profit model, unfortunately the facts are there for everyone to see. It is impossible for us to argue with them. This has been documented in the news. We have heard the harrowing stories of families who have had to deal with the loss of a loved one in a long-term care facilities, of the grandparents whom grandchildren are no longer going to see, and of the entirely avoidable deaths.

For-profit homes have seen, tragically, worse results than other homes. They have had far more deadlier COVID outbreaks. At the same time, we see these big, for-profit operators getting public subsidies, like the Canada emergency wage subsidy, though I acknowledge it is an important measure in this pandemic and has helped many workers keep their jobs. However, when we have a large corporation taking the wage subsidy while paying out dividends to its shareholders and also experiencing this loss of life, that, to me, goes against the spirit of the COVID interventions that our federal government is providing. It is a part of this national disgrace, and we need to have a full reckoning of how that money was spent.

Research has shown that the homes run on a for-profit basis tend to have lower staffing levels, more verified complaints, more transfers of residents to hospitals as well as higher rates for both ulcers and morbidity. This is the fundamental problem here, because when we come to this relationship between profit and care, I think that care is always going to lose out, because shareholders need their dividends, executives need their pay increases and stocks need to climb in value. When it comes to making a profit, it is a fact that private enterprises are going to be managing these facilities with an eye for what they call “efficiencies”. These efficiencies are usually found with the chronic understaffing, low worker pay, reduced investments in equipment and so on. When it comes to profit and to care, I am sorry, but those two concepts do not belong in the same sentence together. I believe that national standards could include basic references to the standards of care that we want to see in our facilities, including in employee health and well-being and pay.

I have been listening to today's debate, and I hear my Liberal colleagues repeatedly falling over themselves to find a reason to vote against the motion. What they often bring up is provincial jurisdiction. We all acknowledge provincial jurisdiction in the delivery of health care services, but there are ways to show federal leadership.

I believe that the Liberals' motto these days when it comes to bold, innovative leadership on the health care file is: Why go all the way when we can go only go half the way? We saw that with their vote against Bill C-213, brought in by the member for New Westminster—Burnaby, on something that was based on their own report and that would follow the principles of the Canada Health Act. We have another proposal to bring forward on national dental care. Here we are using our opposition day motion to propose some basic standards for long-term care homes in the for-profit model.

When we look at the Canada Health Act, it very clearly recognizes provincial jurisdiction, but it puts in place basic principles for provinces to comply with if they want those federal transfer funds, and we are proposing something similar for long-term care. We already have the principle of public administration, comprehensiveness, universality, portability and accessibility, and no one argues about those principles anymore. They are an enshrined part of our health care system, fully recognizing the provincial jurisdiction over health care delivery, but also recognizing that the federal government can play a leadership role with its power of the purse. I remain disappointed in my Liberal colleagues for finding yet another way to vote against a bold proposal when it comes to health care, because health care is top of mind for so many Canadians today, whether it is pharmacare, dental care or serious reform of our long-term care system.

I will conclude by saying that families really want to know that their loved ones are getting the best possible care. If we poll Canadians, we will see an overwhelming majority of Canadians in favour of bringing long-term care facilities under the jurisdiction of the Canada Health Act. An overwhelming number of Canadians want to see government investments to rebuild health care and other public services that were previously cut. We have promise Canadians that our seniors are going to have safe and dignified care, and that families will know that their loved ones will have the care they deserve with proper standards in place.

I appreciate the opportunity to have taken part in today's debate, and I welcome any questions.

Pharmacare

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Madam Speaker, COVID-19 has put enormous strain on the budgets of families. With jobs lost or hours reduced, many have seen their health benefits cut or eliminated altogether. Every month, Canadians are making tough choices between paying for medication, rent, utilities and groceries.

The Liberals first made their pharmacare promise 24 years ago, but two days ago they cynically voted against Bill C-213, which would have established a national pharmacare framework modelled on the Canada Health Act.

Why do the Liberals consistently raise the hopes of working families, only to crush them when the time comes to act?

Canada Pharmacare Act

[The Speaker, Liberal, Anthony Rota]

It being 3:38 p.m., pursuant to an order made on Monday, January 25, 2021, the House will now proceed to the taking of the deferred recorded division on the motion at second reading stage of Bill C-213 under Private Members' Business.

Call in the members.

The House resumed from February 17 consideration of the motion that Bill C-213, An Act to enact the Canada Pharmacare Act, be read the second time and referred to a committee.

Pharmacare

[Jagmeet Singh, NDP, Burnaby South, BC]

Mr. Speaker, today the Prime Minister has a choice. Will he stand on the side of people who cannot afford the medication they need and desperately need help, or will he stand on the side of big pharma, which does not want to see medication coverage for all?

The Liberal government's own report states that the Canada pharmacare act is one of the key steps in establishing medication coverage for all. That is exactly what our New Democratic bill would do.

Will the Prime Minister be voting in favour of our bill to bring in medication coverage for all Canadians, yes or no?

Canada Pharmacare Act

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

Mr. Speaker, it is rare that we have an opportunity in the House of Commons to make a difference in the lives of so many of our constituents. As we well know, over 90% of Canadians support the idea of putting in place public, universal pharmacare. Over 90% means that in every single riding across the country, the vast majority of Canadians support public, universal pharmacare.

When Canadians are asked what they are proudest of among our institutions, it is our universal health care system. Of course, the Canada pharmacare act would put in place the same principles around pharmacare that we already have in place around universal health care.

Any member of Parliament who consults with his or her constituents will get the same reply. Canadians want to see this. Particularly with the pandemic and the devastating impacts that we have seen both on the health and the financial well-being of so many Canadians, it is absolutely essential that we move forward and put in place public, universal pharmacare, which Canadians are asking for and desperately need.

We have been at this debate for a few months. Tens of thousands of Canadians have participated. They have participated by emailing their member of Parliament, by phoning their member of Parliament and by telling their member of Parliament to vote yes on Bill C-213.

During this debate, we have seen a number of facts come to light. We were made aware, through this debate, that millions of Canadians have no access to a drug plan. They have to struggle to pay for the medication their doctor has prescribed for their health and well-being. We have also learned that hundreds of Canadians die each year right across the country because they cannot afford to pay for their medication. Through this debate, we have also learned that for 60 years Canadians have been waiting to have the public, universal pharmacare they so desperately need.

The Hoskins report points out very clearly what the road map is, which is that we have to lay the foundation by ensuring we have the same principles around public, universal pharmacare that we already have around our public, universal health care system.

It would be dangerous to say no to this bill, because that would reject public, universal pharmacare. It would reject the expansion of our public health care system that Canadians are looking for, and it would reject the advisory council's Hoskins report. It would mean that there is no foundation to build the public, universal pharmacare that Canadians so desperately need.

During these debates we also learned that many people in Quebec are calling for a universal pharmacare program. Currently, many Quebeckers are not covered, and that is why the major unions are calling for this type of public, universal program. More than 40 or so municipalities in Quebec are calling on MPs to vote in favour of Bill C-213. There is widespread support.

We have also learned that dozens of organizations with millions of members are asking all members of Parliament to vote yes on Bill C-213. We have doctors and nurses right across the country who are saying that it is absolutely vital for Canadians' health and well-being. We must listen to those voices.

I mentioned earlier this is a historic moment. It is one of those moments that determine the strength members of Parliament have in consulting with their constituents, and we need to think of our constituents at this key decision point in our history.

I am thinking of Cole and his family. He is a constituent in high school whose family struggles with $1,000 a month in drug costs. Those drug costs, that medication, keeps the father of the family alive. That family struggles and every day has to decide how they can pay for that medication and whether they can also put food on the table and a roof over their heads.

Around kitchen tables right across the country, there are millions of Canadian families who are in the same situation. I ask members of Parliament to think of their constituents, more than 90% of whom who support this bill. If members of Parliament do that, I have no doubt they will vote yes next week on Bill C-213, the proposed Canada pharmacare act.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

Mr. Speaker, I am delighted to speak in support of Bill C-213, sponsored by the member for New Westminster—Burnaby.

This bill is historic. It is a bill that would give us the potential to make history by finally getting pharmacare to Canadians who so desperately want it.

We have heard today that approximately one out of every five families in Canada struggles to pay for prescription medications, and we know that the claim that all Canadians have access to medication just is not true. It is not accurate. These are not statistics. These are real families.

Before COVID-19, when I was able to knock on doors and talk to constituents in person, access to prescription medicine was the number one issue I would hear from people. I remember talking to a man who struggled to speak as he was caught up with emotion. He talked to me about skipping days taking his blood pressure medication, hoping that he would get by: that he would make it and would not die. I spoke to a senior in my own neighbourhood who was sharing a prescription with her husband, because they could not afford both. I will never forget talking to one young father who implored me to get pharmacare passed. It was not because his family needed it. His family was doing quite well, but he knew families at his daughter's child care centre who did not have access, and he wanted to make sure that those children were taken care of. This was all before the pandemic, and before things got worse.

There is no doubt that COVID-19 has made Canadians' ability to access medication so much worse. Millions of Canadians who lost their employment due to COVID-19 also lost their prescription drug coverage. People who could count on their health plans before COVID no longer could.

In Alberta, when we were entering the pandemic about a year ago, our provincial Conservative government cut drug benefits for seniors, spouses and dependants so 46,000 people, mainly with ongoing health issues, including dependants living with disabilities, were suddenly without coverage. I find it shocking that the member of Parliament for Calgary Shepard can speak of Minister Shandro as being compassionate, when 46,000 Albertans lost their drug coverage. Many Canadians were facing the stark reality that our medicare system was not going to be able to keep them healthy. This pandemic has opened their eyes, and COVID-19 has shown us just how vulnerable we are.

Canadians have been waiting for this. Canadians have been waiting for nearly 60 years to get prescription medications included in our health care system. Twenty-three years ago, the Liberals first promised Canadians a national pharmacare program, and they have been repeating that promise ever since. We have had five public commissions on pharmacare, and study after study. If the member for Calgary Shepard does not want to believe the PBO report, perhaps he will believe the Hoskins report. All of these reports said the same thing: Canadians need pharmacare, and pharmacare will save Canadians money. However, here we are.

As Canadians face an unprecedented health crisis with COVID-19, there is another health crisis that we can and need to fix right now. Millions of Canadians are without access to medication, and we can fix that with Bill C-213. We need to vote yes to Bill C-213.

We have an obligation to learn from COVID-19 as well. We have a duty to Canadians to create a better Canada that will be more resilient to the crises of the future, including the next pandemic. We must build systems that protect all Canadians, not just some Canadians and not just Canadians who can afford it. When everyone has access to the medication they need, they are healthier and the burden on our health care system is lessened. It is really that simple.

The government has floated the idea of partial pharmacare that is not universal. That is not what Canadians want. Canadians want a simple program that includes everyone. Canadians want to go to the pharmacy and pick up their medications. That is the system we want, and that is the system we need: a national universal system protected against people like Jason Kenney who are determined to undermine it, and a system that will actually save Canadians billions of dollars.

There is something else vitally important that we have learned from COVID-19: Canada has the capacity to do this. We saw how fast Canada moved when the pandemic was declared.

The cost to enact pharmacare is pennies on the dollar compared to the savings. Pharmacare will save families on average more than $500 a year, whether they are insured or not, and employers and small businesses will save $600 a year per job. Pharmacare will reduce emergency wait times and free up more hospital beds for those who need them. It will save the government billions.

I urge this House to follow the recommendations of the Hoskins report and apply them by supporting this bill. The Hoskins report recommends that the federal government enshrine the principles and national standards of pharmacare in federal legislation separate and distinct from the Canada Health Act. The Hoskins report also recommends that the five fundamental principles of medicare embodied in the Canada Health Act also be enshrined in federal pharmacare legislation. Those principles are universality, comprehensiveness, accessibility, portability and public administration. The Hoskins report also proposes that this legislation come into force no later than January 1, 2022.

Now is the time. Now is the time we can do this. As parliamentarians, this is something we can give to Canadians right now, at a time when they need it more than ever. Today is the day to support pharmacare for all. I implore my colleagues within the House to vote yes on Bill C-213.

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Mr. Speaker, the most difficult medication to buy is the one that is not available in Canada. It is the one someone finds out about after going to their doctor and being told that it is in the United States, and if they were an American citizen, they could get access to it. However, since they are a Canadian, they cannot. That is the news that too often happens to patients with rare diseases and to their families. My family is one of those families. The families dealing with cystic fibrosis, with SMA and with cystinosis are other ones. The list goes on and on.

Bill C-213 is a solution looking to address the wrong problem. The problem is access, and access is what I want to talk about this evening.

I have gone through the speech by the member for New Westminster—Burnaby. My colleagues from Calgary Nose Hill and Sarnia—Lambton went over a lot of territory in pointing out what is wrong with this particular piece of legislation.

The legislation is trying to address the wrong problem. I want to demonstrate that by sharing some of the issues I have with what the member for New Westminster—Burnaby said and address them piece by piece to demonstrate why this is the wrong bill.

It does not achieve any goals. The goal should be to provide access to patients in Canada through greater choice in drugs, drugs that will actually ensure they get over their condition or that will provide a therapy that reduces their symptoms, instead of looking at their American counterparts, citizens of America. Some of them are dual citizens, and they, for example, can have access to that medication when they go to the United States, but they cannot access it here in Canada unless they are one of the very few who have a special access program for it.

One of the NDP members mentioned that currently in Canada we have a patchwork of provincial systems. We know that in Canada, 90% to 98% of Canadians have access to some type of either private or public insurance. In fact, nearly all the provinces have a public insurer. In Alberta, it is the Alberta Blue Cross that people can get access to.

Two provinces that I am aware of have already said they will not participate in national pharmacare. In November of 2019, Alberta finance minister Travis Toews sent a letter to the federal government indicating that the provincial government, the Government of Alberta, would not participate in national pharmacare. It will want an opt-out. Members for the Bloc have said that their provincial government will not participate either. What will happen? We will have a patchwork system again. Again, because this bill does not consult with anybody or ask the provinces what they are thinking or recognize that it is in the jurisdiction of provinces, it does not achieve any of the goals.

Speaking of access, the Ontario government, the previous government, took a bunch of people and put them onto OHIP+. It transferred 2.1 million Ontarians who already had private plans onto a public plan at a higher cost, a plan that provided worse coverage than what they had before. I had many people explain their particular situation. They liked their private plan.

When a survey is done to ask people if they like the private plan they are on or the public plan they are on, most Canadians, by a wide majority, say that they do like the plan they are on. I agree that there are people who have difficulty paying for some of the copayments, but this bill does not address that. This bill proposes to centralize everything in Ottawa and then figure it out later.

I have come to believe, after five and a half years here in Ottawa, that when someone says they will figure it out later, it usually will cause harm to Canadians in the long term, especially if they are one of those one in 12 Canadians dealing with a rare disease. Many people have someone in their life who has a rare disease. I have three children with a rare disease. I had a daughter pass away from a different rare disease three years ago.

The problem in Canada, as I said, is being made worse by federal government action through the PMPRB. This problem will not be addressed through anything in this particular piece of legislation. This measure is coming forward because of a false belief that it could somehow artificially reduce the price of medication coming into the market in Canada.

There is a PBO estimate that has been provided and repeated now by several members that the total spent on public health care will be reduced by $4 billion to $4.5 billion. They call it the universal discount. Actually, if we look at the data in the PBO report, 25% is completely random. This is one of the rare times when I disagree with the methodology used by the PBO. This 25% discount is already happening through the pCPA, the pan-Canadian Pharmaceutical Alliance, which is used by the provinces to negotiate with manufacturers. They are basically assuming an extra 25% discount “just because”. I do not think that is the way statistics should be done and I disagree with the analysis.

In fact, one of the members on the NDP side then went on to quote New Zealand as a good example of how it had been able to reduce drug costs. What people in New Zealand do not want to have is a rare disease. There is very little access to rare disease medication or the latest and greatest most innovative drugs to address their condition. There are countless examples online of New Zealand citizens fleeing to other countries to obtain access to medication. New Zealand is the worst example anywhere in the world if people have a rare disease.

There is a Yiddish saying, “He who runs away from fire, falls into the water” and that is what is happening here. There is a problem and the solution that is being called upon is a centralization of all the plans in Canada to wipe out the architecture, the jobs, the system that many Canadians rely on and generally like. It is not perfect; there are issues with it. We are running into a system, we are going to fall into the water and drown. Things would be made worse by the changes being proposed.

On the issue of PMPRB's costing, for example, we often talk about rare disease drug costs and how it puts a huge dent in provincial budgets. If we look at non-oncology drugs, 70% of what the PMPRB says is for rare disease medication is actually being used for secondary uses. Therefore, if people have a rare disease and there is a drug for, it is given by a doctor and it is used, but then there has to be a second, third or fourth usage. The medical system says that it can be used for those other purposes. That is being included in the final statistics. It is wrong to say that rare disease patients will cost the system more when in fact different types of medication are also used for other purposes or uses.

According to the annual report of the PMPRB, the changes in the cost is 2.5% to 2.6%. I will credit the Canadian Forum for Rare Disease Innovators for these statistics and these points. It is very compelling evidence that the costs for rare diseases are not caused by rare disease patients. In fact, it is other uses for the same innovative medicine that is coming to Canada. To reiterate my point, the hardest medication to purchase in Canada is that which is not available in Canada.

I want to take a moment to credit and thank Alberta Minister of Health, Tyler Shandro, for his January 17 interim agreement for Zolgensma, which is a groundbreaking, innovative medication for children with SMA type 1 spinal muscular atrophy, one of the most dangerous conditions that will kill children if they do not get access to a type of medication. This is the same minister who compassionately approved and ensured there was access in Alberta quickly for Spinraza, three weeks after he was named minister. I told him I would hound him until he made it happen. To his credit, he did, and compassionately years later he ensured there was access to Zolgensma for children under age 18 in Alberta. I do not believe a national pharmacare minister like that could act as quickly as a provincial minister could acct when he feels the pressure from constituents, residents and elected officials.

We have Cystinosis, examples of cystic fibrosis, and Trikafta and Orkambi. There is groundbreaking medication out there being made available to people living in other countries that is not available here. The bill would not fix any of those issues. There are other solutions to fill the gaps in place and I would love to discuss those solutions and look for ways to improve the system in different matters.

The member for Calgary Nose Hill brought up a few of them, so I will reiterate them. Common drugs are classified in different countries as over the counter. Australia does an amazing job of this as does the United Kingdom. We can look at what the public health spends on certain medications and maybe find a lower dose that could be available over the counter. Some antibiotics come to mind. Some estimates suggest that just three of those drugs could save $1 billion a year on drug spending.

There are other things we could do to reduce the bureaucracy in the system. Too many Canadians are trapped between the CADTH approval and the pCPA reimbursement agreement.

What I care most about is access for patients with rare diseases. Bill C-213 does not achieve any of those goals. I cannot support it.