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.

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second reading for Bill C-64, an act respecting pharmacare, in the name of the MP for Cumberland—Colchester, be deemed withdrawn, and (b) Bill C-64, an act respecting pharmacare, be deemed read a second time and referred to the Standing Committee on Health.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?