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.

Second reading

[Mario Simard, Bloc, Jonquière, QC]

Madam Speaker, it is rather remarkable when you think of it. When the parliamentary secretary was asked whether he acknowledged that the federal government had a role to play in health, he said yes. In the same sentence, he said that its role was not limited to transfers of funds. However, the federal government does not manage any hospitals or any doctors. It wants to have a role in health but has no health-related expertise.

In the beginning, the health system was a 50-50 proposition. For every dollar invested in health, 50¢ was provided by the federal government and 50¢ by the provincial government. Today, the federal government provides barely 22¢. If the federal government was serious, it would invest more in health care than it offered, and it would address the criticisms of the Parliamentary Budget Officer and the Conference Board, who have stated that provincial finances will eventually become unsustainable because of skyrocketing health costs.

That is your role. It is not your role to meddle in jurisdictions that are not yours.

[The Assistant Deputy Speaker, NDP, Carol Hughes]

I would remind the member to address his comments through the Chair.

Questions and comments, the hon. member for North Island—Powell River.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Madam Speaker, this is a place of debate. We are looking at complex issues and trying to find solutions that would better the reality of Canadians across the country. I believe and understand that bulk buying would allow the cost of medications to go down a lot.

Is there a way the member could envision a respectful process that really looks at us buying collectively, as a country, to see those costs go down, while also honouring the provincial distinctions?

[Mario Simard, Bloc, Jonquière, QC]

Madam Speaker, if we want a robust system, then the simplest thing to do would be for the federal government to stay out of what is happening in Quebec, which is in negotiations with the large pharmaceutical companies.

What the federal government managed to do was to negotiate prices that are worse than what Quebec already had. That is one sign that the federal government does more harm than good when it interferes in areas that are not under its jurisdiction and puts together a poorly thought-out piecemeal program to score election points. That is what is happening here.

If the federal government wants to implement this program, then it needs to come to an agreement with the provinces first. That will help the government to avoid many pitfalls, to avoid wasting public money for absolutely nothing and to respect provincial jurisdictions, which is what we are asking it to do.

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

Madam Speaker, in his arrogant comments that I must say were also ignorant, the member for Winnipeg North said that Ottawa supposedly has powers over health care. He cited the Canada Health Act, which is a manifestation of the federal government's spending power, which Ottawa, which has more revenue than it needs for its own responsibilities, is using to give itself the right to impose conditions on Quebec in Quebec's own jurisdictions.

I would like my colleague to explain whether this is a manifestation of the fact that Ottawa takes in more revenue than it needs to deal with its own responsibilities. I would also like him to tell me, once and for all, why this justifies Quebec having a right to opt out with full financial compensation for programs under Quebec's jurisdiction.

[Mario Simard, Bloc, Jonquière, QC]

Madam Speaker, what a valid and interesting question. My colleague is absolutely right. The Séguin report demonstrated that best. Mr. Séguin, who was Quebec's finance minister, was not a sovereignist, but a federalist. In his report, he clearly demonstrated that the federal government's revenues are much higher and that its expenses are smaller, which means it is constantly putting pressure on the provinces. In the next few years, when there is a Conservative government, we are going to see transfer payments reduced, and it is the provinces that are going to be blamed. Such is the Canadian federation.

[Yves Perron, Bloc, Berthier—Maskinongé, QC]

Madam Speaker, I commend my hard-working colleague from Jonquière on his brilliant speech. My friend is always a hard act to follow.

I wanted to begin my speech by talking about the Quebec National Assembly motion, but my colleague just read it, so I will not repeat it. I will simply add a little to the speech by my colleague from Jonquière, who rightly mentioned that a unanimous motion in the Quebec National Assembly means that all the political parties adopted it. It was not just the separatists, as the parliamentary secretary opposite claims. It was adopted by all the MNAs from across Quebec, including the members of the Liberal Party—the sister party to the federal Liberals—the members of Québec Solidaire, who have a lot in common with the NDP, and of course the members of the Parti Québécois, who have more in common with us. There are no Conservatives in Quebec, because Quebeckers do not vote Conservative, which is not bad news in and of itself. It is important to understand that all the political parties in the Quebec National Assembly asked for the right to opt out with full compensation. Based on that, it seems to me that the next step is simple.

I am somewhat disappointed with the answer that my NDP colleague gave earlier. I admitted quite candidly that I find it difficult to work with the New Democrats. On the substance, our values often closely align in that we want to take care of people and we are progressive-minded. It is on the form, the “who needs to do what”, that they differ quite significantly. The New Democrats want to trample on the jurisdictions of the provinces and Quebec and tell them what to do. When I talk about that, I am told that members of the Bloc Québécois should want Canadians to have pharmacare. Of course we want Canadians to have pharmacare. I want to make an important clarification. The Bloc Québécois is not here to hurt the rest of Canada. We are here to defend the interests of Quebec. If we can help the rest of Canada, then all the better.

We are not opposed to that. All we are saying is that, in the fine system the government wants to put in place, we want our fair share of the money. We are glad this is happening. It is long overdue. Once again, in terms of social programs, Ottawa is way behind Quebec. Quebec has had a similar program for 18 years. We are glad the rest of Canada wants pharmacare. Go ahead. All we are asking is that Quebec be given the money it is entitled to, because we already have a plan that works well. It is not perfect, but it works well. There is not a Quebecker today who does not have pharmacare. It is important to point that out. Quebec is ahead of the curve in this area, as it is in day care and plenty of other areas. I will make a list for my colleagues a little later. The point is that we do not need the federal government for those things.

That highlights, in big fluorescent letters, the Canadian problem with the fiscal imbalance. It highlights how toxic federalism is for the Quebec nation. The federation claimed that we should form an alliance and work together for the common good by establishing jurisdictions for the provinces and Quebec in order to respect the regional disparities and priorities of each province and territory, since priorities cannot be the same in Alberta and Quebec. The people of Alberta might make different choices when it comes to pharmacare and health care. That might happen and that is fine. They can do what they want. As long as they are getting the money from the taxes that they paid, then they are entitled to their own services. They can make their own choices.

Quebeckers have already made that choice. The government seems to be acting out of contempt, ignorance or snobbery. I am not sure which term to use. I think contempt is the most appropriate. We know that Quebeckers have been doing that for a long time, but since the government is under no obligation this time, it is going to go over our heads. It is going to steamroll over us. It will absorb our system and replace it with the great big Canadian system. An exception was allowed for child care, however. I would like the parliamentary secretary to talk to me about child care. How are things going with day cares? Are Canada's day cares in trouble because Quebec got the right to opt out with full compensation? I do not think so. Things are just better in Quebec's day care centres because we have a little more money now than before. That is all we want. We are not out to hurt anyone.

That being said, the legislation sets out some fine principles. It says it will respect the principles of the Canada Health Act. This program will be publicly administered. We like that it will be publicly administered because it is different from the dental care plan, which is being entrusted to a private insurance company. When things are subcontracted to private companies, we know what happens. We recently saw what happened with ArriveCAN, and we do not want to see that again. This waste of public money was atrocious. However, even if the program is publicly administered, if a federal system is imposed on top of Quebec's system, there will inevitably be friction and inefficiency. The government says it is going to come up with a list of drugs. Quebec already does that. Are the feds going to check our list? How will this work? If the federal Minister of Health or the committee comes up with a different list, what will happen then? That is what we do not want. We do not need it.

I will address the Liberals through the Chair, since the Speaker has specified that we cannot address other members directly. We do not need the Liberals to administer pharmacare for us. We have our own system, period.

The bill states that the federal government will have to provide financial support to the provinces through agreements. Could an agreement consist of the right to opt out with full compensation? Could Ottawa simply respect the fact that Quebec already has something in place, that we do not want to change it, that our system is working fine and that we would improve it if we had more money? Would that ever be possible? Unfortunately, that does not seem possible.

As for the federal government's role in health care, it comes from spending power. My colleague from Mirabel did a good job explaining this issue. The parliamentary secretary may find me too boring, but as I see it and as Quebeckers see it, the federal government's role in health care is to transfer money. Its role is to transfer money because the federal government gets roughly half the taxes but does not have half the responsibilities. We have repeated this so many times in the House, but it does not seem like many people are listening or else people simply do not understand. When I said earlier that we should be given the right to opt out with full compensation, it was taken as me saying that I did not want Canadians in other provinces to have pharmacare. We have never said that.

The bill also indicates that a committee of experts must be established within 30 days to look into the operation and financing of national, universal, single-payer pharmacare and to figure out how it could work. This will be done for the rest of Canada, because Quebec wants the right to opt out with full compensation.

I will warn my colleagues that my speech today will be repetitive. We want the right to opt out with full compensation because the federal government has no business interfering in this area. The bill does not in any way recognize what is being done in Quebec right now. It is barely mentioned. There is no recognition of Quebec's expertise, yet in their speeches, the government members are saying that Quebeckers were forward-thinking, that they are going to take inspiration from Quebeckers and that they are going to implement a similar system everywhere. Why would they do away with our system to implement their own? That is the logic.

I am a separatist; it is in my blood. I always end up talking about the fact that the federalist parties are unable to live up to the contract they shoved down our throats in 1982. It does not seem that hard to me. We are demonstrating our good faith. Not only did we disagree and not sign, but we are working within those confines because we have had no choice since 1982. When members of the Bloc Québécois sit in the House, we rigorously respect the institutions.

Despite that, when we asked for compromises on MAID, when we moved a minor amendment that would have put Quebec another 20 or 40 years ahead of the rest of Canada, socially speaking, we were told no. When we ask for the right to opt out with full compensation, we are told no, even by people who have been telling us all day that Quebec's jurisdictions must be respected. Those people voted against this proposal. The way they vote should reflect what they say during the day.

As for the proposal about the oath to the King, it would not have cost anyone anything. We were saying that we would respect a Constitution that we did not even sign. They said that even that was far too much, and on top of that, they sang God Save The King at us.

So be it. Let them keep attacking Quebec institutions.

We are going to get ready. In a few years, we will have a good debate, and when the federal government comes to us with its red flags, the decision will be already have been made and we will be independent.

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

Madam Speaker, I am looking for clarification from the Bloc members. They seem to give the impression that prescription drugs are free in the province of Quebec. I would ask the member if he could, for clarity purposes, give an indication of whether people are charged any sort of deductible or fees.

Different provinces have different mechanisms. Some have private and some have public. I am wondering if he could expand on exactly what type of plan there is in the province of Quebec and how it applies, in particular for contraceptives.

[Yves Perron, Bloc, Berthier—Maskinongé, QC]

Madam Speaker, it is true that contraceptives are not yet covered. That is why we need money. We are going to improve our system.

Since my colleague is asking questions about how it works, I will quickly explain. We have a mixed system in Quebec. People who are not covered by private group insurance pay, if I remember correctly, between $0 and $731 in premiums per year, depending on their income. That is how it works for people in the public system. For everyone else, the employer deducts an insurance premium from the employee's earnings.

I should also point out that ours is the most progressive taxation system in North America. The tax rate is income-based. There is no better place in North America for that.

The Quebec system is certainly not perfect, as I said in my speech. However, we are going to improve it. All we have to say to the government is let us manage it on our own.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Madam Speaker, I studied the pharmacare system when I served on the Standing Committee on Health. The Liberals did not do anything until they introduced this bill.

The Quebec system has a list of drugs, a formulary, and I think it is the best system in the country. What does the member think about the fact that this bill targets only two drugs for this pharmacare system?

[Yves Perron, Bloc, Berthier—Maskinongé, QC]

Madam Speaker, I thank my colleague for her intelligent question and for recognizing that Quebec's list is working well.

We have a good system, but it could be improved, as I mentioned earlier. That is why we want the money. We are often told by government members that we, the Bloc, see the feds as an ATM and that all we want is our money. Well, it actually is “our” money, since it is our citizens who paid the taxes, so, yes, we want our money in order to provide services to Quebeckers in our areas of jurisdiction.

To finish answering my colleague's question, the list could certainly be improved. We sincerely hope so. My biggest fear, however, is that the federal government will come up with a list that will likely be much worse than Quebec's, because when it comes to social issues, I am sorry, but Quebec is ahead of the curve.

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

Madam Speaker, I like my colleague a lot, but I find it hard to accept that the Bloc Québécois is refusing to listen to the people in Quebec who are in favour of this bill.

The Centrale des syndicats démocratiques, the Confédération des syndicats nationaux, or CSN, the Centrale des syndicats du Québec, or CSQ, and the Fédération des travailleurs et des travailleuses du Québec welcome the introduction of this bill.

Luc Beauregard of the CSQ said:

Quebec's hybrid system, with a public plan and private plans, has not lived up to its promises. We think it should absolutely not be used as a model for the rest of Canada. It is a costly, ineffective and unfair plan.

Quebec's unions say that we must pass this bill. Why is the Bloc Québécois not listening to these voices in Quebec?

[Yves Perron, Bloc, Berthier—Maskinongé, QC]

Madam Speaker, we can quote unions, too. The CSN is on the side of Quebec independence. I do not know if my colleague agrees with them on that point. I am guessing he does not agree with them on everything.

The unions know we are part of Canada for now, and they want more money so their members will be able to pay less for their medication.

When we meet with them and explain that if the federal government gets involved, there will be redundancy, it will cost more, it will be less efficient, and that it would be much better if we had our own money, I think that, at the end of the day, they agree with us.

We obviously place great trust in the members of Quebec's National Assembly, who have sent out a clear message.

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

Madam Speaker, it has been interesting to listen to what members have to say about Bill C-64. In some areas, I am not surprised. In other areas, I am surprised. Let me provide a bit of an overview before I get into more detail.

When I think of pharmacare and the potential that pharmacare has for all Canadians, I think that we undervalue and underestimate the degree to which Canadians as a whole would support not only the concept, but also the implementation, of a true pharmacare program. This is not new for me. I have been talking about pharmacare for many years. I have been an advocate for it because I understand and believe in the benefits of a national program.

There is no province or territory in Canada that has absolutely free prescribed medications for its population. Everything depends on the province that one is in. It could be based on age or affordability, but there are all sorts of different variations. There is public sector participation and private sector participation. There is a wide spectrum, a smorg, of different ways that pharmaceuticals are being delivered in Canada. That is the reason I asked the Bloc member to provide more detail of the plan in Quebec. Someone will stand up to says it is free in Quebec, but this bill clearly demonstrates that it is not free.

Many would say that, if we have to pay a deductible or an annual premium, and if things are not in it that should be incorporated, it is not free. I am glad the member said that there is room for improvement. No matter what program we are talking about, there is always room for improvement. I suggest that the way we should be looking at the whole issue of pharmacare is to take a holistic approach to the expectations people have for health care in general.

I have said many times in the past how important health care is to all people in Canada, in all regions of our nation. That has not been lost on the government. The Bloc will say it does not want Ottawa to be involved, other than to hand out money. That particular attitude does not surprise me, and I will add further comments on that in a bit.

What really surprises me is the Conservative Party's approach to health care. It is demonstrated with Bill C-64. People need to be aware of this. At the end of the day, we value and treasure health care here in Canada. The Canada Health Act protects the integrity of the system in all regions. It is one of the reasons the federal government allocates the billions of dollars it does for federal transfer payments.

We have seen a national government and, in particular, a prime minister, our Prime Minister, who has taken a health care initiative, recognizing how important it is to Canadians. We are looking at ways to enhance it, to build a stronger health care system. Nationalized health care or the Canada Health Act are established, and many other countries today that have that form of legislation or that sort of delivery of health care have already incorporated a national pharmacare program.

One does not have to be a Liberal or a New Democrat to see the benefits of it. I used to be the health critic in the province of Manitoba, and I understand just how critical medicine actually is to our health care system.

We can think about it in the sense that, if a person gets sick and goes into a hospital, they receive medications in that emergency setting. I do not believe any province is actually charging for that. This is virtually universal now across Canada. It might be because of an ulcer issue, some sort of a bleed or any other need that might be there. If a person has to stay in a hospital facility for however long a time, the hospital staff does not say, “Well, here's a bandage. By the way, you're going to have to pay for that.” Or for medication, maybe a painkiller, they do not put out their hand, saying, “We want money before we inject the painkiller.”

However, the moment that person leaves the hospital, then it changes. This may not happen in every province, as some provinces might cover prescribed medications more than others, some might not charge as much, some will have a deductible and, as I said, some will have those annual premiums. What happens, generally speaking, is that the individual leaves the hospital and finds that now they are going to have to start paying for the medications.

I cannot tell members how many 55-plus facilities, personal care facilities or independent living facilities I have been to where they talk about the cost of medications, with diabetes being one of them. They will tell us, “Look, we cannot afford the medication.” As a result, I would suggest that there are many people who end up going back to hospitals because they are not getting the medications they require. This is because of decisions they have actually had to make in terms of buying and purchasing the medication versus food or possibly rent, or the amount of medications that are required and the bill that is associated with that. Those are the types of things that end up costing communities, society and the taxpayer a whole lot more when that individual ends up returning to the hospital because they were not taking the medications that were necessary in order to keep them out of the hospital facility.

The problem with the debate on the pharmacare issue is that I would have liked to hear more about, collectively as a House, seeing the value of this and that we want to move forward. This is what Bill 64 is doing; it is moving us forward on a very important issue. I would rather have seen everyone coming to an agreement that, yes, this is good stuff, we should be supporting it, and then adding value to that.

I think of Cardine, whom I met at a local restaurant on a Saturday. She was talking about the issue of the shingles vaccination and how this is something people should not necessarily have to pay for. I raised that with some of my colleagues.

[An hon. member]

Oh, oh!