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.

Motions in Amendment

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mr. Speaker, I would love to hear what Canadians think about this during an election, which may even come this summer. That would be for the greater good of all Canadians.

If this government has the courage to find out what the people want, it should call an election. Otherwise, let it continue to follow the NDP's lead.

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

Mr. Speaker, I am well aware that the member has had a long career and that he lived through the Harper regime, the most expensive regime in Canadian history. Some $116 billion was given to the big banks to increase their profits. According to the Parliamentary Budget Office, $30 billion a year went to tax havens thanks to Mr. Harper and his team. Of course, there was also all the money given to CEOs in the oil patch.

The costly Conservatives spent a lot of money on the rich and affluent. However, now we are talking about pharmacare, which will help people in his riding. It will help 18,000 people with diabetes who are struggling every month to pay sometimes up to $1,000 for their medication.

The question I want to ask my friend is very simple. Why are the Conservatives so keen on spending money on billionaires, CEOs and banks, but do not want to give a penny to people struggling to pay for their medication, such as diabetes medication?

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

Mr. Speaker, I would like to remind my colleague, who was here when I was part of an excellent Conservative government, that the national debt was around $500 billion. It is now over $1.25 trillion. That alone is costing Canadians an enormous amount. Right now, the Liberals are spending more on debt interest than on health transfers. We are paying a huge amount of interest. The 7% that we pay on goods and services goes toward paying the debt instead of toward health care.

That is because the NDP is forcing the Liberals to overspend.

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

Mr. Speaker, I am very interested in getting my colleague's response to the reality. As a community health nurse many years ago and someone who led, for a number of years, a multidisciplinary team at a community health centre that was very much about vulnerability, I saw time and time again the chronic illness implications of diabetics who did not have access to appropriate treatment. I saw repeatedly and was able to demonstrate through our data systems the cost to our health care system when someone with a chronic illness continued to move to the more severe aspects of their disease process because they did not have access to care.

I hear time and time again at committee and in the House that my colleagues are very interested in cost savings. Could the member please explain to me why he is reluctant to move this legislation forward in light of the very well demonstrated implications of cost savings in our health system?

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

Madam Speaker, my colleague asked a very interesting question. I talked about that in my speech. It would have been better to target people who do not have access or who need a lot of prescription medication that they cannot afford. If the government had done that, then it would have to cover only about 1% to 2% of the Canadian population, and we might have supported the measure. However, it bothers us that that the government wants to scrap everything that currently exists in the public and private sector to implement an extremely onerous system with a lot of red tape.

[Ben Carr, Liberal, Winnipeg South Centre, MB]

Mr. Speaker, is it always an honour to rise in this House.

I want to start on a personal level. I was always so proud to grow up with my mother as a family physician, who continues to practice medicine in Winnipeg. In the past number of years, she has moved into working with people battling addictions. Much of my understanding of the health care system and how we care for people in our society has come through the compassion, expertise and professionalism that I have seen on my mother's part, so it is with her in mind that I rise today to speak about pharmacare.

Like so many of our colleagues in the House, I have heard from constituents who are eager for the government to move in a direction that will allow for a universal pharmacare plan. There are a variety of reasons for this, which I will get to later in my remarks. However, what I have heard primarily from seniors, whether it is on the government's plan for dental care, the proposed piece of legislation we are talking about today or investments in aging in place with dignity, is that they are extremely enthusiastic about the direction the government is headed in relation to a variety of different health care policies.

As members know, recently there was an election in my home province of Manitoba. We have been working collaboratively with the new government, and I was very proud to join other colleagues, as well as the premier and the Manitoba health minister, not too long ago to announce a $630-million health care deal with the Province of Manitoba. It is going to see us invest directly in a variety of areas that are going to make a difference in the lives of my constituents, and Winnipeggers and Manitobans broadly speaking. They include things like a reduction in wait times, investments in mental health and addiction and ensuring that we have greater efficiency in our health care system.

I have talked often in this chamber about my experience as a teacher, as a principal and as a coach, having worked for many years with young people, and I am proud of the investments we are making in youth mental health. I would also note that many of the students I have worked with in the northwest part of the city of Winnipeg are unfortunately, and in many instances disproportionately, impacted by type 2 diabetes. It is indigenous communities in particular that are facing those challenges. I come to this debate with some first-hand experience, having seen how difficult it can be to operate without coverage.

Our government promised to bring in a national, universal pharmacare plan so that all Canadians can have access to the prescription drugs that they need.

Our government worked on developing a solid foundation for building a national, universal pharmacare program. This work includes investments in the national strategy for drugs for rare diseases to help Canadians with rare diseases access the drugs they need. It also includes the announcement of the creation of a Canadian drug agency in December 2023.

With the help of the Canadian Agency for Drugs and Technologies in Health, we have also completed preliminary work toward a national formulary. This work included the establishment of a multidisciplinary advisory panel with a recommended framework and process for the development of a national formulary.

In Canada, the roles and responsibilities for health care services are shared between provincial and territorial governments and the federal government, as we know.

The provincial and territorial governments are responsible for the management, organization and delivery of health care services for their residents, which includes determining which drugs are reimbursed, and under what conditions, for their eligible populations.

We look forward to continuing to collaborate with our provincial and territorial partners to improve the accessibility to and affordability of prescription drugs for Canadians. The bill would do just that, starting with contraception and diabetes products.

By continuing our work together and making wise investments, we can ensure that the health care system is there for us when we need it, both now and in years to come.

I said at the outset of my remarks that I spent a number of years as an educator, and it was during that time that I got to know kids and their families on very personal levels. I did not just get to understand them as students, but I got to understand them as people, including all the challenges that come along with daily life. Some of those challenges included access to health care.

I cannot tell members how many times, for example, I would have a first nations single mother with a child in crisis in my office, and she was not sure how to advocate well for her child, because they had had so many challenges over the years in interacting with the health care system. I remember one particular instance where a child was having some significant mental health issues, and I said that I thought we really needed to call the son's doctor and get an appointment for him. The mother picked up the phone and called the doctor, and the receptionist at the office answered the phone and said that, unfortunately, they did not have a spot for the next four months. This was a young person who was contemplating taking their own life at the time.

I was fortunate enough to be able to help that family in that particular instance. This was by virtue of something I mentioned at the beginning of my remarks, and that is having seen my mother's ability to operate in and navigate the system. However, this is not uncommon, particularly for marginalized communities. In Manitoba more specifically, there are indigenous communities, whether first nations, Métis or Inuit, as well as newcomers, who have difficulty accessing our health care system for a variety of different reasons.

In addition, in many of these families, there were single mothers or single fathers working multiple jobs. They had to go long ways across the city in order to make ends meet and to provide for their families, and they did not have access to plans. They did not have access to medications that would allow them to live healthier and more prosperous lives.

I have those families and those kids in mind when I think about what the bill would mean for them and their future. I am proud to have the opportunity to rise today to talk about what we can accomplish through this historic piece of legislation.

I know that my time is running short, so with that, I will gladly take my seat for a moment and welcome questions from my colleagues across the way.

[Branden Leslie, Conservative, Portage—Lisgar, MB]

Mr. Speaker, I congratulate my hon. colleague across the way for a very impassioned speech, based on real lived experiences, that was not intentionally partisan. It was actually about reality. The class of by-elections of 2023, I think, includes some of the best around this place.

I will respond in kind with a bit of a personal reality. My beautiful wife, Cailey, was diagnosed with type 1 diabetes at age one, which I think was the earliest in the country at that point. Prior to meeting her, I did not know a lot about diabetes, so I personally had to learn a lot of the challenges of living with diabetes and what it entails, and I certainly can recognize the costs.

I am going to do a quick shout-out, while I have the opportunity, to wish Cailey a happy birthday tomorrow. I look forward to spending the day with her.

Cailey is on an insurance plan, as are many other Canadians, and a real concern is that the options available for specific products and insulin are adequately covered for the majority of people right now. Why the need to aim for universality when we could be more targeted and use taxpayer dollars more efficiently to still try to seek the same results? Obviously the expectation is to expand this to other products. We need to be smart with taxpayers' money while still trying to seek the results the member wants to achieve.

[Ben Carr, Liberal, Winnipeg South Centre, MB]

Mr. Speaker, as a fellow Manitoban, it would be impolite of me to not also wish Cailey a happy birthday. To my hon. colleague's wife, I hope it is a fun day together tomorrow.

There are tens of thousands, hundreds of thousands of Canadians across the country who do not have access to the medication they need. I appreciate that, in some instances, there are provincial health plans or private plans that cover certain medications, but the reality is that this is simply not enough.

I would respond to my colleague by referencing something my colleague from St. John's East, who happens to be in close proximity to me at the moment, mentioned earlier: We are being smart with taxpayer dollars, and this is an investment in taxpayers. It is an investment in their health and in their future. The more we can get ahead of proactively addressing health care challenges people are facing, the healthier people are going to be down the line. That, in and of itself, is smart tax policy.

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

Mr. Speaker, early in my career as a politician, I was in a meeting with two young people who had type 1 diabetes. They came from two different provinces, so it was very interesting to hear the story of those young people and their parents. What stuck with me was that one young person lived in one province and had an important, often life-saving device, and the other young person from a different province did not have it. The reason they did not have it is that it was costing them a significant amount of money every month. The dad had been hurt on the job; he was now living on very minimal income, and they had to take the device away from their child. Could the member talk about how this would really create that important factor of universality so that all young people who have type 1 diabetes get exactly the same appropriate care across Canada?

[Ben Carr, Liberal, Winnipeg South Centre, MB]

Mr. Speaker, that is exactly the point. When we use the word “universal”, it is to ensure we do not have this kind of hodgepodge patchwork health care system across provinces, but that any Canadian, wherever they live in the country, is able to access these medicines when they need it.

I mentioned in my remarks that I worked with a lot of first nations kids in northern Manitoba in particular. Because there is so much migration within the province through to the city of Winnipeg, as a result of historical harms and all the reasons we know indigenous people are disadvantaged in this country, they are disproportionately susceptible to many of the challenges that come along with diabetes and other poor health outcomes. For first nations kids, in particular, and indigenous kids as a whole, as well as people such as the constituents she was talking about, the legislation would allow for us to fill some of the gaps that exist and make sure they get the type of health services that they need in this country. I am proud to work alongside her and other members across the way who support this legislation.

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

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

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

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

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

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

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

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

[An hon. member]

Oh, oh!

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

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

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

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

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

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

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

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

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

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

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

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