Evidence of meeting #116 for Health in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was diabetes.

A video is available from Parliament.

On the agenda

MPs speaking

Also speaking

Daniel MacDonald  Director General, Office of Pharmaceuticals Management Strategies, Strategic Policy Branch, Department of Health
Michelle Boudreau  Associate Assistant Deputy Minister, Strategic Policy Branch, Department of Health
Jim Keon  President, Canadian Generic Pharmaceutical Association
Steven Staples  National Director, Policy and Advocacy, Canadian Health Coalition
Mike Bleskie  Advocate, Type 1 Diabetes, Canadian Health Coalition
Stephen Frank  President and Chief Executive Officer, Canadian Life and Health Insurance Association
Yves Giroux  Parliamentary Budget Officer, Office of the Parliamentary Budget Officer
Lisa Barkova  Analyst, Office of the Parliamentary Budget Officer
Joelle Walker  Vice-President, Public and Professional Affairs, Canadian Pharmacists Association
Manuel Arango  Vice-President, Policy and Advocacy, Heart and Stroke Foundation of Canada
Celeste Theriault  Executive Director, National Indigenous Diabetes Association Inc.
Diane Francoeur  Chief Executive Officer, Society of Obstetricians and Gynaecologists of Canada

3:35 p.m.

Liberal

The Chair Liberal Sean Casey

I call this meeting to order.

Welcome to meeting number 116 of the House of Commons Standing Committee on Health.

Before we begin, I'd like to ask all members to consult the cards on the table for guidelines on preventing audio feedback incidents.

Please take note of the following preventive measures that are in place to protect the health and safety of all participants, including the interpreters: Please use only the black approved earpiece. The former grey earpieces must no longer be used. Please keep your earpiece away from all microphones at all times. When you're not using your earpiece, place it face down on the sticker on the table for this purpose. Thank you for your co-operation.

Pursuant to the order of reference adopted by the House of Commons last night, the committee is commencing its study of Bill C-64, an act respecting pharmacare.

As was indicated in the memo that was sent out this morning, I'd like to remind members that amendments to Bill C-64 must be submitted to the clerk of the committee by 4 p.m. Eastern Time tomorrow, Friday, May 24, 2024.

It's important for members to note that pursuant to the order adopted by the House yesterday, the 4 p.m. deadline to submit amendments is firm. This means that any amendments submitted to the clerk after the deadline and any amendments moved from the floor during clause-by-clause consideration of the bill will not be considered by the committee.

Colleagues, we also have a budget for the study of Bill C-64 that I propose to present to you after we hear from all the witnesses this evening.

Without further ado, I'd like to now welcome our first panel of witnesses.

We have with us the Honourable Mark Holland, Minister of Health. He's accompanied by officials from the Department of Health. They are Michelle Boudreau, associate assistant deputy minister, strategic policy branch, and Daniel MacDonald, director general, office of pharmaceutical management strategies, strategic policy branch.

Minister Holland will be with us for an hour, and the officials will stay on until five o'clock.

Without further ado, welcome to the committee, Minister. You can now go ahead with your opening statement for the next five minutes.

3:35 p.m.

Liberal

The Honourable Mark Holland Liberal Mark Holland

Thank you so much, Mr. Chair.

It's such a pleasure to be here with the committee.

I am extremely grateful for the work the committee is doing on this important issue. It is essential that Canadians have access to the medication they need. It's a fundamental aspect of our health care system.

First of all, I'd like to thank the member for Vancouver Kingsway for his work.

I think it's an excellent example of how, when we work together as parliamentarians and seek solutions to the difficult issues that are in front of us, we can find solutions.

I want to also thank the now-health critic, the member for New Westminster—Burnaby and the House leader. Both as a House leader and as a health minister, I've had a chance to work with him in his different roles. I thank him for his work.

Of course, within our own caucus, I want to thank the member for Brampton South, who has really been extraordinary in her advocacy.

Of course, there are so many that I could use the full five minutes. However, I'm going to focus today on drugs. We could talk about all the things we're doing on health, but let's talk specifically about medication.

There are 1.1 million Canadians who aren't insured and about one in five who are under-insured. In a very practical sense, that means they don't have access to the medicine they need.

Today in question period, Mr. Chair, we were talking about your home province of P.E.I. and the difference it makes for the folks—for islanders—to be able to afford their medication and how critical that is, not just as a function of affordability but also as a matter of dignity and a matter of prevention.

Let's just take diabetes in the first example. Some folks ask, “Why diabetes?” This is so fundamental to stopping so many other chronic diseases and illnesses.

Do you know that about 70% of chronic diseases and illnesses are preventable? We're taking historic action to deal with the crisis in primary care and to make sure people have access to the doctors and nurses they need.

Making sure we're upstream so that somebody doesn't get sick in the first place is so critically important. When somebody has access to the diabetes medication they need, what does that mean? It means they don't wind up with heart disease or a stroke. They don't wind up with the loss of a limb, or dying. That's fundamentally important as a matter of social justice.

It also is fundamentally important as a matter of savings. We know that about 25% of folks with diabetes right now are saying that cost is a major factor for them in sticking to a regime of taking the medication they need.

You can focus on problems and critiques or you can focus on solutions. That's what this bill does. It says we'll work with provinces and territories on creating a baseline. When we're looking at that formulary, that's a minimum, not a maximum. Let's be very clear that everything we're doing here is additive. It's working with provinces. Nobody is going to lose coverage. This is all about expanding coverage and making sure that patients have choice and that they get the medication they need.

Let's talk about sexual health as well for a second.

We need to have a conversation in this country around sexual and reproductive health, to be able to say that every woman in every part of this country has the ability to choose the reproductive medicines they need to take control of their reproductive and sexual health and futures. To me, that is fundamental. I hope it sparks a general conversation about sexual health in this country and about sex being something that is affirming and makes you grow stronger, not something that's used as a tool for shame and pain and hurt.

As I look at this plan, as I was saying today in the House, there are people who say that it's too much to hope for: Don't hope for dental care. Don't hope for pharmacare. Just give up. Go away.

Well, they said that about dental care, and yesterday at noon we crossed the point of 100,000 seniors getting dental care. To put that in perspective, I was in Vanier talking to a denturist about a patient who for 41 years had the same set of dentures. Next week she'll be getting a new pair of dentures for the first time. That means she won't be crushing food in her mouth with plastic plates. She will be afforded the dignity of teeth in her mouth. This is real stuff that we're doing.

There are people right now waiting for the contraceptives they need for their sexual and reproductive health. They're waiting for the diabetes medication they need. I was talking to Sarah in a diabetes clinic here about what that will mean for people avoiding illness, and about not seeing patients who are reusing syringes and getting blood-borne diseases because they don't have access.

This opens the door for us to negotiate with provinces to make sure that everybody gets that coverage. It will have a huge impact in terms of dignity, social justice, prevention and cost avoidance. I am exceptionally excited to talk about it today.

Thank you, Mr. Chair.

3:40 p.m.

Liberal

The Chair Liberal Sean Casey

Thank you, Minister.

We'll now begin the rounds of questions, starting with the Conservatives for six minutes.

Go ahead, Dr. Ellis.

3:40 p.m.

Conservative

Stephen Ellis Conservative Cumberland—Colchester, NS

Thank you very much, Chair.

Thanks, Minister, for being here.

You talked about access to primary care. Can you tell the committee how many Canadians do not have access to primary care?

3:40 p.m.

Liberal

Mark Holland Liberal Ajax, ON

It's high. It's of course regionally dependent, but far too many Canadians don't have access. That's why we're working on these agreements.

3:40 p.m.

Conservative

Stephen Ellis Conservative Cumberland—Colchester, NS

Just across the country, Minister, how many Canadians don't have access to primary care? You know the number.

3:40 p.m.

Liberal

Mark Holland Liberal Ajax, ON

Well, it varies. Sometimes it's difficult to know, actually, because the circumstances are too opaque. We're missing a lot of the data we need in health to be able to give precise numbers. There are best guesses, but the number is too high. I've seen a lot of numbers all over the map.

3:40 p.m.

Conservative

Stephen Ellis Conservative Cumberland—Colchester, NS

Clearly, Minister, you're too afraid to say the number, because under your watch it continues to increase. Is that not true?

3:40 p.m.

Liberal

Mark Holland Liberal Ajax, ON

Well, no, actually. In the last 10 months, we've made huge progress. On my watch as health minister, we've signed 26 agreements, moving forward with $200 billion in funding. I think you wouldn't find an association or an organization that represents nurses, doctors or personal support workers that isn't saying that we're making tremendous progress, and have, over the last year.

3:40 p.m.

Conservative

Stephen Ellis Conservative Cumberland—Colchester, NS

It's interesting, though, Minister. You've refused to give a number, but now you're telling Canadians that you've made progress. If you can't even count the number of people, how can you tell that you've made progress?

3:40 p.m.

Liberal

Mark Holland Liberal Ajax, ON

One thing we did in the agreement that I think is critically important is to put common indicators across the country and prioritize health data so that we don't have that level of an opaque nature to our health system. We have provincial and territorial governments, and I think it's essential that we have common indicators so that we can have clear and concise answers to these questions. That was one of the things we built into that.

3:40 p.m.

Conservative

Stephen Ellis Conservative Cumberland—Colchester, NS

Let's go back to the question. Let's just give a number. How many Canadians do not have access to primary care? Let's just have a number: How many million; how many—

3:40 p.m.

Liberal

Mark Holland Liberal Ajax, ON

It's too many. We don't know the number.

3:40 p.m.

Conservative

Stephen Ellis Conservative Cumberland—Colchester, NS

No, no, that's not a number. “Too many” is not a number.

3:45 p.m.

Liberal

Mark Holland Liberal Ajax, ON

Well, we don't know the number. I've tried to explain that we can't—

3:45 p.m.

Conservative

Stephen Ellis Conservative Cumberland—Colchester, NS

Everybody knows the number, Minister, except you.

3:45 p.m.

Liberal

Mark Holland Liberal Ajax, ON

Well, if you know the number, say it. Where does it come from? Can you cite the source?

3:45 p.m.

Conservative

Stephen Ellis Conservative Cumberland—Colchester, NS

Thanks very much.

Maybe I will try one of your associates here.

Mr. MacDonald, do you know how many Canadians don't have access to primary care?

3:45 p.m.

Daniel MacDonald Director General, Office of Pharmaceuticals Management Strategies, Strategic Policy Branch, Department of Health

Per the minister's comments, that information is being collected pursuant to the agreements that have been signed.

3:45 p.m.

Conservative

Stephen Ellis Conservative Cumberland—Colchester, NS

Here we are. We have....

Madame Boudreau, could I ask you the same question? How many Canadians don't have access to primary care?

3:45 p.m.

Michelle Boudreau Associate Assistant Deputy Minister, Strategic Policy Branch, Department of Health

Thank you for your question.

Mr. Chair, I wouldn't be able to add anything further.

3:45 p.m.

Conservative

Stephen Ellis Conservative Cumberland—Colchester, NS

What you're telling me is that we have three officials, including the Minister of Health, who have no idea how many Canadians don't have access to primary care. Wow. This is going to go a long way to helping Canadians, then.

How about this, Minister? Why is semaglutide not on your list of medications?

3:45 p.m.

Liberal

Mark Holland Liberal Ajax, ON

What we did was create a base. One of the things we do when we're negotiating with provinces is we say, “This is just a floor” to make sure that we do have a floor for those who are uninsured or under-insured. We're absolutely open to the committee's comments and to negotiations with provinces in order to be additive.

I would say that the list you see is an absolute minimum. I would expect that there will be no final list that doesn't include more. If there are things you think should be on that list, I am quite interested in having that conversation. Hopefully, it would mean you support the legislation.

3:45 p.m.

Conservative

Stephen Ellis Conservative Cumberland—Colchester, NS

I don't think we need to worry about that, because it's bad legislation and it's bad for Canadians.

Can you tell Canadians how long it takes in Canada, in general, from first launch of a medication to public reimbursement?

3:45 p.m.

Liberal

Mark Holland Liberal Ajax, ON

Again, it varies by province.

I will take it back. I hope you won't just summarily reject the idea of helping people who are uninsured to get medicine.