Health Committee on May 23rd, 2024

[Warren Steinley, Conservative, Regina—Lewvan, SK]

No. I said, did he ever ask for it?

[Mark Holland, Liberal, Ajax, ON]

I can tell you that I've had very good conversations with Everett. I have an enormous amount of respect for him. He and I have sat down and talked.

It's about how we can work collaboratively. He has never said to me that he doesn't want dental care for the people in Saskatchewan. If he said that to you, that's not—

[Warren Steinley, Conservative, Regina—Lewvan, SK]

He said that he never asked for it.

I have one more quick question.

Do you know how much coverage we have in Saskatchewan right now when it comes to diabetes programs and the seniors' drug program?

[Mark Holland, Liberal, Ajax, ON]

I think Saskatchewan has done a good job. They have a good program.

[Warren Steinley, Conservative, Regina—Lewvan, SK]

Can you tell me what it is?

[Mark Holland, Liberal, Ajax, ON]

There are still a lot of gaps and there are a lot of things we can do together. Everett and I have talked about those gaps and about how we can improve them to make sure that everybody has care and isn't under-represented.

[Warren Steinley, Conservative, Regina—Lewvan, SK]

Can you tell me what ages are covered in Saskatchewan by—

[Mark Holland, Liberal, Ajax, ON]

I would commend Saskatchewan for the work they've done. I do agree that Everett has done a good job as the health minister.

[The Chair, Liberal, Sean Casey]

Thank you, Minister.

The last round of questions for you this evening will come from Dr. Hanley, please, for five minutes.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you.

I'll add my welcome for seeing you here today, Minister, and thanks to the officials for being here.

My first question is along the same lines as some of my colleagues around the table, perhaps with a little different flavour.

I think Canadians—people in my jurisdiction in the Yukon, for example—have a large number of public employees covered by insurance plans, as well as by some of the larger private employers. They are very interested in the integrity of those programs continuing.

Also, it has been pointed out that in subclause 6(1), there is the authorization for the minister to enter into an agreement to make payments to the province or territory “to increase any existing public pharmacare coverage—and to provide universal, single-payer, first-dollar coverage” for the specific areas of contraception and diabetes.

Is there a vision, ultimately, of a universal single-payer system? A single-payer system is frequently used in advocacy and in various reports recommending that we ultimately move towards universally accessible pharmacare.

Maybe you can tell me about your vision for a single-payer system and how that is compatible with the existing system that many benefit from with third party coverage.

[Mark Holland, Liberal, Ajax, ON]

Thank you very much, Mr. Hanley, and I thank you for your advocacy and work in public health prior to this job and during it.

In the first order, what we've said is that this is a bit of a pilot. We have an opportunity to see a single-payer universal system out of an academic construct and out in the real world.

In P.E.I., we have another model, which is a fill-in-the-gaps model, and we have now a committee that's going to be able to look at it and examine the costs and the future path for a single-payer universal system. We're going to be able to compare that and then be able to make informed decisions about the path forward. What I've said is that the conversation needs to be informed by data and real-world results and action.

If I could, I'll take a moment to talk about, for example, why providing contraceptives is such a logical place to start with a single-payer universal plan. You could have somebody in an abusive relationship with a partner who has insurance, and they have to go through their partner in order to get the contraception they need, or you could have a 16-year-old who wants access to contraception but doesn't have parents who would support them in getting access to that contraception.

This is, I think, a very logical place, when you're talking about that experiment, and also because of the number of under-insured folks with diabetes.

[Brendan Hanley, Liberal, Yukon, YT]

Thanks.

On your latter point, you and I actually just had a discussion with one of the family doctors from Yukon who is an expert in reproductive health care and also a passionate advocate for access to reproductive health care. You said in your opening remarks that Bill C-47 really provides an opportunity for us to talk more about sexual health, about access to sexual health and reproductive health care. Maybe I'll give you a little more space to talk about how important this topic is.

[Mark Holland, Liberal, Ajax, ON]

Thank you so much for that.

When I go to AIDS clinics, just as an example, they have a huge problem getting people to come in and get tested and have conversations, because of the stigma. AIDS is an entirely manageable condition. It's a chronic condition. It doesn't have to be a death sentence. We want people to get care.

On even a more granular basis, how many kids.... We look at teen suicide around sexual identity issues, and shame has led to terrible outcomes. I can say that the lack of conversations around sex in my own household was incredibly damaging. When sexual violence was visited upon my family—and we didn't talk about sex in our household—that was incredibly damaging and left me very confused about sex.

Having a broader conversation in this country about sex and sexuality, and sexual health and sexual autonomy, is critically important, and I hope it's part of the conversation that we'll have as we're talking about contraceptives.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you.

If I can, I'll quickly squeeze in a third question.

You talked about your previous role with the Heart and Stroke Foundation, and you did I think some really excellent work there. The Heart and Stroke Foundation, in their briefing note, pointed out that almost one in 10 people in Canada are visiting an emergency room due to a worsening health issue because they are not able to afford their prescriptions.

Bill C-47, I think, is going to try to help address this gap. Can you comment very quickly on that?

[Mark Holland, Liberal, Ajax, ON]

You're 100% right.

I would encourage every member of the committee to go and talk to a nurse or a doctor—or, frankly, a dentist—about what happens when you don't do prevention right.

It is the most heartbreaking thing in the world to watch somebody you love get sick or die. The only thing that is more heartbreaking is when it was preventable and never should have happened. We are too great a country. Our values are, I think, that we shouldn't allow that to happen in this country—that if we can prevent it, we should prevent it. That's what this bill will do. That's what we need to negotiate with the provinces.

[The Chair, Liberal, Sean Casey]

Thank you, Minister.

We've gone a bit over the time that you had committed for us. We're grateful to you for showing up right off the hop on this study. Regardless of political views, the passion that you bring to your work is evident. Thank you for that.

Minister, you're welcome to stay, but you're free to go.

We still have about 25 minutes with officials. I'm not going to suspend, because I'm sure we have questions for them.

Thanks again, Minister.

Colleagues, I know that we're facing an imminent emergency with the lack of coffee. We've made the folks aware of that impending emergency and trust that it will be rectified fairly soon.

We're going to continue now with rounds of questions. We're back to the Conservatives for five minutes.

Dr. Ellis, go ahead, please.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you very much, Chair.

Interestingly enough, as you know, we had some probing questions with respect to drug approvals in Canada, and, as I said previously, the minister specifically had an opportunity here with respect to this legislation because it does talk about standing up the new Canadian drug agency, and there certainly was an opportunity to have some safeguards around the Canadian drug agency and drug approvals in Canada.

Perhaps now I could ask the officials about the drug approval process in Canada, because, quite frankly, we've already established that Canadians don't have access to primary care. I think everybody out there watching knows clearly that it's hard to get a prescription if you don't have access to a physician to write you one, which, again, this government has failed to address. They've made it clear historically that they would provide 7,500 new doctors, nurses and nurse practitioners to Canada, even though we're missing about 30,000 family doctors.

That being said, one thing that's going to plague Canadians in the not so distant future and is plaguing them now—I spoke about this previously—is the number of days from global first launch to public reimbursement.

There were 460 new medicines launched from 2012 to the end of 2021. My colleague from the NDP referenced New Zealand as a beacon. Interestingly enough, in this particular study, New Zealand had the longest time for approval, at 1398 days.

Could the officials tell me who had the second-longest time for approval of medications in this group of countries? Anybody?

[Michelle Boudreau]

I can't tell you that, but I'm happy to speak a little bit more about any questions that you have around the data and the time it takes in Canada—

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

That's excellent. I appreciate that, but Canada is the second worst, at 1301 days, for getting new drugs approved.

Are you aware, Madame Boudreau, that we are having difficulties getting new drugs approved in this country?

[Michelle Boudreau]

What I can say is that there are a couple of different pathways for drugs to be approved in Canada through our health products and food branch.

There is a faster pathway that is about 180 days, and on average, with the ones that do not proceed via that pathway, it's approximately 300 days. We also have an aligned review process between what happens at Health Canada and what happens at CADTH in health technology to try to speed up access for patients as well.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

I'm sorry. Are you disputing the data that I have here? What you're suggesting is that the pathways you're talking about provide approval in 300 days. Is that what you said?

[Michelle Boudreau]

Sir, I'm not disputing it. I think you were perhaps speaking about the pathway as a whole, between launch and patient access, or access to a prescription.

I was speaking about your latter comment, which is the amount of time it takes for approval of a new drug submission, for example, by Health Canada.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Then are you familiar with that data, but you're not familiar with the data that I'm referencing?

[Michelle Boudreau]

No. I'm sorry. I'm not. I could ask my colleague if he is, if you'd like.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

No, that's okay.

Am I clear then to say that you don't think there's a problem for Canadians in accessing new medications in Canada? It's a long process.