Health Committee on May 23rd, 2024

[Maxime Blanchette-Joncas, Bloc, Rimouski-Neigette—Témiscouata—Les Basques, QC]

Minister, what specific request did Quebec's health minister, Christian Dubé, have for you?

[Mark Holland, Liberal, Ajax, ON]

We have to make sure that jurisdiction is respected. Indeed, we must respect Quebec's jurisdiction in the process. Consideration should be given to how the Government of Canada can work with the Government of Quebec to improve services for treating diabetes and contraceptives for women. There are needs, and it is possible to work in a spirit of collaboration while fully respecting jurisdictions.

[Maxime Blanchette-Joncas, Bloc, Rimouski-Neigette—Témiscouata—Les Basques, QC]

We understand each other.

Just so I'm clear, Minister, I'm going to quote what Quebec's health minister, Christian Dubé, said: “We have no problem adding this money to the pharmacare program. But there cannot be strings attached. It is not up to them to decide on the best drug coverage for Quebeckers.”

Minister, when you talk about respect, are you also talking about respecting the Quebec government's decision not to have a new pharmacare program imposed? Quebec has had its own program for 30 years now.

[Mark Holland, Liberal, Ajax, ON]

We have no intention of encroaching on jurisdictions. For us, it's really about looking at how we can ensure that every person can obtain the medication they need, or the devices they need, as in the case of diabetes. It's not just a matter of medication; it's also about making sure that people have access to the devices and tools they need. There are a lot of needs. Our goal is to make sure that all needs are met.

[Maxime Blanchette-Joncas, Bloc, Rimouski-Neigette—Témiscouata—Les Basques, QC]

Yes, we agree on the needs. Now we have to talk about the way things get done.

Do you agree that Quebec should have the right to opt out of this pharmacare program, with full compensation and no strings attached?

[Mark Holland, Liberal, Ajax, ON]

When I spoke with Minister Dubé, there was no problem.

The same was true with the bilateral agreements. There really was a spirit of co‑operation.

[Maxime Blanchette-Joncas, Bloc, Rimouski-Neigette—Témiscouata—Les Basques, QC]

Let me rephrase the question, Minister, and the answer should be yes or no.

Do you agree that Quebec should have the right to opt out of your new pharmacare program, with full compensation?

[Mark Holland, Liberal, Ajax, ON]

To me, it's—

[Maxime Blanchette-Joncas, Bloc, Rimouski-Neigette—Témiscouata—Les Basques, QC]

Minister, is it yes or is it no?

[Mark Holland, Liberal, Ajax, ON]

Let me explain. You use the expression “strings attached.” I don't see it as a matter of imposing conditions, but as a matter of common purpose. We have to find the common goal.

Certainly, we have federal objectives. They are stated in the bill. However, I'm seeking—

[Maxime Blanchette-Joncas, Bloc, Rimouski-Neigette—Témiscouata—Les Basques, QC]

Okay. The answer is no, Minister.

[Mark Holland, Liberal, Ajax, ON]

—common goals.

Your use of the term “strings attached” is the reason I'm avoiding that.

[Maxime Blanchette-Joncas, Bloc, Rimouski-Neigette—Témiscouata—Les Basques, QC]

You're mostly avoiding answering questions, as you just did again. That demonstrates a lack of respect for Quebec's wishes and, of course, for the request made by the Government of Quebec.

So your decision has been noted, and warm words and negotiations will no doubt follow.

I'll continue, Minister. You must understand that the Government of Quebec's own pharmacare program has already been in place for 30 years—yes, 30 years. You know that you copied the Quebec model for the child-care system. So what we are requesting today is legitimate. We already have a model. We simply want to get our money and manage our own program, which, I repeat, has been around for 30 years.

Quebeckers already have a program and are paying for it. They don't want to pay twice by also paying the federal government for its new program.

So the question we are asking you is this: do you agree that Quebeckers, who already have a program, should be able to get money from the federal government, to which they already pay taxes, and that these funds should be set aside by Ottawa with no strings attached to enhance the existing Quebec program?

That's the question.

[Mark Holland, Liberal, Ajax, ON]

When it comes to federal money and the federal government's goals, it is essential to have a discussion to find common goals. This isn't about jurisdiction at all. In the case of this bill, given our responsibilities and the fact that the funds are federal, this is about finding common goals.

I think we're saying the same thing. This is not a problem when I discuss it with Minister Dubé.

[Maxime Blanchette-Joncas, Bloc, Rimouski-Neigette—Témiscouata—Les Basques, QC]

That's perfect.

The only thing I want you to understand is that the Government of Quebec already has its own program and that Quebeckers pay for it. If Quebeckers pay for a new federal program and that money is not returned to them, they will pay twice. That's the only thing we're asking you to understand and respect.

[Mark Holland, Liberal, Ajax, ON]

Please understand that there is no federal program for that. We will work directly with provinces and territories to use the existing systems to provide people with medication.

So it's impossible with the Government of Quebec. The Government of Quebec is truly a partner in this process and it's important to find common goals.

[The Chair, Liberal, Sean Casey]

Thank you, Minister.

Thank you, Mr. Blanchette‑Joncas. Your time is up.

Mr. Julian, you have six minutes, please.

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

Thank you very much, Mr. Chair.

I want to underscore the important historic nature of this hearing today. It was 60 years ago that Tommy Douglas, the first leader of the NDP and the father of Canadian medicare, helped to push through the House—in a minority Parliament—universal health care. Now we're back, 60 years later.

Tommy Douglas's intention was always to move from universal health care to universal pharmacare, because the reality is that every other developed country that has universal health care also has universal pharmacare, so this is a historic hearing.

I certainly want to thank the many organizations that have brought this into being: the Canadian Health Coalition, the Canadian Labour Congress, the Canadian Federation of Nurses Unions, the Council of Canadians and so many other groups that have been pushing for years for this start of universal pharmacare. It's a historic day.

I want to thank you, Mr. Chair, for giving us adequate notice. We've known about this motion of instruction to the House for weeks, of course. We knew because of your memo last week that we had a week and a half to prepare for today's hearing and to prepare amendments. I appreciate the minister being here.

I do note that my Conservative colleagues have not asked a question on the legislation yet. I hope they took the week and a half you gave them to read the legislation.

Mr. Chair, I would like, through you, to ask the Minister of Health the following questions about some of the clauses of the bill.

First off, clause 8 talks about a national formulary. How do you see this developing as a national formulary that is required—once we pass this bill, as you know—to be put into place one year from now?

[Mark Holland, Liberal, Ajax, ON]

Thank you very much.

Of course, the national formulary is one of the reasons that this bill.... We've also announced the establishment of a Canadian drug agency and put dollars forward to that so that the national formulary can be developed independently by subject matter experts to list that national formulary. I agree that it's critically important.

I was remiss in my opening statements. I think I spent a minute and a half saying thank yous, but you're right that this has been advocated by so many different organizations and groups. You're correct to acknowledge that. I want to acknowledge that omission.

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

I want to move on to clause 9, which talks about the national bulk purchasing strategy.

As you know, Minister, we've seen countries like New Zealand using bulk purchasing, and bulk purchasing can reduce the cost of pharmaceutical products and medications that Canadians depend on by up to 90%.

You have that timeline of a one-year anniversary. How do you see that strategy being developed to meet that one-year deadline? Have you done studies internally to know what the difference would be in terms of the cost of medications to Canadians?

[Mark Holland, Liberal, Ajax, ON]

We know that the action we've taken so far has saved about $300 million a year. We have coordinated bulk purchasing. That doesn't include private purchasing, but we have coordinated a lot of national purchasing through working with provinces and territories. That saved about $300 million a year. It's a significant amount of money. It's made our drugs much more competitive—so much so that we had the crisis with the United States looking to import our drugs.

However, we have more work to do. The exact quantum of how much we can save is difficult to say. There have been a lot of different estimates, but I can say that it is significant. When I talked to private insurers, they acknowledged that the ability to move to one common bulk purchasing program has the opportunity to save consumers an enormous amount of money.

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

It makes you wonder how anybody could oppose lower costs and having more medication available.

Finally, I wanted to ask you to comment on clause 11, which is the committee of experts. Again, the deadlines are very tight—one year. That's why I think we've had so many people and so many organizations across the country urging us to move on this. This bill has been, unfortunately, blocked in the House for months, but now we're finally moving forward, which is wonderful.

With that one-year timeframe, the deadline is tight. How do you perceive the committee of experts reporting back to you and to the House of Commons?

[Mark Holland, Liberal, Ajax, ON]

Yes, the need is urgent. The blocking of the bill is problematic, because people desperately need these medications. It's important that we act expeditiously.

With respect to the committee of experts, the intention would be to immediately name the folks who would populate that committee and for it to be able to report back so that we can get clear and concise information around costs and options on the path forward.

While this work we're doing now is essential in the areas of diabetes and contraceptives, we know there's a lot more work to be done. That committee, I think, is going to be very important in instructing costs and process in the way forward.

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

For my final question for this round, a constituent from Burnaby, B.C., Amber, is paying $1,000 a month for diabetes medication that keeps her alive and in good health. What does this bill mean for people who, like Amber, don't have insurance and struggle to pay for their diabetes medication? What would it mean if this bill continued to be blocked and she didn't have access to the solutions that are provided for in the bill?

[Mark Holland, Liberal, Ajax, ON]

To be very direct, you see it in going to diabetes clinics where patients like Amber are forced into choices of paying for their rent, their groceries or their medicine. Often, medicine is what drops.

What is so tragic is that same clinic will see the person return much later with an improperly managed condition, like diabetes, in a terrible state, or they wind up with a terrible chronic disease or illness.

Seeing something like that for Amber, something that is entirely preventable, I don't think we want to live in that kind of country. Raina, a 12-year-old, was at the announcement of this. She's an advocate and a kid who has diabetes, and she said to me that no one in this country should not not be able to afford their medicine. Sometimes when somebody is young, they can put something so clearly. I find it hard to disagree with Raina or with Amber that they deserve to be able to get their medication.