Health Committee on May 24th, 2024

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

—currying favour with their votes, perhaps, but that's a whole other story.

One of the things you talked about previously, Ms. Silas, related to patients being in hallways in health care. It appears you conflated that, actually, to patients not having medications, which could be one of the issues, but is it really not more of an issue that almost 10 million Canadians don't have access to primary care?

[Linda Silas]

Yes, and that is similar to the question on poverty. Access to health care is about primary health care and about access to medication, acute care and long-term care—and I'm forgetting, I'm sorry, mental health. If we're not able to fill all those silos—right now they're working in silos—our society will not be as healthy as possible, so availability of prescription drugs....

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

Thanks very much for that.

You know, it's interesting. I would suggest that, over my career as a family doctor, I've known many nurses. They're quite happy to have their private drug plan, which covers many things. Sadly, the difficulties of their jobs require them to have access to physiotherapy and, often, chiropractors and mental health practitioners. What do you say to the nurses out there who might be afraid that they're going to lose their plan?

Now, you would suggest that's never going to happen. We had other witnesses here who said, “Yes, it's a really good likelihood that's going to happen with a national universal single-payer system.” If that happens, what do you have to say to nurses out there, when they lose their plan and all they have is a couple of birth control pills, no physiotherapy, no chiropractic, no support hose and no mental health access? What do you have to say to your nurses about that?

[Linda Silas]

First of all, this bill doesn't deal with physiotherapists and support hose. It deals with two categories of prescription drugs. What it will do is bring equity across the country. For our nurses, I never got the mandate to examine their own plans. That's at the bargaining table in every province and territory, and they do a great job. They're not worried about themselves. They're worried about the patients they take care of. They're worrying about that patient who falls through the cracks in Quebec, like I was telling Mr. Blanchette-Joncas, or they're worrying about the patient who doesn't have any plan.

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

Ms. Silas, I'm just going to interrupt you there because that wasn't my question. My question to you was, if this comes to fruition and nurses out there do lose their plans.... I know your contention is that it's never going to happen. We heard from other witnesses who said that's a definite possibility, with previous court cases, etc. What do you have to say to your nurses out there when we know, as our colleague from the Bloc mentioned, that public plans cover significantly fewer medications and, as you mentioned, perhaps no physiotherapy, chiropractic and other important things on behalf of nurses?

What do you have to say to your nurses if they lose their coverage?

[Linda Silas]

I'll negotiate a better plan for them.

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

Ms. Silas, that's absolutely not true because there's going to be only one plan available to them. I mean, this is not something that I find humorous because I know many nurses. You represent them. What will you tell them when they don't have a choice? How are you going to negotiate another choice when there is no choice?

[Linda Silas]

Dr. Ellis, I have 20 years of mandate—nationally—to negotiate a national pharmacare program from nurses from every sector of this country, and they are not worried about not having a plan. They'll always have a plan. Some are richer. If you look at Alberta, the plan is very rich in Alberta, on every facet compared to my own province of New Brunswick, but that is negotiated at the provincial level and will continue to be negotiated at the provincial and territorial levels. We're looking to alleviate some of the costs of those plans to enhance them—so maybe better mental health services, physiotherapists and support hose.

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

I don't share your optimism, but thank you very much for your opinion.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Ellis.

Next is Mr. Jowhari, please, for five minutes.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you.

I'll continue on that topic with Ms. Silas.

Am I right to understand that as a result of the preliminary introduction of these two types of products—diabetes products as well as contraceptives—it will allow more room in the broader insurance programs and benefits, so it can help to actually broaden the scope of other services, as you were saying? Did I understand you correctly? Can you expand on that?

[Linda Silas]

That would be the best scenario, but in 2024, until the act and until the program has some experience, where it will have an impact on our employer-funded health programs, for sure, and where that money will be reinvested will depend on the committees in the provinces and in all employment.... I'm talking about the public sector and health care, but it'll be the same thing in an auto company somewhere in Ontario. They will negotiate the excess of money when that happens.

[Majid Jowhari, Liberal, Richmond Hill, ON]

When you say that it will have some impact by 2024, can you explain what that impact is?

[Linda Silas]

I can't explain it, honestly, not with specific numbers. What I can explain.... Let's say the diabetic drugs are 10% of your health care costs, and it's spread around. That 10% will be reinvested in something else, because it will be covered by the province and the federal government's plan. That's the best example.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Okay.

[Linda Silas]

Until we have experience, nobody will be able to tell you the exact amount. Now, saying that, I'm sure there's an economist that might testify and be able to do that.

[Majid Jowhari, Liberal, Richmond Hill, ON]

I understand you're a nurse practitioner as well. Based on your experience, or based on the experience of the nurses you represent, how many times has it happened in a hospital, in an emergency, that a Canadian has shown up with symptoms that relate to diabetes and, because of a lack of access or because of rationing, they ended up in emergency? How much does the emergency visit cost?

[Linda Silas]

I haven't practised in over 25 years, so I'm really not the person to ask. I'm a registered nurse, not a nurse practitioner. What we have done over the years is that we've brought practising nurses—and physicians have come also—to talk to parliamentarians on the lack of access to drugs.

Most of the time, we leave the dollars and cents to the economists to explain the cost impacts. What we're saying is that there's a human impact to people having to go to see a physician or a nurse practitioner and beg for a sample drug or for the rare disease that Durhane was talking about.... We should not be in a situation where we beg to get care in this country, and access to what your doctor or nurse practitioner prescribes should be included.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Okay. Thank you.

I'm going to go to Ms. Berg.

Ms. Berg, you talked about the supply chain, the distribution and the potential impact of this bill, especially the buying power, and about distributors actually stocking less or eliminating products from their offerings and also that other manufacturers, who are as successful in their bids, are going to completely stop manufacturing or distributing in Canada. How realistic is that?

How realistic is it that a global pharmaceutical company is going to basically say, “I'm not going to manufacture penicillin anymore. I'm not going to sell it directly to the government”? I only have about 10 seconds, but can you quickly respond to that?

[Angelique Berg]

Sure. I would be happy to.

It's not that they will stop manufacturing; they'll stop sending it to Canada. That's happened. Durhane has spoken to that also.

We hear that kind of skeptical assertion that medicines will always be distributed everywhere, just like groceries. Unlike groceries, drug prices are controlled. They're not uncontrolled. They have thin margins and low volumes. They are not high-volume things that you can throw on any old truck. Their handling is extremely complex. It's highly regulated and it requires dedicated transport in temperature-controlled vehicles. They do not store easily and they don't move cheaply. When we think that they will just go along with the toilet paper, that's not true. That can't happen. We have all kinds of regulations on that to prevent that from happening and to maintain product integrity and patient safety.

It will happen. It won't happen overnight. It really won't. We'll watch it erode slowly. Slowly, the access will worsen.

[The Chair, Liberal, Sean Casey]

Thank you.

Next we have Dr. Kitchen.

Go ahead, please, for five minutes.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you, Mr. Chair.

Thank you, everyone, again. It's been interesting to hear some of the responses we've had.

Ms. Silas, I'm just wondering if you understood my colleague's question.

You know, my wife was a nurse for 40 years. She did her first year as a neonatal intensive care nurse at the university hospital in Edmonton. She then went to SickKids in Toronto and was an ICU nurse. She went from there to Royal University Hospital in Saskatoon. She went from there to working in Crosby, North Dakota, and then back to St. Joseph's Hospital in Estevan, where we live today. Then she was basically a critical care long-term nurse.

In her conversations that I've watched and seen, she has been the best patient advocate in this world. I would put her above anybody with respect to that aspect and how she cares about her patients. Some of the things that you have said today shock me, because she's never said any of those things. I find it kind of interesting that this is the way the union sees the nurses versus the way the nurses on the ground see things.

You did, though, mention one thing that I thought was very important, which was that it's not up to politicians to be making these drug plans. I agree with you on that. It isn't up to politicians to be making these decisions; it is up to experts to be doing that. When the government comes out with a plan and it hasn't talked to the experts.... In this case we're talking about diabetes, and the question would be whether they have even discussed things with the diabetes association.

When we look at what the diabetes association has put out and this public plan compared to the NIHB plan and their clinical standards, we see totally different aspects. The public plan has significantly less than the private plans that are out there. I'm sure you're well aware of how Ontario came up with the OHIP+ plan. When they implemented that drug plan for people under the age of 25—and I'm not from Ontario; I'm from Saskatchewan—the reality was that it had a huge impact on young Canadians' being able to get their medications, because they weren't able to access those. That's what this piece of legislation is doing.

It's putting forward a public plan. As my colleague has indicated, we heard yesterday from many other places that said that the private plans would be cut. For you to then say you're going to negotiate, that's not something that's negotiable. It's in this piece of legislation.

What do we need to change in this legislation such that you would be able to negotiate your steps as you move forward?

[Linda Silas]

MP Kitchen, yes, any bill could be improved, but it has to start somewhere. This is a start based on 30 years of evidence.

I do commend your wife for her role, and I'm sure she's a great patient advocate. I'm probably the best nurse advocate there is in the country. I've been elected 11 times to do that over the last 22 years.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

I apologize for interrupting you. My question to you is this: What can we do? That's what we're here for—to come up with plans to improve this. This is the role of this committee here right now. How we can improve that? What can we do today that would make those improvements and put forward steps?

You're not offering any steps that would improve that part. You're saying that you're just fine with this. However, what I'm saying to you is that what is “fine with this” puts people's lives at risk. To step forward for the 10% of Canadians who don't have a plan, regardless of whether it's a good plan or not, the bottom line is to provide the funding to help those people. This is not going to help them, because it's going to provide only basic medications in the diabetes area, and it's not going to help others, who have plans, because this will take that away from them.

What do you see that we can do to change that?

[The Chair, Liberal, Sean Casey]

Ms. Silas, that's all the time for Dr. Kitchen, but take 20 seconds and do your best.