Health Committee on May 27th, 2024

[The Chair, Liberal, Sean Casey]

I call this meeting to order.

Welcome to meeting number 118 of the House of Commons Standing Committee on Health.

Before we begin, I would like to ask all members and other in-person participants to consult the cards on the table for guidelines to prevent audio feedback incidents. Please take note of the following preventative measures in place to protect the health and safety of all participants, including the interpreters. Use only a black approved earpiece. The former grey earpieces must no longer be used. Keep your earpiece away from all microphones at all times. When you're not using your earpiece, place it face down on the sticker placed on the table for this purpose. Thank you all for your co-operation.

Pursuant to the order of reference adopted by the House of Commons on Wednesday, May 22, 2024, the committee is commencing its clause-by-clause consideration of Bill C-64, an act respecting pharmacare. I'd like to provide members of the committee with a few comments on how the committee will proceed with clause-by-clause consideration of Bill C-64.

As the name indicates, this is an examination of all the clauses in the order in which they appear in the bill. I will call each clause successively, and each clause will be subject to debate and a vote. If there is an amendment to the clause in question, I will recognize the member proposing it, who may then explain it. I would like to remind committee members that pursuant to the order adopted by the House on Wednesday, May 22, all amendments had to be submitted to the clerk of the committee by 4 p.m. on Friday, May 24. As a result, the chair will allow only amendments submitted before that deadline to be moved and debated. In other words, only amendments contained in the distributed package of amendments will be considered. When no further members wish to intervene, the amendment will be voted on. Amendments will be considered in the order in which they appear in the package of amendments.

In addition to having to be properly drafted in a legal sense, amendments must also be procedurally admissible. The chair may be called upon to rule amendments inadmissible if they go against the principle of the bill or beyond the scope of the bill, both of which conditions were adopted by the House when it agreed to the bill at second reading, or if they offend the financial prerogative of the Crown.

Amendments have been given a number in the top right-hand corner to indicate which party submitted them. There is no need for a seconder to move an amendment. Once an amendment has been moved, you will need unanimous consent to withdraw it.

During debate on an amendment, members are permitted to move subamendments. Approval from the mover of the amendment is not required. Subamendments must be provided in writing. Only one subamendment may be considered at a time, and that subamendment cannot be amended. When a subamendment to an amendment is moved, it is voted on first. Then another subamendment may be moved or the committee may consider the main amendment and vote on it.

Finally, pursuant to the order adopted by the House, if the committee has not completed the clause-by-clause consideration of the bill by 8.30 p.m., all remaining amendments submitted to the committee shall be deemed moved. The chair shall put the question forthwith and successively without further debate on all remaining clauses and amendments submitted to the committee, as well as each and every question necessary to dispose of the clause-by-clause consideration of the bill, and the committee shall not adjourn the meeting until it has disposed of the bill.

I thank the members for their attention and wish everyone a productive clause-by-clause consideration of Bill C-64.

I would also like to take this opportunity to welcome our witnesses, who are available as experts regarding any questions that members might have related to the legislation. You will recognize them. From the Department of Health, we have Michelle Boudreau, associate assistant deputy minister, strategic policy branch, and Daniel MacDonald, director general, office of pharmaceuticals management strategies, strategic policy branch.

We will now move to clause-by-clause study. Pursuant to Standing Order 75(1), consideration of clause 1, the short title, and of the preamble is postponed.

The chair therefore calls clause 2. Since there are a few amendments to clause 2, the definitions clause, I would suggest, based on advice from the legislative clerks, that we postpone the study of clause 2 until the end. This will allow us to first consider and then make a decision on amendments that could have an impact on the definitions.

As a reminder, the definitions clause of a bill is not the place to propose a substantive amendment to a bill, unless other amendments have been adopted that would warrant amendments to the definitions clause.

For clarity, as an example, there is an amendment—CPC-2—that proposes to add a definition for “Indigenous governing body”, but as of right now, the words “Indigenous governing body” do not appear in the bill. Therefore, by postponing clause 2, we can determine whether or not to put those words in the bill. That would dictate whether or not it is appropriate to assign a definition in the legislation.

I'm asking for your consensus to postpone clause 2 until the end. Is that the will of the committee?

I see consensus. Thank you, colleagues. That will make things move more smoothly.

(On clause 3)

The first amendment for clause 3 is CPC-7. It is on page 7 of the package, and it stands in the name of Dr. Ellis.

Dr. Ellis, would you like to move CPC-7?

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

Sure. Thanks, Chair.

I move that Bill C-64, in clause 3, be amended by replacing lines 1 to 3 on page 3 with the following:

“3 The purpose of this Act is to create a funding framework for certain prescription drugs and related products intended for contraception or the treatment of diabetes, and to support”

It continues on from there.

[The Chair, Liberal, Sean Casey]

Thank you.

Is there any debate?

Go ahead, Dr. Ellis.

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

The big thing we're looking for here is.... It's very clear, in the original title of this bill, that this is not universal pharmacare. Certainly, Canadians need to know that this is what this particular bill is.

The two medications it proposes to cover are contraception and medications for the treatment of diabetes and, potentially, associated devices. Even that is a bit of a stretch, given that we learned during testimony that the lists put out on Canada.ca are really—I apologize for saying it this way—not built on reality, in the sense that they can be modified, added to and subtracted from, etc.

The big thing with respect to those two lists, from my perspective, is that I'm very uncertain as to why they were even put out in the first place, because no one ever said they were examples or anything like that. They alluded to the fact that perhaps they are the formulary to come.

We also heard several glaring examples that were missing from those lists, including perhaps the most successful medication to treat diabetes ever, known as Ozempic, or semaglutide.

Given those points, I think clarity is needed for Canadians that, as I mentioned, it's for certain prescription drugs, certainly not all, and who knows what may or may not come in the future?

I shall leave it at that.

[The Chair, Liberal, Sean Casey]

Go ahead, Mr. Doherty.

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

It's hard for me to chime in after I've missed the majority of the debate and discussion on this bill, but let's call it for what it is. It is being billed as pharmacare, but it really is not pharmacare.

A national pharmacare program implies that Canadians will be able to receive any drugs they are looking for. Further to what Dr. Ellis said, this piece of legislation really deals with just two main areas of concern: contraception and diabetes. They are two very important topics and issues that Canadians face and are dealing with.

If you've read the common-sense amendments that have been put forth by our Conservative colleagues, they say we call it what it is. Let's not mislead Canadians. I think it's important that we, here at this committee.... I've said this all along: We do some of our best work in Parliament at committees, but it calls for common sense from all of us. The work we do here will be reported to the House, and then at that point, Canadians will know what Bill C-64 entails.

I don't think there's any requirement for us to bill this as anything other than what it does: It's a funding framework for certain prescription drugs and related products intended for contraception, for the treatment of diabetes, and to support....

It's not just this bill, but others. We struggle in this House at times to get common sense to come into play. This is just a common-sense amendment that our colleague Dr. Ellis has put forth.

I support CPC-7.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Doherty.

Mr. Julian is next.

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

Thank you, Mr. Chair.

I also want to thank you again for giving us plenty of notice. You wrote to us two weeks ago, letting us know about amendments and the timetable required. That gave us adequate time to prepare amendments.

I would not support this particular amendment. It limits the scope, purpose and principles of the pharmacare bill. The majority of witnesses were very clear about this being important legislation. It will make a difference in people's lives. They want to see the bill adopted, not changed or, in this case, limited in the scope of pharmacare. They want to see it move forward. There was particularly compelling testimony from people with diabetes who are paying $1,000 or sometimes $1,500 per month for diabetes medication. That is a struggle for them each and every day. They have to put food on the table. They have to keep a roof over their head. At the same time, they have to pay for medication.

As you know, Mr. Chair, every other country that has universal health care—the NDP, of course, under Tommy Douglas, fought hard in a minority Parliament to get universal health care—has universal pharmacare. To limit the scope or purpose of the act, to my mind, does a disservice not only to all those who are going to benefit from pharmacare in its first stage—which is for diabetes medication and contraception—but also to all those who are looking to see the next stage of pharmacare.

I particularly flag constituents in my riding. They are paying $1,000 a month for heart medication. If they don't take that heart medication—it's very similar to diabetes medication—they die. They and their families are forced to come up with $1,000 each and every month. Any member of Parliament who believes in fighting against affordability issues....

Of course, under the previous government—the Conservative government—we saw housing prices double and food bank lineups double. Tragically, we've seen the same thing under the current government. I think members of Parliament are all aware of the affordability issues that have happened over the last 17 years—the doubling and doubling again of housing prices, and the doubling and doubling again of food bank lineups.

We need to start providing this relief. The NDP's dental care program has already helped 100,000 seniors access dental care. This pharmacare bill, once it's passed and once the agreements are negotiated by the minister of health, will help six million Canadians with diabetes and nine million Canadians who look for contraception.

If we're concerned about affordability, we should all be voting for the bill, not limiting its purpose. That's why I'm voting no on this amendment.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Julian.

Mr. Naqvi, go ahead, please.

[Yasir Naqvi, Liberal, Ottawa Centre, ON]

Thank you, Chair.

I suggest members vote against this suggested amendment.

This is a framework legislation to develop a pharmacare system in Canada. Clause 3 is important in terms of outlining the purpose under which this framework legislation is developed. Of course, we are talking about the first phase of that framework around pharmacare. Making the kind of amendment that has been proposed limits the scope and purpose of the legislation as a framework piece of legislation.

In that spirit, our recommendation is to vote against these amendments.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you.

Mr. Doherty, go ahead, please.

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

I think it's interesting that our colleague Mr. Julian takes the opportunity to slag the previous government when he's supported the Liberal government for the last nine years. We've seen an affordability crisis like we've never seen in generations. We have more Canadians visiting food banks under this government and under this coalition than ever before. We've seen more homeless encampments under this coalition than ever before, so it's a little rich for our colleague down the way—whom I respect—to stand there and use this as an opportunity to slag a government and slag any intentions that we put forth.

This is not a pharmacare bill. There are no illusions about that. Why are we lying to...? I won't say “we”. Why are they lying to Canadians? They're misleading Canadians, giving false hope that this is a pharmacare bill.

If the heart medication of his constituents that our colleague brings up was truly important to them, why is that not included in this version of this bill? It is simply a campaign brochure so that both parties—the coalition—can stand up and say, “This is what we've done for you.” It's 100% wedge issues, trying to paint the Conservatives and whoever else into a corner and twist themselves up. The simple fact is that they're misleading Canadians on this.

The writing's on the wall. We know what's going to happen. It'll be the Conservatives who are standing up for the truth and trying to make sure.... Look, if this bill is going to pass, why don't we just call it what it is? Why not be clear with Canadians?

It's bizarre to me that we sit here and.... You want to stand up, wave the flag, and trumpet that you've gotten pharmacare through, or a national dental program. It's not a dental program. Most dentists will not subscribe to that dental program because there's not enough information. They have no idea how it's going to work. It's great that our colleague down the way says that there are 100,000 seniors he knows of, or that they know of, in the first 22 days. That's amazing. However, the people I talked to and the dentists I talked to will not sign up for it because there's not enough information.

Therefore, there isn't a national dental care program, just as there will not be a national pharmacare program. It's because the work has not been done in advance to make sure that Canadians from coast to coast who currently have plans will be made whole. As for the Canadians who do not have a plan right now, what will they be getting?

It's very frustrating when we sit here and listen to the rhetoric that comes from some of our colleagues. When we're just having a normal conversation, they simply take every opportunity to slag a party that hasn't been in power for 10 years, yet they've been in a coalition for nine years now, and they have backed this government every step of the way. Through every scandal that this government has gone through, they have sided with them. It's deeply disappointing that the NDP has fallen so far and continues to back a government that is corrupt and on its way out.

[The Chair, Liberal, Sean Casey]

Dr. Ellis is next.

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

Thanks very much, Chair, and thanks to my colleague.

You know, it's interesting. I had been hopeful after my colleague Mr. Doherty and I started off this round with a couple of short, rational comments for accepting the amendment we had proposed. It was, without much in the way of partisan rhetoric, simply to point out realistically that this bill does not talk about other medications. I guess I should be aghast, but probably not now, that a four-page bill, if you take out the preamble, is what this NDP-Liberal coalition thinks a pharmacare bill should look like after 10 hours of witness testimony.

The other part of that interesting witness testimony was having Dr. Morgan and Dr. Gagnon here. Everybody heard their testimony. As interesting as it may have been, the two of them, thankfully, were not in the same room. One was virtual and one was here, but they were both billed as Canada's leading experts on pharmacare. We know that neither one of them had any input into this bill. They had none. It was zero. These were two Canadian experts on pharmacare, who touted the incredible benefits of pharmacare, of what it could be, and what it should be, etc., and what we hear is that they had zero input.

People around the table may think that's normal, and that this is not how a government works. They wouldn't reach out to Canada's leading experts on pharmacare. No, what would they do? Quite frankly, I have no idea what they did. I would suspect that they dreamt up this pharmacare pamphlet of four pages somehow in-house. Sadly, people are going into pharmacies now and asking for their free medications.

We know that this bill does not exist. We also know that there is no possibility anywhere in the near future of this coming into being, in the sense that there is an incredible bureaucratic framework that now exists to continue the creation of the Canada drug agency and the phase-out of the CADTH and the creation of this heretofore unknown council of experts, or whatever the bureaucratic name is. We don't know where they're coming from or who they are.

Maybe two of Canada's leading experts in pharmacare will be on that council of experts. However, again, that council of experts is not there to make this bill better; it is to actually decide which diabetes and contraceptive medications will be on a formulary. The formulary doesn't exist, even though, as I mentioned previously, two lists came out that say these are the medications that will likely be within the scope of the pharmacare pamphlet. That is not transparency.

Those are not sunny ways. That is not allowing Canadians in any way, shape, or form to begin to have an understanding of Bill C-64.

The government may have aspirational goals, which is fine. Everybody should have goals for themselves that they set and re-evaluate, but to pretend that this is anything but an idea... As one of my colleagues once said, “This is out there telling Canadians you have built a house for them that you're going to give to them for free, when realistically you haven't yet consulted with the architect.” Here it is, “We've built your house, but we really have no plan.”

We're now going to have arguments from the NDP-Liberal coalition, suggesting this is a fully completed house, and this will be a comprehensive plan when it's all done. Sadly, on behalf of Canadians, we would implore the acceptance of the amendment, because we know the truth: There is no transparency here and there are no sunny ways here.

The other difficulty, of course, is our NDP colleague talking about the last 17 years. Well, it's fascinating that the ghost of Stephen Harper lives deep in the heads of the NDP-Liberal coalition, rent-free forever.

I wish I had a nickel for every time I heard them mention Mr. Harper's name. It's in a disparaging way, of course, even though we know the average rents since the Harper government left have doubled and the average mortgage payments have doubled. The inflationary cost of interest rates has literally put Canadians in the poorhouse, if there were such a thing.

It's fascinating to me that the NDP part of the NDP-Liberal costly coalition wants to go on and talk about how difficult things have been for the last 17 years. Canadians know that now, more than ever, there's no chance for the NDP to ever form any government in this country. Sadly, the late Jack Layton probably took them as close to the promised land as they're ever going to get. Certainly with the way things are going, the promises they're making, the difficult coalition and the hole they've dug for themselves, I would suggest they're going to be like Moses: They're going to see the promised land, but they're never, ever going to get there.

When we talk about the cost of things and how difficult it is for Canadians, again, this government really is quite fascinating in the sense that it has this strange idea that after it's created a problem for Canadians, it wants to bill itself as the saviour to come in and free Canadians from the bondage it has created. We know its fiscal irresponsibility is one part of that.

Looking at the government's fiscal irresponsibility, I would challenge Canadians out there today to think about the money it spent on vaccine factories in this country.

First, we had the vaccine partnership with the Mitsubishi Tanabe group, which came here with a plant-based vaccine. Because it was based on the nicotine plant, the World Health Organization said it would be very difficult to use it. Also, because Philip Morris International, a major tobacco player, was involved with the development and ownership of that company, the World Health Organization said that in no way, shape or form could that vaccine potentially be used on the world market. That was because of the association with Philip Morris International.

What happened after that? Well, in this fiscal irresponsibility, as I'm pointing out, Philip Morris got out of the whole Medicago-Mitsubishi Tanabe partnership. The Canadian government continued, while working, strangely enough—and I'll come back to this, because I think it's germane and important—in the face of the national microbiology lab scandal, when two scientists were released from the national microbiology—

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

On a point of order, I question the relevance.

As you know, Mr. Chair, within committees, there are two sacred rules when you're trying to block legislation in a filibuster. The two sacred rules are you can't be repetitive and you have to be relevant, and Mr. Ellis's comments are straying now into irrelevance.

[The Chair, Liberal, Sean Casey]

I agree with you, Mr. Julian. I trust that Dr. Ellis will bring it back to CPC-7.

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

Absolutely, Chair.

If the member had been paying rapt attention—as he should, because he fails to understand the facts—he would know that I mentioned this is a dissertation about fiscal irresponsibility, and the irresponsibility and disinformation peddled by this government.

I shall continue. If the member wishes to pay close attention, it won't be necessary to interrupt.

That being said, when we begin to look at this NDP-Liberal costly coalition government's idea of fiscal responsibility, it's related to the fact that even during the time when we knew two scientists had been dismissed—

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

I have a point of order.

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

—from the National Microbiology Laboratory—

[The Chair, Liberal, Sean Casey]

Mr. Julian, go ahead on a point of order.

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

Mr. Chair, this is irrelevant to the discussion of CPC-7. Again, there is an issue of relevance here that Dr. Ellis needs to be attentive to. I would ask you to bring him to order, please.

[The Chair, Liberal, Sean Casey]

Dr. Ellis, the connection you're trying to make between CPC-7 and the lab is tenuous at best, so I'd ask you to come back to it, please.

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

That's not a problem, Chair.

As I was saying, the two Chinese-Canadian scientists dismissed from the National Microbiology Laboratory when the Canadian NDP-Liberal costly coalition government was creating a partnership with Mitsubishi Tanabe and Philip Morris—

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

I have a point of order, Mr. Chair.

You directed Dr. Ellis and he's now flouting the rules in quite a disturbing way.

[The Chair, Liberal, Sean Casey]

Actually, I'm not sure you gave him enough time to make the connection to be able to say that. It appears that you're correct, but I think we need to hear a little more and have him define the connection.

Go ahead, Dr. Ellis.