Debates of Oct. 5th, 2017

Opposition Motion—Pharmacare

[Tracey Ramsey, NDP, Essex, ON]

Mr. Speaker, since 1993 the Liberals have stood in the House and talked about the importance of pharmacare. I do not know how much more evidence needs to come forward. The evidence has been mounting, and 91% of Canadians want a national pharmacare program. I do not know how much more evidence the government needs on this.

Canadians keep speaking loudly and clearly, and the Liberals are ignoring them. I cannot believe the member does not support holding one meeting within a year. Is the member standing in the House and telling Canadians and people from his riding that his government will not even hold a meeting on pharmacare with the provinces?

[Bill Blair, Liberal, Scarborough Southwest, ON]

Mr. Speaker, I thank the member for the opportunity to explain our government's commitment to look at all the ways we can make pharmacare more accessible and more affordable for all Canadians.

I have outlined some of the outstanding work that has taken place over the past several years to ensure that we do our very best to make pharmaceuticals available, accessible, and affordable for all Canadians. That work continues unabated.

We are very fortunate to have the excellent work of our health committee, which has examined the issue with the intent of bringing back a report and recommendations to government. We are very open to those discussions and are looking forward to the final work of that committee, after it has gathered all the evidence and brought its findings to the health minister for consideration.

[Jenny Kwan, NDP, Vancouver East, BC]

Mr. Speaker, surely the member must understand that the motion does not impede the work of the committee.

As well, I would quote the chair of the Canadian Doctors for Medicare:

As a physician, my first thought is about my patients’ health. Knowing now that the millions of Canadians who can’t afford to take their medication could be covered for less than we spend today, I can only ask why Canadian governments aren’t acting now to implement pharmacare.

Based on that, would the member vote for the motion?

[Bill Blair, Liberal, Scarborough Southwest, ON]

Mr. Speaker, I assure the member that our government is in no way impeded by the motion and remains committed to continuing to move forward to gather the best evidence and obtain the advice of the health committee. We remain committed to protecting the health of all Canadians and to ensuring prescription drugs are affordable and accessible, and we will continue to do that work. We are not at all, in any way, impeded in that important work or in that commitment by today's motion.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

Mr. Speaker, I am pleased to have a chance to contribute to today's debate on prescription drugs, which are an important part of our health care system. In order for us to commit to a national pharmacare program, the necessary groundwork must be laid to support efficient management of pharmaceuticals in this country.

That is why I am pleased to be here today to talk about appropriate prescribing and use of drugs. Appropriate prescribing is an important component of our government's commitment to improving the affordability, accessibility and appropriate use of prescription drugs.

Significant increases in the use of prescription drugs to treat health problems have led to an increase in inappropriate use and unnecessary spending on these drugs.

Inappropriate prescribing for seniors comes with a specific set of concerns. More than 80% of Canadians over the age of 65 take at least one prescription drug regularly. In fact, one in three Canadians takes five or more medications a day. It is estimated that 37% of these prescription drugs are potentially harmful or ineffective, costing the health care system more than $400 million a year.

The World Health Organization estimated that in 2012, half of the world's drugs were either prescribed, dispensed, or sold inappropriately, and that half of all patients failed to take them correctly. A proper prescription aims to improve prescription drug use by ensuring that the right drug is prescribed to the right patient at the right time. Our government acknowledges that it is an important part of our health care system that we have to improve if we want to reduce waste, protect patients from unnecessary harm, and make progress in health care.

Patients seek prescription drugs when they are sick, and prescribers use their expertise to choose drug treatments for their patients. When prescribed and used appropriately, prescription drugs can prevent sickness, improve productivity and quality of life, reduce absenteeism, support mental health management, and even cure illnesses.

In fact, when appropriately prescribed and used, drugs are an essential part of clinical care. However, 50% of Canadians do not take their drugs exactly as prescribed. Furthermore, questionable prescribing practices lead to both inefficiency and waste. If they are not used appropriately, prescription drugs can cause serious harm and put additional pressure on other parts of the health care system.

According to the Canadian Society of Hospital Pharmacists, every year, drug non-compliance is the cause of 10% of all hospital admissions and 25% of hospital admissions for the elderly. Every year, 200 drugs are approved, and it is very difficult for prescribers to keep their knowledge up to date.

Many of the new drugs that are authorized for use in Canada each year come with higher price tags but very few additional clinical benefits compared to other less expensive drugs that are already on the market. The appeal of these new drugs may lure patients and prescribers into using them instead of existing drugs or other treatments that are more effective.

Unfortunately, our health care system does not always give prescribers the support they need in choosing the best drugs for their patients. In Canada, colleges of physicians and medical associations develop clinical guidelines to help with prescribing drugs. However, many of these guidelines are developed with the help of industry funding and are not subject to quality checks.

In budget 2017, we allocated additional funding to the Canadian Agency for Drugs and Technologies in Health, or CADTH, to help support existing intergovernmental efforts to ensure that drugs are prescribed and used properly. That includes identifying best practices and promoting new implementation strategies for appropriate use.

CADTH is responding to the need for more guidance on prescribing practices by adapting its products and services. In the future, CADTH's appropriate use programs will include evidence-based prescribing guidelines and examine the comparative efficacy of non-pharmacological treatment options. For example, CADTH's review of first- and second-line pharmacological diabetes treatments meets the need for more sound evidence about categories of drugs, not one drug in particular. This will help prescribers select the right drug and optimize its therapeutic use.

In the past, our ability to address inappropriate prescribing was impeded by limited access to reliable national data on prescribing practices and the use of prescription drugs. Without that kind of data, our understanding of the problem and our ability to address it are limited. Without sound, objective evidence, programs to promote appropriate prescribing and repair the damage done by inappropriate use cannot be designed to focus on the areas of greatest need.

We responded to this challenge with federal investments in budget 2016 and budget 2017, so that Canada Health Infoway could work with the provinces and territories to develop a national electronic prescription program to allow health professionals who issue prescriptions and pharmacists to share information electronically.

This system, called PrescribeIT, will help reduce prescription errors, inform pharmacists of potentially dangerous drug interactions, and help patients take their medication as prescribed. Since it will be integrated into existing drug information systems in the provinces and territories, it will provide decision-makers with a more accurate overall picture of pharmaceuticals in Canada.

PrescribeIT is already in use in Ontario, where the first electronic prescription was sent to Huntsville on August 30. A number of organizations in the country are already working on appropriate use, and Canada has shown its capacity for developing tools and resources in order to create effective programs. What is missing is an active strategy to capitalize on the objectives and progress of existing organizations and programs. Such a strategy could help eliminate duplication of efforts in this domain, address important gaps, and ensure more effective intervention.

In order to help determine how international best practices could be adopted for developing such a strategy, Health Canada is now asking the Drug Safety and Effectiveness Network to conduct an in-depth analysis of international organizations responsible for the appropriate use of drugs.

At this stage, I would like to talk about two leading organizations recognized by the Drug Safety and Effectiveness Network, that were created over the past few years to address the issue of appropriate use in Canada, the Choosing Wisely campaign and the Canada Deprescribing Network.

Choosing Wisely is a campaign to help clinicians and patients engage in conversations about unnecessary tests and treatments, and make smart and effective care choices. To date, more than 40 medical specialists have made recommendations on inappropriate care, including the use of prescription drugs.

Recently, with the help of federal funding, these leading organizations were able to broaden the scope of their message across the country.

The Canada Deprescribing Network was established out of concern for the risk related to the use of medication by seniors. This group of clinicians, researchers, and patients work together to promote the deprescribing of medication that may no longer be of benefit or that may be causing harm. To date, the network has produced a number of resources, including guidelines on deprescribing the four drugs most commonly prescribed to seniors. These two leading organizations are working together with the Canadian Agency for Drugs and Technologies in Health in key areas for improving the care that Canadians receive by coordinating their work on the inappropriate prescription of drugs used to treat insomnia.

I am sure my colleagues will agree that improving the prescription and appropriate use of drugs is key to improving the effectiveness and sustainability of our health care system. On that, I am prepared to answer questions.

[Brigitte Sansoucy, NDP, Saint-Hyacinthe—Bagot, QC]

Mr. Speaker, I listened attentively to my colleague, and throughout his speech I only heard arguments in favour of the motion. All his arguments supported the fact that a universal pharmacare program is important.

We are the only major industrial country that offers health care insurance but not a drug plan. As the parliamentary budget officer stated, how can we pass up $4.2 billion a year? What I heard was a number of arguments in support of today's motion. I presume that my colleague will be voting for the motion.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

Mr. Speaker, I am a member of the Standing Committee on Health, which is studying the possibility of creating a pan-Canadian pharmacare plan. We are in the process of gathering information.

I agree that my speech today further supports the fact that there is a real need for such a plan. However, before negotiating a pan-Canadian program with the provinces and the other Canadian regions, we must finish our study, which we have not done yet. I am in the midst of collecting information and we will ultimately table a report.

We just received the PBO report, which provides all kinds of extremely important information. However, we have to digest the information and then have intelligent discussions based on the evidence. That is what we will do.

[Francis Drouin, Liberal, Glengarry—Prescott—Russell, ON]

Mr. Speaker, I would like to thank my colleague from Thérèse-De Blainville for his excellent speech.

In politics, we must walk the talk. In the last election, the NDP talked about investing in health and creating a national pharmacare program, and also balancing the budget. That is all well and good. However, I went outside and money is still not growing on trees.

I would like to ask my colleague what our government has done to date in order to reduce the cost of patients' medications.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

Mr. Speaker, that is a very good question.

Our government has done a number of things to help the provinces set up a bulk purchasing program so they can reduce costs. Initiatives like that come from the federal government and the House as a whole.

The Standing Committee on Health is talking about these issues and is not waiting for all the results to come in before taking action. The important thing is to keep going, not necessarily to make predictions. We have to act now, and that is what we are doing.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Mr. Speaker, I listened with interest to the hon. member's comments. However, I think he is missing what to me is the basic point, which is that we have gaps in our coverage.

I represent a riding that starts in an urban area and extends out to a rural area. I represent retired people and working people. I want to give the member two examples of a lack of coverage.

A couple who live in the rural area of my riding wrote to me to say:

Since we retired, we haven't been able to afford all of our medications.

From the other end of my riding, the urban end, someone who is working says:

I use the food bank most weeks because all of my money is used up for the drugs I need for my diabetes and blood pressure.

Would the member not agree that all the good things he has talked about have not solved this problem? What we need is a universal pharmacare program to make sure all Canadians get the full benefit of our health care system.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

Mr. Speaker, I really appreciate my colleague's question.

The more we study this issue and the more we look at the facts, the more it becomes clear that we need national pharmacare. I agree with that in principle, but we have to achieve that end as quickly as possible and provide the best possible care. We also have to make sure drugs are prescribed to the right people at the lowest cost possible. That is what we are going to do.

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

Mr. Speaker, I will share my time with the elegant and extraordinary member for Vancouver East.

This is an issue that has a lot of importance in my riding of New Westminster—Burnaby. It is something I hear about regularly. There are seniors who do not have access to medication because they cannot afford to pay for it, and families that, because they do not have access to private pharmacare plans, have to effectively pay out of their pockets, if they can afford to. This is not an issue that is just sterile debate in the House of Commons. This really touches the heart and soul of Canadians' quality of life.

Today we have heard a lot of arguments from Liberal members of Parliament. They have consistently said that we should just wait. Their arguments would have a little more validity if it was not for the history of the Liberal Party on this issue.

In 1964, the Royal Commission on Health Services recommended that we have national pharmacare. The Liberals said that it was not ready yet, so we should wait. Fast forward to 1997, when we had the National Forum on Health. In 2002, there was the Royal Commission on the Future of Health Care in Canada, and in 2004, the premiers' consensus on pharmacare. In each of those periods, we had Liberal governments that said that they supported the principle of pharmacare but needed to wait. It was just not the right time to do it, for whatever reason.

Today the Liberal arguments are similar to what they were years and decades ago. Yet again we have Liberal MPs standing in the House of Commons saying that this is not important and we should wait. Unbelievably, now their excuse is that we have to wait for a committee report. Somehow Canadians should put aside that priority of putting in place a pharmacare plan that the vast majority of Canadians support, because Liberals on a committee want to wait to produce a report.

There would be credibility in that argument if for decades and decades Liberal MPs had not been standing in this same House saying exactly the same thing. In principle, they support pharmacare, but they have to wait for a royal commission or another royal commission. They have to wait for a committee or another committee or a budget. For decades Canadians have been forced to wait.

It would be almost humorous if it did not have such a profound impact on Canadians. If anyone here doubts how important this issue is to Canadian families and Canadians, they should step out of this House, go right across the lawn down to Wellington Street, turn left, and go down over the bridge toward the Château Laurier in this same city. Not every day, but most days, they will find on the bridge between Parliament, the East Block, and the Château Laurier a man named Jim. Jim sits in his wheelchair and has to beg for money to pay for the drugs that will keep him healthy in life. I have spoken to Jim many times, and I have dropped some money in his cup. He has agreed that I could share his story. I know that many of my colleagues, other New Democrats, have stopped and spoken to Jim as well.

Jim looks like a robust guy, and he was. He worked hard all his life, then injuries and sickness meant that he had to purchase drugs to keep him alive. He had to go to the pharmacy and get those drugs, but those drugs are pretty expensive, about $400 a month in the absence of a national pharmacare plan, which we are debating today and could make a reality if Liberals supported the NDP motion. We could start to make that a reality within a year. That is not going to help Jim over the next 12 months. He is still going to have to beg. He is still going to talk to passersby. However, what a difference it would make in his life to know that in a year, the federal government would actually be sitting down with the provinces and starting to put in place and negotiate a national pharmacare plan.

That is what we are called upon to do today. We are not called upon to have a sterile debate. We are not called upon to say let us wait for a particular committee report, and then we will talk some more, and then we will rag the puck, as they say in hockey, and then in five or 10 years, we will come back and have the same debate we had after the premiers consensus of 2004, the Royal Commission on the Future of Health Care in 2002, the National Forum on Health in 1997, and even the Royal Commission on Health Services in 1964. Canadians have been waiting long enough. It is time to have pharmacare. There is no doubt.

If Jim could come here, or the Tracys, the Ramdeeps, the Lemays, or the hundreds of thousands of other Canadians who do not have access to pharmacare right now, if they came to the galleries and we gave them a microphone to tell us about what life is like without a pharmacare plan, they would tell us some pretty sad stories. They would tell us about having to make tough choices between eating and buying the drugs that will keep them healthy. They would tell us stories about what they have had to give up. Some of them would tell us stories about not being able to continue to pay their rent. If they are someone like Jim, they would tell us about what they have to do every day, rain or shine, whether the sun is beating down in Ottawa or it is pouring rain. I have even seen him in the snow. He has to come here to beg to get enough money to get through the month. What is wrong with that picture?

This cannot be a sterile debate. It cannot simply be Liberals saying let us get a committee report together and wait a few more months or years or decades. It has to happen now.

I believe that all members come to the House with the intent to do good. I believe that every member of the House is elected to serve and believes profoundly in making Canada better. We know the horror stories that are out there. We know how much people are suffering now, and we have the ability to change it.

The good news is that, as the parliamentary budget officer has told us, it is even cost-effective. We end up saving $4 billion a year by voting yes to the NDP proposal to start negotiations. We actually will save money for Canadians. Cost is not an issue. The motion clearly talks about sitting down with the provinces, so negotiations are not the issue.

We know that it would still take a year or two to put this together, but I would wager that we would all be proud to come forward in 2019 with a new national pharmacare plan.

Tommy Douglas, the father of Canadian medicare and the premier of Saskatchewan, someone who was voted the greatest Canadian in our history just a few years ago, always believed that moving to medicare was the first step in moving to pharmacare. He believed that we could not have comprehensive health coverage unless we could ensure that medication was actually part of it too and that nobody, no senior, no child, and no family, should have to put aside medication because a person could not afford to pay for it. That is a simple Canadian principle.

This is a very Canadian motion. It is something that every member of the House of Commons should vote on and vote for. If members doubt for just a moment whether they should vote for it, I ask them to go out of the House of Commons for a few minutes, go down outside the Château Laurier, and talk to Jim. Jim will tell them to vote yes for this motion.

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the Leader of the Government in the House of Commons]

Mr. Speaker, there are many Canadians in all the constituencies we represent who have similar stories, including his example, Jim. That is one reason it is important to recognize that it is not a political party or an individual that is driving this. I believe the issue is being driven by Canadians as a whole. That is why a group of concerned members of Parliament who sit on the Standing Committee on Health came up with the idea to pursue this.

The current government has dealt with issues, such as the health care accord and trying to reduce the cost of medications. We have a health committee that is very proactive.

The report this motion is based on is the parliamentary budget officer's report, which will be of most interest to the Standing Committee on Health, because it asked for the report. The report has not even been brought forward for discussion at the committee. It is only a matter of days or weeks before that takes place.

Could the member provide his thoughts on how important it is that the standing committee continue to do its good work looking at the details so that at some point we will be able to deal with it and work with the stakeholders, knowing exactly what is being proposed?

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

Mr. Speaker, I am so saddened by the question from that member. I like the member, but I am so saddened by his asking something that is essentially irrelevant to the Jims, the Traceys, the Randeeps, and the Lemays across this country who do not have access to essential medication today. It is irrelevant. Sure, the committee can keep working. The committee can do all the work it wants. However, what we are setting out today is the possibility of starting that discussion, within a year, and completing it, hopefully, in just over a year so that we can actually bring pharmacare in for Canadians.

I think committees do great work. However, the idea that we sit in this House and talk about when a committee report should be published and when that paper should be produced is irrelevant to the issue at hand. The issue at hand is whether we are going to bring in pharmacare for Canadians. They need it. Some families are desperate. Many seniors are desperate.

Let us just get it done. Let us vote yes on the motion to bring pharmacare to Canada.

[Jenny Kwan, NDP, Vancouver East, BC]

Mr. Speaker, I thank the member for his very passionate and very real story about why we need to pass this motion.

The question we hear from the Liberal government side seems to indicate that somehow this motion is a partisan motion and that supporting it and moving forward on a national pharmacare program is partisan.

The motion reads:

That, given that millions of Canadians lack prescription drug coverage, and given that overwhelming evidence, including from the Parliamentary Budget Officer, has concluded that every Canadian could be covered by a universal pharmacare program while saving billions of dollars every year, the House call on the government to commence negotiations with the provinces no later than October 1, 2018, in order to implement a universal pharmacare program.

Could the member please advise us which part of this motion is partisan?

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

Mr. Speaker, I appreciate the good work of the member for Vancouver East. She comes from a proud tradition of very strong representation in Vancouver East. She is an exceptional member of Parliament in this House of Commons. I admire her work enormously.

She is, of course, asking a rhetorical question. There is nothing in this motion that is partisan. Everything in this motion is conceived for members of Parliament to listen to their constituents and to adopt this plan to bring in national pharmacare. It is very simple.

I have been listening carefully to the debate. There are very eloquent members of Parliament here. However, the ones who are saying to wait another five, 10, 15, or 20 years are not following the wishes of their constituents and of Canadians. Ninety percent of Canadians want to see pharmacare. Let us get it done. Let us vote yes on this motion.

[Jenny Kwan, NDP, Vancouver East, BC]

Mr. Speaker, I am honoured today to rise in the House to speak in support of the motion tabled by my colleague, the member for Vancouver Kingsway, a tireless advocate for not just maintaining but improving Canada's public health care system, and in this case pharmacare specifically.

As my colleague mentioned today, New Democrats champion public health care while Liberal governments need to be dragged forward to make any progress. That is nothing new.

It was a former leader of the New Democratic Party who championed and pushed for public health care, first in Saskatchewan and then nationally, making access to health care a basic right for Canadians for generations to come.

To quote the greatest Canadian, Tommy Douglas, “I came to believe that health services ought not to have a price-tag on them, and that people should be able to get whatever health services they required irrespective of their individual capacity to pay.”

It is well known that the universal health care dream extended well beyond where universal access to care is today and that much more work remains to be done.

I quoted our former leader to highlight the New Democratic roots, our principles, and the battles we have been fighting to improve the lives of Canadians for years.

I say that this issue is important not only for New Democrats but for all Canadians, no matter what their political stripe.

I also quote in light of the election of our new NDP leader, someone who embodies these principles and who will continue this fight with love and courage. To quote our new leader, Jagmeet Singh, “I believe in social democratic values, universal social programs like health care, but expanding them into more universal services like pharmacare and dental care.”

When we are discussing the merits of extending universal access to health care services such as pharmacare, it is important to keep in mind that an ounce of prevention is worth a pound of cure.

Prescription drugs play a vital role in Canada's health care system, whether that is in treatment for an illness, recovery from an illness or medical intervention, or maintenance of a condition to ensure quality of life.

As we have heard throughout this debate from many members—and I could unfortunately quite easily fill up my time with constituent stories that have been brought to me—the cost of prescription drugs in Canada far too often leads to prescriptions not being filled or to unjust sacrifices being made to fill them.

I challenge anyone in the House to stand up and say that they have never met a constituent—or any individual, for that matter—who could not afford to buy his or her medication. I challenge anyone in the House to stand up and say that they have never heard a story of someone, a senior in particular, who could not afford to buy medication or that pills were cut in half or that a day was skipped in order to stretch the medication. I have met seniors who have told me that they are eating cat food so they can save money to buy medication.

The parliamentary budget officer's report cited data that shows costs related to non-adherence to prescription regimes ranged from 7% to 17% across the provinces.

Can we imagine how many thousands of Canadians are not taking their medication because they cannot afford to do it? A 2015 Angus Reid Institute poll found that some 29% of B.C. households reported that they did not take medications as directed because of cost. That is in my home province of British Columbia.

People who do not take their medicine because they cannot afford it is a big deal. People die from not being able to afford their medication.

A 2012 study estimated that inequities in drug coverage for working-age Ontarians with diabetes could be linked to 5,000 deaths from 2002 to 2008 alone. This problem is not restricted to any one province. It is a problem across the country.

It is important to keep in mind that it has an impact on the health care system as well.

A 2014 paper by the Canadian Centre for Policy Alternatives found that studies suggested that some 6.5% of hospital admissions are the result of people not following their medication regime. It estimates that this represents a price tag to Canada of some $7 billion to $9 billion per year. Therefore, to all our Conservative friends who say that we cannot afford to do this, I say to them that we absolutely need to do it. What we cannot afford is to not do this and not bring forward a universal pharmacare program. An ounce of prevention is worth a pound of cure.

Ensuring that Canadians are able to take the prescription drugs they need to maintain their health will have positive impacts on many areas of Canadian society, be that increased productivity because people are healthier, fewer emergency room visits, or fewer entirely preventable emergency medical interventions, just to name a few.

If member had a loved one, a family member, or a friend who could not afford their medication, and as a result their health was deteriorating, how would they feel about that? Worse yet, if they lost their life because of it, how would they feel about that?

This is what we ran for office to do. It was to make that change, and we can do something about it right here, right now, in this chamber, which is what this motion is all about.

According to the World Health Organization, Canada continues to remain the only high-income country with a universal health care system that does not provide for universal coverage of prescription drugs. What is wrong with this picture? Instead, Canada currently has over 100 private and public drug programs. This fragmented approach limits our negotiating power. My colleagues have talked about the impacts of this situation and what it means financially. Frankly, it does not make any sense. It makes no sense for the individual, Canadians on the whole, and it does not make sense for our economy.

I have heard Liberals try to say that somehow we cannot do this, because there is a study going on. Well, I hope that the government can walk and chew gum at the same time. I hope that the minister actually has the wherewithal to pick up the parliamentary budget officer's report, read it, understand what it means, and send staff to do the analysis around it. I hope that the minister will think far enough forward to realize that negotiating a deal with the provinces and territories will take more time than the government seems to think it is going to take, and that we need to get on with it yesterday.

My colleague, the member for New Westminster—Burnaby, said that there have been reports done on this issue. Even before I was born, back in 1964, there was a report, and successively there have been royal commissions on it. How many more studies do we need? How much more evidence do we need?

I put this to the government side: have the courage. The Liberals say that they have the love in their hearts; then demonstrate it with courage and vote for this motion. Let us get on with it so that people like Jim, who is sitting not far from this chamber, have hope in knowing that the people who are representing them will have the courage and the love to act. That is what I am calling for.

[Blaine Calkins, Conservative, Red Deer—Lacombe, AB]

Mr. Speaker, I really do appreciate my hon. colleague's speech. It was very impassioned. I appreciate the opportunity to talk about something that is so important, something that affects every single Canadian. It is refreshing to have something to talk about that might actually unify Canadians, in contrast to the Liberals across the way, who keep on bringing things that divide Canadians into class warfare.

The Canadian Institute for Health Information has basically indicated that the total cost for health care across Canada right now is somewhere in the area of $230 billion. My colleague said in her speech that it did not start out that way. It started out small and it has grown. It has actually grown into the largest line item of government spending across the board.

The plan that the member is talking about, a national pharmacare plan, would start out small, but we would have no assurances that it would not grow into the second-largest government spending program. Therefore, my question for the member is this: if she were government, what would she either cut or make less of a priority in order to pay for this program? What would she do in terms of being able to pay for it? Would she raise taxes on Canadians, and how much would that cost the average taxpayer, who is already paying between $6,000 and $7,000 a year per Canadian for health care?

[Jenny Kwan, NDP, Vancouver East, BC]

Mr. Speaker, the premise of the member's question is, frankly, wrong. Maybe if he actually picked up the parliamentary budget officer's report he would see that there would be savings to our health care system if we brought forward a national pharmacare plan.

Let us try this on for size, for the member's information. A year's supply of a drug for cholesterol, called atorvastatin, costs roughly $143 in Canada, but in Sweden, it costs $27, and in New Zealand, it is a mere $15. The number of prescription drugs in Canada that cost more than $10,000 per year has grown almost tenfold in the last decade. If we think about where the savings could be found, we could actually do this. For fearmongers to say that we cannot afford to do this is wrong. There has been report after report, and now the parliamentary budget officer says that it is the right thing to do and the economical thing to do.

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the Leader of the Government in the House of Commons]

Mr. Speaker, I have had ample opportunity to emphasize the fine work of the Standing Committee on Health. It initiated a very important study, because we understand how important the issue is. We have a Minister of Health who has been progressively moving forward on a number of critically important files.

I have a couple of specific questions for the member. The motion asks for Ottawa to work with the provinces. First, why would the New Democrats not have included the territories in the discussion? Second, the member across the way and others on the New Democratic benches said that this is an issue, yet I do not know the last time they raised this issue. They have been in opposition for decades. I believe this is the first time they have raised it. I may be wrong. Perhaps the member could indicate if that is the case. Is it just a coincidence that the health committee met, put in this request, and is finally getting its hands on the report, and the member feels that now is the appropriate time to raise the issue, as opposed to the decades prior, while New Democrats sat on their hands and did nothing on the issue?

[Jenny Kwan, NDP, Vancouver East, BC]

Mr. Speaker, let me first tell the member that if he wants to amend the motion by adding the territories, he is right, they should be added. We welcome his suggestion. We will amend the motion accordingly so that it will pass.

As to the question about the decades of inaction, let me focus on the decades of inaction by a Liberal government, a Conservative government, a Liberal government, and then back to a Conservative government on a national pharmacare plan. In 1964, before I was born, the Royal Commission on Health Services recommended that Canada institute a universal drug insurance plan. That was decades ago, before the current government, and nothing has happened. It was again recommended in 1997 by the Liberal government's own National Health Forum. What happened? Nothing. Then, in 2002, the Romanow commission made the same recommendation. What happened? Nothing.

The government's justification is that it has to study this more. Let us get on with it, shall we?

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Mr. Speaker, I am really pleased to join the debate today. I will be sharing my time with the member for Yellowhead.

I want to thank the NDP for this motion, because the discussion around access to pharmaceuticals is really important. Today we are having an important discussion for all Canadians.

We have heard about the many people who are having challenges accessing medicines. Despite this being an important debate, the NDP has jumped to a one-model solution. I am not entirely convinced that a one-model solution would really be in the best interests of Canadians as we move forward.

The NDP members have lots of heartfelt goals they want to achieve, whether universal child care or housing or many other items. Here I would also note that they tend to be complicit with the Liberals in supporting things that destroy our economy instead of building it. The very difficult news today about energy east and the government's decision to back away from that project was applauded by the NDP. The Liberals made it such a challenge to move that forward.

The NDP are complicit with the Liberals in creating an economic environment that will, over the next few years, make it more challenging to enact the programs they want for Canadians. There should be some careful reflection by both the Liberals and the NDP on how to create an economy that will allow us to do the things that all Canadians want us to do, whether around pharmaceuticals or giving a hand up to those in need. That is my first point.

The next point I want to make is about the issue of constitutional jurisdiction. I remember being on the health committee. At the time, the Bloc had official party status. I can remember that whenever we talked about doing anything national for health, the Bloc members regularly reminded us that health was in their jurisdiction and that federal government should give the provinces the money but not talk about moving forward with any national programs. They felt that the provinces were very capable of dealing with it. The Bloc members said it very explicitly. We hear that from many of the provinces. Even in the most recent negotiations that were held, we heard the provinces saying that the federal government should send the money, but they were very reluctant to be told what to do with it. I think they are rightfully concerned about any large federal government program.

Again, the federal government should probably stick to the pieces of governance that it is actually responsible for. I look at the Liberals and the Phoenix pay system as an example. If the federal government cannot even create a pay system to pay its own employees, how can we expect it to implement a national pharmacare program? The government has a couple hundred thousand employees it needs to pay, but it is much more complex to have a national pharmacare program providing drugs for millions of people. I would be very leery of putting anything like this into the hands of the Liberal government especially, which has shown itself to be inept at that kind of delivery. It is not in the federal government's responsibilities.

I look at the medical marijuana issue, which is another area where the Liberal government, quite frankly, has created a real mess. We have landlords whose homes are being ruined. The Liberals have set up a system that will not work very well, because that is not their area of expertise.

If the NDP is suggesting that they want the Liberal government to take over negotiations and create something that is very complex, it should perhaps rethink what it is asking for.

I really do want to talk about the solutions.

Ten percent of the population is under-insured, and 2% is not covered by a plan. I think that every one of us agrees that we need to find a way to deal effectively with the examples we have heard today. We need to make sure that someone has their diabetes medication, especially those with low incomes. Just as I have always said that the government should not be paying for my child care when I can afford it, we should be focusing on the people who cannot afford child care and to work at the same time.

I also believe there is a role and an opportunity for those of us who, quite frankly, have advantages in life to pay our fair share and to save those valuable dollars for the people who perhaps need it the most. That is the whole idea of universality versus having people support themselves, and we need to make sure that when the opportunities arise, they can take advantage of them.

I want to talk about British Columbia, which we have not talked much about. Some provinces have moved forward, and again this is about the nimbleness of the provinces and their ability to create a system and solutions that work for their province. What might work in Prince Edward Island, which is a small island, might not work in British Columbia, which is much larger, more diverse, and has many more issues in terms of rural and remote communities. This universal one-size-fits-all approach is probably not going to be the most effective way to deal with it.

A number of years ago, B.C. put in fair pharmacare, a provincial income-based program designed to provide fair access to coverage for prescription drugs. The lower a person's income, the more assistance the government will provide them toward eligible drug costs. It is available to single people or families. For example, if a person's net income for two years is $15,000 or less and they are registered for fair pharmacare, they will have 70% of their eligible prescription drug costs covered immediately, with no deductible.

I think that is a good example where, perhaps, if there were additional money provided for the pharmaceutical system, they might be able to look at it and be more responsive. There might still be a few gaps, but a system has been set-up that works and recognizes income.

British Columbia has also done something very interesting in the last little while that perhaps some of the other provinces can learn from. We should be very proud. What they have done is that the first nations health benefit plan is now under BC PharmaCare as of October 1. This was done in partnership with the First Nations Health Authority in B.C., and they joined with the drug insurance program PharmaCare. With this change, first nation clients of the drug services of Canada's longstanding federal system moved to a new made-in-B.C. pharmacare plan designed specifically for first nation clients. Previously, they received this through their non-insured health benefits. B.C. put in place regulations to change and integrate the system.

This week I had an opportunity to talk to pharmacists and asked if this were going to work. They said it would greatly improve their ability to provide prescriptions to the first nation communities they serve, or the indigenous people who come in for medication. They said they were having real challenges before and that this was an amazing change. What I am getting at is that provinces are more nimble and flexible. They can create best practices.

I have listened to a lot, but not all, of the debate today. The NDP have not yet convinced me that their motion and plan is going to be the best way forward to really make sure that those who need drug coverage the most will be the ones who will get it.

[Kevin Waugh, Conservative, Saskatoon—Grasswood, SK]

Mr. Speaker, I thank the member for Kamloops—Thompson—Cariboo for bringing up the indigenous aspect of medical needs in this country. As we know, most indigenous people live on reserves and in various other places, including in the far north where they do not have a lot of access.

I believe our colleague is a former nurse. I would like her to maybe give us that perspective on the pharmacies involved, including maybe the overprescription at times. We have seen that in northern areas of this country, where a lot of medicines are being prescribed that maybe are not needed. However, just because they are in the far north, they seem to get that little extra attention that others in this country do not get.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Mr. Speaker, the point my colleague is making is very clearly that one size fits all will not work for how we both administer and deliver our systems. We know that the First Nations Health Authority in B.C. is part of self governance by first nations in British Columbia. They have chosen a way to create access to medication that will be far more seamless. Instead of someone going through the very centralized bureaucratic system of the first nations non-insured health benefits program, they will be able to bring their status card, see a pharmacist, and have the seamless provision and delivery of pharmaceuticals.

On the issue pf appropriate prescriptions, we all know about the opioid crisis not only in the north but also across this country, and certainly in Vancouver and British Columbia. It is a huge issue, although perhaps that is a bigger debate for another day.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Mr. Speaker, I listened with interest to the member for Kamloops—Thompson—Cariboo, whom I both like and respect. I know she and her party like to be seen as strong advocates for small business.

I would like to ask her about the impact of a universal pharmacare plan on small business. Would she agree with me that this would help small business in a very big way? It would reduce unnecessary time off by small business employees who cannot afford their prescriptions. It would make small businesses more competitive in hiring and retaining workers versus large corporations that have better benefit plans. It would help entrepreneurs who might want to leave a large company and start their own business, but might be afraid to give up the health care benefits for their family and children. Those small businesses that do go to the expense of providing benefit plans could reduce that unnecessary cost.

In addition to recognizing the health benefits of a universal pharmacare plan, does the member also see it as a big benefit for small business in this country?