House of Commons Hansard #213 of the 42nd Parliament, 1st Session. (The original version is on Parliament's site.) The word of the day was drug.
The Speaker Liberal Geoff Regan
Pursuant to subsection 72.02(2) of the Parliament of Canada Act, it is my duty to present to the House a report from the parliamentary budget officer entitled “Fiscal Sustainability Report 2017”.
François-Philippe Champagne LiberalMinister of International Trade
Mr. Speaker, on behalf of the Minister of Foreign Affairs and pursuant to Standing Order 32(2), I have the honour to table, in both official languages, the treaties entitled “Agreement to Amend, in respect of investment and trade and gender, the Free Trade Agreement between the Government of Canada and the Government of the Republic of Chile, done at Santiago on 5 December 1996, as amended, between the Government of Canada and the Government of the Republic of Chile”, done at Ottawa on June 5, 2017; and the “Agreement to Amend the Free Trade Agreement between the Government of Canada and the Government of the Republic of Chile, done at Santiago on 5 December 1996, as amended, between the Government of Canada and the Government of the Republic of Chile”, done at Ottawa on June 5, 2017. An explanatory memorandum is included with each treaty.
I think this is a great day for Canadians. This is Canada's first free trade agreement that includes a provision on gender equality.
Scott Brison LiberalPresident of the Treasury Board
Mr. Speaker, it is an honour to table today, in both official languages, the Public Accounts of Canada 2017. The Auditor General of Canada has provided an unqualified audit opinion on the Government of Canada's financial statements.
The government is committed to sound financial management, and to monitoring the use of public funds to enhance accountability and transparency.
Mark Holland LiberalParliamentary Secretary to the Minister of Public Safety and Emergency Preparedness
Mr. Speaker, I am pleased to table, in both official languages, the 2016-17 annual report of the Security Intelligence Review Committee, as required under section 53 of the Canadian Security Intelligence Service Act.
Anishinabek Nation Education AgreementRoutine Proceedings
Toronto—St. Paul's Ontario
Liberal
Carolyn Bennett LiberalMinister of Crown-Indigenous Relations and Northern Affairs
Mr. Speaker, I have the honour to table, in both official languages, copies of the Anishinabek Nation Education agreement.
Anishinabek Nation Education Agreement ActRoutine Proceedings
Toronto—St. Paul's Ontario
Liberal
Carolyn Bennett LiberalMinister of Crown-Indigenous Relations and Northern Affairs
moved for leave to introduce Bill C-61, An Act to give effect to the Anishinabek Nation Education Agreement and to make consequential amendments to other Acts.
(Motions deemed adopted, bill read the first time and printed)
Larry Bagnell Liberal Yukon, YT
Mr. Speaker, pursuant to Standing Order 34(1), I have the honour to present to the House, in both official languages, the report of the Canadian Parliamentary Delegation respecting its participation at the Meeting of the Standing Committee of Parliamentarians of the Arctic Region, held in Kangerlussuaq and Sisimiut, Greenland, Denmark, from May 15 to 18, 2017.
Bill Casey Liberal Cumberland—Colchester, NS
Mr. Speaker, it is my distinct honour to present, in both official languages, the 12th report of the Standing Committee on Health in relation to Bill C-45, an act respecting cannabis and to amend the Controlled Drugs and Substances Act, the Criminal Code and other acts. The committee has studied the bill and has decided to report the bill back to the House with amendments.
I want to commend all the members of the committee for their contribution to this study. We did a marathon session. We had 109 witnesses and we did a lot of work. The amendments provide for two more steps, one in one year, and one in three years. It is an improvement. I want to thank all the members of the committee for their good work.
Transport, Infrastructure and CommunitiesCommittees of the HouseRoutine Proceedings
Liberal
Judy Sgro Liberal Humber River—Black Creek, ON
Mr. Speaker, I have the honour to present, in both official languages, the 15th report of the Standing Committee on Transport, Infrastructure and Communities in relation to Bill C-49, an act to amend the Canada Transportation Act and other acts respecting transportation and to make related and consequential amendments to other acts. The committee has studied the bill, and we had great co-operation from all members of the committee from all sides of the House. It was an example of how to deal with legislation in a proper and effective way in the House. We have decided to report the bill back to the House with amendments.
Marjolaine Boutin-Sweet NDP Hochelaga, QC
Mr. Speaker, there have been discussions among the parties, and if you were to seek it, I think you would find that there is consent to adopt the following motion:
That, at the conclusion of today's debate on the opposition motion in the name of the Member for Vancouver Kingsway, all questions necessary to dispose of the motion be deemed put and a recorded division deemed requested and deferred to Tuesday, October 17, 2017, at the expiry of the time provided for Government Orders.
The Speaker Liberal Geoff Regan
Does the hon. member have the unanimous consent of the House to propose the motion?
Kevin Lamoureux LiberalParliamentary Secretary to the Leader of the Government in the House of Commons
Mr. Speaker, I ask that all questions be allowed to stand.
Don Davies NDP Vancouver Kingsway, BC
moved:
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.
Mr. Speaker, I am honoured to be splitting my time today with the member for Salaberry—Suroît.
Canada is a country that prides itself on our universal health care system. It is no exaggeration to say that our public single-payer system of physician and hospital coverage is one of the features of our nation of which Canadians are most proud. I believe it defines us as a country.
However, our health care system is neither perfect nor comprehensive. Indeed, it has a number of glaring coverage gaps. These include services such as outpatient, dental, mental health, rehabilitation, and home care. The motion the New Democrats are proud to introduce today calls on the government to take action to address one of the most pressing and solvable of these gaps: pharmaceutical drugs.
Currently, this gap consists of a patchwork of private and public coverage that varies widely across Canada. Outside of Quebec, every province and territory provides public drug coverage for people only in very limited circumstances, sometimes for those on social assistance, sometimes for seniors, and sometimes for people with specific conditions such as cancer, transplants, and infectious diseases. For those outside these groups, folks have to pay the cost of the medication out of their own pockets.
Quebec is the only province with a mandatory program, requiring that every citizen obtain insurance. However, it is a mixed private-public scheme where the most expensive and difficult-to-insure citizens are foisted onto the public plan, making it extremely costly. The situation is problematic even for those who have extended benefit plans through work. These plans often have annual limits or copayments that leave claimants exposed for out-of-pocket costs. Employers across Canada report difficulty paying for these benefits and increasingly are dropping coverage for their employees.
The consequences of this omission are present in every community and every demographic. They are real. They are pressing. They are serious.
Here is a typical example, recently described in an article written by two physicians from Alberta. They describe the real case of a 60-year-old Calgary woman with high blood sugars and very high blood pressure. She paid for medications out of her own pocket each month, she had no employer insurance, and she could not afford the premium for Blue Cross. One month, however, when facing extra expenses, she did not have enough money to pay for her expensive diabetes and blood pressure medications. She ended up in the hospital. This woman would likely have avoided the emergency room altogether if she had stayed on her medications. Ironically, by having to access hospital care, she ended up costing our health care system much more than the cost of her medication.
Unfortunately, stories like hers are all too common. A number of studies have established that 10% to 20% of Canadians have no pharmaceutical coverage whatsoever. This means that four million to seven and a half million Canadians are living every day without the medicine their own doctors prescribe for them and which they need to stay healthy and sometimes even alive. One in five Canadians reports that he or she or a family member neglects to fill prescriptions due to cost. In fact, Canada has the second-highest rate of skipped prescriptions among comparable countries. This particularly hurts seniors and the poor. One in 12 Canadians over 55 skips prescriptions due to cost. Low-income Canadians are three times more likely to experience financial barriers to accessing essential medication.
Shamefully, Canada stands virtually alone among developed countries in this regard. We have been identified as the only developed country in the world with a universal health care system that does not provide some sort of universal prescription coverage. Canada is one of only five OECD nations whose public health system does not provide publicly funded drug insurance to all citizens. Even as millions go without coverage, Canadians pay among the highest prescription drug prices in the industrial world, second only to the U.S., and these costs are growing at an alarming rate.
Here is the absurdity. If someone cuts a finger, he or she goes to the doctor who stitches it up, and the individual leaves and never sees a bill. However, if people go to a doctor and their ailment needs to be treated by medication, they are at the mercy of their ability to pay. This is irrational, it is unfair, it is not consistent with a modern universal health care system, and it is also unnecessarily expensive.
However, there is a solution. In fact, it is a solution so clear, so established, and so patently feasible that there is no reason why we should not begin to implement it at once. That is what this motion and the New Democrats are urging the government to do; to begin to implement a universal pharmacare system in Canada.
By implementing a universal public pharmacare system, we can cover every single Canadian, every man, woman, and child, and save anywhere between $4 billion and $13 billion a year. Let me repeat that, just as with universal health care, we can make sure that all Canadians can get the necessary medicine they need when they need it and we can collectively save billions of dollars as a nation. Here is how and why.
A universal public system would save money in myriad ways. It would establish a national, independently monitored, evidence-based formulary that covers drugs that are the most effective and cost sensitive. It is estimated that more than $5 billion a year is wasted because private drug plans pay for unnecessarily expensive drugs and dispensing fees. By reimbursing drugs only when they represent value for money, public plans are much better equipped to rein in such costs.
Second, it would allow for the effective national bulk purchasing of drugs, a proven method that reduces drug costs by an average of 40% for brand-name drugs, as has been the experience in New Zealand, the U.S. veterans administration, and countries throughout Europe. A year's supply of atorvastatin, a widely used cholesterol drug, costs about $143 in Canada, but only $27 in Sweden and $15 in New Zealand.
It would allow for the negotiation of exclusive licensing agreements with pharmaceutical companies to achieve the best prices for widely used medications. It would streamline administration costs, reducing thousands of duplicative administrative systems, perhaps to one per province and territory. The administration costs of for-profit private plans average 15%, while administration costs for public plans are less than 2%.
It would avoid cost-related non-adherence, the technical term for the increased costs that come when folks do not take their medicine and become more seriously ill. The health committee heard evidence that one diabetic patient who ends up in intensive care because that individual could not afford to take insulin costs more money than providing free medication for life.
However, members do not have to take my word for it. The parliamentary budget officer's report on the federal costs of a national pharmacare program, released September 28, confirms what health policy experts have been saying for years, that Canadians could have a pharmacare system that covers everyone for billions of dollars less than they now pay for prescriptions. The PBO found that, in 2015, Canadians spent $24.6 billion on pharmaceuticals that would have been eligible for coverage under a national pharmacare plan. Accounting for pricing and consumption changes, the PBO estimated that Canada would have, instead, spent $20.4 billion in 2015 under national pharmacare. Using the most conservative assumptions, leaving out certain cost savings entirely, and applying the Quebec formulary, one of the broadest in Canada, he found that Canada would have saved $4.2 billion that year.
Other studies, including by renowned Canadian researchers, estimate the annual savings to be even higher, perhaps between $9 billion and $13 billion. That is why so many voices in Canada are advocating for a national pharmacare program. This includes many organizations—retirees, physicians, nurses and other health professionals, business and employer associations, the Canadian Labour Congress, health care researchers, and patient advocates of all kinds—and we know that the public broadly supports national pharmacare. A 2015 poll found that an astonishing nine out of 10 Canadians support the concept of national pharmacare.
The details of what kind of system we create are yet to be determined. A pan-Canadian pharmacare program could be a stand-alone federal program, or we could fold it into the Canada Health Act and add prescription coverage as an insured service, just as we do with any other medically necessary service.
Ultimately, of course, we have to pay for our medicine, but it is always Canadian citizens who pay, in any event, whether they pay through public or private sources. The question is whether we want to pay $24.6 billion a year, with millions of Canadians left uninsured, or instead, pay $20 billion overall, with coverage for every single Canadian. To ask that question is to answer it.
Our most important goal should be to ensure that no Canadians go without the medicine necessary to their health. New Democrats in the House, therefore, call on the Liberal government to agree to this goal. We ask Liberals to vote for this reasonable and necessary motion and meet with the provinces within one year to begin the discussions to make it a reality.
It took New Democrats and courage to bring medicare to Canadians. We will continue to work to do the same thing for pharmacare.
Bill Casey Liberal Cumberland—Colchester, NS
Mr. Speaker, I am very honoured to be the chair of the Standing Committee on Health, and the member for Vancouver Kingsway is one of the more active members. He has done a lot of work on the committee and made a great contribution to it. However, I honestly feel, and I am sure he knows, that we are not at the stage where we can say we can start a national pharmacare program.
He said that the PBO brought the study forth. It is an excellent study. We asked for that study, and were very grateful for having the study. However, there are so many questions left unanswered. I wrote down what the member said, and he said that Canada would spend $20 billion on pharmacare if we had a national pharmacare program. We do not know whether that $20 billion would come from the federal government, the provinces, or who. There are just so many questions.
We have a meeting scheduled on October 17 to bring the parliamentary budget officer in, and I am sure the member for Vancouver Kingsway will have lots of questions for him. After he asks those questions and we have the answers from the parliamentary budget officer, then we can maybe consider a model for the plan.
Of the $20 billion that Canada would spend, as the member just said, how much would come from the federal government?
Don Davies NDP Vancouver Kingsway, BC
Mr. Speaker, I would like to also express my gratitude to the hon. member for his wise and judicious chairing of the health committee. It is a pleasure to sit on that committee with him.
As I said in my speech, of course the mechanics of how this system would be delivered are a matter for negotiation between the federal government and the provinces. That is why the motion clearly calls on the Liberal government to commence negotiations with the provinces no later than October 1, 2018, in order to implement a universal pharmacare program. The New Democrats are calling on the government to take action. There have been a lot of words by the government. It is a government of good intentions, but it is a government of, frankly, no action.
We are asking the government to take action sometime with the next year. I chose that date because I think it is a reasonable amount of time to schedule a meeting between the federal government and the provinces to discuss whether we want a national stand-alone federal program, whether we want to fold prescription coverage into the Canada Health Act and have it covered just as all other medically necessary services are now, or whether there are other models as well.
What we do know is that, without a shadow of a doubt, millions of Canadians right now cannot get the medicine they need. We also know, without a shadow of a doubt, that a national universal single-payer pharmacare system will save billions of dollars. What more does the government need to spur it to actually start the process of taking action?
Jim Eglinski Conservative Yellowhead, AB
Mr. Speaker, there is discussion about $20 billion for the cost of health care. The statistics we have from 2014 are that the cost in Canada was $28.8 billion. My concern is that, if the federal government is to look after this program, where is the money coming from?
The Liberal government has put enough loopholes in it that the energy east pipeline has gone south now and is no longer happening. We have the only other energy pipeline to the west coast in the courts right now, and it may not happen.
Where is that money coming from? The NDP members support the stopping of oil and gas production in Canada. Where do they think the money is going to come from to pay for these programs?
Don Davies NDP Vancouver Kingsway, BC
Mr. Speaker, I am really perplexed at what connection there would be between oil pipelines and pharmacare. I will tell members where the money comes from for this program. It comes from where money always comes from to pay for health care in this country. It comes from the people of Canada, the citizens. I will make it as clear and simple as I can for the members of this House. The parliamentary budget officer said that we spent $28 billion on pharmaceuticals in this country in 2015-2016, and then he took out about $4 billion of that because that was extra private coverage that would not be covered under a pharmacare system. He is saying that we paid $24 billion for drugs that would be covered under a national pharmacare program, using the Quebec formulary. He ran the numbers, using conservative estimates, and found that if we had a national pharmacare program we would have paid $20 billion.
The last time I checked, $20 billion is less than $24 billion. I would rather pay $20 billion in this country for pharmaceuticals and cover everybody than pay $24 billion and leave 20% of Canadians not covered. The citizens of this country are the ones who are going to pay for it. Whether their dollar or employer pays it to the pharmaceutical companies or whether it is paid to the government that administers the program, it does not matter. The dollar comes out of someone's pocket. The purpose of national pharmacare is that we would pay less money in this country and cover everybody. That fact is undeniable.
Anne Minh-Thu Quach NDP Salaberry—Suroît, QC
Mr. Speaker, I am very proud to rise here today to support the motion by my colleague from Vancouver Kingsway to give all Canadians access to universal pharmacare. This would be tremendously beneficial, not only for public health, but also for public finances. The NDP has been working towards this goal for at least 50 years in order to improve our society, protect our poorest and most vulnerable citizens, and promote solidarity and health across the country.
Canada is a rich society and member of the G7. This means that we are one of the seven richest countries on the planet, but unfortunately, we are the only industrialized nation that has universal medicare but no pharmacare. The province of Quebec has helped by creating its own pharmacare system. How is it possibly fair that a resident of Cornwall, in Ontario, does not have access to medication while a resident of Saint-Anicet does, when only a river separates them?
It is very clear that a federal pharmacare program will require thoughtful consideration, negotiations with the provinces, and discussions here in the House. That is why we need to start those discussions as soon as possible and initiate talks with the provinces next year.
Let us take another look at Quebec, which has been leading the way when it comes to pharmacare. Quebec MNAs fought hard and got what they wanted: guaranteed coverage for Quebeckers when they need help covering health care costs and the cost of prescription drugs. To do that, Quebec came up with a mechanism for providing access to those drugs.
The Régie de l'assurance maladie du Québec is in charge of managing the public prescription drug insurance plan. People who want to use this service must register with the Régie ahead of time. The system is similar to others used in Europe, for example. It not only addresses a public need, but, above all, it also shows some humanity.
This is how it works. In Quebec, for a drug to be covered under the plan it must be included in a list previously established by the appropriate authorities and obtained through a prescription from a pharmacist. The parliamentary budget office, the PBO, used the Quebec model as a benchmark in its study. It says that covering all Canadians under a national pharmacare program could save nearly $4.2 billion. That is quite remarkable. This type of program could help lower the cost of drugs for millions of Canadians who use the public health care system.
The Canadian Centre for Policy Alternatives reported that we are the only OECD country with a universal health care system but without pharmacare coverage, and our country's drug costs rank among the highest. In fact, only the United States has higher drug costs than Canada. The cost of prescriptions in Canada is 30% above the OECD average.
Furthermore, according to the CCPA study, the public sector could save approximately $18 billion a year. Canadian families and businesses could save approximately $13.7 billion. The PBO and the CCPA have also shown that the cost of putting in place such a system is very high, but that does not mean that we should not move forward. It would still cost less than paying private companies for drug coverage.
As my colleague from Vancouver Kingsway mentioned, it would cost approximately $4 billion less to cover all Canadians. What do members not understand? It is simple. Every Canadian could have fair access to prescription drugs and protect their health while continuing to pay less for their medication. It seems to me that 1 + 1 = 2. We have been saying this for years.
When Tommy Douglas first proposed universal health care, he did not let anything stand in his way. He looked for a way to implement the system without draining the public coffers. Health Canada employs many talented civil servants and experts. Our university centres, think tanks, and research centres can help us develop a pharmacare program that covers all Canadians.
I am positive that we can succeed if we get to work right away. These are common-sense measures. What we hope to achieve with this motion is simply to ensure that all Canadians have the same health rights.
We pride ourselves on being a powerful, modern, developed, democratic country, but one of the fundamental criteria for assessing those characteristics and maintaining our high standing is the level of inequality.
Our patchwork of vastly different reimbursement systems is a source of inequality. The fact that you might pay a different price for a drug depending on whether you live in Quebec or Saskatchewan creates inequality among Canadians. This injustice disproportionately affects those already most in need, namely our young and our seniors.
Are we really going to risk our children's health in an attempt to save money, when we know that we are not going save any money and that we are actually losing close to $5 billion a year by not implementing a universal pharmacare system?
This also affects seniors, people who worked their whole lives to build this country so they could make society better and leave a better world for their children. As everyone here can agree, we are smart enough to know that the longer we put something off, the more it will cost us later on. It is time for us to invest in our future, in our health, and in the future of our youth and our country as a whole.
Like I said earlier, the other group who is most affected is our seniors. We know and we recognize what they have done for Canada. They spent their lives contributing to our economy and our government. After a lifetime of work, regardless of their occupation, they deserve a health care system that provides fair access to drugs.
In fact, a number of studies show that people who do not fill their prescriptions because of cost can suffer real consequences. For example, one researcher found that patients 65 and over were less likely to fill their prescriptions because they had to pay for them, and they did not have the means to do so.
This tendency has led to an increase in hospitalizations, emergency care, and doctor visits. For some health policy researchers, this is evidence that prescription drugs should be considered as necessary drugs under the Canada Health Act.
Now I would like to take a closer look at the conditions under which people would access this public system. The program's beneficiaries would hardly be taking advantage of the system. In Quebec, the goal would be to help people who do not have a private health plan and their families, as well as seniors and people living in extreme poverty who have nowhere to turn but to the state.
This system is both workable and necessary. We can help our friends, neighbours, and fellow citizens who are in need and who are asking not for handouts but for a decent standard of living.
Do we care so little that we would reject a public pharmacare system in favour of an ineffective private insurance system that does not cover all Canadians? If we do not pursue fair access to prescription drugs on a national scale, we will fail to meet our obligations to Canadians under the Canada Health Act.
The state's primary responsibility is to keep its citizens safe and end violence, but forcing people to choose between food and medicine is a pretty serious form of violence in my opinion.
In closing, we need a universal pharmacare program along with our universal medicare program. Experts say that it will be cheaper to implement a universal health system that covers all Canadians than to maintain the current system where one-fifth of Canadians cannot afford their medication. It is an ambitious plan, but ultimately a win-win when it comes to public health, protecting Canadians, and public finances.
I ask my colleagues, in all sincerity, how can we in 2017, in a country as rich as Canada, a G7 country, make some seniors choose between refilling their fridge and refilling their prescriptions?
How can we turn our backs on a former industrial cleaner in declining health who, after inhaling chemical products her entire life, cannot even afford her medication on her disability payments?
How can we tell our children that we are a society that supports one another when we refuse to help our poorest citizens?
Hon. colleagues, let us write history instead of letting it pass us by. Let us finish what Tommy Douglas, the greatest Canadian, started. Let us make sure everyone has access to pharmacare.
I hope the financial argument will sway even those who believe that the economy is more important than the health of others.
Jim Eglinski Conservative Yellowhead, AB
Mr. Speaker, according to a study done by the Commonwealth Fund, about 8% of Canadians had to skip doses of their medicine because of the cost. Although there is room for improvement, this is on par with Germany, where about 8% of people skip their drugs; and it is notably better than France, at 11%; Australia, 14%; and New Zealand, 18%. These are all countries with national pharmacare programs. We only have a number of provinces with pharmacare programs, and yet we have one of the smallest percentages of people who are missing out.
Could the member explain why she thinks there is a difference between Canada and the countries that already have national pharmacare programs?