Debates of Oct. 5th, 2017

Opposition Motion—Pharmacare

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

Mr. Speaker, that is a very important point. My issue is that we do not necessarily need to look at a one-size-fits-all universal program. There are many opportunities to be flexible and creative to make sure that those who are most in need get support. There are other ways to support small businesses. I look at how the Liberal government could have reduced the tax burden like they promised to do. Had they not been threatening our small businesses with extraordinary changes in how they are taxed, then perhaps our small businesses would have had more of an opportunity to invest in their employees and business.

[Cheryl Hardcastle, NDP, Windsor—Tecumseh, ON]

Mr. Speaker, does my hon. colleague understand the research showing that Canadian employers waste between $3 billion and $5 billion a year because of employment related private insurance that is ill-quipped to handle pharmaceutical costs effectively? Would the member not agree that this inefficiency creates unnecessary drag on the Canadian economy and on for those businesses alluded to earlier?

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

Mr. Speaker, we have also heard today that the health committee is reviewing this whole issue intensively and looking at all the different opportunities. What the NDP has done, which is typical of the NDP, is to go to the universal system, one that is universal for everyone, and they do not analyze the different opportunities that could present themselves.

I agree that perhaps there are opportunities, but most importantly, we do not want the federal government with its big bureaucracy taking over something like the Liberals did with the Phoenix system and making a huge mess of something so important.

[Jim Eglinski, Conservative, Yellowhead, AB]

Mr. Speaker, I am pleased to rise today to speak to the NDP opposition motion on pharmacare.

The motion states, “millions of Canadians lack prescription drug coverage”. It goes on to say, “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 motion ends my calling on the government “to commence negotiations with the provinces no later than October 1, 2018, in order to implement a universal pharmacare program.”

One must ask this. Do the provinces and territories in Canada want this and has there been a discussion between the governments? We all know the federal government's role is to provide health care funding, via Canada health transfers, to the provinces and territories to support the principles of the Canada Health Act.

Federal, provincial, and territorial governments all offer drug insurance plans, providing some coverage to approximately 53% of the Canadian population. Each jurisdiction stipulates the specific eligibility requirements for its population and the specific drugs it will cover, as well as any cost-sharing measures required. Jurisdictions typically provide some level of drug insurance for specific populations or individuals meeting some eligibility requirements. Most of these plans typically cover seniors, low-income families, or individuals.

The health needs of each province's population, prescribing habits of physicians, generic drug pricing, and price negotiations vary. Provincial drug plans vary in their determination of the patient's co-payments, for example, a fixed co-payment and a means-tested co-payment.

Provinces also set different thresholds for both the income and the drug expenditure. Thus, a patient's out-of-pocket expenditure can vary, depending on which province or territory he or she lives in. We must also take into consideration private plans that individuals have across the country, which may exceed the provincial coverage. How would the proposed motion affect these plans?

According to a study by the Commonwealth Fund, 8% of Canadians with below-average incomes said that they had not filled a prescription or had skipped doses in the previous year because of cost. Although there is room for improvement, this is on par with Germany, which also had 8% of its people not fill their prescriptions, and is notably better than France at 11%, Australia at 14%, and New Zealand at 18%. I would stress these countries have national pharmacare programs. It is obvious people are more concerned about patients not taking the medication even though they have a national pharmacare program.

Canadians should be wary of replacing our mixed system with something like what exists in the U.K. or New Zealand. Socializing a larger part of drug spending through a single-payer pharmacare plan would give more power to government and its bureaucrats to make decisions on behalf of the insured. Policies that restrict access to new medicines would be applied across the board and would penalize all Canadians in the same way.

However, replacing our current mixed public-private plans, administered by the provinces, with a national drug insurance monopoly is definitely not the solution. It would harm Canadians, putting patients at risk and increasing the cost of our health care system in the long run. Would one plan fit all segments of the country? I do not think so, due to provincial and territorial jurisdictions, as well as private health plans negotiating, individually, the best prices for prescription drugs.

If there is only one buyer and our federal government is in control, common sense tells me the cost for prescriptions would be much higher.

A 2002 study estimated that 11% of Canadians faced the risk of high prescription drug costs, 2% because they lacked coverage and approximately 9% because they were under-insured.

Prescription drug expenditures in Canada were $28.8 billion in 2014. When adjusted for inflation, out-of-pocket expenditures on prescription drugs per capita amounted to $180, rounded off, in 2014. Prescription drug expenditures have three components: the drug cost; the dispensing fees charged by pharmacists; and the pharmacy markup, where applicable.

In 2012 and 2013, drug costs made up 74.4% of prescription drug expenditures in the public drug plans in Canada, whereas dispensing fees accounted for 21.4% and wholesale markup accounted for 4.2% of expenditures.

The motion before us today begs the question. How do we pay for a national pharmacare program when the parliamentary budget officer says it would cost $22.6 billion annually? That is just an estimate. We have only to look at what took place today. The energy east pipeline failed because of government bureaucracy, red tape, and restrictions. Fifteen thousand jobs will not exist and revenue will not come into our country. Money does not grow on trees.

The 2016 census stated that the portion of working-age population, those between the ages of 15 and 64, declined from 68.5% in the 2011 census to 66.5% in the recent one. Results from the 2016 census from Statistics Canada shows the proportion of those aged 65 and older, including myself, climbed to 16.9% of Canada's population. We now exceed the share of those less than 15 years of age, who are at roughly 16.6%. These statistics tell me that the costs will be much higher. I do not believe I ever took any medication when I was under 15, but I take a little off and on now.

What the Conservative Party is concerned about is the lack of data and the high initial cost of implementing a national pharmacare program. The share of drug spending paid for by each payer differs substantially across age groups.

Unfortunately, what concerns me is that the out-of-control spending and deficits of the Liberal Government will make it extremely difficult for any meaningful federal investments in health care or any other social program. The Conservative Party supports a high-quality, sustainable health care system that ensures Canadians get the best possible care. I believe that Canada's health care system is envied around the world.

When I have travelled over the last few years, I have talked to strangers about their health care programs and their governments, and they are envious of what we have in Canada. However, I always say that we can always make things better.

Prescribed drug expenditures account for just 13.4% of Canada's total health spending, which is $214 billion a year. A singular preoccupation on pharmaceutical cost containment risks missed opportunities for cost savings in other areas of the health system through improved medication adherence, early detection, chronic disease management, and preventive health measures.

The Canadian Pharmacists Association's website in January 2016 stated that a “national discussion on a pan-Canadian pharmacare framework requires clear evidence for policymakers and a clear national consensus on priorities important to Canadians.” That is very important. Our Conservative Party wants to ensure that Canadians receive the best health care possible and that the most vulnerable have access to the most innovative drugs. We need to have fair drug prices and access to necessary medications. Patients also require access to the full range of pharmacy services, such as prescription renewals, care plans, and prescription modifications to ensure safe and effective drug therapy.

A national pharmacare program raises a number of the following questions. What would be the short-term costs? Would these costs be affordable to government? What would be the role of the federal government? What drugs would be covered by the drug plan? What criteria would be used in deciding who gets them? How would the added costs be split between the federal government and the provinces and territories? How would a national pharmacare program affect drug prices?

[Linda Duncan, NDP, Edmonton Strathcona, AB]

Mr. Speaker, it is always a pleasure to hear my colleague from Alberta speak, but I am a bit surprised at the member's comment, saying that it would not be common sense to institute pharmacare. I know he comes from a party that believes we should be fiscally responsible. The Standing Committee on Health actually commissioned a study through the parliamentary budget officer. He said that Canadians would save up to $4 billion a year if they instituted pharmacare.

If the member believes in being fiscally responsible and in ensuring that all of his constituents have equal access to the medicines they need, does he not believe it would best to take the most fiscally responsible route to providing medicines to Canadians?

[Jim Eglinski, Conservative, Yellowhead, AB]

Mr. Speaker, as I stated earlier, our party believes health care should be available for everybody, but it does not have to be done through a motion forcing the government to meet with the provinces. We have a committee that is studying the program, looking at the best ways to make recommendations to the current government. All three parties are involved in that committee.

We need to have negotiations with the provinces and the territories. We should not have a motion before the House, forcing us to start those negotiations before the committee has reasonable time to study all parameters around it.

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

Mr. Speaker, I find myself inclined to agree with what the member said about the motion, which is somewhat unbelievable.

My question is related to the fact that there is no individual or party that should stake a claim to owning the issue of pharmacare and the importance of it is for all Canadians. We understand the many complications and issues surrounding it. I guess it is more of a statement, looking for affirmation from the member, as he already has in one sense.

The membership of that standing committee has done a fantastic job in bringing many of the stakeholders together over the last while. As the member has already implied, if not said it, we need to allow allow the parliamentary budget officer's report, as one of the documents among other documents, to be taken into consideration by the standing committee, with the idea that the standing committee as a whole will be able to come up with some good, solid ideas that maybe would enable us to move forward?

[Jim Eglinski, Conservative, Yellowhead, AB]

Yes, Mr. Speaker, we need to rely on the committee. The budget officer's report is just one tool we should look at. We need to bring the appropriate witnesses, whether they are the provinces one by one, or the provinces as a group.

One plan will not fit all. We have to provide the best health care we possibly can for all Canadians, but it will not eliminate the problem if some people do not get proper health care. Some people may not register properly. Some people may not go through the proper channels, and they will be stopped whether it is a federal plan, a private plan, or a provincial plan. We need to work together to ensure we provide the best services we can for all Canadians.

[The Assistant Deputy Speaker, Liberal, Anthony Rota]

It is my duty pursuant to Standing Order 38 to inform the House that the questions to be raised tonight at the time of adjournment are as follows: the hon. member for Regina—Lewvan, Canada Post; the hon. member for Windsor West, Government Appointments.

The hon. member for Saint-Hyacinthe—Bagot.

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

Mr. Speaker, let me start by saying that I am honoured to be splitting my time with my esteemed colleague from Edmonton Strathcona.

Close to 8 million Canadians have no drug coverage whatsoever, because Canada is one of the few industrialized nations that offers healthcare without offering medicare. Without medication, there can be no treatment. Health care without drugs is inconceivable.

We have heard specific examples all day long. In each of the ridings we represent, there are people who are unable to afford the medication they need. It is time for the government to find a solution to this problem.

In Quebec, we pay for our prescription drugs through a hybrid public-private insurance plan. Those whose employers have a plan are required to join. For all others, there is a public plan. This mandatory system guarantees better access than in the other provinces, but it is ineffective in containing spiralling costs.

The solution the NDP is proposing today is to implement a universal pharmacare program. According to data from sources such as the parliamentary budget officer, universal pharmacare would improve access to prescription drugs for Canadians and save billions annually.

The parliamentary budget officer's report, entitled “Federal Cost of a National Pharmacare Program”, which was released on September 28, reveals that a national pharmacare program would actually save Canadians $4.2 billion a year.

Professor Marc-André Gagnon, an expert in public policy at Carleton University here in Ottawa, estimates that the government could cut its spending in half. That is why we are calling on the government to begin negotiations with the provinces within the next year to bring in such a pharmacare program.

I simply do not understand how this government can continue to ignore the benefits of implementing a national pharmacare system. Why wait, when people are suffering today because they do not have the drugs they need?

I will go over all the reasons why this system would be much better for Canadians. According to the brief presented to the Standing Committee on Health in November 2015, a universal system would reduce the cost of drugs by over $1 billion through the use of evidence-based therapeutic options. A number of Liberals have said so today. There would be an additional savings of more than $1 billion from the elimination of administrative costs related to private insurers.

Did members of the House know that a hundred or so generic drugs are more expensive in Canada than they are in the United Kingdom, France, and the United States? Why is it so expensive to get care in Canada? In addition to these potential savings, drug reimbursements would increase and the process would be simplified. Private plans cover millions of people in different ways. Each has its own conditions, restrictions, and co-payments, and every time a person needs a prescription drug, they have to check whether that drug is covered by their plan.

In 2015, more than one in five Canadian households were not taking their prescribed drugs because of the cost. With a public, universal pharmacare program, prescription drug prices would drop and drug reimbursements would increase for everyone. The process would be simplified because there would no longer be so many private players proposing countless plans and sometimes preventing the consumer from making an informed choice.

According to the same brief submitted to the Standing Committee on Health, a national pharmacare program can improve drug safety, mainly by limiting the number of insured drugs and ensuring that they are chosen carefully, in the interest of patient health and safety. Currently, Canada has no national strategy for integrating the safe and appropriate use of prescription drugs into the Canadian health care culture.

Both patients and prescribers have access to only a limited amount of unbiased information, which creates disparities and confusion.

A single list based on sound evidence would help to make sure that drugs are used properly, while taking into account their therapeutic value for patients. It is estimated that 80% of new drugs do not offer any added therapeutic benefit compared to less expensive drugs that are already on the market.

In countries that have a universal pharmacare program, the price of both patented and generic drugs is negotiated with the pharmaceutical companies. Buying drugs for entire populations gives these countries a lot of bargaining power. Depending on the plan, they negotiate the bulk price, establish budgets, hold competitive bidding processes for companies, and consider bundling several drugs.

Most drug expenditures come from thousands of private plans wherein people either have absolutely no power to negotiate lower prices or have no interest in doing so because workers and employers are the ones who pay for the drugs, not the insurance companies. The negotiations the provinces hold for their public plans have led to higher prices for the rest of the population, who are covered by private plans or who have no coverage. A universal pharmacare plan would give the government more power to negotiate with pharmaceutical companies.

This would also be the end of a no-win research and development strategy dictated by major pharmaceutical companies. The cost of newly approved medications is set by a federal body, the Patented Medicine Prices Review Board. This board examines the price of medications in other countries and uses the median price to set the Canadian price. However, the countries used for comparison purposes are those with the highest prices in the world, so we end up with unnecessarily high prices. This approach was intentional; it is part of an industrial policy that aims to increase the investments of pharmaceutical companies in research and development and job creation. It is no wonder the Liberals talked about research all day long. This policy, however, has proven to be an abject failure because investments in research and development between 1998 and 2013 declined dramatically compared to sales. It is high time to curb the powers of pharmaceutical groups in Canada.

Currently, New Brunswick, Alberta, and Quebec do offer pharmacare programs, but so far, we have only seen action on the provincial level. We need the federal government to show true leadership, because it is lagging behind on this issue. Quebec may be ahead of the curve once again, but that does not mean that it should have to sustain the entire system alone, when we have the means to implement a national, universal, and publicly funded pharmacare program.

The federal government needs to do more for all Canadians. If we had an entirely publicly funded universal pharmacare program, the Quebec government alone would save an estimated $1 billion a year. Currently, Quebec residents are required to join their employer's private plan. The problem is that, for some types of employees, the cost of these private drug insurance programs represents a significant proportion of their salary. After paying the premiums, they do not have enough left over to pay for medication. On top of the potential savings to Quebec, a universal pharmacare program would relieve employers of a huge cost, enabling them to be more competitive and offer higher salaries and added benefits.

Lastly, a universal pharmacare program would be more fair for all Canadians. It would allow our poorest citizens to receive their medication for free. We have heard many examples today of people unable to afford their medication. We need to make sure that no one in Canada has to choose between paying for the medication they need and feeding their family. This cannot wait. For too many opposition days, we have heard the Liberals say they are going to oppose the motion so they can propose something better. Enough is enough.

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

Mr. Speaker, I would like to believe, whether in this House or in the Manitoba legislature, that I have been a strong advocate on the health care file.

However, pharmaceuticals are one of the aspects of health care that quite often do get overlooked. For example, there is the issue of home care services, the issue of hospice care, and even issues such ambulance services. I remember knocking on someone's door on Pritchard Avenue or it may have been a block over, and the individual was afraid to call an ambulance because of the cost. There are all sorts of issues surrounding health care.

One of the things that is important for us to recognize is that, in that we have the Canada Health Act, the national government does play a significant role. However, part of the role and responsibility of the national government is to work with provinces, territories, and indigenous groups in terms of trying to have the quality health care service that Canadians expect, want, and quite frankly, deserve.

My question for the member is twofold. One, why did NDP members not include the territories in their motion, and is that something they intend to change before there is any sort of vote on it? Two, does the member not concur that the Standing Committee on Health has actually been doing an outstanding job on this particular issue?

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

Mr. Speaker, as one of my colleagues said, if adding the word “territory” will get the Liberal government to vote for this motion, I will happily do so.

Yes, the Standing Committee on Health is doing excellent work, but the Canada Health Act guarantees the universality and accessibility of health care, which is why we need a universal public pharmacare system. The federal government needs to take the lead on that. It is our job to take the lead.

Health is a jurisdiction we share with the provinces and territories. We have to work with them to ensure that each and every Canadian can get their prescription drugs, whether they can cover the cost themselves or need to get them for free because they are poor. All Canadians must get the medication they need to take care of themselves. We cannot be the only major industrialized country whose health insurance plan does not include universal public pharmacare. We can certainly start that conversation with the provinces and territories right away.

While the health committee carries on with its excellent work, I think we can start negotiations now. Canadians are suffering as we speak because they do not have the means to buy the medications they need.

[Cheryl Hardcastle, NDP, Windsor—Tecumseh, ON]

Mr. Speaker, I want to congratulate my hon. colleague for her very succinct speech. I know she is concerned that Canada currently has the second highest rate of skipped prescriptions due to the cost.

We did hear from our colleague across the way who asked a question about the concern for costs for ambulances, home care, and other related health care. Does the member see the relationship? Do those needs for health care services come from the cost of pharmaceuticals; maybe people are denying themselves and requiring more health care?

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

Mr. Speaker, I thank my colleague for her question.

All I have to say in response is that the arguments I heard from my colleagues suggest that they are trying to come up with arguments, but cannot find a valid one to make. I think we need to look at the health care system as a whole, but that is no reason to deprive Canada of a universal public pharmacare system. We need this system. I have not heard a single argument to convince me otherwise. When I hear someone suggest that past administrative abuses is a reason to not look to the future and come up with a solution for tomorrow, that the motion is missing just one word to make it acceptable, or when I hear talk on subjects that have nothing to do with the motion, what that tells me is that they have no valid argument against it.

[Linda Duncan, NDP, Edmonton Strathcona, AB]

Mr. Speaker, it is with great pleasure that I also rise to support the motion that we have brought forward.

At the outset, it is important to point out that, when my colleague brought forward the motion, he was very clear that we are calling on the government to begin negotiations with other orders of government. It would be nice if the government also talked to first nations, whom it has excluded from its tables up until now.

The member was reasonable in saying that the negotiations should begin in October a year from now. We are not saying immediately, although it would be nice if we had pharmacare today, but my colleague has given a reasonable timeframe. This is a reasonable proposition to the government.

I will give some information toward the end of my speech that will puzzle members on the other side as to why we, not they, had to bring forward the motion.

Many have said in this place that the Standing Committee on Health has been examining the issue of the access to pharmaceuticals to Canadians, the problem of rising costs and the fact that those who are not well endowed with dollars, and are seniors, are not taking the medicines that are actually prescribed to them.

Why was this study commenced by the committee? Why is this a critical issue that we should be dealing with in Canada?

Angus Reid did a survey in 2015, which found that one in seven, or 14% of Canadians, have reported that they or someone in their household did not fill a prescription. They were prescribed a medicine by their doctor but they did not fill it. One in 10 did not renew a prescription. One in seven, or 15%, did things to make a prescription last longer—in other words, took the pills intermittently or cut them in half. More than one in five, or 22%, reported that in the past 12 months they or someone in their household did not take their medicines at all because of the cost.

We have medicare in this country and many, including Tommy Douglas when he proposed medicare, have long called for it to cover everything, including medicines and dental care. I would like to share with this place an excerpt from a speech by Tommy Douglas in 1982, when he said:

Let's not forget that the ultimate goal of Medicare must be to keep people well, rather than just patching them up when they get sick.... It means expanding and improving Medicare by providing pharmacare and denticare programs. All these programs should be designed to keep people well—because in the long run it’s cheaper than the current practice of only treating them after they’ve become sick.

Those are very wise words by our former leader Tommy Douglas.

Who has echoed that study? It was the parliamentary budget officer for Parliament.

The parliamentary budget officer was asked to do a study by the health committee. The parliamentary budget officer set forth to determine if it would be more cost-effective if we had pharmacare or if we continued with this hit or miss system that we have now, where some people have private plans like Blue Cross and others have no plan all. If people are in the hospital they get the medicine, but when they come out they have to pay for it themselves.

What did the parliamentary budget officer determine, having done a very thorough assessment of the costs? This is what he found:

While spending on drugs has grown rapidly (5.1 per cent annually from 2004 to 2014), many Canadians are still unable to obtain necessary drugs because of their cost. This includes an estimated 2 per cent of Canadians who lack drug insurance coverage and 10 per cent of Canadians who have coverage, but lack the financial means to pay for their prescriptions.

There are many Canadians who are working hard and diligently to look after their families, some with two or three jobs, and still they cannot afford to pay for medicine for their family.

The parliamentary budget officer also said:

After accounting for pricing and consumption changes, PBO estimates total drug spending under a national Pharmacare program would amount to $20.4 billion, if implemented in 2015-16. This represents savings of roughly $4.2 billion.

It sounds like a fiscally responsible approach to take, so it would be reprehensible if those in this place do not support this. We have many calls for fiscal responsibility coming from our Conservative colleagues, and I am looking forward to their supporting the motion.

Where are we at in Canada?

As I reported, Angus Reid found that many Canadians, particularly seniors, one in five, were spending $500 or more on prescriptions for the household in the past year, and a total of 7% paid $1,000 or more out of pocket.

Many Canadians can barely afford to pay their rent. A senior approached me when I hosted a tea this summer. She said that her apartment building was being torn down and that she would not be able to afford to move into the new building. She gets the bare minimum of money from Canada pension. She says that she cannot find any place in Edmonton where she can afford to live, let alone be able to buy the prescription drugs she will likely need as she grows older.

Almost 90% of Canadians say that they would support the introduction of a pharmacare program. Canadians are calling for it. The Liberal government says that it is a populace government, that its believes in following what Canadians want to have happen, yet it is not moving forward.

I mentioned that I would share something in my speech about why I was puzzled that my colleague, our critic for health, had to bring this motion forward. The Liberal Party, at its 2016 convention, passed a resolution. The resolution states:

...that The Liberal Party of Canada urge the government of Canada to seize this unique opportunity for serving the public and all levels of government to:

reconvene the first ministers and the health ministers conferences that had this item on their agendas before getting unilaterally aborted by Mr. Harper in 2006;

capitalize on its leadership and widespread national support to have a national PharmaCare plan in place within its first mandate.

If the government supported the motion by my colleague, that this initiative would start one year from now, then it may well be that it could deliver exactly what the membership voted for. Presumably those members in this place who are Liberal card carriers also voted for the resolution.

What did the former minister of health have to say? On CBC's the fifth estate, she said:

There is no question that the current status is not fair, that it's not right, that we're paying much higher prices than other countries are and that's exactly what I'm working on.

She then said:

I've been a family doctor for over 30 years so you don't need to convince me that making sure Canadians have access to appropriate medications is absolutely essential.

Then, on May 8, the member for Oakville said this to the The Hill Times:

I wanted to make sure that we continued to have a strong universal health-care program, and there is a need to add a universal pharmacare program to that.

I rest my case, only echoed by Friends of Medicare, a credible organization in my province of Alberta, which fought diligently to protect medicare for Albertans and to fight against the former premier of Alberta's push for two-tiered health care.

We have two-tiered pharmacare in the country, those who are on corporate programs, or a government program where they get some level of subsidy, but the vast of Canadians do not have access to those. Therefore, we essentially have two-tiered pharmacare in this country.

Friends of Medicare have said:

Albertans need a pharmacare program that ensures everyone has access to affordable and safe prescription drugs.

Ensuring universal access to medically necessary prescription drugs is not only the ethical thing to do, it is also fiscally responsible.

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

Mr. Speaker, I have had the opportunity, this morning and this afternoon, to emphasize the fact that we had a Standing Committee on Health, which has done a great deal of work.

The motion presented by the opposition is based on the parliamentary budget officer's report, a report that was requested by the hard-working Standing Committee on Health. If it were not for that request, the opposition would not have that report, on which the motion is based.

Canadians are driving the issue. We are listening to what Canadians have to say. One of the first actions of the former minister of health was to get the provinces to come together to deal with lowering the costs of pharmaceuticals. The minister of health also achieved the health care accord. All of that within 18 months.

Our government is in tune with what Canadians want. We have a standing committee that is working hard. I have a very simple question for the member.

In devising its motion, the NDP forgot to include the territories, and I do not know why. Would the member not agree that any sort of agreement has to include working with the stakeholders, with the provinces and territories, and indigenous people? All have to be engaged on this very important issue. Would the member not agree with that?

[Linda Duncan, NDP, Edmonton Strathcona, AB]

Mr. Speaker, what has come clear to me is the circumstance that we witness in the House over and over again in the two years of this session of Parliament. I am beginning to suspect that the reason the Liberal members will not vote for the motion is that they did not think of raising it themselves. Time after time, we have had motions that we presented that were really good ideas and the Liberals voted them down, and then a few weeks or a month later, they tabled exactly the same motion, and guess what. We have a majority in favour.

I am sure the Liberal members at the committee are very enthusiastic about pursuing better options. Simply bringing down the cost of drugs is not enough. We need to make sure that all Canadians, no matter how well-to-do they are, no matter where they live in this country—territories, provinces—whether they are indigenous or non-indigenous, whether they are refugees, should have access to drugs so they can have good health and not raise health care costs by their having to go to the hospital.

[Jim Eglinski, Conservative, Yellowhead, AB]

Mr. Speaker, the member mentioned Alberta's health care plan, and I think both of us are very fortunate to live in the same province and that we benefit from one of the best programs found anywhere. I think she is fully aware of that. I agree with the member that we need to involve all parties, if such a thing as national health care were to come forward.

A number of years ago, the Liberal government said it would start a long-gun registry. It said it was only going to cost a couple of million dollars, but it blew up to about $1 billion. We see the fiasco that happened here with the Phoenix pay system. Liberals rushed it in, although they were told not to rush it in, as evidence came forward from the NDP this morning.

Does the member really think it would be cheaper if we relied on the federal government to take this over and get it working? I think it would be much cheaper if we leave it in the hands of the provinces.

[Linda Duncan, NDP, Edmonton Strathcona, AB]

Mr. Speaker, it is my understanding that the issue of how pharmacare would be delivered is not determined at this point, whether it would be delivered singularly through a federal system, through the individual provinces and territories, through first nations health authorities, and whether that would be coordinated. We are fully open to that being discussed and looking at the most cost-effective and most effective way to get those medicines to people as expeditiously as possible.

Indeed, I similarly feel fortunate to live in Alberta. We have a good health system, but we also need to make sure all our fellow citizens have access to medicines when they need them.

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

Mr. Speaker, I am quite pleased to rise at the end of the debate today. We have heard a lot from the Liberals about process, and we have heard a lot from the Conservatives about fear of bureaucracy. For me, the debate comes down to a simple question: whose side are we on? Are we on the side of ordinary Canadians or on the side of big pharmacare? In our country, we pay the second highest drug prices in the entire world, second only to the United States, so whose side are we on? Are we on the side of big pharma, or retired couples, like those I have heard from in my riding who skip or reduce their medications because they cannot afford those costs? Are we on the side of big pharma, or working families, whose incomes might just be above the income limits for getting assistance, and they skip or reduce their medications in order to feed and clothe their kids and keep a roof over their heads? Are we on the side of big pharma, or veterans, who often have limits on their coverage and the kinds of things they need? They have served their country. We limit the amount of medication, in particular for those who have pain problems PTSD problems. Whose side are we on when they cannot afford to buy more medication?

We know that in our country there is a cholesterol drug that is commonly prescribed. It costs $143 a year in Canada, but only $15 a year in New Zealand. Why is that? It is because we have a mix of private programs that do not give us the purchasing power to get the best deal on drugs in our country.

We know that employers waste between $3 billion and $5 billion annually because of inefficiencies in managing drug costs in their private plans. We know that over the last 12 years, Canadian drug expenditures have increased by 184%, faster than any other country, including the United States. We know that small businesses quite often cannot afford to provide the coverage to their employees they would like to provide.

A universal pharmacare program would reduce costs for those small businesses who do provide those programs. It would also reduce time lost for those who cannot provide the programs when their employees take time off, sick because they cannot afford prescriptions. Of course, it would help small businesses with retention and recruitment of employees because they would no longer have to compete with the benefits that large corporations are able to offer.

Amidst all the other things we have heard in the House today, it comes down to that one simple question: whose side are we on in the House? If we are on the side of ordinary Canadians, working Canadians, retired Canadians, veterans, and low-income families, then we will proceed now to get started on the necessary negotiations with the provinces and territories to make sure that universal pharmacare comes into existence and helps to complete the medicare system we already have in our country.

I urge all members, Liberals and Conservatives, that if they support medicare, they should also support universal pharmacare.

[The Assistant Deputy Speaker, Liberal, Anthony Rota]

It being 5:15 p.m., pursuant to an order made earlier today, all questions necessary to dispose of the opposition motion are deemed put and a recorded division deemed requested and deferred until Tuesday, October 17, 2017, at the expiry of the time provided for government orders.

The hon. member for Laurentides—Labelle.

[David Graham, Liberal, Laurentides—Labelle, QC]

Mr. Speaker, I wonder if we could have the consent of the House to see the clock at 5:30 p.m.

[The Assistant Deputy Speaker, Liberal, Anthony Rota]

Is that agreed?

[Some hon. members]

Agreed.

The House resumed from May 31 consideration of the motion that Bill C-349, An Act to amend the Criminal Code and to make consequential amendments to other acts (criminal organization), be read the second time and referred to a committee.