Debates of Feb. 17th, 2021

United Nations Declaration on the Rights of Indigenous Peoples Act

[Jamie Schmale, Conservative, Haliburton—Kawartha Lakes—Brock, ON]

Mr. Speaker, I thank my friend across the way for that question, and I do mean “friend” in the true sense of the word. I appreciate his work on the file as well. However, there are a number of indigenous communities that are concerned about the wording of Bill C-15. We have even had letters from provincial ministers responsible for those files saying the exact same thing.

As we come out of this pandemic, those in industry will be looking for certainty. They will be looking for markets that allow them to invest their money and have light at the end of the tunnel, if they meet all of the requirements.

Until we have a definition of free, prior and informed consent, that certainty remains up in the air. When we are trying to rebuild the economy, bring these jobs back and bring opportunities to some of these first nations communities that, in many cases, rely on natural resources as their source of revenue and jobs, we need to have that certainty.

[Sylvie Bérubé, Bloc, Abitibi—Baie-James—Nunavik—Eeyou, QC]

Mr. Speaker, experience has shown us that failure to obtain consent for development projects often leads to crises involving indigenous peoples. That is what happened with the Oka crisis and with the Wet'suwet'en this winter.

Can the member tell us what the problem is with making sure natural resource development projects are carried out properly in accordance with the FPIC standard?

[Jamie Schmale, Conservative, Haliburton—Kawartha Lakes—Brock, ON]

Mr. Speaker, I agree that everything has to be done in the proper way. Whether it be natural resources projects, or anything really, the rules have to be clearly defined and outlined, so people undertaking the application process understand the path forward and if there is a path forward. If we do not know that at the beginning, it makes it very difficult to continue on a project or even start one in the first place.

That is why we keep saying that we approve of the aspirational part of UNDRIP and of Bill C-15. However. What we are opposing and questioning, which is no secret, is the lack of due diligence in putting forward this legislation without coming to a common understanding of what free, prior and informed consent actually means.

[Taylor Bachrach, NDP, Skeena—Bulkley Valley, BC]

Mr. Speaker, I listened closely to my hon. colleague's remarks. I have a lot of questions, and I know I only have a short time to ask them.

The member spent a lot of time speaking about this conflation between the concept of consent and the concept of a veto, which has been spoken to at length by legal experts and dozens of witnesses at committee. It is clear that there is a distinction between these two concepts, so it is unfortunate that he continue to conflate them.

Part way through his speech, he said something along the lines of supporting the goals and aspirations of UNDRIP. However, I listened carefully, and 90% of his speech was speaking negatively about the risks he feels it poses. I am curious what parts of it he supports and feels are worthy of his support.

In his question to the minister, he indicated that he supports treaty rights. Does he support section 35 rights of indigenous people in the Constitution of Canada?

[Jamie Schmale, Conservative, Haliburton—Kawartha Lakes—Brock, ON]

Mr. Speaker, there is a lot to unpack there, and I will try to get through it as quickly as possible.

On his first point regarding free, prior and informed consent, if what he is saying is true, then why is it not included in the bill? If it is that simple and clear, why not put it in the bill and get unanimous support for this bill? The problem is that it is not there, which is causing issues.

We are in this chamber to discuss issues such as this, which could have profound impacts on the way forward. It does not have to be natural resources projects. I keep saying it is a larger impact than that. We should be debating this in the chamber. We should be debating it instead of pushing it through. If it is clear, let us make sure it is clear.

In terms of his negative comment, yes, there are lots of positive things in there addressing issues of discrimination and racism. However, what we are trying to do is reach a consensus on the part we disagree with so we can get to what we do agree with and get this passed. Let us address the issues that we have on this side of the House, which are with the definition of clear, free, prior and informed consent. If it is clear, put it in the bill and we will be a lot happier with that. I am sure industry will be as well.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Mr. Speaker, my colleague rightly pointed out some of the issues and questions on free, prior and informed consent with the Wet'suwet'en, where even within the band there were people who did not agree.

I have had conversations in my own riding with the leaders of various aboriginal groups. They had no expectation of having the right of veto. They agreed that no individual Canadian should be able to stand against something that is in the national interest. They asked why we could not just put a clarification in the bill to make that clear. They then asked if there was anything else we would not support.

Is there anything else, other than that free, prior and informed consent, that would keep the member from supporting the bill?

[Jamie Schmale, Conservative, Haliburton—Kawartha Lakes—Brock, ON]

Mr. Speaker, that is a big part of it, but, as I said, we are not opposing UNDRIP per se. We are opposing the government's lack of due diligence. When it comes to free, prior and informed consent, that is a big piece of it. We saw, as the member rightly mentioned, this with the Wet'suwet'en community.

The elected chiefs and the band councils, which had just gone through an election process in which many of the candidates were victorious on pro-energy platforms, wanted to move ahead with the energy project that was pre-approved. Then the hereditary chiefs expressed concern. When we talked to the members of the elected bands and councils, they felt that their voices were not even heard in this debate.

This is why we need that clarity. This is why we need the certainty for industry and we need to ensure that consultations are done properly and in a meaningful way, so we have certainty and also the conversations to address any problems.

[The Deputy Speaker, Conservative, Bruce Stanton]

It being 7 p.m., the House will proceed with the consideration of Private Members' Business as listed on today's Order Paper.

The House resumed from November 18, 2020, consideration of the motion that Bill C-213, An Act to enact the Canada Pharmacare Act, be read the second time and referred to a committee.

Canada Pharmacare Act

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Mr. Speaker, it is a pleasure to rise tonight to speak to the bill on pharmacare. I want to thank the member for New Westminster—Burnaby for bringing it forward. I am sure the reason he has brought it forward is to call for action. There has been a lot of talk about pharmacare but, to be fair, there has not been a lot of action.

By way of background, the Liberals have been talking about pharmacare since 1992. They have been studying and talking, but nothing really concrete has come forward. Therefore, I am glad to see we are talking about this tonight.

Members may want to pay heed to my commentary. As a former shadow health minister, I was on the health committee when we studied pharmacare. We have heard all kinds of testimony from every province and territory and from all sorts of Canadians about what they think about pharmacare as well as on related topics, like the drug approval process and rare disease medications, which are also important and need to be addressed.

All parties in the House are looking for a common outcome. We all want to see Canadians have access to prescription medications. The discussion is about the best route to get there. This bill proposes to put everybody on provincial coverage essentially. That may be an oversimplification, but that is what it is.

If we look at the situation today, between 95% and 98% of Canadians have prescription drug coverage, depending on which report we look at and depending on the types of coverage. Many people have private plans. Those private plans typically cover more than 14,000 medications compared to the public plans that cover 4,000 to 5,000 medications. The private plans cover, in addition to the medications, many services. People are getting physiotherapy, orthotics, various and sundry, with their plans. However, not a lot of people who have a private plan would want to give that plan up to go on a public plan that would have less coverage. That is certainly one issue.

Most provinces have a plan that covers people. There are some exceptions. For example, in Ontario, people under 24 get coverage. If they are over 65, they get coverage. If they are on social assistance, they get coverage. Otherwise, unless they have a private plan, there is no coverage. There are some gaps there.

The other gap happens in the Atlantic provinces. In some cases, there is a plan there, but because the list of approved drugs is small, many people cannot get coverage for the particular drug they are taking.

This brings up an important consideration when we talk about the bill. The member's bill talks about the Canada Health Act and its requirements for accessibility and universality. If we talk about universality, it is difficult to have that in different provinces when each province has a different list of drugs that are covered. This is called a formulary.

Some Canadians move between provinces to get coverage for the medication they need because is not covered by their province. Through consultation and discussion with the provinces and territories, we could come to a more common list of medications that would be covered. That would go a long way.

Many people who do not have coverage may not be aware that they have access to a provincial plan. There is an opportunity to increase awareness in that way, and that should be done.

On the cost of these systems, the cost of transferring and putting everybody on provincial plans has been estimated. The Liberal proposition was for a single-payer federal system of pharmacare, and the Parliamentary Budget Officer costed that at about $20 billion a year. However, some of the costs we were paying for prescription drugs were underestimated by about another $20 billion. Therefore, we are looking at about $40 billion a year for that. I think there was a lot of resistance in the public to that idea.

We have seen what happens when the federal government tries to implement things. For example, the Canada Revenue Agency has a 30% error rate with the advice it gives people and is not always friendly on the phone. I do not think people would necessarily want their prescription medications administered in that kind of system. However, people are fairly happy with the provincial systems, so filling the gaps that way is one option.

Other options could be considered, and it is certainly worthwhile thinking about them. C.D. Howe published a report that said if we put the people who did not have coverage on the existing provincial plans, the cost would be about $2.2 billion a year. That would be reasonable.

As an engineer, when I was a contractor, I had to buy my own benefits. For $1,200 a year, I could not only have prescription drug coverage but I could have dental and medical coverage. On a volume discount, if we take the 2% to 5% who do not have coverage and add it up, that is about $2 billion a year. There is an idea where people could go on government benefits.

There are a lot of ways to approach this and the discussion needs to be about which way makes the best use of taxpayer money and takes advantage of some of the systems already in place.

Let me talk for a minute about rare disease medications, because this proposal would do nothing to address some of the issues with respect to that.

Today, to get coverage for rare disease medications, private insurance companies pool their money so not any one company has to take the risk of these very expensive medications, some of which cost $250,000 a year or a million dollars a year. If the government infused money into that pool on the condition that everybody would get their rare disease medications covered, that would be another great way to ensure people would have coverage for some of the most difficult to cover drug costs.

Access to medications also depends on ensuring that drug companies want to market their drugs in Canada. Unfortunately, the Liberals have put changes in place to the drug approval process which will make the process longer and more costly. As a result, many companies do not want to market their medications in Canada because we are a small population and they would have to operate at a loss. This has also impacted the number of clinical trials happening in Canada. The government needs to definitely reconsider that poorly thought out policy.

If we look at some of the examples of innovation happening in the world, Chile has a great funding model that is infusing money into a rare disease fund, but also allowing people to buy government bonds that also kick into that fund. There are a number of innovative ideas around the world at which we should take a look.

I look forward to working with my colleagues on this bill toward the common goal of getting prescription medication access for all Canadians. A number of things could happen to our benefit out of this. We would have better volume leverage and could reduce the cost of drugs and take away some of the co-payer issues that provide barriers. I look forward to discussing all these things with my colleagues when this comes to committee.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Speaker, Bill C-213 builds on the Canada Health Act to establish a universal, comprehensive, single-payer pharmacare program.

The federal government would simply provide money to the provinces who would put in place a pharmacare program that meets the criteria it sets. The federal government can impose sanctions if it deems that the province's pharmacare program does not meet the federal criteria. The bill also creates a drug agency responsible for approving the drugs covered by the program and negotiating drug purchases.

The Bloc Québécois is against this bill primarily because we represent the voice of Quebec in Ottawa. If the government did not need NDP votes to stay in power, it would never accept the centralist agenda of this bill that completely violates Quebec's jurisdiction. In fact, the National Assembly of Quebec was unanimous on June 14. I will read the motion that was passed unanimously by all the parties at the National Assembly of Quebec: Québec solidaire, the Parti québécois, the Quebec Liberal Party and the Coalition avenir Québec.

The motion reads:

THAT the National Assembly acknowledge the federal report recommending the establishment of a pan-Canadian pharmacare plan;

THAT it reaffirm the Government of Québec's exclusive jurisdiction over health;

THAT it also reaffirm that Québec has had its own general prescription insurance plan for 20 years;

THAT it indicate to the federal government that Québec refuses to adhere to a pan-Canadian pharmacare plan;

THAT it ask the Government of Québec to maintain its prescription drug insurance plan and that it demand full financial compensation from the federal government if a project for a pan-Canadian pharmacare plan is officially tabled.

When our National Assembly speaks with one voice on an issue dealing with Quebec-Ottawa relations, we in the Bloc Québécois pay attention and make sure that that consensus is echoed in the House of Commons of Canada. Given that the National Assembly was careful to specify that Quebec would refuse to adhere to a pan-Canadian pharmacare plan, we would find it strange to ask for a program that would not apply back home.

The NDP adopted the Sherbrooke declaration in 2005, in which it said it recognized asymmetrical federalism and intended to give Quebec the systematic right to opt out, so it is odd that the New Democrats now seem to be writing off Quebec.

There is no question that health is a Quebec jurisdiction. The Bloc Québécois finance critic, my hon. colleague from Joliette, took a similar position before the Fédération des travailleurs et travailleuses du Québec, the FTQ. His position echoed that of the FTQ.

Let me quote from a statement from the FTQ, a labour organization that has been advocating for a universal public pharmacare program:

For the FTQ, the terms and conditions of a public, universal pharmacare program must first and foremost be discussed in Quebec and established according to the needs of its people.

That is why Quebec must be able to opt out with full compensation from any pharmacare plan...

Furthermore, the federal government cannot discuss pharmacare without addressing the problems in health care funding....The Liberal government's desire to expand public coverage of health care by including prescription drugs is not consistent with its intention to limit health transfers to the provinces....To ensure the viability of Quebec's health system, the portion of federal funding must be increased.

If Ottawa wants to move forward with its national pharmacare plan, Quebec must have the unconditional right to opt out with full compensation. Ottawa must respect the solemn moment on June 14, 2019, when the Quebec National Assembly unanimously adopted a motion calling on Ottawa not to interfere in Quebec's jurisdictions and to provide full and unconditional financial compensation.

It was impossible for the member for New Westminster—Burnaby to not be aware of this when he introduced his bill.

Quebec is a progressive nation. It is surprising that the NDP, which calls itself progressive, wants a nation that lags behind ours to tell us what to do. Generally speaking, Quebec society has more comprehensive social programs than Canadian society. Quebec has the best family policy on the continent, which includes parental leave and child care. Quebec has the best access to post-secondary education and the most progressive taxation on the continent. Furthermore, Quebec has a pharmacare plan that leaves no one behind. Everyone is covered by insurance.

Although it is not perfect, our situation is unlike any other in North America. Quebec's pharmacare plan has been leading the pack among Canadian provinces and territories since 1996. Quebec will not entrust the development of its social programs to the neighbouring nation, whose coverage does not compare to ours.

The members of the Quebec National Assembly are unanimously opposed to this initiative. The members of the Bloc Québécois, who rise in the House to impart the general consensus of the Quebec National Assembly, will not compromise at the expense of Quebeckers to salvage some votes in the west, in the east or in Ontario. Not to mention, Ottawa is not even able to manage its own affairs. Just look at the firearms registry, which ended up costing $2 billion, or the Phoenix pay system; and yet people think Ottawa should manage our pharmacare program?

Quebec is quite capable of improving its own program without surrendering its autonomy. The $3.6-billion price tag for Quebec's public pharmacare plan is fully covered by the Régie de l'assurance maladie du Québec, or RAMQ, which covers health care costs. What Quebec needs is an increase in health transfers.

Since 2017, the health transfer escalator has been capped at 3%, but health care system costs are going up by about 6% because of factors like technological advances and the aging population.

The Bloc Québécois is asking Ottawa to respect the wishes of Quebec and the provinces and increase its share of health care funding from 22% to 35% unconditionally. Let us not forget that, back when the Canadian system was created, federal funding covered 50% of the cost.

The Bloc Québécois is also opposed to the creation of a Canadian drug agency that would tell Quebec how to use its drugs. Quebec is already managing its public prescription drug insurance plan expenses itself through the pan-Canadian Pharmaceutical Alliance, the pCPA, and the national institute for excellence in health and social services, or INESSS, and Quebec's system has rigorous criteria.

The INESSS supplies Quebec with its own expertise and updates the list of drugs covered by the RAMQ, Quebec's health insurance plan. A new Canadian drug agency would just duplicate the work being done in an area that is not under federal jurisdiction. That is nonsensical.

That is why I moved a motion on October 26 at the Standing Committee on Health to study how reforming patented medicine pricing could affect the whole life sciences ecosystem and patient access to innovative therapies.

During the election campaign, the Liberals said they wanted to do something about the cost of drugs used to treat rare diseases. They reiterated that intention in the throne speech, but we are still awaiting the strategy. The federal government needs to give us more details about its plans. Most importantly, it needs to tell us whether it intends to harmonize its rare disease strategy with Quebec's.

In closing, recognizing that Quebec's plan is the best one on the continent and emphasizing that Quebec has the right to decide does not mean that our plan is perfect, but Quebeckers are perfectly capable of managing it. The NDP and the Liberals have a harmful obsession with wanting to interfere and wanting to decide for Quebec where Quebec should spend its money. Rather than clinging to its centralizing vision, the government should instead agree to Quebec's demands and permanently and substantially increase health transfers so that Quebec can take care of its people.

[Jagmeet Singh, NDP, Burnaby South, BC]

Mr. Speaker, I appreciate the opportunity to share my thoughts on this very important bill. It is an immense honour for me to take the mike right now and speak to my colleague's bill. I want to thank my colleague from New Westminster—Burnaby for bringing this bill forward. This is a very special opportunity that we have right now to make a massive difference in the lives of Canadians.

In Canada in this pandemic, we have seen millions of Canadians lose their jobs, and when they lost their jobs, they also lost their benefits. That means millions of Canadians were not able to purchase the medication they needed. This is on top of the millions of Canadians who already simply cannot afford their medication. Whether they do not have coverage at all or have coverage that costs too much, very, very many Canadians are not taking the medication they need because they simply cannot afford to.

I have spoken to so many families and so many people who tell me of the pain of not being able to afford their medication. I think of a family in which the father works in construction, and he has a heart illness that requires him to take medication to stay healthy, but he cannot afford that medication, and on top of that, his children need medication. Therefore, he has to choose not only between paying the bills or buying his medication, but also between buying the medication either for himself or for the children he loves. That is an impossible position to be in, and he is not alone. There are so many families that face the same decision.

We know that one out of five Canadians are not taking their medication, simply because they cannot afford to. We know that when someone cannot treat an illness, they end up at the worst stage of that illness, and it costs the system and the family and the person so much more. Having universal access to medication so that everyone in our country could afford it would dramatically improve the lives of everyone.

The Liberals have been promising universal pharmacare for 23 years. They promised again in 2019, but have people seen any difference in their lives when it comes to accessing medication? They have not. We have seen, sadly and again and again, that the Liberal government sides with the pharmaceutical industry instead of with Canadians who are desperate to stay healthy and afford their medication.

We have a concrete solution. The solution is to use the combined power of our entire nation to negotiate better prices so that everyone in our country can afford medication. This is so important. This is an opportunity to save lives. I am asking everybody to think about the millions of Canadians who cannot afford medication, to think about our health care system that allows someone to go to a doctor and be diagnosed with an illness but not to be able to afford the medication they need to stay healthy, to think about the only health care system in the world that provides universal health care but does not include medication coverage, and to pick up their phone and call their local MP.

I ask people to sign petitions and write letters. We have a week left. This vote on the first step to establish the first-of-its-kind, free medication coverage for all Canadians is next week. We can put pressure. We can show that this is the way forward and we can win. People have shown the power of organizing; they have shown again and again that when people come together, we fight and we win.

Once implemented, medication coverage for all Canadians would mean that no one in our country would have to worry about paying for medication. If someone needed medication in this country, they would use their health card and not their credit card. That dream can be a reality, and once implemented, it would establish a savings of at least $4.2 billion that could be reinvested into our health care system.

Here is an opportunity for the Liberal government to back up its words. Its own report states that one of the key steps to establishing a universal public medication-for-all system is to pass a pharmacare act like the one we have proposed. It is far past time to pass such a measure and deliver universal pharmacare to Canadians. Let us get it done now.

No one should have to choose between paying the rent and filling a prescription. One in five Canadians is not taking the medication they need because they cannot afford it. Many Canadians are cutting their pills in half or even deciding not to buy their medication at all because they cannot afford it. Too many people are ending up in the emergency room or in the hospital for an extended stay because they cannot afford to take the medication they need. Hundreds of people are dying prematurely every year. Even those with private insurance are seeing the coverage offered by their employer decrease. People are in more precarious jobs, and their family budget is getting tighter and tighter. We need to help families, not make their lives more difficult.

I have met many families in Quebec who say that it is getting harder and harder to buy private prescription drug coverage. It is getting harder and harder to get drug coverage and buy medication. I spoke with unions that represent thousands of workers, and they all say that prescription drug insurance cost workers too much.

It is essential to have fully public pharmacare in Quebec and across the country. Canada is the only industrialized country whose health insurance does not include universal, public coverage of prescription medication. That does not make any sense.

The Liberals have not stopped breaking promises for the past 23 years. They would rather protect the profits of big pharmaceutical and insurance companies than help people. In 2019, they made yet another promise to introduce pharmacare, but they have done nothing concrete since to keep that promise. The Liberals say all the right things in public, but they keep putting powerful pharmaceutical companies' profits ahead of people's needs. They now have an opportunity to vote for our bill to give Canadians a comprehensive universal pharmacare program.

This bill is the first step toward creating a pharmacare program. If the Liberals really want to help Canadian families, they can work with us to provide the universal pharmacare program people need.

I invite all Canadians to contact their MP and ask him or her to vote in favour of a universal public pharmacare program. We must vote in favour of Bill C-213, a bill to help families and save lives.

I am grateful I had the opportunity to share these words. Again, we have an opportunity to save lives, to help families and workers. It is essential that our health care system cover everyone and that also means providing a universal pharmacare program. Together, we can do this. I invite everyone to demand that we undertake this next step towards a universal, comprehensive health care system.

[Darren Fisher, Liberal, Parliamentary Secretary to the Minister of Health]

Mr. Speaker, I am pleased today to address Bill C-213. As all members know, I firmly support national universal pharmacare and the government knows that pharmacare is the missing piece of universal health care in the country. Pharmacare must remain a priority for all members in the House.

Implementing national universal pharmacare is one of the government's top priorities, as reiterated in the September 2020 Speech from the Throne and in the 2020 fall economic statement.

No Canadian should have to choose between paying rent or paying for needed prescription drugs. Too many of my constituents, too many Canadians, are experiencing this every day. The COVID-19 pandemic has exposed many unfortunate truths in the country and one of those truths is that too many Canadians are also a step away from this unfortunate reality.

While drug coverage is an area of provincial-territorial jurisdiction, the pandemic has reminded us that collaboration between governments is essential to support the health of Canadians. The federal government recognizes the important role that both orders of government must play to ensure all Canadians have the drug coverage they need. We understand that the federal government must support provinces and territories as they implement pharmacare so it will become an enduring element of our health system. This simply is not achieved by imposing federal legislation without consultation and without co-operation of our partners at the provincial and territorial level.

I firmly support national universal pharmacare and I will continue to work tirelessly with our government to move it forward. I will be opposing this private member's bill. The issue at the heart of the bill and the reason I will be opposing it is that it discounts the need for co-operation.

We know that in order to make national pharmacare a reality in Canada, we need to recognize the key role the provinces and territories play in providing health care for their citizens. The bill misses the mark and overlooks a wealth of experience built up about how to do that, not in Ottawa but in Dartmouth, Victoria, Quebec, Charlottetown and all across this amazing country.

Establishing universal pharmacare successfully requires a collective approach, a collaborative approach, where the federal government works with and through the provinces and territories. Unilateral federal action to impose national universal pharmacare as proposed under Bill C-213 would be akin to establishing public medicare for hospital and physician services without prior discussion with provincial and territorial governments and health system stakeholders. Such unilateral action would contradict commitments the Government of Canada has made over the past three decades to take a collective approach to social policy issues of a national concern.

The government must be careful not to disregard the vital role that provinces and territories currently play in designing and delivering public drug coverage in Canada. Over time, provinces and territories have developed more than 100 distinct public drug plans, typically designed to provide coverage for vulnerable groups, including seniors and people on social assistance. If we are going to transform a complex patchwork of drug coverage into a national pharmacare program, we must do it in collaboration with our partners, relying on the considerable expertise that jurisdictions have in this area.

Our government has been clear in its commitments to national pharmacare. Now is the time for governments to take action and make it a reality. Co-operation from provinces and territories will not just get pharmacare up and running; it will ensure it continues to operate smoothly well into the future.

In the 2020 Speech from the Throne and the fall economic statement, the government reiterated its intention to accelerate steps to implement national universal pharmacare, including a rare disease strategy to help Canadian families save money on high-cost drugs; establishing a national formulary and a Canadian drug agency to keep drug prices low; and, perhaps most important, working with those provinces and territories that are willing to move forward without delay. We all know that actions speak louder than words, which is why I am pleased to say that our government has already started taking these steps.

In November, the government initiated discussions with provinces and territories on the strategy for high-cost drugs for rare diseases. Earlier this month, the government began engaging with key partners and stakeholders, including patients and patient groups. As public engagement continues, our government will also consult with clinicians, academics, researchers, health technology assessment organizations, pharmaceutical manufacturers, private insurance providers and indigenous partners.

Budget 2019 also announced $35 million over four years to establish a transition office. This office is being created to provide dedicated capacity and leadership to advance work on pharmacare-related priorities.

We are committed to taking the appropriate next steps to implement national universal pharmacare. We are rolling up our sleeves and putting the resources in place to make it happen. First ministers have initiated a dialogue on health care funding, and that conversation will continue. In parallel, the Minister of Health will seek to establish a collaborative process with willing provinces and territories to define the broad terms of the pharmacare plan.

As I have said, our government fully supports national universal pharmacare and will continue to do the work needed to make sure this becomes a reality for all Canadians. Although we support the spirit of Bill C-213, we recognize that imposing this criteria on the provinces and territories without working with them would be premature and would not build national pharmacare as an enduring final piece of Canada's universal health care system.

People do not frame and put a roof on a house without building a strong foundation first. That is why we are moving forward with willing jurisdictions to build a collective commitment to national pharmacare, guided by the advisory council on the implementation of national pharmacare.

Turning our current patchwork of drug plans into a coherent, comprehensive approach that benefits all Canadians will be no small feat. As we move forward, we need a thoughtful conversation about how best to meet this challenge together. We must work with the provinces and territories, as I have said, to implement a national pharmacare plan that works well for our residents. We must work with first nations, Inuit and Métis governments and representative organizations to make sure national pharmacare is appropriate for their communities. We must work with patients and providers to make sure a national pharmacare plan gets Canadians the drugs they need.

I am looking forward to discussions with provincial and territorial counterparts. Together, we are making progress toward a pharmacare program that will meet the needs of all Canadians from coast to coast to coast.

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Mr. Speaker, the most difficult medication to buy is the one that is not available in Canada. It is the one someone finds out about after going to their doctor and being told that it is in the United States, and if they were an American citizen, they could get access to it. However, since they are a Canadian, they cannot. That is the news that too often happens to patients with rare diseases and to their families. My family is one of those families. The families dealing with cystic fibrosis, with SMA and with cystinosis are other ones. The list goes on and on.

Bill C-213 is a solution looking to address the wrong problem. The problem is access, and access is what I want to talk about this evening.

I have gone through the speech by the member for New Westminster—Burnaby. My colleagues from Calgary Nose Hill and Sarnia—Lambton went over a lot of territory in pointing out what is wrong with this particular piece of legislation.

The legislation is trying to address the wrong problem. I want to demonstrate that by sharing some of the issues I have with what the member for New Westminster—Burnaby said and address them piece by piece to demonstrate why this is the wrong bill.

It does not achieve any goals. The goal should be to provide access to patients in Canada through greater choice in drugs, drugs that will actually ensure they get over their condition or that will provide a therapy that reduces their symptoms, instead of looking at their American counterparts, citizens of America. Some of them are dual citizens, and they, for example, can have access to that medication when they go to the United States, but they cannot access it here in Canada unless they are one of the very few who have a special access program for it.

One of the NDP members mentioned that currently in Canada we have a patchwork of provincial systems. We know that in Canada, 90% to 98% of Canadians have access to some type of either private or public insurance. In fact, nearly all the provinces have a public insurer. In Alberta, it is the Alberta Blue Cross that people can get access to.

Two provinces that I am aware of have already said they will not participate in national pharmacare. In November of 2019, Alberta finance minister Travis Toews sent a letter to the federal government indicating that the provincial government, the Government of Alberta, would not participate in national pharmacare. It will want an opt-out. Members for the Bloc have said that their provincial government will not participate either. What will happen? We will have a patchwork system again. Again, because this bill does not consult with anybody or ask the provinces what they are thinking or recognize that it is in the jurisdiction of provinces, it does not achieve any of the goals.

Speaking of access, the Ontario government, the previous government, took a bunch of people and put them onto OHIP+. It transferred 2.1 million Ontarians who already had private plans onto a public plan at a higher cost, a plan that provided worse coverage than what they had before. I had many people explain their particular situation. They liked their private plan.

When a survey is done to ask people if they like the private plan they are on or the public plan they are on, most Canadians, by a wide majority, say that they do like the plan they are on. I agree that there are people who have difficulty paying for some of the copayments, but this bill does not address that. This bill proposes to centralize everything in Ottawa and then figure it out later.

I have come to believe, after five and a half years here in Ottawa, that when someone says they will figure it out later, it usually will cause harm to Canadians in the long term, especially if they are one of those one in 12 Canadians dealing with a rare disease. Many people have someone in their life who has a rare disease. I have three children with a rare disease. I had a daughter pass away from a different rare disease three years ago.

The problem in Canada, as I said, is being made worse by federal government action through the PMPRB. This problem will not be addressed through anything in this particular piece of legislation. This measure is coming forward because of a false belief that it could somehow artificially reduce the price of medication coming into the market in Canada.

There is a PBO estimate that has been provided and repeated now by several members that the total spent on public health care will be reduced by $4 billion to $4.5 billion. They call it the universal discount. Actually, if we look at the data in the PBO report, 25% is completely random. This is one of the rare times when I disagree with the methodology used by the PBO. This 25% discount is already happening through the pCPA, the pan-Canadian Pharmaceutical Alliance, which is used by the provinces to negotiate with manufacturers. They are basically assuming an extra 25% discount “just because”. I do not think that is the way statistics should be done and I disagree with the analysis.

In fact, one of the members on the NDP side then went on to quote New Zealand as a good example of how it had been able to reduce drug costs. What people in New Zealand do not want to have is a rare disease. There is very little access to rare disease medication or the latest and greatest most innovative drugs to address their condition. There are countless examples online of New Zealand citizens fleeing to other countries to obtain access to medication. New Zealand is the worst example anywhere in the world if people have a rare disease.

There is a Yiddish saying, “He who runs away from fire, falls into the water” and that is what is happening here. There is a problem and the solution that is being called upon is a centralization of all the plans in Canada to wipe out the architecture, the jobs, the system that many Canadians rely on and generally like. It is not perfect; there are issues with it. We are running into a system, we are going to fall into the water and drown. Things would be made worse by the changes being proposed.

On the issue of PMPRB's costing, for example, we often talk about rare disease drug costs and how it puts a huge dent in provincial budgets. If we look at non-oncology drugs, 70% of what the PMPRB says is for rare disease medication is actually being used for secondary uses. Therefore, if people have a rare disease and there is a drug for, it is given by a doctor and it is used, but then there has to be a second, third or fourth usage. The medical system says that it can be used for those other purposes. That is being included in the final statistics. It is wrong to say that rare disease patients will cost the system more when in fact different types of medication are also used for other purposes or uses.

According to the annual report of the PMPRB, the changes in the cost is 2.5% to 2.6%. I will credit the Canadian Forum for Rare Disease Innovators for these statistics and these points. It is very compelling evidence that the costs for rare diseases are not caused by rare disease patients. In fact, it is other uses for the same innovative medicine that is coming to Canada. To reiterate my point, the hardest medication to purchase in Canada is that which is not available in Canada.

I want to take a moment to credit and thank Alberta Minister of Health, Tyler Shandro, for his January 17 interim agreement for Zolgensma, which is a groundbreaking, innovative medication for children with SMA type 1 spinal muscular atrophy, one of the most dangerous conditions that will kill children if they do not get access to a type of medication. This is the same minister who compassionately approved and ensured there was access in Alberta quickly for Spinraza, three weeks after he was named minister. I told him I would hound him until he made it happen. To his credit, he did, and compassionately years later he ensured there was access to Zolgensma for children under age 18 in Alberta. I do not believe a national pharmacare minister like that could act as quickly as a provincial minister could acct when he feels the pressure from constituents, residents and elected officials.

We have Cystinosis, examples of cystic fibrosis, and Trikafta and Orkambi. There is groundbreaking medication out there being made available to people living in other countries that is not available here. The bill would not fix any of those issues. There are other solutions to fill the gaps in place and I would love to discuss those solutions and look for ways to improve the system in different matters.

The member for Calgary Nose Hill brought up a few of them, so I will reiterate them. Common drugs are classified in different countries as over the counter. Australia does an amazing job of this as does the United Kingdom. We can look at what the public health spends on certain medications and maybe find a lower dose that could be available over the counter. Some antibiotics come to mind. Some estimates suggest that just three of those drugs could save $1 billion a year on drug spending.

There are other things we could do to reduce the bureaucracy in the system. Too many Canadians are trapped between the CADTH approval and the pCPA reimbursement agreement.

What I care most about is access for patients with rare diseases. Bill C-213 does not achieve any of those goals. I cannot support it.

[The Deputy Speaker, Conservative, Bruce Stanton]

Before we resume debate with the hon. member for Edmonton Strathcona, I will let her know that we are just short of the 10 minutes that are usually allocated, with leaving five minutes for the sponsor of the bill to have his right of reply.

Let us get started, and I will give her the signal as we get close to that time, which is around eight minutes or so.

The hon. member for Edmonton Strathcona.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

Mr. Speaker, I am delighted to speak in support of Bill C-213, sponsored by the member for New Westminster—Burnaby.

This bill is historic. It is a bill that would give us the potential to make history by finally getting pharmacare to Canadians who so desperately want it.

We have heard today that approximately one out of every five families in Canada struggles to pay for prescription medications, and we know that the claim that all Canadians have access to medication just is not true. It is not accurate. These are not statistics. These are real families.

Before COVID-19, when I was able to knock on doors and talk to constituents in person, access to prescription medicine was the number one issue I would hear from people. I remember talking to a man who struggled to speak as he was caught up with emotion. He talked to me about skipping days taking his blood pressure medication, hoping that he would get by: that he would make it and would not die. I spoke to a senior in my own neighbourhood who was sharing a prescription with her husband, because they could not afford both. I will never forget talking to one young father who implored me to get pharmacare passed. It was not because his family needed it. His family was doing quite well, but he knew families at his daughter's child care centre who did not have access, and he wanted to make sure that those children were taken care of. This was all before the pandemic, and before things got worse.

There is no doubt that COVID-19 has made Canadians' ability to access medication so much worse. Millions of Canadians who lost their employment due to COVID-19 also lost their prescription drug coverage. People who could count on their health plans before COVID no longer could.

In Alberta, when we were entering the pandemic about a year ago, our provincial Conservative government cut drug benefits for seniors, spouses and dependants so 46,000 people, mainly with ongoing health issues, including dependants living with disabilities, were suddenly without coverage. I find it shocking that the member of Parliament for Calgary Shepard can speak of Minister Shandro as being compassionate, when 46,000 Albertans lost their drug coverage. Many Canadians were facing the stark reality that our medicare system was not going to be able to keep them healthy. This pandemic has opened their eyes, and COVID-19 has shown us just how vulnerable we are.

Canadians have been waiting for this. Canadians have been waiting for nearly 60 years to get prescription medications included in our health care system. Twenty-three years ago, the Liberals first promised Canadians a national pharmacare program, and they have been repeating that promise ever since. We have had five public commissions on pharmacare, and study after study. If the member for Calgary Shepard does not want to believe the PBO report, perhaps he will believe the Hoskins report. All of these reports said the same thing: Canadians need pharmacare, and pharmacare will save Canadians money. However, here we are.

As Canadians face an unprecedented health crisis with COVID-19, there is another health crisis that we can and need to fix right now. Millions of Canadians are without access to medication, and we can fix that with Bill C-213. We need to vote yes to Bill C-213.

We have an obligation to learn from COVID-19 as well. We have a duty to Canadians to create a better Canada that will be more resilient to the crises of the future, including the next pandemic. We must build systems that protect all Canadians, not just some Canadians and not just Canadians who can afford it. When everyone has access to the medication they need, they are healthier and the burden on our health care system is lessened. It is really that simple.

The government has floated the idea of partial pharmacare that is not universal. That is not what Canadians want. Canadians want a simple program that includes everyone. Canadians want to go to the pharmacy and pick up their medications. That is the system we want, and that is the system we need: a national universal system protected against people like Jason Kenney who are determined to undermine it, and a system that will actually save Canadians billions of dollars.

There is something else vitally important that we have learned from COVID-19: Canada has the capacity to do this. We saw how fast Canada moved when the pandemic was declared.

The cost to enact pharmacare is pennies on the dollar compared to the savings. Pharmacare will save families on average more than $500 a year, whether they are insured or not, and employers and small businesses will save $600 a year per job. Pharmacare will reduce emergency wait times and free up more hospital beds for those who need them. It will save the government billions.

I urge this House to follow the recommendations of the Hoskins report and apply them by supporting this bill. The Hoskins report recommends that the federal government enshrine the principles and national standards of pharmacare in federal legislation separate and distinct from the Canada Health Act. The Hoskins report also recommends that the five fundamental principles of medicare embodied in the Canada Health Act also be enshrined in federal pharmacare legislation. Those principles are universality, comprehensiveness, accessibility, portability and public administration. The Hoskins report also proposes that this legislation come into force no later than January 1, 2022.

Now is the time. Now is the time we can do this. As parliamentarians, this is something we can give to Canadians right now, at a time when they need it more than ever. Today is the day to support pharmacare for all. I implore my colleagues within the House to vote yes on Bill C-213.

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

Mr. Speaker, it is rare that we have an opportunity in the House of Commons to make a difference in the lives of so many of our constituents. As we well know, over 90% of Canadians support the idea of putting in place public, universal pharmacare. Over 90% means that in every single riding across the country, the vast majority of Canadians support public, universal pharmacare.

When Canadians are asked what they are proudest of among our institutions, it is our universal health care system. Of course, the Canada pharmacare act would put in place the same principles around pharmacare that we already have in place around universal health care.

Any member of Parliament who consults with his or her constituents will get the same reply. Canadians want to see this. Particularly with the pandemic and the devastating impacts that we have seen both on the health and the financial well-being of so many Canadians, it is absolutely essential that we move forward and put in place public, universal pharmacare, which Canadians are asking for and desperately need.

We have been at this debate for a few months. Tens of thousands of Canadians have participated. They have participated by emailing their member of Parliament, by phoning their member of Parliament and by telling their member of Parliament to vote yes on Bill C-213.

During this debate, we have seen a number of facts come to light. We were made aware, through this debate, that millions of Canadians have no access to a drug plan. They have to struggle to pay for the medication their doctor has prescribed for their health and well-being. We have also learned that hundreds of Canadians die each year right across the country because they cannot afford to pay for their medication. Through this debate, we have also learned that for 60 years Canadians have been waiting to have the public, universal pharmacare they so desperately need.

The Hoskins report points out very clearly what the road map is, which is that we have to lay the foundation by ensuring we have the same principles around public, universal pharmacare that we already have around our public, universal health care system.

It would be dangerous to say no to this bill, because that would reject public, universal pharmacare. It would reject the expansion of our public health care system that Canadians are looking for, and it would reject the advisory council's Hoskins report. It would mean that there is no foundation to build the public, universal pharmacare that Canadians so desperately need.

During these debates we also learned that many people in Quebec are calling for a universal pharmacare program. Currently, many Quebeckers are not covered, and that is why the major unions are calling for this type of public, universal program. More than 40 or so municipalities in Quebec are calling on MPs to vote in favour of Bill C-213. There is widespread support.

We have also learned that dozens of organizations with millions of members are asking all members of Parliament to vote yes on Bill C-213. We have doctors and nurses right across the country who are saying that it is absolutely vital for Canadians' health and well-being. We must listen to those voices.

I mentioned earlier this is a historic moment. It is one of those moments that determine the strength members of Parliament have in consulting with their constituents, and we need to think of our constituents at this key decision point in our history.

I am thinking of Cole and his family. He is a constituent in high school whose family struggles with $1,000 a month in drug costs. Those drug costs, that medication, keeps the father of the family alive. That family struggles and every day has to decide how they can pay for that medication and whether they can also put food on the table and a roof over their heads.

Around kitchen tables right across the country, there are millions of Canadian families who are in the same situation. I ask members of Parliament to think of their constituents, more than 90% of whom who support this bill. If members of Parliament do that, I have no doubt they will vote yes next week on Bill C-213, the proposed Canada pharmacare act.

[The Deputy Speaker, Conservative, Bruce Stanton]

Accordingly, the question is on the motion.

If a member of a recognized party present in the House wishes to request either a recorded division or that the motion be adopted on division, I ask them to now rise and indicate so to the Chair.

[Lindsay Mathyssen, NDP, London—Fanshawe, ON]

Mr. Speaker, we request a recorded vote.

[The Deputy Speaker, Conservative, Bruce Stanton]

Pursuant to an order made on Monday, January 25, the division stands deferred until Wednesday, February 24, at the expiry of the time provide for Oral Questions.

A motion to adjourn the House under Standing Order 38 deemed to have been moved.

[The Deputy Speaker, Conservative, Bruce Stanton]

The hon. member for Calgary Nose Hill will not be present to raise the matter for which the adjournment notice had been given. Therefore, this notice is deemed withdrawn.

Foreign Affairs

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Mr. Speaker, there has been a great deal of discussion in recent days about the genocide of Uighurs and other Turkic Muslims in China. The evidence of that genocide could not be clearer, and I look forward to continuing to make arguments about this issue and calling for recognition by the government of that genocide and an appropriate response.

However, today I am speaking following a specific question that I asked about the Canada pension plan investments made in Chinese military affiliated tech companies that are playing a significant role in the surveillance, mass detention and, yes, genocide of Uighurs.

One of the particular characteristics of the Uighur genocide is its high degree of technological sophistication and the use of the latest technologies to screen, track, control, suppress and otherwise violate the rights of Uighurs. These technological tools are deployed to facilitate the internment and population suppression of Uighurs through measures that include a systemic campaign of sexual violence.

Certain companies that are in some sense private but are also very much state-affiliated are developing the technology for this genocide. People are sitting in office towers making investment decisions to maximize their profits and those of their shareholders by tasking researchers to find ways of better tracking and controlling other human beings.

The Canada pension plan invests money around the world with the goal of maximizing return for Canadian investors. It has important work to do in this respect. However, I would firmly contend that its only considerations should not financial risk or financial return. During the tenure of the current government, our pension dollars have been invested in Dahua and Hikvision, two of the companies that are working closely with the Chinese government and supporting its horrific operations in East Turkestan.

We are not just talking about building components or tools that could be used in this context. We are talking about ongoing collaboration to facilitate the customization and deployment of this technology as part of this genocide.

When these issues have been raised in the past, the government has either ignored the question or defended the investment choices of the CPP Investment Board. When this was first raised in the House, the member for Louis-Hébert said, on behalf of the government, “I simply want to remind my colleague that the Canada Pension Plan Investment Board operates independently, at arms' length from the government, and we expect it to make wise investments in the interest of Canadians and Canadian pensioners.”

Frankly, I expect better from the government than to support these investments or to shrug them off. Considerations must include Canadian values as well as Canadian interests.

While the Conservatives oppose efforts by politicians to micromanage these investments, there must be some minimum moral standards. Those standards should involve clear and unambiguous criteria that exclude investments that violate international law and that involve deep and fundamental violations of international human rights.

I expect and hope for better from the CPP Investment Board, but to be fair to the board, while I want to see minimum moral standards, the board operates within a legislative framework set by politicians. Politicians have to set those minimum standards. They easily could, but they have not.

I would like to ask the government this again. Very specifically, what plans does it have to ensure that Canadian pension investment dollars are never again complicit in acts of genocide?

[Darren Fisher, Liberal, Parliamentary Secretary to the Minister of Health]

Mr. Speaker, the human rights violations in China affecting Uighurs and other ethnic minorities are deeply disturbing and of grave concern for Canadians, this government and the global community. The actions of the Chinese government in the Xinjiang Uighur Autonomous Region, including repressive surveillance, mass arbitrary detentions and religious persecution, run counter to the basic freedoms enshrined in China's own constitution and violate China's international human rights obligations. This government has taken every opportunity to raise this issue, both directly with Chinese authorities and through multilateral institutions. We call on China to address and end the repression.

Canada is not alone in voicing concerns. We are working in collaboration with other countries to call on China to abide by its obligations under international human rights law, and we will continue to take action as part of a concerted effort by the broader international community.

This government recognizes the risks that the alarming human rights situation in the Xinjiang Uighur Autonomous Region poses for Canadian businesses and investors. This is one reason the trade commissioner service recently updated its guidance for businesses on the risks of doing business in China, including risks related to human rights abuses and forced labour in their supply chain. We expect all Canadian companies active abroad to respect human rights and adhere to the highest ethical standards.

As members know, the Canada Pension Plan Investment Board was set up by the federal and provincial governments to prudently invest Canada pension plan funds. It is accountable to federal and provincial ministers of finance, but operates at arm's length, as the member said, from Canadian governments. CPP Investments is recognized internationally as a leading example of sound pension plan management. It has an independent, highly qualified board of directors and operates with a commercial investment mandate.

Companies that effectively manage environmental, social and governance factors are more likely to create financial value over the long term, improving investment performance. As such, CPP Investments considers ESG factors, including human rights, when evaluating opportunities, making investment decision and engaging with companies to seek improvements in business practices and disclosure. CPP Investments was a founding signatory and abides by the United Nations-supported principles for responsible investment, which provide guidance for incorporating ESG factors.

Just as Canada will continue to hold China to account when it comes to human rights violations, so will we continue to take action to ensure that Canadian supply chains are free of forced labour and that Canadian businesses have the tools they need to mitigate the risks of doing business abroad.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Mr. Speaker, that response was obviously a total farce. The Parliamentary Secretary to the Minister of Foreign Affairs cannot even be bothered to show up here, so we have the Parliamentary Secretary to the Minister of Health answering questions on things that are totally unrelated to his file. He is not answering the question. In some sense I do not blame him for not answering the question, because this is not even in his file. He has been given a bloody sheet of paper to read on a fundamental issue of genocide, instead of actually engaging with the subject matter at hand.

My question was about whether the government is prepared to define fundamental minimum moral standards for our investment and whether it is willing to put in place standards to ensure that Canadian pension investments are not complicit in genocide. Essentially, the parliamentary secretary's response is no. To the extent that human rights might come into play when considering financial considerations, then they are brought in, but there is no willingness from the government to recognize this problem of Canadian pension investments complicit in genocide.

The government needs to do so much better if it is going to pretend to be serious about human rights.