Debates of May 30th, 2024

Alleged Breach of Deputy Speaker's Impartiality

[An hon. member]

Oh, oh!

[The Speaker, Liberal, Greg Fergus]

I am going to ask the hon. member for South Shore—St. Margarets to not take the floor until they are recognized.

I thank the hon. member for Mégantic—L'Érable for his intervention.

I also thank the hon. member for New Westminster—Burnaby for his point. The Chair will take this under advisement and come back to the House.

The House resumed consideration of Bill C-64, An Act respecting pharmacare, as reported (with amendments) from the committee, and of the motions in Group No. 1.

Pharmacare Act

[Warren Steinley, Conservative, Regina—Lewvan, SK]

Mr. Speaker, after the NDP House leader, let us get this back on track and talk about the pharmacare bill, Bill C-64. I am pretty happy to take to my feet. I did have the opportunity to sit in committee for five hours a couple days ago and listen to some of the witnesses and some of the comments and concerns around the pharmacare bill, Bill C-64. I want to put some of my concerns on the record. I see the former health minister and I am looking forward to hearing him talk about it, if he is going to get to his feet.

A year ago, I asked the former health minister how many provincial health ministers at an FPT meeting had asked to bring forward a pharmacare bill. Was it on the top of their priority list? At that time, the minister did not have an answer for me. In committee, a couple of days ago, I had the opportunity to ask the current health minister that exact same question. I do believe that health is a provincial jurisdiction.

My question was whether they were able to name any health ministers who proactively came to the federal government to ask for this bill to be brought forward or whether there were other requests.

I know, in Saskatchewan, that we have a shortage of nurses. We have a shortage of doctors. There are a lot of issues, and I think many provinces do have concerns around doctor and nurse shortages. I think we are short 30,000 doctors right now in Canada. That is a pretty big deal. I think around seven million Canadians do not have access to a family physician.

I think that is something that health ministers probably brought forward at the FPT meetings. I believe that is something that we do need to look at: how we can support our provincial partners and have that conversation.

Once again, the current health minister did not answer my question about whether this was a priority at FPT meetings. Tonight, I was able to ask that question again to the member from Winnipeg North. I asked if he could name a health minister who brought this pharmacare bill forward as a priority for the provinces. I have never seen him play hockey but he was pretty good at skating around that question. He went full circle, but he never really came to the crux of my question as to whether a health minister had asked for this.

This is not partisan rhetoric. This is a legitimate question around public policy and the priorities of provincial governments. I heard from my colleague from Victoria. She talked about a child who needed diabetes care. I listened to her speech and when I asked her if she could tell me the age of full coverage in Saskatchewan, she could not. That is a very real concern of mine, the fact that they are bringing forward this legislation and that people voting for this bill do not know what the different coverages are out there in different provinces.

That is a legitimate problem. We should know where the coverages are across the provinces. In my home province of Saskatchewan, I have been texting with our health minister, I asked him if this was one of the things he brought forward and he said no, that they just came to them and said they were going to do this, take it or leave it. Then they asked for details. The minister said that they never gave them any details because they did not have any yet. It is surprising for a provincial health minister to not have any details on a pharmacare bill. A pamphlet, in my opinion, is not a bill, as it is four pages long. It covers diabetes and contraceptives, but there is little detail given to our provincial partners and that is a legitimate concern that we have to discuss.

They rammed this through. They bring in time allocation and then they just expect everything to be okay. We all know that this is just what the NDP asked for to keep the government in power for a little bit more time. This is part of the supply and confidence deal. They continue to tell falsehoods to Canadians. It is not coverage; two things are being covered.

For NDP members to bring up Tommy Douglas in the House is laughable. He would be embarrassed by the NDP and the situation it is in right now. He would probably be a Conservative right now. He would be completely embarrassed by what the NDP, the rump of the NDP, has become: a bunch of activists. I think it is very funny whenever they bring forward the name of Tommy Douglas, because he probably rolls over in his grave when that happens.

Being from Saskatchewan, I also had a time to be in government, with the Saskatchewan Party and former premier Wall, which takes me to another point. The NDP-Liberal government continues to bring in bills and then it says it is going to do consultation. I think that is a little bit backward. I remember being in Saskatchewan, and I was a member of the all-party traffic safety committee. We travelled around Saskatchewan for a couple weeks, in all corners, and took feedback from all of the stakeholders.

We consulted. We gathered feedback. Then we made legislation. Is that not a novel idea? Talk to people, ask what is going on, ask what works and what does not work, and then put forward legislation, instead of bringing forward legislation and then asking if it can work. Sometimes, I just find that some of the things the government does are quite backwards. The same thing happened with nuclear consultations. We started nuclear consultations in Saskatchewan in the first term of 2007 and continued to talk to people and consult before we even got to the point of even the discussion of small nuclear reactors. That was how long we actually consulted with the people of Saskatchewan. Can members imagine having that approach here in this House, to continue to talk to people, instead of ramming things through based on political ideology and what people think they need to stay in power?

Getting back to my point about diabetes, I have a cousin who plays for Regina Thunder. He was diagnosed with type 1 diabetes when he was two. That is why I am such a champion of diabetes care. His mother and father had to wake him up at night and prick his finger when he was a baby and when he was two or three years old. Then he would get insulin pills. Now he has tracking on his arm. He has a pump that is covered by the province of Saskatchewan. That is progress. That is how to listen to people and get things done. I think that is what we should take forward.

The NDP have talked about compassion. Where is their compassion for the 27 million Canadians who have insurance, but who are scared right now that they are going to have less coverage? I know 1.1 million Canadians are under-insured. We can take care of them.

Just imagine if one of the health ministers of the NDP-Liberal government went to a provincial-territorial meeting and asked how to get people insured under their provincial programs. What is the need out there? The Liberal government of the day wants to take credit for everything. There did not have to be a national program. Imagine if it had worked with its provincial partners and then supplemented their programs? Maybe the provinces would have needed extra money. I guarantee that it would not have cost $1 billion or $2 billion. This program is going to cost $2 billion.

There are several public policy reasons why this bill should not go forward in the form it is in. We should continue to work with our provincial partners. I would love for one of these ministers of health to answer how many provincial health ministers asked for this program to come forward. The same could be said for the dental plan.

Today is a pretty special day in my life. On May 30, 1944, my father, Ron Steinley, was born. I am not able to be home with him, but I want to wish him a very happy 80th birthday. He is in Swift Current, Saskatchewan. I am going to try and rip out there, maybe this week or next week, so we can take him out for supper. Happy birthday to my dad and all the best.

[The Speaker, Liberal, Greg Fergus]

Not only do I thank the hon. member for Regina—Lewvan for his intervention, but I would like to congratulate him for two things, one, to wish his father a very happy birthday and, second, how his father's birthday has united this House. Great job to Mr. Steinley, Sr. I hope you have an opportunity to see him soon.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Mr. Speaker, I have to start by saying remembering our humanity in this place is really important. I, too, wish a very happy birthday to the member's father. I think it is a beautiful thing to have these opportunities. We are away from them far too long.

Through you, Mr. Speaker, I just want to remind everybody in this House that, in fact, Tommy Douglas was very clear. His first step was going to be medicare, and the second step of his vision was pharmacare. I stand here as a proud New Democrat, feeling that I am carrying a legacy forward in a profound way. I will always be proud of that.

I do not know if the member knows this, but, in my province, the B.C. NDP are making sure that all contraceptives will be covered, knowing that is an important right. When this program is in place, it will actually free up resources so that the province can reallocate funds to a different place. I just hope the member understands that and is looking forward to what his province will receive based on this allocation.

[Warren Steinley, Conservative, Regina—Lewvan, SK]

Mr. Speaker, I thank the member very much for wishing my father a happy birthday.

The New Democrats talk about Tommy Douglas a lot. I actually had the time in the Saskatchewan legislature to read his master's thesis, which was on eugenics. Is that the third step, then? If they are going to talk about Tommy Douglas, they should talk about all the things he thought health care needed. They never talk about that, which is interesting.

I believe the provinces really do need to work together with the federal government. The fact it is trying to ram this down the provinces' throat is actually quite funny. I can text the health minister right now, who will say that, because he has no idea what is in this plan, he does not know how the province is going to be prepared for it or how much it is going to spend because it has no idea what it actually entails.

[Nathalie Sinclair-Desgagné, Bloc, Terrebonne, QC]

Mr. Speaker, my question is rather simple. If the member believes in respecting jurisdictions and can talk about the pharmacare that exists in several provinces of Canada, then why did his party vote against the Bloc Québécois' proposed amendment to the budget? That amendment sought to require the government to respect jurisdictions in its budget, including Quebec's jurisdictions. Why did his party vote against that amendment?

[Warren Steinley, Conservative, Regina—Lewvan, SK]

Mr. Speaker, we are talking about Bill C-64. I think the provincial government has jurisdiction over health care and the federal government should butt out.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Mr. Speaker, I would like to congratulate his father on behalf of the Liberal Party. We will share a beer in his honour tonight.

The member at least implied in his speech that he took part in ensuring that young diabetics in Saskatchewan have the cost of their medication paid for. Maybe he could speak a little more about that.

I would also say is that not what we are trying to do with our bill here? Would it not be a good thing if the health minister did this in Saskatchewan? If he did, great.

[Warren Steinley, Conservative, Regina—Lewvan, SK]

Mr. Speaker, in Saskatchewan, in 2011, the Saskatchewan Party made a commitment to campaign on providing coverage for diabetics up to the age 18. Then, in 2016, we campaigned to move that to age 25. That is exactly what we did: we provided coverage for diabetics until the age of 25. The theory behind that was, after the age of 25, a lot of people had their own coverage when they were gainfully employed and had private insurance. There are still other programs to cover people who are less insured.

The problem I have with this is that we do not know what the coverage is going to be. Not all diabetics take the same medicine either, so we do not know which medicines would be covered in this program, as it is not going to be all of them, which goes to my point that consultations should be done before bringing in legislation so we know what works and what does not.

[Colin Carrie, Conservative, Oshawa, ON]

Mr. Speaker, my colleague mentioned two important points that are missing here. One is that it was a top-down approach and there was a lack of consultation. The other is how many provincial ministers actually asked about it.

One of the things the member touched on that I thought was really important is that many people in his province have very good coverage already. My question for the member is this: If it becomes a top-down approach, why does he fear the federal government would make it worse for the people who are doing good on their medication?

[Warren Steinley, Conservative, Regina—Lewvan, SK]

Mr. Speaker, the Liberals always talk about providing coverage for the 1.1 million people, which is important, but they would take away some of the better coverage that 27 million people have. That is fake compassion and the lie of the left.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Mr. Speaker, I am pleased to rise to speak to this issue and this bill, finally.

As others have already pointed out, Canada is the only country with a universal health care system that does not provide some sort of universal drug coverage. Under the British, Australian, New Zealand, French and Belgian systems, basically to some degree or another, people's medications are paid for by the government and they do not have to pay for them. Having said that, admittedly, in some countries there is copay.

This is an important bill. It is the first step in creating a national pharmacare system, and this I truly support. However, I did not always feel this way. As somebody who has long-practised in the health care system, I was a bit worried, because with the health care system as it presently is, we are struggling to pay for it. It occurred to me that what the government ought to be doing in health care is making sure that this sucker stays on the road. Certainly, I had a bit of trepidation with the idea that we were going to add another cost like pharmacare. However, having thought about it and having sat through committee meetings where we talked to experts, I have changed my mind because I think that a national pharmacare system would save the health care system money, not increase costs.

The current system, as we have it, which is a patchwork of private and public plans, is really inefficient. Multiple studies and recommendations since the 1960s have all basically said that. In fact, one study from the Canadian Medical Association Journal in 2017 concluded that we in Canada pay 50% more for our drugs than people do in 10 other wealthy countries that have national pharmacare programs. In addition, the inefficiency of our pharmaceutical system is demonstrated by the fact that we in Canada pay the second most for drugs of any people in the world. The Americans pay more, but other than that, we pay more for drugs than anyone else.

The inefficiency of our system comes from the fact that we provide pharmacare in Canada like the United States does. We, like the United States, have a patchwork system of private and public providers, and the private providers are often set up through employers. At times, these are non-profits, but for the most part they are for-profit companies. Similarly, there are public systems and public plans, and there are multiple public plans. For example, in Ontario, there is the Ontario drug benefit plan for those over 65, there is a Trillium plan for higher-cost medications and there is OHIP+.

Basically, we pay for our medications in Canada like Americans pay for all parts of their health care system, but our system for paying for medications, like the U.S. health care system, is really inefficient. Americans pay twice as much for health care as Canadians do. On average, Americans pay $12,000 per person for health care, and in Canada we pay $6,000 for health care per person, and they have worse outcomes than we do. For example, they have a lower life expectancy than we do in Canada.

I studied health law and policy both in Boston and at Georgetown University in Washington, D.C., and learned a bit about the health care system. I was certainly impressed by the inefficiency of the American health care system. They have private hospitals, private health care providers and private insurance companies, and each of these organizations has administrators who basically spend half of their time scheming on how they can decrease costs and increase profits. They have to pay for these administrators. Similarly, they have to pay the CEOs and the higher-up executives, who all bring in the big bucks, for working in those positions. On top of that, and most of all, a lot of money goes to the shareholders of corporations, which are legally obliged to financially benefit shareholders. All this money comes out of the health care system, money that ought to be going toward trying to improve the health care of Americans.

Similarly, in Canada, we currently have 1,100 private and public plans according to a Lancet 2024 study, although according to the Hoskins report, we have 100,000 private plans. If instead of having all these plans, we just had one plan, then surely there would be tremendous savings coming from economies of scale. We would not need 1,100 organizations with 1,100 sets of administrators administering their own plans. We would not need hundreds of CEOs siphoning money that would otherwise go to health care, and there would be no profits going to shareholders rather than going to health care.

There would be all sorts of savings from economies of scale and increased bargaining power. For example, if someone went to a provider or manufacturer of drugs and bought 10 million pills rather than 10,000 pills, I am sure they would get those pills at a cheaper cost, so there are savings there. Also, shipping costs are lower when buying in bulk, and there are fewer inspections needed.

When we add up all these savings, how much do they add up to? Well, according to the 2019 Hoskins report, with national pharmacare by 2027, which is when it would come into effect, total spending on prescription drugs would be $5 billion lower than it would be without national pharmacare. That is money we could use in the health care system for other things. That means more money to afford expensive cancer therapies, more money to address the long waiting times for either surgeries or diagnostic tests and more money to do research and try to find new cures for things like cancer, ALS, etc.

However, it is not just about saving money in the system. It is also about helping Canadians who struggle to meet the high costs of medications. According to the Hoskins report, between 5% and 20% of Canadians are either uninsured or under-insured, which amounts to two million to eight million people. Furthermore, one in five households reported that a family member in the past year had not taken a prescribed medicine due to its high costs, another three million Canadians said they were not able to afford one or more of their prescription drugs in the past year and almost one million Canadians borrowed money in order to pay for prescription drugs.

For all these reasons, I support this legislation and moving to the next step toward a national pharmacare system. I also welcome that we will be able to provide diabetic medications and contraception to people as one of the next steps in getting to a national pharmacare system.

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

Mr. Speaker, my colleague from Thunder Bay—Rainy River is always thoughtful here and mindful of the shortfalls of things the government puts forward. There are a couple of things, though, to think about. At the health committee, we had two of Canada's experts, Drs. Morgan and Gagnon, and as the member well knows, they had no input into but much criticism about this bill. It related to the fact that it would not create a national, universal, single-payer, first-dollar pharmacare system. I heard them say that and I know the member across heard them say that as well.

The other criticism we heard clearly is that the newly formed Canadian drug agency will have absolutely no oversight, especially from the point of view of an Auditor General's audit, with respect to its activities. We know on behalf of Canadians that at the current time, the time from application to approval for a drug in Canada is one of the longest among the OECD countries.

I would appreciate my hon. colleague's comments with respect to those two things.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Mr. Speaker, this is a step toward universal health care. Yes, it does not bring us to that point yet, but it is a step.

With respect to the committee that is going to be involved in this, I thought the member was going to ask me about the fact that those two people were not consulted in the process. That is too bad. However, I agree with the member that how we do this is really important. If we have an efficient system and an efficient bureaucracy, this can save Canadians money. If we create a gigantic bureaucracy that costs a whole ton of money, more than the private system, then it will not end up benefiting Canadians. It is really crucial who we put on that committee and the steps we take in subsequent days, weeks and years.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

Mr. Speaker, I have worked with the member very closely on a number of files, and I know him to be a very honourable member of this place.

He referenced the Hoskins report many times, and of course this is the report that was commissioned by the government to look at this. It found that $5 billion of savings would be available if we were to put in a national pharmacare program. Like the member, I recognize that this is not a full pharmacare program. This is a framework on which we could build a pharmacare program.

Could the member comment on the medications or drugs that he thinks should be next in the pharmacare program now that we have dedicated this particular step to diabetes medication and devices and to contraceptives?

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Mr. Speaker, the member's question is very pertinent. I have some background in this. Once upon a time, years ago, I worked in a tiny country in the South Pacific, Vanuatu, on its essential drug list, which was its first essential drug list. The WHO is trying to do this with a lot of countries.

Similarly in Canada, this act calls for the creation of an essential drug list. On that essential drug list, we would have the input of physicians and other specialists from across Canada to determine what the priority drugs are that a government finance system ought to supply its citizenry.

That is an important question, and it is one of the next steps. I, like her, realize that this does not bring us to a national pharmacare system, but it is an important step on the way to that.

[Yasir Naqvi, Liberal, Parliamentary Secretary to the Minister of Health]

Mr. Speaker, I appreciate being recognized again.

It is a great honour for me to work with the hon. member for Thunder Bay—Rainy River on the HESA committee. Given his medical and legal background, I find him quite beneficial to me for my understanding of a lot of health care issues.

One of the things we heard a lot about at committee is the impact of this framework legislation on private health insurance. There was a lot of fearmongering on the Conservatives' part that somehow it would disappear.

Could the hon. member for Thunder Bay—Rainy River comment and give us his views on what impact this bill would have on private health insurance?

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Mr. Speaker, I welcome the very perceptive question by the member from Ottawa.

This is a very important point. We heard from a lot of people, and there was a lot of concern about having a basic system. What if we needed more expensive medications for certain things? Would we be getting rid of private drug plans? That is not necessarily the case. There will be a public plan, but I think there would still be the option, if people wanted, to pay additional money for a private plan that would cover all the things that are not currently insured, as there is for other kinds of health care at the moment.

[The Speaker, Liberal, Greg Fergus]

Before I go to the member for Nunavut, who will be joining us virtually, I want to let members know that I have tried to provide members with about 40 seconds to ask and answer questions so that we can do the full rotation. It is really important that we all try to keep to that so that everybody can participate. I am also providing some flexibility, because questions are interesting and I want to hear as complete an answer as possible, as I am certain a person who asks a question would like that.

The hon. member for Nunavut.

[Lori Idlout, NDP, Nunavut, NU]

Uqaqtittiji, before I begin my speech, I will take this opportunity to congratulate Sharon DeSousa, who just became the first racialized national president at the Public Service Alliance of Canada. I first met her when the Iqaluit Housing Authority Inuit workers had their 136 days of striking to advance the rights of workers, not just for Iqalummiut, but also abroad. I am excited about Sharon's election.

I will get to my speech. As the member of Parliament for Nunavut, Bill C-64, an act respecting pharmacare, put me in a bit of a personal dilemma. I wondered if I should support a bill that would do too little for the majority of my constituents. Through my speech this evening, I will share how I came to support the importance of this bill.

As an Inuk from Nunavut, I continue to see the impacts of what happens when the federal government purposefully underinvests in indigenous peoples. The lack of investing in housing means that people live in overcrowded housing conditions. Many live in mouldy homes. These conditions create poorer health outcomes and deep-rooted social issues, such as increased violence, substance abuse and the continuation of intergenerational trauma being passed on to our children and our grandchildren.

Having lived through these hurdles, I am always analyzing bills and debates with sensitivity to how all too common my experience is for indigenous peoples in Canada. I know all too well what it means to suffer. I hope when Canadians hear me, that they do their part to act on reconciliation with indigenous peoples.

When I became the member of Parliament for Nunavut, I learned to act on solidarity. Before I was an MP, it was just a word. I wholeheartedly thank my colleague and friend, the member of Parliament for Hamilton Centre. This is what I am doing in supporting this bill. I am compelled to act knowing this bill, when it is passed, will help so many Canadians. It will help women and gender-diverse people access contraceptives. It will help many Canadians pay for diabetes medication.

On another note, I must express my view regarding the Bloc's position on this bill. Its main concern seems to be that of jurisdiction and telling the government to stay out of its jurisdiction. I do hope its members reconsider their position because, regardless of jurisdiction, this bill can help more Canadians. This bill sets a foundation to create a universal single-payer system across Canada.

This reminds me of Jordan's principle. I take this opportunity to honour the family of Jordan River Anderson, who this program is importantly named after. Jordan died a preventable death. He died while different jurisdictions were fighting over not having jurisdiction to cover his expenses and care. Because of Jordan's principle, care for first nations and Inuit has improved.

While the Liberal government's responses take too long and it allows funding to lapse, Jordan's principle has made significant impacts for Inuit and first nations. Bill C-64 is an opportunity to model Jordan's principle so women and gender-diverse people have immediate access to contraceptives and people with diabetes can stop stressing about their finances knowing they can rely on this program for diabetes medication.

I must share my criticism of the bill. I am dismayed to see that, once again, when it comes to indigenous peoples, we are forced to wait. While I appreciate that Bill C-64 would require the Minister of Health to initiate discussions based on essential medicines lists with provinces, territories and indigenous peoples, this work must start immediately.

While first nations and Inuit have the non-insured health benefits program to have services such as dental care, eye care and mental health services paid for, much of the investments in Nunavut go toward medical travel because of the lack of health care in Nunavut. Children are flown thousands of kilometres to access basic care and dental care. This program funds millions of dollars to the airline industry. Ensuring pharmacare improves on the NIHB program will be very important in making sure that Nunavummiut, northerners and indigenous peoples see better care closer to home.

The pharmacare bill must avoid the pitfalls that we have seen in NIHB. I remember, for example, my colleague and friend, the MP for Algoma—Manitoulin—Kapuskasing, bringing to me a witness when the indigenous and northern affairs committee studied the non-insured health benefits program. She brought forward a pharmacist, Rudy Malak, who struggled to get paid for providing eligible people the drugs covered under the non-insured health benefits program. The proposed act must ensure that pharmacists would be paid immediately without worrying about closing their doors because the federal government may take too long to pay its bills.

I conclude by reminding everyone that, when it comes to helping Canadians, we must do so with a foundation of removing barriers for people. As much as I am conflicted about the bill, I must practise what the MP for Hamilton Centre taught me about acting in solidarity, knowing that the passage of the bill will help so many Canadians.

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

Mr. Speaker, I appreciate the member's general attitude in recognizing the importance of the legislation to the degree in which it would assist millions of Canadians in all regions of the country. I am wondering if she could expand on why it is so important that Liberals, New Democrats, Bloc members and Conservatives should be behind this bill to help so many of our constituents.

[Lori Idlout, NDP, Nunavut, NU]

Uqaqtittiji, as I said earlier, having empathy is really important, but acting on that empathy is even more important. When I hear about so many Canadians possibly having amputations because they cannot afford diabetes medication, I feel we all have to do our part to make sure that we act when we can, and it is our duty as parliamentarians to make sure that all Canadians get the drugs and the care that they need, so we can keep making sure that Canada is a better place to live in.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Mr. Speaker, when we are in this place, we have to wrestle with really hard pieces of legislation that benefit some but not all, and I am afraid that in this place, historically, up until today, indigenous people are left out of so much decision-making, and their needs are extensively not met, again and again.

I am just wondering if the member could talk about what she sees as being needed right now to start including indigenous people in a more meaningful way so that we can start to repair the harm that has been done, specifically in this place.