SoVote

Context: House Hansard - 300 - Apr/16/24

Apr/16/24 11:10:32 a.m.
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Madam Speaker, it was true in the 1960s and it is true now, that there are purveyors of doom. There are those who try to push people to despair. When one does not believe in a public health care system, what does one want people to do? One wants people to despair, because nothing comes from despair. All change comes from looking at what is hard and true and driving for change. Let us talk very specifically. Every health care system in the world is facing extraordinary backlogs as a result of COVID and stress on their system. It is a question how we meet that. These 13 agreements and these investments of $200 billion are demonstrating that we are meeting that challenge. In these plans, in articulated detail, is exactly how we are going to get to the health system Canadians deserve. With respect to dental care, we have thousands and thousands of dentists who have signed up across the country. Secondly, just on Thursday, I met with the dental associations, and I can tell the House that we are down to a couple of minor issues and that I am extraordinarily confident that over the next number of months, we will see virtually every dental office in the country participating in this program.

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Mr. Luc Thériault (Montcalm, BQ)

Apr/16/24 11:11:54 a.m.
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Re: Bill C-64

Madam Speaker, the minister spoke about a lot of things. I feel he spoke very little about Bill C-64. However, when we talk to him about Quebec’s interests, he rises in the House and always says that the Bloc Québécois is looking for a fight. Quebec has been administering a mixed drug insurance plan for the past 28 years, but the minister never sat down with Quebec before making his announcement to see how Quebec manages this and how much it might cost. Does the minister know how many prescription drugs are covered by Quebec’s drug insurance? Has he sat down with the health minister, who says that Quebec does have constitutional rights? When the minister says we are looking for a fight, he should add the word “constitutional”. It is as though we Bloc members have more respect for Canada’s Constitution than he does, despite his party having done all it could to prevent Quebec from signing the Constitution in 1982. Is he aware that the minister wants nothing to do with his pharmacare plan as proposed?

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Hon. Mark Holland

Apr/16/24 11:13:04 a.m.
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Madam Speaker, there is no denying that Quebeckers’ interests are absolutely the same as those of everyone else in the country. Everyone wants access to a health care system that works properly for all. As for the questions surrounding drug insurance, I have had some really good conversations with Minister Dubé in Quebec. There is a clear spirit of co-operation. If one goes looking for a fight or problems, they are easy to find, but the idea is to find solutions and a way to work together to resolve the situation, to improve people’s health across the country. For example, it is absolutely essential that we take into account the indicators for Quebeckers, so that we can compare and contrast how things evolve in their system and how they evolve in the other provinces and territories. This is a very good thing to do, and it is also good to see where the federal money is in the plan. That is why it is more important to co-operate than to pick a fight.

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Mr. Peter Julian (New Westminster—Burnaby, NDP)

Apr/16/24 11:14:31 a.m.
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Madam Speaker, I would like to congratulate the minister for working attentively with the effective NDP opposition to actually bring about this historic debate today. It is going to make a difference, on average, and I point this out to the Conservatives, to 18,000 constituents in each of the Conservative ridings across the country. I wanted to reference one of my constituents, a Burnaby, B.C. resident, Amber Malott. She learned she had diabetes when she fell into a coma just before her 21st birthday. With all of the types of insulin and injections that she takes, her monthly bill on insulin because of her diabetes is close to $900. We saw last week the disgraceful exhibit of Conservatives blocking even bringing this bill forward to the House. They blocked it from the kind of debate we need to have on this bill. Conservatives have indicated they would like to destroy this initiative. What would be the impact on people like Amber if the Conservatives had their way?

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Hon. Mark Holland

Apr/16/24 11:15:50 a.m.
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Madam Speaker, I want to thank the hon. House leader for the NDP. I am very pleased to work with him again in his role as the critic for health. He is absolutely right. I appreciate that these were not always easy conversations. They were indicative of the conversations we had when we were both House leaders. Finding that common ground, as two different parties, is often difficult. I think, for people like Amber, we can see what the difference is. The cost consequence for Amber of not being able to have access to the life-changing medication she needs, let us be very direct, could be devastating. It could mean that Amber winds up with a heart attack or stroke. It could mean that she has a limb amputated or that she dies. It certainly means that Amber is less productive, less able to contribute to society and almost definitely going to have an earlier death. The cost of not providing that medication is far superseded by those negative outcomes, not just as a matter of social justice but as a matter of material cost. Are the Conservatives going to be there for Amber? Are they going to be there for people who need their diabetes medication? Are they going to vote for their constituents who need these medications, or are they going to vote against them?

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Mr. Michael Coteau (Don Valley East, Lib.)

Apr/16/24 11:17:13 a.m.
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Madam Speaker, I am proud to be part of a government that is bringing forward new national programs like child care, student nutrition, a dental plan and pharmacare. It has been decades since a government in this country has moved forward with such massive programs. In fact, we have not seen this type of movement for many decades. I would like to ask the minister about the relationship we have with the provinces and territories as we move forward. As you move forward, what has been the response by some of the key people, like ministers and stakeholders in other provinces, for this specific plan?

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Stakeholders

The Assistant Deputy Speaker (Mrs. Alexandra Mendès)

Apr/16/24 11:17:51 a.m.
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I will remind the hon. member to speak through me, please. The hon. Minister of Health.

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Hon. Mark Holland

Apr/16/24 11:17:55 a.m.
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Madam Speaker, I thank the member and my friend for an important question. I have been so encouraged by the conversations that I am having with every provincial health minister across the country, regardless of their stripe. Whether I am talking to Everett Hindley in Saskatchewan or Uzoma in Manitoba, the conversations have been incredibly productive and positive. They are focused on how we get people the care they need. I would challenge the Conservative opposition. They talk about wanting to destroy dental, how they do not want pharmacare and how they are going to block the national food program. They tell people not to dream about it and that they cannot have it. They tell people not to dream that they can get medication. They say not to dream that they can have dental care. The Conservatives are going to make sure it does not work. They are going to call dentists and scare them. They are going to give them false information. They are going to work against people getting care, for political reasons. I think we should listen very carefully to what the Conservatives say. Are they asking questions about how they can help or how they can ensure that people get dental care? Are they asking questions about the problems that dentists have and how we can help fix them because they want to make sure people get dental care? No, they are saying to give up and have despair, and that they cannot do it. Shame on them for it.

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Mr. Stephen Ellis (Cumberland—Colchester, CPC)

Apr/16/24 11:19:25 a.m.
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Madam Speaker, hopefully today we will move into reality as opposed to the fantasyland that has been painted by the Minister of Health. When we look at it, the pharmacare program that is being introduced is really about the preservation of the costly coalition. We also know that Canadians are not going to be fooled by the foolishness that has been presented in the House this morning. We know that the other plan its members have is to clearly extend the date of an election so they can access their pensions. The worst state of being a politician one could possibly imagine is to be self-serving, when all of us who come to the House know we should be here for the benefit of Canadians. That is clearly not the case with the costly coalition members. Rather, it is about their preservation, which they have made very clear throughout Canada, which is an essential part of their ability to keep this inept government in power for as long as they have. That is the first part that Canadians, of course, are well aware of. The other thing that Canadians are well aware of is the state of coverage with respect to pharmacare. My Bloc Québécois colleagues are well aware that pharmacare falls squarely within provincial jurisdiction. We know that 97.2% of Canadians are already eligible for some form of prescription drug coverage, which is not some funny Conservative talking point. It comes from Stats Canada, CIHI, CLHIA and the Conference Board of Canada. Therefore, when we look at the numbers, it becomes very simple to understand that there is a gap of about 1.1 million Canadians who struggle without coverage for pharmacare. I think it is important to point that out because we are attempting to have an honest conversation here. We also know that the numbers of those who are uninsured have decreased precipitously since, for instance, the Ontario government introduced OHIP+. It is also interesting that the minister talked a bit about his historic meetings with all the provincial ministers of health, which I also chose to undertake myself. When I did, what those provincial ministers of health made clear was not the rubbish the federal minister brought forward, but that they in no way, shape or form want another large federal program dropped on their heads to fund, which, as I said in French, is clearly a provincial area of responsibility, the delivery of health care. Oddly enough, the federal Minister of Health himself pointed out that the delivery of health care is a provincial responsibility and not that of the federal government, despite the fact he continues to intervene in moving the responsibility from the provincial authority to the federal government. I did have an opportunity to mention this bill, and I would like to expand upon that. The bill would create another government agency, which is exactly what Canadians would like to have, more bureaucracy and more gatekeeping. It would create the Canadian drug agency, which would cost about $90 million to create and perhaps another $30 million or $35 million a year to continue to exist as time goes on. However, who worries about monetary policy? It is certainly not the NDP-Liberal coalition. It is also odd that the government posted on its Canada.ca website a list of drugs, diabetic drugs and contraceptives that may or may not represent what would actually be on the formulary in the future because we know it would be the responsibility of the Canadian drug agency, in consultation with provinces and other stakeholders, to create a formulary to be used. I think it is also important to point out that, if we are to have any faith whatsoever, which I personally do not, in the formulary that has been put out thus far, much to the chagrin of Canadians, it is rife with older medications, with no fees for pharmacists or the primary care provided by pharmacists to many Canadians because of the sad reduction in the number of family physicians. It is also worth noting, very specifically, that the blockbuster drug in treatment of diabetes in a generation, namely Ozempic, is not included. There is no surprise there. As I was saying, after the creation of the Canadian drug agency and a formulary, and after holding these consultations, the only consultations that have happened thus far, of course, are with the NDP costly coalition partners, which should not give Canadians any warming in their hearts. When we look at the other issues that are clearly brewing in Canada at the current time, Canadians know that the state of our beloved health care system has been under siege by the inept management of the NDP-Liberal coalition. We know that wait times have surged beyond what they have ever been in history. For instance, the wait time from seeing a family physician to a specialist to obtaining specialist-based treatment has increased 195% to a 27-week wait time. This is the longest it has been in three decades. Is this a system that Canadians should be proud of? The other disturbing statistic is that 6.5 million Canadians are without access to primary care. As time will march forward, as it always does, by 2030, in Ontario alone, the 2.3 million Ontarians currently without access will surge to four million Ontarians without access to primary care. It is very clear, even if this were a good pharmacare plan, which it clearly is not, that without access to primary care, there is really no way to get medications. I would suggest that there is a bit of a misguided nature here. The other difficulty that Canadians are also very aware of is that the newest medications, a class of medications called “biologics”, which account for 2% of claims, are now accounting for 30% of spending. Of course, none of these biologics are included on any of the proposed fantasyland formularies from the NDP-Liberal coalition. The other problem we have in our health care system is wait times from application to approval of medications to be on the formulary to the actual acceptance on 50% of public formularies, and we have the longest wait times in the world at 25 months for new life-saving therapies. A government should be seized with policy changes to improve the lack of bureaucratic control and the ability to change things that would be cost effective for Canadians, and indeed changes like this to make a government work more efficiently, which would actually not cost the government anything, it would cost Canadians nothing. However, what is the government doing? As I said previously, it is interfering with clear provincial jurisdiction and adding federated programs that in no way, shape or form could possibly reduce the cost for medications. The other reason, of course, is that the cost of these medications are already in a forum which allows all of the public plans to come together under a program called the “pCPA”, which already allows all public plans to negotiate for low prices for those medications. For the federal Minister of Health to suggest that this new plan would suddenly allow prices to drop precipitously is absolutely and categorically untrue. The other major issue is related to finances and the cost of living. When Canadians were asked what the major cause of their inability to afford their medications was, and I suspect my colleagues know very well what the answer to that question is, it was inflation. Yes, inflation is cited as the major cause of Canadians' inability to afford their prescription medications. Why do we have 40-year high inflation? Well, of course, it is because of the costly coalition of the NDP and Liberals. We know that the chance of a young Canadian now owning their own home is almost zero. It is a dream that is almost dead because of the NDP-Liberal coalition's incompetence. We also know that, more than ever, Canadians are turning to food banks to enable themselves to feed their families. Two million Canadians a month, very sadly, are having to go to food banks, and what do we see? We are seeing more large federal government spending in what David Dodge called last evening “likely to be the worst budget” announcement in the history of this country. We are waiting for more of these terrible budget announcements today, in which we will see another estimated $40 billion of deficit spending. On top of that, we know that the $1.2-trillion debt that the NDP-Liberal coalition has coffered together, more than all Canadian governments in history combined, is costing more now to service than we are spending on health care. That is an incredibly sad state of affairs. I would suggest that it is one that Canadians are paying very close attention to. We also know that simply saving for a down payment for a house is now taking 25 years, when the Canadian dream would be that those 25 years would allow us to pay a mortgage, not simply to save for the down payment. Canadians are suffering more and more with their mental health. We also know that the Liberal government had committed $4.5 billion to the Canada mental health transfer, and not one penny of that has been transferred. That is a very sad state of affairs, when one-quarter to one-third of all Canadians are currently suffering with mental health issues, and it is believed that 50% of those are suffering with inadequate treatment. The $4.5 billion could go a long way to help treat the mental health of Canadians. This NDP-Liberal coalition has had a multitude of failures, and they are worth pointing out simply because we question why Canadians would believe that another large federal program would ever come to fruition. What we know is that these programs are great announcements. The next prime minister of Canada has spoken about how people cannot eat the papers the announcements are printed on. They are incredible photo ops, when ministers go out to say that they might be capable of doing things, but Canadians know they are absolutely unable to do so. I had asked a question of the Minister of Health, which he, sadly, once again, failed to provide an answer to, but now I am quite happy to provide that answer on the Canadian dental care program. Last week I had the opportunity to speak to every dental association in this country, save the Yukon, simply because of time. That being said, I have a sample of the number of dentists who have signed up for this widely touted program. In my home province of Nova Scotia, four, not 400 or 14, but four dentists out of 400 have signed up for this program. It is shameful. In Prince Edward Island, it is even easier. The number is zero. There is no debating zero, it is none, zilch, nada. In New Brunswick, once again, to be clear, four out of 370 dentists have signed up. The most we were able to find was in speaking with the British Columbia Dental Association, and it had 400 out of 4,000, which is still a mere 10% of dentists. This is a program that has been created without any consultation with respect to dentists. It has been creating an incredible administrative burden on dentists. It has also created a conflict where dentists have to sign a contract with a provider, namely the federal government, as opposed to having a relationship with the patient, which is how health care has historically been delivered in this country. Dentists will continue to ask questions about this program. Why would they sign up for a program when they have distrust in this NDP-Liberal coalition? Let us talk a bit about affordable housing, which was another failure. It was promised by the government in 2015. It would have to build 9.6 million homes over the next 10 years. We also know they are now building less than this country was building 50, and not 15, but 50 years ago. Fewer houses are being built now because of the terrible policies of the NDP-Liberal coalition. We also know that the Prime Minister sat here in the House of Commons and promised 7,500 new doctors, nurses and nurse practitioners, and as I mentioned previously, 6.5 million Canadians now do not have access to primary care. We also know that the government continues to spend money, which could be easily used to generate these spots for Canadians, on its consultants. The government is quite happy to line the pockets of its friends. The Liberals also said they would reduce Canada's federal debt-to-GDP ratio every year, which sadly has not happened. We know that they can barely even deliver passports, which is actually one thing that is in the purview of the federal government. It is now announcing things that certainly delve into provincial jurisdiction, yet it cannot do things it should be able to do that are the purview of the federal government. As we begin to look at these things, we know that the NDP-Liberal coalition is an abject failure. People will often say that I have a lot of negative things to say. Why do I not give Canadians hope? Let us focus on that for a few minutes. The blue seal program we have announced, as Canada's Conservatives, would allow those who have trained internationally to quickly and safely have their credentials recognized here in Canada. That is a program that we would create because, as we go around this country, what we hear from new Canadians who have trained in other countries is that now they are driving taxicabs. I heard a story from one trained physician who is not allowed to work in this country. He was very sad because his young child asked him why, if he was a physician, he went to work dressed as a security guard every day. It does not get any worse for new Canadians than that. As we look at that, we know that Canada's Conservatives have been working hard to create policies that, when we form the next government, would easily allow new Canadians to have their credentials recognized here in Canada, so they can support Canada's health care system and work in a manner that is attuned to the training they have undertaken in their home countries. We have, again, a photo op. We have papers. We have announcements. We do not have a plan that has been put forward by the NDP-Liberal coalition, in any way, shape or form. We have more announcements. We have no actions, and we have continued interference in provincial jurisdictional matters. As I said, I have gone around the country speaking to provincial ministers of health. The last thing they want is another federal program dropped in the laps of the provinces, which they have to pay for because of the ineptitude of the NDP-Liberal coalition. We await the time when the Conservatives will form the next government of this country. We would have a new prime minister and new hope for Canadians, as they would be able to afford their lives, and the inflationary pressures and inflationary spending that continues to be put forth by the NDP-Liberal coalition would end. Canadians could then not be priced out of their lives. We would axe the tax, build the houses, fix the budget and stop the crime. I would like to put forward an amendment. I move: That the motion be amended by deleting all the words after the word “That” and substituting the following: “The House decline to give second reading to Bill C-64, An Act respecting pharmacare, since the Bill does nothing to address the health care crisis and will instead offer Canadians an inferior pharmacare plan that covers less, costs more and builds up a massive new bureaucracy that Canadians can't afford.”

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Mr. Kevin Lamoureux (Parliamentary Secretary to the Leader of the Government in the House of Commons, Lib.)

Apr/16/24 11:40:49 a.m.
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Madam Speaker, it is really important to look at the contrast between what the Government of Canada, the Liberal Party, and the Conservative Party are espousing. We are the only party that is espousing the national health care system that Canadians have grown to love for generations now. What we are talking about is expanding it and looking at ways we can complement the national health care system by bringing in a pharmacare program or at least taking a good step forward. That is what we are proposing. The Conservatives, on the other hand, are proposing to kill it. They are proposing that the federal government should not play a role in many aspects of health care. I believe that the Conservative Party is doing a great disservice to Canadians. Can the member give a clear indication as to why the Conservative Party does not believe pharmaceutical care has the role to play in Canadian health care that Canadians want it to play?

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Mr. Stephen Ellis

Apr/16/24 11:42:00 a.m.
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Madam Speaker, what this member says is categorically untrue. What we have pointed out with the eloquent speech that I just gave is that 6.5 million Canadians do not have access to health care. We know that the wait times are the longest that they have ever been in the history of this country. With the booing and guffawing behind me, they know it is all true that the difficulty that exists inside the current health care program is the inability of Canadians to access the program. Why would we continue to put lipstick on a pig when the Liberals' inaction has allowed the system to deteriorate to the point where many Canadians say that the system is failing them, as indeed it is? When 17,000 to 30,000 men and women a year in this country are dying on a waiting list, that is a failing system.

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Mr. Luc Thériault (Montcalm, BQ)

Apr/16/24 11:43:11 a.m.
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Madam Speaker, my colleague, the Conservative Party health critic, touched on an important point: access to care and wait times. Would he tell us about the Conservative Party's plan to reduce wait times? After all, when we were talking about health transfer agreements, I did not hear his leader lobby very hard in favour of doing more than what was on the table, which the provinces know will not be enough to resolve the problem he raised earlier. How does his party plan to really strengthen health care systems in the provinces and Quebec?

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Mr. Stephen Ellis

Apr/16/24 11:44:13 a.m.
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Madam Speaker, I believe it is always important to work with all the provinces and encourage necessary changes within the system, but also to respect provincial jurisdiction, which is a fundamental issue. I am sure provincial jurisdiction is important to my colleague as well. That will be the Conservatives' goal when we form government.

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Mr. Peter Julian (New Westminster—Burnaby, NDP)

Apr/16/24 11:44:55 a.m.
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Madam Speaker, I had flashbacks when the member was speaking because, of course, we lived through the terrible years of the Harper regime. When the member said the Conservatives would take care of health care, we saw what the Harper regime did, which was to gut health care across the country, leading to the crisis we see today. The member talked about credential recognition. I heard the same speech from Harper and his minions just before the Conservatives formed government, and the reality was that they did nothing on credential recognition. They doubled the cost of housing. They increased and doubled the lineups at food banks. The Harper regime was absolutely dismal. We lived through it and that is why the Conservatives were thrown out of power. Now, the Conservatives are saying that this time they would be better, but it kind of strikes at credibility. The member did say very clearly that the Conservatives would destroy pharmacare. This is in Cumberland—Colchester, where 17,000 of his constituents actually need the kinds of supports that come from providing support for diabetes medications, which can run up to $900 a month. I would like the member to say clearly to his constituents in Cumberland—Colchester whether Conservatives would gut pharmacare. Do they refuse the kinds of supports that 17,000 people in Cumberland—Colchester need?

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Mr. Stephen Ellis

Apr/16/24 11:46:23 a.m.
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Madam Speaker, I am not sure in what fantasyland the member was listening to the fantastic speech I gave. There was no mention of anything that he said in his question, so I am not sure where that came from. That being said, what we do know is that a new day, a new dawn and a new sense of hope is out there with Canadians because of the hope that we, as the next Conservative government, are able to give Canadians. We know of the damage the policies of the NDP-Liberal coalition have caused for Canadians. As I said, the numbers speak for themselves. There are 6.5 million Canadians who do not have access to primary care. As far as the great people of Cumberland—Colchester go, Nova Scotia, much like my colleague's riding in the great province of Quebec, has a program for pharmacare that already enables all Nova Scotians to access a pharmacare program, which, indeed, covers even more medications than the one put forward by the inept NDP-Liberal coalition government with the anemic formularies that it has so far put forward. The great people of Cumberland—Colchester have access to wonderful programs and those are the things that a Conservative government should be supporting in the future.

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Mr. Larry Maguire (Brandon—Souris, CPC)

Apr/16/24 11:47:52 a.m.
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Madam Speaker, in relation to the question my colleague from Cumberland—Colchester asked the Minister of Health, I have a letter from a local dentist in my area and I am wondering if the member could refer to any similarities between the Canadian dental care plan and what is being rolled out in the pharmacare plan. This dentist says that it may place our oral dental care system in serious jeopardy. He goes on to say that it is deeply flawed and stands to jeopardize our entire established system and how they deliver care to their patients. He said that only 70% of dentists have said they are likely to participate as a provider in the CDCP program. He went on to say that patients are going to be surprised to learn that dental care will not be free, they may not be able to choose their preferred dentists and nothing has been done to protect access to third party insurance. I would ask my colleague from Cumberland—Colchester if he can outline more than he did in his speech, which was a great speech, by the way, any similarities he can see between this plan and the pharmacare plan.

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Mr. Stephen Ellis

Apr/16/24 11:49:00 a.m.
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Madam Speaker, we know that the NDP-Liberal coalition wants to create federated programs that are going to reduce choices for Canadians and push those who do have access to the beloved care they now have into programs that will cover much fewer medications. For instance, we know at the current time that public programs cover about half of the medications that privately funded plans do. That will reduce choice for Canadians. What incentive will there be for employers to continue to provide plans for their hard-working employees in the future if a federated plan with a few old medications on it is what is being offered “for free” on the backs of all Canadians? Of course, we know that does not account for the bloated bureaucracy that it will take. As I mentioned, just to create a new Canada drug agency, in and of itself, will cost at least $90 million. Even though my great colleague suggested that perhaps 70% of dentists may support it, we know from the figures now that only less than 10% of the 26,500 dentists in Canada have signed up for this program, which is severely limiting access for Canadians. Indeed, last week, in one day, four great supporters in Cumberland—Colchester showed up at my office and said they have a shiny card for the dental care program, but they cannot find a dentist to provide the care because of the terrible nature of this program, which was created without consultation with the great dentists who provide care to millions of Canadians across this country. It is a shame. Liberals should be ashamed of their program and should be ashamed of the fact that they want to introduce another bloated federated program on the backs of hard-working Canadians.

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The Assistant Deputy Speaker (Mrs. Alexandra Mendès)

Apr/16/24 11:50:57 a.m.
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I would remind hon. members that we are debating the amendment. The hon. member for Montcalm.

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Mr. Luc Thériault (Montcalm, BQ)

Apr/16/24 11:51:13 a.m.
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Re: Bill C-64

Madam Speaker, after what I have heard, I would like to begin my speech by commenting briefly on the answer given by the Conservative health critic, with whom I serve on the Standing Committee on Health. In his answer, he spoke strictly about the jurisdictions of Quebec and the provinces and made no mention of what kind of additional funding the Conservatives would provide for health transfers. If I understood him correctly, basically, the only real option Quebeckers have is the Bloc Québécois. On one hand, we have the Liberal Party, which says that it will give the provinces money but only on its own terms and while infringing on their jurisdictions. The Liberals are duplicating programs and efforts. On the other hand, we have the Conservative Party, which says that it will not bother the provinces and will respect their jurisdictions but it will not give them a single cent more. That is the choice facing Canadian voters, except in Quebec, where they can vote for the Bloc Québécois. I will begin my speech with a brief comment, and I hope that the Minister of Health will listen carefully to what I am saying. He always talks about the great discussions that he has with the Quebec health minister. I will come back to that a little later. I want to begin by saying that in June 2019, the Quebec national state, through its National Assembly, with a single voice and across party lines, responded to this desire to implement coast-to-coast pharmacare. The National Assembly and the national state of the people of Quebec have not changed their position on this issue. The motion that was adopted the day after the Hoskins report reads as follows: 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; I should point out that it has now been nearly 28 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. That is what is going on right now. This motion was moved in June 2019. The House passed a motion twice on recognizing Quebec as a nation. When we respect a nation as a national state, by allegedly giving it more than mere token recognition, then the least we can do is avoid the kind of heavy-handed approach taken by the current federal Liberal minister of health. We have to sit down respectfully with the people who administer a plan, which is not perfect. In fact, I imagine that if the federal government was being stingy with the health transfers, it was because it wanted to funnel some of the money into pharmacare and dental insurance. We will talk about that later. In this case, the government should have come and sat down to see who has the expertise, learn how the Quebec system operates and arrange to provide the full compensation that Quebec is calling for, with no strings attached. In that regard, we need to stop all the speculation around what Quebec wants to do with the money. Quebec’s health minister was very clear when he said, “we have no problem adding this money to the drug insurance program. But it has to be without conditions. It is not up to them to decide what the best drug coverage is for Quebeckers”. His intention seems pretty clear. There is respect for Quebec symbolically. They call Quebec a nation to avoid looking foolish. When it comes down to it, though, this must not have any legislative consequences, period. The debate could end here if full compensation were offered. The bill provides for a list to be prepared. Earlier I asked the minister if he knew the list of drugs covered in Quebec, but he did not wish to answer my question. Do members know how many drugs are covered by Quebec’s drug insurance plan? The answer is 8,000. I wanted to bring this 792-page list, but I found it a bit heavy. These sorcerers' apprentices would have us believe they will arrange all this in no time at all. They will create the Canadian drug agency while in Quebec, there is already infrastructure. Ottawa has so much money that they are going to create another structure. There will be a duplication of structures. Is the Institut national d'excellence en santé et en services sociaux, or INESSS, not doing its job properly? It has been 28 years since Quebec has been making decisions, analyzing all the elements at a molecular level and determining whether these elements, many of which are innovative, are to be reimbursed. They are included in the list. Whether we are talking about the public part or the private part of this mixed plan, everyone has access to the same drugs. This would have been a great opportunity to respect the Quebec nation. The Quebec national state and all its parties are asking for the same thing. The leader of the NDP, that progressive party, is lecturing us. He is completely out to lunch, though, when he says that the health problem in Quebec has to do with the fact that the government has not invested enough in health care. The Government of Quebec increased its budget by 50%. It has enacted reforms to try to do more with less. It implemented a number of reforms and a lot of structural modifications in an effort to achieve greater health efficiencies. We have a partner that has not been putting enough money on the table. Then, a few years later, this same partner has the nerve to say that Quebec does not know how to manage its own health care system and tries to explain how it should be done. The first thing that partner should do is hand over the money. That would be a good starting point. Quebec's current resistance to all this federal interference should not be that hard to grasp. It is easy for the Prime Minister to say that he does not care about jurisdictions. The Prime Minister does not care about the Constitution. Well, let him reopen the Constitution, then. We will see if he really does not care. The government likes to lecture everyone else, but cannot even take care of its own people. That is the federal government. I will come back to that. One might think this bill was well-intentioned, but the road to hell is paved with good intentions and the devil is in the details. I asked only one question: How many prescription drugs will be covered by the national public pharmacare program with a single universal payer? Will Quebec's list be used? Will Quebec have to take any prescription drugs off its list? Will INESSS be made redundant, or will it be able to continue doing its good work? Why is a Canadian agency being created to supersede the process we have in Quebec? We are not getting any answers to these questions. However, the minister claims he has maintained a very good dialogue with Quebec. I gave an example. I think the minister is having a dialogue of the deaf, where he listens only to himself and not the other party. It seems to me that it was quite clear when Quebec's health minister, Christian Dubé, said, “we have no problem adding this money to the drug insurance program. But it has to be without conditions”. He then added the following: The government is not only refusing to give us the money we asked for in health transfers, but it also wants to interfere in an area under Quebec's jurisdiction. The federal government knows full well that this is a provincial jurisdiction. We have had our own pharmacare program since 1997. That is almost 30 years. We also cover the widest range of prescription drugs of all the Canadian provinces. The federal health minister just told us that he has very good conversations with him, even though the Premier of Quebec felt it necessary to hold a press conference to tell the federal Liberal government—which is in a coalition with the NDP and was not so centralist before the NDP got involved—to mind its own business. The minister just told us this morning that they have very good conversations, but when we stand up in question period, we are told that we are trying to pick a fight. All we are saying is that the federal government should mind its own business. We are only relaying the message from the National Assembly of Quebec, not from a single party but from all parties, on pharmacare. The reason Ottawa has money in the first place is because of the fiscal imbalance. Well, we are going to enhance our own program. I challenge anyone here this morning to prove they could do a more competent job managing our program than those who are doing it right now in Quebec City. I challenge anyone willing to make that claim to go make their case to those managing the program and prove that they have the competence. I am talking not only about provincial competence in the jurisdictional sense, but also about incompetence. In that respect, I have a short list I will return to later. Bill C-64 has put the cart before the horse, as the saying goes. Today, rather than sitting down, holding a summit, talking to people, looking at what was being done and coming up with something of substance, the government announced an intention of putting something in place. However, it did not talk to anyone, it is not open to anything without conditions, and it is saying that Quebec must march to the beat of Ottawa's drum. This is not well intentioned; this is a political deal to stay in power until October 2025. That is what this bill is really about. That is what is behind it, because no one could be this keen to jump into as sensitive and critical a field as pharmacare. Drugs in 2024 are not like they used to be in 1996 or 1997. We are not talking about codeine or Tylenol. We are talking about innovative molecules that often give rise to treatments that could potentially allow patients to avoid surgeries and transplants. A case in point is Trikafta for cystic fibrosis. Patients can take two pills and a glass of water a day, instead of being hospitalized for 280 or 320 days a year, instead of having to get a lung transplant. This drug needs to be covered. How will the list be compiled, and how can we trust the federal government, which starts things but then walks away? After all, this is the government that pilfered from the EI fund and from workers and that never did the right thing by returning the money. This is the government that dumped the federal deficit on the provinces and cut health transfers in the mid-1990s. Jean Chrétien travelled the world, boasting to the G7 countries that all he had to do to balance his budget was cut health transfers and that the best part was that people were protesting in front of the Quebec National Assembly, not in front of the Parliament of Canada. That is what the federal government is like. It is creating a program now, but how many years will it be before the government disengages because it got the math wrong, it is unable to manage the program properly, and the infrastructure is cumbersome and redundant, when the money should be on the ground, going directly to patients as quickly as possible? The minister delivered a very nice speech, saying the governments get along really well, the principles are sound, the Quebec government wants to co-operate. In reality, the Quebec government's response was to ask Ottawa to mind its own business. The federal government is not even capable of handling its own affairs properly. Think about the whole F-35 saga or the lack of investment in defence. Think about Phoenix, the borders, passports, asylum seekers. The national emergency stockpile was empty when the pandemic hit. The Global Public Health Intelligence Network had been dismantled and was ineffective at the start of the pandemic. The federal government should mind its own business and clean up its own house before lecturing us. It lectures the provinces about health care management, but it is the worst employer for federal health employees. Communities under the federal government's jurisdiction are neglected. The funding Ottawa provides for public health care is insufficient, to be sure, but the federal government treats its employees worse than the provinces do. How it can then lecture anyone, I just do not know. The bill seeks to put in place principles, and then, based on these principles, a list will be compiled. After this list is compiled, an agency and then a committee will be established. The government is so clueless about where it wants to go with this that it is tabling a bill to create a committee that will make recommendations for rolling out pharmacare. Bravo. The Bloc Québécois is not opposed to state pharmacare. It already exists in Quebec. It is far from perfect, there are positives and negatives, but it does guarantee minimum coverage. What we are calling for is what the National Assembly has always demanded: the right to opt out with full compensation. Given how long Quebec has been administering pharmacare, if there was a real need elsewhere, I imagine others would have followed suit. However, that was not the case. We are going to ensure that no one is ever allowed to dismantle our system or reduce our coverage. Medication is currently free for people aged 18 and under. The system is not perfect, of course, and there are certain fees involved. However, if we had the money, we could increase free coverage without compromising on the list of drugs we cover. Does the federal government really know how much it is going to cost to make everything free from the first dollar invested? I am not sure these sorcerers' apprentices really know what they are doing. Based on the reaction of the National Assembly and the Quebec government, I am certain the federal government has never sat down with them to have a serious conversation about it. Quebec's example and expertise are not going to be on the agenda as the government implements its system.

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Mr. Kevin Lamoureux (Parliamentary Secretary to the Leader of the Government in the House of Commons, Lib.)

Apr/16/24 12:11:18 p.m.
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Madam Speaker, many years ago, the Province of Saskatchewan implemented a policy and a program that ultimately led, in good part, to the national government recognizing how important it was to develop a national health care system. As a direct result, over generations now, we have benefited from Canada's system. However, many people advocated, over the years, for a pharmacare component. What we are seeing today is historic legislation that would lead us to achieving that particular goal. This is something that is universally shared across the country. People residing in every province understand and have faith in the Canada health system, whether they are in Winnipeg, Toronto, Montreal, Vancouver, Halifax or any municipality in between. There is a great deal of support for the federal government to be involved in health care. That is why we have the Canada Health Act. Does the member not believe that Canada has more of a role to play than just being an ATM?

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