- Member of Parliament
- Member of Parliament
- Liberal
- Thunder Bay—Rainy River
- Ontario
- Voting Attendance: 64%
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- May/30/24 10:35:50 p.m.
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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.
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- May/30/24 10:34:00 p.m.
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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.
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- May/30/24 10:32:12 p.m.
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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.
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- May/30/24 10:22:58 p.m.
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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.
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- May/30/24 10:20:29 p.m.
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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.
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- May/30/24 9:43:30 p.m.
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Mr. Speaker, I appreciate the passionate speech by the member from the NDP. I agree that this is really a milestone. There are medications for rare diseases, which are very expensive. There are medications for cancer treatment, which are very effective but cost hundreds of thousands of dollars a year. How would this national pharmacare program help to ensure that these medications are affordable to our society? I would give a hint: It is probably because it actually looks like a national pharmacare system would end up saving health care dollars rather than costing.
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- May/30/24 6:39:55 p.m.
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Madam Speaker, under the statute, there would be a requirement for the government to come up with an essential drug list within a year of its getting royal assent. It would seem to me this would be a difficult process. I am sure all kinds of doctors are going to want different things to be part of the essential drug list. What does the member think about our ability to do that and to do it within one year?
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- May/23/24 2:06:11 p.m.
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Mr. Speaker, last Saturday night, Ukrainian boxer Oleksandr Usyk defeated much bigger fighter Tyson Fury to become the undisputed heavyweight champion of the world, the first in 24 years. Ironically, Fury himself first became a champion in beating another Ukrainian fighter, Wladimir Klitschko, the brother of the current mayor of Kyiv, Ukraine.
As Ukraine continues to defend itself against a much larger Russian invader, it has been struggling to hold the front line in recent weeks, largely due to a shortage of ammunition, which is thankfully starting to arrive from the United States. Saturday was a great victory for Usyk, a great victory for boxing and, most of all, a great victory for Ukraine, as Usyk showed the world how, with sufficient heart, strength and intelligence, a smaller fighter can always defeat a larger one.
Slava Ukraini.
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- Apr/30/24 10:15:56 a.m.
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Mr. Speaker, I have been truly blessed in life to have been able to have six children. They are absolutely one of the best parts of my life, but unfortunately not all Canadians have the same good fortune. In fact, one in six Canadians, at some point in their lives, has some sort of fertility problem.
I would like to present a petition on behalf of Fertility Matters Canada, with 5,300 signatures. The petition calls on the government to develop a national fertility strategy and, in collaboration with provinces, to build a more equitable future for fertility care in Canada.
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- Apr/9/24 2:03:04 p.m.
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Madam Speaker, every three minutes in Canada, someone is diagnosed with cancer, a diagnosis that will change their life and the lives of all their family members forever because, if one is diagnosed with cancer, pretty well everything else in life, including much of what we do here, seems pretty insignificant in comparison.
The COVID pandemic showed us what the global scientific community can do when it puts its collective mind toward something. Experts were predicting it was going to take us years to come up with vaccines, and we came up with several within a year. Why can we not do the same thing to try to beat cancer?
In the United States, the Biden administration has pledged to prevent four million deaths by the year 2047. We in Canada can and ought to make a similar commitment. Nothing in life is ever accomplished unless one tries.
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- Mar/20/24 9:16:40 p.m.
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Madam Chair, I would like to thank the member for his compassion for the Ukrainian people.
As to what Canada has to do at the moment, certainly, it has to hope for a good result in the upcoming election in the U.S. We certainly fear what is going to happen should Trump be re-elected.
What the member said earlier about the effects on children was very apropos for me, because the harm caused by this invasion will go on for years. The effect on the education of children is something that we are going to feel for years.
The fact that the Republicans are blocking this is absolutely terrible in my mind. The reality is, perhaps, that we in the western world, parts of NATO that are not the United States, need to contemplate the possibility that we will have to do far more on our own. At some point in the future, should Trump be elected, we may need to do things without the support of America. I certainly hope that Canada would be willing to make the commitment that is needed to continue support of Ukraine against Russia with or without the United States. However, I would certainly like to see the United States continue its historical role in promoting and supporting the international legal order.
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- Mar/20/24 9:14:02 p.m.
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Madam Chair, to tell the truth, I went through the whole agreement, but I did not see anything on medical assistance. However, that is exceedingly important.
In fact, I know that Canadian surgeons, as part of teams with American surgeons specializing in plastic surgery, orthopaedic surgery and neurosurgery, have gone to Ukraine to assist people who have been injured in the war. They try, as much as possible, to make them as close as they can to what they were before their injuries. Therefore, I think Canada has really contributed a lot in that respect, and, certainly, continuing to do so is important. However, I will stress that it is far better to prevent injuries and death than having to send surgeons and medical teams to try to undo what war has done.
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- Mar/20/24 9:08:11 p.m.
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Madam Chair, I will be sharing my time with the Minister of International Trade.
I think it is really unfortunate that I am here yet again to talk about Ukraine and the war and using those two words in the same sentence. I wish, when I thought about Ukraine, my thoughts would be limited to growing up with my baba in Fort William. We would sit on the front steps of her corner store. She would bribe me with Coca-Cola and chips to get me to sit and listen to her Ukrainian hymns and stories about the old country.
I wish my thoughts of Ukraine were limited to thinking about my family in Odessa, which I visited, and visiting the village of my baba, which was near Horodenka in Chernivtsi, or the village of my dido, which was near Kamyanets-Podilskyy.
Instead, here we are talking yet again about the war, an unprovoked attack by the Russian state, led by Vladimir Putin, in complete and utter disregard for the most fundamental principles of international law. In starting this war, Putin has committed what is known in international law as the crime of aggression, which in the words of the Nuremberg judgment is “the supreme international crime...[as]...it contains within itself the accumulated evil of the whole”, the evil being all other international war crimes.
I would love to talk more about how the invasion has affected the international legal order, which grew out of the horrors of the Second World War, and how the resulting international trade rules have brought prosperity to millions of poor people around the world. However, time is limited, there is a war on, so let me talk about some of the specifics and highlights of the agreement.
In 2024, Canada will provide $3.02 billion in macroeconomic and military support to Ukraine. The agreement states:
In the event of renewed Russian aggression or attacks against Ukraine following the cessation of current hostilities, and at the request of either of the Participants, the Participants will consult within twenty-four...hours to determine measures needed to counter or deter the aggression.
There is a section of the agreement that commits both countries to establish closer defence industrial partnerships. In that, there is an explicit recognition of the acute need for ammunition in Ukraine.
There is talk of the need for Canada to continue to support demining. As a doctor who has operated on land mine injuries, that is really important to me.
Canada, in this agreement, commits to supporting Ukraine in making sure it holds Russia to account for war crimes, including in front of the International Criminal Court.
Lastly, the agreement commits Canada to working with other countries to establish a compensation mechanism whereby Russia would pay for the damages done to Ukraine.
I read a quote earlier about how starting a war is the supreme international crime. That quote came from the International Military Tribunal at Nuremberg. There were eight judges on the tribunal; two of them were Soviet judges. As we all know, both Russia and Ukraine were part of the Soviet Union. It is ironic that Russia not only committed the supreme international crime but also committed it against its own brothers and sisters in Ukraine.
It is also ironic that two of the judges on that tribunal were American. The United States is the historic champion of the international legal order. However, right now, we are seeing the United States struggle in order to continue to finance military assistance for Ukraine; much assistance has been absolutely crucial in preventing a Russian victory.
Crass political gamesmanship and unbridled self-interest seem to have guided many American Republican congressmen to try to block the Biden administration's attempt to provide a further $60 billion in security assistance for Ukraine. This is an affront to the memories of those esteemed American jurists who sat at the Nuremberg trials and to the millions of people who fought and died on the side of the allied nations, both to fight the Nazis and to create the present international legal order.
Thankfully, we know that the war in Ukraine will eventually come to an end. Ukrainians will then be able to return to what they do best, which is to grow cucumbers, tomatoes, sunflowers and dill and, occasionally, to be able to sit down and calmly enjoy a nice glass of horilka. Unfortunately, that day will not come soon enough.
Slava Ukraini.
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- Mar/19/24 5:02:00 p.m.
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Mr. Speaker, as I was saying, the experts seem to think the carbon tax only minimally contributes to inflation. Let me quote a few of those experts.
The Governor of the Bank of Canada in September came to the conclusion that the carbon tax only contributes 0.15% to the inflation rate. In a recent review in Policy Options, a couple of Alberta economists calculated that the carbon tax increased consumer prices by only 0.6% in the last eight years. Stats Canada, in a B.C. study, estimated that the carbon tax only contributed or increased the cost of food by 0.33%.
Where are their statistics from? I quoted some. I would like to hear from the opposition. Where are they getting their stats from?
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- Mar/19/24 5:01:30 p.m.
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Mr. Speaker, I can certainly comprehend this argument that the cost of the carbon tax is going to be passed on to consumers and this is inflationary. It is a good story that the opposition is trying to sell. The problem is that it does not seem to be true or, at least, a lot of experts seem to think that the carbon tax—
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- Mar/19/24 10:42:39 a.m.
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Mr. Speaker, I can understand the argument that the carbon tax would be inflationary. The problem is that the experts do not seem to think that.
For example, the Governor of the Bank of Canada, in September, said that the carbon tax only contributed about 0.15 percentage points to inflation. A Policy Options review in 2023 estimated that carbon taxes increased consumer prices between 2018 to 2023 by 0.6%. Stats Canada, in a B.C. study, figured that only about 0.33% of the increased cost of food was attributable to the carbon tax.
I am not sure where the Conservatives are getting their statistics from, but I would like to hear some of their statistics.
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- Feb/15/24 4:16:58 p.m.
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Mr. Speaker, I would approve of that. However, as a medical practitioner, I would not volunteer to become a MAID practitioner. If this position is going to be created, the only people who are going to take on the job are people who believe in MAID, believe that it is all about personal autonomy and believe that it is not for others to question a person's suffering. Whatever they are going to be taught, a lot of them are going to be the kind of people who do have a cavalier attitude toward taking life. Those of us who disagree with it are not going to accept the position to begin with.
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- Feb/15/24 4:15:01 p.m.
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Mr. Speaker, I am not against MAID for physical illnesses. That is a totally different situation. The problem with MAID for mental illness is the inability to determine who is not going to get better. The unfortunate reality is that there are a lot of doctors who have a very cavalier attitude toward taking someone's life, and that there are people who could or would get better with a little time and with better treatment who would otherwise have their lives foreshortened by one of these zealous practitioners.
Certainly it is very different from, for example, the Carter situation, or someone who has ALS and is terminally ill with a neurodegenerative disease. That is a totally different story, and in those cases I certainly approve of MAID if that is what the person wants.
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- Feb/15/24 4:13:02 p.m.
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Mr. Speaker, I absolutely support that. What a humane society does when someone who is suffering comes before it is that it tries to help them. Maybe that means better psychiatric care, but maybe it means addressing their socio-economic problems. Certainly I do not think that a humane society's first response to that person ought to be to offer them death. That is an absolute failure and a solution of an inhumane society. We ought to be helping people who are suffering, not ending their lives.
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- Feb/15/24 4:03:00 p.m.
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Mr. Speaker, let me start by apologizing to the four or five people who might have listened to my last speech and who are here listening again today, because this is going to sound a little repetitive.
I certainly support the legislation, and I know there are a lot of people out there who are really worried about allowing MAID for mental illness. There are people who are worried about their friends. There are people who are worried about their parents. I am most sympathetic to people who are worried about their children. I have six children, and I know that they are going to, at some point in their life, go through difficult times. I would certainly be a little worried for them if we were to allow MAID for mental illness to be implemented with the current safeguards.
I know that there are also many psychiatrists who are worried about and/or oppose the legislation. In fact, the latest statistic I heard was from a survey that showed that about 75% of psychiatrists were against it. They are worried that their patients who would otherwise get better would instead resort to MAID.
Let me take a step back and look at the arguments coming from the other side. People are going to say, “Why not? Is it not a matter of personal autonomy? Is it not my body and my choice?”. This is not about the state's dictating to the individual what they can do with their own body. It does not criminalize trying to commit suicide or committing suicide. This is about what role, if any, the state should have in assisting people to commit suicide.
I am going to come back to the issue of whether MAID for mental illness is the same as assisting suicide.
The question of whether the state ought to take a role in assisting people in ending their lives is, I think, a little like the question of whether the state should try to prevent people from killing themselves. This is a topic I know something about, having worked a lot of years as an emergency room physician. In that role, my job, if somebody came before me and was suicidal, was to keep them in the hospital, even against their will, to prevent their suicide from happening.
Occasionally people would ask why I should I have that power, saying, “ Is it not my body, and my decision to make?” I think that there are two legitimate reasons for the state to try to prevent people from killing themselves. One is to protect someone from themself. When one is in the depths of depression, they cannot realize that things will get better; that is partly why someone is so depressed and wants to kill themself. The reality for most people is that they do in fact get better.
The other legitimate reason for the state's intervention is to protect the family. The person who commits suicide is dead. The rest of the family lives on and lives with the pain, but it is not only that; they are constantly haunted by whether the death was because of something they did or did not do.
Some people are going to say that, no, MAID for mental illness is not the same as assisted suicide, that we are talking about a small group of people who have intense, prolonged suffering and have tried every form of treatment but nothing has worked, and that it is cruel and unconstitutional to not allow those people access to MAID. I disagree. The Canadian law is far more permissive than, for example, the Dutch law. There is absolutely no requirement that all forms of treatment have been tried and been unsuccessful. Our law does not even require patients to have tried any treatment at all; it requires only that the patient have no other treatment that is acceptable to them. There are going to be people who refuse all forms of treatment altogether.
I know that there are people who support MAID for mental illness who will say that the safeguards are going to come from the medical profession, that they are going to require someone to have tried all forms of treatment beforehand. Unfortunately, I do not have the same sort of faith in the medical profession's doing that. Why do I not? If we look at what has happened with the MAID regime for people with physical illnesses, we see that there are a lot of MAID practitioners who are very zealous about its being all about one's personal autonomy and saying it is not for them to question someone's suffering, and who are quick to approve people.
Let me give some examples from the media. The Fifth Estate aired a program that said that a 23-year-old diabetic going blind in one eye was granted MAID. Another person, a 54-year-old man, had back problems, but his main problem seemed to be that he was worried about losing his housing and ending up on the street. He too was granted MAID.
CTV published a couple of relevant articles. A 51-year-old woman was actually granted and got MAID for multiple chemical sensitivities. Again, from CTV, a 31-year-old woman who seemed to use a wheelchair from time to time and had multiple environmental allergies, applied and was approved for MAID; again, however, her main problem seemed to be that she could not find suitable housing.
There are those who have such faith in my fellow doctors to come up with the system and all the safeguards, but I do not share the same sort of faith. I, as someone with a lot of children, realize it is inevitable that at times in their life they are going to go through a hard time, the breakup of a relationship or financial hard times. I am really worried that they would walk through the door of a zealous practitioner who will tell them it is all about personal autonomy and is their decision to make, because who is the doctor to question their suffering. There is not any requirement in the current legislation that the MAID practitioner talk to the family or the previous treating practitioner to find out whether in fact the depression was motivated by, for example, the breakup of a relationship.
I also want to talk about what I think is a really fundamental and perhaps fatal flaw in the current regime with allowing MAID for mental illness, which is the problem, the impossibility, of determining irremediability: Who is not actually going to get better? I have spoken previously about the inability of suicidal individuals to appreciate the fact that they are going to get better. Some people would ask whether there are people who are not going to get better, who are irremediable. That is in fact the requirement of the legislation. The problem is that doctors do not have a crystal ball. They are not really good at being able to determine who really is irremediable.
In fact, a recently published study looking at the ability of clinicians to determine irremediability for treatment-resistant depression concluded:
Our findings support the claim that, as per available evidence, clinicians cannot accurately predict long-term chances of recovery in a particular patient with [treatment-resistant depression]. This means that the objective standard of irremediability cannot be met....
Furthermore, there are no current evidence-based or established standards of care for determining irremediability of mental illness for the purpose of [MAID] assessments.
For me, as a long-time medical doctor, it is absolutely mind-boggling that there are medical practitioners and psychiatrists who are not particularly bothered by the fact that they really cannot say whether the illness is irremediable, and would grant MAID. If we allow MAID for one such person who would actually get better, to me it would seem tantamount to the same sort of tragedy as the state's hanging someone who later turned out to be innocent. We in this place cannot let that happen.
Last, let me address the assertion of proponents of MAID who say that it is inevitable that the Supreme Court would find not allowing MAID for mental illness unconstitutional because it is allowed for physical illness. I think that, yes, there would be a finding that such a provision would violate section 15 or section 7, but as always, the question comes down to the section 1 analysis and whether the state's actions constitute a reasonable limitation as prescribed by law that “can be demonstrably justified in a free and democratic society.” I do not think the answer to that is clear. It is not just me; there was a letter written by 32 law professors who came to the same conclusion: it was not clear whether it would be found unconstitutional.
I am not going to say that we should never allow MAID for mental illness; in fact, I know personally of a case where this might have been the ethical thing to do, but I think we are a long way now from being in a situation where we should start to allow it. I would prefer the pause be indefinite, but so be it. We have what we have. Let us look at it in two years and see what has changed. I doubt very much will have changed.
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