|| That, given that millions of Canadians lack prescription drug coverage, and given that overwhelming evidence, including from the Parliamentary Budget Officer, has concluded that every Canadian could be covered by a universal pharmacare program while saving billions of dollars every year, the House call on the government to commence negotiations with the provinces no later than October 1, 2018, in order to implement a universal pharmacare program.
He said: Mr. Speaker, I am honoured to be splitting my time today with the member for .
Canada is a country that prides itself on our universal health care system. It is no exaggeration to say that our public single-payer system of physician and hospital coverage is one of the features of our nation of which Canadians are most proud. I believe it defines us as a country.
However, our health care system is neither perfect nor comprehensive. Indeed, it has a number of glaring coverage gaps. These include services such as outpatient, dental, mental health, rehabilitation, and home care. The motion the New Democrats are proud to introduce today calls on the government to take action to address one of the most pressing and solvable of these gaps: pharmaceutical drugs.
Currently, this gap consists of a patchwork of private and public coverage that varies widely across Canada. Outside of Quebec, every province and territory provides public drug coverage for people only in very limited circumstances, sometimes for those on social assistance, sometimes for seniors, and sometimes for people with specific conditions such as cancer, transplants, and infectious diseases. For those outside these groups, folks have to pay the cost of the medication out of their own pockets.
Quebec is the only province with a mandatory program, requiring that every citizen obtain insurance. However, it is a mixed private-public scheme where the most expensive and difficult-to-insure citizens are foisted onto the public plan, making it extremely costly. The situation is problematic even for those who have extended benefit plans through work. These plans often have annual limits or copayments that leave claimants exposed for out-of-pocket costs. Employers across Canada report difficulty paying for these benefits and increasingly are dropping coverage for their employees.
The consequences of this omission are present in every community and every demographic. They are real. They are pressing. They are serious.
Here is a typical example, recently described in an article written by two physicians from Alberta. They describe the real case of a 60-year-old Calgary woman with high blood sugars and very high blood pressure. She paid for medications out of her own pocket each month, she had no employer insurance, and she could not afford the premium for Blue Cross. One month, however, when facing extra expenses, she did not have enough money to pay for her expensive diabetes and blood pressure medications. She ended up in the hospital. This woman would likely have avoided the emergency room altogether if she had stayed on her medications. Ironically, by having to access hospital care, she ended up costing our health care system much more than the cost of her medication.
Unfortunately, stories like hers are all too common. A number of studies have established that 10% to 20% of Canadians have no pharmaceutical coverage whatsoever. This means that four million to seven and a half million Canadians are living every day without the medicine their own doctors prescribe for them and which they need to stay healthy and sometimes even alive. One in five Canadians reports that he or she or a family member neglects to fill prescriptions due to cost. In fact, Canada has the second-highest rate of skipped prescriptions among comparable countries. This particularly hurts seniors and the poor. One in 12 Canadians over 55 skips prescriptions due to cost. Low-income Canadians are three times more likely to experience financial barriers to accessing essential medication.
Shamefully, Canada stands virtually alone among developed countries in this regard. We have been identified as the only developed country in the world with a universal health care system that does not provide some sort of universal prescription coverage. Canada is one of only five OECD nations whose public health system does not provide publicly funded drug insurance to all citizens. Even as millions go without coverage, Canadians pay among the highest prescription drug prices in the industrial world, second only to the U.S., and these costs are growing at an alarming rate.
Here is the absurdity. If someone cuts a finger, he or she goes to the doctor who stitches it up, and the individual leaves and never sees a bill. However, if people go to a doctor and their ailment needs to be treated by medication, they are at the mercy of their ability to pay. This is irrational, it is unfair, it is not consistent with a modern universal health care system, and it is also unnecessarily expensive.
However, there is a solution. In fact, it is a solution so clear, so established, and so patently feasible that there is no reason why we should not begin to implement it at once. That is what this motion and the New Democrats are urging the government to do; to begin to implement a universal pharmacare system in Canada.
By implementing a universal public pharmacare system, we can cover every single Canadian, every man, woman, and child, and save anywhere between $4 billion and $13 billion a year. Let me repeat that, just as with universal health care, we can make sure that all Canadians can get the necessary medicine they need when they need it and we can collectively save billions of dollars as a nation. Here is how and why.
A universal public system would save money in myriad ways. It would establish a national, independently monitored, evidence-based formulary that covers drugs that are the most effective and cost sensitive. It is estimated that more than $5 billion a year is wasted because private drug plans pay for unnecessarily expensive drugs and dispensing fees. By reimbursing drugs only when they represent value for money, public plans are much better equipped to rein in such costs.
Second, it would allow for the effective national bulk purchasing of drugs, a proven method that reduces drug costs by an average of 40% for brand-name drugs, as has been the experience in New Zealand, the U.S. veterans administration, and countries throughout Europe. A year's supply of atorvastatin, a widely used cholesterol drug, costs about $143 in Canada, but only $27 in Sweden and $15 in New Zealand.
It would allow for the negotiation of exclusive licensing agreements with pharmaceutical companies to achieve the best prices for widely used medications. It would streamline administration costs, reducing thousands of duplicative administrative systems, perhaps to one per province and territory. The administration costs of for-profit private plans average 15%, while administration costs for public plans are less than 2%.
It would avoid cost-related non-adherence, the technical term for the increased costs that come when folks do not take their medicine and become more seriously ill. The health committee heard evidence that one diabetic patient who ends up in intensive care because that individual could not afford to take insulin costs more money than providing free medication for life.
However, members do not have to take my word for it. The parliamentary budget officer's report on the federal costs of a national pharmacare program, released September 28, confirms what health policy experts have been saying for years, that Canadians could have a pharmacare system that covers everyone for billions of dollars less than they now pay for prescriptions. The PBO found that, in 2015, Canadians spent $24.6 billion on pharmaceuticals that would have been eligible for coverage under a national pharmacare plan. Accounting for pricing and consumption changes, the PBO estimated that Canada would have, instead, spent $20.4 billion in 2015 under national pharmacare. Using the most conservative assumptions, leaving out certain cost savings entirely, and applying the Quebec formulary, one of the broadest in Canada, he found that Canada would have saved $4.2 billion that year.
Other studies, including by renowned Canadian researchers, estimate the annual savings to be even higher, perhaps between $9 billion and $13 billion. That is why so many voices in Canada are advocating for a national pharmacare program. This includes many organizations—retirees, physicians, nurses and other health professionals, business and employer associations, the Canadian Labour Congress, health care researchers, and patient advocates of all kinds—and we know that the public broadly supports national pharmacare. A 2015 poll found that an astonishing nine out of 10 Canadians support the concept of national pharmacare.
The details of what kind of system we create are yet to be determined. A pan-Canadian pharmacare program could be a stand-alone federal program, or we could fold it into the Canada Health Act and add prescription coverage as an insured service, just as we do with any other medically necessary service.
Ultimately, of course, we have to pay for our medicine, but it is always Canadian citizens who pay, in any event, whether they pay through public or private sources. The question is whether we want to pay $24.6 billion a year, with millions of Canadians left uninsured, or instead, pay $20 billion overall, with coverage for every single Canadian. To ask that question is to answer it.
Our most important goal should be to ensure that no Canadians go without the medicine necessary to their health. New Democrats in the House, therefore, call on the Liberal government to agree to this goal. We ask Liberals to vote for this reasonable and necessary motion and meet with the provinces within one year to begin the discussions to make it a reality.
It took New Democrats and courage to bring medicare to Canadians. We will continue to work to do the same thing for pharmacare.
Mr. Speaker, I am very proud to rise here today to support the motion by my colleague from to give all Canadians access to universal pharmacare. This would be tremendously beneficial, not only for public health, but also for public finances. The NDP has been working towards this goal for at least 50 years in order to improve our society, protect our poorest and most vulnerable citizens, and promote solidarity and health across the country.
Canada is a rich society and member of the G7. This means that we are one of the seven richest countries on the planet, but unfortunately, we are the only industrialized nation that has universal medicare but no pharmacare. The province of Quebec has helped by creating its own pharmacare system. How is it possibly fair that a resident of Cornwall, in Ontario, does not have access to medication while a resident of Saint-Anicet does, when only a river separates them?
It is very clear that a federal pharmacare program will require thoughtful consideration, negotiations with the provinces, and discussions here in the House. That is why we need to start those discussions as soon as possible and initiate talks with the provinces next year.
Let us take another look at Quebec, which has been leading the way when it comes to pharmacare. Quebec MNAs fought hard and got what they wanted: guaranteed coverage for Quebeckers when they need help covering health care costs and the cost of prescription drugs. To do that, Quebec came up with a mechanism for providing access to those drugs.
The Régie de l'assurance maladie du Québec is in charge of managing the public prescription drug insurance plan. People who want to use this service must register with the Régie ahead of time. The system is similar to others used in Europe, for example. It not only addresses a public need, but, above all, it also shows some humanity.
This is how it works. In Quebec, for a drug to be covered under the plan it must be included in a list previously established by the appropriate authorities and obtained through a prescription from a pharmacist. The parliamentary budget office, the PBO, used the Quebec model as a benchmark in its study. It says that covering all Canadians under a national pharmacare program could save nearly $4.2 billion. That is quite remarkable. This type of program could help lower the cost of drugs for millions of Canadians who use the public health care system.
The Canadian Centre for Policy Alternatives reported that we are the only OECD country with a universal health care system but without pharmacare coverage, and our country's drug costs rank among the highest. In fact, only the United States has higher drug costs than Canada. The cost of prescriptions in Canada is 30% above the OECD average.
Furthermore, according to the CCPA study, the public sector could save approximately $18 billion a year. Canadian families and businesses could save approximately $13.7 billion. The PBO and the CCPA have also shown that the cost of putting in place such a system is very high, but that does not mean that we should not move forward. It would still cost less than paying private companies for drug coverage.
As my colleague from mentioned, it would cost approximately $4 billion less to cover all Canadians. What do members not understand? It is simple. Every Canadian could have fair access to prescription drugs and protect their health while continuing to pay less for their medication. It seems to me that 1 + 1 = 2. We have been saying this for years.
When Tommy Douglas first proposed universal health care, he did not let anything stand in his way. He looked for a way to implement the system without draining the public coffers. Health Canada employs many talented civil servants and experts. Our university centres, think tanks, and research centres can help us develop a pharmacare program that covers all Canadians.
I am positive that we can succeed if we get to work right away. These are common sense measures. What we hope to achieve with this motion is simply to ensure that all Canadians have the same health rights.
We pride ourselves on being a powerful, modern, developed, democratic country, but one of the fundamental criteria for assessing those characteristics and maintaining our high standing is the level of inequality.
Our patchwork of vastly different reimbursement systems is a source of inequality. The fact that you might pay a different price for a drug depending on whether you live in Quebec or Saskatchewan creates inequality among Canadians. This injustice disproportionately affects those already most in need, namely our young and our seniors.
Are we really going to risk our children's health in an attempt to save money, when we know that we are not going save any money and that we are actually losing close to $5 billion a year by not implementing a universal pharmacare system?
This also affects seniors, people who worked their whole lives to build this country so they could make society better and leave a better world for their children. As everyone here can agree, we are smart enough to know that the longer we put something off, the more it will cost us later on. It is time for us to invest in our future, in our health, and in the future of our youth and our country as a whole.
Like I said earlier, the other group who is most affected is our seniors. We know and we recognize what they have done for Canada. They spent their lives contributing to our economy and our government. After a lifetime of work, regardless of their occupation, they deserve a health care system that provides fair access to drugs.
In fact, a number of studies show that people who do not fill their prescriptions because of cost can suffer real consequences. For example, one researcher found that patients 65 and over were less likely to fill their prescriptions because they had to pay for them, and they did not have the means to do so.
This tendency has led to an increase in hospitalizations, emergency care, and doctor visits. For some health policy researchers, this is evidence that prescription drugs should be considered as necessary drugs under the Canada Health Act.
Now I would like to take a closer look at the conditions under which people would access this public system. The program's beneficiaries would hardly be taking advantage of the system. In Quebec, the goal would be to help people who do not have a private health plan and their families, as well as seniors and people living in extreme poverty who have nowhere to turn but to the state.
This system is both workable and necessary. We can help our friends, neighbours, and fellow citizens who are in need and who are asking not for handouts but for a decent standard of living.
Do we care so little that we would reject a public pharmacare system in favour of an ineffective private insurance system that does not cover all Canadians? If we do not pursue fair access to prescription drugs on a national scale, we will fail to meet our obligations to Canadians under the Canada Health Act.
The state's primary responsibility is to keep its citizens safe and end violence, but forcing people to choose between food and medicine is a pretty serious form of violence in my opinion.
In closing, we need a universal pharmacare program along with our universal medicare program. Experts say that it will be cheaper to implement a universal health system that covers all Canadians than to maintain the current system where one-fifth of Canadians cannot afford their medication. It is an ambitious plan, but ultimately a win-win when it comes to public health, protecting Canadians, and public finances.
I ask my colleagues, in all sincerity, how can we in 2017, in a country as rich as Canada, a G7 country, make some seniors choose between refilling their fridge and refilling their prescriptions?
How can we turn our backs on a former industrial cleaner in declining health who, after inhaling chemical products her entire life, cannot even afford her medication on her disability payments?
How can we tell our children that we are a society that supports one another when we refuse to help our poorest citizens?
Hon. colleagues, let us write history instead of letting it pass us by. Let us finish what Tommy Douglas, the greatest Canadian, started. Let us make sure everyone has access to pharmacare.
I hope the financial argument will sway even those who believe that the economy is more important than the health of others.
Mr. Speaker, I rise today to debate the opposition motion calling on the government to commence negotiations with the provinces to implement a national pharmacare program.
Our government is committed to protecting and promoting the health and safety of all Canadians. We are also committed to improving the affordability, accessibility, and appropriate use of prescription drugs within our country.
As the member is likely aware, the Standing Committee on Health, better known as HESA, is studying the development of a national pharmacare program as an insured service under the Canada Health Act. As part of the study, the committee asked the parliamentary budget officer to prepare an estimate of the cost of a universal federal pharmacare program. The results of the study were published on September 28 of this year. Based on it, the member has called on the government to begin negotiations with the provinces and territories no later than October 1, 2018, in order to implement a universal pharmacare program.
Mr. Speaker, our government is well aware that we need to improve access to necessary prescription drugs and make them more affordable for all Canadians.
We need to make the current prescription drug system more effective and flexible before we begin discussions on the national medicare program. Our government is taking bold action to improve the system in order to reduce the cost of prescription drugs and better manage their use. I would also like to remind members of our government's approach to strengthening the way our health care system deals with prescription drugs.
Prescription medicines contribute directly to the health of Canadians. We all know that. They can help prevent, control, and cure diseases. Health care professionals and providers in hospitals and community settings turn to prescription drugs to help them manage patients' symptoms, improve their well-being, and also to save lives.
New research and discoveries continue to expand the range of conditions and the number of people who could benefit from drug treatment in our country. As such, the use of prescription drugs in evolving. The statistics are very compelling. Health Canada approves about 200 new drugs for the Canadian market every year.
We are seeing a correlation between the aging population, and the increase in chronic conditions and prescription drug use. Nearly 40% of Canadians take at least one prescription drug on a regular basis. That percentage increases to 80% for Canadians 65 and older.
Nearly one in three seniors take at least five different drugs every day. Though that may be of some benefit in some cases, in others we have reason to be concerned about the number of prescription drugs that seniors are taking. At the same time, we are seeing more expensive niche buster drugs designed to treat illnesses that affect smaller populations coming from all over the world. In fact, the number of drugs that cost more than $10,000 per patient, per year, has doubled over the past five years. The number of drugs that cost more than $50,000 per patient, per year, has increased by 50%.
While some of these drugs offer real breakthroughs in patient care, others do little to improve health outcomes. Therefore, stronger management of our use of pharmaceuticals is essential, and the cost demonstrates this. Every year across the system pharmaceuticals account for an ever greater share of health spending in the country. In 2014, drug spending reached $29 billion. That represented about 16% of our health spending. When we add up drug spending for 2016, we expect that amount to grow to about $36 billion a year. That is a significant number.
Clearly, pharmaceuticals play an increasingly important part in Canada's health care system. Unfortunately, even as public and private payers wrestle with the growing costs, Canadians are not getting all of the benefits that this level of investment should provide to them. A key reason for this is that Canadian prices for both patented and generic drugs are high by international standards.
Our patented drug prices are exceeded only by the U.S. and Germany, and we are well above the average for the 35 countries of the OECD. According to the most recent data available, in 2015, OECD generic drug prices were, on average, 28% lower than those in Canada.
There are some other factors that feed the challenges we face in managing the use of pharmaceuticals within this country. For example, Canada's drug review and approval system, which includes federal regulatory review for quality, safety, and efficiencies to determine if a drug should be authorized for sale in Canada, followed by a review of cost-effectiveness by the Canadian Agency for Drugs and Technologies in Health, is cumbersome and needs to be revised.
This system lacks the flexibility to meet patients' needs in a timely manner. These concerns need to be addressed before we can start to consider any expansion to the pharmacare program. That is why our government is tackling these challenges by taking action to improve the affordability, accessibility and appropriate use of prescription drugs for Canadians.
The last federal budget, which was tabled in 2017, supported these actions with an investment of $140 million over 5 years, followed by $18.2 million per year on an ongoing basis. This funding supports the work of Health Canada, the Patented Medicine Prices Review Board, and the Canadian Agency for Drugs and Technologies in Health. In collaboration with pan-Canadian health organizations and our provincial and territorial counterparts, we will work to lower the cost of prescription drugs, provide faster access to new drugs that Canadians need, and improve patient care through more appropriate prescribing practices.
To better protect Canadian consumers and public and private drug plans from excessive patented drug prices, our government is modernizing the way prices are regulated. For the first time in more than 20 years, the will update the patented medicine regulations, which, together with relevant provisions of the Patent Act, provide the PMPRB with the tools and information it needs to monitor and regulate prices in today's pharmaceutical environment.
At the end of June, Health Canada held its first round of public consultations on potential changes. Stakeholders and all interested Canadians will have another opportunity to comment once the regulatory changes are published in Part I of the Canada Gazette later this year. The Government of Canada is also working closely with the provinces and territories to reduce the country's drug costs.
In addition, the Government of Canada is working closely with the provinces and territories to reduce drug costs. As a member of the pan-Canadian Pharmaceutical Alliance, established by the provinces in 2010, we are combining the collective purchasing power of all public drug plans in Canada to make prescription drug prices more affordable and to lower generic prices for all payers.
This initiative has been extraordinarily successful. As of March 2017, the work of the alliance has resulted in annual savings of almost $1.3 billion.
Our government also recognizes the importance of supporting breakthrough innovation and giving Canadians quicker access to the new medications they need while continuing to ensure the quality and effectiveness of those drugs. That is why Health Canada launched a new five-year initiative to make the minister a more modern, flexible, and responsive regulator. Under this initiative, the government will harmonize federal medical review procedures with those of its health care partners, such as CADTH. Jointly implementing these programs will speed up decisions about adding new drugs to the list of insured drugs, which means that useful new treatments will be available to Canadians sooner.
In addition, Health Canada will expand its priority review policy and establish new regulatory pathways to expedite the consideration of new drugs that have the potential to meet the pressing needs of patients in the health care system.
The initiative will also see the expanded use of real-world evidence about new drugs after they enter the market. This will ensure that they are as safe and effective as expected and will allow the government to take action if a problem is identified.
Finally, our government will work collaboratively with health system partners to improve the quality and efficiency of patient care through more appropriate prescribing practices. With enhanced federal support, CADTH will develop improved prescribing tools and provide health care practitioners with guidance on the optimal use of drugs and drug products.
All these measures combined will have major repercussions and will make drugs more affordable and more accessible while ensuring the appropriate use of prescription drugs. They will help advance the common interests of the federal, provincial, and territorial governments by improving Canada’s pharmaceuticals management system to ensure that it is sustainable and meets the needs of Canadians.
I wish to add that the federal, provincial, and territorial governments committed to making prescription medication more affordable and our health care more innovative as part of recent discussions on health care funding.
To improve access to prescription medications and lower drug prices, budget 2017 invested over $140 million over five years. As I noted earlier, this will support work by Health Canada and by groups like the PMPRB and CADTH.
To expand e-prescribing, virtual care initiatives, and the adoption and use of electronic medical records, we will invest over $300 million over five years to help support the Canada Health Infoway.
Canada Health Infoway is developing a national secure electronic prescription system, which will contribute to reducing prescription errors, advising pharmacists of potentially harmful drug interactions, and helping patients take their drugs as prescribed.
We are also investing $51 million over three years into the Canadian Foundation for Healthcare Improvement to make our health care system more responsive and innovative.
As well, we plan to invest $53 million over five years for the Canadian Institute for Health Information to improve decision-making and to strengthen the reporting of health-related polices and outcomes.
I appreciate this opportunity to provide the House with this overview of the significant actions this government is taking in this important area that concerns us all. I would like to underscore the important role research plays in providing the kinds of evidence that will support our progress going forward.
As I said earlier, our government understands that, in order to meet the health needs of all Canadians, before anything else, it needs to make Canada's current prescription drug system more efficient and flexible.
We are also confident that the measures we are taking to improve the system will help lower the price of prescription drugs and better manage their use.
Our government is determined to strengthen Canada's health care system by making drugs more affordable and more accessible, while ensuring that prescription drugs are used appropriately.
We look forward to reviewing the parliamentary budget officer's analysis of the costs of a universal national pharmacare program. However, the actions proposed by the member for , while well-intentioned, would be premature if we have not first achieved the related goals we are pursuing, goals such as bringing down prescription drug prices and improving the management of how these drugs are used in our health care system.
Prescription drugs are an important part of Canada's health care system. They help Canadians by preventing, treating, and healing illness.
That is why making drugs more affordable and accessible has been established as a top shared priority for federal, provincial, and territorial health ministers, while also ensuring the appropriate use of prescription drugs.
As I mentioned, for the first time in more than 20 years, the government is proposing substantial—yes, substantial—amendments to the patented medicine regulations.
As I have noted, for the first time in more than 20 years, the government is proposing major updates to the Patented Medicines Regulations. That is significant. Put simply, we need to make Canada's existing prescription system more efficient and more responsive before we can begin to discuss a national pharmacare program.
In light of all these initiatives and others I have outlined today, I would argue that the government is making progress on a number of these issues and that members of the House should vote against the opposition motion.
Mr. Speaker, today I will be splitting my time with my colleague from .
As deputy health critic for the official opposition, I am happy to speak today to the motion by the member for . In summary, his motion relies heavily on the results of the recent report prepared by the parliamentary budget officer on the costs of a national pharmacare program in Canada. The motion calls for the government to start negotiations with the provinces next year to implement a universal program.
As we consider this motion, we should be aware that the principal role of the federal government in pharmaceuticals, according to the parliamentary budget officer's report, is to regulate market access, thereby ensuring the efficacy, quality, and safety of drugs; to provide financial support to the provinces through the Canada health transfer, as required by the Canada Health Act; to deliver pharmaceuticals to particular populations; and to regulate the price of new and innovative drugs.
The Standing Committee on Health is currently studying the possibility of a national pharmacare system. In fact, it was that committee that requested a report by the parliamentary budget officer on the potential costs involved. The completed study was provided to the committee just last week. Given this, I would suggest that the opposition day motion is a bit poorly timed. Does it not make sense for the committee to now have time to examine the report, consider its findings, and then report back to the House? I would ask the member for , the vice-chair of the health committee, to provide his committee colleagues the time they need to do their job.
The Conservative Party of Canada wants to ensure that Canadians are receiving the best health care possible and that even the most vulnerable have access to the latest in pharmaceutical care. As we know, the Canada Health Act provides universal drug coverage for prescription drugs administered in a hospital setting. In addition, the federal, provincial and territorial governments all offer drug insurance plans, providing some coverage to approximately 53% of the Canadian population. If we are to consider an additional level of coverage, we need to bear in mind that private drug insurance programs provide coverage to 24 million Canadians in total.
I think we should focus on the result of a 2002 study by the Fraser Group that estimated that 11% of Canadians faced the risk of high prescription drug costs because they either had no coverage at all, or were significantly under-insured. These are the Canadians who need this type of program. Therefore, I would suggest that a more targeted approach would be to begin with the health committee's study on a national pharmacare program.
Let us look at the costs, the logistics, and the overall effect of a program focused on Canadians currently without any existing coverage at all. This would include seniors, those with low fixed incomes, people with uncertain work or low wage jobs without benefits, the disabled and others in need. Should the committee and the House agree to examine a plan like this, we could receive feedback from the provinces, stakeholders and, indeed, from Canadians themselves on whether it would indeed provide quality health care to those in need of it. Additionally, the information obtained on the actual versus estimated costs would be invaluable for future discussions of a possible and potentially expanded program.
This brings me to the fact that my Conservative colleagues and I are concerned about the lack of data and the high initial cost of implementing a national pharmacare program here in Canada, considering the growing deficits that Canadians are facing as a result of the irresponsible government. This motion unfortunately reflects what I would describe as typical NDP thinking. The members somehow believe that there is an unending supply of tax dollars that can be accessed into infinity.
The PBO has evaluated what it would cost to provide a national pharmacare program to all Canadians, even those with an existing plan, to be approximately $22.6 billion dollars annually. The PBO indicated that its initial study shows that a national program would grow by 11% in just five years, from $19.3 billion to $22.6 billion in 2020. It also clarified that this number could be off quite substantially, as overall consumption of prescription medication could very well increase under a national pharmacare plan. The cost of prescription medications is the largest factor causing patients not to follow their prescribed treatments, and with the sudden implementation of a universal pharmacare program, individuals with newfound access could end up flooding the system. These costs are unpredictable.
Although the parliamentary budget officer provided a budget based on the drugs list in Quebec, the drugs on that list are quite different from other provinces', which is another factor making the true costs unknown. The health needs of each province's population, prescribing habits of physicians, generic drug pricing, and price negotiations vary. This creates differences in the consumption by and even coverage of various drugs for specific populations. To seriously consider pharmacare, we must determine the potential source of the funds, particularly as the current government has well exceeded its proposed deficit targets, leaving us with little room to consider this plan.
The Conservative Party of Canada supports a high-quality, sustainable health care system that would ensure that Canadians get the best possible care. As previously mentioned, approximately 12% of Canadians are under-insured or not covered by a plan already. Due to the fact that the majority of people are already covered, we should be targeting our limited resources at a more efficient way of covering individuals who do not presently have coverage. This would involve focusing on individuals such as seniors, those with low fixed incomes, people with uncertain work or low-wage jobs without benefits, the disabled, and others in need.
The fact is that there are alternatives to reduce the costs for Canadians, especially those without drug coverage, as I discussed recently with regard to Motion No. 132. Costs can be lowered through volume leveraging and generic-versus-brand purchases without the scope of a program, as costed by the parliamentary budget officer. The resulting savings could be upwards of $7 billion.
Again, I would remind the House that the framework of the parliamentary budget officer's report on funding health care is based on Quebec's inclusive list of drugs, eligibility requirements, copayment levels, and eligibility requirements for copayment exemptions. It is important to note, however, that Quebec runs a hybrid system that is close to universal pharmacare by requiring that residents have drug coverage either through a private plan sponsored by their employer, a professional association, or through the government-run public plan. Even in that province, 7.2% still do not adhere to prescribed treatment due to the cost.
I would suggest that the health committee look at how my home province of Alberta is handling this issue. Alberta works hard at providing publicly funded drugs to those who need them the most, such as seniors. It provides public drug coverage plans for individuals who have no other type of coverage and who are not necessarily experiencing high drug costs relative to their income. There, the number of people who do not adhere to their drug treatment plans due to the cost is only 0.4% higher than in Quebec. However, the key point is that with similar results to Quebec, Alberta is able to do so at $209 billion lower cost.
In summary, while no Canadian should be without necessary pharmaceuticals, we must consider the most efficient and cost-effective way to achieve this. I would ask the member to allow the health committee to finish its work so that we may go forward with complete information as we consider the best way to achieve universal drug coverage for Canadians.
Mr. Speaker, today we will be discussing the motion by the NDP for a universal drug plan. The Office of the Parliamentary Budget Officer released a report entitled, “Federal Cost of a National Pharmacare Program”. This 88-page report sets out to give Canadians an overview of its findings. It concludes that a universal pharmacare program would cost $22.6 billion.
There was a time in the House when governments would explain how they would pay for new programs. I understand the NDP is not the current government, but there is a responsibility that falls on all of us in the House to save for the future and take responsibility.
I want to tell a great story, one I heard from the former Speaker Mr. Milliken. We would sometimes have the privilege of entering his chambers in the back and he would point to this wonderful chandelier. There was a great story attached to that.
He told us that there was a former Speaker who felt that because important dignitaries and people would be invited to the office, a proper light was needed instead of the plain looking light that was there. He went out and bought himself a beautiful chandelier. Later on, he was called into the office of then prime minister John Diefenbaker. John threw him the invoice, wanting to know what it was for. The Speaker explained that it was for the new chandelier in his office. John looked at him and said that they did not pay for light fixtures, and the Speaker wound up paying for that bill. I love that story, and I tell it to people.
The real story behind that was that John Diefenbaker knew what was being spent in the House. I wonder how many of us today know exactly what is being spent in our office, let alone in the House. It teaches us something. It teaches us that we are responsible for the public purse. I want to talk about that a bit today. I will talk about other things too, but I want to talk about the Liberals and what they seem to have done.
The Liberals have this new approach to governance, as witnessed by their reckless spending in the past budget. There will be a $30 billion deficit, with no sign of changing that trajectory in the foreseeable future. Now, they adopted a budget that was balanced, yet they set out to indebt future generations, our children and grandkids. They will saddle them with that debt. They had a great explanation that they had a wonderful program. I have kids with kids, and they receive this monthly cheque for child care. It is nice to receive, but they recognize, as do most Canadians, that somebody has to pay for this.
In all fairness, and I want to be fair with my colleagues on the other side, they have been telling Canadians how they are going to pay for this and how they are going to handle their reckless spending. It is through higher taxes. We just had a series of debates and pleadings with the Liberals, putting pressure on them to please stop what they were doing. They are going to put a tax on businesses and start taking away some of the benefits from businesses, farmers, and ordinary Canadians in order to try to balance their books. They want to take this money to pay for their reckless spending.
The Conservative Party knows that businesses hire people. In fact, SMEs, the small and medium-sized businesses, account for most of the hiring in the private sector today. Make no mistake about it. All of us get really excited when we hear about a big corporate organization or company moving into our riding, and those are great things when they happen.
However, the vast majority of jobs in our country are created by small and medium-sized businesses. They account for the wealth that is generated. They fill the coffers of the government, through taxes, so we can give back to the people what they expect to receive. They expect to receive good health care. They expect to receive education. They expect to be defended by our military. The list goes on and on. All in all, we have done an admirable job of doing that as a society. However, there is a troubling trend. We have forgotten that we have to pay for what we want.
The Conservatives, because we understand markets, opened markets for our businesses, our farmers, and our resources. I served on the trade committee as well as the finance committee. It always surprises me when I see the number of free trade agreements for which the Conservatives were responsible, countries like Colombia, Honduras, Peru, Panama, Jordan. One might think these are small countries, but there is bigger stuff, such as Israel and South Korea. For the Ukraine agreement, the work was done by the Conservatives when we were in government. The Liberal government, to its credit, has finalized that. A Canada European free trade agreement was made before the famous CETA one. I will talk about that in a second. There were a number of small countries in Europe that were not part of CETA. Then of course, there is CETA, the largest trading agreement that has ever been entered by two groups. There are 500 million people in Europe, and the possibilities are vast and endless. That is the sort of thing we need to do if we want to grow the economy so we can afford to do the very things the NDP has proposed.
In all fairness, the Liberals are pushing through a new drug bill. I sit on the health committee. We went through clause-by-clause study. That bill will be enacted in July of next year. It will give everyone over the age of 18 the ability to smoke marijuana legally. There are a number of added parts to it that, which people really have to get a grip on and understand. We will have an opportunity to talk about that later. The NDP supports the bill. In fact, the party's new leader supports legalizing all drugs.
I am a dad. A lot of members know I have a lot of kids and grandkids. I love to give my kids gifts and good things. That is why the Conservatives, when in power, fought for lower taxes. We knew that if we wanted to give those things to our constituents, the people of Canada, we had to pay for them. We recognized that we had to get our goods to market. Therefore, we began the process, right to the door of the completion of the Gordie Howe bridge, so we would have access to our largest trading partner at the busiest port.
I say these things because we have to pay for what we do in this place. It is our duty as legislators, as representatives of our constituents, to ensure we do not saddle our children and grandchildren with the debt now. We can do a number of great things in the area of drugs. There are things that are possible for us to do, but the proposal by the NDP is not sustainable. As such, I will not be supporting the motion.
Mr. Speaker, today I will be splitting my time with the member for .
As the seniors critic for the NDP, I am sadly too familiar with the cost barriers of medications in our country for the most vulnerable of us. I am pleased that the House of Commons is taking the time to discuss the implementation of a universal pharmacare program. Without the hard work and dedication of our health critic, the member for , I am not sure we would be in this position today to address it in such a credible fashion.
I have consulted with seniors across my riding and heard from many across Canada. I hear too many disheartening stories, and too many of them are focused on the high cost of prescription drugs.
Too many senior Canadians are sharing the reality that they are facing with increasing poverty. Affording the essential medication they need as they age is a barrier that is only increasing. I have heard from seniors who are taking their medication every second day to make it last, and from health care professionals who are desperately working to find the most affordable medication, because too many of their patients are not able to afford the costs and therefore not taking what they need to support their health.
Sadly, Canada is the only country with a universal health care system that does not have universal coverage of prescription drugs. I think it is time to change that.
Seniors 65 and older are the heaviest users of prescription drugs in this country. The majority of seniors are using multiple drugs. In fact, 62% of seniors on public drug programs are using five or more drug classes. This gets very expensive, very fast.
There is a reason I believe we need a universal pharmacare program. The statistics paint a crying need for federal leadership. Here are a few examples. British Columbia shows the highest levels of access to medication problems, at 29%. One in five Canadians report that either they or a family member neglects to fill prescriptions due to cost. In fact, we heard evidence of this reality this week at HUMA committee, where we are studying a national seniors strategy, from Ms. Wanda Morris at CARP who confirmed this very clearly.
Canada currently has the second highest rate among comparable countries of skipped prescriptions due to cost. This ends up costing our health care system much more in the long run, as untreated conditions get worse, resulting in preventable hospital stays and doctor visits.
The Canadian Centre for Policy Alternatives estimates that between 5.4% and 6.5% of hospital admissions are the result of non-adherence, resulting in costs as high as $1.63 billion. In a country like Canada, this is a horrifying statistic.
Spending is also increasing. Public drug spending on seniors increased from $603 million in 2002 to $1 billion in 2008. By 2036, the number of seniors will double. How many more billions are we going to spend before we actually take action and do something?
In September 2016, the House of Commons Standing Committee on Health asked the parliamentary budget officer to provide a cost estimate of implementing a national pharmacare program. The committee provided the program's framework, including the inclusive list of drugs to be covered by pharmacare.
The PBO costing found out that, in 2015-16, Canadians spent $28.5 billion on pharmaceuticals. Of this, $24.6 billion would have been eligible for coverage under a national pharmacare plan. Accounting for pricing and consumption changes, the PBO estimates that Canada would have only spent $20.4 billion in 2015-16 under a national pharmacare program. The reality is that this place would have saved $4.2 billion in 2016, if action were actually taken.
The PBO is not the only credible source to suggest a universal pharmacare program is sound economic policy.
In 2015, a report authored by Canada's leading health policy experts was published, entitled “Pharmacare 2020: The future of drug coverage in Canada”. This study estimates that universal pharmacare would result in public and private savings of between $4 billion and $11 billion per year under reasonable assumptions.
Pharmacare would yield significant savings for Canadians, principally because of the increased spending power it would bring. During price negotiations drug companies often inflate the price of their drugs and provide confidential rebates based on the bargaining power of each purchaser. Universality would further increase Canada's bargaining power by extending coverage to every single Canadian.
All Canadians understand the real reason we need to be having this conversation.
The most common drug class used by seniors is to lower cholesterol levels. Is it normal that a year's supply of a widely used cholesterol drug costs about $143 in Canada but only $27 in the United Kingdom and Sweden and under $15 in New Zealand?
Canadians pay among the highest prescription drug costs in the industrialized world, second only to the United States.
The administration costs of for-profit private plans are also enormous, around 15%, while administration costs for public plans are less than 2%. This is just good fiscal policy. Replacing private plans by a universal public plan would not only reduce wasteful spending, but it would save Canadians an additional $1.3 billion a year in administrative costs.
An overwhelming majority of Canadians, 91% in fact, expressed support for the concept of a national pharmacare program that would provide universal access to prescription drugs. That is not a surprise, when millions of Canadians cannot access the essential medication they need when they need it. That is simply not right.
Tommy Douglas, the father of medicare, never intended to create such an odd gap in Canadian health care coverage. Prescription drugs and other services were always meant to be integrated into a system of comprehensive public coverage along with hospital and physician services.
Today I stand before the House, as New Democrats have for over half a century, to proudly proclaim our belief that health care in Canada must be a right and not a privilege.
With the recent release of the PBO's report, it is clearer than ever that a national pharmacare program is not only good for the health of all Canadians but also sound economic policy for all Canadians, especially our seniors.
Our motion today calls on the government to commence negotiations with the provinces no later than October 1, 2018, in order to implement a universal pharmacare program. With a little political will we can finally make this happen for all Canadians.
Mr. Speaker, I am happy to speak today to the motion of my colleague, the member for , because this is something that is extremely important to understand. It is something that would allow us to do so much for the health of Canadians.
Listening to all the members who spoke before me, it was clear that none of them had any doubt that implementing universal pharmacare in Canada would save us millions of dollars. I do not want to dwell too much on this point because it is so obvious. All the studies show that there would be savings to be made. No one has ever said that it would cost us more than the current system. Since that has been laid out very clearly, I will not dwell on it any further.
Someone also mentioned the system in Quebec, the first one in Canada. Quebec's system was in some ways a response to a particular situation. We wanted to make sure that everyone would at least have access to pharmacare, but it is by no means a perfect system. Even the health minister knows that it is not perfect. That is why he is interested in having a truly universal system, and why he is open to discussions. We do not usually see a Quebec health minister who is interested in a national program. In this case, he is interested because he is aware of the potential cost savings and he knows that it could be more efficient than our current system.
I will try to clearly describe the limitations of the Quebec system. If an individual does not have access to insurance provided by an employer, he or she must take the government insurance. If this person does have access to a pharmacare plan provided by an employer, they are required to take it.
The problem is that some employers have substantially increased the price of pharmacare insurance for different reasons, and contracts are individually negotiated by the employers. Given that the employees of an employer in a sector with higher risks will use more prescription drugs, that employer's insurance premiums will be higher. Thus, people are forced to sign up for a pharmacare plan that is more expensive than the government's because it is the only one they can access. They are also required to take their employer's pharmacare plan even if they do not have the money for the premiums.
Take the example of an employee who starts working as an orderly in a private centre. At first, he may work one shift a week or every two weeks, depending on the staff schedule. He might work a relief shift or an on-call shift. He might work one week and perhaps earn $100. If the pharmacare premium is $60 a month, almost his entire salary will be used to pay for the insurance that he is required to take. Employer pharmacare plans do not take into account an employee's ability to pay. Most of the time, it is a fixed monthly rate, no matter the ability to pay. That is one of the significant limitations of the Quebec system, and the minister is well aware of it. It is not a perfect system. That is why he opened the door to universal pharmacare.
I would like to talk about all the savings we could achieve if we had universal pharmacare. Granted, they are not always easy to calculate, but they are still eye-opening. Since we have medicare, we often forget how much a hospital visit can cost. We forget that a stay in intensive care can cost in the tens of thousands, and that is just for a couple of days. Hospitalization is expensive. We tend to forget that because, at the end of the day, we do not see the bill. After we go to the hospital, none of us here ever see the bill that shows how much it would have cost if we did not have medicare. Since we are less aware of this, we do not realize just how much we could save if Canadians had equal access to drugs. One thing we noticed was that people who are not covered will often wait before consulting a doctor, because they do not have the money to pay for their medication. At the end of the day, when they do decide to consult, their condition has worsened to such a degree that they now require more advanced, and much more expensive, treatment.
The same is true when it comes to medication. When people are unable to pay for the medication they need, they do not take it and just hope that they will get better. Their health deteriorates, but they tell themselves they will be careful. They finally get to a point where their health is so bad that treatment ends up costing a lot more money than if we had just been able to provide them with the medication they needed in the first place.
It costs a lot less to provide prescription drugs to a person with heart problems than to care for someone who has had a heart attack and needs a triple bypass, stents, or some other form of surgery, and a hospital stay in intensive care.
This is not necessarily as easy to quantify as just calculating the cost of the drugs, as the parliamentary budget officer did, but it is possible. When people can take better care of their health, it can save money.
A universal pharmacare program would also save money when it comes to access to information and related health interventions. Since we do not have a universal pharmacare program right now, it is very difficult to learn about doctors' prescribing habits, to find out whether they are prescribing the right drugs or if they are prescribing too many drugs. It is impossible to look at the data.
A universal pharmacare program would provide access to data that would help us get a much more accurate picture of the health profile and make more effective interventions, for example in prevention. Doctors could be monitored and prevented from over-prescribing drugs. As things stand now, that data is not easy to get because it is stored in a number of private medical insurance programs. That is another aspect that is not quantifiable.
Many times, private firms are commissioned to conduct health studies in order to gauge what is happening in the area. However, a universal pharmacare program would provide access to that data much more easily, which would translate into more effective health care interventions.
It is not easy to implement such a program. Nevertheless, with the provinces amenable to the idea, the public would be better served with a universal pharmacare program. We could better monitor various health problems and do more for patients. We would avoid complications, and we could ensure that much less expensive generic drugs were prescribed instead of brand-name drugs.
This program will result in greater financial efficiency in patient care and public health. For that reason it is very important that we move forward on this file. We must create this program for all Canadians. It will also prevent the unfairness created when some medications are covered by a private pharmacare plan while others are not. For example, some public pharmacare plans only cover oral contraceptives even though there have been many changes in contraception and birth control, with products such as patches, contraceptive rings, and IUDs, which provide more effective contraception for women who have problems with the contraceptive pill.
People do not always make the best choices when it comes to their health, because pharmacare plans often do not provide choice, even though other methods of contraception exist and the monthly cost is about the same. People have to make choices based on what their pharmacare plan offers. Unfortunately, when a decision is not based on what is best for someone in a given situation, it is less likely that it will be effective or that the medication will be taken properly.
A universal pharmacare plan providing coverage for a broad range of medications will help health professionals. They would be able to choose a medication based on the needs of their patients, while helping them better manage their health.
Madam Speaker, I will be dividing my time with the hon. member for .
First of all, I want to talk about the member for . We go back quite a ways. He was actually my seatmate one time over here, and we got to know each other quite well. We are both on the health committee. I want to acknowledge the good work he does on the health committee. He is very sincere and diligent about his work. We passed a motion in the health committee. The member agreed with that motion, and he is kind of jumping the gun now. That is all I am saying. The committee accepted the decision of the steering committee, and the hon. member is on the steering committee, "To undertake a study on the development of a national Pharmacare program as an insured service for Canadians under the Canada Health Act and to report the findings to the House”.
We are not there yet. We have not completed that motion that all of us agreed to on the committee. We are partway through the process, but we have a lot yet to know. The parliamentary budget officer's report was really interesting and very encouraging to all of us who are interested in this subject. However, in no way did it propose a model we can use or show a framework we can present to the government, the provincial governments, and all the different agencies involved. There are so many agencies and organizations involved with health care in this country, it is breathtaking.
We have heard 89 witnesses at our committee. We have had 20 meetings on this, and we are still not done. We are well along in the process, but we are not done. We still have a lot of questions. The parliamentary budget officer is scheduled to come to our committee on October 17, and I am sure the member will be asking him lots of questions, because there are lots of unanswered questions.
The report is very encouraging for those who are optimistic about this. I went into this debate on the pharmacare program with no preconceived notion or position. Witness after witness testified that Canada would be better off with a national pharmacare program. I am just speaking on behalf of my own observations and not on behalf of the committee, but there were a significant number of presentations on the strong points of a national pharmacare program. In general, I am really encouraged.
I was amazed to learn how many Canadians do not take their prescriptions because they cannot afford them. I was also amazed to learn that if they could take them, it would save our health care system a lot of time and money. It was amazing to learn about the integrated system in the pharmacare industry in Canada. They have secret deals with each other and all these things. I was amazed to learn how the pharmaceutical system works in Canada. It is very hard to get straight answers on how it works, but a national pharmacare program would eliminate all of that.
There are about 100 or so different pharmacare programs already in Canada. The provinces each have one for seniors. They have one for disabilities. They have one for social services. They have one for their own employees. The RCMP has one on the federal side. The military has a pharmacare program. The government has one for indigenous people. There is a plethora of pharmacare programs. They are all different. They all take management. They all require overhead. One pharmacare program would eliminate all those different agencies. We would have one consistent program across the country. Everyone could have access to pharmacare.
I am leaning toward a pharmacare program myself, but we are not there yet. We still have a lot to learn. Our job as a committee, as the original decision said, is to report the findings to the House when we are done our study. We are not done the study. There are so many questions.
We asked the parliamentary budget officer to do this, and it took him many months to do it. We have been at it for almost two years. Again, we have had 89 witnesses and 20 meetings, and we are still learning a lot as we go. The parliamentary budget officer came back a couple of times and asked for clarification on what he should use for formularies and a structure. We are very grateful to him and his team for doing the work. However, we still have to finish our work. We have not finished our work. Part of that work is to interview him and find the answers to some of the questions we have. I am sure he cannot answer them all yet, because we did not give him a model to use.
We talk about saving billions of dollars, but it is going to cost other organizations and levels of government billions of dollars, so we have to figure out the proper model before we start negotiations. We cannot go into negotiations not knowing what we are talking about or having a model to work with.
The Standing Committee on Health has been almost two years at this now, and we are still hearing from witnesses. We have witnesses coming the week after next. We have heard from patient advocates. We have heard from experts in medicine, social policy, and constitutional law. That is an issue we have not touched on here. The parliamentary budget officer has not touched on it either, because it is not his jurisdiction, but there are constitutional issues in creating a national pharmacare program. What are the responsibilities of the provinces? What are the responsibilities of the federal government? Where do they fit, and how can we work that out? We have to start with a model, and we do not even have an idea of a model yet.
There is a process, and we are only partway through it. The committee, in the end, is going to make a recommendation to the government, and the government will decide. We are not even ready. The member who proposed this is a member of that committee. He has kind of jumped the process to get ahead of us, which is what the motion is asking us to do. It is asking us to not complete the study we all agreed to do. He wants us to go ahead with just part of the information. It is a contradiction. It does not make sense.
I admire the member's work and his intention. Certainly the testimony we have heard has been very compassionate and compelling, but we are not there yet. Our own committee is not ready to make a recommendation, so I do not know how the government could go ahead and start a process to negotiate, without the committee, of which he is a member, coming to conclusions on how we are going to do this and developing a model.
There is no question that we have heard compelling evidence, and all the arguments for it are really good. It is amazing to sit through the testimony we have heard about our health care system.
Again, I go back to the purpose of the study we started. The reason we are debating this motion today is that it came up in our committee meeting. We proposed in our committee to have the parliamentary budget officer do this budget. We proposed it as part of the process, so we now have that. It is valuable. It has given us a lot of information, but there are many questions about who would be responsible for what areas, and we do not have those answers.
Some people say it is not even constitutionally possible. We have to nail that down. We have to get a better idea of who is going to be responsible and what jurisdiction is what. Are we going to bring it in slowly? Are we going to phase it in or bring it in with a big bang? Both have been recommended to us, but we have not come to a conclusion yet, because we have not finished our meetings.
The Canadian Agency for Drugs and Technologies in Health has a role to play. We need to hear from it. The Patented Medicine Prices Review Board will have a say in this, because pricing is everything. Part of the PBO report is based on a significant discount based on volume-buying for the whole nation, one buyer for the whole nation, effectively. We have to confirm that this discount is actually real. Right now the pan-Canadian Pharmaceutical Alliance gets a discount. We have to confirm with the alliance that this could be applied nationally, and so on.
The point I am making is that we have a lot more work to do. What formulary would be used? Everyone has a different formulary. Some approve these drugs and some approve different ones. We do not even have a formulary we have agreed upon.
I admire the member, and I do not blame him for leaning toward a national pharmacare program. Based on the testimony of the 89 witnesses we have heard, one could not come away with any other leaning than that we at least have to look at it as a country. However, we have not finished the report. We have not drawn our conclusions. We have not reported back to the House, as we all agreed to do. Therefore, we are not ready to go ahead with this.
Madam Speaker, I am thankful for the opportunity to speak on this very important issue. For Canadians, our health care system is a source of great pride.
As the opposition has moved that the House call on the government to enter into negotiations with the provinces to implement a universal pharmacare program, I would like to talk about a very important part of the health care system and the connection it has with improving the accessibility, affordability, and suitable use of therapeutic products in Canada.
Our government is committed to advancing this important work in collaboration with pan-Canadian health organizations and our provincial and territorial partners.
Since 1989, one of those pan-Canadian health organizations, the Canadian Agency for Drugs and Technologies in Health, or CADTH, has been a vital part of our health care system. CADTH delivers evidence, analysis, advice, and recommendations to health care decision-makers so that they can make informed decisions. As part of the reforms this government is implementing to ensure that prescription medicines are more affordable, accessible, and properly prescribed, CADTH's role will be expanded.
Canadians deserve the best health care in the world. However, contemporary health care is heavily dependent on drugs and health technologies. In 2014, the most recent year for which final data are available, drug spending reached $29 billion. The latest estimate, from 2012, for medical devices sold is $6.4 billion. These numbers are only expected to increase in the coming years.
Used effectively and efficiently, these drugs and other health technologies contribute to better health outcomes and deliver good value for money. However, they can also be misused and overused, resulting in harm to patients and a waste of valuable resources that could be better deployed elsewhere. For example, a recent study on unsuitable medication use found that over one-third of seniors filled one or more potentially incorrect prescriptions, resulting in an estimated $419 million being spent by provincial drug plans on the wrong drugs. The current opioid crisis provides us with another example of drugs that may not be properly prescribed. These are clearly calls for better evidence and prescribing.
CADTH, originally named the Canadian Coordinating Office for Health Technology Assessment, was created after a joint committee representing the federal, provincial, and territorial ministries of health identified the need for a new national and independent body to evaluate or assess health technologies to ensure that all Canadians would benefit from the advances being made in this area.
Health technology assessment is the systematic evaluation of the properties, effects, and impacts of a health technology. CADTH provides comprehensive evaluations of the clinical effectiveness, cost-effectiveness, and the ethical, legal, and social implications of drugs and health technologies on patient health and the health care system.
Health technology assessments, or HTAs, offer a valuable tool to policy-makers to support more rational, evidence-based decisions on the adoption of new drugs and other health technologies. CADTH's mandate is to deliver timely, evidence-based information to health care decision-makers across Canada about the effectiveness and efficiency of pharmaceuticals, medical devices, diagnostics, and procedures.
CADTH has helped Canada become a world leader in the field of health technology assessment. CADTH is a great example of provincial, territorial, and federal co-operation in health care. It is an independent, not-for-profit corporation. The agency is owned by, and reports directly to, the 13 provincial and territorial deputy ministers of health and the federal deputy minister of health. It is jointly funded by federal, provincial, and territorial governments, with the federal government providing approximately 70% of CADTH's $27 million budget, and the provinces and territories providing the remaining 30%. Canadian taxpayers get an excellent return for the investment of this money.
One of CADTH's most important programs is the common drug review, or CDR. The CDR is a process for carefully reviewing the clinical cost-effectiveness and patient evidence for drugs. Federal, provincial, and territorial governments across our country use the information to make decisions on which drugs should be listed on formularies and covered by their public drug plans. The pan-Canadian oncology drug review, also managed by CADTH, performs a similar role for cancer drugs. Both of these programs help ensure that patients have access to effective treatments and that taxpayer dollars are spent wisely. Some new drugs do not offer real health improvements and are significantly more expensive than existing treatments. Should these drugs be paid for by public drug insurance plans? CADTH helps us make these important choices.
CADTH's recommendations have also contributed to greater consistency in new drug listings across public drug plans. Additionally, as a signatory to the opioid action plan, CADTH is a part of the joint task force created to address this Canada-wide crisis.
CADTH provides a variety of other important services. For example, CADTH does HTAs on new and existing health technologies. These HTAs provide a full analysis of the clinical and economic aspects of health technology and sometimes include other factors that examine the broader impact of the technology on patient health and the health care system. These assessments cover topics ranging from the effectiveness of drugs for the management of rheumatoid arthritis to the best ways to quit smoking.
Other roles CADTH plays in our health care system include conducting environmental and horizon scans. These scans inform decision-makers about the use of health technologies in other jurisdictions and help guide important decisions within Canada's health care system. For example, environmental scans examine health care practices, processes, and protocols inside and outside of Canada. They help decision-makers better understand the national and international landscape. Horizon scans conducted by CADTH help alert decision-makers to new and emerging health technologies that are likely to have an impact on the delivery of health care in Canada. This early information supports effective planning for the introduction of new technologies in our health care system.
As illustrated by the foregoing, we know that CADTH currently plays an important role in our health care system, but there is more to be done. In addition to exploring the need for a national formulary, our government intends to invest millions of dollars in CADTH. This money will allow the organization to better align its cost-effectiveness reviews with Health Canada's regulatory reviews and to expand the scope of its activities, including conducting evidence reviews at all phase of the therapeutic life cycle and working with the provinces and territories to develop a needs identification and prioritization process. This will better support effective and evidence-based management and prescribing and use of therapeutic products across Canada's health care system.
Right now, Health Canada approves a drug after it reviews its safety, quality, and efficacy. Does the evidence show that the drug does what the manufacture claims? Is it safe, and does the manufacturer meet quality standards? In most instances, drug sponsors begin the process of applying for their drug product to get listed on provincial and territorial formularies by submitting information to CADTH for review only after the Health Canada approval. That could mean a delay of six months or more as CADTH works up a recommendation to public drug plans about whether a drug should be covered, in part on the basis of its cost-effectiveness and in part on clinical and patient evidence.
These two processes should be aligned; if possible, they should be run at the same time so Canadians can get faster access to new, worthwhile treatments.
We are presently pilot-testing the alignment of these processes. This improved coordination would better support effective and evidence-based management, prescribing, and use of therapeutic products across Canada's health care system. Additionally, we will—
Madam Speaker, I will be sharing my time with my colleague from South Okanagan—West Kootenay.
Last Saturday, I attended the Forever Young Seniors Expo in Cranbrook, in my riding of Kootenay—Columbia. It was a wonderful event organized by Kootenay CARP in celebration of National Seniors Day. I spoke to many seniors at the event and to many advocates on seniors issues. There certainly are many issues facing retired people today. CARP, which is the Canadian Association of Retired Persons, has a list of 10 advisory items that it wants the members of the House to address. Let me go over them briefly.
The first is retirement income security. Pensions and the guaranteed income supplement, or GIS, must increase. As members heard in a question I asked earlier this week, it is essential the government consider how critical it is for payments like GIS to be made consistently, every month. Many Canadians do not have enough savings to carry them beyond one month if they miss a cheque. However, every time the Canada Revenue Agency decides to review a case or make a change to a file, it stops the monthly payments that many of our seniors depend on, including for buying prescription drugs. This leaves seniors and other pensioners forced to choose between their rent, groceries, and prescription medications. Consistency is important, and so is the amount of income pensioners receive.
CARP's second item is the transformation of our health care system. It recognizes that reductions in federal health transfers to the provinces are putting undue pressure on the entire system. At the same time, private clinics are working through the courts to overturn our cherished universal health care. This is extremely worrisome to today's seniors.
Improved home care is another program that would save Canadians money. CARP points out that we need to do everything we can to keep seniors in their homes by supporting everything from Meals on Wheels to the United Way's better at home program. Improved home care would keep many seniors out of hospital, freeing up expensive hospital beds. It would provide better services for seniors, while reducing wait times and health care costs.
Prescription medication also impacts hospital times. I will get to that a bit more a little later.
Linked to home care, CARP wants to see better support for caregivers, which is why the NDP's push for a $15 an hour minimum wage is so important. It would help ensure caregivers earn better pay.
CARP's sixth point is better opportunities for older workers—other than running for political office, of course.
The seventh on the list is to make our cities more age-friendly by improving accessibility for people who use wheelchairs and walkers.
Investor protection is also on CARP's list. It gives an example of a 93-year-old woman who was able to negotiate a mortgage, but the bank refused life insurance protection. That is simply not acceptable.
The NDP has spoken often of the need for improved end-of-life care. We support a national palliative care strategy to accompany the current physician-assisted suicide laws. We are pleased to see that CARP has made end-of-life care a priority.
Similarly, and as part of a national mental health strategy, CARP asks for a national dementia care strategy. As Canada's senior population grows larger, the incidence of dementia grows larger as well. Now is the time to respond better to this health care crisis.
I skipped over one of CARP's top priorities, but it is the issue that brings us here today, which is the need for a universal pharmacare program.
Let me take a quick moment to read our motion again for those who may have just tuned in at home. It states:
|| That, given that millions of Canadians lack prescription drug coverage, and given that overwhelming evidence, including from the Parliamentary Budget Officer, has concluded that every Canadian could be covered by a universal pharmacare program while saving billions of dollars every year, the House call on the government to commence negotiations with the provinces no later than October 1, 2018, in order to implement a universal pharmacare program.
Many of my NDP colleagues have already covered the basic issues: we are the only nation that has universal health care that does not include universal pharmacare, and a pharmacare program would save money. The parliamentary budget officer made that very clear this week with a groundbreaking report that said Canadians can have a universal pharmacare system for billions of dollars less than we now pay for prescriptions. In fact, the PBO estimates conservatively that Canadians would save $4.2 billion a year with a national pharmacare system.
Here is the kicker. I think the PBO got it wrong. When I read the PBO's report, I see it missed an important reason why pharmacare would save money. Let me explain.
We know that many doctors will keep patients in hospitals longer, including seniors, because they need to take prescription medications and patients in hospitals get their medications for free. They are covered under health care in every province. However, the moment patients are released, they have to buy their own medications. Doctors know that many patients do not have private insurance to pay for medications and that even programs that provide medications to seniors do not bear the full cost. Therefore, patients who are released from the hospital may or may not keep taking the life-saving medications they need. As a result, doctors often keep these patients in the hospital longer than they would otherwise need to be there. There is a cost to this.
According to the Canadian Institute for Health Information, hospital care in Canada costs about $63 billion a year. On average, the cost of a hospital stay is about $6,000 per day. This is a significant cost, and it could be a significant saving. Introducing a national pharmacare program would lower the health care costs for taxpayers while at the same time freeing up hospital beds and reducing wait times for patients. That is a win-win-win situation. The PBO's excellent report did not include these savings. Therefore, we can assume that the $4.2 billion each year that it estimates Canadians would save would be higher.
The PBO's report was not the first to state the benefits Canada would receive if we adopt a universal pharmacare program. Speaking lightly, I might suggest that the PBO got it wrong. However, the report was incredibly well thought out and extremely important. It tells us that pharmacare would have significant savings for Canadians because of the increased spending power it would offer. A single buyer for all medications in Canada would be able to negotiate with the drug companies to push the costs of medications down. The report estimates that Canadians can negotiate savings of 25% over what we are now paying for drugs. However, in Quebec, the province just negotiated a 40% savings. Therefore, the cost savings to Canadians may prove to be much more than the PBO estimated.
There is an urgent need for pharmacare. Yesterday, I met with some of my constituents from Cranbrook and Nelson here in Centre Block. Some of them are nurses. One of them is on multiple medications. They all said how important this was to them.
Canada currently has the second highest rate of skipped prescriptions due to cost among comparable countries. One in five Canadians report that either they or a family member neglect to fill prescriptions due to cost. In the past, my home province of B.C. has had the highest levels of problems accessing prescription drugs, with 29% of citizens, mostly the young, the elderly, and the poor, unable to afford necessary prescriptions. Of course, we pay some of the highest prescription drug prices in the industrialized world. Therefore, we know the problem, we know the solution, and we just need the political will.
The Angus Reid Institute recently completed a poll that found 91% of Canadians support the introduction of a universal pharmacare program. There are many supporters of pharmacare, including Canadian Doctors for Medicare, the Canadian Diabetes Association, and the Heart and Stroke Foundation. All of them have said that having a national pharmacare system is important to the health of Canadians.
Nationally, highly respected organizations that work for better care in Canada support pharmacare, doctors support pharmacare, and 91% of Canadians support pharmacare. Today I ask my colleagues on all sides of this chamber when they will join them and support pharmacare as well. This is an excellent time for you to do that.
Madam Speaker, I am happy and proud, as a New Democrat, to speak today to our motion on the need and the great opportunity for a national pharmacare program that would provide free access to prescription drugs for every Canadian. Just as I am proud to stand for that belief, Canadians are proud of their health care system. It defines us as Canadians. We do not think health care should only be available to those who can afford it.
When Tommy Douglas brought the concept of universal health care to Canada, it was always intended to include the cost of necessary medicines. Unfortunately, this was not implemented when universal health care came into effect in Canada. Now Canada is the only country in the world with a universal health care plan that does not include the cost of drugs in its coverage. How can we consider our system to be universal if it excludes the very drugs that bring us back to health and indeed save our lives?
We have the nonsensical situation where I can go to my doctor to get my cut foot stitched up at no cost, but then I have to pay for the antibiotics necessary in that situation. If I cannot afford to pay for that prescription, I may well end up at the emergency room, needing the free medications I can get in the hospital. It does not make any sense.
That added pressure on our health care system adds costs to all levels of government. The Canadian Centre for Policy Alternatives estimated that about 6% of hospital admissions were the result of people not filling their prescriptions, not taking their medicine. That results in an annual cost as high as $1.63 billion across the country, to say nothing of the loss of quality of life for those people who try to get by without proper medication and end up housebound or bedridden because of that inaction. This is a clear case of how unfair our present system is. Why should people with the financial means to buy their medications be afforded better health care than those who cannot afford them?
In the debate today, I have heard several members ask where we will get the $20 billion to fund pharmacare in Canada and who will pay for those medications. We will all pay, just as we do now. The good news is that if we had universal pharmacare plan, we would be paying at least $4 billion less than we do now, according to the report produced by the parliamentary budget officer last week. That is a highly conservative estimate. The savings could be as much as $11.5 billion, as reported by other very credible studies. We could have a universal pharmacare plan in Canada where everybody is covered, everybody gets free medications, and we end up paying billions and billions of dollars less every year.
Getting back to the question of who pays for our present system, the answer is individuals, businesses, and government. The Conservatives are always talking about the effects of payroll taxes on small businesses across the country. Extended health benefits that include prescription payments are one of those payroll taxes, one of the most expensive ones, and the costs are rising steadily for Canadian businesses because of that.
It is perhaps just a little hypocritical of members here to denounce a national pharmacare plan when their own medications are already paid for by the people of Canada. Like many Canadians with good jobs, we in the House of Commons have most of our drug costs covered by private insurance paid for by our employer. I was covered by a similar plan under my previous employer before I was elected, but millions of Canadians lack that coverage.
Also like many Canadians, I take cholesterol-reducing medication to reduce the chance that I will have a serious heart attack or stroke. If I had to pay for that medicine myself, it would cost me well over $100 a year. If I were still self-employed, I would probably choose not to take that drug, putting myself at risk, risking higher costs for our health care system. One of the interesting facts about the medication I take is that Canadians pay an extraordinarily high price for it. Elsewhere in the world, in countries that have universal pharmacare and the strength of negotiating fair prices with pharmaceutical companies, that drug is much cheaper.
People in New Zealand only pay one-tenth the amount we pay in Canada for that cholesterol-reducing drug. This is true across the board for most medicines we use in Canada. We pay more for drugs in Canada than almost every country of the world. That could be fixed through a national pharmacare system, with central purchasing for a powerful negotiating position with drug companies.
Today we have heard many examples of Canadians who cannot afford to pay for their medicines, the negative effect that has them, and the costs incurred by the health care system across the country.
I will mention just one more example. One of my constituents is a veteran. He uses medical cannabis to treat his severe PTSD. Veterans Affairs has covered the cost of that prescription, which has allowed him to have a relatively normal life for the past few years. This coverage has helped hundreds of other vets across the country, keeping them off dangerous opioids and away from the destructive use of alcohol.
Recently Veterans Affairs cut back on that coverage. This has forced my constituent, and many like him, to endure the painful effects of PTSD once again. Some repeatedly end up in the emergency rooms of hospitals. The costs of those visits, especially when compared to the small savings from the cutbacks in coverage, are astronomical.
The report of the parliamentary budget officer is clear. Our present system that separates the cost of prescription medicines from other health costs does not make any sense. It does not make sense from the perspective of keeping Canadians healthy and it does not make sense in terms of how much money we spend on our health care. Universal pharmacare is sound, economic policy.
If members do not believe the PBO, they can listen to what the Heart and Stroke Foundation of Canada says:
|| It's time for Canada to fill a gap in our health care system and truly provide universal health care for all. The Heart and Stroke Foundation believes in the values of universality, equity, and equality in our health care system. All people living in Canada should have equitable and timely access to necessary prescription medications based on the best possible health outcomes rather than their ability to pay.
The Canadian Diabetes Association believes that “universal access to necessary drugs is critical to the health of all Canadians and a sustainable health-care system in Canada.”
Universal pharmacare will save Canadians billions of dollars. Everyone in the House should be happy to hear that. It will save individual Canadians money, and it will mean significant savings for business owners across the country. It will also relieve pressure on our health care system, saving billions of dollars there as well. It would keep us all healthier.
The motion simply asks the government to begin talks with the provinces about how a universal pharmacare program could be structured in Canada. It gives the government a whole year to organize those talks.
Now the government side has said that the time is not right for this. Well, we have all heard the saying that the best time to plant a tree was 50 years ago and that the second-best time is today. We should have included pharmacare in our health care system 50 years ago, but we have the opportunity to make that bold step today.
Madam Speaker, I will be sharing my time with the member for .
Thank you for the opportunity to speak to the motion of the member for on national pharmacare.
For me, it is pretty simple. Any Canadian who needs treatment should be able to meet with their family doctor, or equivalent; receive a prescription for a drug, if it is required; proceed to their local pharmacy, and have that prescription filled at no cost, or at very low cost.
Today approximately 10% of Canadians cannot afford to have that prescription filled. Further, one in four Canadians report they cannot afford either to fill their prescriptions or complete their prescriptions. Traditionally, this under-treatment burden has fallen most heavily on our more disadvantaged populations, particularly those who are working in low-paying jobs, which often have no benefits. Often these are temporary jobs, and the people who hold them face periods of unemployment.
I believe Canadians would not want to hear that a temporarily unemployed mother with two children cannot afford to provide basic drug treatment when needed because it is unaffordable to her, yet that is the case in Canada today. Increasingly, even with full-time jobs, many of us are experiencing difficulty affording prescriptions as employers reduce their percentage coverage to lower levels, increasing the self-pay burden.
New treatments for rare and uncommon diseases are emerging, but they are very expensive. One of our most famous Canadians, Paul Henderson, who in the 1972 Russia summit series scored the winning goal, was diagnosed later in life with chronic lymphocytic leukemia. I understand the cost of the life-saving drugs to treat his condition is over $50,000 a year, and that could last for the rest of his life. Who among us can afford this life-saving pharmaceutical intervention without all of us sharing in the cost? All of us and our families face the risk of not being able to access essential medicines because we cannot afford them. We need to work together, pool risk, and support each other, as we have in other important health services.
Our government is already working to improve the affordability of prescription drugs and our access to them. Our current focus is on reducing the price of drugs, which will help improve access to necessary medications. We join provinces and territories as a member of the pan-Canadian Pharmaceutical Alliance, which negotiates lower drug prices on behalf of public drug plans. In the year and a half since joining, we have been able to use this bulk buying power to negotiate 60 agreements that are already saving Canadians money. We continue working collaboratively with the provinces and territories on other ways to make prescription drugs more affordable and accessible for Canadians.
Through the Patented Medicine Prices Review Board, the Government of Canada regulates the maximum allowable prices of patented drugs. The board recently completed the first phase of a consultation with Canadians on changes to its guidelines that would enable it to better protect consumers from excessive patented drug prices.
While much has been done to make pharmaceuticals more affordable for Canadians, I believe more can be done. I do not believe that lowering the cost of drugs would make them any more affordable for that single, temporarily unemployed mother of two. The problem is that prescription drugs outside of hospital care are not covered by the Canada Health Act.
As Canadians, we are proud of our national health care program. Today our national program covers doctor care, most diagnostic services, hospital stays, and prescription drugs while in hospital. It does not cover the $28.5 billion that was spent on pharmacy-filled prescription drugs in 2015.
The Standing Committee on Health, of which I am a member, began a study of the development of a national pharmacare program in 2016. We have heard from dozens of witnesses, including patient advocates. We have heard from experts in medicine, social policy, constitutional law, and pharmaceutical manufacturing, as well as pharmacists and the insurance industry.
In September 2016, the House of Commons Standing Committee on Health asked the parliamentary budget officer to provide a cost estimate of implementing a national pharmacare program. The committee provided the program's framework. We included the inclusive list of drugs to be covered by pharmacare, based on Quebec's gold standard formulary; eligibility requirements; copayment levels; and eligibility requirements for copayment exemptions.
The committee received the report, which is a public document, on September 28, a short week ago. The paper estimates the cost to the federal government of implementing this particular framework for pharmacare. It incorporates assumptions of the potential savings resulting from a stronger position for drug price negotiations, consumption or behavioural responses of providing universal coverage, and potential changes in the composition of the drug market.
After accounting for pricing and consumption changes, the PBO estimates that total drug spending under a national pharmacare program would have amounted to $20.4 billion if the program had been implemented in 2015-16. This would have represented savings of roughly $4.2 billion on the actual expenditures, which I believe is a conservative estimate.
In 2015-16, $13.1 billion was paid by public insurance plans for prescriptions, while private insurance plans, mostly through private employers, covered $10.7 billion. These two existing coverage streams would cover the entire population of Canada with a national pharmacare program and yield savings back to the employers. This is a win-win scenario.
I agree fully with my NDP colleague that Canada needs to adopt a national pharmacare program. As a caring society, I believe all of us are interested in ensuring that no one in Canada has to go without essential prescription drugs. Why, then, as caring Canadians, would we not move immediately to adopt a national pharmacare program, as proposed in this motion?
As I mentioned earlier, the Standing Committee on Health has heard from many witnesses on this topic. We have heard that affordability is not the only challenge. There are other complexities that need to be considered. Should there be a formulary to decide what drugs are insured? Should the formulary be set nationally or set by each province and territory? How do we ensure that research and development continues in Canada and provide patent rights while ensuring that we can all access generic drugs to make the program affordable? Should there be a single-payer model, or would we continue with the multiple private insurance system? How would our model of federalism be applied?
There are many complexities around this issue. For example, the U.K. has created the National Institute for Health and Care Excellence, whose role is to improve outcomes for people using the national health system and other public health and social care services. It produces evidence-based guidance and advice for health, public health, and social care practitioners, but, most importantly, it advises on the use of new and existing medicines, treatments, and procedures within the national health system. If we are to proceed with a national pharmacare model, we would need a corresponding scientific and evidence-based body to advise on what drugs should be in the insured plan.
The Standing Committee on Health is currently engaged in the final stages of its study of a national universal pharmacare system. We can bring recommendations on all of these complexities and on the cost model. The committee asked the PBO to prepare a report, given certain parameters, to guide the committee in its evaluation of policy options, and we are looking at options.
We have not even had the chance to meet with the PBO, examine his PBO's work, and ask about the assumptions and procedures used to produce the report. As a committee, we have not finished that work on this report. I strongly feel that it is premature for Parliament to call upon the government to act when the committee has not even drafted, let alone tabled, its report. I am disappointed that a valued member of the standing committee would rush to the House to table a motion asking Parliament to direct the government ahead of his own committee's report. Therefore, I say to my fellow committee member from that we should let the committee finish its work.
I also believe we need strong federal leadership to drive this change, starting with amendments to the Canada Health Act, and not just by initiating conversations with the provinces and territories, as is proposed in this motion. We need federal leadership on this issue.
For these reasons, I will be voting against the motion, but I want to be very clear on this issue to the residents of Oakville, my colleagues in the House, and those across Canada who are championing a push for national pharmacare: I fully support this initiative. One of the primary reasons I entered politics was to do my best to see that all Canadians are entitled to receive prescription drugs.
As I said earlier, all of us and our families face the risk of not being able to access essential medicines because we cannot afford them. We need to work together, pool risk, and support each other, as we have on other important health services.
I support national pharmacare, but it must be implemented appropriately and with thoughtfulness to ensure that Canadians receive the excellence in care that they deserve.
Madam Speaker, there is so much that could be said about the issue of pharmacare and how important it is in the whole health care field. Over the years, I have had many opportunities to discuss it, and I have enjoyed every one of these discussions. The issue we have before us today is not quite as simple as the NDP try to portray it.
I believe that we have a government that has been very progressive in moving forward on the health care file. Maybe that is a good way to start my remarks. When I was sitting in opposition, for years I challenged the government, as many others did, to deal with the health care accord. I remember the ministers of Stephen Harper standing up and saying that they were contributing more money to health care transfers, which were at record highs, and all of that kind of stuff. In reality, it was a health care accord by Paul Martin that had increases embedded in it.
Liberal governments in the past and today understand just how important health care is to each and every Canadian, no matter what region, province, or territory they live in. It is a top priority for this government. In fact, within a year and a half, our was able to get together with the different provinces and territories on a one-to-basis to put in place a new health care accord.
When we talk about health care, we also talk about pharmacare. We should also be talking about issues like home care services and hospice care. There are so many aspects to health care that are so critically important to all Canadians.
I was a bit disappointed at one of the questions to my colleague from . Whether it is my colleague from Brampton or , or other members of the standing committee, they have recognized the true value of pharmacare and what Canadians' expectations are. They were part of the standing committee. When the steering committee asked what they would like to study and talk about as a standing committee, those two members participated and said they wanted to talk about pharmacare, as did members of other political parties. They understand and appreciate how important it is. That is a very obvious thing to give consideration to at the Standing Committee on Health.
I was very proud of our standing committee in recognizing and coming to an agreement that it was something they needed to work on. I applaud the efforts they have put into it to date. The study has not concluded yet. They have held many meetings and heard from many stakeholders and witnesses on the pros and the cons of a universal pharmacare program, and about many of the problems that exist. I know there are a lot of problems, because I used to be a health care critic in the province of Manitoba.
There are serious issues and problems in health care, and pharmacare is something that consistently came up. We would like to think that an individual who leaves a tertiary hospital, community facility, or access facility would be in a position to take the medications necessary. The concerns I have are reflective of the concerns of the constituents I represent, and I know full well what Canadians would like to see the government deal with. That is why I applaud the efforts of the standing committee.
It was the standing committee that requested the parliamentary budget officer to look into and report back to the committee on this very issue. Yes, there was a report that just came out. The standing committee wanted it, but now one member of the committee is trying to say this is an NDP idea.
This has nothing to do with an NDP idea. I know they are very few and far between, but this is not an NDP idea. This is being driven by Canadians. It is their interest in this very topic that ultimately led to this being discussed by the Standing Committee on Health. It was the committee that asked the parliamentary budget officer to conduct a study and report back to the committee. The committee has not even heard the report yet. I believe it will happen in the coming days, possibly within a week, when it will get the report. It is absolutely critical information that needs to be shared, discussed, and debated as part of the committee's own report before the committee can be in a position to come back to the House.
I understand full well the importance of the issue. I cannot tell members the number of times I have talked to constituents, particularly seniors in my community. We talk a great deal about the cost of medicine. However, we have to understand that Ottawa cannot just dictate to the provinces and other stakeholders the way it will be.
A Liberal administration decades ago brought into force the Canada Health Act. If members check with Canadians today, they will tell them that it is part of our heritage, our Canadian identity. We believe in our health care system. However, that was not achieved by one, two, or three individuals. There was a consensus achieved among the public and parliamentarians at different levels. It was not just Ottawa that turned it into a reality.
We have a government that understands the issue, which is why members will find government members who are exceptionally supportive of the idea of moving forward on this file. We do not need to be reminded or told something by the New Democrats. We consult with our constituents. We understand what is important. However, we also have a a responsibility.
I am looking forward to hearing from the standing committee and ultimately seeing its report. At the end of the day, when I look at the provincial side of it, there have to be negotiations. There will be very delicate discussions in the years ahead on how to deal with the cost of pharmaceuticals.
When I was first elected back in 1988, I believe our health care expenditures were roughly $1.5 billion. That is my best guesstimate. However, if we look at them today, they are is well over $6 billion. Some may find that a laughing matter across the way, but I can tell members that from a provincial perspective, it consumes over 40% of provinces' budgets.
Before opposition members, particularly New Democrats, start jumping up to say they want a national pharmacare program, they better understand how that program would be financed, unless, of course, they are advocating that the national government pay for 100% of it. However, coming from a party that vowed it would not have a debt, those members do not understand the concept.
There is a responsibility to work with the provinces. I cannot recall offhand from my just under 20 years at the Manitoba legislature, most of them under an NDP administrations, when there was a push to resolve that issue.
Now, within 18 months of coming into government, we have this wonderful initiative by the Minister of Health, the pan-Canadian Pharmaceutical Alliance, which negotiates lower drug prices on behalf of public drug plans. This is our Minister of Health working with the provinces and stakeholders to come up with a better way to keep those drug plans' costs lower.
The point is that we have members who understand the importance of what our constituents are telling us, and we have a government that is acting on the important issue of health care. We have seen that not only with that one measure I just made reference to but also in terms of the renewal of the health care accord—
Madam Speaker, it is a pleasure to speak to what is a very timely motion on pharmacare. For the benefit of those listening who have not already heard what the motion reads, it is worth reading it into the record again:
|| That, given that millions of Canadians lack prescription drug coverage, and given that overwhelming evidence, including from the Parliamentary Budget Officer, has concluded that every Canadian could be covered by a universal pharmacare program while saving billions of dollars every year, the House call on the government to commence negotiations with the provinces no later than October 1, 2018, in order to implement a universal pharmacare program.
These kinds of common sense initiatives are the reason I got into politics. It is about trying to help ordinary people in their day-to-day struggles with affordability, and it is good public policy. It is good public policy because it would deliver help to those who need it in a more effective way. It is be good public policy because it would also help save money.
I will be splitting my time with the member for , who will have more to say on this, I am sure.
This is exactly the kind of public policy initiative the government should be looking to take, regardless of where it stands on the ideological spectrum. Nobody should be ideologically opposed to helping people out with the things they need to live a healthy life. I do not think anyone is ideologically opposed to doing that for less money.
The parliamentary budget officer's report is the most recent of a series of reports that have been published over the years. I am more familiar with the ones published in the last three years or so, but reports on pharmacare go back decades.
I hear the Liberals pretending that this is a new issue and that they need to know what is in the parliamentary committee's report to pass the motion. The motion only talks about beginning conversations with the provinces. The motion would not prejudge or preclude action on any of the recommendations in the report. It would simply signal a commitment by the government to actually do something about pharmacare instead of just talking about it in the House. I cannot really understand how the Liberals can get up in this place and make that argument and look at themselves in the mirror.
The need for pharmacare has been long-standing. I invite Liberal members to come to my riding and talk to seniors and young people who need medication to go about their day-to-day lives and who are struggling to afford that medication. They can tell them that it is too soon for a national pharmacare program, and it is too soon to start a dialogue with the provinces about how it would be paid for and what the details would be. Those are important, but the bottom line is that whichever governments end up paying for it, they are funded by the same people. They are funded by Canadian taxpayers. They are funded by the people who have to pay for those drugs.
We hear from the parliamentary budget officer that right now Canadians are paying around $24 billion a year for prescription drugs. By having a different level of government pay so that it is more coordinated, those same Canadians could be paying $20 billion instead. For those who struggle with the math, that is $4 billion less per year spent by Canadians on prescription drugs. I am baffled that the motion does not enjoy the support of the whole House, but particularly of a government that styles itself as progressive and as wanting to help people and help the middle class.
I want to raise a particular example of a young women from my riding named Kerri, who is part of the Faces of Pharmacare campaign. I would encourage people listening at home and members here to check out Faces of Pharmacare. They can Google it. It is stories of Canadians across the country who are struggling with prescription drug costs and are calling for a national pharmacare plan. Kerri says:
|| The four asthma medications I take keep me relatively healthy, and being diagnosed with severe ADHD in my early twenties, ADHD medication has been positively life-altering for me. My ADHD medication is not fully covered by [the Manitoba pharmacare program], but with assistance from other programs I am able to cover the full cost of the name brand medication as my doctor has prescribed.... This adaptation allows me to feel and function at my best, both in traditional employment scenarios as well as in self-employment. Without Manitoba Pharmacare, my prescriptions would have cost 24% of my income—nearly a quarter of an income which a totally “healthy” person would not have to pay!
A national pharmacare program could do more to assist Kerri and people like her who are struggling to afford the medications they need, as she rightly points out, to participate in the labour market. We are talking about reducing the sticker price of drugs, but there are other costs we are incurring economically, in terms of lost productivity, that are not measured by the PBO report but are very real when people cannot afford the prescription drugs that keep them going.
I have talked to a lot of seniors in Elmwood—Transcona as well. It is clear that seniors on fixed incomes who are just receiving CPP and are relying on the GIS are not able to afford their prescription drugs. Having a national pharmacare plan would make those drugs affordable for them and would take away one of the many pressures people who do not have enough income face. They face those pressures when it comes to housing. They face those pressure when it comes to food. One way we could help that is concrete and makes sense is to establish a national plan so that by virtue of coordinating our purchases in a different way, the money we are already spending on drugs would be less, which would mean more money for other things.
To the extent that a lot of the people who would benefit from a pharmacare program are those who do not have high incomes, that money would go back into their pockets, whether it was refunded by the federal government, provincial governments, or municipal governments, or there was a lower cost at the drug store for certain other drugs. However the money would go back to Canadians, we understand that at least $4 billion a year, and some studies say as much as $7 billion or $11 billion a year, would end up back in the pockets of Canadians. When we put money back in the pockets of low-income Canadians, it is money that is spent in the community. It is not money that goes off into a tax haven somewhere. It is not money that would not be captured because there is a CEO stock option loophole being taken advantage of. It is money that would go back into Canadians' pockets, and it would be spent at local grocery stores. It would be put back into the public transit service of the municipality they are in. Those are the kinds of things people are struggling to afford in Canada, and those are exactly the people that a national pharmacare program would help.
What are the arguments we are hearing against it from the other side? It sounds to me like the government has agreed that people are struggling with the cost of prescription drugs. It does not seem to deny it, although there was an allusion to the idea that maybe the PBO report is not authoritative or that they need to examine the study themselves and then pronounce on whether the parliamentary budget officer did a good job. Maybe he is off by $4 billion, in which case there is a net zero effect. I do not know. Liberal backbenchers would like to redo the work of the PBO. I do not know what kind of resources they have in their offices, but I am willing to take the parliamentary budget officer at his word.
Liberals say it is too fast. The Liberals were calling for this in 1993, and the NDP much longer. Canadians who are struggling with the cost of prescription drugs have been calling for this much longer. There is no way to implement a pharmacare program today, tomorrow, or a year from now that would be too soon. We are way past doing this too soon.
New Democrats want the government to support this motion. That is why the motion simply calls on it to convene a meeting of the provinces and the federal government within a year. That would give them a lot of time to prepare for that meeting and to get into all the details.
The Liberals are right. There are details to work out about this, but there are details to work out with respect to the legalization of marijuana as well. That is a complicated issue. That involves Canada's commitment under international treaties. That involves discussions with the provinces. That involves discussions about how much to tax it, where the revenue is going to go, and to whom, and how old people will have to be to smoke it in their provinces. That is something the Liberals said, in light of others who said it was too complicated and they were moving too quickly, was a question of political will, and they were going to get it done.
On an issue that has been decades in the making and that hurts seniors and others who are struggling to afford prescription drugs, I do not understand why the Liberals do not have the political will to start this discussion as soon as possible. They should bring the provinces around the table and get it done. They are doing it on other issues, and they ought to be doing it on this one.
Madam Speaker, I am proud to rise today in support of this NDP motion that calls upon the government to have a meeting to start the conversation about implementing a universal pharmacare program. This is something that New Democrats have been fighting for since Tommy Douglas introduced and implemented public medicare in our country.
New Democrats refer to the amazing vision that Tommy Douglas had. His vision of a social system that is accessible to us all still guides us today. It is a fundamental belief that we are all in this world together, and that the only test of our character that matters is how we look after the least fortunate among us—how we look after each other, not how we look after ourselves—and that no matter what, people should get whatever health services they require, irrespective of their individual ability to pay.
Tommy Douglas never intended to create such a gap in Canadian health care coverage. Prescription drugs and other services were always meant to be integrated into a system of comprehensive public coverage along with hospitals and physician services.
Canada is the only developed country in the world with a universal health care program that does not include a universal prescription drug plan. This means that our multi-payer system has resulted in the second-highest prescription drug costs in the world, second only to the United States. Our patchwork prescription drug system is inefficient and expensive. It has left Canadians with wildly varying prescription drug coverage and access. Many people are paying different rates for the same medications.
Currently people are not benefiting from our system, but do we know who is? It is the pharmaceutical and private insurance companies, the same ones that make billions of dollars in profit every year. Did members know that in 2016 Merck Canada made a $35.2 billion profit, while Bristol-Myers Squibb earned $19.2 billion? What about the fact that in 2016 Purdue Pharma reaped profits of $31 billion? Purdue sells oxycontin and other products prescribed for the treatment of pain, and Purdue has been found to have misled doctors about the safety and effectiveness of oxycontin. As we all know too well, Canada is facing a public health crisis in which at least 2,400 Canadians died as a result of opioid overdose in 2016.
What about the top private insurance companies? Do members know that the top three companies in Canada collectively raked in net profits of over $8 billion in 2016?
Pharmaceutical companies can charge higher prices for drugs because they sell to so many buyers. Private insurance companies benefit by charging employers, unions, and employees to administer these private drug insurance plans.
Why is it acceptable that in Canada a corporation can have profits of $35 billion, but seniors living in my riding cannot afford to both heat their homes and buy their medications?
Seniors represent one of the fastest-growing populations in Canada today. The number of seniors in Canada is projected to reach 9.8 million in 2036, and many more seniors will be retiring in the years to come. Therefore, we need to have a social safety net in place to avoid dramatic increases in the rate of poverty. A universal pharmacare program would significantly help our seniors and would cost our health care system less.
I want to specifically speak today about what I see in my constituency office. I have people who come into my office who are desperate for help. Many seniors, but certainly people of all ages, tell my staff that they cannot afford their medications. Couples will often split one prescription between them, or they will skip taking their medicine so that they can afford a new pair of glasses to allow them to see properly.
A woman who was on ODSP, the Ontario disability support program, came in last week. She cannot work because she has very serious mental health issues. She needs her medication to function. However, not all of her medications are covered by ODSP, and sometimes they are only partially covered. Often she must decide whether to pay her utility bills, buy groceries, or pay for her medicine. She came into my office because she chose to pay for her medication one month, but then she could not afford to cover her utility bills, so her phone was cut off.
This woman relies upon the services of our local mental health crisis phone line. The counsellors provide her with the support she needed to manage her illness, but her phone was cut off. She was devastated. She told my staff that she regularly uses her food money to cover her utilities or medication costs. That simply is not right, yet we see it in all of our constituency offices every day.
Earlier this week, when we debated tax fairness in the House, I spoke about the true unfairness of income inequality. I will repeat some of the shocking, heartbreaking statistics that are a reality in Canada today.
According to the census data in 2015, the richest 1% now make 6.8 times more than a worker making Canada's median wage of $34,204.
In the Windsor-Essex area, the United Way said that about one-quarter of our youth live in poverty, which means that in 2013, 19,900 children under the age of 17 lived in families that had an income of less than $17,000 per year. This is not only unacceptable; it is offensive. When someone earns so little per year, there is no room for paying for medications, and people are making very difficult decisions about their health. It is time to move forward with a universal prescription drug plan that will save money through bulk purchasing power.
In New Zealand, where a public authority negotiates on behalf of the entire country, a year's supply of the cholesterol-busting drug Lipitor costs just over $15 a year, compared to $811 per year in Canada. This is a life-saving drug, and hundreds of thousands of Canadians take it. That is why Canada needs to combine the purchasing power of all Canadians under one plan. An annual investment of $1 billion by the federal government would mean that Canadians would save $7.3 billion a year on the medications they need.
What I wish to emphasize today is that New Democrats are of the fundamental belief that people should not have to worry about whether they can pay their hydro bill or afford their medication.
Today I have some statistics from the Canadian Labour Congress, but before I do that I want to read a quote from its president in a release that was issued today. This is from CLC president Hassan Yussuff. It states:
|| We are pleased that the NDP under its new leader Jagmeet Singh is continuing to make pharmacare such a priority, and we hope all political parties respond by making this much needed program a reality as soon as possible.
If the Liberals claim to be standing up for labour in this country, if they claim to be standing up for working people, then I hope that they will heed the advice of the Canadian Labour Congress president today and support what the New Democrats have brought forward.
I want to read some of the statistics from the Canadian Labour Congress, which state:
|| About 8.4 million working Canadians don't have prescription drug coverage.
|| The less you earn at work, the less likely you are to have prescription drug coverage.
|| Women and young workers are less likely to have the coverage they need.
|| Even those with drug plans are paying ever-increasing co-payments and deductibles.
The New Democrats are not alone in our belief in national pharmacare. An overwhelming majority of Canadians, 91%, believe that our public health care system should include a universal prescription drug plan. It is not just the New Democrats who are calling for this desperately needed action; several national health care commissions have recommended the same, along with the Canadian Medical Association, the Canadian Federation of Nurses Unions, Canadian Doctors for Medicare, the Federation of Canadian Municipalities, the Canadian Health Coalition, the Council of Canadians, CUPE, Unifor, and the Canadian Labour Congress.
If the current government is a true friend to all of those organizations, and labour, it is time for it to stand up. We are calling for a meeting. Surely the Liberals can commit to one meeting to talk about where we are going in this country with respect to pharmacare. All we are asking in this motion is that in one year we have that meeting.
It is time for action. Canadians have waited long enough. It is time to start the conversation.