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View Don Davies Profile
NDP (BC)
View Don Davies Profile
2020-03-12 10:37 [p.1980]
moved:
That the House:
(a) acknowledge the government’s intention to introduce and implement national pharmacare;
(b) call on the government to implement the full recommendations of the final report of the Hoskins Advisory Council on the Implementation of National Pharmacare, commencing with the immediate initiation of multilateral negotiations with the provinces and territories to establish a new, dedicated fiscal transfer to support universal, single-payer, public pharmacare that will be long term, predictable, fair and acceptable to provinces and territories;
(c) urge the government to reject the U.S.-style private patchwork approach to drug coverage, which protects the profits of big pharmaceutical and insurance companies, but costs more to Canadians; and
(d) recognize that investing in national pharmacare would help stimulate the economy while making life more affordable for everyone and strengthening our health care system.
He said: It is a great privilege and an honour for me to rise on behalf of my colleagues in the New Democratic Party caucus and on behalf of the New Democratic Party of Canada and all of those Canadians from coast to coast to coast who care so deeply about our health care system.
It is timely to note at this time that Canadians find themselves in the grip of what can fairly be called a major public health crisis. The COVID-19 public health outbreak is affecting communities across our land. The one thing that Canadians feel extremely proud of and strong about at a time like this is that we have a strong public health care system that helps keep everybody across this country healthy and responds to keeping people healthy and, most importantly, regardless of anybody's ability to pay, but rather as a birthright of citizenship in this country.
That is why it gives me great pleasure to stand today and speak to an issue that represents an immediate, urgent and critically important gap that exists in our current health care system, and that is the lack of public coverage for prescribed pharmaceuticals, the medicines that Canadians need as their doctors prescribe.
I am going to cover four basic elements in my remarks today. I am going to read the motion, I am going to discuss the need, I am going to discuss the solution and I am going to talk about the responsibility that we have as legislators in this country.
First I will read the motion. New Democrats propose:
That the House:
(a) acknowledge the government’s intention to introduce and implement national pharmacare;
(b) call on the government to implement the full recommendations of the final report of the Hoskins Advisory Council on the Implementation of National Pharmacare, commencing with the immediate initiation of multilateral negotiations with the provinces and territories to establish a new, dedicated fiscal transfer to support universal, single-payer, public pharmacare that will be long term, predictable, fair and acceptable to provinces and territories;
(c) urge the government to reject the U.S.-style private patchwork approach to drug coverage, which protects the profits of big pharmaceutical and insurance companies, but costs more to Canadians; and
(d) recognize that investing in national pharmacare would help stimulate the economy while making life more affordable for everyone and strengthening our health care system.
I want to briefly review the need, the context in which the motion emanates, and what is really happening in all of our communities across our country.
Right now, as we gather today, one in five Canadians, that is 7.5 million people, either have no prescription drug coverage whatsoever or have such inadequate or sporadic coverage as to effectively have none at all.
Currently, each province offers different levels of drug coverage for different populations, creating significant and profound inequalities in prescription drug coverage between regions.
Canada currently does have a U.S.-style patchwork of more than 100 public and 100,000 private drug insurance plans. One in five Canadian households reports a family member who, in the past year alone, has not taken the prescribed medicine simply due to cost.
Nearly three million Canadians per year are unable to afford one or more of the prescription drugs their doctors prescribe as important and sometimes essential for their health. Of those three million Canadians who cannot afford their medications, 38% do have private insurance and 21% have public insurance, but these insurance plans are not sufficient to cover the medicine they need.
One million Canadians per year cut back on food or home heating in order to pay for their medication. One million Canadians per year borrow money to pay for prescription drugs.
Canadian adults are two to five times more likely to report skipping prescriptions because of costs than residents of comparable countries with universal pharmacare systems, like the United Kingdom. In fact, Canada is the only country with a modern economy that has universal health care coverage and does not provide some form of universal access to prescription coverage.
A recent study from the Canadian Federation of Nurses Unions reveals the human costs of this problem. It has found, just studying two different serious health conditions, diabetes and heart disease, that every year up to 1,000 people die, purely because they do not have access to the medicine that would save them. That means that there are thousands of Canadians, if we include all medical conditions, maybe tens of thousands of Canadians, who die unnecessarily and prematurely because this country simply does not provide them with the medicine they need.
On the other hand, despite this horrific deficit in human terms, economically, Canadians perversely consistently pay among the highest prices in the world for prescription drugs due to our fragmented patchwork of drug coverage. In fact, prescription drug spending in Canada has increased every year since the current Liberal government took power in 2015. I am going to pause, because in 2015 the Prime Minister gave a mandate letter to then-Minister of Health Jane Philpott, and in that mandate letter he specifically tasked her, as a major goal, with reducing the cost of prescription drugs in Canada. I think Canadians know anecdotally that their access to drugs has not increased in the last five years, and they know that the price of prescription drugs certainly has not gone down.
I wanted to get the scientific answer to that question, so two months ago I wrote a letter to the Canadian Institute for Health Information, CIHI, and I asked what has happened to drug prices in Canada since 2015, when the Liberals took power. What it found was shocking. It found that on absolute terms, Canada as a country has spent more money every single year on prescription drugs since the Liberals took office and, on a per capita basis, each Canadian in this country has spent more money on prescription drugs every single year since the Liberals came to power.
That mandate, which was given in 2015, to reduce prescription costs has not only gone completely unfulfilled, it has actually gotten worse. From an institutional point of view, prescription drugs represent the second-largest category of spending in Canadian health care, surpassing spending on physician services. Only what we spend on hospitals costs us more as a nation than what we spend on prescription coverage.
What happens when patients cannot afford their prescription drugs? Besides getting sicker, which I will talk about in a moment, they access provincial and territorial health systems more often as their condition deteriorates. In 2016 about 303,000 Canadians had additional doctor visits, about 93,000 sought care in emergency departments and about 26,000 were admitted to hospital after being forced to forgo prescription medication due to cost.
HealthCareCAN, the national voice of health care organizations and hospitals across Canada, estimates that between 5.4% and 6.5% of all hospital admissions in Canada are the result of cost-related non-adherence to prescription medication, resulting in costs that they estimate to be at least $1.6 billion per year.
It has been almost one year, a Parliament and a general election ago, since the Hoskins advisory council on the implementation of national pharmacare issued its report. What was the conclusion of that Liberal-appointed committee, headed by a former Liberal minister of health from Ontario, a committee that crossed the country listening to consultations from every stakeholder group across the country?
What did the committee recommend this Parliament do? It said that Canada must implement universal, single-payer public pharmacare and get started on it now. Not only that, it gave us a blueprint.
The Hoskins advisory council told Parliament to work collaboratively in partnership with provincial and territorial governments to begin the implementation of national pharmacare in 2020, right now. It advised that we should have federal legislation in place by January 1, 2022, that outlines how governments will work together and share costs. It listed federal responsibilities and said that legislation must include the steps required for provincial and territorial governments to opt into national pharmacare. That is in less than two years.
The council said that Parliament must act immediately so that we offer universal coverage for at least a list of essential medicines by January 1, 2022. That is about 20 months from now. It suggested that we implement a detailed national strategy and distinct pathway for funding and access to expensive drugs for rare diseases by January 1, 2022, and said that this country needs to offer a fully comprehensive formulary, covering all medicines that Canadians need, that are cost effective and that are required to keep them healthy and covered by a public single-payer system, no later than January 1, 2022.
Liberals often accuse the NDP of being in a hurry. Let me just pause for a moment and review the history of pharmacare. It was in 1964 that the Royal Commission on Health Services, chaired by Justice Emmett Hall, who was appointed by the Conservative then prime minister John Diefenbaker, issued a report to Canadians saying that Canada needed to offer prescription drug coverage in this country. That was almost half a century ago.
It was 23 years ago, in 1997, that the Liberal Party of Canada promised Canadians in a platform, in writing, that if the Liberals were elected and given the privilege of serving as the government they would bring in public pharmacare and they would produce a timeline in that Parliament for doing so. Incidentally, the Liberal government has had at least three majority governments since then, as well as a minority. They have had 13 years of majority government and minority government to make that happen since that time, and they have failed to do so.
Is half a century for bringing necessary medicine to Canadians too much of a hurry? Is 23 years to have a political party deliver on a promise that it made to Canadians in a solemn platform, in a public way, too much of a hurry?
Almost a year has passed since the Liberal-appointed advisory committee recommended the same thing as seven different royal commissions, task forces, Senate committees and House of Commons committees of all types have recommended and come to the same conclusion on. I want to pause and emphasize that every single body that has ever looked at this question of what is the most effective, efficient and fair way to make sure that all Canadians get the medicine they need when they need it, has found that it is through a public single-payer model.
The NDP does not just talk. We act. We do not dawdle. We work, we create and we deliver. The NDP has done the work that the Liberals promised to do and have failed to do, and that the Conservatives refused to even commit to. That is, we have drafted the very first, historic, groundbreaking legislation to make pharmacare a reality in the Canada pharmacare act. We will be introducing that legislation in the House of Commons in the weeks ahead.
What would the proposed act do? It is based on the recommendations of the Hoskins advisory council, along with the other expert reports, and we have modelled it on the Canada Health Act because prescription medicine should be covered, like every other medically necessary service, through our public health care system.
Our act would enshrine the principles and national standards of pharmacare in federal legislation, separate and distinct from, but parallel with, the Canada Health Act.
That means that the federal government would take a leadership role and ensure pharmaceuticals were delivered to Canadians just as other services are delivered, with provinces respecting the principles of universality, comprehensiveness, accessibility, portability and public administration.
Like the Hoskins report, our legislation would come into force exactly when Dr. Hoskins said it should: on January 1, 2022. The bill says that the federal government should take leadership by providing a stable fiscal transfer to the provinces that agree to respect the principles of it and make sure their citizens get the drugs that are covered on a negotiated formulary at no cost, just like they do every other medically necessary service.
I want to pause a moment and go to those who cannot afford it. Study after study, from the Parliamentary Budget Officer to academics, says that we can cover every single Canadian in this country and save billions of dollars doing so. The Parliamentary Budget Officer, using conservative assumptions, said that we would save $4.2 billion every single year by bringing in public pharmacare. Academics have said that is a low estimate and it would be billions more.
Why is that? It is because by bringing pharmacare under our public health care system, we could have national bulk buying led by the federal government for 37.5 million Canadians. We could have streamlined administration. We could take those 100,000 separate private plans and fold those into a single streamlined, efficient and effective administration program in each province. We would save money from the results of cost-related non-adherence, because we know that when Canadians do not take their medications, they get sicker, and when they get sicker, they end up in the ICU.
It has been estimated that having one diabetic in the ICU for three or four days because that person did not take his or her insulin costs more money than giving that person free insulin for life. That is the kind example I am talking about, and we would save money by having universal pharmacare.
Finally, we would save money by using a disciplined, evidence-based formulary, and by having an independent body in this country that assesses medication based on science and that gets the best value for money and efficacy. That would form the basis for prescribing practices in this country, and it would better prescribing practices.
It is time to act. Canadians cannot wait any longer for this and should not have to wait any longer. This is an essential health care policy initiative. It is essential from an economic point of view. It has been found that an average Canadian family would save $500 a year with public pharmacare and that the average employer would save $600 per insured employee. I have rarely seen a public policy that has broader stakeholder agreement than public pharmacare.
Outside of the pharmaceutical companies and the insurance companies, every single stakeholder group that appeared before the Standing Committee on Health said that it supported what the New Democrats are proposing. Employers support it because they want a healthy workforce. They know that pharmaceuticals are the fastest-growing and most expensive part of their extended private health care plans, and they cannot afford it. They know it is better to have this delivered through the public health care system. That is why Canada spends less money per capita than the United States does in delivering health care, and we cover every single Canadian.
It is time to act. I no longer want to hear the Liberal government give excuses about why it cannot move faster and it is studying the situation and has work to do. I have never heard the Prime Minister or the health minister, or in fact any Liberal health minister since 2015, utter a commitment to public health care. I have heard the Liberal finance minister tell his business colleagues that he prefers a U.S.-style private-public patchwork, but there has been radio silence from the government on public pharmacare. That ends today.
I challenge my Liberal colleagues to stand in the House today and tell Canadians if they support public pharmacare or if they support a private, U.S.-style patchwork. Canadians deserve to know. After 50 years of study after study telling us that Canadians need pharmacare, the New Democrats are going to continue to fight for patients and do what we have always done, which is to create and build public health care in Canada, just like Tommy Douglas envisioned back in the 1940s.
We are going to continue working hard until every Canadian has pharmacare, dental care, eye coverage, auditory coverage and full comprehensive coverage under a public health care system.
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