Francis Scarpaleggia
Francis Scarpaleggia
Member of Parliament for Lac-Saint-Louis
Speech: national pharmacare
April 16, 2024

Madam Speaker, I am very pleased to stand today and speak in support of this bill to bring in the first stages of national pharmacare to this country. Pharmacare has figured as a commitment in the Liberal platform. I would go further and say that it is an extension, really, of an arc of social justice that began many decades ago with hospital insurance. Before we had medicare, we had hospital insurance. If someone went to the hospital they did not have to pay, but then they would have to pay if they went to see their physician. Then, of course, we brought in medicare.

On that score, I would like to come back to something that the member for Cumberland—Colchester said that made me think back to 50 or 60 years ago. He said, in reference to dental care, that the plan for dental care would result in the dentist focusing more on the relationship with the payer, the insurance companies, than on the relationship with the patient.

That was one of the main criticisms of medicare in 1970 when the federal and provincial governments were implementing medicare. At the time, many medical professionals, doctors, said it would not be good because it would bureaucratize their profession as they would have to deal with government bureaucracy and that would leave less time to deal with patients. In the final analysis, we saw that it was a more efficient system. Doctors know that they will get paid. They do not have to hire a bill collection agency to collect medical bills and so on. It is funny that we are going back to arguments that were raised 70 years ago when there was opposition, initially, to implementing medicare in this country.

I would like to go back, for a moment, to the pandemic, because I think it is important. The pandemic was a watershed moment in so many ways. I think it will take decades of analysis and doctoral theses, maybe, to really understand how the pandemic changed our world. However, the pandemic did something for public policy that I am not sure we think enough about. It showed us that we can deliver support to citizens in ways that we never thought possible. If one had asked the government before the pandemic to offer support directly to Canadians through the CRA, through payments based on attestation, one would have been shut down right away. The bureaucrats and politicians would have said that it was absolutely impossible.

We proved that it was possible in a crisis to bring financial support to Canadians in a very streamlined way, in a very direct way and in a very timely way. I think that gave confidence to government that it could deliver other services in a very efficient way. Dental care is one example of that. I would bet that if someone had said we could deliver dental care directly through dentists with an insurance company making payments to dental offices and so forth, people would have said we could not do that as lots of bureaucracy would be needed. However, the pandemic showed us that we can do things directly and efficiently.

That brings me to pharmacare and this initial building block of a national pharmacare system. We have heard the Conservatives raise the spectre of a national pharmacare system requiring immense amounts of bureaucracy, but we have learned from the past that these kinds of services with this kind of financial support can be delivered rather effectively.

Now, we know that provincial health care systems across this country are bogged down in bureaucracy. We have seen some of the tragic consequences of that, but when we are talking about the delivery of drugs, each province has a very efficient and effective pharmacy network that already liaises with governments and with private insurance companies, such that when one gets a prescription, the pharmacist already knows that one is covered by a private insurer, or if one is not covered by a private insurer, they know that one is covered by the government system. There is already a very efficient infrastructure in place to deliver national pharmacare with the help of the infrastructure set up within the provinces, so I do not believe this idea that national pharmacare is going to create a heavy burden of bureaucracy.

The member for Cumberland—Colchester talked about the so-called blue seal program that his party is putting forward as a way of recognizing credentials for foreign-trained doctors. Our government is already doing that. Taking away from the fact that it is already provincial jurisdiction to recognize credentials, we do not hear any objections from the other side about invading provincial jurisdiction when we talk about recognizing credentials. The recognition of credentials is, in fact, something that is done by provincial colleges of medical professionals. All of a sudden, the invasion of provincial jurisdiction does not seem to enter into the picture.

However, the point is that, if we want to do that kind of thing, we are still going to need some bureaucracy. We are going to have to have some government employees who are coordinating something. That is just the way it is in modern governments. Sometimes I fear that the Conservatives do not understand the realities of modern governments, but I will not get into all of that right now.

In terms of the role of the federal government when it comes to pharmaceutical products, let me go back to the CERB. It is conventional wisdom that it is the provincial governments that deliver social assistance in this country, yet during the pandemic I did not hear any provincial governments complaining that we were providing CERB to citizens in need. I did not hear it then. All of a sudden, it is back in the picture.

Back to pharmaceuticals, the federal government is deeply involved in the pharmaceutical industry. It does inspections of pharmaceutical companies. The Patented Medicine Prices Review Board has a role in determining the prices of pharmaceuticals. Health Canada is involved in approving drugs for safety and medical devices. This idea that there is this clean-cut distinction between the federal government and the provinces when it comes to those kinds of products is, I think, a bit of a stretch.

That being said, I am not in the government but I think I can speak on behalf of the government. The federal government is not seeking to manage more things. We have lots of responsibilities. If the provinces can do something well, why not? If the provinces can achieve the goals that we have set, based on what Canadians want, then why not? The federal government is not seeking to manage all aspects of pharmacare, but I think that we are responding to the wishes and priorities of Canadians in proposing this plan.

I would like to come back to another argument that was raised by the Conservatives in this debate. Somehow, in a kind of twisted logic, it was suggested that national pharmacare is going to cause inflation. I do not understand that, but I could be wrong. Maybe I have a blind spot and I do not see all of the logic of the argument, but how can providing free drugs to Canadians who need drugs fuel pharmaceutical price inflation?

Pharmacare is an affordability measure. The Conservatives claim to care so much about affordability, but every time we want to do something on affordability, whether child care, pharmacare or dental care, they vote against it. I do not think they care about affordability.

 

 

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