Honourable senators, I first acknowledge that we are on the unceded, unsurrendered territory of the Algonquin Anishinaabe Nation. My home is on the unsurrendered and unceded traditional Wolastoqiyik land as established in a series of peace and friendship treaties and near the Wolastoq, the beautiful and bountiful river.

I rise before you today to give my full support to Bill C-64. To paraphrase the Hoskins report, a full, comprehensive, universal single-payer pharmacare that provides universal, first-dollar coverage of pharmaceutical products is the right prescription for Canada. For the last 50 years, I have had a front-row seat to the evolution of health care in Canada. I graduated as a nurse less than a decade after the Medical Care Act was passed, and New Brunswick became the last province to implement medicare just after the province of Quebec in January 1971.

It had taken six years for all the provinces to get on board, and by then there had already been a royal commission calling for the addition of a national pharmacare program to our health care system. The Canada Health Act came next in 1984, establishing the core principles of the public health care system — that it be publicly administered, comprehensive, universal, portable and accessible to all.

While opinion polls suggest that Canadians’ support of medicare has remained more or less constant since its inception, the health care system has not remained constant.

Notable changes in health care technology have occurred. One of the most dramatic has been the increased availability and use of prescription medicines to treat a wide range of medical conditions in the community setting, which means that pharmaceutical advances have helped keep people out of hospital and manage their chronic conditions to maintain their well-being. Appropriately prescribed prescription drugs would generally seem to fit the definition of “medically necessary care.”

Yet owing to the structure of our medicare system, universal public health insurance in Canada ends as soon as a patient is handed a prescription to fill. Medicare does not cover the cost of prescription medicines, leaving many patients out of pocket for necessary drugs unless they are hospitalized. Many more reports were tabled in Parliament during the 1990s and early 2000s, including the Kirby report in this chamber, calling for a national pharmacare program.

For some of us who were watching pharmaceuticals become a more and more important part of achieving good health outcomes despite being out of reach for many Canadians, it seemed like a dream. In Canada, 1 in 10 people were not able to afford one or more of their prescription drugs. In this group, 38% had private insurance coverage, and 21% had public coverage but their insurance did not cover enough of their prescription drug costs.

According to a 2024 report from the Canadian Institute for Health Information :

Prescription drug prices in Canada are the third highest among the Organisation for Economic Co-operation and Development (OECD) countries and are expected to rise.

Simply put, at least 7.5 million Canadians can’t afford medication because they don’t have adequate insurance.

The fact that pharmacare would be too expensive has often been taken for granted in Canada, especially after the rapid increase in effective pharmaceutical therapies and drug prices in the 1960s. However, during this time, similar countries like the U.K. and Australia were adopting and consolidating their universal, comprehensive pharmaceutical benefit programs. Both the U.K. and Australia have universal, single-payer programs for pharmaceuticals, and they do a better job at containing costs than Canadian drug plans do currently. When it comes to combined public and private spending on pharmaceuticals, Canada pays more per capita than all OECD countries apart from the United States, and Canada pays more while providing less access. Other countries like Australia provide examples of how Canada might integrate this analysis more fully into formulary decisions and price negotiations.

Nurses are well acquainted with the heartbreaking stories of patient health condition deterioration or death due to the rising costs of prescription medications and patchy coverage. Known as cost-related non-adherence, or CRNA, the financial barriers that prevent patients from properly following prescription regimens have a significant impact on both the health of individuals and our health care system. Consider the following:

Research shows that Canadian patients are more likely to experience CRNA than are residents of high-income countries with universal prescription drug coverage. This is particularly true for working-age Canadians who don’t qualify for the public drug plans that are available to older residents in many provinces. In fact, working-age Canadians are more than twice as likely to report CRNA as similarly-aged residents of countries like the UK, France, Norway and the Netherlands, which include drug coverage in their universal health systems.

When a fully realized pharmacare program is implemented, Canadian patients will have access to their necessary medications, which will improve their financial security and their health outcomes. Bill C-64 creates the conditions and the foundation for a truly universal pharmacare system.

Every day, nurses see first-hand the consequences of failing to provide universal equitable coverage for birth control and diabetes medication to their patients, from unwanted pregnancies to individuals who divide their diabetes medication to make it last longer or who go without food. As a first step, Bill C-64 will ensure that all Canadian patients receive the birth control and diabetes medication they deserve. The value to our health system of reducing cost-related non-adherence should be highlighted.

In the report Pharmacare 2020: The Future of Drug Coverage in Canada, Steven Morgan, Danielle Martin, Marc-André Gagnon and colleagues argued that the provision of universal, publicly funded drug coverage will reduce costs to the health care system by preventing the underuse of medications by individuals that can cost the health system between $1 billion and $9 billion annually.

The Canadian Medical Association, or CMA, also commends the federal government for introducing Bill C-64 and fully supports its swift passage. They have said the following: This bill, at its core, is about removing barriers to one of the most fundamental aspects of health care: access. Over 70% of CMA members consider a patient’s ability to afford prescriptions before writing them. With the inclusion of contraceptives and diabetes medications in its first phase, pharmacare will make a significant impact in the lives of so many Canadians. This is a step toward a continuum of affordable and accessible health care for everyone.

A new national poll released in February 2024 found that more than one in four adults in Canada — 28% — have had to make difficult choices to afford prescription drugs, such as cutting back on groceries; delaying rent, mortgage or utility bill payments; and incurring debt. That poll also found nearly one quarter of Canadians — 22% — have reported splitting pills, skipping doses or deciding not to fill or renew a prescription due to cost. In 2021, 16% of adults aged 25 to 34, as well as 4% of seniors aged 65 and older, did not adhere to taking their drugs as prescribed because they could not afford it. As a result, 1 in 10 Canadians with chronic conditions have ended up in the emergency room due to worsening health because they were unable to afford prescription drugs. The cost to the patient’s health and to the health care system is severe.

Much of the work of establishing national pharmacare, as outlined in Bill C-64, will be carried out in negotiations with provinces and with the help of the committee of experts and the newly created Canada’s Drug Agency. In particular, Bill C-64 provides that the new Canada’s Drug Agency will work toward the development of a national formulary — a comprehensive, evidence-based list of prescription drugs covered by pharmacare. They will also develop a national bulk purchasing strategy and support the publication of a pan-Canadian strategy regarding the appropriate use of prescription medications. The minister would further establish a committee of experts to make recommendations on the operation and financing of pharmacare in Canada.

A single entity purchasing medications on behalf of all Canadians will have the leverage needed to negotiate lower drug prices, resulting in billions of dollars in annual savings. Families, individuals and employers will all benefit financially from the implementation of pharmacare.

As Dr. Marc-André Gagnon points out:

The main claims of those opposing universal pharmacare is that such drug coverage reform would eliminate “more generous” private drug plans and reduce current access Canadians have to more expensive drugs. Most of these claims are simply misleading; the fear that a universal pharmacare plan would ration drugs, and impede drug access for some patients, misunderstands the reality of drug coverage, pricing, and access.

The goals of this bill are the following: improve the accessibility of pharmaceutical products, including those through their coverage, in a manner that is more consistent across Canada, which is very important for a province like New Brunswick; improve the affordability of pharmaceutical products, including by reducing financial barriers for Canadians; support the appropriate use of pharmaceutical products, namely in a manner that prioritizes patient safety, optimizes health outcomes and reinforces health system sustainability, in order to improve the physical and mental health and well-being of Canadians; and also provide universal coverage of pharmaceutical products across Canada.

The principles included in the bill are intended to guide efforts to improve coverage for Canadians and align with ongoing work related to drugs for rare diseases and Canada’s Drug Agency. This bill legislates a path to bilateral agreements with willing provinces and territories by providing a federal commitment to long-term pharmacare funding beginning with existing funding for drugs for rare diseases, as was announced in 2019.

On December 18, 2023, the Government of Canada announced the creation of Canada’s Drug Agency. The CDA will be built from the existing Canadian Agency for Drugs and Technologies in Health, or CADTH, and in partnership with the provinces and territories. CADTH is a long-standing organization.

It is vital that the next steps outlined in Bill C-64 are taken without delay so that implementation can begin.

The bill outlines the functions of the Canada’s Drug Agency, or CDA, a key foundational element of national pharmacare, as follows:

Clinical and cost-effectiveness analysis, including advice to inform formulary listing by federal, provincial and territorial drug plans. This formulary is a floor, not a ceiling, and, like all formularies, it is expected to grow. The pharmaceutical data and analytics will be part of their work, as well as appropriate prescribing and use of pharmaceuticals and pharmaceutical system coordination.

The minister must request that the CDA complete the list and strategy no later than the first anniversary of the day on which this act receives Royal Assent.

The minister must, within 30 days of the day on which this act receives Royal Assent, establish a committee of experts and provide for its membership to make recommendations respecting options for the operation and financing of national universal single-payer pharmacare.

The committee must, no later than the first anniversary of the day on which this act receives Royal Assent, provide a written report to the minister setting out its recommendations.

Ministerial outreach will commence on next steps, including discussions with provinces and territories regarding bilateral agreements.

Of course, this work has already begun, and British Columbia is leading the way. That province has already signed a memorandum of understanding, or MOU, with the federal government, paving the way for a bilateral agreement once Bill C-64 has passed in this chamber.

The minister will request that, within one year of this act receiving Royal Assent, the CDA also develop a national bulk purchasing strategy.

As I said in the beginning, medicare has evolved since its inception. Health care in Canada can and must continue to evolve. With Bill C-64, we are taking a first step toward improving access to the care that Canadians want and need.

A universal single-payer pharmacare program is supported by the Canadian public. A 2024 national poll found that around 8 in 10 people — 82% — agreed that the federal government has a responsibility to ensure there is prescription drug coverage for all people living in Canada.

There are 7.5 million Canadians waiting for access to life‑saving drugs. I am asking you, colleagues, to join me in supporting Bill C-64. Let’s take that first step toward better health and well-being for all Canadians.

Thank you. Woliwon.

Honourable senators, I would like to begin by acknowledging that I am speaking to you from the unceded land of the Algonquin and Anishinaabe peoples.

I rise today to speak in support of Canada’s pharmacare act, Bill C-64.

The bill we have before us is a result of collaboration and negotiation between Minister of Health Mark Holland and NDP Member of Parliament Peter Julian. This bill is a first step in delivering on universal single-payer pharmacare. Pharmacare has been a missing piece of the puzzle when it comes to delivering on the promise of a true universal single-payer Canadian health care system.

Bill C-64 is not perfect, but it is important. It is important for us to keep in mind that this legislation is the product of careful and sometimes difficult negotiations in the other place between parties with different views on how Canadian universal pharmacare should be established.

When the Minister of Health appeared before our committee, he emphasized this point when he said:

This is, by far — and I’ve been involved in a lot of complex things — the most difficult bit of business I’ve ever been in. Every syllable and word in this bill was debated and argued over. It is the result of really important collaboration. It was not one political party but two, with two very different views, finding a way to find common ground.

I freely acknowledge that it’s imperfect, but, in this instance, we have to be very careful of not allowing perfection to be the enemy of progress. . . .

I believe the difficulty negotiating Bill C-64 resulted in some ambiguities found in the legislation. However, colleagues, what is not ambiguous is the intent of the bill and how this bill will benefit Canadians.

Senator Omidvar shared statistics from the Conference Board of Canada, highlighting that nearly 10% of Canadians are not insured or can’t afford their premiums.

Senator Osler cited a 2022 Statistics Canada report that found that 21% of Canadians reported not having insurance to cover the costs of prescription medications.

Senator Mégie noted that in the 2019 final report of the Advisory Council on the Implementation of National Pharmacare, they found that one in five people — 7.5 million Canadians — have no drug coverage or insufficient coverage to adequately cover the cost of their medications.

Whichever statistic you choose to believe, we can agree that these are alarming numbers. Those left without affordable access to medications are some of Canada’s most financially vulnerable citizens, and these are the Canadians that will be directly and immediately impacted in a positive way once the program is delivered.

Senators, the ultimate goal here is to create a pharmacare program that truly complements our health care system by making prescription medications more accessible and affordable to Canadians from coast to coast to coast. As the Canadian Federation of Nurses Unions stated in their brief, submitted to our committee:

A universal single-payer pharmacare program is not only a moral imperative but also a practical solution to improving health outcomes and financial stability for all people in Canada. . . .

Colleagues, we heard from witnesses that the list of diabetes medications and contraceptives was far from comprehensive enough, and we heard that the legislation is too limited, focusing only on diabetes and contraceptive medications and devices. I agree. That’s all true.

However, I also agree with the minister’s approach, which is to start with a focused baseline of coverage when launching a universal pharmacare program off the ground. Honourable senators, let’s get a pharmacare program started. A program of this scale and scope is no small task. It has the potential to be a great relief for Canadians from the current patchwork of public coverages and plans.

As you know, pharmacare is a provincial and territorial responsibility. Negotiations with each province and territory will be required. We have already heard that a memorandum of understanding has been signed with the Province of British Columbia, so we know that work there has already begun. I am confident that as the program becomes established, it will continue to expand and evolve. But let’s just get started.

I will be voting in favour of Bill C-64 so that all Canadians will have access to diabetes and contraceptive medications and devices.

Honourable senators, I fully support passing this bill. I believe there are too many uncertainties in the present political climate to delay this bill any longer. If you believe in universal single-payer pharmacare in our country — as I do — I feel it is incumbent on us to pass this legislation sooner rather than later. Otherwise, this opportunity may be lost for what could be another generation. Thank you.

Honourable senators, I rise today on the unceded and unsurrendered territory of the Algonquin Anishinaabe Nation to speak in support of Bill C-64, An Act respecting pharmacare, marking a historic advance for the health and well-being of Canadians, for human rights, for equity and for fiscal responsibility.

As Senator Mégie said yesterday evening, it fills a significant gap in our existing health care system. It is about fairness for the 7.5 million Canadians without insurance coverage.

As Bill C-64’s capable sponsor, Senator Pate, articulated in her second-reading speech, the pharmacare act lays out:

. . . the first and vitally important steps towards national pharmacare for Canada. It outlines a plan to work with all provinces and territories willing to provide universal single-payer coverage of necessary medicines, starting with a number of contraceptive and diabetes medications. . . .

It also supports the development of a national formulary of essential prescription drugs and related products, as well as the development of a national bulk-purchasing strategy to be led by Canada’s Drug Agency.

Senator Omidvar, other colleagues and witnesses at committee have pointed out that the bill is not perfect. Some have called it problematic. There are, in fact, a number of concerns about clarity, definitions, provincial jurisdiction and other points. Most but not all have expressed a desire to move forward no matter what, recognizing this as an important first step.

Colleagues, I will start off by sharing a couple of personal stories related to our topic. I will touch on matters related to the health of Indigenous peoples in Canada, diabetes in particular. I’ll briefly make reference to my province of Nova Scotia, and I’ll conclude with points on the cost of not investing in pharmacare.

Colleagues, 49 years ago, I was pregnant. I was a 20-year-old second-year linguistics student at the University of Ottawa with a long-term boyfriend — since Grade 11, who later became my husband — who was studying at the University of Guelph. The birth control we had used was inadequate and had failed us. We were told abortion was available in New York City and adoption was an option locally.

The pregnancy rocked our world, and it threw me — and us — into a crisis. We did end up raising a wonderful family together, including that first, unplanned child, but I am acutely aware that this sort of outcome was not at that time and still isn’t possible or desirable for many people who find themselves in the same situation.

Access to quality, reliable contraceptives is essential to allowing women to live their lives to their full potential. Action Canada for Sexual Health & Rights provided the following quick facts in their brief, and they encouraged swift passage of Bill C-64: Nearly one quarter of Canadians — 9 million people — are of reproductive age, and 46% of pregnancies in Canada are unintended — like my first one. Seventy per cent of people seeking abortion report no contraception coverage, and cost is the single most important barrier to accessing contraception in Canada. The organization asserts that unintended pregnancies have a profound effect on individuals, families, health systems and society at large.

Colleagues, on another personal note, in 1992, my 71-year-old father, Bernard Charles Patterson, died in the Ottawa Civic Hospital after a diabetes-related leg amputation had led to complications including a stroke and a heart attack. While my father suffered a premature death living in Ottawa, he had access to care, and he was able to afford medications. This is not the case for many others living with diabetes in Canada.

In a September 26 article in The Globe and Mail entitled “Fighting the phantom,” Patrick White cited a number of studies related to diabetes in Indigenous and rural populations. He wrote the following:

A 1937 Canadian Medical Association Journal article stated “Indians are not subject to diabetes,” and cited physical exams and urinalysis of 1,500 First Nations peoples in Saskatchewan where no sign of the condition emerged.

In the 1970s, a study published in the Lancet would shatter that illusion. Researchers found that nearly half of Arizona’s Pimas had diabetes . . . . Canada had its own Pima moment in 1997 when researchers declared that one in four people in Sandy Lake First Nation, located in Northwestern Ontario, had the chronic disease. . . .

. . . In 2002, the Manitoba government issued a report showing First Nations peoples in the province were being treated . . . at four times the rate of other Manitobans, but that their prevalence of diabetic amputations was 16 times higher. . . .

The article stated that in the regional health authority of Marquette, diabetic amputations were 71 times higher for First Nations people.

The author says, “Researchers consider 85 per cent of all diabetic amputations preventable with adequate medical screening and care.”

According to Diabetes Canada:

Canada’s Indigenous populations . . . face greater health challenges than most, including an increased risk of developing type 2 diabetes. This is a result of several overlapping and compounded factors, including Canada’s historic and continued colonial policies, such as residential schools, Indian hospitals, and the 60’s scoop; lack of access to healthy, nutritious, and affordable food; and a strong genetic risk for type 2 diabetes. . . .

Diabetes Canada also notes:

Indigenous peoples are diagnosed with diabetes at a younger age, have more severe symptoms when diagnosed, face higher rates of complications, and experience poorer treatment outcomes.

In their September 25 briefing note on Bill C-64, the National Indigenous Diabetes Association said they support the intent of the bill. They also stated:

While we have concerns about the proposed implementation, we do not wish for the Senate to delay or amend this bill. Access to a number of diabetes and contraception medications is urgently needed by some of the most vulnerable Indigenous Peoples—particularly Non-Status First Nations and Métis—who currently fall outside the NIHB program.

NIHB stands for non-insured health benefits, a program which provides coverage to status First Nations and Inuit.

At committee, Céleste Thériault, the Executive Director of the National Indigenous Diabetes Association, went on to say:

We really believe that this bill offers transformative change to how we care for Canadians, including Indigenous people in Canada, when it comes to pharmacare. . . . Indigenous people need access to pharmacare now — more specifically, non-status First Nations and Métis individuals who are currently paying out of pocket, if they do not have private insurance. . . .

Our colleague Senator Thomas Bernard brought our attention to the work of the Health Association of African Canadians, or HAAC. She highlighted that, like Indigenous people in Canada, African Canadians are disproportionally affected by chronic disease, including diabetes. The organization states:

HAAC is hopeful that removing affordability barriers to prescription drugs and related products . . . will move us closer to the equitable health care we envision.

In Nova Scotia, poverty rates are highest in the country. Twenty-two per cent of families with children in Nova Scotia live below the poverty line, and 39.6% of African Nova Scotian children up to 17-years-old live in poverty. The Nova Scotia Health Coalition states they believe that the introduction of a national public, single-payer pharmacare program is a necessary expansion of public medicare in Canada and that such a program must be universal, accessible, comprehensive, evidence-based, accountable, publicly administered and fully funded.

Speaking of funding, before I conclude, I will move on to raise some points about the costs of not investing in pharmacare.

Colleagues, I am a big fan of Dr. Iris Gorfinkel, a Toronto-based family physician. She is a plain talker and is highly knowledgeable on a range of health issues. I always enjoy it when she is a guest expert on CBC radio, one of my favourite stations to tune into.

I would like to share some excerpts from an opinion piece she and health policy professor Joel Lexchin published earlier this month in the Toronto Star. The title is “We’re doctors. This is the glaring hole we see in our national health care conversation.” I will quote a few sections of that article. The first of them reads:

While much has been said about the added public costs of universal pharmacare, there’s been far too little emphasis on the other costs continually paid from not having prescription drugs covered.

Another section reads:

Nearly 60 per cent of Canadians with diabetes reported failing to adhere to their prescribed therapies due to affordability issues related to their medications, devices and supplies. Unaffordability triggers an expensive cascade of damage to nerves and blood vessels that can lead to heart attacks, stroke, kidney failure and blindness, each of which in turn triggers more visits to the emergency room and hospitalizations and raises the likelihood of prematurely dying.

Yet another section reads:

Unplanned pregnancy forces women to confront abortion, consider allowing their babies to be adopted, or raising a child without the necessary financial, physical, and emotional support. Each of these is costly to not only the health care system, but also to public assistance programs as well.

The article also states:

Unaffordable drugs reduce the overall quality of life and take a toll on both physical and mental health; 7.5 million Canadians lack drug coverage because the cost too often competes with basics like rent and food.

And another section reads:

Every other OECD country offering universal health care coverage includes prescription drugs. The reasons why they do so are crystal clear — to prevent the physical, emotional and societal harms that directly result from unaffordable drugs. Ignoring these multiple benefits minimizes the greatest gifts that universal drug coverage offers.

Dr. Gorfinkel and Professor Lexchin add to the compelling case for Bill C-64, An Act respecting Pharmacare.

Honourable colleagues, the pharmacare act has the potential to have a significant positive upstream impact on the health and in the lives of many people in Canada, particularly the most disadvantaged. This first step in bringing universal pharmacare to Canadians is an important one, and, as our colleagues have said, it will require great attention to get it right, iron out the details and work through the relationships — implementing, evaluating, adjusting and ultimately expanding. A well-designed and well-implemented pharmacare system has the potential to be a game changer for our society, as it will fill the gaps in our highly valued Medicare system.

Honourable colleagues, let’s pass this historic legislation, and let’s follow, support and promote its success. Our fellow citizens are counting upon us.

Thank you.

Honourable senators, I first want to thank Senator Cardozo for allowing me to speak ahead of him today.

A few years ago, a friend of my older sister had lost her parents and, in a scene that will be familiar to many of us, was going through the papers. She posted one of those pieces of paper on Facebook. It was the bill her parents had been given when she was born at the hospital in Whitehorse.

This piqued my curiosity. All my brothers and sisters were born in Royal Air Force stations all over Great Britain, so I knew there were no bills for their deliveries. However, it prompted me, as I have the family papers, to wonder if perhaps in one of those boxes in the basement there was a bill for my birth in Edmonton in 1960. Fortunately, in these days of modern search engines, I didn’t have to go through the boxes; I found that Alberta has provided hospital services at no charge since An Act to amend The Hospitalization Benefits Act had been adopted in 1958 and a cost-sharing arrangement had been established with the federal government.

Our family moved to the Yukon in 1964 for my father to take a position with the Yukon government in hospital and health care administration. I recall in my elementary school days defending my dad’s work on the Yukon’s Health Care Insurance Plan Act. The legislation required mandatory registration, which is not always a popular concept with some Yukoners. The Yukon’s Health Care Insurance Plan Act of 1972 has remained largely unchanged, with the exception of payment and non-payment of premiums. Some of my colleagues with provincial experience might recall those sorts of days and discussions.

For context, honourable senators, the Yukon, until the mid to late 1970s, was very much a territory with administrative links to Ottawa. Elected representatives to the Yukon Territorial Council, now the Yukon Legislative Assembly, assumed greater and greater control. Of particular note, in 1985, the Territorial Formula Financing arrangements were introduced, and the Yukon managed our own budgets through three-year and five‑year plans.

My advocacy for Canada’s health care system that I was arguing in elementary school was reignited when I was an elected politician. During my first Western Premiers’ Conference in 2000, I bore witness to former Premier Klein and former Premier Dosanjh arguing on the team bus about Bill 11 in Alberta. Some believed that it was outside the Canada Health Act. Many times, I have had a flashback when experiencing disinformation among the Canadian public — of Ralph Klein waving his finger at the other premiers and saying, “Have you actually read the bill?”

Most pointedly, at that Western Premiers’ Conference, I also recall former Premier Doer saying that Canada is the fourteenth province at the table when it comes to health care. Canada has responsibility for First Nations, Inuit and Métis people; the Canadian Armed Forces; and the RCMP. His administration was particularly challenged with transporting patients from northern Manitoba to Winnipeg for dialysis and other medical treatment.

Mr. Klein also stepped outside that meeting and resolved a nurses’ strike that had implications for all our budgets.

It was either that conference or another that on the table was the Yukon and the Northwest Territories working with B.C. and Alberta to achieve a bulk buy from pharmaceutical companies on drugs supplied to citizens through hospitals and public programs to achieve cost savings for our health care budgets. It was much cheaper if we all bought together, if only we could work together.

The Romanow Commission followed shortly after my time in office. Bearing witness to my earlier remarks about former Premier Doer and the rising costs of transporting patients, one of the highest costs in the Yukon health care budget is transporting patients to Vancouver, Calgary or Edmonton for medical treatment not provided in the Yukon. One of two recommendations of the Romanow Commission was about access — again, talking about remote and Northern areas’ access to health care services. The principle of access to health care is one of the principles in the Canada Health Care Act.

Romanow also recommended a Catastrophic Drug Transfer to protect Canadians when they require expensive drug therapies, making the system more comprehensive by integrating priority home care services within the Canada Health Act and improving prescription drug coverage.

I left politics around this time to work in the same health care registration and administration offices that my father had once occupied.

Allow me to share with you in-the-trenches experiences with Romanow’s second recommendation, which was pharmacare. In the Yukon, the Pharmacare and Chronic Disease programs provide drugs for those without insurance for a number of specific diseases, diabetes among them. These programs are not income-dependent and rely upon a doctor’s recommendation. For those over 65, prescription drugs are provided at no charge.

There is one key exception, for those who are status First Nations and entitled to coverage under the Non-Insured Health Benefits Program, or NIHB. Such clients would go to NIHB for their drug coverage.

A real-life example of one of the challenges of this dual system when I was involved was the drug Avastin. Originally approved as a bladder cancer treatment, its off-label use was for macular degeneration. NIHB clients were able to access the drug before it was approved on the Yukon formulary as treatment under the Chronic Disease Program. So some Yukoners received coverage and others did not. From a political and administrative background, even today, the administration of and payment for prescription drugs remain issues.

Constituents in the Yukon have shared with me that new high-cost treatments — for multiple sclerosis, for example — might be in one province’s formulary but not another’s. A portion might be covered in one plan and partially by the province, or there might not be access or any coverage at all in another province.

Colleagues, I believe that these personal experiences I have shared with you illustrate a number of points. Ultimately, Canada’s health care system is a work in progress, and we are a comparatively young country.

A side effect of bearing witness and being part of this transformational change, such as this legislation to our health care, is that it calls upon our patience. And I do recognize that for some Canadians, patience is wearing a little thin.

In her book Health for All, Jane Philpott noted, as Senator Pate did in her speech:

Our health systems suffer from arrested development. After impressive progress in the last half of the twentieth century, Canada’s health systems did not implement the full vision of the founders of medicare, which included universal publicly funded pharmacare . . . .

The importance of a national formulary has been discussed so that all Canadians are able to access essential prescription drugs and related products that are needed at a reasonable cost to their health care plans. That’s clause 8 of Bill C-64.

Honourable senators, may I return your attention to the Yukon. In 2018, the then-premier of the Yukon and the then-Minister of Health and Human Resources asked distinguished Yukoners to embark upon a comprehensive review of the health and social programs in the Yukon. Chapter 8 of the report Putting People First was on ensuring financial sustainability. Recommendation 8.4 states, “Work in partnership with the federal government to support a model for a Canada-wide universal pharmacare program.”

This is the Yukon position today, and I am fully supportive of it.

Finally, colleagues, may I note that the Yukon recommendation and my final point today is the reference to partnership. There are currently elections in three provinces, and these are challenging socio-political times everywhere. Development of a national pharmacare program requires all partners to come to the table to continue our work in developing a national health care system that we can all be part of and justifiably proud of.

Just as we are about to come together and gather around the table to give thanks and celebrate family, I see Bill C-64 as Canada setting the table of a national pharmacare program and inviting the territories and provinces to join in the meal. For some in this chamber, perhaps the fork is in the wrong position, or perhaps someone forgot the cranberry sauce. Nonetheless, we sit together around the table. We join in the meal.

Sometimes we have heard senators refer to legislation as sausage making. In a personal note, thanking our retiring Senator Lankin, I recognize that many of her qualities include someone who understands that good legislation is an imperfect process, and that there are times it is better to have a ball on the field and being thrown a Hail Mary pass even if it is not quite as inflated as it should be.

Just like sausages and the preparation of a good meal, it takes time, and it takes essential ingredients.

Bill C-64 has enough of the essential ingredients to undertake a national pharmacare program. I call upon my Senate colleagues to support its passage so that Canada, the provinces and the territories can gather around the table, work together and ensure it is another part of Canada’s health care system that works toward good health for everyone.

Maybe Canada can’t make the provinces come, and there are three provinces in the middle of elections right now. Who is going to predict the future? That being said, I think it is incumbent upon us to help Canada set the table to encourage people to come — to encourage people with kindness and respect for what is going on in their own provinces and territories — and to sit down in order to work out a formula to implement this legislation so that Canadians throughout the country are able, on an equal and fair basis, to access the drugs they need at no charge.

Colleagues, I thank you this afternoon for your time and attention. Mahsi’cho.

Honourable senators, it is a rare pleasure to rise in this important chamber to speak about this very important bill: Bill C-64, or the pharmacare act. I have raised this matter several times in this chamber before the bill was introduced, so it is welcome to be here today.

Colleagues, I am the Progressive Senate Group critic of this bill, so I have 45 minutes to speak, and the Speaker has assured me that we will stay as long as it takes for me to complete my speech; I’m just kidding. I do believe that all speeches should be capped at 15 minutes. If you can’t say it in that amount of time, it is probably not worth it. But that is another issue for another time.

Much has been said about this bill. I want to take a few minutes to place this in the historical context of what we are doing. While we are here, I want to speak to two important developments in 1960 and two more in 1961, which I want to identify because they are relevant today. They involve all three national political parties.

First, in 1960, the Saskatchewan NDP led by Tommy Douglas proposed medicare in the 1960 electoral platform. Second, the Liberal Party of Canada had their “Thinkers” Conference that year under the leadership of Lester B. Pearson, known as the Kingston Conference. That was when the Liberal Party first identified medicare as a national objective, and it became a part of their platform in 1962 and 1963.

Then, in 1961, the government of Tommy Douglas implemented the Saskatchewan Medical Care Insurance Act that was supported by voters in the province, although controversial among some and strongly opposed by the medical profession.

Second, also that year, Progressive Conservative Prime Minister John Diefenbaker established the Royal Commission on Health Services, headed by Emmett Hall — who was also a Conservative — which reported in 1964. In that report, Hall said, “The only thing more expensive than good health care is no health care.”

The federal medicare act was passed by a minority Liberal government and supported by the NDP. The federal NDP of that time was led by the aforementioned Tommy Douglas, whose pioneering program in Saskatchewan inspired the national medicare program.

Interestingly, it is the same situation today. A Liberal minority government supported by the NDP has now brought forward the pharmacare bill.

I want to mention that, in 1966, while the Liberal Party was obviously committed to medicare, the funding of it was yet to be confirmed. The story is that the Minister of Finance was Mitchell Sharp, and, days before the budget of that year, he was considering pulling back from announcing the funds that would make medicare a reality because he felt the government could not afford it. A revolt broke out in the Liberal caucus, and, at the last minute, Sharp put the medicare bill back into the budget.

I say that because, today, much as we might think medicare is a core Canadian value that has been with us forever, it almost did not happen at that time. Who knows what would have happened if it didn’t happen then? I draw the parallel to the national child care program brought in by the government of Paul Martin in 2005-06. And then because it was not confirmed by Parliament in full, it was cancelled by the subsequent government and did not happen until almost 20 years later.

What we do this week in this chamber matters. This is a good chapter of Canadian history that is taking place here.

On the bill today, as the Hoskins report made clear in 2019, Canada is the only country in the world with universal health care that does not provide universal prescription drug coverage. It is about time we stop being the exception and join the mainstream.

The 1964 Hall Commission report that led the medicare reforms actually recommended pharmacare — that the federal government should develop a national formulary, centralize drug purchasing and engage in bulk buying, with prescription costs that should be kept at $1, which in today’s money would be about $10. Emmett Hall’s recommendations on this aspect were not implemented then, and here we are 60 years later, but it is better late than never. I am glad that the recommendations set out by that royal commission are now seeing the light of day.

The roots of pharmacare can be traced to all three parties over six decades.

The next major development was the passage of the Canada Health Act, introduced by Monique Bégin, who was the Minister of National Health and Welfare in the government of Pierre Trudeau. It has five principles: portability, accessibility, universality, comprehensiveness and public administration. Looking back at that significant development, my only regret is that it did not include pharmacare.

To come to Bill C-64, so far, this bill will cover two types of medication. They are very important medications, and this coverage will help a great many Canadians, but I would like to have seen this bill be more ambitious. What we have now is, I think, considered a good and strong start. What we are doing is opening the door to comprehensive drug coverage for Canadians.

I want to take a moment to compliment Minister of Health Mark Holland, a Liberal, and the NDP health critic Don Davies for the bill we have in front of us. It takes parliamentarians with vision and ambition to work across party lines to make things happen, and they did just that.

It has truly been a long road. It is worth remembering that medicare was built brick by brick. Not all provinces signed on immediately. Some had pre-existing systems and they made demands for compensated opt-outs, but in the end, they did join. It took six years to get all provinces on board, but they did come. I want to add that opting out with compensation remains an option in this bill, in my view, whether for Quebec or other provinces.

Colleagues, I support Bill C-64. I support finishing the work of John Diefenbaker, Emmett Hall, Lester B. Pearson, Tommy Douglas and Monique Bégin on the work they have done over these several decades. Thank you.

Senator Batters, do you have a question?

No.

Will Senator Cardozo take a question?

Given the time, I’m happy with the questions I have answered. Thank you.

Honourable senators, as an independent senator from Manitoba, I acknowledge that I come from Treaty 1 territory and the homeland of the Red River Métis Nation. I thank the Algonquin Anishinaabeg peoples for allowing the Parliament of Canada to be situated on their unceded territory.

Honourable colleagues, for some years now, I have been honoured to co-chair the Canadian Association of Parliamentarians for Population and Development, which focuses on how we as parliamentarians can promote and protect sexual health and reproductive rights with the freedom to choose as the core value. Contraception is a foundational component of this pharmacare legislation and essential to the mental and physical health of millions of people in Canada. Today, I wish to give voice to young leaders in Canada who treasure their sexual health and their reproductive rights.

With kudos to Senator Pate for her skillful sponsorship of this important, life-changing bill, and to our colleagues on the Social Affairs, Science and Technology Committee, ably chaired by Senator Omidvar, for their careful and thorough examination of Bill C-64 on our behalf — I miss you guys — Bill C-64 is highly aspirational and should be viewed as an entry point. It is not perfect, but it is needed now, and I am eager to vote in support to make it law in Canada.

I thank my Manitoba colleague Senator Osler for setting out her thoughtful concerns yesterday because I share the worry for a smooth implementation with the necessary bilateral funding negotiations that must follow. It is not a surprise that our common law shows that the lack of clarity on payment allocation in health services will likely give rise to potential legal challenges. This was seen in Chaoulli v. Quebec, highlighting the tension of how unclear responsibility between private and public health care funding can cause legal conflicts. I note well the concerns that were voiced by Senator Gignac.

A second apprehension concerns the mandate and composition of the proposed committee of experts. As was stressed by multiple witnesses at committee, transparency and accountability must be vigilantly enforced pertaining to committee membership, conflict of interest and, perhaps most dangerous, potential industry interference. I endorse Senator Moodie’s assertion that this bill should properly be viewed as the ground floor, not the ceiling. But it is a beginning, long overdue and desperately needed.

For all the shortcomings in this bill, the NDP and government should be commended for prioritizing contraception medication as an initial class of covered medications. The ability to make informed choices about sexual health and to access adequate sexual and reproductive health services is, theoretically, a basic right in Canada. But, as I regularly reminded my students in human rights, knowing your rights, claiming your rights and living your rights are, in fact, three different states of being.

The truth is that, in Canada, even with the legal precedents in place, the lived reality of women, girls, two‑spirit, trans and non‑binary people is too often lesser in actuality than the concept of their rights. Their autonomy, safety, self-determination and ability to make true choices often cannot be lived, currently, as their rights.

Some have been disproportionately impacted. Indigenous women and women with disabilities have faced forced sterilization and forced contraception. Socially marginalized women and those with low incomes experience continued barriers to reproductive health because they can’t afford it. Young people have had uneven sexual health education at school. Achieving an inclusive democracy in Canada requires true reproductive justice. This includes access to a full spectrum of supports, including abortion services, birth control, health education and family planning.

Nearly a third of Canadian women have at least one abortion in their lifetime, but access differs wildly depending on who you are and where you live. The evidence clearly indicates that supporting genuine reproductive choice provides a wide range of benefits to society, to children and to their families. As Senator Coyle noted today, many pregnancies in Canada are unintended. Marginalized and vulnerable populations are overrepresented among those with unintended pregnancies, particularly among those seeking contraception and reproductive health choices.

Currently, in Canada, safe contraception is often just a dream for many people, including those who are living in northern, rural or remote locations, of Aboriginal heritage, living with substance use or mental illness and of lower socio-economic status. In the absence of a federal drug plan, access to modern, effective and affordable contraception differs from province to province or territory to territory despite Canada having a universal health care system and a universal health care act.

Across the country, provinces provide a patchwork of financial supports to access contraceptives, meaning that while targeted vulnerable populations such as young people, low-income and uninsured people may have subsidized access to some form of contraception, financial cost remains the greatest barrier to overall access for Canadians. While financial coverage remains inconsistent, people must rely upon networks of advocacy organizations such as Action Canada for trustworthy, evidence-based information on the available forms of contraception in their respective provinces and territories, help on how to obtain them and be empowered to make decisions that are right for their health.

Senator McPhedran, I’m sorry, it being 4:00 p.m., I have to interrupt.