[Recorded by Electronic Apparatus]
Thursday, October 24, 1996
.0932 
[English]
The Chairman: Can we come to order?
On the issue of our pre-budget discussions, the Standing Committee on Finance of the House of Commons is very pleased to have before us today a group representing just about every aspect of Canada's health care delivery system that I can imagine. With us are, from the Council for Health Research in Canada, Dr. Richard Murphy, director of the Montreal Neurological Institute and Hospital; Bill Tholl, executive director of the Heart and Stroke Foundation of Canada; Russell Armstrong of the Canadian AIDS Society; Kenneth Kyle, director of public issues with the Canadian Cancer Society; Mr. Darrell Brown and Mr. William Anderson from MEBCO. From the Royal College of Physicians and Surgeons of Canada comes Hugh Scott. Also with us are Dr. Barry McLennan from the Coalition for Biomedical & Health Research; Michael McBane from the Canadian Health Coalition; Judith Kazimirski of the Canadian Medical Association; and Cal Gutkin of the College of Family Physicians of Canada.
Have I missed anybody? Yes, Mr. Léo-Paul Landry. I'm sorry, I don't have you on our list here. I apologize.
Having stumbled through that, I apologize to you all.
As I understand it, you will each be making about a three- or four-minute presentation, after which we'll go to questions from members. If any of you have not had adequate time to express your views, we'll make sure you get it. I'll then ask each of you to summarize very briefly before we wrap up.
Thank you very much for being with us. I understand we're going to start with you, Judith Kazimirski.
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Dr. Judith C. Kazimirski (President, Canadian Medical Association): Thank you,Mr. Chairman.
As the voice of organized medicine in Canada, the Canadian Medical Association welcomes the opportunity to meet with you today.
[Translation]
As spokesperson of the Canadian medical profession, the Canadian Medical Association is pleased to meet with you today.
[English]
The CMA is committed to a strong, publicly funded health care system. Promoting the highest standards of health care for Canadians is central to our mission. Because of this, we must express alarm at this government's performance in the area of health. The Canadian Medical Association is of the opinion that when this government's record is assessed, it will receive a failing grade on the subject of health care. Whether it is this government's inaction on tobacco control or its cuts to health care funding, it is clear that the current government has lost touch with the compassionate values that once set it apart from other parties.
Today we will focus on health care funding. The truth is that the Canadian health care system is in decline. The single, most important reason for the deterioration of the system is the significant and ongoing decline in federal financial support for health care funding. After chronic destabilization caused by $30 billion withheld from the federal health transfer payments since 1982, the cuts now continue. As of April 1, 1996, this government has cut $2.5 billion from the Canada health and social transfer. The government is scheduled to cut another $4.5 billion next year, and another $1.4 billion in cash leading up to the year 1999-2000. This translates to mean that the level of federal cash transfers for health and social programs will effectively be cut in half between April 1, 1995, and April 1, 1996. Canadians are saying enough is enough, and our message is simple: the cuts have gone too far.
We have surveyed the population on this issue. Our polling results indicate that Canadians are now very aware of problems within the system. Almost three-quarters of Canadians think cuts in health care funding have adversely affected the quality of care in their communities. Our members - physicians - are at that interface between the patient and the system, and they are discouraged about the continued ability of health care providers to ensure access to quality health care for Canadians.
It is time to put on the brakes and stop all further cuts. It's time for a re-infusion of money into the health care system. Already, three provinces have admitted that they have cut too much, and they are now putting money back into their systems. It's time for all governments to take a serious look at the funding of Canada's health care system. Canadians look to you, our federal MPs, to be the protectors, not the destroyers of our health care system.
To restore access to quality health care for Canadians, the Canadian Medical Association recommends: that the federal government refrain from implementing any further scheduled cuts to the CHST cash component; that the federal government fully index the total CHST entitlement to growth in the economy beginning April 1, 1997; and that the federal government convene a meeting of federal, provincial and territorial ministers of health and finance to assess the affects of health care funding cuts made to date.
[Translation]
Mr. Chairman, we thank you for this opportunity to contribute to the budgetary process.
[English]
Mr. Chairman, we thank you and all members of this committee for giving us the opportunity to contribute to the budget-making process.
Thank you.
The Chairman: Thank you very much, Dr. Kazimirski.
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Our next witness is Dr. Richard Murphy, from the Council for Health Research in Canada.
Dr. Richard Murphy (Director, Montreal Neurological Institute and Hospital; Representative, Council for Health Research in Canada): Mr. Chairman and members of the committee, I am the director of the Montreal Neurological Institute and Hospital at McGill University. I'm here today to represent the Council for Health Research in Canada, a coalition of voluntary health agencies and medical research institutes across Canada, representing thousands of medical scientists, volunteers and donors committed to medical research aimed at treating and curing disease.
We are here today to speak out because government has significantly reduced funds for university-based basic research in medicine and other sciences. Adjusted for inflation, these cuts will amount to 25% over four years. The cuts have been taken to reduce the deficit, but cuts of this magnitude will disadvantage Canada for years to come by severely limiting Canadian-produced innovation and technologies. If university science were a horse, it would have lost an entire leg.
Consider Canada's cuts to science research in light of these four international comparisons. All other G-7 countries are increasing their support for university-based science, while Canada is the only country to reduce science funding. No other country in the OECD, save Italy, allots less to science research than Canada. At a time when Canadian medical research funding is being reduced by 25%, U.S. medical research funding will increase by 20%. And Japan, which is a country currently in recession and which has a higher per capita deficit than Canada, is going to target $175 billion U.S. to university-based science over the next five years. The reason is that Japan realizes today's technology is spent and tomorrow's major technological breakthroughs will emerge from university-based science.
In short, the rest of the world is strengthening university-based science and Canada is gutting it. The irony is that university-based science has proven to be an excellent investment for Canada. It creates innovative technology in new equipment. It trains students for high-technology jobs. It links Canadians to the world network of science, it creates spin-off companies and jobs, and, most importantly, it creates a science infrastructure that is essential for the idea economy of the next century.
We are now in real danger of losing our best scientists and students to the United States, where the smart money is flowing towards innovative science, and Canada will quickly fall behind in emerging technologies like biotechnology, which is already a $50 billion growth industry. For the next budget, the federal government needs to recognize that university-based science is not an expense but an investment in the future. There should be no further cuts for Canada's science councils, and funding for university-based science should be restored to 1994 levels at a minimum.
The public wants to save university science. Canadians are highly knowledgeable about science, and they want our universities to be competitive in a technological world, a world that is not going to stand still for Canada. A three-legged horse won't carry Canada into the 21st century.
Thank you, Mr. Chairman.
The Chairman: Thank you, Dr. Murphy.
From the Heart and Stroke Foundation, Bill Tholl, please.
Mr. Bill Tholl (Executive Director, Heart and Stroke Foundation of Canada): Thank you very much, Mr. Chairman. Bonjour, mesdames et messieurs. I'm here as the national executive director of the Heart and Stroke Foundation of Canada.
The Heart and Stroke Foundation is the second largest charity in Canada, next to that of my colleague from the Canadian Cancer Society. Total fundraising last year was approximately $65 million, over 80% of which goes into biomedical research, health promotion and educational programming.
This is our 40th anniversary at the Heart and Stroke Foundation of Canada. Our alumni, if you will, include the likes of Dr. Fraser Mustard and Senator Wilbert Keon. As we look into our 41st year, I'd like this committee to know and remember as we discuss some of these issues that we don't receive one dollar from government in terms of direct support. All of our money comes from fund-raising, from kids jumping rope - which we'll come back to in the form of an analogy later on - from door-to-door canvasses, and from corporate gift canvasses.
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There are three basic messages that I carry into the committee, one of which is as a member of the coalition you've just heard from and that is dedicated to looking at ways in which we can stabilize federal government support for basic or discovery-level research in this country. From the Heart and Stroke Foundation point of view, however, I want to give you what is perhaps a concrete indication of what we think are some of the repercussions of decisions that have been taken in the past - and I am aware that we are in a sense preaching to the converted with this committee, which has recommended on at least two different occasions not to reduce spending on biomedical and other basic research.
From the Heart and Stroke Foundation's point of view, you need to understand that our applications have increased by 20% over the last two years. On fund-raising, I think the Canadian Cancer Society and the Heart and Stroke Foundation are among the few that have been able to sustain, let alone increase or grow - we saw a 1% growth last year - their total revenue bases. So there has been a 20% increase in demand and a 1% increase in the supply of funds to do worthwhile heart and stroke-related research. I might add that Canada is among the best in this if you look at things like citation indices and other kinds of indirect indicators of how good a job we do in this whole arena.
Because we have not had sufficient time to form them, it's not my place here today to make specific recommendations to this committee. I would first commend the government for its initiative in the health service research fund, however, and simply say to Mr. Dingwall and others, get on with it, let's get going on the $65 million. I would also give credit to the government where credit is due in terms of some of the smaller things that were done in the budget of last year to encourage Canadians to give to worthwhile charities.
We look forward to working with Mr. Martin and the Department of Finance. We are a member of another coalition that I understand is to speak to this committee at a voluntary sector round table. There is a group called the Charitable Incentives Review Task Force, and I believe it has spoken with this committee. I would simply urge you to take seriously that process, and to look particularly at the stretch proposal, which I understand they've been speaking about with you.
These are all important parts that will help us to grow the revenues, but at the end of the day charities can't pick up the slack from decisions that are taken at the federal government level. We've heard about the $7 billion on the CHST. We have an $80-billion industry, and I just remind you that we are the second-largest health charity with $80 million in total. The total health care spending envelope is 1,000 times greater in this country. We can't expect the charities to take up the slack as the deficit reduction strategies get passed along.
Finally, Mr. Chairman, the third point I'd like to bring to you is the need to harmonize a different kind of tax. We read yesterday about the harmonization of the GST or HST. It's time to start looking at harmonizing the north-south tobacco taxes, but I leave it to my colleague from the Canadian Cancer Society to perhaps elaborate on that. We would, however, certainly stand four-square in favour of moving at this time to begin to remedy and to make up some of this shortfall that has been created over the past number of years.
Thank you for the opportunity to be here. We only had 48 hours notice. We had planned to have a written submission but were unable to do it within that timeframe.
The Chairman: Thank you, Mr. Tholl.
We now have Mr. Kyle, who is here from the Canadian Cancer Society.
Mr. Kenneth Kyle (Director of Public Issues, Canadian Cancer Society): Thank you,Mr. Chairman and members.
The Canadian Cancer Society has sent me here today with one main message: if we give more attention to the health system, this will have positive impacts on the health care system later on. Let me give you a few examples.
I agree with my colleague from the Heart and Stroke Foundation. If we include measures in the budget to encourage more charitable giving, it will help the health system. My colleague has mentioned the Charitable Incentives Review Task Force. We understand some very good dialogue has taken place with Department of Finance officials. We, too, would encourage a look at the stretch credit proposal.
In the area of research - and I think I am speaking for a board of lay people across Canada; I'm not here representing scientists - the board of directors of the Canadian Cancer Society, along with its volunteers from across Canada in every block and rural community, is really concerned about the cuts to granting councils and NHRDP, MRC, SSHRCC and NSERC. These cuts threaten the effectiveness of the money raised by the Canadian Cancer Society for health research.
.0950
One point I'd like to make here is that if there are sufficient funds for health research, the research can be undertaken to figure out how to contain health care costs. If research is done to evaluate new therapies and existing therapies, we can actually save money down the line.
We're concerned about women's health. We recommend that Health Canada have the funds to continue the Canadian breast cancer research initiative for another five years, so we don't lose the tremendous current momentum in breast cancer research in this country right now and so we can accurately assess the gains that have been achieved in the first five years of the program.
Another emerging issue is prostate cancer. By the year 2010 the incidence and mortality rate will increase by 50%. We think Health Canada needs the funds to develop strategies to deal with increases in prostate cancer.
I have two last points. One is tobacco taxation. Young people are very price sensitive to tobacco products. As we make tobacco less affordable, fewer kids will start smoking.
We have eight recommendations. I won't go into detail; they're in the handout.
We recommend extending the current manufacturers surtax, which is due to expire in March 1997, and our paper gives some reasons for that. We think the excise tax could be increased to replace tobacco sponsorship money, in consultation with the arts and sports community. We need to end the tax subsidy for fine-cut tobacco products. We need to end different federal taxes in different provinces. We would like to see a timetable for a return to higher tobacco taxes.
I think some research and thought should be given to looking at health-based tax differentiations. Maybe we could have higher tobacco taxes for higher-tar cigarettes. After you get to a level of four milligrams of tar in a cigarette the incidence of cancer from smoking those kinds of cigarettes jumps dramatically. Perhaps that would contribute to health.
We agree that sufficient resources should be given to Revenue Canada and the RCMP to continue to monitor and control tobacco smuggling from the U.S. With the hope that we will have new tobacco legislation tabled in the House of Commons by the Minister of Health...Health Canada will need sufficient resources to enforce the new tobacco legislation and to enforce the current Tobacco Sales to Young Persons Act.
Finally, as I mentioned at the beginning, we need to concentrate on health status as well as health care. We think there should be a focus on the prevention of illness as well as on the treatment of individuals with disease. We think federal departments and agencies should have adequate resources to develop public policies that have an impact on health. It's not just the health department and the finance department, through transfer payments; many federal departments and agencies can enact healthy public policy. Maybe a health impact statement should be given for every policy developed by various ministries.
The Chairman: Thank you, Mr. Kyle.
From the Canadian AIDS Society, Mr. Russell Armstrong.
Mr. Russell Armstrong (Executive Director, Canadian AIDS Society): Mr. Chairman, members of the committee, thank you for the opportunity to speak this morning.
Unlike my two colleagues who spoke previously, the Canadian AIDS Society represents charitable organizations at the other end of the spectrum, where because of the issue we deal with and the relative newness of the particular condition of what the Canadian AIDS Society is all about, we're a charitable organization that relies quite heavily, at this point, on government support.
I want to speak on two areas this morning. One is budget issues affecting organizations, since we're a coalition of community-based organizations. The other is budget issues that affect individuals with chronic conditions such as HIV/AIDS, since we're also the national voice for people living with HIV/AIDS and affected communities.
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Some of you may know this, but some of you may not. AIDS is now the leading cause of death for men between the ages of 25 and 44 in Canada's major urban centres. It's the second leading cause of death nationally for men in this age group.
John McCallum, the chief economist for the Royal Bank of Canada, recently estimated that in 2000, the cost of human capital lost to AIDS will be more then $15 billion.
Despite the fact that almost one in three Canadians say they personally know of someone with HIV/AIDS, the disease is still heavily stigmatized and competes very poorly in the marketplace of charitable causes that attract private sector support. If not for government funding through the national AIDS strategy, there would be no community-based response to this disease and no effective national leadership on this important health issue.
As some of you may know, the national AIDS strategy expires on March 31, 1998. That's just over a year away. Because it's over a year away, it may make making a decision on this issue beyond this current budget year... Given that we're dealing with a health epidemic, acting proactively in trying to address this question as soon as possible makes better sense to me than waffling and waiting until the last minute.
The current Minister of Health has said that he's interested in dealing with the question, although time is ticking and as yet we haven't seen any clear direction.
I want to talk specifically about one of the most important components of the national AIDS strategy, which is its support for community-based AIDS programs. The strategy has helped build a national infrastructure of local, volunteer-driven agencies with direct links to people living with HIV/AIDS and communities most affected by the disease. I think this aspect of the strategy has been one of the most successful joint ventures nationally, as most agencies receive, in addition to federal funds, support from provincial, regional, and local levels of government, as well as private sector dollars.
An investment of a few hundred thousand dollars for some of the larger health agencies supports an agency that delivers volunteer health-related services. If we value them nominally at $10 or $12 an hour, we quickly arrive at a value of service of several million dollars.
It's estimated that the total cost to society of one AIDS case is now $600,000, including direct and indirect costs. So if we give one agency $200,000 and they prevent only one new transmission, it's clear that they've then paid for themselves three times over.
Since these organizations are charitable, it's clear that they will benefit from improved incentives for individual and corporate giving. We have also been studying the options proposed by the Charitable Incentives Review Task Force. Most individual donors to these organizations contribute small amounts, so we're more interested in improving the tax treatment of donations at this level and improving incentives for corporate donations than some of the more complex proposals regarding endowments and large, one-time givers.
As I mentioned, there are several budget issues for individuals that I'd also like to address.
On the whole, what people living with HIV face, as well as other people with chronic disabling conditions, is a number of barriers, particularly in the employment sector, that make people living with HIV and other health conditions dependent, tax-receiving citizens, rather than productive, tax-paying citizens, which is what they would otherwise be.
Currently the single highest-priority issue for us and for our community of people living with HIV/AIDS is the cost of medication and the way our society does and doesn't assist people with that measure.
In terms of the employment market, group benefit programs for new employees routinely exclude those with pre-existing conditions. This is what happens. When you're faced with drug bills of more than $10,000 a year and you can't get that covered through employment-based benefit programs, you end up taking the route toward social assistance in order to get drug benefits covered.
So we have a situation in which people who would otherwise be able and willing to work are forced to make the hard choice of being totally dependent on government assistance merely to get their lifesaving medications paid for. I think that kind of situation is a tragedy and an unbelievable gap in our social and health policy at this point.
Because people living with HIV/AIDS, for one of the reasons I mentioned, rely more and more on government assistance programs, and because their health needs are quite extensive in the late, symptomatic stages of the disease, they're acutely affected by cuts to health and social programs.
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In recent public opinion research that we conducted, over 80% of those polled opposed further cuts to health spending. A majority supported maintaining or increasing spending on programs that care for the sick. In addition, more then 86%, when asked directly about the national AIDS strategy, for instance, and the role of the federal government in providing funding to support AIDS programs, supported maintaining or increasing this money in the future.
In conclusion, I'll just emphasize two points. I believe the federal government has a responsibility for the welfare of disabled Canadians, including those with terminal illnesses like HIV. I think that while we all like news about positive economic terms and better-than-forecast deficit reductions, this cannot be achieved on the backs of Canadians least able to do with less or least able to benefit from these economic developments.
The other point, on which I'll conclude, is that voluntary health agencies, like those that belong to the Canadian AIDS Society, provide substantial economic benefits and cost savings. The money the federal government spends on these organizations is minimal compared to their benefit. The investment in the national AIDS strategy, at $40 million a year, is a drop in the bucket compared to the costs that might have accrued if the federal government had not taken the lead in this particular health issue.
For us, at the moment, all of this hangs in the balance. I guess the question is: will we take the high road and do the right thing or, for the sake of cutting costs, will we gamble on the odds of a disaster because we don't think we can afford our success any more? Thank you.
The Chairman: Thank you, Mr. Armstrong.
From the Multi-Employer Benefit Plan Council of Canada, William Anderson and Darrell Brown.
Mr. William D. Anderson (President, Multi-Employer Benefit Plan Council of Canada): Thank you, Mr. Chairman and members.
The committee may be familiar with MEBCO, Multi-Employer Benefit Plan Council of Canada, but for those who aren't, MEBCO represents more than one million Canadians involved in diverse industries throughout Canada in multi-employer benefit plans and pension plans. These industries cover such trades as graphic arts, food, retail, hotels, garment manufacturing, security, textiles, transportation and, of course, building and construction.
Part of my comments over the next four minutes may diverge a little from the health field, but I think that, overall, they will fit. We must get our points across. I have six points I'd like to touch on if I may, please.
The first point is the taxation of multi-employer pension and benefit plans, MEPPs and MEBPs, under the GST. Single employers who sponsor group benefit plans and pension plans are eligible to claim input tax credits, ITCs, respecting the GST. It pays for administrative service charges to the extent that the employer is engaged in commercial activities.
MEPPs, under current Revenue Canada policy, are not permitted to claim ITCs. Consequently, the cost of administering an MEPP is up 7% more than the cost of administering a plan sponsored by a single employer.
MEBCO opposes this inequitable treatment and requests that the standing committee recommend legislative amendments to correct this anomaly.
The second point is the harmonization of the GST and provincial retail sales tax. The federal government is actively pursuing harmonization of the GST with provincial retail sales tax. The tax base under harmonization is a matter of negotiation between federal and provincial officials. Ontario has yet to agree to harmonization.
Currently, Ontario levies a retail sales tax on contributions to group health and dental programs in the amount of 8%. MEBCO opposes the imposition of this tax by the Ontario government and also opposes its harmonization with the GST.
The third point is the taxation of health care and dental benefits. We reiterate our conclusion from our previous pre-budget submissions. The taxation of group benefit plans will discourage workers from participating in health programs, thereby placing the corresponding burden on the public health care system, which clearly is in no one's interest.
It would be more appropriate to provide the comparable tax treatment to self-employed individuals with respect to the purchase of health care and dental coverage. This would eliminate the current inequity in treatment between employed and self-employed individuals. Fewer than 7% of Canadians at the present time are self-employed. They must self-fund supplemental health benefits.
The fourth point is the taxation of pension and retirement saving plans. The characterization of this tax assistance as an expenditure is incorrect; this is a tax deferral. The assets and pension plans will be subject to tax upon the pay-out of pension benefits. MEBCO opposes any attempt to tax either contributions or earnings in registered pension and retirement savings plans.
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MEBCO opposes any lowering of the targeted pension area. The effect of lowering pension levels is to delay retirement - we know that. Individuals will retire when they have the necessary financial independence that will permit a reasonable standard of living in retirement.
Fifth is Canada Pension Plan reform. MEBCO strongly recommends that the CPP continue to provide the benefits that have been promised to working Canadians and stress that any changes to the structure of CPP render it accountable to the contributors to the CPP.
MEBCO accepts that there must be changes in the contributory rate and contributory period and outlines specific proposals in the body of this submission. However, MEBCO strongly opposes any increase in the retirement age or reduction in benefits. MEBCO acknowledges that CPP is comprised of two different types of benefits - a retirement pension benefit and disability, death and survivor benefits - and it may be more appropriate to establish different funding mechanisms for both elements.
The final point is amendments to the Pension Benefits Standards Act. MEBCO suggests that the governance of pension plans does not parallel other financial institutions, and in particular the issues that face MEPPs differ significantly from those that face single-employer plans. Any move to streamline all financial institution legislation that ignores the special nature of pension plans will result in legislation ill-suited to the promotion of and proper governance of registered pension plans.
MEBCO strongly opposes any process that demands more than 100% funding of benefit promises. Also, in conclusion, establishing in the superintendent a power to issue formal directions to plans where alleged imprudent or unsafe practices exist must also provide an opportunity for representations to be made by the person or bodies affected by such directions. It is not sufficient merely to provide an avenue of appeal.
Thank you, Mr. Chairman.
The Chairman: Thank you very much, Mr. Anderson.
From the Royal College of Physicians and Surgeons of Canada, Dr. Hugh Scott, please.
Dr. Hugh M. Scott (Executive Director, Royal College of Physicians and Surgeons of Canada): Thank you, Mr. Chairman.
The Royal College of Physicians and Surgeons of Canada, whose mission is to promote the highest possible standard of specialist medical care for the people of this country, also represents more than 25,000 medical and surgical specialists in Canada and some 5,000 specialists abroad.
[Translation]
On behalf of the Royal College, I would like to thank you for this opportunity to express some of the basic steps that have to be taken to ensure the survival of a quality health system in Canada, within the present economic context where each dollar is important.
[English]
The first point we would like to address relates to the funding of the health care system. We recognize that there is no clear evidence of a proportional relationship between increased expenditures in health care and the health status of the population. That is, ``more dollars'' does not necessarily mean ``more health''. The system, however, has not had the opportunity to assess fully how much less dollars will mean in terms of the quality of care. Physicians, hospitals, academic health science centres and faculties of medicine, and even patients in this country are feeling the multiple effects of the changes in the health care system, which for the most part are being driven by economic factors.
The environment has been well summarized by Dr. David Naylor, one of our fellows, a general internist and leader in health care research in Canada, and I quote:
- Every Canadian province is now struggling to reduce health care expenditures without
jeopardizing access to health care and quality of care. This challenge is compounded by rapid
technological change, an aging population, demands for greater accountability and growing
awareness of unexplained variations in clinical practice.
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The wisdom in finding some stability has been recognized, for example, in the Province of Alberta, which since 1993 has slashed health care spending by more than $500 million, but in 1996 established a moratorium on further cutbacks, taking effect this year, to assess amongst other things the results of budget reductions and to focus on setting priorities for care.
These priorities, we feel, must also include taking steps that will ensure a sufficient number of physicians in the future. Adjustments to the system are not taking into consideration the fact that we must deal with an increasingly aging specialist workforce that will have to provide care to an even more aging population, which is the highest consumer of health care services delivered by physicians and surgeons.
We are faced, for example, with alarming statistics that show that more than 50% of general surgeons are 55 years of age and over, and that in seven provinces, 40% of internists are in the same age group. Conventional estimates show that in a situation of declining enrolment and output, eventually existing cohorts will be larger than entering cohorts when we talk of physicians entering the medical workforce.
What this translates to is that in less than 20 years there will be more graduates of Canadian medical schools leaving the medical workforce than entering. We are thus unnecessarily denying satisfying careers in medicine to literally hundreds of Canadians. This arises from the dubious assertion that health care costs can be significantly contained by decreasing the number of physicians, especially specialists.
From the perspective of the Royal College, it is a challenging task, to say the least, to strive to establish education objectives that will produce future specialists and clinical researchers in this country who are able to respond to the societal health care and research needs. We are planning in an environment that is unnecessarily unstable.
Bearing in mind that it takes an average of between four and seven years to prepare a specialist after graduation from medical school and another three or four years for a clinician scientist, we must be able to plan on more stable ground.
To emphasize this I would point out that it's already too late to influence the number of Canadians entering specialty practice prior to 2005, and for specialist clinician scientists we're talking about 2010. We all need some time to take stock.
Therefore the Royal College strongly recommends that health care spending be given higher priority and that funding under the Canada health and social transfer initiative be guaranteed and at a minimum be sustained at current levels for at least three years to allow for an evaluation not only of the impact of the reductions but also of the effectiveness of realignments resulting from funding cuts.
The second point we would like to raise today deals with research support in this country. Our colleagues from the Coalition for Biomedical and Health Research and numerous other groups represented here this morning make a clear case that basic research and its validation through clinical research produces positive effects on the economy of Canada and creates highly skilled jobs. Basic research as well as applied, clinical, health and health care research also have a positive impact on our economy as we see more effective means of providing care, shortened hospitalization and reductions in the cost of providing many types of health care.
We thus applaud the government for introducing in its 1996 budget the new health services research fund. We strongly urge you to ensure that this fund is realized to its full potential and to bring corrective measures in the 1997 budget to provide the granting councils with funding levels that will place Canada in a competitive position with other G-7 countries.
[Translation]
Thank you, once again, for the opportunity to speak to you, Mr. Chairman.
[English]
The Chairman: Thank you, Dr. Scott.
From the Coalition for Biomedical and Health Research, Dr. Barry McLennan, please.
Dr. Barry McLennan (Chair, Coalition for Biomedical and Health Research): Thank you, Mr. Chairman, for inviting the coalition to appear before the committee.
I believe you have copies of our brief in front of you.
In September the Conference Board of Canada delivered an ominous message to all of us. They said our relative position among our competitors has slipped drastically in the past decade.
As we debate the changes in federal transfers as defined by the Canada health and social transfer initiative, we must strike a balance between preserving and enhancing our quality of life and maintaining our competitive position in the world.
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The former Minister of Health, Diane Marleau, stated that this is the role of research, to preserve our health system in difficult circumstances. This June our present Minister of Health, theHon. David Dingwall, stated that Canada must set priorities to address critical research funding gaps that could threaten our internationally competitive health research capacity. He was of course referring to this graph, which shows an alarmingly low level of health research funding in Canada compared to our G-7 countries. The graph is in appendix 2 of the brief.
Like some of my colleagues who've spoken this morning, I believe the government should be commended for having recently introduced a new health services research fund. Given that this endowment should grow to at least $300 million, it should yield significant annual support for evaluative health research, the kind of research Dr. Scott was just referring to.
CBHR recommends that health care spending be stabilized for a minimum of three years at current levels to allow an optimal use of evaluative research and give us time to adapt the health care system to the new fiscal realities.
If I might be permitted a quick personal note, I'm from Saskatchewan, the birthplace of medicare. It's very important to me that we preserve our health care system, but I'm not alone. A poll in August showed that my view is shared by most Canadians, who said focus on health care preservation and focus on education.
Most importantly, a study in the United Kingdom by Her Majesty's Treasury clearly reveals the benefits of health research. It's important to point out this was not done by health researchers. These benefits are listed on page 5 of our brief.
Here in Canada we have seen evidence of concrete benefits resulting from research supported by the Medical Research Council of Canada. BioChem Pharma in Quebec, TerraGen in British Columbia and Vascular Therapeutics in Ontario are only three examples. BioChem Pharma, for example, grew from a few people in a university laboratory to 1,000 employees within 10 years. They are now the fourth-largest biotech company in the world.
As stated in my article published in The Globe and Mail on July 15, health research funding in Canada is in a tailspin while all our G-7 competitors are increasing their investment. Earlier this month at a meeting of the Council of Deans of Medicine, it was revealed that cuts to transfer payments for health and post-secondary education this year translated into an 18% to 30% decline in support for biomedical, clinical and health infrastructure at the academic health centres.
Our second recommendation, therefore, is that the committee urge government to bring corrective measures in the February 1997 budget that will provide the granting councils with funding levels competitive with the other G-7 countries.
Third, it's imperative that the Advisory Committee to the Prime Minister on Science and Technology evaluate the impact of the government's deficit reduction measures on research in Canada.
If we are to preserve Canada's health care system, we also need to be more innovative in health research funding. Our proposal, built on the concept of potential output, looks not only at stabilizing funding for three years but at creating 32,000 jobs in the near future, low-cost jobs, at $5,500 per person per year. This is 20 times less than the cost of creating one job by venture capital investment.
In the longer term, given strong leadership by the federal government, other beneficiaries of research such as the medical device industries, the generic pharmaceutical companies and the insurance companies should be enticed to contribute funding for health research.
In conclusion, as stated earlier in a presentation to this committee, the Hon. Paul Martin stated in front of this committee:
- There are things businesses and markets can't and won't do. The private sector can't succeed in
providing universal health care. Business doesn't do enough basic research.
The Chairman: Thank you, Dr. McLennan.
From the Canadian Health Coalition, Mr. Michael McBane, please.
Mr. Michael McBane (Coordinator, Canadian Health Coalition): Thank you,Mr. Chairperson.
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The Canadian Health Coalition was formed in 1979 to work hard to get the Canada Health Act in place. We worked very closely with the federal Minister of Health at the time, and our goal today is to preserve the Canada Health Act - a system built on non-profit principles.
Most people in society today claim to be a friend of the Canada Health Act and a defender of health care. The Canadian Health Coalition believes the key issue is preserving the system on non-profit principles. The distinguishing feature of our system is universal access. That's the one feature that distinguishes Canada from the United States of America. That's all we have left as a defining feature of this country in terms of universal social programs.
Health care is therefore an extremely symbolic issue, and the polls confirm that. We have to move beyond the rhetoric and the poetry about our beliefs and get to the issue of defending principles of health care based on non-profit provision and universal access, which are the defining features of our system.
We believe that Canada is a world leader in what makes and keeps people healthy. We think this information is extremely important. The latest report on the health of Canadians prepared by the Federal/Provincial/Territorial Advisory Committee on Population Health is essential reading for the finance committee and the finance minister. I think the idea of finance ministers meeting health ministers is a great idea. We are a leader in the world in this field. This information has to get translated in our fiscal policy.
It is time that health policy expertise be reflected in federal-provincial budget decisions. Deficit reduction that creates a sick society is something we cannot afford. We know the Government of Canada supports universal access, and so do the polls, but it's time to stop divesting from that investment; otherwise, over time, the system is going to fall apart in terms of universal quality access. We're going to end up with two-tier health care by default, by stealth. These things will be the trend lines unless we get the money back into the transfer.
It makes no sense in our global economy that jobs are disappearing for structural reasons through no fault of individuals. There is irrefutable. Jeremy Rifkin is an international expert. Another expert, Ian Angell at the London School of Economics, points out that fundamental changes in the nature of work are taking place and these structural changes have nothing to do with individual training or individual attitudes.
Given the essential nature of work, the essential nature towards public health, it makes no sense at a time when jobs aren't there for the federal government to be undermining the social programs that we know contribute directly to people's health. There's a direct relationship between wealth and health - it's irrefutable. Therefore, now more than ever the Canada health and social transfer must be stabilized. The projected cuts must be stopped. We have to not only be concerned about health delivery in this transfer, we have to be concerned about education and welfare. These are what make people healthy.
In a future where - all the experts agree - not everyone is going to get secure employment and security through work, these social transfers are all the more important and are a fundamental obligation of the federal government. This is what defines Canada. The red book is clear on this, and so are the public opinion polls.
We cannot afford not to invest in health care. This is clear on moral grounds, but even economically. People are concerned about competitiveness, and rightly so. Health care makes us competitive. You just have to look at the auto industry. We have an advantage of $10 an hour per worker because of our health care system. Therefore, for economic reasons alone, why would we stop investing in health care or in our social infrastructure? This is what makes Canada competitive. Therefore, it doesn't even make sense on economic let alone ethical grounds.
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The Canadian Health Coalition wants to see a reversal to these cuts in the transfer. We also want to see health care expanded. Medicare should be expanded to cover medications outside of hospital settings. We are proposing, together with the alternative budget project, establishment of a national drug insurance plan in cooperation with the provinces.
This is a plan that over time would save us money if we were to rationalize all the private plans and address the issue of over-prescribing and other medication problems arising through lack of coordination between the provinces and the federal government. This is one area we would like to see given serious consideration by the finance department in its budget planning.
To conclude, we consider this budget extremely important on the eve of an election. We want to see the financial numbers match the political commitment to the importance of health care. The dollars have to be there. We can't afford not to invest in it.
Thank you.
The Chairman: Thank you, Mr. McBane.
From the College of Family Physicians of Canada, Dr. Cal Gutkin, please.
[Translation]
Dr. Cal Gutkin (Executive Manager and Chief Executive Officer, College of Family Physicians of Canada): Thank you, Mr. Chairman. I am very pleased to speak to you this morning on behalf of the College of Family Physicians of Canada.
[English]
The College of Family Physicians of Canada is in some ways the equivalent organization to Hugh Scott's Royal College of Physicians and Surgeons of Canada. They are responsible for the education and standard-setting for the consultant specialists in Canada, and our organization addresses the educational programs and activities of the family physicians in Canada, representing those who are not in consultant specialties.
We have as our mission the education of these physicians through their training years and when they are out in practice; the accreditation of all 16 university medical school programs in family medicine; and a very close liaison with our branch chapters in each of the provinces and territories of Canada.
We have become immersed in the debate with respect to health care and health care reform over the last few years, not because we see ourselves organizationally as becoming, if you will, a labour negotiator on behalf of our physicians and physician members, but rather, because of the mission of our organization and the dedication and commitment of our members, continuing to improve the quality of care they deliver to Canadians across this country.
We recognize, and our members have made it clear to us, that it's becoming impossible for them to achieve the standards that all of us who are involved in looking at the attempt to augment standards in health care delivery...if the milieu or environment in which they are practising is not appropriate. In Canada, unfortunately, over the last many years the situation has been deteriorating in terms of the practice and research and teaching environment in which our practitioners find themselves.
Between the CMA and ourselves we have had several surveys over the last few years focusing on our concerns with respect to health care accessibility. Indeed, in our surveys of patients and providers we are finding a very dangerous trend in terms of decreasing accessibility. In our own organization the 14,000 family physicians are in contact on a day-to-day basis across this country with over 18 million Canadian patients registered in their practices. That's 18 million Canadians who are not with their family physicians for episodic care but for continuous and comprehensive care, in many cases lifelong.
I can't think of a better base of contact to find out what Canadians really feel about health care in this nation than the feedback and interaction that takes place between them and their family physicians. Indeed, it's a scary situation in terms of the fears and anxieties that not only the providers but also the patients across Canada have about what is happening around them.
The focus of all of this is our attempt to try to maintain the principles of the Canada Health Act while not at the same time showing support for the funding required to basically adhere to these principles. Until we can get those two messages consistent and on the same track, I'm afraid the Canada Health Act is in extreme danger of falling apart. There is no way this government can pretend to support the tenets of the Canada Health Act without supporting it with funding.
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As has been mentioned by many of my colleagues, the Canada health and social transfer payments to the provinces are basically becoming a sham. The provinces are unloading on all providers and ultimately on those who receive care in Canada, and are basically pointing a finger at the fact that the federal government is not supporting the provinces with adequate funding. This is resulting in decreased funding for appropriate care to patients, for research, for teaching and for ongoing education of all our providers. This is a responsibility that cannot be shirked, cannot be shrouded or clouded in political language; it must be addressed directly.
Another inappropriate message that has been delivered over the last many years is the artificial goal that has been set before all Canadians of continuing to decrease the percentage of dollars spent on health care expressed as a percentage of our gross national product. I think this is something the bureaucracies have created. They have not researched it. I would challenge you to find out if Canadians who place health care at the top of their list of priorities in this nation, as a defining characteristic of this nation, would share the objective of continuing to decrease the percentage of GDP spent on health care.
We are not other nations. We are not the other nations we are being compared to, in many cases comparing apples and oranges when we look at percentages of GDP being spent. If you're looking for economic growth and job creation, you have to look at the money being put into health care and you'll find your answers in those very objectives that supposedly you share.
I think it is essential that within the context of the Canada Health Act we clarify what we really mean by medically necessary services. Even with appropriate funding, the public purse can afford only so much. As an organization, we at the College of Family Physicians of Canada strongly support a single-payer, single-tier, universally funded, publicly funded health care system for all medically necessary services. But it's essential that we come clean and roll up our sleeves and together define what we mean by medically necessary services.
Our college would challenge you, therefore, to look at these very tenets of the Canada Health Act, to be consistent with the funding that is provided to maintain the tenets and principles of the Canada Health Act. We challenge you to support primary health care reform across this country.
The reputation of health care in Canada has made us a model for nations around the world, and a major part of that has been the strong primary care base we have established over the last couple of decades. A major part of that primary care base has been the discipline of family medicine developed over the last couple of decades in Canada. In the literature around the world on family medicine, our college and the work we have done in developing programs in family medicine and higher-quality family doctors is envied, and we are constantly asked to present the Canadian model to other nations around the world. It's ironic that we're having difficulty maintaining it in our own country.
One of the tragic ironies - perhaps the most tragic - is with our neighbour to the south. The United States has recognized that the major weakness in its health care system is a weak primary care family medicine base, and it is desperately trying to fill that gap. Part of the strategy unfolding is that the United States is recruiting well-trained Canadian family physicians, and recruiting them at a time when these physicians are very disillusioned. They see no future for themselves in Canada. In province after province the opportunities for new young physicians to begin practice in their home communities, in their home provinces, are diminishing. They are easily attracted south of the border.
We have a major challenge on our plate in Canada to maintain this important health care system we have all cherished. In the same way as our physicians are heading south, I feel that with the funding strategies we have had to support our health care system, we are all going in the wrong direction.
The Chairman: Thank you, Dr. Gutkin.
Lastly, from the Canadian Institute of Child Health, we have Dr. Graham Chance and Dr. Jenni Tipper. Welcome.
Dr. Graham Chance (Chairperson, Canadian Institute of Child Health): Thank you, Mr. Chairman and members of the committee, for inviting us to present to you again. We're speaking on behalf of children, and we particularly want to address the problem of child poverty today.
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For several years we've been told by the United Nations that in terms of human development Canada leads the world. Without question Canada is a great country in which to live, but the United Nations' assertion must be viewed as directed essentially to adults.
In 1989 the House of Commons voted to seek to achieve the goal of eliminating poverty amongst Canadian children by the year 2000. It was very specific. At that time the poverty rate amongst children was 14.8%. By 1993 it had risen to 21.2%. Currently it's 19%. Moreover, children living with single parents face approximately four times the likelihood of living in poverty compared with those living with two parents.
Why we are so concerned about child poverty is that no matter what health determinant one cares to address, children living in poverty face approximately a twofold increase, or more, in that particular health determinant. For example, infant mortality, school drop-outs, and psychiatric illness all increase by at least twofold when we face poverty in childhood.
Among Canadian children, aboriginal children account for the poorest group by far and are at extremely high risk of experiencing negative health outcomes. For example, suicide amongst Canadian aboriginal youth is approximately fourfold that of Canada as a whole. The rate among Canadian adolescents has risen fourfold in the last 30 years.
Compared with other OECD countries, Canada fares less well in supporting children in poverty. An example would be that data from the Luxembourg income study of 1995 showed that among 18 OECD countries, as far as child poverty was concerned, 11 of them lifted their children out of poverty in at least 50% of instances. As far as this country was concerned, the effect was seen in only 38% of children. In other words, there was a 9% decrease in poverty, leaving 14% of children in poverty after the government corrections had taken place.
In actual dollar value, Canada ranks 12th out of 12, at the bottom of the list of industrialized nations, as far as basic child care and benefits are concerned. Moreover, Canada is third-highest in the developed world as far as the poverty gap is concerned.
The government strategy for adjusting child poverty must address the labour market problems and social security problems plaguing many Canadian families. The latter reflects weak child benefits, weak income supplements, weak assurance systems, and inaccessible quality child care. We believe the federal government must take a more active role in honouring its commitments to support the healthy development of children. Economic growth cannot be sustained at the expense of child development and social development.
As for policy options in addressing the issues of child poverty, health and well-being require development of a national policy taking the life cycle approach. As a nation over the years we've made a sizeable improvement in the health and well-being of our seniors. Our challenge is to provide children with comparable support. Helping vulnerable children and their families must not, however, be made at the expense of support to seniors or other vulnerable groups. Intergenerational equity is essential.
I cannot overstress the importance of early intervention. Research in the field of human development shows clearly that the first six years of life, and especially the first three years of life, are vital in determining the paths of physical and psycho-social growth and the future health and well-being of children. Dr. Fraser Mustard, president of the Canadian Institute for Advanced Research, maintains that investment in early childhood is the most important investment society can make for future productivity.
We visualize two basic approaches to protecting children. The first we promote is supporting Campaign 2000, and it is relatively specific in its targets. The alternative, and more general one, is that put forward by the Caledon Institute.
The Campaign 2000 recommendations embody an approach that will see the federal government secure an envelope of funds for administering national programs for children.
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It would comprise a comprehensive child benefit system, which would guarantee at least 50% coverage for raising children in low-income families, and a guaranteed family supplement, which would bring families up to sustainable levels of housing and environment and would include the housing allowance. For example, this would support adequate growth of children in their environments.
Second is a national early child development program. We prefer this terminology to day care. It would be a multi-year plan and would ensure that every child has the opportunity to learn and to receive quality care in those vital early years. For this we visualize an envelope of a certain percentage of the GDP.
Moreover, the development of a national youth education endowment plan would support the able young youth of the country to achieve their optimum, through academically supporting those with suitable qualifications in their first year's post-secondary education.
In addition to this, we see the need for the Canadian government, in collaboration with industry, to develop enforceable policies that would enable adequate parental leave, flexible work hours, limited overtime and job sharing to ensure that the available work for the Canadian population is spread among those qualified for it.
In summary, another aspect we're concerned about is the reduction in the CAPC funding. We see several revenue options, but one that I would propose is important is the safeguarding of an aspect of the CHST so that the Canadian federal government has a definite impact on the provincial activities in regard to children. We believe that a proportion or a percentage of the CHST should be safeguarded by the federal government and directed towards benefits for children. I'm sure the government has other measures in mind to raise money through taxes, and corporations can't be excluded.
The Chairman: Thank you, Dr. Chance.
[Translation]
Let us begin with Mr. Dubé.
Mr. Dubé (Lévis): Let me first introduce myself. I am not a permanent member of the Finance Committee but I attend the meetings from time to time. As a matter of fact, I am presently a member of the Health Committee, and I was for two and a half years a member of the Standing Committee on Human Resources Development. I agree with Mr. McBane when he states that health issues are directly linked to social programs and to everything that is related to the Department of Human Resources Development.
I have been very pleased to hear in less than an hour those statements from the major health organizations of Canada. This is better than many conventions. It is perhaps too short, and I am sure that all of you still have many things to say, but that is what the next period is for. I would also like to underline that some important actors are absent today: the provinces.
In any case, you have talked about the reduction of transfer payments to the provinces and you have stated that this should stop as far as health care is concerned. Even if you did not all refer to this, some of you stated that the provinces had to make cuts in their health services, for example in their hospitals.
I know that the federal government has tried for some time to inject more money into research, into education and into prevention. And we have seen also that the Health Committee has tried to develop new strategies in the field of prevention. If it is true, as someone stated, that a dollar invested in prevention saves 7$ to 10$ in health care, I think that the payoff is obvious.
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I have also heard other people state that the federal government should stop cutting transfer payments to the provinces and should provide more incentives to individual donators to charities. This is very well but it would imply also that the minister of Finance would agree with individual or corporation tax cuts which would lead to reduced tax receipts. If I were in his shoes, I wonder if I should choose one or the other or a little of both. It would certainly be very difficult.
When I look at your statements, I wonder what your own decisions would be. One of you referred to the fact that children should be our priority, and he was right. In a recent report, the Health Committee recommended the appointment of a minister for the health of children because some members of that committee think it is a very important issue. Someone also referred to our aging population.
This is the shortest summary I can make of all your statements, and you know that the minister of Finance faces very difficult decisions. Even though I belong to the Opposition, I have eyes to see and ears to hear, and I am convinced that we are being overtaken by other G-7 countries as far as our competitiveness and our research are concerned. We are also lagging behind as far as children, research, health care and prevention are concerned.
All this is very serious. Everybody keeps talking about universal access to health care. You state that it is absolutely necessary and that we should at least preserve some minimum level of accessibility. However, others are fighting not for a minimum but for excellence, that is for providing the best services possible, their argument being that we would spend less as a country if we invested more in prevention and research. However, what should be our priorities? I'm not asking the question to one particular group but to all of you: what should be our very first priority?
The Chairman: Thank you very much.
[English]
Dr. McLennan, I know you have to leave because you have other hearings. Just before you leave, is there any last parting message you'd like to give us?
Dr. McLennan: The prime message is we're in a drastic situation. As far as the academic health centres are concerned, we must restore their ability to conduct basic research. We've demonstrated that there's an economic return here. That's the source of solving the problem.
The Chairman: Thank you, Dr. McLennan.
Dr. McLennan: Thank you.
[Translation]
The Chairman: Who would like to answer Mr. Dubé?
[English]
Dr. Kazimirski, please.
Dr. Kazimirski: Thank you very much.
Mr. Dubé, you raised some very interesting questions and some major challenges. You're asking basically where we can put some priority. Is it in prevention? Is it in realignment?
Prevention is important, and it's also important to know that the current Canadian health care system does not pay for prevention. Two of the organizations here represent some of the major money coming into prevention in Canada; they are the Heart and Stroke Foundation and the Canadian Cancer Society. They bring a great deal of money into prevention.
How can we priorize in a time of restraint? Listen to the Canadian public. What are they telling us? You've heard almost everyone around this table cite different references, studies and polls that have been done, and Canadians are saying clearly that health care is important. If we need to develop priorities, then the priority should be on a national issue. Priority should be on an issue where it is important to have a national standard. That is health care.
If I talk again about priority, then we have to remember that what everybody here has said comes down to one simple message: enough is enough. Health care in this country is about people. I can tell you the universal value of access to quality care is what is threatened. Access is not what it used to be. Patients can't get into the system.
I sit in my office on a day-to-day basis. I can't get people into diagnostic services. I can't get them in to see specialists. I can't get them into facilities. When they do get into the system and then go back home, the infrastructure is not there. We can put in all of the institutional efficiencies we want, but when we send people home in our system, we need an appropriate home care program to support them. We need community-based programming to support them. Those infrastructures are not present.
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This is what we mean when we say there needs to be an infusion now of moneys to stabilize the system and to create access and openings for Canadians.
I apologize for talking so long, but somebody here talked about the increase now in cancer of the prostate. A research study done from the Queen's University oncology section shows that patients in Canada wait longer than any place in the United States for appropriate and necessary radiotherapy. The gentleman with prostate cancer has to wait 40 days. That is unacceptable.
What does it mean when you talk about waiting times? It means the outcome is affected because you cannot have early intervention. Women in Canada with breast cancer wait 43 days. That is unacceptable. Our universal value of access to quality care in the current economic climate is seriously affected.
We are approaching a crisis in health care in this country. Couple that with what the public is seeing. They walk down the street of Windsor, Nova Scotia, and three departments have been closed in the hospital. The hospital in the town next door is closed. They cannot get into laboratory services. Unemployed nurses are walking down the street. What does that translate into? It translates into ``When I need the system, it's not going to be there for me''.
We have to re-infuse money, stabilize the system and confirm to Canadians that this government hears the messages. Health care is in crisis, health care is important to Canadians, and we want you to do something about it. That means putting money back in the system now.
[Translation]
The Chairman: Thank you, Mr. Dubé.
[English]
Dr. Gutkin.
Dr. Gutkin: Thank you, Mr. Chairman.
I couldn't give a better list of examples than Dr. Kazimirski has just given. Our organization, like theirs, is inundated with examples of decreased access to care as the family physicians are attempting to coordinate or provide this care.
A couple of points were brought up by Mr. Dubé. The $1 of prevention providing $7 of cure may be true. We do not have the evidence to support a lot of the assumptions being made in that regard. I would like to believe it will be true, and I and our organization strongly support dollars being put into prevention and feel it's a priority. But even if it were true, those savings and those cures are not going to happen right away. They will be years down the road, I assure you.
There's a mistaken assumption that you can transfer dollars directly, now, into preventive and health promotion programs and take them out of programs that are needed to treat patients. Those patients are still sick and injured and vulnerable, and they're still on our doorsteps and on the doorsteps of all health care providers and hospitals and nurses, and the dollars aren't there.
You ask what is the priority, because a balance has to be found. The priority is be honest with Canadians. That's the priority. The frustration for the people in the system - the consumers of health care and the providers - is we recognize the dishonesty. There is not an attachment of funding support to the tenets of the Canada Health Act. The Canada Health Act is presently unsupported, and in a few years - a few years - it's going to be unsupportable.
The Chairman: Thank you, Dr. Gutkin.
Mr. Solberg, please.
Mr. Solberg (Medicine Hat): Thank you very much, Mr. Chairman.
I'd like to welcome such a distinguished panel before the finance committee. I apologize for being late. After having heard some of the presentations, I'm even more sorry I was late.
Obviously health care is one of the most important issues, perhaps the most important issue, facing Canadians today. I completely agree with some of the comments I've heard today - the forthright assertions that the health care system is in terrible shape today and that it's underfunded. You're absolutely dead-on. Canadians believe that, and I think most politicians, if they examine their own hearts, believe it as well.
My party, the Reform Party, is not known for being particularly forthcoming with funds, but I want you to know we've listened pretty hard to what people have said, and they've told us in no uncertain terms that we need to put money back into health care. We've heard that, and in our new platform document we've said we would put $4 billion back into health care and higher education and also more money back into research. That's just by way of interest.
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My question is actually for Dr. Gutkin, because he mentioned it, but anyone else can jump in.
Is there a consensus that there is a need to identify the core services that have to be provided, the medically necessary services, in the health care community? If so, when can we expect people such as you to come forward and make that presentation to the provinces, who obviously have to be on line and in agreement with this and with the federal government?
Second, how much money needs to go back into health care, and where do we find some of the savings in order to make that happen?
Dr. Gutkin: I will try to answer part of that. I know some of my colleagues can certainly contribute to trying to answer your questions.
First of all, the leaders for all of us in organized medicine in terms of addressing some of your questions are at the Canadian Medical Association. We all play a part at the Canadian Medical Association in many of the strategies being developed through the CMA. Perhaps Dr. Landry andDr. Kazimirski can address these. The strategies we've all contributed to are right in the area of your question.
The issue of medically necessary services is at the core of our problems right now in defining how we fund health care through the tenets and principles of the Canada Health Act as a universally publicly funded system. The challenge to define which services should be medically necessary is not simple. I think what we are definitely committed to is working with consumers of health care, providers of health care and planners of health care to be able to develop that list appropriately. We haven't seen an openness on all parts to be able to move that process forward, although we've been very interested in being at the table. I personally do not believe it should just be up to physicians to define what's medically necessary.
There are certain aspects of health care service in which our providers and certainly our provincial ministries of health feel bound, in terms of needing to stick and adhere to the Canada Health Act, that might come under this category of medically necessary. They have to be looked at somewhat realistically. They aren't specific services. For example, if you have a cough related to an upper respiratory infection, that's not medically necessary. It's not in that category. It's in the category of things such as, ``while deliberations are being carried out in certain provinces for the possibility of introducing rostering or patient registration''.
Whether some of us do or don't support that is somewhat irrelevant, but in the context of trying to introduce that as a strategy to address health care reform, one of the key points in there to make it work, one that's absolutely essential, is that should patients registered with a particular practice seek non-urgent - that's non-urgent - services elsewhere, the patient has to pay. If that factor is not introduced in our system somewhere, then the public purse will carry on being unable to afford all necessary service.
The block to this, as the debate unfolds, and the message that comes back at the provincial level from the ministries to the representatives of our associations is that this doesn't seem to be consistent with the Canada Health Act and they're going to be penalized should they allow that.
Another area involves the true definition of ``third-party requests'' and the services attached to third-party requests that the physicians must provide. Patients are sent to them with a request for a certain service. Some of this, perhaps the filling out of the form, is allowed to be billed to that third party. But the actual service - and in many cases these are not essential services - is still billed through the public system.
There has to be a discussion of these kinds of principles to allow some opening up such that all Canadians have the opportunity to have the essential services, the medically necessary services, paid for by the single payer, publicly funded, while these other situations are addressed by other strategies.
The Chairman: Thank you, Dr. Gutkin.
Dr. Scott.
[Translation]
Dr. Scott: To answer Mr. Dubé and Mr. Solberg, I would say that one of our priorities should be children living in poverty. This is not linked to any particular political party but to public policies in general.
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Someone referred to tobacco, but we should also mention gambling. Several governments have decided that encouraging people to gamble millions of dollars would be an excellent method to collect new funds. If I am not mistaken, this industry is worth half a billion dollars at the present time. If there is one government policy that is responsible for the deterioration of the welfare of our children, it is that one. I believe that this national experiment, illustrated by the magnificentTaj Mahal in Hull, is extremely negative.
I would like to refer to another issue: education. We keep hearing that it is very important to invest in research but one should not forget that researchers have to be trained. I realize also, since I have always worked in the province of Quebec, that education and health are provincial responsibilities.
But if we want to build something that is really national in scope, such as in research, there has to be a link somewhere between education and our national and international policies.
[English]
When we speak about medically necessary procedures, my colleague Dr. Gutkin has mentioned that, but I think we have to do this with extreme caution and prudence. In a former life I was a cardiologist. When the aorta-coronary bypass began it was considered highly dangerous and highly experimental. Probably now it would be on anybody's list of essential procedures.
How procedures move from experimental to desirable to medically necessary is an extraordinarily difficult thing. The same thing might be done, for example, with a very successful operation, hip replacement. Some might say, well, there's no reason why you can't continue to walk around with your sore hip; you can still live. But I think most people who have faced the problem of hip replacement, an expensive but highly successful operation, would say it's ``medically necessary''. So that distinction, as Dr. Gutkin has indicated, has a bit of a chimera quality: it's highly attractive, but it's a little harder to get your arms around it.
I'd like to make one final comment about that. The direct answer to Mr. Solberg's question is that the answer to where the savings are going to come from is really more health care research. That is one of the very real reasons. We simply don't know where some of them come from. But if we take some very recent examples and success stories, the movement to day surgery has saved many millions of dollars in this country. Five or ten years ago many of our colleagues, distinguished surgeons in this country, were highly skeptical and there were very pessimistic suggestions that this widespread movement to day surgery was going to lead to disaster. It hasn't happened. To the contrary, it has probably resulted, in many cases, in better patient care.
I was speaking to a colleague recently, an anaesthetist. This is just an anecdote. What used to be the situation of children going in for minor procedures the night before, after the parents had gone home... I don't think it was good medical care to have terrified four- and five-year-old children in hospital the night before their tonsillectomy. That is an example of where health care research - not that we want to have research at all levels - has resulted in cost savings and better health care.
So it is possible to work together, and I think all my medical colleagues on all sides agree that King Canute is not our model - we don't want to stop everything and just not move - but we want the decisions to be taken rationally, and when decisions are taken, for whatever reason, for them to be analysed.
The final point is a very interesting example. I'm not fixed on hip replacement, but usually studies of differential utilization suggest the underlying image is that if in one area of the country there are twice as many hip replacements going on per 100,000 as in another, that must mean twice too many are going on somewhere. In fact in Ontario, Dr. Naylor's study shows that in the areas where less hip replacement is going on there is inadequate medical care.
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The reverse is certainly true as well. There are lots of areas where there are too many medical procedures going on at great cost.
We have to work together collectively to make sure the dollars go where they can go. But it won't be done by just thinking about it. It's good solid research that's needed, and we can move this country forward and achieve continuing greatness. Thank you.
The Chairman: I have two more people who would like to comment on this. Dr. Kazimirski.
Dr. Kazimirski: Thank you very much.
Mr. Solberg, your question really raises two issues: core and funding.
The Canadian Medical Association has long called for planned, monitored, evaluated reform. That's what Dr. Scott has just said; that's what Dr. Gutkin has just said. To date we have seen slash and burn approaches, attempting to live within imposed budgets.
As an association we have established a document called Core. It's a policy on core and comprehensive services. It's a framework for decision-making that is available for policymakers, for governments, for regional health authorities, for individual physicians, to do exactly the task you have asked, which is to look at quality of care issues, ethical concerns, and at the affordability of the services we provide, and, together with Canadians and health policymakers, governments and practitioners, to come to some consensus. What can the system afford? What do we want the system to provide? That's one of the biggest challenges, but it's also one of the opportunities for a solution, and we would like to be very much a part of that.
The Chairman: Thanks, Dr. Kazimirski.
Lastly, Mr. McBane, please.
Mr. McBane: I want to address some of those questions, too, in terms of where we can make some savings in health care. I think the biggest area, the one area in health care budgets that's out of control in spending, is obvious. It's drugs, particularly the cost of new drugs. Essential medications are being denied Canadians because of government policy that prohibits competition in the marketplace for medications. This monopoly protection is going to threaten people's health when these new drugs will be denied after the generics are off the market in a number of years.
We haven't seen the full effects of Bill C-91 monopoly protection yet. But we have a golden opportunity to address this with the parliamentary review of Bill C-91 coming up in February. That's a billion dollar subsidy. We have to evaluate: is this where we should be putting our money, or should we be doing something else with this have a medication strategy and control misappropriate use of drugs, etc.? That's one huge area.
I'm glad to hear people around the table say that defining core, medically necessary services is a very dangerous game, and we have to be careful of that. It could seriously undermine universal access, because it could set up a second commercial system of health care.
The Chairman: Thank you, Mr. McBane. Thank you, Mr. Solberg.
[Translation]
Mr. Duhamel, please.
Mr. Duhamel (St. Boniface): Thank you very much for your statements which I have found very useful.
[English]
I have two questions with a couple of sub-questions, very briefly.
There appears to be a need to clarify for me the question of revenue transfers. There have been some comments that have indicated there has been less money transferred - and I understand that, but perhaps we could review that - as well as the decreases in funding. I've put these separately, although one could look at them as a whole.
We're also told, or at least I've read from some government documentation, that the transfer of funding will start to increase shortly. That question of funding could be addressed by whomever.
The other question is with regard to another statement that was made this morning; that is, that we should be seeking to be competitive with our G-7 partners. I wanted to know how much that would take, roughly. I believe that comment was made within the context of research funding.
Thank you, Mr. Chairman.
The Chairman: Thank you, Mr. Duhamel.
Who would like to respond? Dr. Kazimirski, I know you addressed the issue of cuts to the CHST.
Dr. Kazimirski: Yes. Beginning in the early 1980s, cash withholding was put in place from the provinces. From the early 1980s to the beginning of the CHST, that amounted to approximately $30 billion that was not available.
Mr. Duhamel: And that has continued to decrease from that period of time. Is that correct? There was a certain base that has eroded over time.
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Dr. Kazimirski: That is correct. The base of funding to health care has eroded significantly over time.
Mr. Duhamel: Has it been a continual erosion?
Dr. Kazimirski: That is correct. Now, in 1996, with the introduction of the CHST, specific cuts to funding were withdrawn from the transfers to the provinces for health and social services. The total that will be withdrawn by the year 2000 in that area is another $8.4 billion.
The effect of the initial withholding has already resulted in the medical community trying to put efficiencies in place to deal with it, but it had the effect of destabilizing the system.
Now, with very specific funding cuts to the provinces, their ability to meet the increased demand that was pointed out by other speakers - the increasing population, the increasing age of the population, the opportunities presented by technology, the creation or development of new and more difficult diseases, all of the demand side - is being met with continually diminishing resources on an already lowered base, so low that our past president used to use the term ``the floor that we talk about is now the basement''.
Mr. Duhamel: I just want to make sure I get this. In terms of the information you've received, is this about to turn around?
Dr. Kazimirski: If one follows the proposed government strategy, there would be some levelling off of cuts after the year 2000 - approximately. The point that everyone around this table is making is that right now the system is in significant trouble and needs funding.
Mr. Duhamel: That I can understand. I guess I did not understand satisfactorily. I understood there were cuts, but when that might turn around, when it was going to bottom out...
Is someone going to address the question of the reduction? I assume this is primarily in the area of transfers, in the reduction of the funding for research.
Dr. Murphy: Let me address that. I think the best example we can use is funding in the United States for medical research. Between 1991 and today the National Institute of Health has had an increase of about 40% in current dollars in research moneys.
One of the major advances over this decade has been the advance in biotechnology. The National Institute of Health has strengthened biotechnology in the United States to such a point that there has been another $15 billion worth of investment in the United States by foreign companies, simply so they can be around the strength that the NIH created.
I think the rate of increase that NIH showed was somewhere around 2% to 5% above the inflationary increases during that timeframe.
In Canada between 1991 and today the total increase in funding has been something like minus 5%. Are we attracting offshore people here? No, we are not, so we are losing that income.
Let me just touch upon one other point. All of us in Canada and North America look at the miracle of Japan. For 30 years it made billions of dollars on the science of other countries. Japan has realized now that it can no longer do that and is putting enormous amounts of money into its universities to build a science infrastructure, not for tomorrow, not for the year 2000, but for the years 2010 and 2015. The investment is long term and they realize it's long term.
Canada is doing just the opposite. If we think we can survive on someone else's science - I think Japan is a wonderful example - we will fail. We will not be able to do that.
Mr. Duhamel: There is only one point that has not yet been addressed and that's the question of how many dollars are needed in order for us to be competitive with our G-7 partners.
Dr. Murphy: We have to maintain a growing support for research, which would be inflation plus somewhere around 3% to 5% above that.
The Chairman: Thank you.
Mr. Tholl.
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Mr. Tholl: Thank you, Mr. Chairman. This is perhaps in direct response to the question from Mr. Duhamel.
I want to pick up on something I said earlier about where some of this pressure winds up. I mentioned earlier that the kids are skipping rope. Well, they can't skip rope any faster to generate any more funds. On the other hand, as some of these cuts trickle through the system, they wind up as demands on charities for service provision. We simply don't have the quantum of funds nor do we have the infrastructure to respond to some of these demands. But they do wind up in increased demand for service delivery and we're not in that business. If we don't take it on, who does?
I'd like to link this to the health service research fund. To figure out the impact of all these changes on charities and others, it seems to me the health service research fund is something that should have come before the cuts rather than after. But since we have it after the cuts, let's get on with it and make sure it's in place, looking at the effects of the cuts to date before we continue cuts in the future.
The third point I would make, and I have mentioned this, is that others have taken some innovative steps toward making up the research gap. I point the committee in the direction ofSir Michael Peckham, who has been through Canada on at least two occasions in the last six months advocating the notion of a 0.5% or 1% earmarking of health service expenditures, which would be directed back into health services research. I think that answers at least two questions here on where the money might come from to fund the research that's necessary.
The Chairman: Ms Brushett, please.
Mrs. Brushett (Cumberland - Colchester): Thank you, Mr. Chair. I consider this probably the most important panel to come before the finance committee, because as each one has said here this morning, health care in Canada is vital, the number one interest to all Canadians.
I would like to make a couple of points. We talked about research a few moments ago. Canada is marginally behind other countries, but not so far as may have been indicated, to set the record straight. It is a fact that industry in Canada doesn't contribute to research the way it does in Germany and some other G-7 countries. I think that's a vital point. It's not that our government is so far behind in its contribution; it's marginal. It's that industry isn't putting in the bundles of money here in Canada as it may be in other G-7 countries.
I'd like anyone and maybe all of you to answer this other point. I've worked in medical health care for many years and I was closely involved with a lot of physicians and health services. One point that always comes out is that there's plenty of money in the system. It needs to be re-evaluated, redirected and re-economized, for lack of a better word.
I'd like anyone to pick up on this. It comes to the point of how to focus on this moving target, because as in every sector of our society, it's changing more rapidly than we can keep up. Yet at the same time, there's no more money going in to keep doing things the old way and still focus and evaluate the new ways. How do we do that?
The Chairman: A lot of people will want to pick up that gauntlet. We will start withDr. Murphy, briefly.
Dr. Murphy: I agree with you that industry in Canada does not put as much money into research as does industry in other countries. But you have to realize that industry cannot be expected to take over government's role in funding long-term, high-risk, medically relevant research. Industry doesn't have the deep pockets to do that. The reason industry in Canada doesn't put in as much money is there's not much industry in Canada, and the industry that's here is doing R and D that's targeted research for their products.
One reason Canadian industry is not investing here is that the infrastructure in our country is not as strong as in other countries. The fact is that business cannot be expected to take over government's role: one, because research is for the public good; two, because government needs to fund research for the public good; and third, the benefits of research need to be driven and to benefit society through market mechanisms. While business has its own role, government has its own role as well. We are fooling ourselves if we pretend that business in Canada is in a position to take over government's role. Business certainly is in a position to play a supplementary function, but not a replacement function.
The Chairman: Thanks, Dr. Murphy.
Mr. Kyle.
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Mr. Kyle: One concrete suggestion, which has been looked at by the Charitable Incentives Review Task Force, is to develop incentives for the corporate sector to give donations to health charities. In the case of the Canadian Cancer Society, half of our money goes to health and medical research. So there's one way in which recommendations from this committee for the budget might address that issue.
The Chairman: Thank you.
Lastly, Dr. Scott.
Dr. Scott: Mr. Chairman, very briefly I'd like to make a couple of comments.
The statement was made that ``there is enough money in the system'', but it must be better used. Certainly there are still efficiencies to be realized, but we do feel one has to reflect on Canada's aging population.
I know this committee is heavily stressed with the issue of the Canada Pension Plan. Well, the Canada Pension Plan is another manifestation of the same phenomenon: quite a few of us are getting older. So what may have been enough money in the system in 1990 - or pick a year - for the number of people over 65... You know all those statistics. What we do know very distinctly is that the burden of disease on all of us is much greater as we get older.
So I think we have to be a little careful when we say ``there is enough money in the system'', but that's not to say there are no economies to be realized. I just think there is a concept that there has to be a limit, and we think we're getting pretty close to it.
Finally, to pick up on something that Dr. Murphy said and add to it, the final point I want to make deals with the excellence of our universities. We're talking about health today, but you're particularly talking to a sector in which two aspects of the Canada health and social transfer come together, namely health and higher education. It's interesting that the word ``education'' isn't in there, although I guess it's a social entity.
I think if we worry collectively that there's a tendency to say we have to support health and can let education go down or vice versa, this isn't going to work. This is a very tight and important balancing act, and the kinds of excellence that Dr. Murphy has referred to are partly in the United States due to the extraordinary excellence of some of their institutions of higher education. If we do not see the continuing support of our faculties of medicine and universities in general, we're going to lose on the swings what we gain on the rounds. It's a very delicate balance. I'm sure this committee is aware of it, but I hope it can be reflected.
Some of us worry a little bit that here there has almost been a competition set up whereby health and education are going to go toe to toe. These are not competing forces. These have to be complimentary at all levels, and certainly at the higher education level.
The Chairman: Thanks, Dr. Scott.
Lastly, Dr. Chance.
Dr. Chance: Thank you, Mr. Chairman. I was concerned that children might not get back into this picture.
While I'm an academic professor and certainly have gravest concerns over the reduction in research funding, likewise I'm a health care giver. I work with sick children, so I see the needs of sustained funding for health care.
I can't let this panel leave without stressing again the importance of prevention. I was concerned that Dr. Gutkin produced a picture of long-distant benefit. As far as children are concerned, preventive measures act in the next months and the next years of life.
The savings in preventive measures are very definite. For example, we know low birth weight prevention is possible in approximately 20% of instances, and the value is $1.35 to $1 in Canada and $1 to $7 in the U.S. I could go on with all the measures we know will save money through prevention in children.
Mr. Dubé asked for a priority. Presently, preventive measures take approximately 2% of the health care budget. That is inadequate. What I was arguing for earlier, as regards poverty, is really directed at prevention of ill health. More money must be directed toward preventive measures.
The Chairman: Thank you very much, Dr. Chance.
I'm now at the point where I would ask if any of you wish to expand on anything that you've heard, or if you have anything else you wanted to bring up before but didn't have the chance to. I would then ask you to sum up, in perhaps thirty seconds, the major points you want us to take away from here.
I'll go to Mr. Tholl, and then Dr. Kazimirski.
Mr. Tholl: Thank you, Mr. Chairman.
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Just in terms of its overall R and D effort, Canada ranked seventh in 1993 OECD data on total expenditures on biomedical R and D, at 1.1% of total health care spending. That compares to Switzerland, which led the pack at 6%. So I'm not so sure that we are, by that indicator at any rate, at the top of the list.
In terms of being at the head of the class in terms of public expenditure on biomedical R and D, in 1991 - and I would point out that we looked good then as compared to what we look like now - we ranked thirteenth behind Switzerland, Denmark, Germany, the U.K., Sweden, the United States, Japan, Belgium, France, Australia, New Zealand and Italy. I'd be happy to leave this data with the committee, but I'm not sure we stack up just as rosily as we believe.
Secondly, if I may, I would just like to echo what Dr. Scott has said, Mr. Chairman.
As I hear some of the discussion about priorities, it assumes that research, teaching and service delivery necessarily are at odds with one another. There are ways to spend additional marginal dollars to benefit all three at once, rather than having to pit research against education against service delivery. I would urge the committee to think of them as a triumvirate that we're trying to promote.
The Chairman: Thank you.
Dr. Kazimirski.
Dr. Kazimirski: We will be submitting a brief in which we will perhaps outline in greater detail the concept of efficiencies versus the present system, reality. I think there is a great deal of evidence to show that while major efficiencies have been made and are continuing to be made by all of those who are in the system, the system is currently underfunded.
Take a look at the Canadian polling evidence. It says access is restricted, quality of care is significantly affected. Listen to the politicians across Canada. One month ago in New Brunswick, Russell King said, ``I will not be able to implement the next round of cuts in health care for this province''. Listen to the experiential evidence of those who are on the front lines. There is not enough money in the system; otherwise the problems with getting people into the system for necessary care would not be there.
Look at what the system is demanding and what it pays for. It pays for medical care and it pays for some other services, but not all provinces cover home care. Not all provinces, or very few, cover rehabilitation care. The concerns that my colleagues have brought up about drug costs, which are very real health concerns, are not covered within the context of the Canadian health care system at present, and that demands more money.
The Chairman: Thanks, Dr. Kazimirski.
Lastly, Mr. Kyle.
Mr. Kyle: Dr. Chance talked about prevention. He talked about children. What can members of Parliament do? I have one suggestion. Ask the Minister of Health, Mr. Dingwall, where the tobacco legislation is. Ask the Prime Minister where the tobacco legislation is and what the blocks are. That will do more for prevention than anything this Parliament can do.
Thank you.
The Chairman: Thank you.
Could we turn now to summaries? Perhaps we could start with you, Dr. Gutkin.
Dr. Gutkin: I think the key points have certainly been well emphasized around the table. I strongly repeat that the support for the principles of the Canada Health Act have to be tangible or the tenets of that act basically will not be able to be implemented across Canada. Organizationally, although at times in organized medicine in general the perception of the Canadian public may be that we seem to not be defenders of the Canada Health Act, the exact opposite is true. We are strong defenders of the Canada Health Act, but we are extremely frustrated with the practicality of trying to serve our patients and work together with our patients in a context that does not provide the adequate funding. I agree with those who were responding to that last question. The assumption that there are adequate funds still in the system is not a correct assumption.
The Chairman: Thanks, Dr. Gutkin.
[Translation]
Dr. Landry, you are not usually so quiet.
[English]
Dr. Léo-Paul Landry (Secretary General, Canadian Medical Association): To be honest, I thought you had forgotten me the last time. I thought you wouldn't make such a comment.
I'm going to pass because the others have done a superb job.
The Chairman: Thank you. It's good to see you back.
Dr. Kazimirski.
Dr. Kazimirski: Thank you very much.
Mr. Chairman, I said at the beginning that enough is enough. I meant that, and I think everyone around the table has given basically the same message. As an association, we have polled Canadians. We have gone directly to the Canadian public and have asked them how the system is meeting their needs. What one out of two Canadians is telling us is that cuts in health care spending have adversely affected the quality of care in their communities. They reported a reduction in availability of nursing care, in access to necessary surgery and to hospital care, and increased waiting times in emergency rooms and for surgery. That has an economic impact, and it has an impact on quality of care.
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The Minister of Health spoke to our general assembly, to our council, this year. At that time, he admitted health care reform was needed, but the vision of this government on that reform remains unclear. While it talks about a commitment to health care, it has laid out a strategy that is very slowly choking the system to death. Those on the front lines, the ones who see patients on a day-to-day basis, know that Canadians are suffering. Canadians deserve very concrete solutions, and they deserve them now.
The Chairman: Thanks, Dr. Kazimirski.
Mr. McBane.
Mr. McBane: To conclude, the Canadian Health Coalition would urge the government to make sure that the next budget has stable and adequate transfers to deal with health, education and welfare. These three things are inseparable. We can't afford not to invest adequate funds in that transfer, otherwise there will be no federation left.
The Chairman: Thanks, Mr. McBane.
Dr. Scott.
Dr. Scott: Thank you, Mr. Chairman.
I would just like to echo that we also feel the issue of stability, at least, is crucial. We wish to remind the committee that health care and research are given and done by people, therefore the education and preparation of the next generation is crucial. Research ought to be the basis of our decision. If it has to be after the fact, at least let's do that research.
Finally, we will face as a nation an unnecessary and self-inflicted major shortage of physicians generally, and specialists and clinical researchers particularly, quite early in the next century.
The Chairman: Thanks, Dr. Scott.
William Anderson.
Mr. Anderson: Thank you.
Since we haven't spoken, perhaps I can take a minute rather than thirty seconds. May I please do that?
The Chairman: You can take a minute and a half, if you wish.
Mr. Anderson: Thank you very much.
Sitting here, I'm trying to figure out what type of context we fit into with all the people at this table. MEBCO is responsible for people who pay for their own health and welfare and pension programs. Our concern is that those programs aren't taxed and that there is less interference from government. The reason is that if they are, those programs are going to disappear. If those programs disappear, it's going to put more of a burden on the system. As I hear today, there's one heck of a burden on the system right now.
One of the things those people outside - security guards from Bradson Security Services, my clients, Steelworkers at $7.25 an hour - are picketing for, not against the government but against their employer, is a drug program. I don't know whether they're going to get it or not, but I have talked with them in-depth. I know the problems they go through at $7.25 an hour when they're trying to and have to get a drug for their child, and I know what the long-term effect is on their health. It's the same with proper pensions. If people don't live with quality care, there's more of a concern on their health.
You've been very good; you've listened to us all along. We've had great interface back and forth. Let's try to preserve that in the system, please.
The Chairman: Thanks, Mr. Anderson.
Mr. Armstrong.
Mr. Armstrong: There are two points. First of all, maintain your investment in the voluntary health sector through things like the national AIDS strategy. The economic benefit is substantial, and the cost of doing that is peanuts. The cost of not doing it is incredible, however. The other point, with regard to individuals - and I'll echo what other people have said - is that we have to find a way to deal with the cost of drugs. People with major health conditions like HIV/AIDS can no longer afford to pay for their drugs. I think it's inhumane to live in a society that does not let people have access to things that will save their lives.
The Chairman: Thank you, Mr. Armstrong.
Mr. Kyle.
Mr. Kyle: There was an excellent suggestion from the Council for Health Research: put a designated percentage of the health care budget into research. There is a terrific bang-for-the-buck potential there.
The Chairman: Thanks, Mr. Kyle.
Mr. Tholl.
Mr. Tholl: Thank you for the opportunity to be here, first and foremost.
I have two summary points. Like never before, Canada needs a national vision for health research that rises well above what we've talked about here today. Secondly, help to create a level playing field for the charitable organizations to compete. There are all sorts of good reasons to donate to health charities, but one of them is the tax reason. Help to create a level playing field for my kids skipping rope.
Thank you.
The Chairman: Thanks, Mr. Tholl.
Dr. Murphy.
Dr. Murphy: I have two final points on research. One is that 80% to 90% of the external moneys that come to Canadian universities come to those universities for the support of science. As those budgets decrease, that is going to have a very negative effect on our universities. It's a lowering tide that will sink all ships, and we cannot afford that.
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I would also say that Canadians do not want Canada to be a third world country technologically. Unfortunately, the policies currently in place will make us third world very quickly. We cannot afford that, and I think the government has to recognize that.
The Chairman: Thank you, Dr. Murphy.
Lastly, Dr. Chance.
Dr. Chance: Thank you, Mr. Chairman.
The Canadian Institute of Child Health recognizes the vital importance of basic science and clinical research for reducing the burden of illness in childhood; likewise the vital importance of health care services research in reducing the burden and the inappropriate expenditure on health care that occurs. If we could have evidence-based medicine practised across Canada, then health care would improve and the dollars spent would be reduced.
However, we are very concerned that we should recognize the vital priority that must be given to preventive aspects from the point of view of children. Measures for prevention will reduce the costs of health care and improve the health of the nation generally, both for children and in adulthood. We are concerned, amongst these, that the children in poverty are a specific group that should be addressed.
The Chairman: Thank you, Dr. Chance.
When we asked you to be with us here today...I don't think members on any side of this table are really surprised at what we were going to hear. We felt it was important, though, to have you, in your own words, reiterate to us the importance of health care delivery, health care research, biomedical research. I think it's important for Canadians to hear from you directly, and through our committee, the urgent message you've all given to us today, that we are perhaps at a crisis stage in the delivery of health care and we're far behind other countries and where we should be in medical research, and in our biomedical industries as well, which flow from that.
You've talked about the iniquity of tobacco. You've talked about the cost of drugs. We've heard yet again the problems we face as a nation because of child poverty. You have made very strong pleas for increased funding for health care delivery, funding to our universities, funding to our granting councils. You want the transfers to the provinces for health care to be increased.
I'm pleased that in anticipation of our hearings next week on charitable donations and increased tax incentives, which have been the inspiration of this committee in past times and which we are pushing very strongly...the support you're giving in advance for enhanced tax incentives for charitable donations to assist in all the areas you're talking about.
I was particularly struck too, in the AIDS area, by how many people are volunteering their time to provide health care. I know that's true in many other areas. When you visit hospitals today, you're often met by volunteers. I believe this is totally within the spirit of giving and sharing we see in so many Canadians.
You've also made the point that good health care is good business; that our Canada Health Act gives us a competitive advantage in seeking jobs. It was put by Mr. McBane at $10 an hour, at least in the auto industry. It creates jobs itself, and it creates industries that create jobs and give us exports.
I don't think you had to reiterate to members from any party here today that Canadians place the quality of their health care at the top of their priorities. That's as it should be. In a caring, rich society we should be able to deliver the best health care of any country in the world.
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You have given us many ideas and rededicated us to directing our minds as politicians to how we can go about doing this, achieving the high standards we all seek and that Canadians demand and insist on - have the right to insist on - at a time when we have so overspent that we have had to, out of necessity, cut back on budgets.
I'm sure your message to us is, cut where you have to, but certainly not any more in the areas you represent, and represent so well. On behalf of all members I thank you for your contribution, not only to us but to all Canadians as you carry out your daily lives.
The meeting is adjourned.