Finance Committee on Sept. 30th, 2014

[Dr. Chris Simpson]

I appreciate the question very much, because that is the issue, of course.

The way I like to think about it is to look at some of the European jurisdictions that have been more successful than ours has. By country, their health care systems rank higher than ours does in performance ratings, and they spend a smaller proportion of their GDP on health care. So they're doing a better job with less money. How are they doing it? They are doing it with three things. They are doing it with a very strong medical profession that's willing to put skin in the game and lead. I'm telling you, we are willing to do that and are doing that. The second thing is that we have to have strategic goals that go beyond sound bites and political cycles. There has to be an endgame and something we want to achieve. The third thing is a committed national government.

I think the jurisdictional wrangling that happens is a distraction. I think it's allowed us to avoid making some of these tough decisions. Certainly, there are aspects of health care that are a provincial responsibility, but the achievement of health for Canadians surely must be the responsibility of all levels of government. We're asking the federal government to be a partner at that table.

[The Chair, Conservative, James Rajotte]

Merci.

We'll go to Mr. Keddy, please, for five minutes.

[Gerald Keddy, Conservative, South Shore—St. Margaret's, NS]

Thank you, Mr. Chairman.

I welcome our witnesses.

Picking up the comments from your brief, Mr. Simpson, you mention that a hospital stay costs somewhere in the neighbourhood of $1,000 a day, a seniors' home costs $130 to $140, and home care is $50 to $60 a day. Quite frankly, I've always argued that for some patients in hospitals who are able to look after themselves, it would be cheaper to put them up in a hotel, quite honestly.

You said something that really got my attention: that there are other jurisdictions doing a better job with less money. Health care is a huge cost to the federal budget. There is a jurisdictional problem and I think you went over it a little too easily. For any federal government and any provincial government, it's a real task to wrestle that to the ground.

One thing we have done is the Canada Health Infoway. Have you seen the direct results of that on the ground? Is it saving Canadians money? Are you getting patients' records quicker?

[Dr. Chris Simpson]

I appreciate that question as well. I think the current stats are that something like roughly two-thirds of family doctors now have an electronic health record. That's a substantial improvement. We're definitely going in the right direction, although we lag behind.

How much money that has saved I think is a little unclear. It may not have saved any money yet, because the entire system isn't completely integrated. For example, as a specialist in a hospital I don't have access to the health records from the family doctors who refer patients to me, so that leads to duplicated tests and delays and that sort of thing, all the stuff you already know.

But I think that's definitely a key piece, not just for the sharing of patient information but for measuring the performance of our system, which is arguably a big part of why some of the countries such as Denmark and even the U.K. have made some of the leaps that they have recently. We rank 10th out of 11 in the Commonwealth Fund in the performance of our health care system. Only the U.S. is worse.

[Gerald Keddy, Conservative, South Shore—St. Margaret's, NS]

Thank you.

We really do have very little time for this round of questioning, and the bells have started, but again you've mentioned something that I have to pick up on, and that's measuring performance. At our university and community college levels, at the end of the day everything is results based.

There's really no adequate way, Mr. Barnard and Mr. Gordon both, to measure your performance. When we're lobbied, we never get the results for how many students you've graduated and how many are working. We never get the results. Are we sending diesel mechanics through community college when we should be training more carpenters? That results-based information is really, I think, something that we need as a government to make decisions. Would you care to comment on that?

[Dr. David Barnard]

Certainly, universities track that information, and a lot of that information can be shared with you, such as what the graduation rates are and what the completion rates are. If that's information that's of interest to the committee, we can certainly provide it to you.

[A voice]

Yes.

[Gerald Keddy, Conservative, South Shore—St. Margaret's, NS]

I have a little more time than I thought I had, so I'm going to ask you to forward that information to us. We can get that at a later date and we'll have an opportunity to look at it, because I really do have a question here that I want to get on the table for the National Institute for the Blind.

Ms. Nolan, thank you for your presentation. I just wanted to get this straight on our 2011 funding for infrastructure. Really, I believe your most important ask is for $10 million over three years for a continuation of the infrastructure that's already been put in place.

[Victoria Nolan]

I'd like to direct that question to our representative from the library.

[Andrew Martin, Senior Project Director, Centre for Equitable Library Access, Canadian National Institute for the Blind]

My name is Andrew Martin. I'm the director of the Centre for Equitable Library Access and I'm assisting Victoria with her presentation.

The reason for the request is that there is a significant cost to producing materials in a format that people like Victoria, say, or Craig can use. They can't read a regular book. Nor is the kind of e-book that you might order on Amazon going to meet their needs, because it isn't accessible. We could explain in more detail what that means, perhaps at a later date, but it isn't accessible.

They need material in a specially formatted file—Daisy audio is the most common one—and these books can cost anything up to $2,000 to $2,500 to produce. You need the original material, ideally with an electronic file. There are costs in obtaining that. Narrators need to be paid. There are the production costs.

Basically, we've isolated the total production cost as being somewhere north of $3 million a year. We are asking the Government of Canada to supply that cost because it doesn't fall into the category of library service. I hope that answers your question.

[The Chair, Conservative, James Rajotte]

Thank you. I'm trying to move things along and to be fair to every member of Parliament here, but you can certainly supply any additional materials to the committee.

Mr. Brison, go ahead, please.

[Scott Brison, Liberal, Kings—Hants, NS]

Thank you.

I have a comment on CNIB and CELA's presentation. The funding to help your services join the digital age is particularly important today. Even the changes to Canada Post's services make some of these things less available and accessible than they were in the past. Many of us on this committee who have family members who benefit from the work you're doing get this and understand it.

Also, I think I speak on behalf of all members of this committee when I say that we would never want to take any position that would get Craig Oliver upset at us, so I think you can count on good support.

I'd like to ask a question to Travis Gordon.

First of all, Travis, not every organization that comes to this committee gets its member of Parliament, such as Sean Casey, who is here with us today, to offer support, so this is pretty important stuff.

On CASA's presentation, the Conference Board of Canada's recent report on intergenerational inequality focuses on the youth job market today, and it speaks to the challenges young people face upon graduation. With higher levels of student debt and a very tough youth job market, should we move to a more flexible approach in terms of repayment of student debt, something over a longer period of time, recognizing the challenges young people are faced with today upon graduation and in getting good employment?

[Travis Gordon]

Certainly when we're looking at addressing these issues it's very important to look at all avenues. Methods of repayment could be something. I've heard discussions in the past on perhaps extending the grace period and re-evaluating interest rates. It's also important to target student debt specifically at its core. CASA is here advocating for a 9.4% increase to the Canada student grants program, and that would make up for the shortfalls that have happened since 2009 when the program was first introduced. That program has been very effective at directly impacting student debt, and so when we have these sorts of conversations, as I said, it's very important to address or look at all angles.

[Scott Brison, Liberal, Kings—Hants, NS]

Thank you very much.

Ms. Friendly, thank you very much for appearing again.

In 2005 the federal government negotiated and achieved agreements with all provinces and territories for a national early learning and child care program. Do you think it would be possible to get buy-in today from the provinces and territories for that type of national program? Given your understanding of the provincial and territorial positions, do you think it would be possible?

[Martha Friendly]

The Premier of Ontario has actually said this publicly. I think it was in her throne speech. She mentioned the poverty reduction strategy that they just released and said that we need a national child care program and that Ontario would welcome it. I haven't asked them, but I think it would depend on what a federal government would do.

The provinces are the ones that are basically on the front lines on child care. It's not that they haven't been making changes—and many of them have been trying to make improvements—but basically they don't have the money.

I want to emphasize again the point that this isn't really a provincial issue. It's like health care. In fact, a lot of the things that Dr. Simpson said are very applicable to child care. It really needs to be done within a kind of overarching policy framework, because what we have is a real waste of money and resources because we don't have a coherent approach.

Just so we understand, there is a way to do this in Canada. We have done this before by having a federal government that works with the provinces and territories to actually execute a program that isn't one-size-fits-all but is one that fits Canadians in rural communities and in indigenous communities all across the country. Based on what the Premier of Ontario has said, certainly that province would welcome it, and there would probably be buy-in from provinces, depending on what a federal government was putting on the table.

[The Chair, Conservative, James Rajotte]

Okay, you have about one minute maximum.

[Scott Brison, Liberal, Kings—Hants, NS]

Dr. Simpson, should we make the caregiver tax credit a fully refundable benefit such that low-income Canadian families would benefit?

[Dr. Chris Simpson]

It would certainly be a step in the right direction. The other issue with it, although the concept is very good, is that only 3% or 4% of Canadians who would be eligible for it actually availed themselves of it, and it was something to the tune of about $300, but it's a good example of where the federal government can intervene in something that's important to the health of seniors that's not really in the health care portfolio to get around those jurisdictional concerns that others had.

The support for informal caregivers is very important. We'd like to see a lot more, and your suggestion is a great one.

[The Chair, Conservative, James Rajotte]

Mr. Brison, you have time for one very brief question.

[Scott Brison, Liberal, Kings—Hants, NS]

The federal funding for tri-councils has been cut in recent years. What kind of impact have you seen on the ground, Dr. Barnard?

[The Chair, Conservative, James Rajotte]

Okay, that's....

Mr. Brison loves doing this to me: I ask for a brief question, he asks for the origins of the universe.

[Voices]

Oh, oh!

[Scott Brison, Liberal, Kings—Hants, NS]

You said to be very brief. My question was very brief.

[The Chair, Conservative, James Rajotte]

Mr. Barnard, if you could answer in 30 seconds maximum, I'd appreciate that.

[Dr. David Barnard]

The actual number has been going up. It hasn't kept up with the purchasing power. What does it look like on the ground? It looks like increased competition for good researchers who have good ideas. The system's been growing. There are more people in it. The real purchasing power of the grants hasn't kept up, so there are probably good ideas in Canada that aren't being funded.