Finance Committee on Dec. 6th, 2007

[Roberto Jovel]

Again, that's only one part of the problem, as I was telling your colleague.

At least in Ontario last year, Bill 124 was enacted. That is the fairness commission and recognition of foreign-trained professionals' diplomas.

It's going to start being implemented now. It has a few exceptions, I think, as regards some medical professions, but it has become legislation, so we're really looking forward to its implementation. They have as well appointed a fairness commissioner, someone who has a little background in terms of systemic discrimination issues, and I believe that's part of what you need as well with what's going on.

I'm sorry, I'm trying to finalize my sentence....

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

I'm trying to get more time with the chair.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

We'll move on to Ms. Alexa McDonough.

You have seven minutes.

[Alexa McDonough, NDP, Halifax, NS]

Thank you, Mr. Chair.

I'd love to get seven questions in, but I doubt that I'll do it.

I'll quickly start with Glenn Drover.

I appreciated your citing authoritative references that indicate that other countries using public policies and taxation measures different from Canada's have produced results of lower poverty rates, more equal distribution of income, higher pensions for seniors, lower infant mortality rates, higher educational outcomes, and better environmental performance. I don't want to say it's all-inclusive, but it seems to me that you've just cited the general aspirations that Canadians express, and why they pay taxes, if not joyfully, at least with an understanding that this is the price for a civilized society.

Can you speak directly to the government on this issue, in the sense that we can talk until we're blue in the face, but the government is not listening? You have government members here; you have a committee that reports back to government on this issue. What is it? Is it pure ideology? Is it pure ignorance? What is it that makes it impossible for them to understand this, and can you try again?

[Dr. Glenn Drover]

I can tell you in more general terms.

If you look at the taxation trends within Anglo-Saxon countries, which tend to be the United States, Canada, the U.K., and to some extent Australia, we've gone down a similar path. If you look at the Scandinavian countries and parts of Europe, they've gone down a different path. They've made different choices both economically and socially. I think they're winners in some respects, and perhaps we're winners in some cases. But ultimately, whether it's this government or any government, it has to look at it in terms of what the reasonable objectives are that they're trying to achieve and whether they're achievable using the tax system that they have.

I was struck by a couple of things in terms of how it's always getting into a level of detail we probably don't want to get into in talking about tax incidence, tax levels, and so forth. In terms of the tax incidence in Canada, we know taxes are now mostly proportional to income. You talk about things being progressive. The only tax really left that is progressive is income tax, and that represents about 30% of total revenue, I think. It's declining. We also know that at the top end of that, it's becoming regressive. That's pretty well documented with research.

So if the current government or any government wants to continue in that direction, it seems to me they have to somehow show that Canadians are going to benefit from it. I don't really think that has been shown, by studies for sure, and by other countries. Those are the kinds of challenges we're facing.

In terms of these kinds of initiatives, there's a fair amount of evidence. The example that would be closer to our political tradition is the U.K., where the Blair government certainly kept fairly conservative fiscal policies. On the other hand, they came up with some very strong measures on poverty and developed an anti-poverty strategy that we've been talking about several times today. They laid out all the ingredients of such a strategy, and they have been relatively successful.

[Alexa McDonough, NDP, Halifax, NS]

Ms. Sholzberg-Gray, I noted that several of your strongest recommendations are very high priorities from the Romanow commission. I know how closely engaged you were in that process. What do you think happened? The Romanow royal commission recommendations were measured to be supported by some phenomenal percentage of Canadians, yet the previous government didn't move on most of those recommendations, and certainly the current government isn't doing so either. I'm thinking about the information stuff, about the home care, and about the national pharmacare program, just to mention three.

[Sharon Sholzberg-Gray]

To be fair, the 2004 accord did have a home care program--a two-week post-acute, after-hospital stay, and a bit of palliative mental health care in the community. What we don't have is a comprehensive approach to home care that deals with chronic needs, ongoing needs, frail elderly, and what not. We're actually going to the Senate Special Committee on Aging on Monday on those kinds of things.

I think the real issue is that we have to be a little flexible in the way we fund the programs. There is a bit of a social test on some of these social support programs, and we have to admit that there ought to be, because not everything can be done according to Canada Health Act rules and because there hasn't been that flexibility between the federal government and the provinces.

With respect to pharmacare, the real issue is that we haven't addressed issues of utilization, inappropriate prescribing, the high cost of generic drugs, and those kinds of things. Most people want to address those issues; otherwise, the costs can escalate. When you look at total health costs, what's going up fastest is still pharmaceuticals, not all of the other things, which may be good or it may be bad. Hospitals are not really going up at all. As you may have noticed, they're much lower than they were years ago.

So the real issue is that there has to be a will to do it. I haven't yet given up on a pharmacare program, with opting in or not opting in, or opting out, as long as people everywhere in this country have access to pharmaceuticals. I haven't given up on electronic health records. That's something we're going to have to have to improve quality, efficiency, access, and all kinds of things and to sustain the system over time.

So I haven't given up on these things. I just think things sometimes take a long time. I've been making these presentations for twenty years, and you know, we've made progress in a number of areas. So I'm always hopeful.

[Alexa McDonough, NDP, Halifax, NS]

Just before asking a final brief question to Ms. Kirk, I just wanted to say to Mr. Wiebe how much I appreciate your confirming the sound practical recommendations that have been made by Phil and Elizabeth Pacey in this province for years and years. They're always responded to by a lot of the corporate interests as some kind of pie in the sky, when they're in fact very practical solutions.

Ms. Kirk, I was interested in asking you to comment briefly on two things in relation to your recommendations. One is the community foundations movement and how you see that intersecting with the charitable organizations' needs.

Secondly, I was interested in the fact that you didn't make reference—and I've forgotten the exact question that you were asked—to what came to my mind, and that was the voluntary sector initiative that took place over a period of years. I know there were a lot of concerns by the charitable organizations about the constant pressure to eliminate advocacy, or at least downplay advocacy to a very alarming degree. I wonder if you could comment on that.

[Teri Kirk]

I'll respond very quickly. I see the chair noting the time constraints.

We're huge fans of the community foundation movement and organization. They supported our brief here today, and we work closely with them. They've done an extraordinary job in making Canada a leader worldwide in providing a community-based foundation where donors can give and enjoy a more strategic approach to the community's needs. They are themselves charities, and important charitable organizations.

In terms of the VSI, one of the comments I made is that charity seems to be a little bit off the agenda, and we really hope the government will put it back on. We realize you're a new government and were elected to achieve a very specific set of policy objectives. We'd like to see this among your policy objectives. The VSI was there for a decade, a voluntary sector initiative. It achieved some really great and important gains. Frankly, we feel we don't have a champion or minister responsible, and we encourage you to provide one. The key data sets at Statistics Canada are subject to being cut right now, as we speak, and we're very concerned about that. We'd like to see a champion in cabinet and have brought forward that recommendation already.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

We'll now move on to Mr. Savage. You have seven minutes.

[Michael Savage, Liberal, Dartmouth—Cole Harbour, NS]

Thank you, Chair.

I want to thank you all for coming out. We've had a very interesting day here in Halifax-Dartmouth.

I want to chat a bit with Ms. Sholzberg-Gray, if I could. This may be partly philosophical, but it's partly financial. I'm taking advantage of your years of service on the health care front. I want to talk about caregiving with you, because you mention this in your brief—informal caregiving.

My experience with caregiving is a personal one, as is most people's. My parents died close together four and a half years ago. I had two sisters who moved from Toronto and came back to the family home and saw my parents out. We're a large family, so we all helped, but those two women in particular provided so much care to my parents, which is a wonderful experience. I can recall my parents, late in their lives, saying how wonderful their death was about....

It occurred to all of us then that it's an experience everybody should be able to have if they so choose—to die at home rather than in a hospital. It seems to me there's an economic argument here, that by keeping them out of the hospital, if you have volunteer caregivers, family caregivers.... There's an organization in Nova Scotia called Caregivers Nova Scotia. Alexa has a close association with them, as do I, and perhaps Mr. Keddy has as well. These are people who can make the case that they are providing so much care and are taking a significant burden off the health care system in terms of personnel and a hospital bed.

You talk about volunteer caregiving. Would you agree with me that this must be something we could work out financially; that we could shift some resources directly to people who are providing care for loved ones in a way that would actually reduce the burden on the health care system and improve the quality of life and death of citizens—not just for those who can afford it, like my family, but to enable other families to have that same experience?

[Sharon Sholzberg-Gray]

First of all, we're not only talking about palliative care here, though that's part of the picture. We're talking about anything that involves ongoing chronic needs of relatives, whether it's children or the elderly or what not. We actually had proposed a package of supports for informal caregivers. One of them, which we mention in this brief, is a drop-out period from the Canada Pension Plan for people who take time off to be caregivers, just as there's a drop-out provision for children. That's one way. There are a number of other ones we could put on the table.

But it seems to me also that we have to recognize that another thing is to have positive programs, such as better respite programs, that are part of an expanded home care program. These are the kinds of things that have to be in any definition, it seems to me, of pan-Canadian approaches if there's going to be any more federal money. I know that all over the country there are those kinds of programs, but they're not necessarily enough, and they don't support and relieve families enough, because families can't do this 24 hours a day.

Absolutely, people ought to be at home rather than in hospital. People always ought to be in the appropriate setting as opposed to the most expensive setting, which is the hospital. In some provinces, though, because they don't have access to pharmaceuticals at home, they have to choose to go into the hospital so that they get the pharmaceuticals.

What I'm trying to say is that there's a link between everything and everything else. If you don't have pharmaceuticals at home, you're going to want to be in a hospital, and that's going to be the place with the most expensive care, so it would actually be cheaper to bring a pharmaceutical program to people who are at home—and so on and so on.

We have a package of those kinds of things to recognize the support to informal caregivers--but all the links between all parts of the system.

[Michael Savage, Liberal, Dartmouth—Cole Harbour, NS]

I recognize there are a lot of parents with autistic children and situations in which sisters are taking care of brothers. This should apply to everybody, but it would seem to me to be an awfully good stake in the ground to say that anybody who wants to die at home should have that opportunity.

You came in on the same plane as I did last night. You woke up this morning in Halifax. You saw that the front pages of both local newspapers were talking about private health care and what appears to be the premier's endorsement of some degree of private health care. Would that concern you? What thoughts do you have?

[Sharon Sholzberg-Gray]

Our association has an evidence-based approach to issues of private delivery. We are pretty well on record as saying that the single-payer system works. There ought to be a social analysis here and there if you want to bring on home care social programs, and there is room for copayment in long-term care facilities, providing, of course, people aren't impoverished by those copayments. But let us put that aside and talk about whether or not we can save money by contracting out to private surgical clinics. Can we be assured that there is accountability, that there are cost savings, that there is quality, and that there is no cream-skimming? Because you realize that the publicly funded health system can do easy procedures just as cheaply as any private clinic. The real issue is how to do complex things in private clinics.

I'd just like to cite my friends in the American Hospital Association, because I go to their board meetings. By the way, 80% of American hospitals are not-for-profit. The worst problem they say they have is private surgical clinics that take the easy things, the cream-skimming things, the routine things, including healthy people who need knee replacements and routine cataract procedures for people who have no comorbidities like high blood pressure or heart problems. They take all the easy things, and as soon as there's a complex case that lands on their doorstep in their emergency, boom, they have all the costs. So I don't think cream-skimming to private surgical clinics is an answer.

We would say we should look at the evidence. Show us where it's cheaper. The evidence is that it isn't cheaper. If it's cheaper, we'll go for it, because it's good to have values. I oppose private this and private that, but I don't think values are enough. Values need to be supported by evidence. So we would say that you should show us that you get quality, accountability, cost savings, and what not. Maybe you do for urine testing, blood testing, and maybe some housekeeping services; let's see. Let's look at the evidence. I'm not convinced.

[Michael Savage, Liberal, Dartmouth—Cole Harbour, NS]

Do I have time for a question for Mr. Drover?

[The Chair, Conservative, Rob Merrifield]

You have less than a minute.

[Michael Savage, Liberal, Dartmouth—Cole Harbour, NS]

Mr. Drover, you mentioned the Caledon Institute of Social Policy in your brief. They've done some very good work. Ken Battle has written on a number of issues. Have you seen any of the stuff they've done on the universal child care benefit?

[Dr. Glenn Drover]

Do you mean their criticism of it?

[Michael Savage, Liberal, Dartmouth—Cole Harbour, NS]

Yes. I don't want to get into it. They had criticism of it, I would agree, but also there is their recommendation that it would be better delivered through, for example, the child tax benefit and a number of other things.

[Dr. Glenn Drover]

Their proposal is to integrate the initiatives.

[Michael Savage, Liberal, Dartmouth—Cole Harbour, NS]

Do you think that makes sense?

[The Chair, Conservative, Rob Merrifield]

We'll now allow Mr. Dykstra to finish off the questions.

[Rick Dykstra, Conservative, St. Catharines, ON]

I did want to ask Mr. Wiebe a question. We've had an extraordinary number of heritage organizations presenting over the last number of weeks. That's probably not a coincidence, but it is certainly not a negative thing, and we appreciate your being here.

One of the things in the 2007 budget that I've asked a couple of the other presenters about is the whole aspect of the Canadian national trust. That was a program that tried to emulate one from the United Kingdom. As to your program, in trying to move government away from it, if you will, in terms of actually building a heritage trust organization that actually can do some things, we've dedicated funds to that, obviously.

I wondered what your thoughts were on it, and whether people from your organization are participating in it.

[Chris Wiebe]

Yes, actually our executive director has been in discussions with people in the federal government about the ongoing shape and nature of this national trust that was announced, and it was obviously natural we'd see ourselves as being key participants in that discussion.

I also want to point out that when we're thinking about a national trust, we're thinking about owning particular buildings and saving them in perpetuity. There are limits to what can and can't be done in that regard. We can't save every building. The cost would be prohibitive, so there will have to be some limits put on that. Then these other measures in place for the other buildings that may not be able to be afforded those protections have to be there in terms of the incentive to allow the private sector to intervene and to help rehabilitate them.

[Rick Dykstra, Conservative, St. Catharines, ON]

Thank you very much.

The next question is for Ms. Kirk. It's nice to see you again.

One of the interesting points you made in terms of your recommendations is to consider incentives for private debt funding for charities and not-for-profits. I wonder if you could expand on that a little bit.