Evidence of meeting #116 for Finance in the 41st Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was education.

A video is available from Parliament.

On the agenda

MPs speaking

Also speaking

Richard Wilkinson  Emeritus Professor, Social Epidemiology, University of Nottingham, As an Individual
Robin Boadway  Professor, Department of Economics, Queen's University, As an Individual
Miles Corak  Professor, Graduate School of Public and International Affairs, University of Ottawa, As an Individual
Ian Lee  Professor, Carleton University, As an Individual
Michael Holden  Senior Economist, Canada West Foundation
Anna Reid  President, Canadian Medical Association
Daniel Muzyka  President and Chief Executive Officer, Conference Board of Canada
Benjamin Eisen  Assistant Research Director and Senior Policy Analyst, Frontier Centre for Public Policy
Brenda Lafleur  Program Director, Conference Board of Canada

9:50 a.m.

Conservative

The Chair Conservative James Rajotte

Thank you.

We'll go to Mr. Van Kesteren, please.

9:50 a.m.

Conservative

Dave Van Kesteren Conservative Chatham-Kent—Essex, ON

Thank you, Chair.

Thank you, all, for coming here.

Mr. Lee, are you a professor of economics?

9:50 a.m.

Professor, Carleton University, As an Individual

Dr. Ian Lee

No. I'm in the Sprott School of Business at Carleton University.

9:50 a.m.

Conservative

Dave Van Kesteren Conservative Chatham-Kent—Essex, ON

We talk about the poverty level, and I think Mr. Caron was talking about how incomes have failed to rise. Is it fair to do that and not put into the equation the benefits that we as a society have obtained since, say, the fifties in health care? If I'm working for an employer, I may be paid $20 an hour, but if I'm getting dental and health care, etc., and we have paved roads.... The list goes on and on.

Is it fair to compare those and not put that into the equation?

9:50 a.m.

Professor, Carleton University, As an Individual

Dr. Ian Lee

I think I understand your question. That's why I was referring to Professor McCloskey at the University of Illinois who has studied the origins of the market economy and what it has done.

I should have disclosed earlier that almost immediately after I became a professor in 1988, the Berlin Wall came down, and beginning in March of 1990, I started teaching in countries that were under the former communist system. I've taught in just about every form of communist country in the world. I've been teaching in China since 1997, and I've taught in Russia, Bulgaria, and so forth.

Although they had radical equality in these countries, they were all radically poor. I saw this up close, first-hand, and personally, because when the wall came down, they didn't suddenly become wealthy western countries. It took literally 10 years. Some of these countries still haven't transformed. I'm talking about countries such as Ukraine and Russia, which are still radically unequal and radically corrupt, whereas Poland transformed much more rapidly, so it has become much more successful.

9:55 a.m.

Conservative

Dave Van Kesteren Conservative Chatham-Kent—Essex, ON

So they need all those layers of wealth that we've accumulated.

There's one thing that's not coming into this equation, and that is experience. You spoke of your experience. I could speak of my experience, and I think probably others could too. I was born poor. I know what poverty is, so when people talk about poverty, here's the thing that poverty did for me: I didn't want to stay poor.

But there was opportunity back then. That's the difference I see. I don't see too much opportunity. I remember that as a young man.... And listen, I finished Grade 12. I went to Grade 13 for one week and said, “Forget it, I'm going to work.” I saw opportunity as a young man, as I think every young woman did. Everybody saw opportunity. At every street corner, it was “I could go into business doing this” or “I could go into business doing that”. That opportunity is gone. Would you agree with that?

9:55 a.m.

Professor, Carleton University, As an Individual

Dr. Ian Lee

Indeed. There's a professor at the London Business School—I wish I could remember his name—who is originally from India. He said that people look at the slums of Calcutta and say, “Oh, look at all these victims.” He said, “All I see are entrepreneurs.”

9:55 a.m.

Conservative

Dave Van Kesteren Conservative Chatham-Kent—Essex, ON

I just came from South Sudan. I see the same thing. It's a poor country. I'm not worried about those people because those people want to go...they just see opportunity.

9:55 a.m.

Professor, Carleton University, As an Individual

Dr. Ian Lee

Where you stand depends on where you sit.

9:55 a.m.

Conservative

Dave Van Kesteren Conservative Chatham-Kent—Essex, ON

I'm going to ask another question. We've compared the rich countries to the poor, and in the developed countries the United States comes out at the bottom. What would happen to this world if the United States were to collapse? What would happen to the GDPs of all these other countries?

9:55 a.m.

Professor, Carleton University, As an Individual

Dr. Ian Lee

I fully acknowledge the inequalities. They are there, and of course we want to reduce them. Of course we do. But at the same time, I think we are ignoring the larger picture. As Professor McCloskey has noted, in the last 200 years the average human being around the world has gone from a dollar a day in the western countries to $150 a day almost overnight, from 1800 to 1900, and this is something that we should be celebrating, I think, rather than condemning.

9:55 a.m.

Conservative

Dave Van Kesteren Conservative Chatham-Kent—Essex, ON

Are we missing something? I seem to remember that the Americans used to say “give us your poor and give us your downtrodden”. Did they see something that we don't see today? Did they see that as a vehicle to lift that nation out of poverty?

9:55 a.m.

Professor, Carleton University, As an Individual

Dr. Ian Lee

Going back to my experience in travelling in these very poor developing countries, there's one thing that struck me over and over.

I haven't counted them up, but I've done somewhere between 80 to 100 trips in the last 15 or 20 years to these countries, and the lineups outside the Canadian and the American embassies for visas to emigrate are 10 times longer than those outside any other embassy of the embassies I see. I am always teaching in capital cities, such as Sofia, Bulgaria, and Bucharest, and Kiev, and the lineups are vastly longer.

People see these two countries and for whatever reason...we could say they are uninformed, except that they have relatives who tell them what's going on here.

9:55 a.m.

Conservative

The Chair Conservative James Rajotte

Okay.

A very brief question, please.

9:55 a.m.

Conservative

Dave Van Kesteren Conservative Chatham-Kent—Essex, ON

I'll be very quick.

I had a group of young people who came in, and I applaud them. They were advocating for higher education for the poor. I asked each one of them where they came from. They all came from parents who were professionals who pushed them...except for one student who came from immigrant parents and whose dad said, “Listen, you're not going to do this, so you're going to school.” Is that a pretty good analysis as to why we're not having success—

9:55 a.m.

Conservative

The Chair Conservative James Rajotte

Okay.

Very quickly, please.

9:55 a.m.

Professor, Carleton University, As an Individual

Dr. Ian Lee

I'll be quick: yes.

9:55 a.m.

Conservative

The Chair Conservative James Rajotte

Thank you.

Mr. Côté, you have the floor.

9:55 a.m.

NDP

Raymond Côté NDP Beauport—Limoilou, QC

Thank you very much, Mr. Chair.

Instead of focusing on emotions, I will stick to facts and figures.

Ms. Reid, I very much enjoyed your presentation. I must tell you that, for the past 30 years, one of the areas I have been personally interested in is the public health system, its impacts and related costs. One thing I'm particularly interested in and that I found very interesting in your presentation is that, when we talk about social determinants of health, in reality, factors like housing situations, adequate nutrition and so on account for 50% of a person's health status and that it is income that has the most impact in that regard.

I would like to bring another point up with you, and I will tell you that my question will be fairly difficult.

Let's agree that Canada's current universal health care system has been the victim of significant neglect, particularly at the federal level. In fact, the initial agreement in the 1960s stated that the federal government would cover half the costs. It has dropped significantly since then.

Could you please comment on the fact that this may be affecting health care coverage for the less fortunate and inequality among the provinces, since some of them are in a much better position to support their health care system, despite the neglect at the federal level?

10 a.m.

President, Canadian Medical Association

Dr. Anna Reid

We know that the health care system has a lot of problems. It's responsible for about 25% of your health outcomes, which is not inconsiderable. One of the big issues we see as physicians is that the health care system only covers physician visits and hospital care. There are many other things going on outside of the health care system that are difficulties for people who don't have adequate income right now. For example, we know that one in 10 Canadians cannot afford to buy their own prescription medication. So we've been advocating for some sort of pharmacare plan that would find ways to fill in those gaps. This would involve a pooling of risks between public and private plans so that every Canadian can have access to their needed medication. That's certainly a big concern and it's something outside the Canada Health Act.

The same goes for long-term care, home-based care. We know very well that if you are poor in this country, your prospects of requiring any kind of reasonable long-term care are not good. You may block up hospital beds. For example, my father has advanced dementia and I pay $6,000 a month to put him in assisted living with care. If I did not have that money, he would be sitting in a hospital bed right now at the Ottawa General Hospital and bumping the cost of the system up. These are the issues outside the current health care system that I think we need to put some public policy towards.

10 a.m.

NDP

Raymond Côté NDP Beauport—Limoilou, QC

Thank you, Ms. Reid.

The Beauport—Limoilou riding, which is located in Quebec City, is particularly disadvantaged. I have a table from the public health authority that outlines these differences. For some health factors, that sometimes doubles. That's the case for mental health, in particular. It is a huge motivation for me, as a politician. Thank you very much for the information about that.

Professor Wilkinson, in the observations I've made in the past 30 years or so, I have been struck by the fact that a comprehensive public system where there is large public coverage was much less costly. The case in the United Kingdom is very interesting in that respect. In fact, when I consulted the OECD data for 2007—I don't know if more recent data is available—I saw that the United Kingdom is in a particularly good position with a health system that costs much less than in other G7 countries, while providing coverage to much more of the population. This is the case compared with Canada and, more particularly, the United States, which is the extreme case for G7 countries.

Would you like to comment on that?

10 a.m.

Emeritus Professor, Social Epidemiology, University of Nottingham, As an Individual

Dr. Richard Wilkinson

I think there are economies in the administration of health services that are funded out of taxation rather than insurance systems. Certainly, it's a benefit that the coverage is universal. But I think it's important to recognize that there are not strong relationships between almost any measure of health care—whether it's hospital beds, doctors per head, or expenditure per head—and accrued outcomes like death rates.

Health services are important, but much more important is whether you get a life-threatening disease to start with. It is a matter of the social and economic conditions in the society that the influence of those sorts of factors vastly outweigh the importance of medical care in determining things like life expectancy.

10:05 a.m.

Conservative

The Chair Conservative James Rajotte

Okay, thank you.

Mr. Côté, your time is up, unfortunately.

Mr. Adler.

10:05 a.m.

Conservative

Mark Adler Conservative York Centre, ON

Thank you, Chair.

First, let me retrace a little history. We've had in this country a system of universal single-payer medicare. Historically, we've had good, well-funded social programs. We have had more of a social focus than, say, the Americans. Going back to the sixties, the U.S. had the “New Frontier”, the “Great Society” programs, where the impetus was on challenging the American people to lower taxes. Here in Canada, we had the so-called “Just Society”, which led to increase in taxes, which led to wage and price controls, which led to inflation, which led to high interest rates.

How effective would you say the Just Society experiment was? Dr. Lee, would we have been better off going down a Great Society route as opposed to a Just Society route?

10:05 a.m.

Professor, Carleton University, As an Individual

Dr. Ian Lee

Are you referring to Lyndon Johnson's “Great Society”?