Finance Committee on Sept. 28th, 2017

[The Chair, Liberal, Wayne Easter]

I'd like to say, Erin, as well, that it would be great if we could get back to the pre-budget aspect of this hearing. We've heard a lot on the tax measures, but the floor is yours.

[Erin Weir, NDP, Regina—Lewvan, SK]

I'm asking questions about the testimony I heard and the responses to questions from a previous MP. I realize, though, that time is of the essence, and I'm wondering if you could give me an update on where the clock sits.

[The Chair, Liberal, Wayne Easter]

You're okay for another two minutes, because I took 30 seconds from you.

[Erin Weir, NDP, Regina—Lewvan, SK]

Thanks so much. I really appreciate that.

Of course, the history of medicare in Canada is that the original vision was for physicians to be paid a salary, which would include pensions and other benefits, like other public employees. It was the Canadian Medical Association that fought tooth and nail against that, in favour of fee-for-service compensation.

Do you see that as the best model, or do you actually think it would be better if physicians had pensions and health benefits?

[Dr. Emil Lee]

I think the overall circumstance of health care in Canada is complex, so it would not be appropriate for me to say yes or no to that question because I'm certainly not an expert in that nature of health policy. What I can say is that, given the totality of what we're dealing with, I think this would certainly be something that might enter further discussions. Obviously, that would involve the federal government, the provinces, and physicians.

Certainly, what we're talking about here and what we're saying is that this one particular tax policy is something that we have major concerns about. This isn't necessarily something that would make a vast, humongous change to the rest of health care; again, we're talking about unforeseen circumstances and possible unforeseen deleterious effects on the health care system from a massive policy change. I certainly would not feel comfortable saying, “Yes, let's go there.” I can't do that.

[Erin Weir, NDP, Regina—Lewvan, SK]

In your testimony, you suggested more government funding to help purchase diagnostic equipment, which strikes me as a very reasonable request. We certainly want the best possible equipment for Canadian health care, but it seems that a large part of your justification for physicians incorporating is that they need to buy this equipment themselves. I'm wondering how you reconcile those two points.

[Dr. Emil Lee]

We do talk about the equipment purchases. The vast majority of clinics that radiologists own outside of a hospital system have X-ray and ultrasound machines, and certainly that is a part of the process that they need to do. It's part of the incorporation process to do that.

What we're actually talking about, mainly, are CT and MRI machines, the vast majority of which are in the public system. In my province, certainly, the vast majority of CT machines are in public institutions. In fact, a patient is specifically prohibited from having a private CT for a medically indicated service.

[The Chair, Liberal, Wayne Easter]

Mr. Grewal.

[Raj Grewal, Liberal, Brampton East, ON]

Thank you, Mr. Chair, and thanks to our witnesses for testifying.

Mr. Lee, you belong on this side of the table. You're very good at not answering the question directly, but Mr. Weir gave it a pretty good shot.

This morning the CMA said that 66% of their members are incorporated and that the average revenue of each incorporation was $396,000. Does your association not collect information on how much an average radiologist makes?

[Dr. Emil Lee]

Our association does not collect information on what our members make. The purview of the Canadian Association of Radiologists is not actually towards income per se, because that's mainly a provincial jurisdiction. We don't dive into the fee-for-service environment, per se. We do know, as the CMA has said, that the CIHI data says that's what the average is. I understand that.

[Raj Grewal, Liberal, Brampton East, ON]

Thank you, Mr. Lee.

To the Canadian Association of Fire Chiefs, thank you for your testimony. You've said that a majority of your fire crews in the country are still volunteers. How does that model work?

[Ken Block]

It works quite well, and yes, absolutely, the majority of the fire service in Canada is based on volunteers. Volunteers are about 80% of the fire service. The way the population in Canada is dispersed, there are an awful lot of rural areas with smaller populations, and they just don't have the economies of scale to support a full-time fire service.

[Raj Grewal, Liberal, Brampton East, ON]

How is recruitment going?

[Ken Block]

Speaking in terms of the volunteers, that is by far the number one challenge, or barrier, if you will: attracting and retention of volunteers. This is not a job for the faint of heart. Quite frankly, it takes an awful lot of dedication and time. There is a constant turnover. I can tell you that for chiefs of volunteer departments across the country that's probably their number one priority.

[Raj Grewal, Liberal, Brampton East, ON]

How about recruitment for general fire departments? In Brampton, I've met with the fire chief a few times and have gone out to the different fire stations. They're having trouble with diversity in terms of their recruitment, and they're having trouble with recruitment in general in terms of trying to convince younger Canadians to join the profession. How is it across the country?

[Ken Block]

It varies. I can talk about Edmonton briefly, based on my experience as chief there for the last nine years. We don't have a problem in attracting folks. We do have a diversity challenge, and we're addressing that through outreach. We're trying to create an awareness in the diverse communities of the great opportunities in this profession and to make the folks in those diverse communities aware of how to prepare themselves to compete to get on the job.

As an example, Edmonton would get about 1,500 qualified applicants per year. Of that 1,500, we would place between 80 and 100 folks on a hiring roster, if you will.

[Raj Grewal, Liberal, Brampton East, ON]

Thank you so much for your answers.

Charlotte, thanks for your testimony. I have a soft spot in my heart for students because I still carry student debt—

[Voices]

Oh, oh!

[Raj Grewal, Liberal, Brampton East, ON]

—so every time I hear from the Canadian Federation of Students, it brings back many memories.

You're advocating for free tuition across the country. I want to ask you a question. What percentage of student debt is defaulted on?

[Charlotte Kiddell]

Pardon me?

[Raj Grewal, Liberal, Brampton East, ON]

What percentage of student debt is defaulted on? What percentage of students cannot afford to make their student loan payments?

[Charlotte Kiddell]

I don't have that number in front of me, and I'm very embarrassed about that. I'm sorry.

[Raj Grewal, Liberal, Brampton East, ON]

That's okay.

[Charlotte Kiddell]

What I can say is that with the changes made to the repayment assistance plan, which say that you don't have to start paying back your student loan until you're making $25,000 a year—that is still, I will mention, well below the poverty line—I believe that a third of folks holding Canada student loans qualify for that program, which is an alarming number, in my opinion.

[Raj Grewal, Liberal, Brampton East, ON]

Okay. A humble suggestion would be to figure out what that number is, what the percentage is of students who are defaulting on their student loans, because it will strengthen your argument to say that a lot of Canadians aren't able to make their student loan payments as they're currently set up.

One thing I never fully appreciated is that we live in a country of equality, except that if you're born in Quebec and go to university in Quebec, the undergrad tuition is much lower than if you go to university in Ontario. I want to get your feedback.