Finance Committee on April 18th, 2024

[Alexandre Boulerice, NDP, Rosemont—La Petite-Patrie, QC]

Ultimately, then, you'd like to see a public, universal dental plan.

[Olivier Surprenant]

Yes.

[Alexandre Boulerice, NDP, Rosemont—La Petite-Patrie, QC]

Excellent. We agree on that.

Of course, when I talk about a public, universal plan, you can probably guess where I'm headed. Several stakeholders in Quebec civil society, such as the Fédération des travailleurs et travailleuses du Québec, the Centrale des syndicats du Québec and the Confédération des syndicats nationaux, are calling for a universal, public pharmacare plan.

There is a plan in Quebec, but it's hybrid. It's a public-private plan that has its flaws, among which is an inability to adequately control drug prices. A few years ago, you submitted a recommendation to the Standing Committee on Health in favour of universal pharmacare, and you hoped that the government would work with the provinces to achieve this goal.

In your opinion, why is this the best option for controlling and lowering drug prices, not only for patients, but also for the health care system?

[Olivier Surprenant]

Of course, when you're the sole purchaser of drugs—which is what a universal, public, single-payer drug plan would propose—you have greater bargaining power with pharmaceutical companies. So we need to bring all these parties together, all Canadians, all provinces and the federal government, to make medication accessible. In the long run, this will lower our bills and, of course, help us avoid health problems that would otherwise lead to hospitalization. So it's essential for us. Too many Canadians and Quebeckers still go without medication today because the coverage is incomplete and doesn't include all the drugs they need.

[Alexandre Boulerice, NDP, Rosemont—La Petite-Patrie, QC]

On that score, former Quebec health minister Jean Rochon, who introduced the plan 30 years ago—a great step forward at the time—admitted that it was time to stop asking whether a universal program was relevant, but rather when to implement one.

In your opinion, what are the flaws in the current hybrid Quebec system? In what ways does it fail to respond adequately to the needs of the population? It partly does, but not fully.

[Olivier Surprenant]

It's simply that a plan should be entirely public. There should be no distinction between those who have insurance through their employer and those who don't; everyone should have the same public insurance and access to the same pool of drugs deemed essential to treat health conditions. Such a drug plan would be ideal, in our view.

[Maxime Dorais]

We also need to talk about free medication, which we don't have right now in Quebec. Premiums are paid on a monthly basis, at the beginning of the year and with every transaction. These premiums mean that even people who are insured go without medication, or take it less frequently. This creates additional health problems, since these people end up being treated in the public health system. So we end up footing the bill anyway.

[Alexandre Boulerice, NDP, Rosemont—La Petite-Patrie, QC]

I just want to make an additional comment about supplemental insurance. I met with many part-time workers who told me what the cost of such insurance represents. Between 25% and 30% of their salary goes to paying supplemental insurance, because we can't control the cost of drugs in Canada. Therefore, a universal public pharmacare plan would help a lot of people.

[The Chair, Liberal, Peter Fonseca]

Thank you, Mr. Boulerice.

Now we're going to our second round, and because we don't have enough time for a full round, we're going to do three minutes per party.

We're starting with MP Williams for the first three minutes.

[Ryan Williams, Conservative, Bay of Quinte, ON]

Thank you, Chair.

Ms. Quaid, I'm going to continue with you. We have, of course, Bill C-59, and we're talking about competition changes.

The budget was just released this week, and it also points to Bill C-59 in saying that it's tackling some of these affordability issues. They talk about lowering everyday costs and affordable groceries.

Have you seen the budget or not? Is the budget going to fix competition for Canadians, yes or no?

[Dr. Jennifer Quaid]

Not from what I've read so far.

[Ryan Williams, Conservative, Bay of Quinte, ON]

It's surprising to me, because it does say that it's going to do that. It's going to bring affordable groceries and more competition. Obviously, there's a lot more work to do.

You've written before that we need to stop spinning the changes to competition as an affordability measure. Is that something we need to focus on, as you've said before...real changes to the act piece by piece?

You've also talked in podcasts before about having a broader scope on competition. We need to really look at creating a new recipe for this. How do we do that? How do we fix competition in Canada?

[Dr. Jennifer Quaid]

I think the first point is that we have made some progress. I'm not the only one to have said that of course the existence of competitive markets and a functioning competitive system does contribute to keeping price levels down. It's also being responsive to demand because it's not just about price. It's about quality and it's about what consumers want.

I don't want to say that competition does nothing about it, but it's not as direct or as causal as is being suggested. Certainly none of the changes.... That's what I worry about particularly.

You ask what the recipe is. I think the recipe is to take a step back and ask what our objectives are.

People didn't like it when I said this, but I said that the purpose clause identifies the benefits from competition, but maybe we need to rethink that. Are those the rights ones? Is that all of them?

You can't have 15 objectives, but you could think that, in the 21st century and where we are at with the way things are, maybe we have to think about things differently. I've always said that competition policy should be aligned with the priorities of Canadians. We need to ask ourselves...and you are the best placed, as members of Parliament, to figure out what Canadians want.

Then you ask what tools we need, how much money we need and what resources we need. How much expertise do we have to go and get?

The bureau has a lot of expertise. It has some budget, but I would suggest that for some of the things we're asking them to do, it doesn't necessarily have the capacity now. They could develop it, but that doesn't come out of thin air.

To me, it starts with the master plan and asking, “What do we want? What are the important things?” Then you build around it.

Right now, we're doing a lot of targeted, reactive things that I worry are not going to play out the way people think.

[The Chair, Liberal, Peter Fonseca]

Thank you, MP Williams.

Now we'll go to MP Thompson.

[Joanne Thompson, Liberal, St. John's East, NL]

Thank you to all of the witnesses. I'm sorry the time is so short.

Dr. Burry, if I could start with you, you noted in your opening comments that you spent a significant portion of your career with vulnerable populations.

I want to give a shout-out to the Newfoundland and Labrador Dental Association, which I worked quite closely with in putting a largely volunteer clinic in place with hygienists and denturists. They're really having incredibly strong outcomes for the most vulnerable in the community.

I really want to touch on that. I saw first-hand, obviously, the health care outcomes and how this becomes preventative.

Would you speak to what you saw in your practice with vulnerable persons and the importance of dental care for all, so that it truly is an equitable, essential service?

[Dr. Aaron Burry]

I've dealt with everything from individuals living on the streets, to individuals in long-term care, to individuals with significant health problems. As you age in particular, you have significant health problems. Oral health becomes a real, critical part.

Not surprising, if you have other health-related problems, you have oral health-related problems and you need a lot of additional care.

I'm familiar with the projects. I know the dentists that you're speaking of specifically. I know the volunteer effort they put in.

That's something you simply cannot do in private practice settings. These individuals need a lot of additional support. I would say the same thing applies to individuals in long-term care in particular because you're not just dealing with the individual. You're dealing with the families, the caregivers and others who provide that support.

This program is so important to us, in that the group of individuals who the government is now going to be offering these benefits to are seniors and people with special needs. Individuals well over the age of 87 are now starting to come in.

Providing dentistry to those groups is challenging. I did it for a good part of my career. That's why the program needs to be designed to assist them.

[Joanne Thompson, Liberal, St. John's East, NL]

Absolutely.

I certainly want to note that it's a continuum of care for people across all aspects of society. Certainly in the project that I referenced, they were truly the most vulnerable, which is part of wraparound support and primary health care. You need a wide range of supports to assist children and others who are vulnerable, in terms of just the ability to visit a dentist.

Thank you for the work you're doing. I look forward to the day when we have oral health for all, regardless of the ability to pay.

[The Chair, Liberal, Peter Fonseca]

Thank you.

Now we'll go to MP Trudel, please.

[Denis Trudel, Bloc, Longueuil—Saint-Hubert, QC]

How much time are you giving me, Mr. Chair?

[The Chair, Liberal, Peter Fonseca]

You have three minutes.

[Denis Trudel, Bloc, Longueuil—Saint-Hubert, QC]

Mr. Dorais and Mr. Surprenant, we talked a bit about the fact that the grocery code of conduct is quite imperfect at present. It's not mandatory, and Loblaw and Walmart, among others, have yet to sign on. If we were to make it mandatory, would that force everyone to sit down at the table and talk, and thus bring about a substantial reform that could have an impact on prices? What could you tell us about that?

[Olivier Surprenant]

The short answer to your question is yes. You're referring to the difference between self-regulation and government-led regulation. Regulations or legislation establishing a framework or requiring compliance ensure that all parties are represented. As you so clearly stated, to date, so far, Loblaw and Walmart have indicated that they wouldn't sign on to a Canadian grocery code of conduct. So there's an inherent problem with the approach.

[Denis Trudel, Bloc, Longueuil—Saint-Hubert, QC]

In your opinion, why won't the government move ahead now with that kind of reform and force everyone to sit down at the table?

[Olivier Surprenant]

I can't speak for the government.

[Denis Trudel, Bloc, Longueuil—Saint-Hubert, QC]

I have about a minute and a half left.

The federal budget was tabled two days ago. Do you have any specific comments in that regard? Is it good news or bad news?