Finance Committee on May 17th, 2023

[Meghan Nicholls]

There would be two other items. There would be continued advances in child care provision to enable adults who want to work to be able to afford to work. Open up enough spaces that meet the needs in each community.

The second would be supports for newcomers to support them to land well in Canada. For whatever reason, through whatever program they come here, how do we equip folks to find the right kind of work, find the right kind housing and be able to have a successful start? Many newcomers start off using the food bank. I think it's understandable. People who come to Canada have saved money for a time. They get here, and it doesn't go as far as they thought it was going to.

How can we consolidate all those newcomer services to really ensure that people are financially starting off on a good foot?

[Adam Chambers, Conservative, Simcoe North, ON]

Thank you.

Mr. Hetherington, do you have anything to add?

[Neil Hetherington]

Earlier I was asked what the correlation was between unemployment and food bank usage. Roughly, you can say that a 1% increase in unemployment will drive a 10% increase in food bank usage nationally. Those are numbers from the 2008-09 recession.

We're in a new world here, to be very clear. We have never had unemployment low and quadrupled the amount of food bank usage. That's why you all ought to be very concerned.

The other correlation I might add to Ms. Nicholls' testimony is the correlation between those experiencing food insecurity and race. In Toronto, 8% of our population is Black, and 23% of them are food bank users. One per cent are indigenous, and 5% of them are food bank users.

[Adam Chambers, Conservative, Simcoe North, ON]

Thank you very much. I have about 20 seconds left.

I have a quick question, Dr. Lafontaine.

What's the CMA's position on, one, using artificial intelligence to drive down the cost of delivery, and two, sending patients to the United States? There's a troubling story out from B.C. this week. Do you have positions on those, quickly?

[Dr. Alika Lafontaine]

In regard to artificial intelligence, we're developing a position on that. I think there are two parts to AI that will be useful. There's the helpful part where it helps us to categorize and streamline patients' access to care. There's the unhelpful part where you have a deep fake like those Tom Cruise videos that you see, where you have someone telling someone to do something that's unhealthy for themselves. AI is extremely good at being convincing.

With regard to folks going down to the States, it's a reality in this country right now that if people can't get access, they search wherever they can. I think we're seeing that.

[The Chair, Liberal, Peter Fonseca]

Thank you MP Chambers.

Now, we're going to MP Sidhu.

Welcome to our committee, MP Sidhu. I know you've done a lot of work on diabetes. I don't know if that's going to be your question, but thank you for that work you've been doing for our country.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Chair.

Thank you to all the witnesses for being here. Thank you for your testimony.

My question will be directed to Dr. Lafontaine.

Thank you for the tireless work you are doing. We know there are many internationally trained doctors and nurse practitioners in Canada who want to work in their fields. This is why the federal government identified the need to work with the provinces and territories on simplifying the licensing process for IMGs, doctors and other professionals.

We have already seen positive movement in Atlantic Canada with the regional licensing, which we can hope to extend nationally.

I'm wondering if you can expand on how the new federal health care commitment in budget 2023 can support the provinces and territories, so that people who come to Canada can quickly use their talents and expertise to serve Canadians.

[Dr. Alika Lafontaine]

My impression of the effects on provinces of the federal budget and the commitments is, number one, that people are rethinking the way they currently regulate and license doctors. The Right to Care Act in Ontario, to a great degree, was for compliance with the bilateral agreements that they knew were coming.

There's also recognition of international credentialing for the U.S. in places like B.C. and Nova Scotia. Nova Scotia is obviously going to have effects across the whole Atlantic region because of that licence that's shared across the different regions for locum providers.

I think we are definitely seeing early signs. The CMA has been a part of federal tables, with a lot of other groups across the country. The coalition for health workers is a place that we gather to try to accelerate some of these changes. We've adjusted some of our advocacy to reflect the needs of other members in that coalition so we're all moving in the same direction.

I think you definitely are seeing early signs of what the federal government is supposed to do, which is to bring people to the table and get them to start to hash out exactly how we solve these very complex problems.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Dr. Lafontaine.

We know the health care funding in the budget also identifies electronic health information that is shared between health professionals as a priority. We know there's a need to adopt digital health into clinical practice while we also address the barriers in a patient-centred approach.

What do you believe are the most significant benefits to digital health technologies? How can we ensure that adoption is done in a way that prioritizes patient care and also addresses the administrative burden?

[Dr. Alika Lafontaine]

The first part of that is a real focus on patients having access to their own health data. We have custodial data systems where we care more about whether or not the custodian of the data—not the person who actually owns and uses the data—has access to information in the way that they actually utilize care.

The second thing is the secondary effects you're going to see with things like pan-Canadian licensure. In Alberta, a lot of our patients migrate between B.C. and the Yukon. In the Yukon, they love having locums from Alberta because they have access to Connect Care, which means that all the patients who come through there now can have their information shared with local providers because they now have someone in the group who can actually access this information.

I think focusing on the way that patients migrate between systems and the ways that providers migrate and where they provide care is going to be really important as far as how we track.

[Sonia Sidhu, Liberal, Brampton South, ON]

We also heard about the importance of data and evidence-based decision-making in health care. This is why the data sharing is a key priority.

Can you speak to how this funding can be used to improve data collection and analysis in health care? How can this contribute to better health care outcomes?

[Dr. Alika Lafontaine]

I think Canadians on average grossly overestimate how much actually gets shared with the federal government and across provinces. Depersonalized data is extremely important to identify where needs are and then to have people migrate toward where those needs are.

One of the things we saw in mid-pandemic waves, when there were huge spikes in acuity early in places like Quebec and Ontario, was the migration of providers who had skill sets that were needed in those communities, because there was good communication and people actually went to places where they were needed.

I believe that, if we start to have a faster cycling of that data, we can have the same sorts of responses for many other things. There is some amazing data being collected right now. Quebec actually has the most advanced patient-reported outcome measures in the country, in my estimation, and their dashboard is incredible for helping people on the ground understand what patients actually need.

How can we take those ways of collecting and scale them across the system but have the federal government fulfill its role as a coordinator and collaborating place for provinces and territories to work together?

[The Chair, Liberal, Peter Fonseca]

Thank you, MP Sidhu. That is your time. I know—it goes very quickly.

We are going to the Bloc and MP Ste-Marie for two and a half minutes.

[Gabriel Ste-Marie, Bloc, Joliette, QC]

Thank you, Mr. Chair.

Mr. Céré, at the start of the pandemic, Bill Morneau told us that EI wasn't working well enough to support people who were losing their income. The government decided to set aside EI because the system was so broken. It put in place temporary measures, measures that were less targeted and more costly.

The pandemic is now over, and we're back to the employment insurance program. However, this measure still isn't working, despite the government's promise to reform it last summer and then last fall. That's now a thing of the past, and no action has yet been taken.

The current situation is fraught with uncertainty. We're seeing it with inflation, interest rates and hardship. We've heard witnesses talk about that today.

I think now is the ideal time to undertake this reform. It's now or never.

I'd like to hear your comments on this one last time. If you want to add anything related to EI to the committee members, that would be good as well.

Again, thank you for coming on short notice.

[Pierre Céré]

For my part, Mr. Ste‑Marie, I'd like to thank you for your excellent questions.

It's true that now is the time to solve the EI problem. Now is never the right time for the government. At the height of the crisis, we were told that it couldn't be done because it was a crisis and that it would be done after.

We're now “after”. The employment situation is going very well, and money is coming in. When the employment situation is good, the money goes into the EI fund. However, we're still being told that now is not the time to reform it.

It's never the right time.

If we don't fix the social safety net, we'll be condemned as a society to relive the same situation during the next crisis. There will be future crises, whether they be economic, financial, health, environmental or related to climate change. We see what's happening out west. We can see what is happening all over the world. There are going to be future crises. If we don't fix the social safety net, we're condemned to reliving exactly the same problems we experienced a few years ago.

Let's remember that Canada is the only country in the world where the EI system has failed. Everywhere else, in Europe, in the United States and in other countries, it was the EI system that stepped up to help people during the crisis. This program, this dysfunctional social safety net, has collapsed. It needs to be fixed.

Problems aren't solved with charity; they're solved with social legislation. It's by building a strong government with legislation, with a model of social legislation that will help people. That's how we do it.

That's what history tells us. Charity belongs in the 19th century, but social legislation belongs to the 20th and 21st centuries. That's the direction we need to go in. That's why we're still calling on the government to fix the social safety net.

Thank you, Mr. Ste‑Marie and members of the committee.

[Gabriel Ste-Marie, Bloc, Joliette, QC]

Thank you again, from the bottom of my heart.

[The Chair, Liberal, Peter Fonseca]

Thank you, Mr. Ste‑Marie.

Now we go to MP Blaikie for two and a half minutes.

[Daniel Blaikie, NDP, Elmwood—Transcona, MB]

Thank you very much.

Mr. Staples, I certainly share your desire for a proper universal dental care system. I'm proud of the work that we've done to get it under way. Likewise, we're working hard to ensure that we pass a Canada pharmacare act by the end of the year.

I wonder if you could speak a little bit to the human impact of putting those programs in place.

[Steven Staples]

It's going to have a huge human impact. I can tell you that we're already getting phone calls at our office from seniors who can't wait for the Canada dental benefit—even the one that was put in place in December—to be applicable to seniors. I just fielded a call today from somebody who was going on the CRA website and trying to get access.

This is a huge demand—a huge demand—and it's going to be very important in terms of providing better health care for people, better health outcomes and helping with affordability issues. There's no doubt that it's going to help millions of people. We do hope it becomes a universal program, but we applaud the excellent work. This is an historic expansion of our health care system.

But we want to keep the ball rolling. Pharmacare is next on the agenda. We are looking forward to a solid pharmacare act being brought forward in the fall. We really hope it takes the universal approach so that it melds very well with our already existing system, is not an add-on and blends right in.

As we know, this is also going to hit an affordability issue. One in five Canadians, almost as many as don't have dental, are having problems with affording their drugs. We don't want them to have that same choice: Do I buy food or do I take my medication? Filled prescriptions mean empty emergency rooms, and we know that—

[Daniel Blaikie, NDP, Elmwood—Transcona, MB]

For the studies that have been done on a national pharmacare plan, can you speak to the overall savings that are possible to realize through the implementation of such a program?

[Steven Staples]

The savings would be tremendous, mostly from the ability to coordinate the bulk buying of medications and negotiate lower costs.

I know there's been a lot of focus on the PMPRB and the problems with that. However, some experts we've talked to have said, “Look, if we get a good pharmacare program in place, those venues become less important to get the costs down because of our bulk buying.”

It could be in terms of $5 billion a year that governments would be saving on the cost of drugs. That's money that would be used elsewhere within the health care envelope.

[Daniel Blaikie, NDP, Elmwood—Transcona, MB]

Thank you very much.

[The Chair, Liberal, Peter Fonseca]

Thank you, MP Blaikie.

Now we will go to MP Lawrence, please.

[Philip Lawrence, Conservative, Northumberland—Peterborough South, ON]

Thank you.

I want to quickly summarize, and then maybe get a story from one of you with respect to it so that we can humanize some of this.

One thing I would throw out there, before we summarize this quickly, is that in the past the federal government has matched the donations of Canadians. I suspect you would agree with me that this might be something valuable in terms of making these donations go further.

[Neil Hetherington]

We would agree with that, but we also agree with Mr. Céré that we need to ultimately have a social system that does not rely on a charity.