Health Committee on Nov. 22nd, 2018

[Tom Kmiec, Conservative, Calgary Shepard, AB]

The juvenile diabetes research foundation and Diabetes Canada are supporting a private member's bill that I've put forward to actually reduce the hours from 14 to 10 and include the dosage time—the time it takes you to calculate your dosage—because that's one of the most stressful things. That's what I'm hearing from you, Victor. I'm guessing the dosage is something that most type 1 diabetics worry about: “Do I have the right amount? Am I feeling well enough at the moment I'm in?” Maybe Michelle can jump in here, with her experience.

Reducing the hours and including the dosage are only one part of it. My private member's bill also proposes to include a lot of people with different types of rare diseases in being eligible for DTC, but they still have to apply for it. It's always saying, “Okay, I'm going to apply for this to get that tax relief.” The CRA is really good at chasing down what I would call vertical taxation equity, which is when a person makes more money. They're very good at making sure they calculate how much you owe. But they're very bad at horizontal tax equity. I would say that someone with type 1 diabetes who is dealing with a $45,000 average income should not be taxed at the same level as a healthy person who doesn't have to manage this condition and live through the stress every single evening.

Michelle, in your experience, how many people take advantage of the DTC? Do they even know about it?

[Michelle Corcoran]

Many people don't know about it. Many people talk to their friends about the tax credit. I can't give you exact numbers, but I can find that out for you. Most people talk to their family doctors, and the doctors will say, “Well, you're going to get denied, because you don't spend 14 hours a week looking after your condition.” Maybe they do, but it's not in the inclusive criteria that are listed or outlined in that tax credit.

I will argue that it's not just type 1 diabetes. It's type 2 diabetes, which can be equally complicated for those who are taking insulin and medications and have other co-morbidities and other chronic diseases. That comes into play when they're managing things like their chronic kidney disease risk or they're managing their blood sugars. They're managing all of those things in their life as well—every day. I'm not sure that even the 10 hours.... Certainly, reducing it from 14 to 10 would make a considerable difference. Refining the criteria for that would help many people get access to that.

I would agree with Louise as well. It's not a disability, but it would certainly help with living with a chronic disease.

[The Vice-Chair, Conservative, Marilyn Gladu]

Very good.

Now we're going to Mr. Davies for seven minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Madam Chair.

Thank you to all the witnesses for being here.

I think it is so profoundly important that we conclude our study on diabetes by hearing from patients and people who deal on the front lines with patients. We've heard a lot of academic and interesting policy information on diabetes, but you're bringing home to this committee in the most powerful way possible what we need to hear as policy-makers to address this chronic, widespread and, frankly, growing problem.

Ms. Kyle, I want to start with you and pick up on something I heard you say. You don't view diabetes as a disability. We know that individuals with type 1 and type 2 diabetes can face diabetes-related stigma. I'm curious what your comments might be on that, because I think that may have emerged from your very clear statement.

[Louise Kyle]

Yes, I think that plays a role, certainly. For me, a big frustration is seeing that we don't have consistent coverage for all the tools that someone with type 1 or type 2 diabetes needs in order to live a healthy and happy life with their condition. Instead, we are put through the burden of having to apply for a tax credit. It's a lot of paperwork. I've talked to my physicians and my educators about it. It's a huge burden to put on someone who is already dealing with something 24 hours a day—to be put through this sort of administrative process of coming up with 14 hours a week of things that don't even scratch the surface of what someone with diabetes has to deal with.

Victor, I think you would probably feel the same way. There are a lot of things I do to manage my condition that don't fall into that. I exercise; I make food choices when I'm grocery shopping; I make food choices when I'm out purchasing lunch or when I'm making food at home. Those are things that don't go into this basket.

For me, I guess it is a bit of a principle thing. It's also a burden. It puts a burden on people who are dealing with a chronic condition 24 hours a day.

[Don Davies, NDP, Vancouver Kingsway, BC]

I want to follow up. If I heard you correctly, you said that the price of insulin has tripled between 2003 and 2013. Do you know why?

[Louise Kyle]

It is a complicated problem. In Canada, we don't have the same problem that other countries are facing. We have other issues with access, but our insulin prices have not seen the same kind of skyrocketing increases that the United States, for example, or other places around the world have seen.

To be truthful, we don't completely know why this is happening. It is a multi-faceted issue. We are lacking a lot of transparency in terms of the way things are priced, which is a major issue. We don't know where along the supply chain these price increases are always happening.

[Don Davies, NDP, Vancouver Kingsway, BC]

Ms. Corcoran, do you know why insulin prices are going up?

[Michelle Corcoran]

I would hazard a guess, and this is a professional guess. Research costs do contribute to some of these things. As industry sets their points of pricing, I know that the costs do vary from one company to another. I did some analysis of what it would cost for 50 units of one type of insulin, which could be $40 per month in comparison to $169 a month. The price is considerably variable.

Yes, there is technology that goes into developing these resources, these medications and insulin; however, in terms of a disability tax credit, I think access is the bigger issue. We should be providing this as a basic necessity of life.

[Don Davies, NDP, Vancouver Kingsway, BC]

On the disability tax credit, I have many constituents who have conditions. When their physician fills out the paperwork saying that they have the condition, they qualify for the disability tax credit and other programs—not because of the amount of hours they spend each week dealing with it, but simply because they have the condition. It strikes me that this is how we should be treating diabetes.

If you have type 1 or type 2 diabetes, just on its own, leaving aside the stigma of the word “disability”, the point is, should there be some sort of tax relief issued to recognize the extra burdens or barriers of dealing with this simply because you have the condition, as opposed to trying to measure how many arbitrary minutes or hours a day you deal with it? Would that not be a wiser policy approach to this?

[Michelle Corcoran]

It would be brilliant.

[Don Davies, NDP, Vancouver Kingsway, BC]

Ms. Kyle, go ahead.

[Louise Kyle]

Yes, I agree. Also, I think a wise policy approach is to make sure, in the first place, that everyone has access to the tools they need that make this condition easier to manage.

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Lepik, I want to turn to you. That was very powerful testimony. Thank you for detailing with such precision what your monthly expenses are.

By my figures, the blood glucose monitor, the insulin pump and the insulin itself add up to—if you add in the $7,000 replacement every five years—over $7,000 a year. That's $900 a year for insulin and $5,600 annually, I think, for the blood glucose monitor pump. Maybe I'm getting them mixed up, but it's certainly $6,000 or $7,000 a year. Do you know people with type 1 diabetes who are going without their medication, monitoring or any other tools or resources because they can't afford it?

I think we have lost Mr. Lepik.

While we're waiting, I'm going to come back to this. I think we have a very clear picture here. We have provincial variation. We have patients who are rationing or going without what they need to manage what is a life-threatening if not potentially fatal disease. We have the issue of more expensive complications down the road if this is left untreated, whether that's amputation, blindness, kidney failure or stroke down the road, which obviously costs the system much more money.

Would the answer not be that we should be moving to a universal public pharmacare system whereby patients get their necessary medication provided through our public system, just like any other medically necessary service? Would that be your position, Ms. Corcoran?

[Michelle Corcoran]

That would be my position.

[Don Davies, NDP, Vancouver Kingsway, BC]

How about you, Ms. Kyle?

[Louise Kyle]

Yes. We are the only country in the world that has a universal health care system that doesn't include pharmacare. We absolutely need to move towards that.

[Don Davies, NDP, Vancouver Kingsway, BC]

I'm not sure, Madam Chair, how I'm doing for time or with Mr. Lepik.

[The Vice-Chair, Conservative, Marilyn Gladu]

You have one more minute.

[Don Davies, NDP, Vancouver Kingsway, BC]

I would like like to direct some questions to Mr. Lepik.

[The Vice-Chair, Conservative, Marilyn Gladu]

We'll go to the next round, but we will come back to you for the one minute you are owed.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

[The Vice-Chair, Conservative, Marilyn Gladu]

Let's go to Monsieur Ayoub.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

Madam Chair, I would suggest that we wait for Mr. Lepik, because I will have some questions for him also. We could wait for him if it wouldn't take too long.

[The Vice-Chair, Conservative, Marilyn Gladu]

We will suspend until we get Victor back.