Health Committee on Nov. 22nd, 2018

[The Vice-Chair, Conservative, Marilyn Gladu]

Now we go to Mr. Lobb for five minutes.

[Ben Lobb, Conservative, Huron—Bruce, ON]

I'm going to turn my time over to Mr. Kmiec.

Thank you.

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Let's talk more about taxes. The regular committee that I sit on is the finance committee, but this is a particular interest of mine. One of the problems that I've heard is that after your diagnosis of diabetes, you have these ancillary costs. You might have access to your insulin, but then you don't have access to the strips that you need or the pump that you need.

All three of my living kids have a chronic kidney condition. Eventually it will result in their losing their kidneys and requiring transplants. In their cases, when I looked into the cost, they will have the same situation. They will need all the stuff that comes with.... The public health care system will provide them, at end-stage renal disease, with dialysis, but everything that comes with that—the tubing and everything else—you have to pay for, so the Kidney Foundation does that. It's a lot of the same costs that I find here, and it changes from province to province. I think only Canadians who move to different provinces get to fully experience how different the health care system is.

I grew up in Quebec, moved to Ontario for work, and then moved out to Alberta for love. I represent Calgary. Every single system is totally different. What is it about them? Is it that when you move you should be warned ahead of time? Could it be done through the foundations? Could the foundations tell you the differences that will happen? There are costs associated with it, too.

That's why I like the DTC, because that's where the federal government, through the tax system, can get involved and try to level the playing field as best it can so that there's horizontal tax equity, at least. Everybody presumably pays some taxes at some point, and the income tax system is a unique way to try to get to that goal.

Michelle, since you're with the health network, how much information on the tax portion of it do you give to your patients, clinicians and others who are accessing the system?

[Michelle Corcoran]

Very little, only because I know very little. I tell them to find out, to call the person who does their taxes or call the 1-800 number to find out more about it. It would be great if clinicians had more information on how to direct people, but we don't have that readily accessible unless we dig for it.

The only thing I can tell people who are moving from one place to another is that, before they move, they'd better call and find out what coverage they're going to get when they get there.

[Tom Kmiec, Conservative, Calgary Shepard, AB]

They should call ahead of time. So, they have to do their homework before they start moving around.

[Michelle Corcoran]

A lot of people perhaps don't have the capacity to do that, nor should they have to.

[Tom Kmiec, Conservative, Calgary Shepard, AB]

It's not a question for Victor, but Victor mentioned that he was working and had a union before. Part of unions' collective bargaining agreements is that they negotiate access to a private insurer. Typically, public sector workers and members of large unions in the private sector have access to health insurance, which is also a way of gaining that equity across Canada. As you move across the country, your union will still cover you, and the health coverage that you receive will come with you to whatever province you go to.

Is there a solution for diabetics there?

[Louise Kyle]

Why should I be forced to make a decision about where I work in order to have the coverage I need? I should be able to start my own business. I should be able to choose a job that doesn't come with benefits and not have to worry about what coverage I have. We should have a national pharmacare program that covers all these supplies. It's a no-brainer to me.

[Michelle Corcoran]

We shouldn't have to make people choose between working and not working. Some people are not able to work and, therefore, have no access. A large proportion of people living in New Brunswick, upwards of 40% or so, have either the public plan or no plan at all, not because they haven't tried. They just don't have that access to coverage, and they can't afford it, because it's inequitable. They can't get access because they have a pre-existing condition, so it will cost them too much.

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Is it that they don't have access because they're not eligible, or is it that they're eligible but don't have access because they can't afford it or don't know about it?

[Michelle Corcoran]

All of them.

[Tom Kmiec, Conservative, Calgary Shepard, AB]

So when you look at the statistics, and I'm not sure who mentioned it here, the 30% or 36% of Canadians who don't have access for costing reasons, that's based on the survey. If you look at it, it's an impression.... It's not just they themselves, but it's others, members in their direct circle. That's the impression that you may have, but if you look at the numbers themselves, about 1.8% of Canadians, mostly in Newfoundland and Ontario.... This is more broadly, beyond just persons with diabetes. These are people who were not eligible for anything. They've kind of fallen through all the different cracks of the different programs, and they see this very often in the tax system as well. People will fall through different cracks. I think type 1 diabetics should have access to the DTC.

You mentioned your support for national pharmacare, but I want to take it back to the tax system itself and my private member's bill.

[The Vice-Chair, Conservative, Marilyn Gladu]

I'm sorry, but that's your time.

We're going now to Dr. Eyolfson for five minutes.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you, Madam Chair.

Thank you all for coming.

Ms. Kyle, that was very refreshing, what you said about recognizing coming from privilege and not having to struggle in the way many people do. I'm in a very similar boat. I was raised by a lawyer. I'm a physician married to another physician. I will never have trouble making ends meet if I have a catastrophic diagnosis of any sort. Whatever else I have to worry about, how I pay for it is never going to be an issue.

However, for 20 years I was an emergency doctor, and for the last eight years it was in an inner-city hospital. If you spend time in a hospital like that, you understand.... I understand how truly privileged I am when some of my patients literally didn't have homes, never mind that they couldn't afford medications.

One of the things I've been passionate about is national pharmacare. Again, I know we're talking about diabetes, but this folds into it because it's such a major disease.

One of the things concerning me of late is the amount of very organized push-back we're getting from certain interests in the community. At another meeting, a representative of Johnson & Johnson claimed that our strategy to decrease drug prices is going to make Canada a non-competitive environment for the development of new medications.

There's some information out there claiming that if we decrease the price of our medications, it's going to inhibit development of new drugs, and this will put the lives of Canadians at risk. Could you respond to that statement? I'll ask all three of you in turn.

Ms. Kyle, go ahead.

[Louise Kyle]

Yes, I would be happy to respond to that statement.

The last time I was here, we were talking about federally funded health research. Some of you may remember that we talked about different models of incentivizing research and making sure that the products of research are available to all who need them at the end of the day.

Part of the rhetoric you talked about is that it costs so much to bring a new drug to the market that we have to recoup those costs, and if we don't invest and we don't sell these drugs for an arm and a leg, innovation is going to die. We know that's not true. We know there are models that are working and producing drugs on a different model from the one we're looking at right now. We know a lot of drugs are publicly funded, so that rhetoric is inaccurate and false.

It's not surprising to me that you're getting that organized push-back.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you.

Ms. Corcoran, go ahead.

[Michelle Corcoran]

I would agree with Louise's comments. As you say, many research studies are publicly funded through grants and monies, for which they apply, available from the Public Health Agency of Canada and so on. They have money that is helping them do the research they are doing, so I question that comment.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you.

It's easy to forget about you, Mr. Lepik, because we can't see you right now, but do you have anything to add to that?

[Victor Lepik]

That's all right.

In regard to the push-back from the drug companies, I think that's a natural thing on the playing field. As the national health care system goes, they should really take a look at a country like New Zealand. I lived in New Zealand for many years. What New Zealand pays for drugs is so much less than what we pay in Canada, because they negotiate as a country. They don't have 10 different provinces and regions negotiating separately.

With a national pharmacare system, we have a pretty good population in this country, and I think the push-back by the drug companies would be insignificant. You know, everybody wants to sell something. If we had a national system, the bargaining power would be huge.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you very much.

I have only 10 seconds left. Thank you so much to everyone for coming.

[The Vice-Chair, Conservative, Marilyn Gladu]

Very good.

Now we go back to my colleague Mr. Kmiec for five minutes.

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Thank you, Madam Chair. You're always so fair.

Is any insulin not covered by a public drug insurer?

[Michelle Corcoran]

Yes. There are some long-acting insulins that are not covered by publicly funded plans. There are concentrated insulins, as well as mealtime or rapid insulins, that are not covered by publicly funded plans.

I will add that most times we can get coverage for some type of insulin, but it's difficult for people to give insulin without the pen needles that go with it. They may have to be paid for up front, or they may not be covered at all.

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Why are those insulins not covered by the public drug insurers?

[Michelle Corcoran]

I assume it's related to the cost to the province. In terms of our negotiations, they negotiate a cost of availability. In all honesty, that's the only thing I can think of, that it's related to cost.