Health Committee on Dec. 11th, 2020

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

I feel like I have to put a few points on the record. It's my understanding that the Patented Medicine Prices Review Board was created by the federal government after they extended patent protection to pharmaceutical companies. It was a quid pro quo for the extended time that pharmaceutical companies would be able to have exclusive profit-making for their molecules. By the way, a lot of research of pharmaceutical companies is done by them, but a lot of it is also done by public taxpayer dollars to universities as well. In exchange for that, there was a commitment by the federal government to control prices.

Ms. Fuller, this committee has received evidence indicating that Canada pays the fourth-highest prices among 31 OECD countries, 17% above the median price of those countries. Canada is the second-highest in the OECD in terms of how much it spends on patented medicines as a proportion of total health care costs, and in per-capita spending. Only the United States is higher in both cases. From 2014 to 2018, growth in spending on patented medicines in Canada has doubled that of GDP, and it's over three times the growth of inflation.

Ms. Fuller, do you believe the changes that the PMPRB is set to bring in will help to lower prices in Canada? The same question goes to you, Mr. Frank.

[Colleen Fuller]

I think they will strengthen the ability of the prices review board to ensure that the introductory price on drugs is fairer, so my answer is yes.

I also want to point out that the mandate of the prices review board is to basically, as you say, protect consumers from the impact of extended patents. There is a relationship between the patent period and the exposure of Canadians to unfair pricing.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

Sorry, Mr. Frank.

[The Chair, Liberal, Ron McKinnon]

That brings our third round to a close. I'd like to thank all of the witnesses for sharing their time with us today and for their excellent information. It will be a great help to our study.

I'd also like to take the opportunity to note that this is the last day on this committee for our analyst Karin Phillips. She is moving along to work with PHAC, I believe. I've worked with Karin for quite a number of years now, and she has been an enormous asset. I would like to thank her for that. She is leaving us in very good hands. We have Sonya here, who will be taking over, and of course Dominique will be here as well.

Thank you, Karin, for all your great work and your great writing. I hope you can carry the message of the Oxford comma to your next location.

With that, we will suspend and bring in our next panel.

Thank you, all.

[The Chair, Liberal, Ron McKinnon]

The meeting is now resumed.

We are proceeding pursuant to the order of reference of Tuesday, December 1, 2020, on Bill C-210, an act to amend the Canada Revenue Agency Act related to organ and tissue donors.

We will now begin our clause-by-clause consideration.

(On clause 1)

We have an amendment on the floor. I believe Mr. Sorbara wishes to move it.

Mr. Sorbara, please go ahead.

[Francesco Sorbara, Liberal, Vaughan—Woodbridge, ON]

Thank you, Chair, and good afternoon, everyone.

Clerk, I believe you received the amendment and have distributed it to all committee members.

Chair, I will obviously be moving this amendment on Bill C-210, and then I wish to speak on it.

Thank you, everyone, for making yourselves available and hearing me out for a few minutes.

First, it's great to be here. It's great to be speaking on a bill that I know is very important to deputy Webber and is very important to MPs on all sides of the aisle. I'm very galvanized by that. It is within that spirit that I present this amendment. In my view, at the end of the day, it's about increasing the number of registered organ and tissue donors in Canada.

I have some prepared remarks for everyone. I thank you for the opportunity to join your committee today as we look at this legislation that seeks to promote a cause that, it's fair to say, all parliamentarians support—namely, increasing the number of registered organ and tissue donors in Canada. This is an extremely important issue to assist Canadians in desperate need. It is truly a matter of life and death. We need the best legislation possible.

I know we all support the intent of the legislation. I do personally, and I applaud the member for Calgary Confederation for his work and his desire to get this bill passed in the House and the Senate. I too am committed to advancing the bill's objective. That's why I'm advocating certain amendments to make Bill C-210 more workable for the Canada Revenue Agency so that it can be implemented as soon as possible. Hopefully, if Parliament can pass it quickly enough, it would be in for the 2021 tax-filing year. We need to ensure that the legislation proposes the most efficient and effective way for the Canada Revenue Agency to collect this information, and for the process to be efficient and useful for the provinces and territories, who are ultimately responsible and within their jurisdiction for organ and tissue donation.

As Parliamentary Secretary to the Minister of National Revenue, I've made it a priority to examine the legislation in great detail and to discuss it with experts at the CRA who would be asked to implement it. I truly believe this committee should hear directly from those professional experts at the CRA regarding this legislation, especially their experiences with the precursor legislation to Bill C-210 from the last Parliament, Bill C-316, and the CRA's interactions with the provinces and territories on that legislation that occurred.

Nevertheless, I am proposing a strongly recommended amendment to make the legislation more straightforward for the CRA to implement with the provinces and territories, and also to make it so that it can be implemented in the quickest fashion possible. This amendment does not change the objective of the bill, but rather the manner in which the objective will be achieved, to remove potentially significant roadblocks and time-consuming delays.

This simple amendment would do as such. Rather than having the CRA directly collect organ and donor consent on behalf of the provinces and territories, the CRA would collect and share the personal information of individuals wishing to become organ and tissue donors with their respective provinces and territories, which would then obtain direct consent. The amendment, accordingly, would remove references set out in proposed subsections 63.1(1) and (2) of the bill, which would make reference to returns of income filed under paragraph 150(1)?(d) of the Income Tax Act.

Rest assured that under this approach, a form would be included within the T1 return, both a paper format and in certified tax software, asking if the individual wishes to be sent information by their province or territory on becoming an organ and tissue donor. It should also be noted that the notice of assessment would still advise the individual that, in accordance with their request, their information has been forwarded to their province or territory as a potential organ and tissue donor. Once the information would be sent to the relevant province or territory, the province or territory would then be able to follow up with the individual on the actual consent to organ and tissue donation.

This is an important and appropriate role for provinces and territories to undertake, as it is within their jurisdiction as opposed to that of the Canada Revenue Agency. Legal requirements for donor eligibility and informed consent are very complex and vary greatly by jurisdiction in Canada, meaning different provinces and territories have different roles. By having provinces and territories play their proper roles in obtaining consent, we are not only respecting their jurisdiction, but equally important, we are removing an obstacle by eliminating the need for protracted negotiations and complicated agreements with each of the provinces and territories on legal requirements for collecting the proper consent.

With the amendment I am proposing today, our hope is that we would put the federal government in a position to reach swifter agreements with provinces and territories on a more straightforward, simple and efficient approach, which, I understand from CRA officials, might need only months instead of potentially years to achieve.

I repeat, we all want the objectives of Bill C-210 to become a reality, and sooner rather than later. However, for the CRA to meet the earliest window of the 2021 tax-filing year—next year's income earned, when you file your taxes in January to March or the period in 2021—the provinces and territories have to come on board. We need to create the quickest path to make that happen.

I would like to add that the approach taken here, for the MPs who have been elected from the beautiful province of Ontario, would be a similar approach to where information is collected for what's called the Ontario trillium benefit, where a separate page is provided in the tax package, whether it is online or in paper format, and where the information is then passed to the Province of Ontario.

I am confident that our amendment today will do that and make the member for Calgary Confederation's objective a reality, potentially—and most likely—saving the lives of thousands of Canadians.

Chair, thank you for the time today.

To the committee, I wish to again applaud deputy Webber for his efforts over the years in making the bill come to fruition and bringing it this way.

We are with you in the spirit of the bill, Mr. Webber, and I applaud your work on it.

I thank my colleagues for listening to me this afternoon.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Sorbara.

Members, I will remind you that to engage in the debate, you should use the “raise hand” function on the participants panel.

Mr. Webber, please go ahead.

[Len Webber, Conservative, Calgary Confederation, AB]

Thank you, Mr. Chair.

I want to start off by saying hi to everyone. It's good to be back in a HESA committee meeting. I served for five years with you guys and I miss it, but I'm now on the public accounts committee, so that's quite interesting as well.

Mr. Chair, as all of you are aware because I sent you a document indicating my thoughts on the amendments here, in short I cannot support the proposed changes. It changes the scope and it changes the spirit of the bill, which is to get the initiative front and centre on the income tax form.

I want to talk a bit about the bill and the fact that it would not infringe on the provincial responsibilities of managing donor lists. It would just support their existing work.

My proposal is so simple and it could be implemented so quickly. The federal government, via the CRA, already successfully shares, every day, with the provinces and territories via these encrypted networks with strong privacy and reliability safeguards. The existing infrastructure is already in place so there would be virtually no cost to the CRA. The CRA, as you guys know, already shares dozens of data fields on information on every taxpayer with the provinces and territories. This would simply be one more data exchange.

The actual proposal by Mr. Sorbara, in my mind and in many people's minds, would change the scope of the entire bill. It would take it off where you can see it, which is right on the front page of the T1 form. By moving the question off the main income tax return, it becomes a footnote of irrelevance, and the effectiveness is dramatically reduced to the point of being basically pointless. These amendments would allow CRA to put the question somewhere less obvious and it could even be as obtuse as asking people to file a separate form, which nobody would do.

This issue came up in the last Parliament, in the HESA committee, and all the parties were clear that they wanted the question to be on the front page. The CRA was also clear about their ability to do this, as requested and expected by the members of Parliament.

I want to ensure today that the CRA hears loudly and clearly that the expectation of Parliament is to have this addition made on the front page of the T1 tax returns in all provinces and territories. This is déjà vu. We covered the same issue in the last Parliament. I testified at this health committee on the bill, which at the time was Bill C-316. I said that I wanted to ensure that the CRA hears loudly and clearly that the expectation of Parliament is to have this addition made on the front page of the T1 tax returns in all the provinces and territories. I also wanted it made clear that we expect people to have the option to tick a box on that front page, which would basically be a call to action.

I have to indicate also that the CRA was at the committee meeting and it was made clear to them. In fact, Sheila Barnard was at that meeting. She is with the CRA. She is responsible for the legislative changes affecting the T1 returns. She testified and stated that they had understood the intention of the bill to be on the annual tax return.

Mr. Frank Vermaeten, the assistant commissioner with the Canada Revenue Agency, was also there, and he was more direct in confirming his understanding on this issue. He stated:

The front page is certainly a crowded page, especially when you move into the French version of it. That being said, we believe we can put it in that first page. That would be our intention.

Even our colleague Sonia Sidhu discussed it at HESA. She commented, “You said it's possible that, on the T1 layout, we can have a tick box on the front page so it can't be missed.”

That is the point here. If we allow this question or process to be buried, it will be ineffective. I completely agree with her.

Mr. Chair, you also said:

In our discussion, we have talked about the importance of this data capture appearing on the first page of the T1, but it doesn't specify that anywhere in the bill. Is there a way to ensure that this happens?

The CRA, Mr. Frank Vermaeten, said:

I don't think there's a clear legislative way to ensure that this happens. As I indicated, it would be our intent to put it on the front page.

The CRA, then, indicated at the time that it can be done and that they were going to do it. All of a sudden, here we are again: déjà vu.

We have to simply ask ourselves the question: Does the amendment that MP Sorbara put forth strengthen the effectiveness of the bill and better improve the outcomes for those awaiting a life-saving transplant? I believe the answer is painfully obvious and I would strongly welcome your agreement, committee members, in this regard.

We have all worked so hard. I have worked so hard. Parliament has passed this unanimously, up to this point. We have worked hard to make sure that this initiative has been unanimously supported, just as it was in the last Parliament.

There are many people awaiting a life-saving transplant. They would be bitterly disappointed if we wasted this important opportunity and buried the question on some form in the back pages that nobody is going to fill out. Let's show all Canadians that we are united and determined in our desire to truly improve Canada's organ and tissue donation procurement system here in Canada. Please do not support the proposed amendments.

Thank you, Mr. Chair.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Webber. It is indeed good to have you back.

We go now to Mr. Davies.

Mr. Davies, go ahead.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you. I don't have a lot to say, but I do have a question for clarification.

Just in general I want to thank Mr. Webber again for being so determined and persistent in this bill. I can say that I've worked with many parliamentarians, and—I said this in the House and I want to put it on the record here—there has been no more collegial or finer parliamentarian to work with in any venue than Mr. Webber. His contributions to this health committee were incredibly important.

Thank you.

I also want to second every single thing Mr. Webber said. I was privileged enough to serve on the health committee through the entire last Parliament, and I can vouch that every single fact and every single point that Mr. Webber just made is exactly true. I won't belabour the points. It's just that this is not just Mr. Webber's opinion; this is actually a very accurate recitation of what the evidence was.

My question, really, is to Mr. Sorbara. I want to make sure I understand what the purpose of his amendments is. It didn't strike me, when I was listening to Mr. Sorbara's remarks, that his purpose is aligning with what Mr. Webber says the changes are.

Mr. Sorbara, I'll ask you a direct question and feel free to elaborate if you feel it necessary.

Is it the intent of your motion, basically, to allow CRA to put the indication as to whether someone wants to have their information forwarded to a province for a potential organ donation anywhere on the form, including on a separate form or otherwise? Is that the main thrust of your amendment?

In other words, is Mr. Webber characterizing your amendment accurately?

[The Chair, Liberal, Ron McKinnon]

Mr. Sorbara, you may respond to the question, if you wish.

[Francesco Sorbara, Liberal, Vaughan—Woodbridge, ON]

Thank you, Mr. Chair. I'll try to be as succinct as possible.

The intention of the amendment would be to have a separate sheet or page inserted into the tax package—it would be within the contents of the tax package—whereby if, for example, in negotiations with provinces a province wanted to have more information or less information with regard to the collection of information on tissue and organ donations, that wish could be accommodated. If it were solely contained on the first page of the T1 form, it would be very constrictive, given what's already on the front page of the T1 form.

As we know, the Province of Nova Scotia has already opted out of this process with their own system. Please correct me if I am wrong, my fellow parliamentarians.

We have also committed $35 million or $36 million over five years, I think it is, to improve the collection of data related to tissue and organ transplant.

As I said in my remarks, MP Davies, the page that would be inserted would be very similar to what is happening here in Ontario, whereby we have a separate page for what's called the Ontario trillium benefit. That information is collected and then shared with the Province of Ontario.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Sorbara.

Mr. Davies, did you wish to continue?

[Don Davies, NDP, Vancouver Kingsway, BC]

Maybe I'll offer a little bit of follow-up.

The purpose of Mr. Webber's bill, and Mr. Webber can correct me if I am wrong, is...because of jurisdictional issues. I remember when the NDP proposed—I think MPs from all parties at that one time proposed—the national organ donation registry. The reason it couldn't be done, according to, I think, the Liberals, was because of jurisdiction. They felt that was the jurisdiction of the provinces, which I think has informed Mr. Webber's bill.

This means that what we're doing on the tax form is having each taxpayer check off a box that will authorize CRA to furnish the information—the name and the contact information, I suppose—to a province that is in control of organ donation and that would then contact the person and take it from there.

If that's the case—and maybe I will ask Mr. Webber to confirm it—it's my feeling that we should stay with Mr. Webber's position, because we want the most prominent placement possible. Again without belabouring the point, CRA said that, although it was a crowded first page, it could be done. They understood that, and they had the resources and the ability to do it.

Do I understand this correctly, Mr. Webber and Mr. Sorbara? Really, all the tax form is doing is indicating to the province that the person may want to be available for follow-up.

This is why I'm not quite clear, Mr. Sorbara, what else would be on this single form, when this is the process we're actually doing.

[Len Webber, Conservative, Calgary Confederation, AB]

Mr. Chair, that is the case. The fact that the national registry that was attempted by a colleague on the Conservative side years ago was shot down was the fact that the Liberals thought it was a provincial jurisdiction, which is fine. That's why my bill came to fruition.

Yes, Mr. Davies, all that is required by the CRA is to collect the name and contact information from the tax filer. That's it. You don't need a form put on the back pages of the tax-filing documentation system. It needs to be front and centre. Otherwise, it will not be filled out. Mr. Davies, that's the information there.

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you.

Mr. Sorbara, did you wish to respond quickly?

[Francesco Sorbara, Liberal, Vaughan—Woodbridge, ON]

Yes, I have a quick follow-up.

Obviously, becoming a tissue and organ donor is a very personal issue for all Canadians, and we want to make sure they have the proper information before making that decision. I would encourage everyone to become a tissue and organ donor, absolutely.

With regard to the placement within the tax package, to use the characterization that it's going to be buried in the back and that no Canadian is going to see it or that it has to be placed right on the front of the T1 form.... In my role as the PS to the national revenue minister, I often wonder why Canadians are filing their taxes. Obviously they're doing it to voluntarily declare how much income they've made to pay taxes owing or to get taxes received, but also to get their benefits and credits back, which they obviously have worked very hard for and deserve. That's within the CRA's mandate. We are now asking CRA to expand the scope of their original mandate to also include this information collection from Canadians.

Having it solely put on the T1 form would be.... If a province or Canadians asked for further information on why they were being asked to answer this, it would be very prudent to have it on a separate page so that provinces could get the information they need and Canadians could give the information needed and be confident. We also remember that 70% of tax forms are not prepared by the tax filer. We need to ensure that Canadians have the information they need and that the provinces will be able to rest assured that jurisdictional issues are being respected.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Sorbara.

[Francesco Sorbara, Liberal, Vaughan—Woodbridge, ON]

I just want to say thank you to Mr. Webber.

I understand this issue and I'm with you. Obviously, there's a view here that I've brought forward. Len, I've reached out. We've chatted and had conversations, and I want to thank you for explaining your position. I fully respect it. The goal is to increase the number of people who have signed up to become organ and tissue donors.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Sorbara.

Mr. Davies, I don't know if you're done, but I'd like to move on to Mr. Van Bynen. Thank you.

Mr. Van Bynen, please go ahead.

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

Thank you, Mr. Chair.

Given the history, I've been struggling to support the amendment. If, as a result of not amending the bill, there's a delay in implementation, it's a trade-off with the effectiveness of where it is positioned on the tax document. I am happy to say that I am an organ donor as a result of the process that was in place in the province of Ontario.

I will support the bill either way, but I do believe that the proposed amendments will improve the process and expedite the implementation. For that reason, I'll support the amendment.

Thank you, Mr. Chair.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Van Bynen.

We'll move to Mr. Fisher, please.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

Thank you, Mr. Chair.

I'm not speaking on the amendment, but please keep my name for when we are past the amendment stage.

Thank you.

[The Chair, Liberal, Ron McKinnon]

Okay, I'll try to remember that. It gets too hard to keep track of.

Ms. Rempel Garner, please go ahead.