Health Committee on March 23rd, 2023

[Luc Thériault, Bloc, Montcalm, QC]

Actually, it is not 35%, Minister. Apply the rule of threes. Quebec's budget is $59 billion. According to the chart published by the Government of Quebec yesterday, the federal government granted $8.66 billion only for health transfers. Even if you add transfers for postsecondary education and other social programs, which total up to $1.366 billion, the federal contribution to Quebec's budget for health represents only 16%. However, we know full well that social services do not represent the totality of this line item.

The national average was 22%. You added funding. According to statistics from the Conference Board of Canada, it's now between 24% and 28%.

Why did Quebec end up so far below the Canadian average?

[Jean-Yves Duclos, Liberal, Québec, QC]

The statistics included several percentages, for example 80%, 35%, 7% and 10%. The 80% represents the Canadian government's portion of COVID‑19 pandemic expenditures, which are ongoing in several cases—

[Luc Thériault, Bloc, Montcalm, QC]

No, I'm talking about 2023‑24.

[Jean-Yves Duclos, Liberal, Québec, QC]

Let me finish—

[The Chair, Liberal, Sean Casey]

Just a moment, Minister.

Mr. Thériault, you asked questions which took one minute. The minister started to answer and you interrupted him after 10 seconds.

If you take a minute to ask your questions, the minister should be entitled to one minute to answer.

[Luc Thériault, Bloc, Montcalm, QC]

I would just like him to answer the questions directly.

[The Chair, Liberal, Sean Casey]

Mr. Minister, you have the floor.

[Jean-Yves Duclos, Liberal, Québec, QC]

People often bring up the 35%. Quebec premier Mr. Legault and the other premiers often refer to it. Yes, the percentage of provincial and territorial spending covered by the federal government has been 35% for the past 40 years, if we include the tax point transfer. If we include that in the calculation, this year and in the next few years, the share comes out to be 35%.

When it comes to the 7% and 10% statistics, the Quebec government's health care spending is going to increase by 7% over the next year, while the Canada health transfer alone is going to go up 10% in the next few weeks.

Also, as you saw in the budget, new funding has been added.

Therefore, all of this gives you an idea of the federal contribution to provincial health care spending, both over the long term and the short term.

[Luc Thériault, Bloc, Montcalm, QC]

So you are challenging the Quebec government's chart showing the changes in federal transfers, which was submitted with Minister Girard's budget. We can discuss that at another time.

You demand that your health care system be universal. We also support universal health care. However, when accessibility becomes an issue, it's highly likely that some people in an emergency situation will be forced to seek care in the private sector. We've seen it, although it's not what we want.

You're claiming $41,867,224 from Quebec. Mr. Minister, your methodology is based on a survey to which six out of 56 clinics responded, making it a 10% response rate. You extrapolate these responses and figures from all of Quebec and are claiming that amount back from it. That's sloppy, Mr. Minister.

[Jean-Yves Duclos, Liberal, Québec, QC]

The Canada Health Act is based on several principles.

[Luc Thériault, Bloc, Montcalm, QC]

I'm talking about your methodology.

[Jean-Yves Duclos, Liberal, Québec, QC]

I will quickly summarize two of them. The first is, it must be accessible; the second is, it has to be free of charge.

The provinces and territories need to find new ways to increase accessibility to essential health care, including diagnostics. It's their right and responsibility.

That said, free access to services, including diagnostic services, is essential under the Canada Health Act. The Canadian government and the federal Health Minister have an obligation to impose deductions when people are forced to pay, or when they can't pay and therefore don't have access to essential health care in the provinces and territories.

What we've seen in the past few years, since 2018, is that some provinces like British Columbia have been able to reform their fees—

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Minister, did you have an accurate analysis of what had been billed to Canadians?

[Jean-Yves Duclos, Liberal, Québec, QC]

I will let you ask the question and I'll try to respond a little later.

[Luc Thériault, Bloc, Montcalm, QC]

Did you have an accurate analysis of what had been billed to Quebec, or did you simply extrapolate based on the responses submitted by 10% of 56 clinics across Canada?

Do you know what that represents, that $41,867,000 estimate? Do you have any idea how many medical procedures can be done with that amount of money? You could prevent colon cancer by administering colonoscopies to 41,867 patients. Colon cancer is the second most fatal type of cancer among men.

Don't you find that your sloppy health care estimates are taking their toll on people's health? Aren't you ashamed to be using health care estimates like this to claim money back when we need the funds to provide care to our people, given the current state of the system?

[Jean-Yves Duclos, Liberal, Québec, QC]

You ask good questions, Mr. Thériault. However, if you want good answers, you need to give me time to respond. I will try to do so as quickly as possible. You're entitled to good answers, but the fact remains that I need a little time to answer you.

First, those figures are based on a collaborative effort begun in 2018. It's been five years now that the various departmental teams have been working together on this.

Second, I'll use British Columbia as an example. In 2018, it began to carry out reforms similar to those that Quebec may want to make in the coming months, to keep people who need key diagnostics from paying for it or, even worse, can't get them done because they can't pay for it.

That's a key feature of our health care system in this country: People should receive care based on their needs, including key diagnostics, not on the depth or breadth of their wallet. So we'll continue to work together in a collaborative and transparent way to ensure that this continues to be the case in this country.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Minister.

Next is Mr. Davies, please, for six minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Chair.

Thank you, Minister and all of your officials, for being with us today.

Minister, I want to pick up on where you very astutely acknowledged the federal government's responsibility to enforce the Canada Health Act. I agree with you very much on that.

We know that for-profit clinics across Canada are currently charging desperate patients tens of thousands of dollars in some cases for two-tier access to non-emergency surgeries. Those clinics are exploiting a loophole in the Canada Health Act that allows people to pay to jump the queue, as long as that surgery is performed in a province they don't reside in. I don't think any of us think that's the way the Canada Health Act is supposed to work.

Minister, will you act to close that cash-for-access loophole?

[Jean-Yves Duclos, Liberal, Québec, QC]

It's a difficult but important conversation.

We are in 2023. We need to take advantage of new ways of delivering care, including virtual care, including using the skills of workers who were not used earlier to provide essential services, such as nurse practitioners and physician assistants. This is great news. Provinces and territories can and should do that.

At the same time, as you pointed out, we need to ensure that these essential health care services are provided free of charge. Otherwise, as you also mentioned, there are some people who won't be able to access these services or who will have to wait until others are able to access them, based on a two-tier or two-speed system. This is not what we want to have in Canada.

A two-speed system is not what aligns with our values of equity, solidarity and efficiency, including from a public health care perspective. That's why we are, therefore, going to continue, as you've seen and as you are supportive of, the important work we need to do with provinces and territories over the next weeks, months and years.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thanks, Minister.

Minister, nearly a quarter of Canadians report going hungry due to cost, and two million children across the country are at risk of going to school hungry. In the last election, both the Liberal Party and the NDP pledged to invest $1 billion, starting in 2022-23, to establish a national school nutritious meal program, to ensure that no child is forced to struggle through the day on an empty stomach.

Minister, you've wisely identified the importance of social determinants of health. Given that this is an important preventative health measure and that this commitment has not been fulfilled to date, can you confirm that funding will be included in the upcoming budget?

[Jean-Yves Duclos, Liberal, Québec, QC]

I can confirm exactly what you're saying. Prevention, as we were mentioning earlier, especially for children, is absolutely essential and a key health care and health determinant. That includes healthy eating, not only from a physical health perspective but also from a mental health perspective—the ability to learn and to develop the child's full potential over time. That is why we have committed to building a national food program.

That is under the leadership of Minister Gould and Minister Bibeau. They know it really well. You will want to have a conversation with them.

[Don Davies, NDP, Vancouver Kingsway, BC]

I'm sorry, Minister, but I'm going to interrupt. We're at about the same amount of time.

I'm not hearing a clear answer to that. I think we'd appreciate one, if you could give one to the committee.

In 2021, former health minister Patty Hajdu told Canadians that a “full investigation” into Canada's COVID-19 response would be required at the “appropriate time”. She said, “We are still in a crisis and so our focus remains right now on getting Canadians...through this...crisis... And when the time is right, our government will be very open to examining very thoroughly the response of this country to the COVID-19 crisis”.

Minister, in September 2022 you noted that a government decision could come “soon” on what kind of review should be held, but your government has yet to take action in the six months that have passed since you made that comment.

We're clearly out of the crisis. Will you make a firm commitment today to launching an independent public inquiry into the federal government's COVID-19 response?

[Jean-Yves Duclos, Liberal, Québec, QC]

There are a couple of pieces to that important question.

First, as we know, there have been a number of different studies on our reaction to and our collaboration in terms of COVID-19, including several reports from the Auditor General and significant internal collaborative studies within the federal government and between the federal government and other governments. Those have also involved, obviously, public health agencies. I personally have had many meetings with stakeholders and experts from different communities, and I have invited them to keep providing us with their input on that reaction.

We are currently discussing a bill in the House that is also pointing to the importance of having a review of COVID-19.

Finally, we need to do this in two ways. First, it has to be inclusive of all perspectives, and second, it has to be inclusive of all aspects of that work.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thanks, Minister.

I think my question was on an independent public inquiry. If you have further thoughts on that, could you please indicate those to the committee?

Minister, I don't have much time left.

Given that the health department recently noted that alcohol is a carcinogen that can cause at least seven types of cancer, why aren't alcohol containers required to carry warning labels in Canada, as tobacco products are?

[Jean-Yves Duclos, Liberal, Québec, QC]

That's a great question.

In fact, we have Dr. Njoo with us today, who is, as you all know, a public health expert.

There is the data piece and the epidemiological or clinical piece to that.

I would invite you, perhaps, Dr. Njoo, if you could, in a short amount of time, to provide your reaction to what you just heard.