Citizenship and Immigration Committee on Nov. 21st, 2017

[Nick Whalen, Liberal, St. John's East, NL]

Are you also saying for your statistics that the amount of immigration costs is exactly the same as the resident population?

[Prof. Arthur Sweetman]

At the moment, on average, in Ontario—

[Nick Whalen, Liberal, St. John's East, NL]

I can tell you that the health transfer is on a per capita basis which updates every year. If immigrants are added to the mix, and the per capita costs are calculated every year, then it just comes out in the wash. You've already proven that immigrants have the same costs in health care as everyone else, and the health transfers are the same. If you add more immigrants, it all comes out in the wash.

Why are we forcing the government to quantify immigration if we already know it's the same as the base human population in the country?

[Prof. Arthur Sweetman]

I think you paid attention to my third point but ignored the first point, and that is—

[Nick Whalen, Liberal, St. John's East, NL]

Please reiterate it and try to justify this.

[Prof. Arthur Sweetman]

The first point is that there are high-cost users of the system and that right now 1.5% of the population is responsible for just under two-thirds of all health care costs. If you're increasing that 1.5%, if you're adding people to that very high-cost user, that is a very substantial, or potentially very substantial, amount of money. It's not an average—

[Nick Whalen, Liberal, St. John's East, NL]

I'm just going to step back. So 1.2% of the Canadian population—

[Prof. Arthur Sweetman]

It's 1.5%.

[Nick Whalen, Liberal, St. John's East, NL]

It's 1.5%, about half a million people. We're talking about adding a thousand people to that every year. Again, it sounds de minimis. It sounds like something that comes out in the wash. It sounds like the number of high-cost users in the immigrant population remain statistically the same as the Canadian population. Forcing this dehumanizing act of quantifying their additional.... As a class of a thousand, each one of them feels it. Forcing the government to do that just seems to me unnecessary and overly bureaucratic, and it would not change the transfer because it's de minimis.

[Prof. Arthur Sweetman]

I don't disagree with you on some dimensions. However, my view is that, right now, services for people who are high-cost users are insufficient. If you think it's a small amount of money, why don't you just increase the budget to the provinces by that amount right now? Why don't you make that one of your recommendations?

[Nick Whalen, Liberal, St. John's East, NL]

I think it's rising by 3.5% a year, and the overall population—

[Prof. Arthur Sweetman]

Make it more than that. It's a small...de minimis I think is the term you used. Why not just increase it by a de minimis amount?

[Nick Whalen, Liberal, St. John's East, NL]

That's a wonderful sentiment, Mr. Sweetman, but we're not in the health committee today. We're here in the immigration committee, and we're focusing on a number that.... You would like some other number, and you're lobbying on behalf of increasing medical transfers to the province. I do not see a direct link between that and immigration, because as your own numbers prove, the per capita cost for immigrants taken as a whole is the same as that for the Canadian population taken as a whole. If the Canadian health transfer is already based on per capita costs, provinces that receive more immigration get more of the transfer.

[Prof. Arthur Sweetman]

You missed an important clause. This is the immigration system as it operates at present. You're talking about changing that. I think you want to be calculating new numbers for your changed immigration—not the current system, but your new system. I'm not opposed to bringing people in—

[Nick Whalen, Liberal, St. John's East, NL]

So, you're saying that—

[The Chair, Liberal, Rob Oliphant]

I'm going to need to draw this one to an end.

I do have a question for Professor Sweetman on the other side of the ledger.

I'm not an economist, but I am a former accountant. You've looked at the costs of health care. Have you also looked at the benefit of newcomers and the added amount of money they bring to the economy in terms of revenue and tax dollars? Have you looked at the costs of maintaining the system to net that out? I know you're an economist, so you'll be looking at a complete picture. We've only heard one part, so I will just put it on record that I'd like that answered before the end of the day.

Mr. Maguire.

[Larry Maguire, Conservative, Brandon—Souris, MB]

Thank you, Mr. Chair.

I want to thank all three witnesses for their excellent presentations this morning.

I want to get a little more in-depth information with regard to the types of disabilities that we may be talking about. We heard a lot last evening from some witnesses about the average health costs that my colleague was referring to on a per capita basis and what we should do with section 38 for sure.

I'll get to you, Mr. Sweetman in a moment, but Dr. Hanes and Dr. Bennett, can you both articulate for us the kinds of disabilities that are predominant, not necessarily in how they impact the budget, but which ones are more pertinent with regard to the inadmissibility of persons?

[Roy Hanes]

One issue that I find here around the debate is that first of all, I don't see disability as a health issue. Disability is a social issue, a political issue, an economic issue. This is one of the concerns I have around the excessive demand clause. For me, the person that I'm working with right now is trying to support his family coming here. His brother has cerebral palsy. I've been working in this field for 40 years. I've been working with a number of people with disabilities, and I still do: people who are blind, people who have cerebral palsy, spinal injuries, etc. If you're thinking about who it is, I would say not to do that, I would say, as a minority representation and the significance of people with disabilities. Sometimes I don't use that term. I think I come from a position of disability pride. I keep wanting you to think about the changes in definitions around disability, the social construct of disability, that we as a society disable people with impairments.

We talk about costs. Similar debates, I'm sure, had to do with new immigrants when they were coming here after World War II or years ago: what about the cost to train these people to speak English, to learn English, and so on and so forth; what will happen to our society? Well, what's happened is that we have a wonderful society. I want to shift that to the concept of investment. As we were saying, it's not a heck of a lot more money, so it'll shift.

Some of the cases right now are small issues. Some of them have to do, for example, with Down's syndrome—like with one person I know, Nico Montoya. There's a family in western Canada that is facing deportation whose daughter has what I would refer to as minor impairments. The Chapman family, who wanted to immigrate, sold everything they had to come to Nova Scotia from England.

[Larry Maguire, Conservative, Brandon—Souris, MB]

Yes, and I must interrupt you because of time, sorry. I have three in my own constituency right now who are exactly like that.

[Roy Hanes]

I'm sure a lot of you do, yes.

[Larry Maguire, Conservative, Brandon—Souris, MB]

Ms. Bennett, could you comment on that as well as the cost side you're developing?

[Sheila Bennett]

Yes. As a person who's spent all my career in education, I'm quantifying it in terms of school systems. When school systems talk about additional cost, talk about children by what we would think of as type of disability, we often hear autism, Down's syndrome, cerebral palsy, but really it's any physical, cognitive, social, or emotional diversity. Children who have excessive behaviour problems, for example, can cost a system money.

What we think about in the education system when we look at cost is how that cost gets distributed. As I mentioned, some systems self-contain that cost and some systems extrapolate it over the entire school population. How school boards do that is up to them. Some provinces extrapolate it across the entire province. The notion is that all children then have access to differentiated learning, differentiated opportunities, and support systems.

For example, one of the projects I worked on with McMaster has to do with occupational therapy services as delivered in schools. When we used a model that brought occupational therapists into the schools, the waiting lists in every school we went into went to zero, and children who had not previously been identified as having occupational therapy needs were identified early, and the costs were saved.

So in terms of school system costs in disability, I would argue pretty vehemently, based on my 30-plus years of experience, that there's an added benefit to having a student with a diverse way of interacting with the world, whether that be physical, cognitive, or emotional. It adds incredible value to us as citizens, because it allows us to create friendships and to build a society and then create gainful employment for people who, when we look back at when immigration [Technical difficulty—Editor] were done, were discriminated against.

[Larry Maguire, Conservative, Brandon—Souris, MB]

Thank you, and say hi to your new president, Dr. Fearon, for me.

[Sheila Bennett]

I will.

[Larry Maguire, Conservative, Brandon—Souris, MB]

He came from Brandon.

Mr. Sweetman, perhaps you could elaborate on the costs. You made a comment that the Canadian population base has the same medical concerns as those of other immigrants. I'm wondering if there's more of a role for the provinces to play, because they're on the field, and municipal governments as well. Sometimes, as Mr. Hanes said, even these people couldn't pay for their own family, even if they could afford to pay for the whole process. If provinces or municipalities pick up some of that cost, or are willing to, should they be able to?

One answer we had last night was that would perhaps lead to some provinces being more unfair than others that are able to pay more.

Could I get a comment from you on that?