Justice Committee on Nov. 22nd, 2016

[Ahmed Hussen, Liberal, York South—Weston, ON]

Thank you, Chair.

Thank you, gentlemen, for coming in to speak to this committee about Bill S-201.

My first question goes to Mr. Boudreau and Mr. Howard. You mentioned in your paper to us that, according to your research, premiums could go up by 30% for males and by 50% for females, regardless of their genes or whether they have been tested or not.

According to the testimony of Senator Cowan, one of the sponsors of the bill before our committee, he indicated that for the countries that have instituted a ban on genetic discrimination there was no significant increase in premiums, certainly not 30% to 50%. Do you care to comment on that?

[Robert Howard]

Yes. There are several reasons why this is going to be an issue. If you compare with the U.K., there was a paper written by Professor Angus Macdonald, and I believe he also did a report for Senator Cowan. He found a negligible increase in premium rates because of the ban, as it was constituted in the U.K.

There are some problems with his research. One thing is that he used only six genes, and the genes that I've used include several for heart conditions. He had nothing for heart conditions. The ones that I have included are about five times as serious as the ones that he included. That's a very significant factor.

The second thing is that he assumed that there would be no anti-selection. In other words, the people who test positive for one of these genes would be no more likely to buy insurance than others, and they would buy no more insurance than others who were untested. That seems to me to be very unlikely when you take into account anti-selection. That pushes up the cost quite dramatically.

Mr. Boudreau has already commented that the genes that are involved are not ones that have an impact within the next few months or even the next few years after buying insurance, but they're delayed for several years. The full effect in the experience in the U.K. and other countries is yet to be seen.

[Ahmed Hussen, Liberal, York South—Weston, ON]

Thank you.

In the current situation, individuals are reasonably discouraged from getting genetically tested because of fears about coverage and because of fears about their future. Don't you think this bill would encourage more individuals to feel confident to get genetically tested for genetic conditions, and isn't that a social good and something that you could support?

[Robert Howard]

Personally, I consider the fear to be an irrational one. Genetic discrimination, as it's being presented, is totally unlike something like racial discrimination. There are people who have been ill-treated in our society for decades, for centuries, because they belong to a certain group. Hundreds of people have been killed for that. People's fear of being mistreated because of discrimination, of not being able to do the things that ordinary people can do, is a very real fear.

Genetic discrimination isn't like that at all. The concern is that people are failing to do things that could be for their own good. It's not that they think there are people out there who hate them and want them harmed, but that they might have a financial disadvantage because of it.

Furthermore, the insurance is available. Even today, people can buy a considerable amount of life insurance. If the concern is that you won't be able to buy insurance in the future, I would first ask you this. How much insurance do you need now, and how much have you bought now, before your test? If your answer is that you haven't bought any because you think you're healthy, then that goes back to the fire insurance example. The fact is that people can get the insurance now that they need.

[Ahmed Hussen, Liberal, York South—Weston, ON]

I'd just like Mr. Cohn to respond.

[Dr. Ronald Cohn]

Thank you for the opportunity.

I have to respectfully disagree with you on this. I would like to maybe step back for a second and make this a bit independent of the insurance issue. The statement that genetic discrimination is not like any other discrimination is simply wrong. It's an insult to the community of patients and the families I deal with who have children with medical disabilities and who are afraid of discrimination independent of any financial aspects.

I'm glad I have an opportunity to talk about it. I chose not to, but with the number of times I have had families in my office talking about how it is to have a child with a disability and dealing with this in a normal social circumstance, I cannot sit here and accept from you that this is not discrimination.

Thank you.

[The Chair, Liberal, Anthony Housefather]

Mr. MacGregor.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Thank you, Mr. Chair. How much time do I have?

[The Chair, Liberal, Anthony Housefather]

Fortunately, nobody is taking this room at one o'clock. I'd like to get you and Mr. Bittle through your questions, and then we'll see. We'll go maybe 10 minutes long.

[Iqra Khalid, Liberal, Mississauga—Erin Mills, ON]

Sorry, Mr. Chair, I have another committee meeting at one o'clock. I'd like to excuse myself, if I may.

[The Chair, Liberal, Anthony Housefather]

You absolutely may.

[Iqra Khalid, Liberal, Mississauga—Erin Mills, ON]

Thank you, gentlemen.

[The Chair, Liberal, Anthony Housefather]

Mr. MacGregor, you have six minutes.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Thank you.

Mr. Frank, I want to direct my first question to you.

Just to put it on the committee record, I'll read from an article in yesterday's The Globe and Mail that's entitled “Sun Life overhauling life insurance application process in Canada”. It announced that Sun Life Financial, arguably one of the largest businesses in Canada, is “overhauling its life-insurance application process in Canada, cutting down on intrusive tests as part of an industry-wide push to make getting coverage easier for customers.” They feel that the life insurance industry is “increasingly looking to technology to simplify its processes” and is catering to “consumers' desire for less invasive and time-consuming tests”.

Now, if Sun Life is going down this road because they see a future in this, I would presume that if it feels it doesn't need medical tests about an applicant's actual health, it probably doesn't need to have access to an applicant's genetic test results. I'd like you to comment on that particular aspect.

[Stephen Frank]

Thank you for the question.

Sun Life did not say that they will not be collecting medical information from applicants anymore. They've shortened the list and types of information that they will be gathering. They will continue to gather all kinds of medical information, including family history and other things that would be relevant to the risk. I think that's the key point here. We're very aware, and the industry understands clearly, that not all genetic tests are relevant to underwriting and understanding an actual risk. We only use those that are relevant. In Mr. Howard's scenario, we picked 13 genes out of about 50,000. We're very selective in how we use this.

The issue for us is a fundamental one, and I think it's been illustrated well, that when you're entering into a contract of good faith, both parties need to understand what the basis is for that agreement. We're very concerned that if one party can come and not disclose relevant information, you're no longer in a good-faith agreement, and that will have profound implications for the business.

I do want to reiterate that we understand that this is a serious concern for Canadians. We do want to find a balanced approach for it. That's why we've announced today that we are in discussions with the provinces on an approach that would see us not use or ask for genetic information for any application for life insurance under $250,000. That will address the issue for the vast majority of Canadians; 85% of people will no longer be asked for any genetic test information that they require. We think that's the right way forward here, and we'll be making an announcement on that issue very shortly.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Thank you. I'm going to move on to Dr. Cohn.

Dr. Cohn, earlier today, and of course before today's committee hearing, we received the submission from the Torys law firm, which outlined why they oppose Bill S-201. Specifically they state that clauses 1 through 7 of Bill S-201 do not address a public health evil. That is their position. They feel that criminal law power cannot be used to promote medical practices.

I would argue that, yes, it's not up to federal criminal law power to promote medical practices. That's your job. That's the job of provincial health ministries. However, given your testimony and your direct experience, would you not say that this law is trying to create the conditions in which you can operate freely to promote health, to protect your patients' fears of a legitimate concern over discrimination?

I would like you to go into a little more detail on that particular aspect.

[Dr. Ronald Cohn]

Thank you. I'm obviously not in a position to comment on the law per se, but when you talk about the issue of how we can freely operate and provide the type of medical care that we feel is necessary, then I think this bill is going to provide us with this opportunity.

I would like to come back to the third point that I made, that genetic information, as we are going to continue to gain more and more knowledge, is going to be power to improve the life of every individual.

Right now there is a somewhat limited effort towards patients who have very severe medical conditions, some of whom never make it to a life insurance age anyway. The knowledge we are gathering that is now able to have us put measures into place that keep us healthy and alive is only going to continue to increase. Having that ability to offer this.... What do you really want as a physician? Yes, you would like to treat your patients, if they're sick. However, in an ideal world, we would like to prevent them from getting sick. That's exactly what we could do.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Looking at the way health care costs are going and the strains on provincial budgets, if you had this tool at your disposal, without any patient fears.... I realize we're only on the doorstep of what's potentially available to us as we progress through the 21st century. Do you feel that savings in the medical system could result, vast savings of money not only for our public health dollars but maybe for the insurance industry as a whole?

If you can confidently tell your patients, because they have a certain marker for things, that you could probably direct them towards a certain lifestyle, that may end up not resulting in a massive insurance payout at the end.

[Dr. Ronald Cohn]

Absolutely. There is the case of this woman with colon cancer. If you take her and the cost of yearly colonoscopies into consideration, which are about $700, maybe $1,000, and compare it to the fact that she would be diagnosed at age 40 with metastatic colon cancer, that's hundreds of thousands of dollars of treatment that is necessary and potentially necessary for the insurance company to pay out, because she probably wouldn't survive it past the age of 50.

The condition she's in right now, honestly, we have very good evidence, since it's a fairly common cancer, that she's most likely going to survive without any significant health care costs, and for sure, with no costs to the insurance industry. This knowledge, the amount of knowledge we're going to gain over time, is just going to increase.

[The Chair, Liberal, Anthony Housefather]

Thank you, Dr.

We have to go to Mr. Bittle. By the way, when the questioner has the questions, it's in their capacity if they ask you or not. I can't recognize you when it's Mr. MacGregor's time.

Mr. Bittle.

[Chris Bittle, Liberal, St. Catharines, ON]

Thank you so much. We heard from the actuaries that this bill, you believe, in and of itself is discriminatory. Mr. Boudreau commented that this is the worst form of discrimination. With respect to that, I believe that's out of touch. We're hearing from Dr. Cohn that there are people who are affected by this. There are children who are being hurt, children who are sick, people who aren't becoming part of clinical trials, lives that are being shortened because of policies by the insurance industry. There are real effects outside of your actuarial tables that I don't believe you're taking into account.

How can you listen to this and still say that this is discriminatory legislation not worthy of government involvement?

[Jacques Boudreau]

Let me give you an example. There's a disease called polycystic kidney disease that used to be determined or diagnosed through an ultrasound. It can now be identified through a genetic test.

Under this law, if it's found through the ultrasound, it would have to be disclosed to the insurance company. If it's obtained through a genetic test, it wouldn't have to. That's what I mean by a form of discrimination.

[Chris Bittle, Liberal, St. Catharines, ON]

Sir, one is actual. One is an ultrasound; you can see it. One is predictive. So few of these tests are predictive, as it stands right now.

I'll move on to the insurance industry. Though I do appreciate your attempt to, sometime in the near future, maybe, possibly, come up with an agreement with the provinces, you have known about this for years. You have known about the consequences it's having on people's health in Canada, and yet you wait until we're on the verge of passing a bill. That's inexcusable, sir.

This reminds me of individuals from the tobacco industry coming before Congress years ago. Why should we believe, now, on the verge of passing this legislation to protect Canadians, that you are going to do right by Canadians and work for their health and best interests?

That's to be answered by the insurance industry.

[Frank Zinatelli]

I'm not sure I understand the question.

[Chris Bittle, Liberal, St. Catharines, ON]

Why should we believe you? Why wait until the last minute? Why not do this years ago when we knew people's lives were being impacted by decisions made by the insurance industry?