Finance committee  I'd better make sure I hear this one right.

Finance committee  I don't think that would be the approach. I think the approach would be to bring people up to speed. In all provinces there are pockets of expertise; there are areas of expertise. Some provinces have a little more than others, but there is expertise in every part of Canada. Here the idea would be to build upon that expertise and to really exploit what is being done much better in one province, and that then could be translated to another.

Finance committee  I think it's important to have different approaches to the same problem, because unfortunately we actually don't know.... We are involved in research, and the reason we're doing research is that we don't know the answer. Preconceived notions of how to go ahead sometimes turn out to be wrong.

Finance committee  It is a huge amount. If you look at the figures, it is quite shocking how much more expensive certain drugs are here than in other jurisdictions. That's detailed in the brief.

Finance committee  How specifically the funding helps?

Finance committee  Again, funding is necessary to deliver the services that we deliver across the country. There is no question that our population demographics are shifting somewhat. This requires perhaps a modicum of more spending, but that really isn't the big issue. To me the big issue is the distribution of that spending and how we're using those dollars.

Finance committee  Well, one can set up coordinations, I guess, in different ways. I'll let my colleagues speak to their areas of expertise. In mine, if I could do it all my way, then I would say, if we had a national cancer program as opposed to just provincial cancer programs, we could be more efficient, take the best innovations that are present in each province and spread them across the whole country, and deliver uniform care that Canadians deserve at the very highest level, in that way.

Finance committee  Yes. It seems counterintuitive, the idea being, for those who propose it, that you can take people waiting in line who have resources, move them into the private sector, get them off the rolls, and that will make both systems function well and the public system will be more efficient.

Finance committee  The case that's before the B.C. Supreme Court now involves a suit and then a countersuit that basically involves the provincial health care authority. The main protagonists here are Cambie Surgeries Corporation, the provincial government PHSA in terms of the Ministry of Health, and then there are intervenors, such as Canadian Doctors for Medicare and the BC Health Coalition, which have that status to inform the discussion.

Finance committee  It certainly is one of the things. We are there because we believe that the medicare system deserves to be protected, but also deserves to be changed and reformed as is required by the times. It's not as though we're for a static medicare system of all things going on as before, forever—that's not true.

Finance committee  In essence, what we've looked at, and what a number of other organizations, including the CMA, have now looked at and agreed with us is we are overpaying drastically in terms of our drug costs. Part of that has to do with where we're located on the planet, but the other part of it has to do with simply not having a large bargaining unit to be able to cut a better deal.

Finance committee  I don't know that I can address the issue of dementia, but there are many experts here on dementia. Certainly in terms of care for the elderly in general, one of the major issues of our time, and perhaps it's coming into its time now, is that we have to shift from a medicare system designed 40 or 50 years ago to deal with acute illnesses and hospital-based care, when the average age to which people lived was in the sixties, to one now where people born today are, on average, going to live to be 85.

Finance committee  Undoubtedly, the federal government should have a major role in doing this and providing leadership in many initiatives. The issue again is that provinces are somewhat siloed and separated in terms of how they have traditionally dealt with their health care issues. What one would hope from a federal government in our system is leadership that maintains the actual provisions of both medicare and the Canada Health Act.

Finance committee  Very briefly, I think the problem has been that a lot of these activities have been siloed in different health care jurisdictions. There is no real reason that it can't happen.

Finance committee  There are two different parts to that question. The gaps in the Canada health accord have to do with the different provincial jurisdictions and the ways in which the funding comes to them currently. At the present time, I'm not an expert but my understanding is that in the current system the funding is based on a head count.