Health committee  Each province is completely different, but I can say that the system in Quebec works well. It's a good partnership between the public and private sector. It provides universal coverage for all Quebeckers. It's a system we're very comfortable with.

Health committee  I would say once again that, for us, it works quite well with INESSS in Quebec and now with the Canadian Drug Agency elsewhere in the country. We're not recommending any changes in that regard. I know that INESSS works very closely with the federal system and that it works quite well.

Health committee  The for-profit companies provide a very compelling solution to clients, and so do the not-for-profits. It's a very competitive market. There are over 20 insurers that compete for business, and employers will make decisions based on what's best for them.

Health committee  You know, that's a case-by-case thing. You'd have to look at the situation of each employer and what they're looking for in their benefits plan, but it is a very competitive space. The majority are not-for-profits, as I mentioned, and I think you can infer that the profit being made in this space is quite low, even for the for-profit companies.

Health committee  I don't think you could make that general statement, no. It's an extremely competitive space. Everyone's competing with a very broad suite, and employers make decisions based on what's in their best interests. It's case by case. There are hundreds of thousands of employers out there who have different reasons for going with different providers.

Health committee  It's very small. Again, I don't have that detail in front of me, but what I can say is that it's a mixed system, with for-profits and not-for-profits competing aggressively. The thing that unites them is we provide coverage for 27 million Canadians. All of them get much better coverage than they would on any public program, and we're very proud of the service that we offer to Canadians.

Health committee  Well, it's a business that's important to us. It's a very competitive business. The margins are low. We're competing every day to offer the best service we can for Canadians. I'll just reiterate that the 27 million Canadians who have that coverage today do not want to lose it. I think that as the government contemplates its go-forward plan with pharmacare, what the minister was talking about today makes a lot of sense.

Health committee  What I can say is that we greatly value the Quebec system. We believe that it works quite well and that it could be a model for the rest of Canada. We completely agree with you. It's a system that works well between public and private. It provides exceptional coverage for Quebeckers.

Health committee  Thank you for that question. That's a common misunderstanding. In fact, the majority of the companies operating in this space are not-for-profits. Medavie is a not-for-profit company, as are GreenShield, the Blue Crosses and Beneva.

Health committee  Those are all of the Blue Crosses across the country. Beneva, which is a large player in Quebec, and GreenShield are all not-for-profits. If you look at the number of carriers in the country, you see that probably over half are actually not-for-profits, and they reinvest everything they make back into their communities.

Health committee  I don't have that number in front of me. I apologize.

Health committee  Well, yes, certainly, if you mean by “service”.... A typical plan will cover prescription drugs, will have dental and vision coverage, and will have all the paramedical services and travel coverage, so there are a suite of solutions that can be provided there, and employers can have some flexibility in what they want to offer.

Health committee  That is a concern, and I think, again, if you read the legislation, it doesn't stop at those two drugs. I think that's one of the big things we need to keep reminding ourselves about. It contemplates, within a year, going well beyond that, and so if you get into a situation in which hundreds or thousands of medications are covered, then employers are absolutely going to start asking themselves, “Why should I be still in the game?”

Health committee  I'll run some simple math on this. It's going to depend on how broad a list of medications you cover, but the typical cost for someone on the ODB program here in Ontario is roughly $1,900 a year. If you took that $1.5 billion, and it was an annual thing, you could probably cover most of that gap and provide access to the ODB.

Health committee  I was encouraged by the minister's comments and I think if we could see that reflected in the legislation, I think we'd be vehemently in accordance with what he has in mind, but we don't see that reflected in this bill. I think that's the issue that we have. Terms have not been defined.