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37th PARLIAMENT, 2nd SESSION

Subcommittee on the Status of Persons with Disabilities of the Standing Committee on Human Resources Development and the Status of Persons with Disabilities

EVIDENCE

CONTENTS

Tuesday, May 13, 2003

0910

The Chair (Ms. Carolyn Bennett (St. Paul's, Lib.))

0915

Mr. Reed Elley (Nanaimo—Cowichan, Canadian Alliance)

The Chair

Ms. Madeleine Dalphond-Guiral (Laval Centre, BQ)

The Chair

Ms. Elizabeth Davis (Senior CPP Advocate, B.C. Coalition of People with Disabilities)

The Chair

0920

Ms. Marjorie Edwards (Retired nurse, As Individual)

The Chair

Mr. John Wodak (As Individual)

The Chair

Mr. Anthony Pizarro (Policy Analyst, Income Security and Social Policy, Federal-Provincial Relations and Social Policy Branch, Department of Finance)

Mr. Réal Bouchard (Director, Social Policy, Federal-Provincial Relations and Social Policy Branch, Department of Finance)

Ms. Susan Kalinowski (Senior Policy Analyst, Income Security, Federal-Provincial Relations and Social Policy Branch, Department of Finance)

The Chair

Mr. Michael David French (As Individual)

The Chair

Ms. Michelle Kristinson (As Individual)

0925

The Chair

Mr. Ellie Stein (As Individual)

The Chair

Ms. Nancy Lawand (Director, Canada Pension Plan Program Policy, Department of Human Resources Development)

Ms. Susan Williams (Director General, Disability Benefits and Appeals, Income Security Programs, Department of Human Resources Development)

Mrs. Susan Scotti (Assistant Deputy Minister, Income Security Programs, Department of Human Resources Development)

Mr. Roy Muise (As Individual)

The Chair

Mr. Walter Nash (As Individual)

0930

The Chair

Mr. Ellie Stein

The Chair

Mr. Ellie Stein

The Chair

Mr. Ellie Stein

The Chair

Ms. Marjorie Edwards

0950

The Chair

Ms. Marjorie Edwards

The Chair

Ms. Marjorie Edwards

The Chair

Ms. Marjorie Edwards

Mr. John Wodak

The Chair

Mr. John Wodak

The Chair

Mr. John Wodak

The Chair

Ms. Elizabeth Davis

The Chair

Ms. Elizabeth Davis

The Chair

Ms. Wendy Lill (Dartmouth, NDP)

The Chair

0955

Ms. Wendy Lill

The Chair

Mr. Roy Muise (As Individual)

The Chair

Mr. Roy Muise

Mr. Walter Nash

The Chair

Mr. Walter Nash

The Chair

Mr. Walter Nash

The Chair

Mr. Walter Nash

1000

The Chair

Mr. Walter Nash

The Chair

Mr. Walter Nash

The Chair

Mr. Walter Nash

The Chair

Mr. Walter Nash

The Chair

Mr. William Young (Committee Researcher)

Ms. Marjorie Edwards

The Chair

Ms. Elizabeth Davis

The Chair

Ms. Michelle Kristinson

1005

The Chair

Ms. Michelle Kristinson

Mr. Reed Elley

The Chair

Mr. Walter Nash

The Chair

Mr. Walter Nash

The Chair

Mr. John Wodak

The Chair

Ms. Susan Williams

The Chair

1010

Ms. Marjorie Edwards

The Chair

Ms. Elizabeth Davis

The Chair

Mr. Ellie Stein

1015

The Chair

Mr. Ellie Stein

The Chair

Ms. Wendy Lill

1020

Mr. Walter Nash

Ms. Wendy Lill

Mr. Walter Nash

The Chair

Mr. Walter Nash

The Chair

Mr. Walter Nash

The Chair

Ms. Susan Williams

1025

The Chair

Mrs. Susan Scotti

The Chair

Mr. Reed Elley

Ms. Susan Williams

Mr. Reed Elley

1030

The Chair

Mr. John Wodak

The Chair

Ms. Elizabeth Davis

The Chair

Ms. Elizabeth Davis

The Chair

Ms. Wendy Lill

1035

Ms. Michelle Kristinson

The Chair

Ms. Michelle Kristinson

The Chair

Mr. John Wodak

The Chair

1040

Mr. John Wodak

Ms. Marjorie Edwards

The Chair

Mr. Ellie Stein

The Chair

Mr. Michael French

The Chair

Mr. Michael French

The Chair

Mr. Walter Nash

The Chair

1045

Mr. Walter Nash

The Chair

Mr. Walter Nash

The Chair

Mr. Walter Nash

Ms. Elizabeth Davis

Mr. Walter Nash

The Chair

Mr. Réal Bouchard

1050

The Chair

Mr. Réal Bouchard

The Chair

Mr. Réal Bouchard

The Chair

Mr. Réal Bouchard

The Chair

Mr. Walter Nash

The Chair

Mr. Walter Nash

The Chair

Mr. Ellie Stein

1055

The Chair

Ms. Marjorie Edwards

The Chair

Mr. John Wodak

The Chair

Mr. Ellie Stein

The Chair

Mr. Ellie Stein

The Chair

Mr. Ellie Stein

The Chair

Ms. Elizabeth Davis

The Chair

1100

Mr. Roy Muise

Ms. Elizabeth Davis

Roy Muise

The Chair

Ms. Elizabeth Davis

The Chair

Mr. John Wodak

The Chair

Ms. Michelle Kristinson

Mr. Ellie Stein

1105

Mr. Michael French

The Chair

Mr. Réal Bouchard

The Chair

Mr. John Wodak

The Chair

Ms. Susan Williams

The Chair

Mr. Réal Bouchard

The Chair

1110

Ms. Marjorie Edwards

The Chair

Mr. Michael French

1115

Mr. John Wodak

The Chair

Mr. John Wodak

The Chair

Mr. John Wodak

The Chair

Ms. Elizabeth Davis

The Chair

Ms. Elizabeth Davis

The Chair

Mr. Walter Nash

The Chair

Ms. Susan Williams

The Chair

Ms. Marjorie Edwards

Ms. Susan Williams

1120

Ms. Marjorie Edwards

Ms. Susan Williams

Ms. Marjorie Edwards

The Chair

Ms. Elizabeth Davis

The Chair

Ms. Elizabeth Davis

The Chair

Ms. Elizabeth Davis

Ms. Marjorie Edwards

The Chair

Ms. Marjorie Edwards

The Chair

Mr. John Wodak

The Chair

Ms. Marjorie Edwards

1125

The Chair

Mr. John Wodak

The Chair

Ms. Elizabeth Davis

The Chair

Ms. Marjorie Edwards

The Chair

1130

Mr. Walter Nash

The Chair

Mr. Ellie Stein

The Chair

1135

Mr. Walter Nash

The Chair

Ms. Marjorie Edwards

The Chair

Ms. Marjorie Edwards

The Chair

Ms. Marjorie Edwards

The Chair

Mr. Reed Elley

The Chair

Mr. Reed Elley

The Chair

Mr. Reed Elley

Ms. Susan Williams

Mr. Reed Elley

Ms. Susan Williams

Mr. Reed Elley

Ms. Susan Williams

1140

Ms. Nancy Lawand

The Chair

Ms. Nancy Lawand

The Chair

Ms. Wendy Lill

Mr. Walter Nash

Ms. Wendy Lill

1145

Mr. John Wodak

The Chair

Mr. John Wodak

Ms. Elizabeth Davis

The Chair

Ms. Elizabeth Davis

The Chair

Mr. Reed Elley

Ms. Elizabeth Davis

Mr. Reed Elley

Ms. Elizabeth Davis

Mr. Reed Elley

Ms. Elizabeth Davis

Mr. Reed Elley

1150

Mrs. Susan Scotti

Mr. Reed Elley

Mrs. Susan Scotti

The Chair

Ms. Marjorie Edwards

The Chair

Mr. John Wodak

The Chair

Mr. Walter Nash

The Chair

Ms. Susan Williams

Mr. Reed Elley

Ms. Elizabeth Davis

The Chair

1155

Mr. Walter Nash

The Chair

Mr. Walter Nash

Ms. Elizabeth Davis

The Chair

Ms. Marjorie Edwards

The Chair

Mr. John Wodak

The Chair

Mr. Roy Muise

The Chair

Mr. Ellie Stein

The Chair

Ms. Michelle Kristinson

The Chair

CANADA

Subcommittee on the Status of Persons with Disabilities of the Standing Committee on Human Resources Development and the Status of Persons with Disabilities

NUMBER 013

2nd SESSION

37th PARLIAMENT

EVIDENCE

Tuesday, May 13, 2003

[Recorded by Electronic Apparatus]

¿ (0910)

[Translation]

The Chair (Ms. Carolyn Bennett (St. Paul's, Lib.)): Good morning. I welcome everybody and especially Mado.

[English]

Welcome to our tiny, perfect committee. It will become a tiny bit less tiny shortly, I hope, as we get the recruits.

I think in the spirit of a real round table, it's very important for all of us to introduce ourselves--maybe in less than two minutes--in terms of why we think we're here and what we hope to have come from the round table today.

I think all of you should have had a set of questions or the document that has some of our draft recommendations. There are two documents. Does everybody have “The Future of the Canada Pension Plan Disability Program: Where Next--Canada's Recommendations”? Okay, cool.

As you know, we began this process last spring when we had a round table with what we lovingly refer to as “the usual suspects”. We then developed the questions we thought should be asked. We then, as you know, put the informational website up over the summer, with some of the background documents, and then began the real e-consultation on the international day of persons with disabilities in December.

The e-consultation had 1,450 Canadians fill out the issue poll, which is spectacular, actually, compared to what even the Department of Foreign Affairs was able to get in their consultation on the foreign affairs review. We think we've done a good job in getting it out there.

There were 135 people who submitted their stories and 28 people who submitted solutions. What we have here today is a mixture of that group of the 135 and 28 who either presented a story or a solution, and we're thrilled.

The researchers and the people who distill and interpret what we hear all the time in parliamentary committees selected you from all of them as the people who really knew what you were talking about and had something to contribute. We are thrilled you've been able to come, especially our friends--virtually--from Calgary. Thank you for being with us.

So on that note, we hope in terms of coming back to the questions we decided to ask...this very exciting new way of talking to different people who have not traditionally spoken to parliamentary committees and in bringing a group back with some of the officials from the department who have struggled with many things.

One of the exciting things about being a public servant is sometimes you don't get to change the policy, you get to just administer it. So we are thrilled to have some of the people who have done a lot of thinking about this and probably do have some suggestions on how the policy could be changed, and to be able to banter back and forth, hopefully, with those of you who have presented the solution.

We hope by the end of this morning we will have some consensus around the way to go. It's like you are now the members of Parliament for all of the people who submitted. You're the representatives. So on your behalf, we want to thank everybody who presented. Now you're the representatives who have to thresh this through on behalf of all the wonderful stories and solutions that were presented.

Let us begin here, in that we're all in this together. Maybe, Reed, if you wouldn't mind introducing yourself, then we'll go right around, including Calgary, and back to this side.

¿ (0915)

Mr. Reed Elley (Nanaimo—Cowichan, Canadian Alliance): Thank you very much, Madam Chair.

My name is Reed Elley. I'm the member of Parliament for Nanaimo--Cowichan on Vancouver Island and the Canadian Alliance representative on this committee.

Beyond that, some of you may be aware we have fostered as a couple for 30 years and have had a number of physically challenged children in our home. One of those has stayed with us. We have a 12-year-old physically challenged daughter who spends most of her waking hours in an electric wheelchair, but other than that is probably one of the greatest kids I've ever met.

I am part of this committee not just because of parliamentary duties, but because of real-life situations I'm involved in every day as a parent.

The Chair: Thanks very much.

Mado.

[Translation]

Ms. Madeleine Dalphond-Guiral (Laval Centre, BQ): Good morning. My name is Madeleine Dalphond-Guiral and I am the MP for Laval-Centre, in Quebec. I have been a member of the Sub-Committee on the Status of Persons With Disabilities for several years.

My interest in this Committee is directly related to the fact that I have spent most of my professional career in the health sector. I am specifically interested in the physical and psychological health of disabled persons, who are more and more numerous in our society and that is not going to stop.

I was listening to Carolyn and I was wondering what we were doing here. That made me think of a song from Jacques Brel, entitled La quête, where he says: “Dreaming an impossible dream” and “Going where nobody goes”. So, we may have to continue dreaming together because, together, we will go where nobody goes, that is where equity is guaranteed to everybody.

[English]

The Chair: Merci.

Ms. Elizabeth Davis (Senior CPP Advocate, B.C. Coalition of People with Disabilities): I'm Elizabeth Davis. I'm a Canada Pension Plan disabilities advocate with the B.C. Coalition of People with Disabilities.

I assist clients in filling out that rather overwhelming form and I assist them through the appeal process right to and including the Pension Appeals Board level. I'm here representing the coalition. I also have some fairly strong opinions on changes that need to be made.

The Chair: Excellent. Thanks for coming.

¿ (0920)

Ms. Marjorie Edwards (Retired nurse, As Individual): Hi. I'm Marjorie Edwards and I'm here representing the New Brunswick Mental Health Consumer Network.

I was a nurse for 23 years, and 10 years ago--the old quotation--I burned out. I ended up in psychiatry and have suffered from major depression off and on in the last 10 years.

My experience with the Canada Pension Plan was I had long-term disability, so initially I had to apply or long-term disability wouldn't do anything for me. Of course, it was too early, and Canada Pension Plan told me they felt I'd be back to work in the near future. I have never gone back to work, so my long-term disability continued.

As far as problems with CPP are concerned, it had been six years when I finally applied again and hadn't worked, so I really didn't experience a problem. But probably it's a lot like long-term disability, where the first two years were fine--except they would stop my benefits when the doctor didn't fill out the form, which I found very discouraging.

Anyway, they discontinued. I went for a year without nurse's income. Unfortunately, we had bills to pay that were in line with what I'd been earning. Finally, I took the insurance company to court just to get reinstated, and my psychiatrist was saying it was too detrimental to my health.

Unfortunately, my illness was an emotional thing, and of course if you don't have any money, it's very hard. Plus, I found it very degrading to have to tell people I didn't have any money. They think, oh, nurses, they're loaded--which we never were. I found it so degrading and humiliating. Then, of course, our credit rating was nil. We went from a comfortable life.... And my whole family suffered, not just me.

So I'm here representing mental health consumers, and I have a personal view about long-term disability that maybe I'll get into later.

The Chair: Great.

Mr. John Wodak (As Individual): My name is John Wodak. My formal organizational affiliation is with the ME Society of Edmonton, Alberta. That is the chronic fatigue syndrome support group, although I work as a volunteer advocate with anyone who comes to me and needs help. So I do a great deal of Canada Pension Plan applications, appeals, and submissions.

My basic position is that the assessment determination process is fundamentally imprecise. That doesn't necessarily mean inaccurate, but until we know exactly what the sorts of errors are, we can't really start to fix the system.

The Chair: Thanks very much.

Mr. Anthony Pizarro (Policy Analyst, Income Security and Social Policy, Federal-Provincial Relations and Social Policy Branch, Department of Finance): I'm Anthony Pizarro, from the Department of Finance.

Mr. Réal Bouchard (Director, Social Policy, Federal-Provincial Relations and Social Policy Branch, Department of Finance): I'm Réal Bouchard, director of the social policy division in the Department of Finance. I also chair the federal-provincial committee of finance officials on the CPP. That committee reports to federal-provincial deputy ministers of finance.

Ms. Susan Kalinowski (Senior Policy Analyst, Income Security, Federal-Provincial Relations and Social Policy Branch, Department of Finance): Hello. I'm Susan Kalinowski, from the Department of Finance. I work with Mr. Bouchard and provide support to the CPP federal-provincial committee.

Merci.

The Chair: Thanks very much.

Michael David French, I think you are next, going around the table.

Mr. Michael David French (As Individual): I'm Dave French. I'm a person who has been on disability for almost 13 years at this point. I dealt with CPP at a time when it was, I understand, a lot easier to obtain than it is now. I'm primarily interested in the way in which CPP, insurance companies, and other governmental agencies tend to offset against each other.

Thank you.

The Chair: Thanks for getting up so early, too.

Michelle.

Ms. Michelle Kristinson (As Individual): I'm Michelle Kristinson. I'm an advocate with the MS Society, and over the last five and a half years I have represented hundreds of people who are trying to access CPP. Most discouragingly, I have seen the devastating consequences of people who can't get onto CPP and are waiting one, two, or three years. Recently I have been dealing with someone who has been going to pension appeals, and it has taken her four years to get there.

I have seen the devastating consequences, emotionally, physically, and financially. As the advocate said earlier, I have some strong opinions about the Canada Pension Plan.

Thank you.

¿ (0925)

The Chair: Thank you.

Ellie.

Mr. Ellie Stein (As Individual): My name is Ellie Stein. I'm a physician, and my practice is primarily working with people who have chronic fatigue syndrome, fibromyalgia, and chemical sensitivity.

I have about three or four points I would like to raise at some point during the meeting, based on my experience in trying to help my patients understand the process and fill out the forms properly and the frustrations of my many disabled patients who are denied.

The Chair: Thanks very much.

Nancy.

Ms. Nancy Lawand (Director, Canada Pension Plan Program Policy, Department of Human Resources Development): Bonjour. I'm Nancy Lawand, the director of CPP disability policy at the income security programs branch of HRDC.

Ms. Susan Williams (Director General, Disability Benefits and Appeals, Income Security Programs, Department of Human Resources Development): I'm Susan Williams, the DG of Canada Pension Plan Disability in HRDC.

Mrs. Susan Scotti (Assistant Deputy Minister, Income Security Programs, Department of Human Resources Development): I'm Susan Scotti, the assistant deputy minister, income security programs, at HRDC.

I'm very happy to be here this morning to hear the views around the table and to see what improvements can be made.

Mr. Roy Muise (As Individual): My name is Roy Muise. I'm from Dartmouth, Nova Scotia, and I am a person living with chronic depression.

For the most part, my dealings with CPP Disability were actually quite positive, although I must admit that it kind of threw me for a loop when I handed in all my completed forms and everything else, and the person in the office at the time said, “Well, you'll get your letter of rejection in about six to eight weeks”. However, that didn't happen. I was very fortunate.

I have to say, too, when I got to the point where I thought I could try to get back to work, I found that CPP was quite supportive at that time. However, because of my involvement with mental illness throughout Nova Scotia, I have dealt with a lot of people who didn't have quite as good a story as what I've had to tell, or anything like that.

Even though my story was fairly positive, there were, and I feel that there still are, a lot of ways in which CPP Disability could be improved.

The Chair: Thanks very much.

Mr. Nash.

Mr. Walter Nash (As Individual): Please bear with me; I'm not a public speaker.

I was injured in 1995, resulting in the full loss of the use of my left arm for a period of six months. I was cutting firewood. A tree came down on my head, broke my hard hat, paralyzed my shoulder, and broke my teeth.

I chose not to apply for benefits at that time but to re-educate myself to a new career, as at that time I was teaching building in remote first nations, and there was no way I was ever going to swing two-by-fours and sheets of plywood, and one thing and another. So I decided to take the necessary Ministry of Housing courses and university courses in order to get a building inspector's ticket, which I did.

I also started a small business, Walt's Woodworks. It had built to the point where in the year 2000 we made a profit for the first time, at which time I was diagnosed with cancer.

I had the surgery, the chemotherapy, one thing and another, and the depression and all the other nutty things that go along with chemotherapy. So I decided, okay, I've done everything I can to stay off this program. I'm not going to be a leech to this government. I have proved I can make my own way. I had a big contract for 2001 from the Ministry of Natural Resources. I was on my way. But I couldn't work. So I applied for Canada Pension Plan disability.

I was told that even though I had paid into the Canada Pension Plan from the day of its inception to 1995--with, I believe, one year's exception when I was at school--I was not entitled because of five years out of seven, or whatever, and I was automatically disqualified from the program, even though my whole idea had been to stay off the program. I thought I had an inside track as to how to get myself going and keep off this program.

So now we start to fiddle with numbers. The year I was hurt, my left arm hung like a banana, so I jammed it in my pocket. I lived in Atikokan, northwest of Thunder Bay. The whole world was on fire that year. I worked 25 night shifts in a row, starting at five o'clock in the evening and finishing at nine o'clock in the morning, guarding 13 helicopters parked in the bush for the firefighters. Then, when I got paid for it, I was informed that the money earned under a program called EFF is eligible for neither Canada Pension Plan contribution nor pogey--pardon me, unemployment insurance.

Therefore, I'm left with a one-year blank in there, even though I had done everything I could to avoid being in the position I am in. There is absolutely nothing I can do about it.

I've tried to be honest and to make my own way, and I feel that I'm being penalized for it. I did everything in my power that I can think of to avoid being in the position of having to apply for assistance, and because of that, I'm disqualified. I was told that if I'd gone whining in 1995 about my sore, aching shoulder, I would have automatically started a file, which would have been activated and would have been opened. Because I didn't, there is no point in talking to anybody, even though it's acknowledged.

There are the medical records, or whatever, up the ying-yang. It's acknowledged by every medical person I've been to that my arm was injured and disabled, and it is to this day. I don't have fine control of it.

¿ (0930)

I'm a wood carver by trade. Nobody has worked any harder to avoid sitting in front of you people than I have. I re-educated myself. I have a teaching ticket to teach building. I have an HRAI ticket, which allows me to design and install heat recovery ventilation systems. I've taken all the necessary college courses, Ministry of Housing courses, to allow me to be a building inspector. I was on a roll.

Then when I was whacked with cancer, I kind of fell off that roll. Because I didn't whine in 1995 I just fall into a loophole. I don't qualify for anything. I think the very fact that I tried to avoid being on the program should account for something.

Thank you very much.

The Chair: Thanks very much.

Some of this reflects where I came in as a family physician. I think some of you may know. The first question I think I ever asked at an HRDC committee meeting was “Are 100% of people turned down, or does it just seem like that?” I then found out it was, in those days, 63%, or something like that, and after all the appeals it comes down to 50%.

We think this is tough. Therefore, in this set of draft recommendations the researchers have tried to put together some of the remedies to what have been elucidated as the problems. We really know this needs to be changed.

What I hope we're going to do this morning is focus on the solutions. I think just from going around the table what we understand is that there are problems everybody recognizes. We want this next chapter of the morning to be about whether these are solutions we've put forward. Would they help you? Would they help the people you're looking after?

I think what we're hoping for is that there'll be some quick things we could do now and then we can take a long-term approach on what the real social safety net would look like in terms of early retirement or different languages, all the stuff that may be a longer fight. In the meantime, I think we're trying to figure out whether these changes that have been recommended here make sense to you and whether they would be responsive to the needs, more flexible, all of the things we've heard time and time again.

Personally, just because this e-consultation was an experiment of Parliament, we want to reserve a little bit of the end of the meeting to just talk about your experience with it and whether you think it was worth while, a little evaluation of this process. In order for us to be able to do it again, we would have to make a case that it worked or that you felt it was useful or you felt that you understood our work a bit better, that kind of thing.

In terms of raising awareness of the program, the questions around adequate level of income support, return to work stuff, the integration with other programs, the processes that could be enhanced or restructured and changes to eligibility--those are the six areas the researchers identified as being part and parcel of a lot of the submissions, as you can see on the first page here.

If you wouldn't mind, let's just suspend for five minutes so you can get a coffee and just think about these things. Scribble all over your piece of paper. Give some notes on what you thought worked. If there's huge consensus on some of these we can go through them really fast. Then we should debate the things we think are debatable if there are a whole bunch of things. Find me the things you think absolutely everybody will agree with, and then we'll go to work debating the tougher things. Okay?

We'll suspend for five minutes, get a coffee, and come back with a consensus on the things that absolutely no one will fight about.

¿ (0938)

¿ (0945)

The Chair: Because this is a draft, there's no index or any easy way through it, so let's go through and see if people had questions or comments. There's awareness, application and appeal process, eligibility and the definition of disability, adequacy of the CPP benefit as an income support, interface and integration of CPP with other programs, and return to work, I think, is the last one.

So in the area of awareness of the CPP-D program, were there comments?

Yes, okay, from Calgary.

Mr. Ellie Stein: Yes. My name is Ellie Stein and I'm a physician.

My very quick comment is that as a physician, when I first started dealing with people who are disabled, I had no idea how to fill out the forms. Nobody has ever told me. I've just been told by one of my colleagues here there are actually some guidelines for physicians, but because I am not a family physician, I was never made aware of them.

So I feel bad that some of my patients may have been at a disadvantage early on in the process when I didn't have a good understanding of the system. I think it would be essential, since doctors are part of the process, to give us some information about how to fill out the forms.

The Chair: Should it come with the form, at least the Coles notes of the guidebook or something, a tear-off sheet?

Mr. Ellie Stein: It could come with the form or it could maybe come through our medical association or our college.

The Chair: Do you open that stuff that comes from there?

Mr. Ellie Stein: I read every page.

The Chair: Especially when it comes from the college personalized, is that right?

Okay. That's a very good point, because I think sometimes we do things based on sector and we assume it's only GPs or only orthopedists or certain specialities. So we should figure out a way of making it more universal in terms of coverage as to who's filling them out.

Were there any other comments on the awareness part?

Ms. Marjorie Edwards: I guess my main comment would be, from personal experience and talking to other people, that unfortunately, you can do a lot of advertising, and it could be media blitzes, but most people think it's never going to happen to them, so they kind of tune those things out. As far as the mention about media blitzes is concerned, I think the front-line people who are dealing with the Canada Pension Plan--and I'm sure you'd have an idea of who they'd be, like physicians, physiotherapists, anybody who deals with CPP--make sure they have the information. But as far as the consumer is concerned, or whatever they're called--I hate that word “consumer”--the person who's going to be applying for it, they don't really want to hear about it until they are going to need it, unfortunately. A lot of people are that way.

Do you see what I mean?

On TV and the rest of it, some people watch a lot of TV; a lot of them don't. Many people do not have access to computers, so it will be good for some people but not for others. You have to think of the different areas you have to target.

¿ (0950)

The Chair: The CPP-D information should be included with the income tax forms. It is our most common, most obvious program of the government. Is it the fact it's called CPP-D? Is that a problem? Should it be called--

Ms. Marjorie Edwards: It is for a lot of people who aren't involved with this. I had been a nurse for 25 years, but when I entered this mental health system, I thought CMHC was Canada Mortgage and Housing. Well, there's also a CMHC in the mental health field. So unless you're into all these buzzwords....

I know I used initials a lot when I was working. For people who don't know, you may as well be saying to some of them.... A lot of the people I've spoken to maybe don't have the education to understand.

There's one here I have to ask about. What's an NGO? I have no idea. The rest I know. But NGO I have no idea about. I've never heard of that one.

The Chair: That's a non-governmental organization.

Ms. Marjorie Edwards: I knew it would be something that would make sense, but I couldn't come up with it.

The Chair: Sometimes I get to go to conferences and get to pay the NGO rate. How funny do you think that is?

Ms. Marjorie Edwards: That would be my main comment.

Mr. John Wodak: I've run into quite a few people who didn't apply because their doctor said they wouldn't qualify. Now, it's not necessarily just doctors, but people should be prevented from offering counsel like that.

The Chair: Would you put that comment under awareness or under eligibility?

Mr. John Wodak: I think I'd put that under awareness.

The Chair: So that people--

Mr. John Wodak: They should not presume at the very first step.

The Chair: Okay.

Ms. Elizabeth Davis: I see a lot of people whose first comment to me is “I thought CPP was only for old people”. The disability part of the Canada Pension Plan isn't that well known, and I think one way to get the word out would be through TV. I really do.

The Chair: If it were called the Canadian disability plan, if underneath CPP Disability--because that's what the legislation says or whatever--it were lovingly referred to as the Canadian disability plan, would that be easier for people to understand--that this isn't about being pensioned off or whatever?

Ms. Elizabeth Davis: Exactly.

The Chair: We now welcome Wendy Lill.

Do you want to just introduce yourself, Wendy?

Ms. Wendy Lill (Dartmouth, NDP): I'm Wendy Lill. I'm a member of Parliament for Dartmouth and I'm the critic for persons with disabilities for the New Democratic Party.

I've had the opportunity to read the preliminary results from the e-consultation process our committee has undertaken, and I'm honoured to be able to be here today.

I apologize for not being here earlier. I'm also on the heritage committee, and all of the actors are in town today to talk about cuts to Canadian programming. I've just been with Gordon Pinsent and Nicholas Campbell and Paul Gross. I had to make a choice--no, I didn't make a choice; I had to be there, but I'm here now.

One thing that's clear when I heard from them, and it's clear when I hear from you, it's people talking and sharing their experiences that has the major impact on legislators and on actually changing things. So thank you for being here and sharing your voices. I'll just be quiet now and listen.

The Chair: You may know, Wendy is also a playwright. Her play Corker would, I think, be of interest to all of you. The subject matter is really about.... It probably would be better for Wendy to do this.

¿ (0955)

Ms. Wendy Lill: I wrote a play before I became an MP, looking at what happens when a cost-cutting female civil servant ends up having to look after somebody who has a disability, because in fact everything's been cut away--all of the good services that used to exist. They certainly don't exist across the board.

She found out that taking care of others is really about taking care of oneself. It's basically a play about community and the importance of understanding we all have to take care of one another, from the local level right through to the national level. It's just my world view.

The Chair: That's great.

Were there any other comments, especially from the committee, on the awareness piece? Yes.

Mr. Roy Muise (As Individual): On the awareness issue, I just wanted to add too that in my case, for example, like this gentleman to my left, I've been paying CPP benefits basically since its inception, and I had no idea there were disability benefits from CPP. It wasn't until I was forced to go on social assistance in Nova Scotia—and of course in Nova Scotia, if you apply you automatically have to apply for CPP disability—that I first found out about it.

I was actually very fortunate, too, as far the medical part is concerned when applying. My psychiatrist was fully aware that the form had to be filled out totally, had to be filled out correctly. I think that's one thing that made the process for me so easy.

As far as getting the word out to people is concerned, I definitely agree that advertising it with the income tax form would cover a huge part of the population. Maybe there could be some sort of media blitz, but as Marjorie said, so many times you'll see those ads on TV and think that's never going to apply to me, or anything else like that. Rather than see a whole lot of money go into something like that, making sure the medical profession is totally aware—that kind of thing—I think would be preferable.

The Chair: Was it a psychiatrist or a family physician who filled out your form?

Mr. Roy Muise: It was my psychiatrist.

Mr. Walter Nash: I have a few statements here too. I went as far as the tribunal hearing, which was held in Thunder Bay—for which, by the way, I have never been reimbursed my costs. The lawyer at this tribunal hearing was from Winnipeg. He stood up at the end, after I had had my say, and said: “I want to get this on the record. You're the first individual—I've done 200-and-some adjudications this year—who has come forward to us only after you have exhausted every possible avenue that you could work out on your own. Now you've come to us for help because you're stuck.” It did no good.

Then they tell me the tribunal is nothing but a face-saving farce. They cannot make policy. If the law is there—and they are using the law that I was two years slack between the time I was hurt in 1995 and the time I developed cancer—because I was two years slack in there, the tribunal could do absolutely nothing about it. So why was I called before a tribunal? I never got a précis.

The Chair: Just help me with this. Did you go to the tribunal because you decided to appeal, or did somebody make you appeal?

Mr. Walter Nash: No, I kept appealing.

The Chair: Okay.

Mr. Walter Nash: Now, remember, I live in a town of 3,000 in the far north, which means every time you pick up the phone you get somebody in Kenora or Dryden. Nobody knows what you're talking about.

The Chair: And the “they” who said it was a face-saving farce, who are the “they”?

Mr. Walter Nash: That was the people outside, who dealt with it before. These were not necessarily government employees. They told me I was wasting my time by going to the tribunal. They proved that was right. As I said, they didn't even reimburse me for my costs.

À (1000)

The Chair: If it's okay with the group, we've gone to the next section, which is the application appeal process.

I'm hearing from Mr. Nash that the last bullet was his reimbursing costs incurred by applicants and appellants for medical reports and assessments. You'd like travel for appeal added to that, is that right?

Mr. Walter Nash: Well, they told me I would be reimbursed, and I never was.

The Chair: You weren't. Okay.

One of the things we're looking at is that the appeal process does turn around a fair number of cases. I think there are a lot of them turned around at appeal. The tribunal turns around some, and then the appeal board turns around some others. What we are trying to find out is do we need all of those layers? Does it make people feel better, or does it make them feel that it's a face-saving?

Mr. Walter Nash: I was told by the tribunal when I went in there was nothing I could do. They would listen to me, but the fellow I was speaking to afterwards said they were hamstrung by the fact of the number of years that I had not made contributions, and no matter how pretty a song I sang, there was nothing they were going to be able to do other than listen to me and smile and nod their heads. My fate was sealed before I went there.

The Chair: Okay.

I don't think that's been all of our experience. Probably the advocates would say they can't change the rules, but they can change the interpretation. The committee has heard mainly that if new information comes to the appeal—a better doctor's letter, a better something or other—those tend to be the ones that get changed around, even though the tribunal can't change rules that are stupid. Is that right?

Mr. Walter Nash: A definition that no one would give me was what was classed as a sustainable income. Everybody refused to even tackle that one.

The Chair: Okay.

Mr. Walter Nash: How does $715 a month sound?

The Chair: Bill has explained to me that as the researcher he is not happy that we finished awareness. Is that correct?

Why don't you just ask the question?

Mr. William Young (Committee Researcher): What I was curious about was the nature of the interaction, because there are so many programs out there. Do other programs give you information about CPP, or do you have to basically dig it up yourselves? You had mentioned that the provincial welfare people referred you to CPP. Is that a common occurrence, that you get a reference from other people?

Ms. Marjorie Edwards: Long-term disability told me they would not pay my benefits if I did not apply to CPP.

The Chair: Ms. Davis, and then from Calgary.

Ms. Elizabeth Davis: Insurance companies in the main insist that people going on long-term disability apply for CPP, whether it's appropriate or not, and I see that as a problem. That wastes a lot of money and resources in adjudicating inappropriate applications for CPP disability. Our provincial income assistance program in B.C. also insists that people apply for CPP disability, whether it's appropriate or not, and I see that as a huge problem.

The Chair: You're not the first to say that; you're absolutely right.

From Calgary, who...?

Ms. Michelle Kristinson: It's Michelle.

I just wanted to say I felt that the appeal levels are critical to have there, including appeals and reconsideration, the tribunal, and the pension, but I believe if the initial application was adjudicated properly, we would avoid all those levels. They are there, I think, for true appeals, but I think there needs to be more education around getting people to fill out the applications properly and then, on the side of CPP, actually adjudicating them—which jumps back to application appeals.

I jumped ahead because I guess we are going back to the first point.

À (1005)

The Chair: Okay, we are back on appeals. Are we happy with awareness?

Ms. Michelle Kristinson: Just as a quick comment, with the social assistance program here in Alberta you also have to apply for CPP. As in B.C. and Nova Scotia, there are a lot of inappropriate applications going in to CPP, and this is just bogging it down.

Mr. Reed Elley: I think when we talk about the level of awareness, and who is responsible for actually making people with disabilities aware of the program, we get into some problems. There is, and I know this from talking with people, some concern, with the more strident and stringent eligibility requirements and cutting back on the number of years allowable, that the government is sending a message: we really don't want to put people on this program anyway, so why would we spend bucks to make people more aware of it?

We have that kind of feeling out there. So Is the government going to be responsible to make people aware of this? Are they going to spend more money on it? Whose responsibility really is it? When it comes right down to it, whose responsibility is it to make people aware of CPP disability?

The Chair: Mr. Nash.

Mr. Walter Nash: I live in a little town of 3,000 people. The nearest city is 204 kilometres away. How do you find this stuff out in that case? I came into this a totally green neophyte. I knew nothing about it, was led down the garden path as to...this is a cakewalk; there's no question you're eligible. You can't work. You've always paid it. Duh, what's the hard part?

Well, I found out there was a hard part.

The Chair: Do you think physicians could have been more helpful?

Mr. Walter Nash: No, my physician was absolutely marvellous.

But in the far north, you're bounced from this town to that. You never know what town you're getting, who you're phoning. You might get Kenora. You might get Red Lake. You might get whatever, all over the place. Nobody knows your case. You have to sit there and explain your case to everybody. It just goes nowhere.

The Chair: Okay.

Mr. John Wodak: My initial contact is usually by telephone, and I have a stock set of questions I ask--for example, is there an insurance policy covering you; what does your employer say; do you have a union; have you applied for CPP; have you applied for the provincial disability benefit? In most cases, I get answered no to all of them. They don't know.

This lack of awareness is not limited to CPP. It's general. I think it's because people who suddenly become disabled have simply been hit by a truck and don't know where to turn.

The Chair: To go back to Mr. Elley's question, maybe to the officials, whose responsibility is it to make Canadians aware of the program?

Ms. Susan Williams: Obviously the federal government has a fair responsibility, but I think it's probably something we all share, and we can only do so much with the best will in the world.

I've been listening with some interest to some of the suggestions about getting the word out through other groups that we haven't contacted, like sending the physician's guide to other groups of physicians besides the GPs. We try to work with advocacy groups. We try to work through a number of other channels. For example, in the statement-of-contribution mail-outs, there is information about eligibility for disability benefits. We send out information with pre-retirement applications. We include it in various publications and newsletters.

I think it's a good point that it's something you don't really focus on until you think you might need it. Then, as John said, you're sometimes just too traumatized to really focus on what's available.

It is a problem, and we're interested in any suggestions.

The Chair: Related to that but not specific is the interaction between the programs. I think with LTD and some of the others, we've heard over the weeks that some people, when they sign on for a group plan, are not actually made aware of the CPP as first payer or any of those things. Is there a different kind of awareness to do with the interaction of those things that should be the responsibility of insurance companies, workman's comp, and some of these other people, so people actually understand what happens?

À (1010)

Ms. Marjorie Edwards: Before my burnout happened, I had sustained a back injury, so I went the worker's compensation route. The thing is, everybody seems to be aware of worker's compensation. I feel it's up to the insurance company to tell you, okay, get ready, because in two years we're going to cut you off. I don't feel it's all CPP's duty. I feel the insurance companies definitely should.

I was on a private plan. I didn't have benefits, but I did have the LTD, and we thought it would protect us. Well, it did for two years, but after that it didn't. I feel the insurance companies have just as much responsibility. Instead of telling people to apply for CPP first, why don't they honour what they're supposed to be doing?

The Chair: Go ahead. Then I think we should move on to the next.

Ms. Elizabeth Davis: I think the insurance companies are trying to off-load their responsibility to their policy holders onto CPP. In my experience as an advocate in this field for the last three years, I've seen a lot of people whose applications for CPP were not appropriate. They might have been a little premature, or they may have been completely inappropriate, but in order to maintain their long-term disability benefits from the insurance company, people are required to apply for CPP.

So I'm not sure having the insurance companies publicize CPP disability is such a good idea.

The Chair: Dr. Stein.

Mr. Ellie Stein: I'd like to make some points on that whole category of the application and appeal process.

I just want to reinforce what other people have said about insurance companies. From a time perspective, I waste a lot of time filling out insurance forms for people I know are not eligible, and shouldn't be eligible, for CPP on behalf of insurance companies and of our provincial AISH plan.

It's already been mentioned several times. I just want to add my voice. To me, that's an appalling waste of a very valuable resource that should be used for people who really are desperate and really need it.

There is another point at the bottom of page 3 about denial letters. In my experience, since I work with people who have illnesses that are not easily defined and proven, and almost all of them get rejected the first time around--that's what I tell my patients to expect--the denial letters never give any information about what they were denied.

It's a form letter. It says the same thing every time. It says your illness is not prolonged and severe and we think you can work--even though there may have been numerous doctors' letters, a lot of evidence that they've been disabled for a long time and that they're not improving. I think it behoves CPP to write something that is actually relevant to that person's case, not just a form letter.

I agree with Michelle that yes, we do need all the appeal process layers because the initial layer is so undiscriminatory. All of my patients get rejected. I don't think I have a single patient who's been accepted the first time around. Many of them do finally get it through the appeal process, because I support them through that process.

That's again a really big waste of money. If we had doctors and people within CPP who had a better understanding of CFS, FM, and chemical sensitivities, I think we could save a huge amount of resources and streamline the process considerably.

There's a comment on page 5 that “assessments of functional abilities are extremely useful in cases where the primary disability is pain-based and/or subjective in nature”. I'm not sure I totally agree with that statement. When my patients get sent for functional ability assessment, they inevitably get told there's nothing wrong with them because their disability cannot be proven in an assessment that generally looks at how many bricks you can lift, whether you can lean forward, and whether you can turn your head around. The disabilities my patients have are in terms of fatigue, pain, and cognitive dysfunction, which are picked up on the functional capacity assessment.

Although I agree with the overall statement that patients have to be tested appropriately, I would want to add the proviso that I'm not aware of any facility in Canada that has the capability of testing patients fairly and adequately, to the extent that at my own personal cost I've just set up such a facility in Calgary. We've just started in the last couple of months.

Most people around the country get tests that are inappropriate. It's like sending someone for a glucose test when they don't have diabetes. It's going to come back normal. If they have some other disorder, like MS, they're going to be told there's nothing wrong with them.

So testing is important, but it's really critical that some education go on, and I would really strongly encourage people involved in CPP and the people on the tribunals to read the new document that has just come out, which is the Canadian consensus definition of ME/CFS. It has the most up-to-date literature and gives very clear guidelines on appropriate assessment. I think that will make a huge difference.

À (1015)

The Chair: One suggestion we'd heard before was that there should be almost a tick-off box on the form to say, “Were you asked by someone else to apply?” That would actually sort out some of these things.

Some of the appeal board members I've talked to say they can figure that out because of all the cc's at the bottom of the letter. There's a transparency in terms of.... I also think there should be some accountability if people have been asked to appeal or they have been asked to apply and they get turned down. If indeed it is someone else's idea and everybody else could have told them they don't actually meet the minimum attachment to the workforce, or whatever, it is a waste of everybody's time to go through it.

Yet I do hear what Mr. Wodak said in terms of sometimes people have been given the opposite--they didn't qualify when indeed they did. So it's difficult.

Now, in the very first bullet, Dr. Stein, where it said “reviewing the application form”, are there things in the first application that could be helpful? I guess some of the things I've been interested in are things like a fatigue tool, or some way you can explain the things that don't have a blood test or a biopsy. Is there a tool, the day in the life of...exercise? Are there the kinds of things I think I used to try to prepare my patients to be able to describe...? Is there something in the initial form that we could actually show that this person really is not able to support themselves?

Mr. Ellie Stein: What I do for my patients is I get them for years at a time to make daily notes, to fill out forms about their energy, sleep, pain, and other significant symptoms so that when they come up for CPP they'll have as many as two or three years of daily recordings. I also get them to write down the activities they've done every day for a week so that there's an overall trend that can be seen of how much they are able to do in a day and the impact it has on them.

There are some tools that some of us are using informally, but certainly when you have the tick-box on page two of “lab reports, consultations, hospitalization”, most of our patients can't tick any of those off, so it makes it look like there's nothing wrong with them.

The Chair: Thanks.

Wendy.

Ms. Wendy Lill: I want to go back to a comment from Mr. Nash about people living in rural and remote communities and their lack of awareness of these programs. I want to put it back to the government. What special efforts are being made to get people in remote and rural communities up to speed on these programs?

Also, are there any figures showing different percentages of people in rural areas who are not getting the benefits they are entitled to because of the lack of information? It would be good to get a statistical analysis of what percentages per population are getting the CPP.

À (1020)

Mr. Walter Nash: I'd like to respond to that if possible.

I can't remember how long this CPP thing has been going on. I could find dates in here. But I didn't find out until just this year that there was such a thing as an Ontario disability support program. I never knew such a thing existed. Nobody told me. Of all the people I talked to on phones, I wrote letters to, I never heard of it.

And in response to one of your other questions about criteria, I think there has to be credit given. Has Joe Smith exhausted all possibilities to help himself, and therefore he has come to us? Yes, no, perhaps, don't care.

If Joe Smith has done everything in his power to avoid coming before this type of a board, I think there should be some credit given for that, because I'm sure there's no one here who wants to stand up on the corner and say yes, I'm on the public purse. We're not proud of that. We've exhausted everything we have.

I've had to put a mortgage on my house. My wife has had to go to work. We're just out of a means of living. It's that simple.

Ms. Wendy Lill: It's a pension plan. It is your money, so you should never feel that you're not entitled to it.

Mr. Walter Nash: I'm automatically disqualified by that two years because I tried to help myself. So automatically, with everybody I talked to, it comes back to that.

The Chair: Obviously, Mr. Nash, a lot of your comments and your experience for us is under the eligibility part of the recommendations. There's a tiny bit in awareness.

By doing what you thought was the best thing to do, you didn't actually know that everything you were doing to try to exhaust all the possibilities would eventually disqualify you for CPP.

Mr. Walter Nash: No, I thought it would be in my favour that I'd done these things...not come back and bite me on the caboose.

The Chair: One of the things we've talked about with the return-to-work people was if there was a more coordinated way that, at the beginning...the LTD people, the CPP people, everybody was figuring out how to get this person back to work. What do you do? Everybody understood that this was a case that had the potential to end up with somebody who might not be able to support themselves. Together there was a joint project to try to get this person back to work. Somehow CPP was apprised at the very beginning of that process that this person might need you eventually, but we were going to try all these other things first. So it wasn't that raw, brutal sort of arithmetic lesson that you had.

Mr. Walter Nash: Madam Chairman, if I'd have had the knowledge, I don't know whether some of these university courses or Ontario Municipal Board housing would have been covered, whether there would have been financial assistance. But there was none. I paid everything out of my own pocket, through to borrowing money to take these university courses.

So that's another. Is it there or isn't it? Nobody knows.

The Chair: Okay. Well, do the officials have anything to say about Mr. Nash's problem? And what would be the remedy to not have that happen in the future?

Ms. Susan Williams: One of the problems that Mr. Nash has in fact pointed out is that the eligibility criteria disqualified him. Those criteria were introduced by Parliament in 1998. Because we can only spend CPP account funds on people who are either eligible or making an application to see if they're eligible, we're not able to spend it on early intervention or assistance to somebody in Mr. Nash's situation, desirable though that seems to be. That's exactly where you'd want to make the investment.

À (1025)

The Chair: So could you see in the future a marrying of EI and CPP in terms of some sort of joint program that included a return-to-work possibility?

Mrs. Susan Scotti: That's something we're certainly looking at. I think it would mean a closer working together at the front end, when a client first comes in, so that at the first intervention, through perhaps our local offices, those who are working on employment insurance and CPP might be able to join forces and look at some possible early return-to-work considerations. We have that work underway right now.

On your comment about the outreach activity in rural areas, that's something I think we need to look into. I'm not currently aware of any special outreach activities that are happening in the rural communities, but we'd be happy to look into that.

The Chair: Reed, and then Mr. Wodak.

Mr. Reed Elley: I would like to talk a little bit about the appeal process and how successful it is. We have heard a lot of anecdotal information about people being turned down, that they're automatically turned down, and that if you are going to go into this process, you might as well be prepared to get turned down.

So I asked our researchers to give me a little bit of statistical information, because you cannot go on anecdotal evidence, but you've got to take a look at the bare facts. What are the facts of this? Our researchers tell us that 60% of people who apply for CPP disability are refused the first time around. Of the people who go back for a second try or make an appeal, 30% of them win their cases; on the second time around after that, 42% win their cases; and on the third time around, 65% win their cases. Of course, this means that every time this thing goes to appeal, the numbers are declining; so it doesn't mean that a whole bunch of people are winning their appeals. But in terms of the layers of bureaucracy, and the costs to taxpayers and individuals who are having to go through this, in terms of time and emotional distress and all of those things people have to do to work themselves up to really get into this again on a second and third time around, that cost is huge.

If 60% are refused the first time, and so many people are accepted on the second or third or fourth appeal, why wouldn't they simply be accepted the first time around? What's the department's answer to that?

Ms. Susan Williams: One of the main reasons is that disability is often a progressive condition by its nature; over time, you often get a deterioration in the condition. So it is not at all uncommon that the evidence on which a decision to grant a benefit is made is only available later. There is new medical information and new reports as a result of a changing or a deteriorating condition. We found this is particularly the case with some sorts of conditions.

Just touching on the numbers, you might be interested to know that the numbers approved in the initial round are now 43%. They have gone up over the last little while. So 57% are denied. By the end of the appeal process, through the two levels, 55% of those who apply get a disability benefit, and 45% don't.

Mr. Reed Elley: I can accept the fact that there is a progressive element to this, but I really think there is more to it than this. Somehow the department has to take a good look at the appeal process to make sure they are not putting undue pressure on people who are sick already—who may be getting sicker because of the process. We somehow have to have a way of evaluating that, to make sure we are not contributing to a person's disability by the very process by which we want to help. I think that's a very real problem for us here.

À (1030)

The Chair: I have Mr. Wodak, Ms. Davis, and Michelle.

Also, Mado has had an ongoing theme that pieces of paper don't seem to be able to tell the story the same as the face-to-face contacts do. Is one of the problems that the first level is all done on paper, and that people don't really get to tell their story in a real way?

When a physician actually signs and submits the form, is there a feeling or a set of rising expectations—other than on the part of the people who have been told, “Don't worry, 100% get turned down”—that “because the doctor filled out the form and signed his name to it, I must qualify”, which are then dashed when it gets turned down? How much of a problem is it if people don't really know what this application or appeal is all about, or frankly don't know much about eligibility?

You had a comment before I asked these questions.

Mr. John Wodak: Yes, Madam Chair. And if I may, I'll take this opportunity to make three comments.

On the awareness point, my first comment is simply to ask the question, could the department's computer be programmed to flag people who stop making contributions, which would make for a more focused opportunity for awareness?

My second comment is to endorse everything that Dr. Stein has said about invisible disabilities, particularly chronic fatigue syndrome, multiple chemical sensitivity, and so on. And I would point out that it's not until you get to the review tribunal stage that the decision-maker actually sees the applicant face to face. I think that's important.

My third comment is more in the nature of the information thing. Several years ago, the commissioner of review tribunals solicited comments from tribunal panel members, and compiled those into a report. Two years ago, he solicited comments from advocates, and I sent him some. I don't know what's happened to those, but presumably a report on those will available in due course. It will also probably provide useful information.

The Chair: I think the commissioner has been very interested in how he can help make this better.

Ms. Davis.

Ms. Elizabeth Davis: Part of the problem with the initial application is that the medical report is very often not very complete. I see so many medical reports where the physician has scrawled a couple of barely legible words, and ticked a couple of boxes, and called it a medical report. It's just not good enough. Somehow, word has to get out to physicians that this medical report is important, and must be very detailed. I'd also like to see physicians paid a little more than $65 for doing these.

The Chair: If the fee went up, would people think it was a more important form?

Ms. Elizabeth Davis: When I send a client to get a medical report completed by their physician, I expect or am asking the doctor to spend a couple of hours doing it. That time is worth something.

The Chair: I agree.

Wendy and then Michelle.

Ms. Wendy Lill: The fact is that many Canadians do not have a family doctor, so the familiarity of a lot of doctors with the people coming before them must be really limited.

You ask them to spend a couple of hours on this form, but if you've never even met this person, or if you've only seen them once or twice, how are you going to...? How can we get people who have enough information about the applicant to put something that's actually worth something down on paper? This seems to be a systemic problem for medical practitioners—besides their scarcity in certain places.

À (1035)

Ms. Michelle Kristinson: My comments are about the applications.

Susan Williams made a comment that after getting more medical evidence, people are then determined to be disabled because perhaps their disease has progressed. But in all of the appeals I've done, whether or not we've gone to a tribunal, we're still paid retroactively, which says that the person was deemed disabled back to the date of the application. Essentially, we've spent two years proving that the person was disabled two years prior. By the time they get a large amount of money retroactively and have paid taxes on it, they've been financially ruined. If they're getting long-term disability, that money is going to their insurance company.

I just don't understand the two-year process, when in fact they've been deemed disabled back to the date of application.

I know that in cases of MS, it isn't that they've progressed, but they've actually been disabled at that initial date. This suggests to me there's a problem with the application phase. We should take some responsibility for the fact that the medical forms are not filled out correctly and that the individuals filling out the forms often don't know the information.

That leads me to the guides for physicians. At least in Alberta, they're going out to family physicians, but the specialists are the ones who know the most about the disease. So it's unbelievable to me that money hasn't been forwarded to ensure that specialists are getting those guides. Dr. Stein has never seen a guide, yet she's dealing with these patients. It's just astounding to me.

Those are my comments.

The Chair: Michelle, while we're talking about MS, a number of years ago I think the MS Society suggested that most of their clients eventually get this, right? I mean, almost 100% of the people do eventually get it. What we talked about was whether or not there could be a tool within the department so the MS Society would work with the officials in the same way as with the chronic fatigue people...maybe with Dr. Stein or whatever.

Are there tools the society could work on with departmental officials such that there is almost an appendix? If it's an MS case, these are the things you want to know. If it's a chronic fatigue case, there's a separate set of questions.

Could the original form be more intelligent, more like a progressive exam where you download the main thing and then you go off to the appendix on a certain disease? Then the original assessment could be more helpful and more likely to tell the real story.

Ms. Michelle Kristinson: I think that would be really beneficial, absolutely.

I know here in Alberta we've made an effort to develop a relationship with HRDC. We do education sessions with them. We've been going up to Edmonton. We've been doing education around MS. They've been coming down to Calgary and other areas doing education about the CPP program. From what I've heard, this is fairly isolated to Alberta and the MS population. I'm not sure what's happening, but I think that would be another avenue where more partnerships...which I guess goes back to that first point.

The Chair: Mr. Wodak, if I was just dreaming in technicolour and there was an online way of doing this such that as soon as you said the word “fatigue” in your report, the fatigue chart comes up on the screen and you have to fill it out, then you actually pay the physician for doing this extraordinarily extra amount of work, which obviously would save huge amounts of money in appeal processes and reassessments and all of that.

It would actually take somebody almost down a programmed learning path where certain key words would bring up a screen of one to ten in terms of pain, fatigue. There's a whole bunch of junk that just isn't...you don't get to show the biopsy result.

Mr. John Wodak: Madam Chair, I would much prefer it if, instead of going through that, the words “fatigue” or “pain” or whatever triggered a personal, face-to-face contact and inspection and assessment to find it, because it always has to be done on an individual basis, case by case.

The Chair: Do you think all cases need a face-to-face visit at the initial...? Or are the ones we all know are giving the most difficulty--chronic fatigue, fibromyalgia, multiple sensitivities, those ones...? Does anybody who has used the words “pain” or “fatigue”, any of those things, need a personal visit?

À (1040)

Mr. John Wodak: I visualize a sort of cross-section of applications for which you could sort of triage with it. There are ones that will never be approved, no matter what, as simply ridiculous applications. There are ones that will be approved almost automatically because they are so obvious. And then the ones I and I think most of my confreres work with are the grey-area ones where, yes, you have to do everything on a case-by-case basis.

So, yes, trigger the visit.

Ms. Marjorie Edwards: From personal experience, my problem was that with my depression I had become extremely good at my mask. My husband always commented that, even though I was at the lowest point in my life, like in the rest of my life.... My psychiatrist was the chief of psychiatry, so his office was in the hospital, and Paul would say, “Marjorie, you walk through those hospital doors and the shoulders go back”--because of the nursing, 23 years of nursing. I can put on a good show. I mean, because I have depression I'm not always going.... But I don't have the self-confidence I used to have. I worked in an emergency room, so I must have had a little bit on the ball.

All my long-term disability panelists, when I met them face-to-face, couldn't believe how articulate I was. Unfortunately, because depression is a mental illness.... But they kept saying it. The lawyer kept saying it: you're so articulate. Well, I mean, they knew I'd been a nurse. It's things like this that are so frustrating. So sometimes it can work against you.

The Chair: We'll hear from Dr. Stein and then Mr. French.

Mr. Ellie Stein: I don't think I had my hand up. I was just nodding in agreement.

The Chair: Okay, Mr. French.

Mr. Michael French: I have two thoughts on this computer possibility, or whatever the case might be.

First of all, doctors have a tendency to try to give the patient the benefit. They would say, for example, that it is unlikely a patient would go back to work, rather than saying he or she can't work now. So there is a positive swing they put on it that I'm afraid tends to show negatively when it gets to the point of CPPD.

The second thing I would like to bring up is the fact that with our medical system the way it is right now, the access to necessary specialists takes a very long time in and of itself. Then to get those specialists to get the reports to your coordinating doctor and going from there delays the process even more. So there has to be, in my opinion, at some point an education of doctors on how to deal with CPP-D.

Thank you.

The Chair: Do you think sometimes people are sent to the wrong specialists, like being sent to an orthopedic surgeon for back pain when you've...?

Mr. Michael French: Or, more specifically, being sent to a forensic psychologist when you have pains in your chest.

The Chair: Mr. Nash.

Mr. Walter Nash: Let's face it, everybody would like to be treated as an individual, but it's totally impossible.

I'm only talking about my case because it's the only one I know. Why can no one see that from 1995 onward the only reason I was not making CPP payments was because I was disabled to the point where I could not earn enough money to make the payments? Duh.

The Chair: Are you agreeing then with the suggestion that there should be almost an intervention as soon as the computer figures out Mr. Nash has stopped making payments? What does that mean to Mr. Nash? Should there be almost a little flag, a little automatic computer letter that goes out, saying we've noticed you've stopped making your payments--are you okay?

À (1045)

Mr. Walter Nash: Well, I think I should know that because I wasn't able to make the payments it was going to come back and bite me down the road. It wasn't my fault I wasn't making the payments. I was disabled.

The Chair: So in a real suggestion what we're saying--because I get the feeling we're sort of moving on to eligibility as the focus now.... Are you saying you want those stupid changes that happened in 1998 reversed? You want it extended?

Mr. Walter Nash: I wasn't aware of the changes.

The Chair: Well, I think they bit you, to use your language. So the four out of six stuff, how can we fix it?

Mr. Walter Nash: I don't know.

Ms. Elizabeth Davis: We should return to pre-1998. Two out of three, or five out of ten, makes sense. I see a lot of people like Mr. Nash who, because they've tried so hard prior to applying for disability benefits, have disqualified themselves. They are disqualified because they have worked a little or gone to school. They've tried.

Mr. Walter Nash: There's such a thing as pride.

The Chair: Maybe the finance officials can help us. Why did we change it?

Mr. Réal Bouchard: The decision of the federal and provincial inisters of finance then was that this was one change among many. There were a few on the disability front. There were a number of them in the other benefits. And of course there were significant changes to the contributory base and the contribution rates. This was only one of many changes made.

Now, more specifically with respect to the entrance requirements, if I may go back to the situation in the mid-1990s and so on, the actuarial projections were showing that the CPP in the longer term--I'm not talking about disability alone--the overall plan was not sustainable and action had to be taken; otherwise the plan was at risk.

On the disability front, there was growth in disability expenditures in the late 1980s, early 1990s, and so on, as I'm sure everybody knows in this room. The number of cases had grown over a seven- to eight-year period to almost double, while the labour market essentially had grown during the same period by about 12%. Obviously something was happening.

As a result, some action had to be taken. Of course, there were some actions being taken by my colleagues from the Department of Human Resources on the administration front. Provinces and the federal government decided some tightening on the eligibility requirements was required.

As everybody knows, we used to have a rule about five of the last of ten, or a third of the contributory period, but in 1987 those eligibility requirements were relaxed to use the two out of three or the five out of the last ten.

There was unanimity, a consensus of the federal-provincial ministers that something had to be done. Disability expenditures had grown so much that some tightening had to take place. The decision was made to go with a slightly more stringent test than the two out of three that had been used in the previous ten years, and use the four out of six.

Now, if I may make one comment, and I don't want to refer to the situation of Mr. Nash in particular, but one has to realize that whether we use two out of three, four out of six, or five out of the last ten, or whatever, there are always going to be people who are just going to miss it. You're always going to have situations of, oh, if it had been slightly more generous, people could have gotten in.

In the case of Mr. Nash, based on the situation he's describing it appears that if it had been two out of three, he might have gotten it; or if it had been something that was linked to the number of years he contributed overall; or if he had been more aware of how it worked, perhaps an earlier application would have made it.

Anyway, to come back to why those changes were made, those changes were made at the time because it was felt to be essential to make changes. It was a federal-provincial decision to proceed on that basis.

Now, I will add only one point--

À (1050)

The Chair: Now, I'm hearing this is all about cost containment, not about the objectives of the program. It's about cost containment. In the cost containment piece, was the integrity of the CPP disability program taken as a lump sum, or was it that it was dealing too much money from the CPP program?

Mr. Réal Bouchard: Madame Chair, if I may, it was more than a financial measure. It was felt that they were returning to the initial intention or objective of the disability benefit, and the test--

The Chair: At that time I was still a family doctor. It was during the recession. A whole bunch of people had lost their jobs. And then they might get really sick with something after they had paid into CPP all their lives. Why wouldn't they be able to collect a disability pension now that they have cancer, or now that they have some real problem? They paid in for 20 years, they lost their job, they weren't able to find work, but now they're very sick. I guess I just found that it wasn't.... I thought that's what the purpose of the program was, and whether they'd worked in the last two years or not shouldn't undermine the fact that they'd paid into this thing for 25 years.

Mr. Réal Bouchard: My colleagues from Human Resources know certainly as much as I do. Of course, those eligibility requirements for CPP disability have been in place. I think the objective was that a worker has to show that he has a long labour-force attachment. As well, there is some kind of recency test; the worker must show that he was in the labour force recently.

The Chair: And where did the “recently” policy piece come from?

Mr. Réal Bouchard: To my knowledge, that has always been the intent behind the CPP disability benefit, going back to the implementation in the mid-sixties.

The Chair: How much, as a Canadian, do you think the “recently” piece should matter?

Mr. Walter Nash: I have never stopped working. Because of my disability I was never able to make enough money to make Canada Pension Plan payments. That is what fries me. I have never stopped working except when I was in the hospital.

The Chair: So the fact that you weren't able to make the payments didn't mean you weren't attached to the—

Mr. Walter Nash: I wasn't eligible to make the payments because I could not make enough money, because I was disabled.

The Chair: Okay.

Dr. Stein, and then—

Mr. Ellie Stein: Many of my patients, by the time I see them, have been underworking for many years because they have had episodes of illness, partial recovery, and other episodes of illness, maybe going back 10 or even 20 years. Because of that, they often have the same problem as the gentleman from the round table, where they have either not worked in the past several years because they have been trying to do it on their own, or they have been relying on family resources and so forth while trying to get better. When they finally realize they are not going to get better and they need support and have run out of all their financial resources, they apply and are turned down because they don't meet the three out of six, or whatever it is, eligibility requirements.

The other thing is that even if they meet the time eligibility, their income has been greatly diminished because they have been ill on and off for years. So even if they qualify for CPP, they often get a very low amount.

À (1055)

The Chair: Okay, thank you.

Marjorie.

Ms. Marjorie Edwards: I don't know if this is the place to bring it in, but my thing takes us back to long-term disability insurance.

I tried to fight them, which certainly didn't help my debt any. I hired a lawyer, and we had a discovery day. I had to settle with them, because I would never have gotten to the level I'm at now. They harassed me; there was no other way. They had a private investigator follow me—except I was in hospital at the time and he never found me.

Can no one do anything with these insurance companies? I paid into that. It's the same.... And yes, I paid into Canada Pension Plan for twenty-some years, and I feel I should be eligible to.... I don't think it should be based on the time, especially if you have long-term disability; there, you have lost two years.

Have the insurance companies...? They made me jump through hoops. They hired specialists to get me back to work. They didn't like the fact that the specialists were saying it was going to take nine months. They wanted me back when they wanted me back.

I guess that's the thing. Who can deal with them? If you made the insurance companies do their job, you'd have more money.

The Chair: Let's just talk straight eligibility. Is there another comment on eligibility? Then we can go on to the interface with the other programs.

John, and then Elizabeth.

Mr. John Wodak: Madame Chair, I have reached an age when I can cheerfully admit that as we get older we just slow down. If we are going to look at changing the eligibility requirements, I must say that I like the provision in the Quebec Pension Plan, which allows for relaxed requirements for people over 60.

The Chair: On page 9, I think, there is the recommendation. Does everybody here think the 60-to-65 group should be dealt with as persons with disabilities, not as early retirement? Does everybody agree with that?

Dr. Stein, did you have another comment on eligibility?

Mr. Ellie Stein: On behalf of the patients I see, where their prognosis is unknown and where there's always a small chance that they might get better, the stipulation in CPP that the disorder must be permanent is very problematic.

Although the literature shows that only about 8% to 10% of people with CFS in the long term get better, nevertheless, that possibility is there. I really agree with the bullet on page 6 where it says a disabling condition of a fixed or temporary term over six months.... I think that would be a vast improvement for my patients.

The Chair: I don't think the law says permanent. I think it says “severe and prolonged”.

Mr. Ellie Stein: Well, in reality the word that comes back is “permanent”.

The Chair: Okay, that's important to know.

Mr. Ellie Stein: I agree that people should be judged on their overall contributions, and recency should not be a factor if you've paid in for a number of years.

The Chair: Okay. Elizabeth?

Ms. Elizabeth Davis: I'd like to see something in the adjudication process that addresses the needs of people who have tried, maybe for three or four years, to return to work—tried to retrain for something maybe a little less demanding and not been successful. I'd like to see the adjudication process address the needs of those people; that would make it fairer.

The Chair: John, did you have another comment?

On adequacy—and then we'll come back to Marjorie's concerns about the interface with other programs—as we've been told many times, this program was never meant to be somebody's full income, in terms of the way it was designed up front.

I think that looks like Marjorie's quote in here. You've been outed, Marjorie.

Are there any other comments people have on adequacy as an income support program?

Á (1100)

Mr. Roy Muise: I wanted to mention, first of all, that when I read Marjorie's quote there I had to agree with it 100%. I was faced with the same thing when I was accepted for CPP disability.

I was at that time on provincial social assistance. I had the drug card. My medication isn't cheap, but at least with the drug card, I didn't have to worry about paying for it. My CPP put me two dollars over what I was getting on social assistance, which meant I lost my drug card.

Ms. Elizabeth Davis: In B.C. you can keep your enhanced medical benefits.

Roy Muise: I need medication for my illness. I need to be on it on a regular basis, and I will probably be on it for the rest of my life. The medication may change, but the fact that I have to be on medication will never change.

That really presented a hardship for me, because there are absolutely no medical benefits or anything else like it when you're on CPP.

The Chair: Is that something that's dealt with at the federal-provincial table? Is there any way we can sort it out when CPP refuses to pay if the province yanks the card?

Mr. Roy Muise: I would hope so.

Ms. Elizabeth Davis: The problem is so many people are not eligible for a provincial program. With the recent changes in British Columbia, you have to qualify financially before they'll even look at your medical information.

A lot of people who in the past would have qualified for the provincial disability program and therefore have qualified to have their medications covered by the province are excluded now because of the change in the legislation. Access to medication is a huge issue.

The Chair: John, do you have any experience with that?

Mr. John Wodak: Yes, I do. This, I suspect, is common to all provinces where the provincial disability benefit is means-tested. I've actually been lobbying the Alberta government to introduce some sort of cushion over the point at which benefits would be cut off, to say that above that point you can retain the medical card under suitable conditions. But I suspect that would be a provincial decision, and not dependent on CPP.

The Chair: We should somehow be saying something about getting people the medication they need.

The Calgary presenters all have their hands up; perhaps while you have the floor, talk to us about medication and how we pay taxes on it.

Ms. Michelle Kristinson: John, you must have done something right, because the Alberta government is now going to provide medical cards to people who are on AISH and who go over the amount of CPP. If you go over $2 or $5, you will continue to receive medical coverage from the provincial program in Alberta. I believe that has to happen next at both the federal and provincial levels.

In regard to taxes, when people are taxed on that income after already having paid their long-term disability premiums, which is tax-free, they've done so in the belief they're going to make $2,000. If that $800 is now taxable at CPP, they're making significantly less money than they should. Once again, that brings them to a lower quality of life.

I think the tax problem is a major issue. Perhaps if they weren't taxed on it, the extra savings might be able to go towards their Blue Cross, or their health care, or to some of those benefits.

Mr. Ellie Stein: For most of my patients with chronic fatigue syndrome, fibromyalgia, and chemical sensitivity, there are no effective medications universally. Although many of my patients use some medications, and need to be able to try them, they also need other modalities. So a drug card is essential, but they also need access to physical therapies, because a lot of them have chronic pain. They also need access to psychological therapies, because many of them have been traumatized by the experience of being ill with a non-accepted, stigmatizing disorder. They've also been traumatized by the up to seven-year process of trying to apply for CPP.

Á (1105)

Mr. Michael French: You ladies have stolen part of my thunder here, but I would like to go back to the taxability of CPP to say that CPP should not be taxable, for the reasons Michelle suggested.

With regard to the indexing of the cost of living, I do not know how much of the CPP disability index is strictly a cost of living index, or whether it's a cost of living index that has an additional weighting for medical costs. The additional medical costs of a person on disability are extremely onerous. It seems to me that medicines and medical treatments should weigh more heavily when it comes to indexing the CPP.

The Chair: I think that's about the CPI, but maybe the officials could help us with it.

Mr. Réal Bouchard: Yes, it is the consumer price index that is indexing the benefits. But no, the index applies to all circumstances, so there's no special weighting for disability.

If I may add another comment, theoretically speaking if one were to think that one could have an index that would grow the benefit faster as a result of this, it would represent a technical problem, because you would have pensions and pay potentially exceeding the new pensions coming into pay.

The Chair: John, did you have a comment?

Mr. John Wodak: With respect to whether CPP should be tax-free or not, another way of tackling that would be for the insurance companies to offset the net rather than the gross, which would put the burden back on the insurance companies rather than the taxpayer.

The Chair: Maybe the officials could comment on what would happen if the offsets were in after-tax terms.

Ms. Susan Williams: If the insurance companies were prepared to take the net rather than the gross, it would be no problem for the administrators of the plan. It would leave individuals with the moneys they require to pay the taxes payable.

The Chair: What does the Department of Finance say?

Mr. Réal Bouchard: I'm not a tax expert. I will leave that to my other colleagues in the department. But as to whether the benefits should be taxable or not, there is a general principle in taxation saying that if premiums were deducted while people made contributions, the benefits should be taxable. That's a general principle in taxation followed in this case, and in other cases as well.

The Chair: That's because the employer is contributing at the same time.

Are there any more comments on the adequacy...? It's much more than a drug and a tax problem.

Marjorie, if we go on to integrate CPP-D with other programs, would you have anything to add to these recommendations on page 12—just to get back to where you were in terms of insurance companies and others? In this group, we did talk a little bit about the interface between EI and CPP-D being more harmonized.

Á (1110)

Ms. Marjorie Edwards: As you noticed, I didn't realize that I was supposed to keep applying for CPP when I was on long-term disability. They didn't tell me that, but told me it when it came to discovery day.

The way I look at it is that I paid my own premiums, because I wasn't in a union. I was aware that after the two years, there is the problem with retraining any occupation. But when you have documentation from psychologists and career counsellors, who were well respected in my area—not that I knew them, because sometimes they say “Well, she's a nurse, and she knew”.... I never really worked with psychiatry, but I feel they should be paying me, because there are a lot of people working who do not have long-term disability.

So why not save the Canada Pension Plan disability for those who have no access to anything else? Why does the insurance company not have to pay me?

On the other hand, in my case, I had to quit, because I would get a letter every three months saying “If we don't receive Dr. Perry's report, we will cut you off”. I went through so many of those letters, saying they'd cut me off for two months, then they'd pay me for the two months. I used up all my retirement savings when I was gone for a year.

I think the insurance companies must be made accountable.

The Chair: So those comments would be in regard to bullet point 4, to make the CPP-D the last payer rather than the first payer.

Ms. Marjorie Edwards: Exactly.

The Chair: Do others have some comments on this? It would obviously mean up front that the LTD premiums would probably be higher, because that's how it's costed out by the insurance company.

Do you think that people would be prepared to pay higher premiums to LTD in order to make CPP-D the last payer instead of the first payer?

Mr. Michael French: On this particular topic, I find the position of insurance companies as last payer to be a real advantage to insurance companies and a disadvantage to CPP. The fact that CPP takes on the situation of first payer means that the funds you receive from CPP are immediately offset against whatever you get from your insurance company. Some insurance company payments would not be as large as, say, the CPP disability benefit. So to say, then, that if you have LTD or some kind of disability insurance we would not allow you to take CPP-D would tend to work negatively against people whose insurance did not make it to the CPP-D level.

At the same time, if CPP-D is a last payer, it will cost the CPP-D no more than it does now. In fact, it should cost less, because the money transferred from CPP-D to the insurance company via me--I have to pay the tax on it, not the insurance company--doesn't change how much I get as a disability, but it does cost CPP.

So if you were to take the last-payer position, CPP-D would only top up to what is a base level, and if my insurance company carried more value than CPP-D did, you would not be losing any money at all from CPP-D.

It seems to me that what we have is a transfer of funds from the CPP plan directly to the bottom line of insurance companies, and at no additional advantage to the individual. I think it's a matter of simply changing the insurance act to make CPP-D the last payer.

Thank you.

Á (1115)

Mr. John Wodak: I hate to put it this way, but if everyone were acting in good faith and were perceived to be acting in good faith, there would be no problem. The insurance companies have a significant image problem in this area. Government agencies, and I speak here as a former public servant, simply have the problem of being called “faceless bureaucrats”.

The Chair: Where do you think the image problem comes from?

Mr. John Wodak: People don't trust faceless bureaucrats.

The Chair: Where does the image problem come from for the insurance companies?

Mr. John Wodak: They are perceived to be motivated by either greed or malice, I'm not sure which.

The Chair: Yes, that's a problem.

Elizabeth.

Ms. Elizabeth Davis: No, I was just agreeing with what John had to say. I don't have a whole lot of positive things to say about any of the insurance companies.

The Chair: But in all of the work you do, do these recommendations sort of fit?

Ms. Elizabeth Davis: Yes.

The Chair: Any other comments?

Mr. Walter Nash: Nobody who has ever sat in front of one of these panels or the tribunal or whatever has done it with the idea of getting rich. We have to survive, man.

Like Ms. Edwards, I have spent my retirement income. I have a mortgage on a house that never had a mortgage on it. What happens when I can no longer do any work of any kind?

The Chair: Do the officials have a comment on this interface business?

Ms. Susan Williams: It is an area of concern to us. We do discuss issues with various insurance companies, and also with the industry association, to try to address specific problems when they are brought to our attention

This idea of the last payer would require a pretty significant legislative change, because what we'd have to do, as I see it, is change the CPP to say that we wouldn't pay benefits to people who are eligible for insurance benefits. So you'd have those who contributed and received benefits out of the CPP--and it is a contributory program, as was pointed out--and then others who contributed would also be eligible for benefits under the same eligibility criteria, but because they had a policy with an insurance company they would not get the CPP benefits.

So it would be complicated. It wouldn't be the easiest thing to work out.

At the moment, of course, we pay if you meet the eligibility criteria, regardless of any other source of income. You could be very well off, but that isn't taken into account. That's the design of the program, because it is a contributory program. What we're talking about is something that would be quite fundamentally different.

The Chair: Maybe Marjorie could speak to her point. I mean, these people paid into both, from what we've heard. So it's their money, or some of it is.

I'm just not sure why I would be paying into both if I would only ever be able to recover from one. Why wouldn't I, on my paycheque every month, say I'd rather pay LTD, or I'd rather pay CPP, because when push comes to shove, I'm only going to get paid by one of them?

Ms. Marjorie Edwards: What was your comment, Ms. Williams? My concentration sometimes gets affected, so maybe I took this wrong, but you said some of us could live quite comfortably on the upper level of the CPP-D payment.

Ms. Susan Williams: No, no.

Á (1120)

Ms. Marjorie Edwards: Okay. That's how I took it, and I was thinking--

Ms. Susan Williams: No, I'm saying that if you meet the eligibility criteria and you've made contributions, we pay you the benefit regardless of any other source of income you have. So you could have all kinds of other income and you'd still get the same benefit as somebody else.

Ms. Marjorie Edwards: Oh, I don't expect to get full benefit from CPP and full from my insurance, but I feel the insurance companies are not doing as much as they could. To bring in some of these changes we want to bring in, you need money, so why not make the insurance companies more accountable? Then CPP will have more funding.

Now, maybe I'm wrong, but....

The Chair: As I think we heard from Mr. French, it would certainly be reflected in your premiums in terms of the bottom line of insurance companies. It would be made up in the premiums if the roles were changed, I think.

Yes.

Ms. Elizabeth Davis: I think it's more an issue of the insurance companies only referring appropriately to CPP disability applications. With a lot of insurance companies, if a person is on benefits for six months, at that time they're required to apply for CPP disability. A lot of the time it's not appropriate, and it's a monumental waste of resources, because they're also required to go through the whole appeal process, including the Pension Appeals Board.

I don't know, but I would really like to see a breakdown of what that costs us. If insurance companies referred more appropriately to CPP disability, I think there would be quite a cost saving.

The Chair: If they've inappropriately sent people to CPP, should there be some penalty?

Ms. Elizabeth Davis: Something like that, because something has to happen to change what they're doing now.

The Chair: If it's just some sort of automatic....

Ms. Elizabeth Davis: Yes, if you are on benefits for this period of time, you automatically are required to apply for CPP.

Ms. Marjorie Edwards: For me, it was at four months they wanted me to apply for CPP. And I totally agreed with what CPP said, because at that point I figured I'd be back at work in six months.

The Chair: It wasn't severe or prolonged.

Ms. Marjorie Edwards: Exactly.

The Chair: John.

Mr. John Wodak: I certainly have a problem with the insurance companies requiring people to appeal through the full process without providing them with the resources to do so. I really have a strong philosophical objection to working for insurance companies, but that's what I wind up doing at the upper levels of appeal.

The Chair: In the integration piece, I think we've heard lots of people say that sometimes the information provided at the initial LTD application--and I think the insurance companies are quite willing--is pretty decent information that may not be reflected in the crummy CPP form you described, where the physician had to fill it out on a very busy afternoon when he didn't have the time to do so.

On the positive side of integration, then, do you think the information should be shared? Would any of you as clients have been concerned that the information the insurance company had would be shared with CPP, and vice versa? No? Because it would help avoid your having to answer the same question nine times, and maybe not as well one of those times.

Okay. I also have another question.

On the recommendation that we do not allow insurance companies to offset the amount of CPP-D children's benefits from their LTD payments to claimants, is there agreement on that?

Ms. Marjorie Edwards: Not having any resources now financially, I couldn't invest anything. I don't have anything to invest.

I have a son in university. It has been very difficult for him, and for us, because we really can't help him. He works during the summer, but it isn't always enough, even with the student loan, because unfortunately--well, not unfortunately--he's going to Bishop's University in Quebec. He's not going to university in New Brunswick. So you almost hate that your children would have to go to a certain place and take a certain education because of what has happened to you as a parent. Parents are supposed to look after their kids, not....

There are a lot of different aspects, but as far as I know, for Jamie, without that children's benefit, which he is losing this fall, and he has one more year...still, we knew that. But it really was a financial help.

Á (1125)

The Chair: John, could you expand on one of the concerns we'd heard, that you're working for insurance companies in some of your advocacy work in terms of the various appeal levels? Some people have told us the determination group over at CPP Disability are doing some of the work of insurance companies. But there's also the converse, that some of the determinations from LTD might actually help on CPP now. Is there anything we could do differently there?

Mr. John Wodak: I would say not. The difference is quite apparent at the review tribunal level. If somebody has an insurance company involved, or particularly WCB, which keeps an enormous amount of paper, the hearing case file is about two inches thick or in four volumes. If it's just an individual who has nothing else in support, then it's about a half an inch thick or less. I haven't really found that this makes a great deal of difference at the review tribunal.

The Chair: Okay.

Are there any other comments on this piece?

Ms. Elizabeth Davis: Representing my client as I'm preparing to go to tribunal or the PAB, I've had experience with insurance companies refusing to share information with me. I've had to try to get that information again from the physicians, so we're duplicating something that really shouldn't be necessary. If the insurance company would share their reports with me, the ones they've received, then I wouldn't have to go back to the doctor and say, well, we need it again because we can't get it from them.

Our provincial car insurance company is a big offender there, but there are other insurance companies that won't provide their client with copies of the medical reports that they have in their file at the insurance company.

The Chair: Okay.

Marjorie.

Ms. Marjorie Edwards: I know when I was getting prepared to try to get some sort of income, I was told that I did not have access to any of my files. I found that hard to believe. I said, well, they're my files. But they wouldn't give them to me. Then, on my day of discovery, they told me the reason they wouldn't give them to me was because I had a psychiatric illness, and they didn't know what it might do to me, if it would set me off when I read it. I knew what was going on. But they will not share things.

The doctors understandably get very upset when they have to duplicate. It's bad enough having to do it for one, but I've had it come back saying, well, can't they photocopy it and send it?

The Chair: In some of the things around resources and consultant reports, I was wondering, has anybody had any experience of...?

Dr. Stein, it sounds like you've done this a lot. I had some concerns at times that people with chronic fatigue or fibromyalgia or something where the tests aren't there would be sent to a psychiatrist, who would say that they were normal in terms of mental health, which of course we already knew. But the point then that they were viewed to be psychologically normal was used against them, as though fibromyalgia and chronic fatigue is actually a mental illness or a fantasy sort of state.

Sometimes if you get sent to a whole bunch of specialists who all say you're normal, the fact that you were sent to the wrong specialist to begin with then looks like this pile of documentation that says you're not disabled. I found that always very frustrating. It seems to be the well-resourced ones who are sending patients off to all of these consultants, tiring them out--some of these appointments are three or four hours long and very disruptive to people--especially that stuff Dr. Stein referred to, putting pegs in things and these sorts of functional assessments that have nothing to do with whether the person's brain worked or not in a brain injury or something like that.

Anyway, is there anything we should say in the report about the use and abuse of clients in terms of sending them off for unnecessary medical opinions or anything like that? There's not much you can do, is there? I always felt so badly.

Walter.

Á (1130)

Mr. Walter Nash: I've always been a very strong believer that you are responsible for yourself until for whatever reason you can no longer take care of yourself, after you have done everything possible. In terms of policing it, good God, it's a nightmare. You can go to ten doctors and con ten doctors into eight different symptoms.

That's the problem right there. How do you convince people that you're on the up-and-up? We all know people who are taking advantage of these systems.

The Chair: Some people have heard me say this before, but I always said if I had one stamp in my office it would have been a rubber stamp that said “Highly motivated--would rather be working”. If you start from that premise, that this person really would rather be working.... The idea that everybody's malingering and trying to rip off the system was a place I didn't think we should start from.

We have some other key questions that we were asking, and then there was this return-to-work last chapter. I wonder if....

Did you have a comment, Calgary?

Mr. Ellie Stein: I was going to very briefly agree with what you said, that getting consultant reports is a double-edged sword. So if you get referred to a consultant who actually knows something about your condition, it can be a very positive thing. But if you're referred by an insurance company, the chances are very high that the consultant will have a similar view as the insurer and therefore you're going to come out looking pretty functional and it's not going to necessarily be on your side to spread that report around to other people like CPP.

The Chair: I think the return to work is pretty obvious, that lots of people would just like help. And I think this early identifier piece that certainly the various experts we have heard in terms of how to get people back to work earlier in terms of accommodation and support for part-time and all that stuff seems.... But we had a couple of very specific questions.

What do you think we should do about the terminally ill? And what about this four-month waiting period? And then we need to ask the officials, what would have to be changed to legislation in terms of just how we go about this and what actually could be done through administrative changes?

One of the things this committee has had a little history with, the disability tax credit, we've had.... I wouldn't mind the round table commenting on how confusing all that language is to be on a full disability pension but not qualify for the tax credit, and whether we should be changing the language. Also, they could comment on whether HRDC could help us with one screen that could actually at the time of processing CPP disability determine whether they qualify for the tax credit as well. And could we do something along those lines in terms of back to harmonization and getting our government side harmonized a little bit?

Walter.

Á (1135)

Mr. Walter Nash: Maybe we should put more faith in the people who know us best: our doctors. That way we are getting individual treatment and we're getting reports filed of a high priority by the people who know us best, our situation best, our condition best, our home life best, know everything about us better than anybody else.

The Chair: I love commercials for family physicians. I just don't think people should go to orthopedic surgeons with back pain.

Ms. Marjorie Edwards: Yes. I agree with him totally, because one of the things I am advocating for is to involve families, the people who are living with us. They know us better than anybody else.

As far as I'm concerned, my family physician knows me.

The Chair: Yes.

Ms. Marjorie Edwards: My psychiatrist medicated me. I saw him for maybe 10 to 15 minutes. He didn't know me from Adam, except for what was written when I was in hospital and then what the nurses had said. But they wouldn't let the family physician.... It has to be that specialist. Specialists are good, but they aren't always the person who knows what you are capable of.

The Chair: Or how much you'd rather be working.

Ms. Marjorie Edwards: Exactly.

The Chair: Reed, Wendy, are there some comments?

Mr. Reed Elley: I'm not sure. Have we actually moved into return to work, or is that the next thing?

The Chair: That's the last thing, yes.

Mr. Reed Elley: Can we talk about that now?

The Chair: Sure.

Mr. Reed Elley: All right.

I'm wondering if the department, HRDC, can tell me, when was the last time the earnings exemption was reviewed?

Ms. Susan Williams: It might be worth clarifying what this earnings exemption is. It's just a threshold after which we ask people to get in touch with us to tell us that they are earning some income. It's not a level at which we automatically review or cut off the benefit.

Previously, we expected you to get in touch as soon as you started earning the first dollar of income, but we wanted to raise the threshold because that was creating unnecessary anxiety. As a practical matter, people would have to be able to earn considerably more than the $3,900 a year, but what we'd like to be able to do, if they are earning at about that level, is talk to them about the other supports available.

So in answer to your question, the last time we reviewed it was I think when we introduced it a couple of years ago, but it does not represent a level at which benefits are cut off, and I think we've actually been fairly successful in communicating that. It's a level at which we want you to touch base with us so we can talk to you about the other supports available in your community.

Mr. Reed Elley: It's more of a guide than a reality.

Ms. Susan Williams: Exactly, yes. Nobody earning $3,900 a year is able to support themselves, and they would not be considered earning at a substantially gainful level by the program by any manner of means.

Mr. Reed Elley: As a supplemental to that, is there any way in which we can harmonize this with say receiving social assistantce benefits across the country? I know that's provincial, and we have federal and provincial jurisdictions involved in this sort of thing. But you hear a lot of concern about people wanting to help themselves, and then in that difficult period when they're trying to help themselves and get back into the workforce, whether they're on social assistance or whether it's through disability pension or whatever, whatever they're getting there's that difficult period when the transition is taking place and they're being penalized for trying to get back into the workforce. It seems that way, anyway.

Is there any attempt to harmonize that with the provinces, to talk about a level of income that may be a standard--and that may be difficult--across the country where people need to have this much to live? You know what I'm saying here.

Ms. Susan Williams: People's income at the time they are trying to get back into the labour force is very much a concern of ours. One of the things we do, if people are beginning to earn at what we consider the substantially gainful level where we would cease their benefits, is we give them a three-month transition period in which we continue to pay the benefit in recognition of this. We follow them quite closely at that point. We are working with the provinces on some issues, if not specifically what you mentioned.

I might ask Nancy to talk about the....

Á (1140)

Ms. Nancy Lawand: Yes, we have a small working group with provincial social services representatives, officials like ourselves, who are looking at all of the various policies that we have, both provincially and in CPP, around return to work.

It's the first step, I believe, to get to the point you raise as to whether there is an opportunity to be better coordinated. We're going to start talking about what the differences are, because provinces set their own earnings exemptions, when the drug cards are made available or not, what the other supports are, and I think it's important for the small group of mutual clients--because it's a small group in each province who also has CPP--to understand what the impacts of those various policies are. So we're making the first steps along that way.

Mr. Reed Elley: Good. I'm glad to hear that.

The Chair: Nancy, maybe you could just share about the pilot that was in B.C.

Ms. Nancy Lawand: Yes, this was actually several years ago now. HRDC, through Canada Pension Plan and some other programs in the region of B.C., linked up with several B.C. ministries. There was labour, there was the office for disability issues, there was the income support--I don't know what it was called at the time--human resources. Also, there was the auto insurer, the WCB, and one private insurer.

We actually ran a pilot for about 18 months on returning to work, removing the barriers for people on income assistance who are on more than one program--they had to be on more than one program. Interestingly, we found about 70 mutual clients, but it was really hard to convince them to take the chance of returning to work. We got about 15 people to actually go through a return-to-work process. Part of it was the fear of losing the benefit.

We couldn't guarantee to everybody that if something happened they could get back on the benefits they had left. Secondly, there was the interface issue between the various programs that was very hard to resolve. But that was the purpose of learning more about how to work together in that environment.

Fortunately, the people who did try, and got jobs, I think got very well-paying jobs. We found more jobs than we had people who were willing to try, if you will. We did an evaluation of the pilot. I think it's been submitted to the committee for consideration. Certainly I think from an HRDC perspective, if there are opportunities in the future to partner in this way with other programs, we would certainly be interested in pursuing them.

The Chair: Wendy?

Ms. Wendy Lill: I want to go back to the issue that both Mr. Nash and Ms. Edwards talk about, the importance of your family doctor and how you want to give them so much of a role in all of this.

I have to say that there are thousands of people who don't have family doctors. I know my mother, who is 86, lives in London, Ontario, and there are 3,000 people, including 86-year-old women, who can't find family doctors. What do we do about that?

What about the whole Romanow model of community health care clinics? Is there a role for community medical consultants who in fact would be there for the purposes of doing the kinds of assessments needed in an efficient fashion and a sensitive fashion with persons with disabilities?

Mr. Walter Nash: It would be better than somebody who's treated you for gout, for everything.

Ms. Wendy Lill: I'm trying to address the fact that there are many people who don't have that. Because they live in the wrong place or they don't have that nice cuddly family physician nearby, they can't even access the kind of person who might be able to help them. How do we address that?

In terms of the department, do you have other gatekeepers who are acceptable to you? Is there another way around this family physician problem?

Á (1145)

Mr. John Wodak: While agreeing completely with what Wendy has said, I have to say that there is more to determination of disability than simply a medical report, or two or three, or half a dozen. I think one of my concerns is that there are people who are not getting benefits because they are unable to deal with the process by themselves and they can't find or can't pay for the sort of help they need. That's a much more gentle thing than simply the medical report business.

The Chair: It's the advocacy piece, and I guess that's what Wendy is saying. And I think one of the questions we are often being asked is should the advocacy case manager kind of person be within the department, or should the government be helping advocacy organizations do their job?

Mr. John Wodak: There's a case in Alberta where the Worker's Compensation Board has appeals advisers for cases that are going to the appeals commission. I find they have very little credibility because they're perceived as being paid by the people who are going to turn them down.

Ms. Elizabeth Davis: Absolutely. I'd like to see more support for advocacy and advocacy organizations to help people through the process, because a government employee will never be perceived by the client as on their side. However good that person is, the perception is still that this person is working against me, not for me.

I really think there is a role for more advocacy in this area.

The Chair: Should the HRDC website link people to advocacy groups?

Ms. Elizabeth Davis: A lot of our referrals come from HRDC staff. People call the 1-800 number, and HRDC staff refers to us, the commissioner's office refers to us.

The problem is there are only two of us at the coalition, and I serve people all through the province. For a lot of people outside of the lower mainland, they have no access to an advocate except someone who can advise them over the phone and by mail. I think that's a huge issue all across the country; I don't think it's just in B.C.

The Chair: Mr. Elley.

Mr. Reed Elley: We went around and around on this one in terms of advocacy, particularly who should be really footing the bill for advocates and associations who do citizens' advocacy.

Of course, you and I both come from a province that's been very hard hit by government cutbacks recently.

Ms. Elizabeth Davis: Our organization lost four full-time advocates.

Mr. Reed Elley: In the area I'm responsible for, Nanaimo and south, I've had all kinds of people coming to meet me because actually the advocates who were out there doing the work on behalf of disabled people either aren't there or they've been cut back so much that they're so heavily loaded they can't do it any more--not adequately.

So we come back to the base question. Who should be responsible to fund groups who act as advocates? Is this a federal government responsibility? Is it a provincial government responsibility?

Ms. Elizabeth Davis: Both.

Mr. Reed Elley: How do we get our act together so that people who need the help are not falling through the cracks ?

Ms. Elizabeth Davis: I think it's a responsibility of both levels of government. We are so overwhelmed now.

Of all the funding cutbacks in British Columbia, one of the organizations hardest hit was legal services. There used to be some excellent service provided to people through the legal services system. Those people lost their jobs last August.

Now there are two of us left.

Mr. Reed Elley: Well, we have federal representatives from HRDC. Do you see HRDC as being a funding agency for advocacy?

Á (1150)

Mrs. Susan Scotti: We do fund advocacy groups through some of our other programs in HRDC, but we don't now have the resources within the CPP program to actually fund the core activities of advocacy groups to help with application filling.

Mr. Reed Elley: So should one of our recommendations be that you get some funding for this?

Mrs. Susan Scotti: Well, a suggestion would be to look at how we can streamline and simplify the application process so that it does become easier for clients to fill out these applications without having to go and seek recourse from consultants to help them fill out the application. A recommendation to harmonize, to streamline, to simplify would be very helpful to us. We are doing some of that now, but there is more that can be done and needs to be done.

The Chair: I think part of what we're hearing is the applicant's application is one, what the doctor fills out is the other, and that tends to be the one that, if it's inadequate, is the real kicker.

So I think for Dr. Stein to not know there's a handbook is huge, but also the examples of the kinds of language.... Not that you're leading the witness, but we have to get the doctors much better at being able to do this job, too, I think. Because that's sometimes what the advocate does, right? The advocate sends the patient back to the doctor, saying this form won't work, so tell them the real story, or it's somehow like that.

Ms. Marjorie Edwards: There is another comment I have to make, but it may have nothing to do with the discussion here. A major comment that is made to me all the time is you're trying to get through to these government agencies, in this wonderful age of technology, and you don't get to speak to an actual person. You call, you want your information. Some people are excellent, they call back.

I've worked in an office setting doing supervision, and I know you can't answer half an hour after they've called, and I understand that, but this goes on sometimes for weeks. They'll call back. Well, there's nothing you can do because you're getting that voice again. That's another frustration. When you're not feeling well, if you haven't got somebody to help you with that, you're frustrated.

The Chair: I think that's a good comment.

John commented that one of the big frustrations for us is we never have enough time.

John.

Mr. John Wodak: The CPP toll-free number always has a live person at the other end. I had this publication from the federal government the other day with a list of contact numbers, and it didn't have the CPP number in it.

The Chair: Yes.

Mr. Walter Nash: Try dealing with these faceless bureaucracies when you're half full of chemotherapy drugs.

The Chair: Thanks very much, Reed.

One last comment.

Ms. Susan Williams: I want to make the point about the medical reports. We don't turn somebody down because of an inadequate medical report. A very standard part of the process, and in about half the applications, involves our staff going back out to the doctors to get additional information to clarify, to make sure that we have enough information. Sometimes we have to go out more than once. That's part of what builds in the delay.

The other thing is, I want to mention what we call our early client contact. We now have a process in place in all regions that's been introduced in the last year or two years. It involves phoning people when they first apply to tell them about the process. Then often we make a phone call during the course of the adjudication process, especially if we don't have adequate information and need to learn more. This is an opportunity--it's not face-to-face--for people to tell us about the impact on their functioning, on how it's affecting their family. This is the kind of information we hope to get in these calls.

Then there's the phone call to explain the reasons for the denial before the denial letter is sent out. All regions are now supposed to be using these detailed denial letters that do explain the reasons for people being denied as well as spelling out their appeal rights.

Mr. Reed Elley: Has anybody ever had one?

Ms. Elizabeth Davis: Yes. I think it's improved a great deal in the last year or so. I have to say my dealings with HRDC staff are great. HRDC staff, I think, on the whole are doing an excellent job. They have the same problem everybody else has of a lack of resources.

The Chair: I guess our one last question for you before we go to sandwiches would be--except for the people in Calgary, who are going to have to...it's time for breakfast for you, isn't it?

Do you have any comments or evaluation on the electronic consultation idea? Is it something Parliament should keep doing, or try to do? Obviously, we like it because we got to meet you people, who we wouldn't have got to meet otherwise, but is there any feedback for us in terms of the process by which parliamentary committees can talk to Canadians?

Walter.

Á (1155)

Mr. Walter Nash: Perhaps, again, from a remote area, you'd be given not a person's name--that's too personal--but a number. That would be your contact number. This person basically would deal with your case. He'd be in Tuesdays, Thursdays, whatever.

The Chair: No, I know that, in terms of dealing with the department. I was talking about the parliamentary committee having done the consultation on the website, and you having presented your.... Did you think that was a good idea?

Mr. Walter Nash: Oh, great.

Ms. Elizabeth Davis: I'd like to see a lot more of it. I think it was really good.

The Chair: Marjorie.

Ms. Marjorie Edwards: Yes. I was really impressed with it.

The Chair: John.

Mr. John Wodak: Yes, I was impressed.

I would ask you a question, if I may, and that is how does this compare with the information you get through MPs' constituency offices?

The Chair: I think it underlines it, and this gave us an opportunity to see the broader ones. The ones that end up in the MPs' offices are the seriously tough cases, right? There's a saying that tough cases make bad law. But I think that's the one group we probably have not focused on the way we had hoped to. At the very outset, we wanted to talk to constituency assistants, because we thought they were trying to do this. They were involved at the very beginning of the launch, but then I don't think we've had the feedback we should have had.

That was an excellent question, John. Thanks.

Roy.

Mr. Roy Muise: I thought the whole process was great, to personally have had that opportunity, because I think a lot of times a lot of us feel we are sort of lost in the shuffle and everything like that.

It was also good because I passed the website along to several other people who I thought might be interested in doing the survey. I know at least two or three of them who did. And it was the same thing--just having that opportunity to speak their voice when there is a process like this going on.

So I think it was a really good thing.

The Chair: Thanks very much.

Now we have a benediction from Calgary.

Mr. Ellie Stein: I was very impressed with the process. I think it made it accessible to someone like me, who probably wouldn't have written a letter or maybe gone to speak to my MP.

I have one problem with the format, and that was that a lot of the questions were forced choices, and the program wouldn't let you continue unless you put one in, even if you didn't agree with any of the choices. I managed to address that in my comments later, so it wasn't insurmountable, but it was a little bit problematic as I was going through it.

I feel very privileged to have been able to participate, and I thought it was great. I also wanted to make the offer that if the committee decides to implement the earlier suggestion about illness or syndrome-specific assessment instruments, it's something I have a lot of expertise in. I'd be more than willing to help for the diseases I'm knowledgeable about.

The Chair: Thanks very much.

Are there any other comments from Calgary?

Ms. Michelle Kristinson: I think it was a good job. I was really pleased to be able to participate in any consultation.

Thank you very much.

The Chair: Well, thank you all. As always, we've learned so much. It's always so humbling how we take this forward. One of my medical partners had a sign on his wall that said “If you're going to bitch, bitch effectively”. I hope we can get e-consultations into a format so people will feel they were effective in their commentary.

As you know, there are always the parameters. We'll try to take everything we got and move into a set of recommendations, but like all pieces of public policy, it's all a work in progress in the art of the possible, and then we move on to the long term.

Thank you all for participating, for giving us your great ideas and spending so much time trying to make the quality of life for Canadians better. If we don't get it totally right this time, don't give up on us. This is the beginning of a relationship. So thanks very, very much.

I once again want to thank the Library of Parliament and the House of Commons staff, without whom we couldn't have done this. This was a huge experiment for them, countless hours of time in a whole new area, and I'm grateful to Chantal, Kevin, Bill, Rémi, Mike, and Megan.

So, à la prochaine. Hopefully we'll see you again. This is our version of democracy between elections, and it's hugely important that you get to feel you have a say in public policy, and not just at the ballot box.

Thanks so much.

The meeting is adjourned.