Bill C-39 (Historical)

An Act to amend the Federal-Provincial Fiscal Arrangements Act and to enact An Act respecting the provision of funding for diagnostic and medical equipment

The purpose of this enactment is to give effect to the 2004 10-Year Plan to Strengthen Health Care by increasing the Canada Health Transfer in the fiscal years in the period beginning on April 1, 2004 and ending on March 31, 2014 and establishing a Wait Times Reduction Transfer, payable first to a trust for the benefit of the provinces, and then directly to provinces as of the fiscal year 2009-10. This enactment also provides funding to provinces for diagnostic and medical equipment.

Supply

[Jean Crowder, NDP, Nanaimo—Cowichan, BC]

Mr. Speaker, the NDP will be supporting the motion and I thank the member for Charleswood St. James—Assiniboia for bringing it to the attention of the House and for some very vigorous debate around an issue that is very important to Canadians.

I will not read the whole motion but I will read the last part which states:

--the government should immediately develop and initiate a comprehensive national strategy on mental illness, mental health and heart disease.

Earlier in the motion it talks about the need for a national strategy on cancer.

The member referred to the coalition of a number of organizations that have been working very actively and very vigorously for a number of years on this very initiative. In a document entitled Establishing the Framework for a Comprehensive Canadian Strategy for Cancer Control, it lays out a number of factors that are critical in looking at a national strategy. These include prevention, screening, diagnosis, treatment, supportive care and palliative care.

I know a number of other members will be talking about various aspects of this national strategy but I would like to focus on prevention and wellness.

In the document it is stated:

True cancer control aspires not only to treat and hopefully cure the disease, but to prevent it, and to increase the survival rates and quality of life among those who develop it. The process encompasses interventions aimed at both individuals and populations.

This is a very critical statement in this document.

After looking at this initiative and after speaking with a number of advocates in the cancer community, one of the things that dismayed me was that this conversation has been going on for years and years. In 2005 one would hope that we would not be in the position of having to spend an entire day of members' time talking about this very important issue and instead we should be talking about the success of a national cancer strategy.

In preparation for the debate today I pulled out a document called Cancer Care in Canada, the voice of the Cancer Advocacy Coalition of Canada. I talked earlier about being dismayed. The coalition produced a report called report card 2003. One of the lead in statements in the report card says:

Since the year 2000, the Cancer Advocacy Coalition of Canada...has been asking for hard facts on the issues that matter most to the country’s cancer patients. Year by year, our mantra has been, “We cannot manage what we cannot measure.

This group did a report card on the provinces throughout Canada. It looked at a number of measures: mortality, which provided rankings for the provinces; 2002 waiting times; per capita funding; rates of funding increases; and transparency and accountability.

When we take a look at a factor such as waiting times, we are looking at a range that goes from unacceptable, borderline, to acceptable. Throughout the provinces we have no consistent way of looking at waiting times, of gathering the information or of reporting the information back to Canadians. What the organization pointed out in this document was that often we were talking about apples and oranges.

My favourite topics are transparency and accountability both at the federal level on how federal dollars are spent on health care, but also at the provincial levels in how they report back to the federal government on how dollars are spent.

The analysis on how provinces reported out information went from unacceptable to borderline to accessible, to actually one case of outstanding. It talked about the fact that the transparency and accountability in the province of Ontario was outstanding. Unfortunately, in my own province of British Columbia it was merely acceptable.

One of the challenges we have when we are talking about cancer control and prevention is that often we do not know what we are measuring, we do not know how to gather the information and we have no consistent framework to talk about this.

Before I go on to talk about prevention and wellness, my good friend from the Bloc referenced the Romanow report and implied that the federal government had actually been working progressively on the Romanow report. I must beg to differ.

The federal government has talked about the fact that it has closed the Romanow gap by allocating some funds over the next 10 years to health care. The only Romanow gap that it has closed is by making a commitment to funding, but when we talk about many of the other initiatives that were addressed in the Romanow report, we are talking about inertia and inattention.

The final report from the commission on the future of health care in Canada specifically talked about prevention and wellness and this is a very good context in which we can speak about the cancer prevention strategy. One of the things the report talked about was anticipating an aging population. We know that age is a factor when we talk about cancer. The demographic trends show that the proportion of Canadians 60 years and older is expected to grow from 17% to 28.5% by the year 2031.

When we talk about the need for a national strategy, the fact is that not only are we seeing cancers identified in people under the age of 60, but we have a very serious demographic bulge that is going to happen over the next few years. If we are not out in front in developing a strategy to address this, it is going to present some serious challenges for our medical system.

The Romanow report goes on to say that much of the international evidence indicated that modest growth in economics should ensure that most countries are able to manage the growth in their elderly populations and increase health care spending in the future. It is worth remembering that there are countries which already have larger elderly populations than Canada, spend significantly less, and achieve similar health outcomes in comparison to Canada.

Romanow also addressed the issues of needs and sustainability. He talked about the fact that Canada's health outcomes compare favourably with other countries. Evidence suggests we are doing a good job of addressing factors that affect the overall health of Canadians. There are, however, areas where there is room for improvement and there are serious disparities in both access to health care and health outcomes in some parts of Canada.

Clearly, more needs to be done to reduce these disparities and address a number of factors that affect the health of Canadians, such as tobacco use, obesity and inactivity. In a few moments I am going to talk a bit more about those determinants of health.

Romanow made some very specific recommendations to strengthen the role of prevention. Recommendation 22 stated:

Prevention of illness and injury, and promotion of good health should be strengthened with the initial objective of making Canada a world leader in reducing tobacco use and obesity

Recommendation 23 stated:

All governments should adopt and implement the strategy developed by the Federal, Provincial and Territorial Ministers Responsible for Sport, Recreation and Fitness to improve physical activity in Canada.

When we talk about promoting good health, we know that many of the factors that lead people into acute care systems and requiring treatment for cancer are directly related to other factors such as lifestyle. In the report Romanow talked about the fact that over 90% of lung cancer deaths and 30% of all other cancer deaths could be prevented in a tobacco free society. Those numbers are from Statistics Canada. They are not made up, pie in the sky numbers.

We are certainly taking steps and I applaud many of the non-profit groups, like Physicians for a Smoke-Free Canada, on their vigorous pursuit of making Canada a tobacco free society. Clearly, there are many issues in prevention that need to be incorporated in the pan-Canadian strategy. I must add that the coalition has advocated for that.

He goes on to say that the impact of determinants of health and lifestyle choices is well known to government and health organizations. Unfortunately, the key problem lies in turning the understanding into concrete actions that impact on individual Canadians and communities. That has been a huge challenge in seeing that translation from talk into action.

Canadians are losing an appetite for more reports. Canadians are losing an appetite for more promises that do not actually result in concrete action.

There are more facts about smoking and again these are addressing the leading major causes of health problems. The Romanow report said:

Estimates are that smoking costs our economy more than $16 billion each year, including $2.4 billion in health care costs and $13.6 billion due to lost productivity through sick days and early death.

Surely if we developed a national strategy, we would be talking about these factors and incorporating these into these factors.

I am going to come back to the coalition specifically because it has done some good work on developing a cancer prevention system for Canada. A report was produced by the Canadian Strategy for Cancer Control: Prevention Working Group in January 2002 . It outlined some important principles regarding a cancer prevention system for Canada. I want to talk about some of the principles that it outlined because these would be important factors to include in a national strategy. It stated:

A cancer prevention system should embody the following principles:

1. Population-Based Public Health Approach that takes into consideration the Determinants of Health

The risk factors for cancer are widespread and have an early onset. Public health is our best vehicle for reaching healthy people in their communities with interventions designed to decrease these risk factors.

1. Integrated and Coordinated

The risk factors for cancer are common to many other major non-communicable diseases. Collaborative action is cost effective and increases the opportunities for learning. There are many stakeholder organizations in cancer control and coordination among them is needed to enhance effectiveness and create synergy.

1. Focus on Community Capacity Building with Strong Linkages

The most promising interventions have multiple interventions in multiple settings at the community level with supportive action at provincial and national levels.

1. Accountability

Funding is needed to bring partners to the table but this must be done in a responsible way that requires participants to meet the performance of set standards in order to receive funding. Standardized data collection is needed to measure the impact that activities are having on established short-term goals.

1. Sustainability

It will take time and committed effort to establish a system. An implementation body with clear responsibilities and adequate resources is needed to provide strong leadership.

These are critical principles to guide the development of this national strategy. They have been developed by pan-Canadian consultation and by not only health care providers and practitioners but by advocates in the cancer community. These five key principles would go a long way to addressing many of the things that need to be addressed at the community level, for example.

We know that many of these strategies and ideas come out at the national level and are developed at the provincial level, but the impact is felt at the community level. I was pleased to see that part of the principles in this strategy focus on community capacity building because it is there that we need to develop our strength.

There is one other element in this document that is really important. Under the case for a cancer prevention system, it lays out the fact that:

Estimates range but most experts agree that at least 50% of cancer cases and deaths can be prevented through healthier lifestyle choices. These include: reducing exposure to tobacco, a diet that is high in vegetable and fruit consumption, protection from overexposure to the sun, adequate physical activity to maintain a healthy body weight, and reducing environmental/occupational exposure to carcinogens.

When we hear this kind of information coming out of prevention that says 50% of cancer deaths and cancer cases could be prevented by paying attention to some of this front-end information, it makes me wonder, in this day and age, why we have not addressed these factors.

I talked a little bit about tobacco earlier, but this document also focuses on tobacco because it is one of the contributors.

I talked a little bit about tobacco earlier, but this document also focused on tobacco because it was one of the contributors. It said that simply educating people about a healthier lifestyle was not enough to effect change. It is not adequate to educate children in school about the hazards of tobacco if they go home and their parents are smoking, or they go to their local sports facility and public smoking is tolerated, or if the price of cigarettes is too low to discourage uptake. The social environment, including public policy, needs to support healthy choices.

Clearly, many good minds have come together to talk about the fact that we need to not only look at treatment, and it is very much a part of this cancer strategy, but we must look at prevention. We must look at lifestyle factors. We must concentrate on educating Canadians and health care providers and practitioners about the necessary factor of prevention.

I am going to shift gears a bit here, from talking specifically about prevention, to talk about some of the challenges that we have when we talk about information systems that would support a national strategy. Although this is broader than the cancer strategy, there was an interim report put together called “No more time to wait--Toward benchmarks and best practices in wait time management” by Wait Time Alliance for timely access to Health Care. Of course, when we are talking about timely access to health care, we are talking about people who have cancer as well as a number of other issues that bring them into the health care system.

The report talks about principles for medically acceptable wait time benchmarks. One of the challenges that we have come across as we look at many of these issues is that we do not do an adequate job of gathering information. We do not do an adequate job of analyzing the information that we do gather and we are often talking about factors that are not gathered in the same way from coast to coast to coast, so we cannot even do comparative studies across the country.

When we talked many months ago about Bill C-39, we talked about accountability in the health care system. One of the critical factors of accountability is that we must have information. When we are talking about programs and services, we talk about what we measure. Well, if we do not even know what we are measuring, how do we know what we are getting? The report talks about medically acceptable wait time benchmarks and I am going to paraphrase from the report.

It talks about the fact that benchmarks need to be pan-Canadian in approach, so that we avoid things like duplication of effort. We want to maximize economies of scale. It talks about the fact that wait time benchmarks need to be derived from an ongoing process. Life is not static in Canada, so it needs to be an ongoing process in order to review the benchmarks and talk about their significance.

There needs to be ongoing and meaningful input of the practice in community and many of us talk about the fact that we all do the statistics around policy. It is great to have policy developed in Ottawa, but we need the ongoing community practitioners and the community residents to be involved in these kinds of initiatives. Public accountability and transparency are exceedingly important and I am going to read this part:

--Canadians must see tangible results in terms of reduced waiting times for health services in the 5 priority areas.

We keep talking about accountability and transparency. Yet, we continue to see an opaque veil drawn over the operations in Health Canada and other government departments as was demonstrated a couple of weeks ago by journalists across Canada about accessing information. Transparency and accountability are fundamental to ensuring that we are getting what we want out of the money that we are spending. Wait time benchmarks and provincial targets to reduce wait times must be sustainable.

Mental health is a critical issue and in the statement of issues that the Mental Health Association put together, it talked about things like affordable housing.

In conclusion, we support this motion before the House and I urge all members to support it. I have an amendment to the motion that I would like to put forward. Following consultation with my colleague, the member for Charleswood—St. James—Assiniboia, I move:

That after the word “provinces” the words “territories and municipalities” be added.

The Budget

[Stephen Harper, Conservative, Leader of the Opposition]

Mr. Speaker, what the Gomery commission will show is that the best friend of the separatist cause in Quebec is the Liberal Party of Canada.

Yesterday the Prime Minister refused to split the Atlantic accords from the budget bill. He told the House, falsely he will have to admit, that the health accord was part of the budget bill. It is not. It is Bill C-39. The Conservative Party will agree today to pass this bill through all stages this afternoon.

If the Prime Minister is serious about passing the bill, will he agree to this proposal?

Message from the Senate

[The Acting Speaker (Hon. Jean Augustine)]

Order, please. I have the honour to inform the House that a communication has been received as follows:

Rideau Hall

Ottawa

March 23, 2005

Mr. Speaker:

I have the honour to inform you that the Right Honourable Adrienne Clarkson, Governor General of Canada, signified royal assent by written declaration to the bills listed in the Schedule to this letter on the 23rd day of March, 2005, at 4:56 p.m.

Yours sincerely,

Curtis Barlow

Deputy Secretary

Policy, Program and Protocol

The schedule indicates that royal assent was given to Bill S-17, an act to implement an agreement, conventions and protocols concluded between Canada and Gabon, Ireland, Armenia, Oman and Azerbaijan for the avoidance of double taxation and the prevention of fiscal evasion--Chapter No. 8; Bill C-20, an act to provide for real property taxation powers of first nations, to create a First Nations Tax Commission, First Nations Financial Management Board, First Nations Finance Authority and First Nations Statistical Institute and to make consequential amendments to other acts--Chapter No. 9; Bill C-6, an act to establish the Department of Public Safety and Emergency Preparedness and to amend or repeal certain acts--Chapter No. 10; Bill C-39, an act to amend the Federal-Provincial Fiscal Arrangements Act and to enact an act respecting the provision of funding for diagnostic and medical equipment--Chapter No. 11; Bill C-41, an act for granting to Her Majesty certain sums of money for the public service of Canada for the financial year ending March 31, 2005--Chapter No. 12; Bill C-42, an act for granting to Her Majesty certain sums of money for the public service of Canada for the financial year ending March 31, 2006--Chapter No. 13; and Bill C-18, an act to amend the Telefilm Canada Act and another act--Chapter No. 14.

A motion to adjourn the House under Standing Order 38 deemed to have been moved.

Supply

[Claude Drouin, Liberal, Parliamentary Secretary to the Prime Minister (Rural Communities)]

Mr. Speaker, I will be sharing my allotted time with the hon. member for Scarborough—Guildwood.

I appreciate this opportunity to speak today in response to a motion of the hon. member for Regina—Lumsden—Lake Centre to the effect that the benefits of the accord on non-renewable resources signed by Nova Scotia and Newfoundland and Labrador should be extended to all the provinces.

This motion raises a question often debated in this House, namely the so-called fiscal imbalance. It is appropriate that I now address it in the context of this specific motion. With all due respect to those who believe that such an imbalance exists in Canada, I say they are wrong, and there are several reasons for that.

First, I think that all our critics have to recognize that there is one fundamental difference between Canada and most federations: the Government of Canada and the provinces have access to the same major sources of revenue to finance their operations. The provinces also have exclusive access to several sources of revenue in their jurisdictions, such as natural resource royalties and gaming revenues.

Second, under the Constitution, the provinces have full jurisdiction over the tax bases under their control. They also have a free hand to develop their own tax policies, set personal and corporate tax rates and decide how to use their tax revenues.

Third, despite the significant progress made in recent years by this government in reducing the debt, the federal debt remains twice as high as that of the provinces. As the father of four and grandfather of five, that is not the legacy I want to leave to my family and to Canadian families. It is important that we reduce this debt.

Finally, we have to take into account that the Government of Canada and the provinces are partners in many areas, including several over which the provinces have full jurisdiction. Take health, post-secondary education, social services, infrastructure and housing for example. The federal government has been contributing more and more in these areas over the past several years. Its contributions are currently at an all time high. That is right, an all time high, and they will continue to grow.

When we factor in the federal transfers, we can see that the provincial and territorial revenues clearly exceed federal revenues. This has been true for more than 20 years, and is not likely to change in the foreseeable future.

Let us look at the benefits derived from this cooperative form of governance. The 10 year plan to strengthen health care is one of the best examples of cooperation involving the various levels of government. In fact, the Prime Minister of Canada and his provincial and territorial counterparts have all signed it. The Government of Canada has promised to spend more than $41 billion over ten years to support the plan, thus acting on all the financial recommendations of the Royal Commission on the Future of Health Care in Canada, the Romanow commission.

An additional sum of $700 million over five years has also been announced for aboriginal health care programs, along with $150 million for health care services in the North.

The Senate is currently studying Bill C-39, which implements the 10 year plan to consolidate health care. Once this bill has been adopted, the provinces and territories will be able to respond to the concerns of Canadians in such important areas as wait times reduction in order to ensure that Canadians have access to essential health care in a timely manner, and they will be able to fund the purchase of essential diagnostic and medical equipment.

Then there is the new framework for the equalization formula and the territorial funding formula or TFF. In October, the Government of Canada established a new framework for equalization and the territorial funding formula, which provides for the transfer of $33 billion in additional funding over the next 10 years.

This additional funding for the provinces and territories will mean that all Canadians will have access to reasonably comparable public services at reasonably comparable rates of taxation, no matter where they live.

This framework includes the five following elements: first, a minimum funding floor of $10 billion for equalization and of $1.9 billion for TFF for 2004-05; and complete protection for provinces and territories against declines in payments in 2004-05 below the amounts estimated in the 2004 budget.

There is also a guaranteed increase in funding for 2005-06, to $10.9 billion for equalization and $2 billion for TFF, and a guaranteed growth rate of 3.5% per year compared to this level over the next 10 years.

Finally, for the first time the government is creating an independent panel to advise on how legislated equalization and TFF levels should be allocated among the provinces and territories. The provinces will be represented on this panel. The legislation establishing the new equalization and TFF framework recently received royal assent, and the provinces have started to receive the amounts allocated. One of the things the provinces and territories had demanded was stable and predictable funding. This is exactly what the Government of Canada has provided.

However, the government did not stop there. I want to mention a few of the positive initiatives in the 2005 budget for Canadians or the communities in which they live.

These funds will be allocated to health care professionals and resources for healthy living, the prevention of chronic disease, flu epidemic preparedness, drug safety and environmental health. These funds reinforce the $805 million the Government of Canada is investing directly in its responsibilities.

The Government of Canada is committed to enhancing its assistance to regional and sectoral development. This year's budget gives priority to strengthening support for innovation and local capacities to meet the challenge of adaptation, investment in northern initiatives, and targeted investments to increase the contribution of certain key sectors of the economy to Canadians' standard of living.

More specifically, the 2005 budget helps to strengthen the economies in the regions through the following initiatives: $800 million more in funding to regional development agencies in Atlantic Canada, western Canada, Quebec and northern Ontario. Having been the minister responsible for this portfolio in Quebec, I can state that this funding will be extremely useful for the economic development of all of Quebec's regions. In addition, $120 million will be allocated to an overall northern development strategy, and there will be additional investments in certain key areas of the Canadian economy, such as agriculture and the space industry.

Hon. members will recall the new deal for the communities which was inaugurated as part of the 2004 budget. With it, the Government of Canada implemented the preliminary measures of the new deal with the reimbursement in full of the goods and services tax, the GST, as well as the federal portion of the harmonized sales tax, the HST, to the municipalities. This initial step will make it possible to provide the municipalities with more than $7 million over 10 years to help them finance their fundamental infrastructure priorities, particularly roads, public transport and water purification.

The 2005 budget takes this still further by respecting the Government of Canada's commitment to share part of the revenue from the federal gas tax in order to support a sustainable and environmentally friendly infrastructure. This commitment will take the form of a new contribution of $5 billion to cities and communities for infrastructure over the next five years.

The new deal goes further than the commitment on gasoline taxes. It is designed to establish new, lasting intergovernmental partnerships and to find new ways of doing things. The governments have worked together to ensure that our health care system has a future, and we have worked together on equalization and the territorial funding formula to establish a detailed plan enabling the provinces and territories to prepare for the future. There is no doubt that all administrations must continue to work closely together in order to achieve real, lasting change.

In short, it is incorrect to say that the government has and jealously guards an unfair financial advantage. In fact, all administrations have the same duty of providing services of the highest quality to all citizens, no matter where they live.

That is exactly what Nova Scotia and Newfoundland and Labrador are seeking to do. The agreement on offshore resources recognizes the special circumstances these provinces are facing. The Government of Canada has seen a need and has intervened to help standardize the rules of the game with respect to other provinces.

After all, Canadians help each other out, right?

Canadians have made it clear that they all want to see their elected representatives cooperating to achieve this goal. Let us set aside these petty quarrels about fiscal imbalance and move on to more positive and more productive debates on practical ways to meet our obligations and on what we can do in the future.

That is how it works where I come from, in the Beauce. When someone has a problem, no one looks for a guilty party; we search for a solution, and that works well. Thank you for your attention.

Auditor General Act

[Jean Crowder, NDP, Nanaimo—Cowichan, BC]

Mr. Speaker, I rise to speak in favour of Bill C-277. Its summary states that the enactment amends the Auditor General Act in order to allow the Auditor General of Canada to act as auditor or joint auditor of crown corporations, certain other bodies established by acts of Parliament and certain corporate entities without share capital.

Let me turn to another bill for a moment, Bill C-39, which has already been before the House. It is the enabling legislation for the first ministers' accord on health care and it sets up a third party trust for wait times reduction transfer. The Government of Canada will set that money aside this year but it allows the provinces to draw upon that money until 2009. The House will not review that agreement until 2008. That is a lengthy period of time without oversight on how that money will be spent.

If the Auditor General were allowed to audit the foundation there would be transparency to Canadians and all their demands on health care funding. It is absolutely essential that we commit to openness and transparency in funding that is being spent by the government on behalf of taxpayers.

I want to quote from a document I found useful in considering how health care funding is provided. It is from the CCAF and the Canadian Healthcare Association. The document is entitled, “Principles for Governance, Management Accountability and Shared Responsibility”. It states:

Health system partners need to demonstrate commitment to public transparency and accountability. They do this by explaining to, and involving the public in, what they plan to do, how well the system is performing, and the implications of both.

A third party foundation that has no parliamentary oversight is not the way to achieve public transparency. If the government continues to insist on using these bodies as a way of providing funding, we need to provide the public with confidence that this money is being spent well, that the money is providing the benefit the public needs and that any deficiencies are being identified and acted upon. We do not want to see a repeat of needing to implement a Gomery inquiry.

Another part of that report reads:

Reporting principles and standards are key to the integrity and utility of reported information and aprerequisite for fair comparisons and benchmarking.

These are critical elements in terms of what we have seen over the last several years of various private practices in accounting like Enron.

The Auditor General provides Canadians with reporting principles and standards in regard to how tax dollars are spent, principles and standards the Liberals seem willing to ignore by salting money away in foundations instead of spending it in a transparent manner. The bill would give Canadians some assurance that money directed into foundations is being spent appropriately.

I would like to turn to another foundation, Canada Health Infoway Inc. It was set up in 2001 to help develop efficient data systems for health care. Make no mistake, the NDP knows that more efficient methods of health information transfer are absolutely vital to our Canadian system, but how do we know if Canada Health Infoway is providing good value on that strategy? Four years after it was set up, the need for improved methods of health information transfer is still front and centre with the wait times reduction fund, the need to better understand what parts of the country are underserviced by health professionals and as a way of developing a comprehensive pharmacare system.

In a recent article in the Ottawa Sun the headline read, “Suspect Worst of Foundations”. The article reads:

Canada Health Infoway Inc: Set up in 2001 to help develop efficient data systems for health care, the foundation so far has managed to spend $30 million administering $51 million in grants. (How's that for efficiency?)

These are the kinds of facts and figures that cry out for the need to have the Auditor General look at what is happening with these foundations, instead of treating them as an arm's length mechanism to tuck away funds that do not have the kind of oversight that parliamentarians should have over these kinds of funds.

When we are talking about oversight and transparency, another bill is being put forward to the House, Bill C-201, which talks about the need to look at crown corporations and access to information. It is just another example of how private members need to bring forward business to encourage the government and the rest of the House to really walk the talk when we are talking about transparency and accountability.

I would urge all members from all parties to support this very worthwhile private member's bill.

Federal-Provincial Fiscal Arrangements Act

[Jean Crowder, NDP, Nanaimo—Cowichan, BC]

Madam Speaker, in question period, the minister's response was that perhaps I needed to turn up my hearing aid. I guess my response to that would have been, for what? To hear more empty promises around credit card medicine?”

However, on credit card medicine, again the Canadian Health Coalition's analysis around the first ministers health care agreement, and of course Bill C-39 is a result of it, was a D grade for stemming the tide of privatization, as well. Again quoting from the analysis, which is very appropriate. It states:

The First Ministers’ Health Care Agreement is silent on the question of for-profit delivery of healthservices. Indeed, the very day the agreement was signed the bold headline in the National Post read:“Privatized Care Keeps Expanding”.

The proliferation of investor-owned private, for-profit clinics and facilities acts like a viral infection inthe body of Canada’s public health care system. The for-profit health care virus cannot exist withoutfeeding off and damaging public bodies. Canada’s largest and richest provinces are laying thefoundations for a private parallel for-profit regime. This trend threatens the integrity and the viabilityof the public health care system. This is happening without any public discussion by First Ministers.Indeed, it is a plan whose objectives no politician dare utter in public.

It goes on to say:

The corporate virus infection in Canada’s health care delivery system may have been driven underground. However, it remains a serious threat as it can spread through stealth, deception, and lack of accountability.

I interject here to underline “lack of accountability”.

It goes on to say:

It flourishes in the dark but runs from the light of public scrutiny. You don’t stopthe spread of a life threatening virus by not talking about it. Instead, you first isolate and then treatand eradicate the virus light of public scrutiny. You don’t stop the spread of a life threatening virus by not talking about it. Instead, you first isolate and then treat and eradicate the virus. The proliferation of initiatives to privatize health care delivery undermines the letter (objectives) andthe spirit (purpose) of the Canada Health Act. It represents a significant threat to the publicly fundedhealth care system, in particular including the requirements that universal access to publicly fundedhealth care be provided on uniform terms and conditions to all insured persons.

I am quoting from Dr. Arnold Relman's testimony at the Kirby Senate committee. He states:

The facts are that no one has ever shown, in fair, accurate comparisons, that for-profit makes for greater efficiency or better quality, and certainly have never shown that it serves the public interest any better. Never.

Why do so many First Ministers and their officials show no interest in the facts, or the values uponwhich Medicare is built? The noticeable exceptions are Premier Calvert of Saskatchewan andManitoba Premier Doer, who both explicitly referred to not-for profit delivery of care. If Canadiansare gullible and listen to the true believers in the miraculous powers of the market to solvehealth care problems, we will pay dearly for the mistake.

That is a very clear indictment of the kind of creeping privatization happening in our health care system. Accountability measures need to be open and transparent so Canadians can see where their health care dollars are spent.

[Jean Crowder, NDP, Nanaimo—Cowichan, BC]

Madam Speaker, I rise in support of Bill C-39. The NDP has already indicated its support; however, I am compelled to speak about the fact that there is a lack of accountability in the bill.

In order for Canadians to have continued confidence in our health care system, they need to know how and where their money is being spent and what the results are. This is not a lone voice in the wilderness that is calling for accountability. It is supported by any number of sources. I will quote from a number of different documents.

The first is the “Health Care Renewal in Canada: Accelerating Change” document put out by the Health Council of Canada. The council is quite unequivocal in its statements around the need for accountability. It starts out by talking about the fact that governments are making significant investments in health care and how Canadians will know whether the money is being spent on health care renewal. The council goes on to talk about the fact that money is important. I will quote directly from the document:

Inform Canadians as to whether the increased investments in health care are supporting the change governments have agreed to implement--

The council stated:

We believe the public has a right to know how the money has been spent across the country.

It will report about this in its annual reports, but it is very clear to the council that there is a fundamental issue attached to the question of money, how it is being spent, what the results are, and what is being achieved.

The next document is quite an interesting one. It is called, “Principles for Governance, Management, Accountability and Shared Responsibility” and was put out by the Canadian Health Care Association and the CCAF. Their opening statement is actually a quote from an address by the Prime Minister at the first ministers meeting on September 13, 2004:

When it comes to health reform, Canadians expect real and meaningful accountability. They deserve to know what they should expect--and what they are getting.

The document lays out some key principles around what we expect out of accountability.

As the minister pointed out earlier today, we are spending significant amounts of money in health care over the next 10 years. Surely Canadians deserve to know how that money is being spent.

One of the things the CCAF and CHA outline is that health system partners need to demonstrate commitment to public transparency and accountability. They do this by explaining to and involving the public in what they plan to do, how well the system is performing, and the implications of both. Surely these are the elements of good practice in any kind of respect. They then go on to outline areas of responsibility. Under public accountability and involvement, the CHA and CCAF outline a principle which states:

Health system partners need to demonstrate commitment to public transparency and accountability. They do this by explaining to, and involving the public in, what they plan to do, how well the system is performing, and the implications of both.

Again, this is a fundamental principle on how Canadians need to have access to how Canadian tax dollars are being spent.

They go on to talk about how these things might be reported. Again, these are principles. These are non-profit bodies that are talking about principles in terms of accountability and transparency. They talk about reporting principles and standards being key to the integrity and utility of reported information and a prerequisite for fair comparison and benchmarking. They state:

Principles and standards may be issued as a pronouncement by the requiring party, or developed cooperatively. Regardless of how they are developed, these reporting principles and standards should be commonly understood and consistently applied.

To me that means there is an agreement on what we should be reporting, and it should be clearly understood by all parties, including the Canadian public.

On the first ministers health care agreement the Canadian Health Coalition actually issued a report card in September 2004. Under the accountability and reporting aspect of the report card the government was given a D . The coalition said that the agreement is based more on trust and an assumption that the public will hold governments to account. We are talking assumptions here.

Since the weak accountability facilitates privatization by stealth, Canadians will have to be diligent to ensure real accountability. Medicare is still on life support, not from lack of money, but because of weak controls on where and how the money will be spent.

The Canadian Health Coalition is talking about the fact that what we really need to do is follow the money. The CHC did a detailed analysis on the 10 year plan to strengthen health care. I will quote from the document on accountability and reporting to Canadians. I talked about the fact that the agreement is based on trust. The document states:

It is no coincidence that the governments with the most resistance to meaningful accountability (Alberta, Quebec and B.C.) are the ones determined to transfer the delivery of insured health services over to commercial, for-profit health care corporations. Proponents of private, for-profit health services do not want public funds accounted for or traced but this is what true accountability requires. Canadians don't realize that current accountability requirements in federal legislation are being ignored by the federal government. Under the Canada Health Act, the Minister of Health has a statutory duty to monitor, report and enforce compliance with the five criteria of the Act. The Minister's annual report to Parliament on the Canada Health Act consistently fails to identify, report and stop privatization initiatives underway in several provinces. This poses a serious threat to the integrity and viability of Medicare.

The CHC goes on to state:

We expect the Canadian Institute for Health Information and the Health Council of Canada to include in their data collection and analysis a breakdown, by mode of delivery of health care services specifically, for-profit and not-for-profit. A full public accounting would expose unfavourable comparisons between private for-profit and public not-for-profit....Citizens need an accountability mechanism which is independent and in the public domain. The Health Council of Canada could grow into that role with public pressure and direction. The first task for the Health Council must include tracking every single dollar of public funds in health care in order to monitor how much is going to investor-owned private for-profit health care, home care, and long-term care and the health outcomes and financial performance achieved. Canadians must also insist that the federal Minister of Health correct the deficiencies in monitoring, reporting and enforcing the Canada Health Act.

It is clear that there is a reluctance by the government to report on the dollars that are being spent, because it is en masse for profit delivery that is creeping throughout Canada.

One of the things that is fundamental in the Canada Health Act and one of the program criterion is public administration. It is a fundamental criterion for receiving funds under the Canada Health Act. The act itself states:

In order to satisfy the criterion respecting public administration,

(a) the health care insurance plan of a province must be administered and operated on a non-profit basis by a public authority appointed or designated by the government of the province--

In the prebudget consultation to the report on the Standing Committee on Finance, which is talking about health care and how money is spent, I quote:

Several witnesses spoke about specific aspects of the Canada Health Act. While witnesses generally support the principles contained in the Act, there was concern that some of the principles are not being respected and that information provided to Parliament is not accurately indicating the degree to which privatization initiatives are underway in several provinces. In particular, it was recommended that the ministers of Finance, and Health fully enforce the accountability mechanisms in the Canada Health Act and that provinces/territories be required to provide information on the mode of delivery of health care services, in particular for-profit and investor owned versus public and not-for-profit.

This is from the prebudget consultation which was clearly calling for more accountability. Yet when we look at Bill C-39, any mechanisms for accountability are absent from that bill. It is very cold comfort to hear that there will be a review done in 2008. That is like slamming the barn door shut after the horse has escaped.

We are talking about some of the pillars around public administration and the issue that we are not able to look at the impact health care dollars are having and where they are being spent. In my own province we have a current P3 under way and the government cannot tell me that this is a for profit situation.

We have an organization called Access Health Abbotsford, which is a consortium that includes the Dutch bank ABN AMRO, U.S. health giant Johnson & Johnson and Sodexho, a French cleaning and food services company, that will be responsible for the design, construction, financing and maintenance of the hospital that is being built in Abbotsford. Surely that is a for profit organization, which seems to be very dismissive of one of the key pillars of the Canada Health Act.

How will Bill C-39 protect Canadian taxpayers from that kind of creeping privatization. There are certainly any number of questions about the quality of for profit health care. Again, independent studies have been conducted and established on these kinds of private health care delivery.

Canadians deserve to know how the money invested in health care is being spent. Canadians are very passionate about their health care system, and they want to continue to see a publicly funded and publicly delivered health care system.

We are asking the Minister of Health and the Prime Minister to honour their commitments. In the minister's own words, he stated after being sworn in:

I can tell you that what we need to do is stem the tide of privatization in Canada and expand public delivery of health care so we have a stronger health-care system for all Canadians.

Those are very strong words. It would be shameful if the government did not live up to its commitment around that.

I will go on and repeat the Prime Minister's words because they bear repeating. He made a commitment around real and meaningful accountability. He said was:

When it comes to health reform, Canadians expect real and meaningful accountability. They deserve to know what they should expect--and what they are getting.

Surely stating that Canadians deserve to know what they should expect and what they get talks about accountability. It should be one of the fundamental principles in the bill. It is glaringly absent.

I would urge that we quickly put in mechanisms to deal with the accountability, so Canadians have some confidence in where their health dollars are being spent, and that we can proudly stand up and talk about the fact that we have a publicly funded and publicly delivered health care system.

[Pierre Paquette, Bloc, Joliette, QC]

Mr. Speaker, I am pleased to speak to Bill C-39 because it shows the true nature of this Parliament. It is unfortunate, but despite the fact we have a minority Liberal government, the Liberals, as you know, have not lost any of the arrogance that has been their trademark for 9 or 10 years, under Mr. Chrétien and the new Prime Minister.

We saw this arrogance when we found out that Bill C-39 was not consistent with the special agreement signed with Quebec at the conference on health. As a matter of fact, Bill C-39 contained only one mention of a specific agreement with Quebec, in clause 25.9. Also, Quebec was not specifically excluded from other requirements in the bill, like the Canadian Institute for Health Information or the dedicated funds. Bill C-39 showed once more this arrogance of downplaying the importance of a specific agreement with Quebec. The agreement was quite clear. I will have the opportunity to deal with this later on.

I mentioned at the start that Bill C-39 shows the true nature of this Parliament because the Liberals, even though they are a minority government, seem unable to suppress this arrogance towards Quebec and this Parliament. Fortunately, the Bloc Québécois and its members in this House immediately sounded the alarm and sent a clear message to the government and the whole Parliament that the bill was not consistent with the intent and the letter of the special agreement with Quebec. Thanks to this intervention, especially by the member for Verchères—Les Patriotes, the Bloc Québécois critic for intergovernmental affairs, and despite the reluctance of the government, we were able to pass an amendment, and Bill C-39 is now consistent with the intent and the letter of the agreement. We think the bill is now quite acceptable and we will support it.

Just imagine what would have happened had the Bloc Québécois not been here. Bill C-39 would probably have been passed unchanged, and Quebec would have been penalized. This goes to show how important it is to have members who stand for Quebec's interests first and promote an exciting collective project--the sovereignty of Quebec.

I mentioned that it cannot be by chance that the government brought forward the original draft of Bill C-39 without taking into account the specific agreement with Quebec, because that agreement was very clear. For the benefit of people watching us, I would like to cite it. In the specific agreement with Quebec, there was a very clear written statement:

--resting on asymmetrical federalism, that is, flexible federalism that notably allows for the existence of specific agreements and arrangements adapted to Quebec's specificity--

Quebec will apply its own wait time reduction plan, in accordance with the objectives, standards and criteria established by the relevant Quebec authorities--

The Government of Quebec will report to Quebeckers--

It could therefore not be any clearer than what I have just read. However, the Government of Quebec, even though it is led by federalists, knowing the reflexes of the federal government, particularly when Liberals are in power, even had the following disclaimer added at the end of the communiqué, to ensure that there would be no confusion possible, and I quote:

Nothing in this communiqué shall be construed as derogating from Quebec's jurisdiction. This communiqué shall be interpreted as fully respecting its jurisdiction.

Members will understand that we were quite surprised to see that, in the original draft of Bill C-39, there were not more references to the clause 25.9 in terms of that specific agreement. Let us recall that, when that specific agreement was signed, for a few days, people believed there really was a new approach on the part of the federal government, which the Bloc Québécois leader, like MNA Louise Harel, had called asymmetrical encroachment.

The federal government was therefore agreeing, in this specific agreement, to respect Quebec's jurisdiction over health issues, as set out in the Canadian Constitution. It was however an innovative approach. In the recent years especially, with the fiscal imbalance and the Liberal government's tendency to impose a federal presence in all areas of Quebec's and the other provinces' jurisdiction, particularly if there was some sort of visibility or political points involved, this asymmetry in terms of intrusion seemed to be a step in the right direction.

Unfortunately, this respect of Quebec's jurisdictions lasted only a few days. Nothing new there. As I was saying, the defence of the 1867 Constitution caused an outcry in Canada. The member for Verchères—Les-Patriotes was talking about that. The former finance minister, Mr. Manley, condemned that. All the dyed in the wool Trudeau supporters told English Canada that the direction we were taking posed a threat to Canada's unity. Since then, we have seen no new asymmetrical intrusion initiatives since the one made at the health conference.

Moreover, a few weeks later, during the funding conference, the federal government unilaterally decided to restrict the conference to the issue of equalization. It announced the amounts available, right at the start, saying that the formula that had been unilaterally imposed before the latest elections would continue to be used. It dealt with none of the provincial concerns, particularly those of Quebec.

When we saw the first draft of Bill C-39, which did not take into account the distinct nature of the agreement entered into at the health conference, the member for Verchères—Les-Patriotes asked a question on February 10, 2005, of the Parliamentary Secretary to the Minister of Health in order to alert the Minister of Health to the fact that there was no explicit reference to the specific agreement with Quebec, except, once again, section 25.9, which was clearly inadequate.

The parliamentary secretary answered that the member's concerns were not justified. We were heading toward a dead end. You will recall that, at second reading, we had opposed Bill C-39. Given the inadequate reference to the specific agreement with Quebec, we could not have supported it.

The Bloc Québécois proposed amendments to Bill C-39, in line with the accord signed in September. First, we reincorporated in the bill the fact that the funding made available by the Government of Canada will be used by the Government of Quebec to implement its own plan for the renewal of Quebec's health care system.

Those who have been following the politics of Quebec for the past few years, know that there have been many studies to reform the health care system, just as in a number of Canadian provinces. First, there was the Rochon Commission, then the Clair Commission. The reforms are now well underway. The so-called expertise of the federal government in this domain is not needed at all. It manages only a few veterans hospitals, which are constantly being criticized.

Second, in our approach regarding the amendments to Bill C-39, we made sure that the Government of Quebec would be accountable to the population of Quebec. We excluded any hierarchical relationship where the federal government thinks that it is supposed to decide on the validity of the actions of the Government of Quebec. The Government of Quebec is accountable to the nation of Quebec, to the people of Quebec only. When elections take place, Quebeckers express their view of government management of health care and many other things.

So our second concern was about the Government of Quebec informing its own population of the progress achieved in the pursuit of its goals.

The third aspect is the Health Commissioner of Quebec being responsible for reporting to the Government of Quebec on Quebec's health system. The Canadian Institute for Health Information should not, therefore, be informing the public on advances by the Government of Quebec, the health department and the other players in the health care system, with respect to the concerns of the public and issues such as the modernization of our health system. These issues must take a number of challenges into account, in particular the challenge of demography, which, as you know, is linked to the aging of our population.

There obviously will be cooperation with Canadian Institute for Health Information. Though it was never a problem, it should have been made clear that Quebec's Health Commissioner was responsible for reporting to the Government of Quebec and, through it, to the public on the state of health care.

This amendment we moved was adopted by the committee. As I mentioned, the original version was unacceptable, but we will support the amended version of Bill C-39.

I mentioned that the concept of asymmetrical federalism, which is in fact asymmetrical interference, was very short lived. To prove it, I point out that on October 26 of last year, at the conference on the provinces' financial situation, which covered more than just health, which had been the only subject of conference in September, Ottawa decided unilaterally that equalization would be the only item on the agenda. The federal government said right at the start what amounts would be available and announced that not one cent more would be added to equalization and that the formula used in its calculation would remain unchanged. I remind you that the formula had been imposed unilaterally by the federal government a few months before the last elections. Moreover, the Prime Minister refused once again to admit that there was a fiscal imbalance and spoke only of fiscal pressure on the provinces knowing full well that the situation is a lot worse.

I repeat that that asymmetrical interference or asymmetrical federalism, as they called it, did not last long. We saw it during today's question period. There is still no agreement on parental leave despite an agreement in principle signed before the elections. There is still a gap of about $200 million between the positions of the federal and Quebec governments. Here again, we can see the federal government's hard line attitude common in its relations with Quebec.

So the problems go well beyond the area of health. Let me give you another, more regional, example. As you know, there is a crisis in the tobacco industry. It is a totally understandable crisis considering anti-tobacco campaigns. Being a non-smoker, I support those campaigns. But the fact is that there was a sharp decline in demand for tobacco. Moreover, the three major tobacco companies decided to stop buying tobacco in Quebec to concentrate their purchases in Ontario.

The region that I represent, namely Joliette and Lanaudière, was home to virtually all tobacco farmers. Out of the 57 who were in business three years ago, fewer than a dozen continue to produce a small amount of tobacco, trying, naturally, to diversify their operations, production and crops, and only three intend to continue growing tobacco to meet the demand of independent manufacturers like Lépine cigarettes and other manufacturers operating in first nations reserves.

This is therefore an emergency. Tobacco farmers need assistance to switch from one type of crop to another, such as Chinese cabbage or kiwi; anything that can grow in sandy soil ought to be considered. Anyway, these growers need assistance.

Like parental leave, this assistance was announced a few days before the election. Electoral democracy is good after all. A few days before the election, approximately $70 million in assistance was announced. That was many months ago, yet we are still waiting for the terms and conditions of this aid package for tobacco farmers in Quebec and Ontario to be defined.

It would appear, and this is more serious, that assistance for the 57 tobacco farmers in Quebec, 95% of whom are in the Lanaudière region, is being blocked by a dispute between Ontario farmers and the provincial government of Ontario.

I find it completely absurd that producers in Quebec are being taken hostage in a situation that is totally out of their control. Naturally, for the federal government—and that is what we were told by the parliamentary secretary in response to a question I put to him last week—the same solution has to apply to producers both in Ontario and in Quebec. Consequently, until an agreement has been reached with Ontario farmers, no money will be made available to the farmers in Quebec.

Their situation is totally different, though. These farmers in Quebec have already stopped growing tobacco or started efforts to quickly switch crop production. To conclude this brief aside, I want to emphasize that the funding problems facing these tobacco farmers is largely due to the fact that tobacco companies have forced them to replace their dryers just two years before they decided to stop buying any tobacco in Quebec.

They need help for converting their land because switching from tobacco to asparagus does not just happen in one season. Often it takes five years before production becomes efficient. They are also burdened by debt, which they are unable to amortize with financial institutions in the region.

As I was saying, this asymmetrical approach was nothing more than a virtual approach, which did not even last long enough for the ink to dry on the separate health agreement. The government no longer mentions this approach. Again, refusing to acknowledge the fiscal imbalance makes it impossible to find a definitive comprehensive solution to the funding problem. This is so for Quebec, but also, unfortunately, for many other provinces. However, the federal government has been much quicker and much more generous with provinces such as Newfoundland and Labrador and others over the past few weeks, while Quebec has to continue to struggle.

As I was saying, the agreement on health does not solve the fiscal imbalance problem. It is like taking an aspirin to try to get rid of cancer. I will give some figures, although the hon. member for Verchères—Les Patriotes already gave some earlier. Nonetheless, if I have time, I would like to go into more detail.

The specific agreement on health provides Quebec with approximately $502 million more this year, out of a budget of $20 billion. Consequently, this fresh federal input represents only 2.5% of the Quebec budget, or about 9 days of operation. That is just for health, so what they have done is the equivalent of helping Quebec meet its health care responsibilities for the equivalent of nine days.

The federal government boasts that it is getting close to the 25% target the Romanow report recommended for health and social funding. When we look at all social spending, that is education, social assistance, the areas covered by the Canada social transfer, which is now, as we know, divided into a transfer for health and one for social programs, it is obviously far from that 25% figure. Especially because, as far as equalization payments are concerned, the results have not been what might had been expected, that is, a new formula that is fairer, more stable and more generous to the provinces needing these federal transfers.

In fact, after the October conference on the provinces' financial difficulties, which eventually shrank to nothing more than a conference on equalization, Quebec will end up with a mere $300 million more in equalization payments.

Overall, in its “generosity”, this government will have transferred $800 million more to Quebec this year, whereas the shortfall—according to the Government of Quebec, or its finance department—is in the order of $3.3 billion. As a result, the shortfall for Quebec, as far as fiscal imbalance is concerned, is still $2.4 billion.

We must therefore hope that the federal government, with its fabulous surplus of $9 billion last year—this year, some $11 billion or $12 billion—will, in the budget to be tabled and debated starting next Wednesday, get its act together and find some definitive solutions by transferring the $2.4 billion Quebec still lacks to resolve the extremely serious problem of fiscal imbalance.

[Stéphane Bergeron, Bloc, Verchères—Les Patriotes, QC]

The doormats in the Quebec Liberal Party have not said even one word about this problem. Yes-men that they are, they have not said even one word about Bill C-39's silence on the side agreement reached with the Quebec government.

Contrary to what the Parliamentary Secretary to the Minister of Health said, namely that my worries were unjustified, it took the Bloc Québécois standing in this House before the government would apply appropriate corrective measures.

[Stéphane Bergeron, Bloc, Verchères—Les Patriotes, QC]

Mr. Speaker, I thank my colleague from Joliette who, in my opinion, has shed light on a situation that should be obvious. The role of the Bloc Québécois in this matter has been instrumental, crucial and fundamental. Had it not been for the presence of the sovereignist members in this House, no one would have raised that fundamental problem in Bill C-39.

[Pierre Paquette, Bloc, Joliette, QC]

Mr. Speaker, I would like to use my few remaining moments to congratulate my colleague on his speech.

Perhaps he could remind the House—he mentioned it at the beginning of his speech but I would like him to say more about it—how essential the work of the Bloc Québécois has been in the case of Bill C-39, and how, if there had been no sovereignists in this House, we would have seen Quebec being weakened.

[Stéphane Bergeron, Bloc, Verchères—Les Patriotes, QC]

Mr. Speaker, it is a very great pleasure for me to take part in the debate on Bill C-39, to implement the agreement entered into last September between the federal government, Quebec, the nine provinces and the three territories.

It is even more of a pleasure for me to speak today on a bill which, you will recall, the Bloc Québécois opposed at second reading. We did so because of the provisions of the bill at that point. In fact, we pointed out one fundamental flaw at that time, and this was corrected in committee. Consequently, we will be able to support it most enthusiastically today.

I believe it would be a good idea to start with the health agreement entered into between the federal government, Quebec and the provinces and territories. We need to take a few moments in order to have a proper understanding of the nature of Bill C-39.

Obviously, additional funds have been put into the health care system by the federal government, but it must be acknowledged that they are insufficient. I will return to that point later. We must also acknowledge that the federal government has concluded a separate, specific agreement with the Government of Quebec, which stipulated the following, in particular:

—resting on asymmetrical federalism, that is, flexible federalism that notably allows for the existence of specific agreements and arrangements adapted to Quebec's specificity—.

Quebec will apply its own wait time reduction plan, in accordance with the objectives, standards and criteria established by the relevant Quebec authorities—

The Government of Quebec will report to Quebeckers—

To be certain that there could be no confusion, the communiqué went on to say:

Nothing in this communiqué shall be construed as derogating from Quebec's jurisdiction. This communiqué shall be interpreted as fully respecting its jurisdiction.

So we have to acknowledge that a specific agreement with Quebec was entered into. This was to be described—as it is in the communiqué—as asymmetrical federalism. A few days ago, the Minister of Intergovernmental Affairs referred to my having praised the health agreement, to having nothing but good to say about it. Let us not get carried away, here. Yes, I did have some good things to say about it, to which I have referred here, but it must also be said—and the minister took care not to—that the agreement suffers from certain shortcomings. We have expressed a number of reservations about it.

For example, reference was made to the so-called asymmetrical federalism. Let us be clear that for the provinces and territories, except Quebec—but a way including Quebec—there is an understanding that the federal government can encroach on a jurisdiction that is exclusive to Quebec and the provinces. We cannot exactly call that asymmetrical federalism. In fact, we should be calling it asymmetrical interference.

The nine provinces and three territories have had no problem recognizing from the outset that the federal government has a role to play and can interfere in their exclusive jurisdictions. In a way, Quebec has recognized that the federal government has a role to play, but that its role needs to be well defined. We could only talk about asymmetrical federalism if the federal government allowed the provinces and territories to encroach on federal jurisdictions. Only then will it be possible to talk about asymmetrical federalism.

Furthermore, this side deal has been presented as quite an extraordinary innovation. Need I remind this House that this side agreement with the Government of Quebec is not a first.

The Government of Quebec has already negotiated side deals and special administrative agreements with the federal government on immigration with the Cullen-Couture agreement, on the pension plan, or on the creation of the Caisse de dépôt et placement du Québec, to name a few. This type of negotiation is nothing new in the history of Quebec and Canada.

We also notice that this asymmetrical agreement, described as asymmetrical federalism, has yielded relatively modest results. The Prime Minister had announced with great fanfare that he wanted to resolve the problems in the health care system for a generation. We can conclude at least that the government is apply a band-aid to the problem in health care for the next few years, or maybe even months, but it certainly has not solved anything for a generation.

I want to look at the numbers simply to understand the limits of this agreement reached among the federal government and the provinces, Quebec and the territories. For the Quebec government, this represents $502 million, or 2.5% of a health budget of over $20 billion. In concrete terms, this amount will run the health care system for nine days. Thanks to this injection of federal funds, the so-called health system will be able to operate for nine days. If, to the Prime Minister, these mere nine days constitute resolving health care problems for one generation, this agreement is obviously quite limited.

It is all the more surprising since the federal government has been literally swimming in the surplus for the current fiscal year. In fact, this surplus is said to be close to $12 billion. So, it is hard to understand the government being so tight-fisted when it comes to ensuring that our constituents have access to the reasonably acceptable health care services they deserve.

I want to come back to the concept of so-called “asymmetrical” federalism. It must be concluded that this concept was strongly contested, in short order, within the Liberal Party ranks. The Prime Minister was even criticized in the newspapers by certain Liberal Party luminaries, such as John Manley and Senator Joyal. So he was criticized for apparently having been too generous to Quebec. Too generous. What an idea. The Prime Minister was too generous to Quebec.

However, what happened—as later events attest—is that a few weeks later, there was another federal-provincial conference, which was supposed to focus on the much larger issue of the fiscal imbalance, which some people, on the opposite side of the House, call the “financial pressure” on the provinces, Quebec and the territories.

The federal government, however, had first set the terms, given its habit of being very authoritarian, to ensure that this conference focused only on equalization. The federal government gave only crumbs to the provinces, Quebec and the territories. As a result, the so-called “asymmetrical federalism” proved its flaws, weaknesses, and shortcomings just a few hours or days after being celebrated amid great fanfare and praise.

The release regarding the agreement between Quebec and the federal government said that the funding made available by the Government of Quebec would be used by the Government of Quebec to implement its own plan for renewing Quebec's health system.It also said that the Government of Quebec would report to Quebeckers on progress in achieving its objectives.

Moreover, it said that Quebec's health commissioner was responsible for reporting to the Government of Quebec on Quebec's health system and that he would cooperate with the Canadian Institute for Health Information.

The agreement was very clear. But when we saw Bill C-39, to our astonishment and irritation and disappointment as well, I must say, we noticed that the bill made no reference to the side deal with Quebec. To be fair, a very slight reference was made to it on page 4 of the bill, in section 25.9, dealing with parliamentary review, the only reference to this side deal with the Government of Quebec.

Naturally, the Bloc Québécois checked with the government, suggesting that there had probably been an oversight, a little something left out. The government took the matter under advisement and came back with a rather terse response, saying that it would look into it. To make sure that the government would indeed look into it, on February 10, I rose in this House to put a question to the Minister of Intergovernmental Affairs. The answer came from the Parliamentary Secretary to the Minister of Health.

With the arrogant, condescending and authoritarian attitude this government is known for, the parliamentary secretary rose in this House—of course, whenever remarks are made or an opinion expressed by an opposition member, the people opposite suggest we are not quite with it because, by definition, an opposition member cannot be right. So, the parliamentary secretary rose in the House and said that my concerns were unjustified. According to the Parliamentary Secretary to the Minister of Health, my concerns about the provisions of the side deal with the Government of Quebec not being reflected at all in the bill were totally unjustified.

This is strange. There is a side deal with the Quebec government. The bill makes not mention of it. We are saying there is something wrong, but we are told that there is no reason to be concerned, that there is no problem, and they wonder why I am complaining again! Of course, we pointed out to the government that the parliamentary secretary was probably out to lunch himself, because the bill is indeed totally silent on this side deal with the Quebec government.

So, the necessary adjustments were made in committee, at the request of the Bloc Québécois, which had identified this problem, this flaw. The government agreed to amend the bill and made the necessary adjustments, so that Bill C-39 reflects, in its essence, the agreement reached with the Quebec government, even though we realize that this agreement is not perfect.

Let us be clear here, Nirvana, it is not. We will always agree with the federal government investing more of its huge budget in health, so that our fellow citizens can have access to proper care. We will always agree with that and with the federal government respecting its own Constitution and, consequently, the jurisdictions of the provinces and territories, even though, in this particular case, this respect may be tarnished by ill intentions.

Of course, we agree with this agreement. However, we realize that it is flawed. It is incomplete.

As I said earlier, the money invested by the federal government will only last nine days in the health care system. This is not enough. The need is much greater. The Quebec government was expecting something on the order of $3.3 billion in federal transfers, for 2004-05 alone. However, as we know, the transfers are far below this figure, both under the equalization program and the health care agreement.

The result is that the Quebec government is still confronted with a shortfall of some $2.4 billion. Therefore, the agreement is not adequate. The federal government must further increase its transfers to the provinces, to Quebec and to the territories. Having said that, we are of course pleased, as I mentioned a few moments ago, that there is more money and that the federal government reached a specific agreement with the Quebec government.

However, it is very clear that the fundamental problem has not been fixed. This fundamental problem is the fiscal imbalance that some members across the way continue to call “financial pressures”. The fiscal imbalance problem has not been fixed. We are hoping that the federal government, in the budget that it will bring down next week, will correct a few things and start to redress once and for all this fiscal imbalance where the federal government collects more tax money than it needs to meet its constitutional responsibilities, while the tax base of the provinces is far too small to meet their responsibilities, such as health and education.

We have to correct this fiscal imbalance. The problem will only get worse, the result being, according to the Conference Board, that, by 2015, the federal government will have accumulated a surplus of some $166.2 billion while the provinces will be running deficits as high as $68.7 billion.

That is what the fiscal imbalance is all about. While the federal government shamelessly amasses surpluses, the provinces must scrape the bottom of the barrel or even borrow to discharge the responsibilities that are within their jurisdiction and that address directly the needs of the public in terms of health, education and welfare, for example. This is totally unfair and inequitable. Whatever happens to Bill C-39, which we will support this time, we must fix the problem of fiscal imbalance once and for all.

[Rob Merrifield, Conservative, Yellowhead, AB]

Mr. Speaker, it is a pleasure for me to speak on this very important piece of legislation, Bill C-39, an agreement worked out between the provinces and the federal government. It is the third accord we have had since 2000. We have had the 2000 and 2003 accords and now this 2004 accord, all giving money back to the provinces, money that was ripped out of the provinces' hands unilaterally by the government. In fact, the Prime Minister of this country is the only individual politician, provincial or federal, who has ever taken money out of health care over the last decade.

It is amazing to see the numbers put before us and to hear the rhetoric that I just heard coming from the government side here a few minutes ago, with the government side talking about this being all about accountability and transparency. I would like to explain why it is about neither of these.

What it is about is an amount of money going back into the health care system, which we agree with. In fact, the numbers that are put forward, the $41 billion put forward in this health accord, are closer to our numbers. They are very much identical to our numbers for the first six years, but are only half of what the Liberals promised in last year's June election. During that election, the Liberals were not being honest with the Canadian public with regard to the number of dollars available for health care, nor were they honest about the number of dollars they were going to give to health care.

As for the numbers that are here, thank goodness they are twice what was promised. These numbers are what the provinces asked for and what we suggested during that election. It is interesting to note that during the election we were criticized because we said that we would have to increase taxes before we could fulfill the promise we made to the Canadian people during that campaign.

All that aside, it is time to put our swords on the table and deal with health care in a non-partisan way, but before we can even get into a debate on health care we have to understand the situation of health care in this country.

This was not a fix for a generation, as was trumpeted by the Prime Minister. He went across the country and said that this is what we had to do, that we needed a fix for a generation to put health care on a sustainable course. Before we can do that, we have to understand that health care cannot be fixed in the next 10 years. The pressure will not even start to hit our system with the intensity that it is going to until we get to 2020, 2030 and up to about 2040, where it will begin to peak.

The pressure will intensify from now until that period of time because of the demographics and the baby boomer population that is going to hit the system. The baby boomers will be consuming large amounts of dollars during that period of time as they become elderly. It does not matter which area we want to look at in our health care system. Whether it is pharmaceuticals, cancer, Alzheimer's or heart disease, we can talk to any of the organizations across this country and they all will tell us that the high costs of these treatments, plus the numbers of patients afflicted with these kinds of diseases, including HIV-AIDS, are going to intensify over the next significantly short period of time and will continue to intensify over the next 40 years.

Therefore, how we sustain our health care system during that 40 year period becomes the true debate. Until we understand what is coming at us, we cannot possibly even start to open up an honest debate on health care.

If we are going to paint the picture honestly, and that is what I think we should do here, it is not only demographics that will inflict a significant blow on and a challenge to our health care system, but it is the obesity situation we have within our country. We have surveys showing us that almost 20% of our students are overweight, almost 8% of them at obesity levels. These individuals will be hitting serious problems, whether it is diabetes or heart and stroke problems, in their thirties, not in their fifties, sixties and seventies. When we couple this with the demographics we are headed into in our health care system, when we understand what is about to hit us, we see very clearly that the challenge will intensify because of more than just an aging population.

There has been talk of a fix for a generation. That is what the member and the Prime Minister have suggested, but we have been given nothing to change the dynamics and the paradigm of health care. We must do this. We must look not just at the health care system, which is crisis management, but upstream much further, and we must start talking about preventative health care.

Back in the early seventies, we had television advertisements stating that a 30 year old Canadian was not as fit as a 70 year old Swede. That is very much the case today. We see an epidemic of obesity in our population, which suggests that we have to do much more than crisis manage our health care if we are to sustain it over the next 40 year period.

We have talked about what is coming. However, what does the health care system look like today? Emergency rooms are absolutely crowded. Patients cannot see doctors or they wait for unbelievable amounts of time to see them. Some of them are reported as having passing away in emergency rooms while waiting for a doctor. A significant number in our population cannot obtain a family practitioner. I think 3.6 million individuals are without a family practitioner at the present time, and 2.4 million of those have given up trying to find a one. We have some very serious problems.

Let us compare Canada to some of the OECD nations, which it is important to do when it comes to diagnostics. Let us talk about MRIs. That seems to be what people like to talk about when discussing diagnostics. We do not rate very well. We rate 13th out of 20 for MRIs and 16th out of 21 for CT scanners. When we look at our health are system, we can see we have a significant problem with trying to access services.

In the papers yesterday and on headline news last night, it was reported that six doctors walked away from their practices in small town Quebec. With the amount of stress on the family practitioners and the nursing population, we can understand full well why we have these kinds of problems. We have a shortage of human resources. People have to understand that our health care system is 75% to 80% human resources.

We are told that 100,000 nurses will be leaving or retiring over the next five year period. There are only a little over 300,000 nurses in Canada today. A third of them are over the age of 50, and the average nurse retires at the age of 55. We have a crisis when it comes to the number of nurses.

To talk about nurses for a second, we have to understand that the most unhealthy workplace in all of Canada is in the hospitals. Nurses are the ones who take the most number of sick days off of any occupation in Canada. That is because of the stress they are placed under by the amount of work we ask them to do.

I was at a meeting last week with the nurses on the Hill. They explained to us that if they were asked to work beyond 55 to 60 or 65, we would have to create an environment for them so they could function well within that job. To do that, we will have to provide some relief and help for them. It is not only about paying them more dollars.

When it comes to doctors, we have a significant problem. A decade ago, when the government took the money out of health care, the ideology was that the doctors drove the costs. Therefore, if we removed the doctors from the system, we would remove the costs. The Canadian Medical Association said at that time that if we did that, in a decade we would run into trouble. We are now a decade from that time and we are in serious trouble with a shortage physicians in the system. That goes back to the kinds of headlines yesterday. More are on their way.

We need 2,500 doctors per year to sustain our physician profession. At the present time, we only educate 2,200 of them per year. We have to understand that the problem is not just educating more of them. They have to stay and work in Canada where they are needed. We have a three-prong problem. When we look at the legislation, do we address any of them? I would like to look at the legislation and ask those questions.

The government has said that it has $5.5 billion to deal with the wait list problem. The money is in a separate trust fund, and over a 10 year period the provinces can draw down on that money whenever they like. It is quite ridiculous when we look at the legislation and see how that is done. Of those dollars, $4.25 billion of those dollars can be pulled down by the provinces immediately. Why set up a separate trust? We might as well just write them a cheque because that is exactly what they will do, draw down that money.

The money is to go into waiting lists. What does that really mean? What criteria is on that money? They are to apply it to wait lists. There are two chronic problems in the health care system, and that is the shortage of human resources, the nurses and doctors, as well as the long wait lists. How do we address it? There are no criteria for how we will address it. It is a provincial jurisdiction, and I think that is appropriate.

One of the good things about the legislation is it would not tie hands, as was tried with some of the other past accords, with regard to some of that money.

However, why not be honest? Why not just be clear to the population of Canada and the health care system. Why does the government not say that it will give the provinces the money and that they should use it where they see fit in order to help the system. However, it should not say that it has a great fix for the wait list problem, which is to put $5.5 billion into a separate trust fund that the provinces can draw down.

If we are going to be transparent, let us be transparent. If we are going to be honest, let us be honest with the numbers. No longer is there any room for playing politics in health care. What I see with this accord is it is not a fix for a generation. It is a way to buy another election. That is really what it will come out to be.

If members will remember, the 2000 accord came in just months before an election. The 2003 accord was an attempt, after the Romanow report, to do something. With regard to this one, the spin is to fix it for a generation. It has nothing to do with fixing a generation, it is to do with buying another election. We are doing it with taxpayer dollars and we are doing it in a very dishonest way.

The dollars need to be there. That is why we support the legislation. However, we have to do it in a way that is clear, honest and is not confrontational.

The other thing that is so dishonest with the legislation is the idea of a catastrophic drug coverage. This was supposed to be done long before now. In fact, with catastrophic drug coverage and home care, in the 2003 accord with the provinces there were performance indicators and a timeline as to when these were supposed to be triggered.

In this legislation, when it comes to catastrophic drug coverage, it is pushes it back, and not to 2006 when the other was supposed to be implemented. The only thing that will come forward In July 2006 is a report suggesting that we might be able to proceed with some sort of a catastrophic drug coverage plan.

When it comes to home care, it is the same thing. It is pushed back again in this accord.

My hon. colleague talked about $500 million to medical equipment. The last time that a fund was set up for medical equipment was in the past two accords. When we traced that money to find out whether it went to medical equipment, we found that much of it went to, what we would say, pretty marginal medical equipment like lawnmowers and ice cube machines. We thought that if it hit the headlines, the government would put in more accountability measures if it were to trigger and target a specific amount of money to go to medical equipment.

However, in the finance committee meeting this last week I challenged the Liberals on this. No further accountability measures have been established. The way the fund is set up in this legislation is exactly the same as the other one. If we do the same thing the same way, we can expect the same kind of results. It is unfortunate that we have to play these kinds of games with health care.

I could go on and on about the significant lack of accountability within the accord. I want to just say that there is some accountability, perhaps, and that will come from the Health Council, which was struck in the 2003 accord. The Health Council of Canada is probably our best hope for full disclosure from the provinces and the federal government, with regard to what happens with taxpayer money. Whether it is provincial money or federal money, it is all taxpayer money.

My suggestion, as we move forward into health care, is to stop this nonsense of playing politics with health care. We could not afford it before and we cannot afford it now. Yet we still see the kind of spins coming from the government side.

If the Liberals are going to be honest, the first thing they should do is stand up and apologize to Canadians for the way they have treated health care over the last decade. They should give that the money back. Then they should consider how they will work together with the provinces in a collaborative way to make it happen. They should look at how we will deal with the next 40 years in health care. They should look beyond the political cycle. Politicians like to work in four year cycles because that gets us elected.

We can no longer do that with health care. We cannot do it provincially nor can we do it federally. We need a paradigm shift. We have to get away from crisis management on health care. We need to start looking at how we deal with the needs of the individual patient ahead of the system.

We think we have a great system in Canada. The World Health Organization suggests that we are 30th in the world. Every time we get into a health care debate, somebody wants to promote an American health care system. Why would we do that? The Americans rate 37th in the world. However, 30 other countries are better than us. Why do we not take some of the examples from those countries and use them pattern a health care system that will be in the best needs of the Canadian population?

We have a good health care system, but we will be unable to sustain it on the course we are on. We have to do more than just come up with one-off accords that do not address accountability or the health of the nation. They deal with crisis management. We agree with the dollars in this accord, and we will support the legislation in that respect. We are frustrated about how we got here and we are frustrated that we have a government that is not more long-sighted than this legislation.

[Larry Bagnell, Liberal, Parliamentary Secretary to the Minister of Natural Resources]

Mr. Speaker, thank you for the opportunity to introduce at third reading Bill C-39, which provides for $41 billion in new funding for provinces and territories under the ten year plan to strengthen health care.

Canadians are justly proud of their social programs and are determined to see them maintained and improved. In particular, Canada's publicly funded, universal health care system stands as a clear testament to its commitment to ensuring equality of opportunity for all Canadians.

The Government of Canada recognizes the importance of providing growing and predictable funding for Canada's health care system to ensure its vitality. It also recognizes the importance of improving transparency and accountability of health care spending.

After all, Canadians want to know that their tax dollars are being spent wisely.

In short, the government is committed to strengthening Canada's publicly funded health care system. It is committed to working with the provinces and territories to make sure that happens. As the Prime Minister has said, Canadians want solutions to health care problems, problems in their communities, problems that affect their families. Canadians also want to know that the health care system will be able to provide the services they need in a timely fashion. They also want to know that the health care system is secure for future generations.

Governments recognize the need to strengthen our health care system. We understand the challenge. It is a challenge that falls to us and we must act.

Last fall, federal, provincial and territorial governments all signed the 10 year plan to strengthen health care. Bill C-39 would implement the federal commitment supporting this plan by providing $41 billion in new federal funding for provinces and territories for health.

Indeed, the 10 year plan will strengthen ongoing federal health support provided through the Canada health transfer, or CHT, as well as to address wait times to ensure that Canadians have timely access to essential health services and to provide additional funding for diagnostic and medical equipment.

Before I outline the details of this ambitious new plan, I would like to first provide some history of recent federal health care funding in Canada.

In September 2000, hon. members will recall an agreement by first ministers for an action plan to renew our health care system. In support of that agreement, the federal government invested $23.4 billion through the Canada health and social transfer and targeted spending, including funding for medical equipment, to accelerate and broaden health renewal and reform.

Drawing on that agreement, first ministers met again in February 2003, committing to the first ministers accord on health care renewal. In response to the important reform and reporting objectives it contained, the 2003 budget increased federal support for health care by $34.8 billion over five years. It also contained an additional payment of $2 billion contingent on funds being available in 2003-04.

In January 2004, the Prime Minister announced that an additional $2 billion would be provided to the provinces and territories. This brought the total increase in federal support over the five year period of the 2003 health accord to $36.8 billion. The majority of this funding was provided to the provinces and territories through increased transfer payments, including $16 billion over five years through the new health reform transfer; $14 billion, including the $2 billion in additional funding, for increases to health and social transfers; and $1.5 billion for diagnostic and medical equipment.

The remaining $5.3 billion was allocated to meet other commitments made under the 2003 health accord, notably increased funding for health programs for first nations and Inuit; the creation of a compassionate care benefit under employment insurance; support for research hospitals; and improved health care technology and pharmaceuticals management.

The Government of Canada's investments over the period covered by the health accord, and its other investments in health and social programs, were implemented as part of a long term legislated framework of predictable and growing support for provinces and territories that includes both cash and tax transfers.

I would like to move on to the 10 year plan to strengthen health care. Last September the Prime Minister and premiers signed a 10 year plan to strengthen health care. As I have already mentioned, the plan will provide $41 billion in new health care funding over the next decade. It also illustrates what we are capable of achieving when the federal, provincial and territorial governments work together toward a common goal.

At the heart of the 10 year plan is the commitment for stable and increased funding starting with immediate funding in 2004-05, to provide an additional $1 billion in this year through the CHT as well as an additional $2 billion in 2005-06.

These investments lead me to the second step, which is the establishment of a new $19 billion base for the Canada health transfer, beginning in 2005-06. The new and higher base level of $19 billion for the Canada health transfer includes $500 million in targeted funding for home care and catastrophic drug coverage, clear priorities for many Canadians.

The plan also proposes a 6% escalator to the Canada health transfer, effective in 2006-07, which will ensure predictable and stable growth in federal transfer support, an unprecedented move to ensure predictable and stable growth in support from the federal government. This commitment fully satisfies the recommendations of the Romanow report on the future of health care in Canada. In fact, this commitment exceeds the recommendations of that report.

Just what action does the 10 year plan take to improve our health care system? It makes investments in these areas: reducing waiting times and improving access, which I know are big desires in my constituency; providing funding for medical and diagnostic equipment; and improving access to home care and catastrophic drug coverage.

I want to talk in more detail about reducing waiting times. What united all the first ministers was a commitment to a meaningful reduction in wait times for health care services. The plan provides funding of $5.5 billion over 10 years for wait times reduction so that Canadians can see tangible progress, particularly in key areas such as cancer, heart treatment, diagnostic imaging, joint replacements and sight restoration.

It is important to mention that the government recognizes that not all provinces and territories are in the same situation regarding the implementation of their wait times reduction strategies. Funding of $4.25 billion from the total of $5.5 billion will be provided through a third-party trust. Therefore, as part of the 10 year plan, provinces and territories will have the flexibility to draw on the funding according to their individual priorities in meeting their wait times reduction commitments.

The funding can be used according to the respective priorities of each province and territory, such as clearing backlogs, training and hiring more health care professionals, building capacity for regional centres of excellence, expanding appropriate ambulatory and community care programs, and tools to manage wait times.

Beginning in 2009-10, $250 million will be provided through an annual transfer to provinces and territories in support of health care related human resources and tools to manage wait times.

Now I will talk about medical and diagnostic equipment, which is also very important in my riding. No health care system would be effective without medical and diagnostic equipment to support it.

That is why, as an integral part of a 10 year plan, the government will provide to provinces and territories a further $500 million for diagnostic and medical equipment in 2004-05. This funding builds on previous investments in diagnostic and medical equipment under the 2000 and 2003 health accords. It will help the provinces and territories continue to improve access to the diagnostic services their citizens need.

Now I want to talk briefly about home care and catastrophic drug coverage. Access to home care and catastrophic drug coverage is a concern for Canadians. As I mentioned earlier, the new $19 billion base level for the Canada health transfer includes an amount of $500 million, which is specifically aimed at addressing these concerns.

It is important to mention that the first ministers were committed to improving access to home and community care services and catastrophic drug coverage. Hon. members will appreciate the importance of improving the quality of life for many Canadians and ensuring that no Canadian suffers undue financial hardship in accessing needed drug therapies.

Now I will talk briefly about reporting to Canadians on these expenditures. As I mentioned earlier, Canadians want to know that their tax dollars are in fact supporting tangible improvements in the health care system. That is why Bill C-39 contains a provision for a parliamentary review of progress made in implementing the 10 year plan.

What I have described is not all the funding that is available to the provinces and the territories. In the debate about federal health funding to the provinces and territories, it is important to remember that this is not their only source of funds from the federal government. For example, equalization payments, which have been in existence since 1957, address horizontal fiscal disparities among provinces by ensuring that less prosperous provinces can provide reasonably comparable levels of public services at reasonably comparable levels of taxation.

Hon. members will recall that last fall federal officials met with their provincial and territorial partners as part of the government's commitment to increase equalization and territorial formula funding by more than $33 billion over the next 10 years. Bill C-24, which is currently before Parliament, sets out this new framework.

This represents a fundamental reform of these programs and establishes the foundation for our commitment to bring greater predictability to the federal government's payments to the less prosperous provinces in support of key public services.

The $33 billion committed to equalization and territorial formula financing payments, when combined with the $41 billion ten year plan to strengthen health care, will result in federal transfers to the provinces and territories of $74 billion. This significant increase in federal transfers illustrates the government's commitment to provide stable and growing funding to provinces and territories.

Although the 10 year plan to strengthen health care makes it clear that money alone cannot sustain health care, the government fully understands the importance of stable and predictable funding to the provinces and territories in support of health and social priorities. In short, the $41 billion 10 year plan represents the best of what the Canadian federation can accomplish and underscores how cooperative federalism has built a country with a standard of living that is the envy of the world.

Before closing, I would emphasize the importance of the bill receiving passage by the end of this fiscal year so that the provinces and the territories can have access to 2004-05 funding and begin to plan for the future. I therefore ask that hon. members continue to provide the bill with timely consideration.

Business of the House

[Tony Valeri, Liberal, Leader of the Government in the House of Commons]

Mr. Speaker, I want to say that once again you have provided an outstanding judgment.

This afternoon we will continue with the NDP opposition motion.

Tomorrow we will begin with the motion standing in my name with regard to the Standing Orders. We will then proceed to report stage and third reading of Bill C-39, respecting the health accord. When this is complete, we will return to Bill C-38, which is the civil marriage bill. This will also be the business on Monday.

Tuesday will be an allotted day.

On Wednesday we will consider report stage and third reading of Bill C-33, the financial legislation; Bill C-8, the public service bill; Bill C-3, respecting the Coast Guard; and Bill S-17, respecting tax conventions.

At 4 p.m. on Wednesday the Minister of Finance will make his budget presentation. We shall take up the debate on the budget on Thursday.

As well, with respect to the hon. member's question, I would say to the hon. member that in the fullness of time we would have the Judges Act in the House. I will take every opportunity to ensure that House leaders are fully informed of when that legislation is to come to the House.