Madam Speaker, the proposal the member puts forward certainly is debatable. I do not have the figures here for transfers to the province of Quebec. Looking at tax revenues going out and transfers going in, I would suspect that at least recently Quebec has not been hard done by, nor has Nova Scotia. At some point we will be net givers. I hope that at some point the province of Quebec will be a true have province according to the fiscal definitions.
If the question is would it not be better if Nova Scotia just collected its own taxes and kept everything it collected, I would like someone to tell me how it is going to decide what 32 per cent of hospital beds should be shut down in that province. I would like somebody to explain which universities will have to close and how people with my type of background will be able to get a university education.
The reality is that not each province at any given point in time is able to pay its way on all these programs. Equalization is not there as a handout; it is supposed to be a hand up. It is supposed to allow the provinces, dealing strictly with equalization, to have enough resources to try to build the infrastructures within their economies so that they can be competitive. It is not meant to keep them in poverty; it is meant to try to take them out of poverty.
When dealing with established programs financing I would caution my colleague to be very careful. My understanding is that those provinces which get EPFs, at least the seven that get equalization, are getting more than what they would get if they just kept their own tax base.
The question is not whether it is better to be sovereign. The question is whether we can work together as a nation with all our component parts to ensure that if the principles are no longer valid then there will be a debate on it. If the principles of a universally funded health care system are not valid and assistance to post-secondary institutions is not valid then let us have a public debate on it, and not necessarily here.
Let the Canadian people speak. We would find that the people in the Gaspé, the people on the greater northern peninsula and the people from the plains of Saskatchewan might jump up and say: "What are you trying to do to our country?"
The question is not whether or not we should have these programs. The question is whether or not we are able to afford them and whether or not the federal government as the senior partner in Confederation is prepared to work with each individual province to ensure that these programs continue.
I want to speak about EPFs and health care in the province of Quebec. The government in Quebec has done some very neat things in dealing with trying to keep the escalating costs of health care from going through the roof. Other provinces should look to Quebec to see what it has done.
I remember reading an article. One of the major costs of the escalation of health care is that every community has an out patient service and in order to properly staff an out patient service, look at the number of people on average coming through and determine how many doctors have to be there, what equipment has to be there, an anesthesiologist, a surgeon on duty, all of those things, and it is based on volume.
Some people say as many as 80 per cent of the visits to an emergency unit can be handled by a GP. They can be handled by a nurse or a nurse practitioner. Because we have become used to it being free perhaps it is over used. Perhaps it is abused.
The province of Quebec decided not to deny anybody health care but make alternate health care facilities available. If I were in Montreal and walked in needing stitching of a cut on my hand it would agree to do it but it would cost me a few dollars because it is not an emergency service. If I went across the road to the clinic I would be covered under the health care program.
That has saved the Quebec health care system tens of millions of dollars. There are efficiencies that we can look at. The federal government must lead in sharing these good examples as the province of Quebec has done.
I was in London, Ontario, at St. Joseph's Hospital, and London decided it had to better manage the health care budget it had in that hospital. It came in with a new management called total quality management, TQM. Within a year not only did it have better and happier staff in the hospitals, not only did it handle more people in a more efficient manner but it saved about 13 per cent of its budget. It was a large budget. It had not even intended when it set out to try to save money.
In health care, in post-secondary education, we have to lead the way. There are fewer dollars here. We have to lead the way in rationalization of services, both in the health care and in the post-secondary educational system.
I would leave my hon. colleague with this comment. I would ask him, and maybe he has figures to the contrary, to check with his party's research bureau to find out whether the province of Quebec, at this point at least, has a net output of taxes or a net input of taxes. If he could find that out I would be pleased again to debate the issue.