House of Commons Hansard #29 of the 35th Parliament, 2nd Session. (The original version is on Parliament's site.) The word of the day was provinces.

Topics

Petitions
Routine Proceedings

12:10 p.m.

Reform

Ed Harper Simcoe Centre, ON

Mr. Speaker, I have two petitions to present today.

The first petition requests that the Government of Canada not amend the human rights act to include the phrase sexual orientation. The petitioners fear that such an inclusion would indicate societal approval of homosexual behaviour. The petitioners believe that government should not legitimize this behaviour against the clear wishes of the majority.

Petitions
Routine Proceedings

12:10 p.m.

Reform

Ed Harper Simcoe Centre, ON

Mr. Speaker, my second petition contains the signatures of 236 constituents.

These petitioners point out that this government is currently spending $90 million a day more than it is bringing in. The petitioners request that the government cuts spending in order to balance the budget by December 31, 1998, without any new taxes or tax increases.

Questions On The Order Paper
Routine Proceedings

April 19th, 1996 / 12:15 p.m.

Saskatoon—Dundurn
Saskatchewan

Liberal

Morris Bodnar Parliamentary Secretary to Minister of Industry

Mr. Speaker, I ask that all questions be allowed to stand.

Questions On The Order Paper
Routine Proceedings

12:15 p.m.

The Deputy Speaker

Is it agreed?

Questions On The Order Paper
Routine Proceedings

12:15 p.m.

Some hon. members

Agreed.

The House resumed consideration of the motion that C-18, an act to establish the Department of Health and to amend and repeal certain acts, be read the third time and passed.

Department Of Health Act
Government Orders

12:15 p.m.

The Deputy Speaker

The hon. parliamentary secretary had the floor and if he wishes he is entitled to speak for another 36 minutes.

Department Of Health Act
Government Orders

12:15 p.m.

Eglinton—Lawrence
Ontario

Liberal

Joe Volpe Parliamentary Secretary to Minister of Health

Mr. Speaker, I do not know why you would want to limit me. We are talking about something that is fundamental to the Canadian health system. We are talking about responsibility, jurisdiction and accountability.

To reframe everything for everyone's edification, when the debate was interrupted by question period I was talking about jurisdiction in the Constitution of Canada. I was looking at why and how it was flexible and why and how the role of the federal government has evolved and continues to evolve under those jurisdictions.

When interrupted I was making reference to section 92. Canada's Constitution does not begin and end with section 92. That is most particularly true in the field of health. Very briefly, let me describe what that means.

I see my esteemed colleague has joined the ranks of the House. He is listening very attentively so that I make all of the appropriate references under the Constitution. I refer to the Minister of Intergovernmental Affairs who is a constitutional expert. I look forward to his applauding my references.

Section 91(27) gives the Parliament of Canada exclusive jurisdiction over criminal law, the basis for a number of laws protecting public health and safety. Section 91(2) assigns responsibilities to the federal government for international and interprovincial trade. This forms the basis for federal regulations on drugs and medical devices, as an example.

Section 91(11) gives the federal Parliament explicit power over quarantine and marine hospitals, which I would add, reveals a good deal of the thinking back in 1867 about where matters cease to be local and begin to take on national significance.

Section 91(7) concerns military and veterans. Section 91(8) has to do with the federal public service and section 91(4) concerns aboriginals and lands reserved to aboriginals.

Every one of these powers establishes or implies a clear federal role in health issues. They account for the considerable array of the duties and responsibilities set out in clause 4 of Bill C-18.

Moreover, they account for the vast majority of Health Canada's operating expenses. Health, when viewed from a perspective of federal constitutional responsibilities, is clearly a good deal broader than the health care delivered. It is a comprehensive view and has been for many years.

This is where other federal powers have come into play. Much has been made in the course of debate of the federal spending power. That is specified in section 91(1A) of the Constitution. Much has been made of the power to raise money by any mode of taxation for which there is provision in section 91(3).

However, do these powers broaden the sphere of federal regulation? Do they offer the opportunity for jurisdiction by stealth, as it were? The reality is that nothing in the Constitution gives the federal Parliament the means to regulate provincial matters in the guise of spending powers. I think my hon. colleague would agree. It can attach conditions to the funds it makes available to the provinces. However, just as it cannot compel the provinces to accept the funds it offers, neither does it buy jurisdiction when provinces accept those funds.

Clause 12 of Bill C-18 makes this limitation clear. It continues a point that was made in the existing Department of National Health and Welfare Act:

  1. Nothing in this Act or the regulations authorizes the Minister or any officer or employee of the Department to exercise any jurisdiction or control over any health authority operating under the laws of any province.

This is why the Canada Health Act does not forbid user fees, if I can conjure up the term, nor does it require provincial legislatures to forbid them. I ask members to take careful note of the language being used. It simply makes it clear that any province that decides to finance medically necessary health services with user fees can expect a corresponding reduction in federal funding. They cannot have it both ways. The government is not obliged as a federal entity to spend money where it has a fundamental objection. This brings me to another myth, that is, the federal government is intruding in provincial jurisdiction.

It has been a constant theme in opposition commentary at almost every stage of the debate so far. Both opposition parties have made common cause in their belief that the best government in Ottawa is no government in Ottawa.

That is difficult to understand from members who get themselves elected to come to Parliament to represent the national interest. The motivation for the federal government's involvement in health financing does not derive from any desire to centralize powers. No one here has a wish to invade a field of purely provincial jurisdiction.

The federal role in health has been an exercise of leadership. There are those who would hold that leadership is not a word that is acceptable. Some of my colleagues opposite might think it is even a dirty word today. Some believe it to be a power grab. We should never apologize for saying that federal leadership in health is a commitment that Canadians expect and want exercised. I dare say that examples of that leadership abound.

We based our commitments on health to Canadians during the 1993 election campaign in a belief that when there are national needs, we need national action. It was part of our platform as a party and part of our platform as a government. It was the basis of programs outlined in the red book commitments. It continues to be the basis of action since. I would like to cite an example.

The Minister of Health has announced a leadership initiative in the blood system. A question came up today in question period. The government understands that the blood system needs to be restructured. Rebuilding the system is appropriate and right for the government to pursue in partnership with other systems.

When we recognize that, we give ample evidence of the kind of leadership role that the government has been exercising. A restructured system can only enhance the government's current efforts as a regulator to ensure safety and quality of the blood supply.

It is essential, I might add, as the minister underscored in question period, to act now and to begin the process before Justice Krever and his inquiry makes the final recommendations. There is no need to wait. The final report will not be ignored. It will be looked at as a building block of the new system.

Let me offer another example, if I may, of the kind of leadership Canadians want and support. In July 1994, some 18 months ago, the then Minister of Health, announced the Canada prenatal nutrition program. The program is helping to support other programs for pregnant women who have a high risk of delivering low birth weight babies. Members probably want to know why that is important. These programs provide food supplementation, nutrition, lifestyle counselling and information to such women.

The government designed this program to dovetail with existing provincial initiatives to encourage them where they do not now exist. Much of the program in the red book was based on building partnerships, not stimulating competition, at least in the area of government services. It was not designed to duplicate good programs that were already in place or to override them.

It should be noted that it could cost up to $60,000 to meet the health needs of just one low birth weight baby. That is just the immediate financial cost. The price in developmental delays that can echo through the lifetime of such an individual, family and society are incalculable. These children start life well behind others. Many, unfortunately never catch up.

When you realize that 21,000 such babies are born each year, you begin to get an appreciation of the sheer magnitude of the problems being addressed by that program.

To hear some during the course of this debate, the federal government should just stick to its knitting and stay out of issues such as this. They seem to suggest that if there is no need for leadership, perhaps some provincial government may take action. If less affluent provinces cannot afford to take action, it is just one of those things, c'est la vie, as they say en français. That is their stand. It is not ours.

We have looked at the facts and the needs and we have taken action. Canadians will not buy limp excuses for inaction from my colleagues opposite, not for one second. They know that leadership does not involve the use of the word perhaps or the word may. They recognize that leadership is about seeing what needs to be done and finding the best way to do it.

Of course, the defining example of federal leadership in health has been our staunch defence of the principles of the Canada Health Act. The Minister of Health has been clear in his stand. He has said that he will debate the principles of the Canada Health Act with anyone, anywhere, at any time. One thing should be clear to all colleagues. Although the five principles may be debatable, they are not negotiable.

The government has never claimed that it wants to tell the provinces how to run their health systems. However, it does claim a nation building role of setting values that Canadians share no matter where they live.

It is equally clear that Canadians trust the government to defend those values. Canadians will not support the whittling away of the principles of medicare which some provinces have attempted. Canadians are clearly supportive of the federal government in its resolve to stand by those principles. Clearly, they do not accept such thin rationale, including the ones trotted out here by the opposition parties which pretend to support the principles of medicare while permitting their decline and erosion.

Leadership means taking a stand on fundamental issues. Medicare is one of those issues. I dare say that Canadians are happy of it.

Let us put the leadership issue into context. There is a real world of relations between the federal government and the provinces. It is not one of differences but one of co-operation. The leadership the government exercises in the field of health does not come from the

barricades. It comes from a long tradition of commitment to the health of Canadians. That commitment is shared by the provinces and the territories.

It is something that cannot be reflected in a written Constitution. It does not appear in the media obsession of conflict and tough talking sound bites, in five-second clips; yet it is a reality, day in and day out.

For us to achieve our health goals for Canadians, the federal government needs to work with provincial and territorial governments, and so we do. All governments need to work with health professionals and administrators, interested organizations and others with a contribution toward better health for Canadians. Once again, we do.

That co-operation takes place in so many ways. For example, we have 12 distinct but interlocking systems of health care in Canada. At a time when some are questioning the merits of federalism, it says a lot that governments have worked together so well that Canadians look at twelve systems and see only one.

They see medicare as a national program even if it consists of 12 different provincial and territorial health insurance plans. One reason for that almost seamless approach to health in Canada is the constant process of consultation and co-ordination that goes on.

One of the important vehicles we have is the conference of federal, provincial and territorial ministers of health. This forum allows governments to work together on research, policy development and practical issues.

This process of co-ordination allows governments to compare notes on the big issues that affect all of them. Consider health system renewal. We have clearly moved passed the time when the nips and tucks to the status quo will do. The issues are moving too fast for us to tinker with old approaches and the old paradigms in many cases.

Consider the broad issues. We have an aging population, which is already creating important implications for how we structure and how we deliver care. We have health inequalities that face the poor, rural dwellers, aboriginal people and women. We have a group of issues which speaks to how the health system works; cost control, the supply and distribution of physicians and the respective roles of all health professionals and need analysis.

The balance between institutional and community based care and the appropriateness and intensity of care are significant concerns. They all need good answers.

Leadership means thinking through these issues and their implications for the health of Canadians in a comprehensive and intelligent manner. The federal government has taken a leading role in these efforts through initiatives such as the national forum on health.

The federal government has never claimed sole ownership of this issue. We have recognized the impressive work of the provinces and the territories because they too exercise leadership. Within health care every province and territory has taken innovative reform and renewal actions. We have made clear our belief that we can learn from each other.

We can all contribute to addressing common priorities. Some are as basic, as the research into clinical practice guidelines. It is hard to believe but we have no firm idea how effective some common medical practices are in terms of either costs or results. This is an affliction for all western societies. Governments are working together to address issues such as this, but it is something governments alone can do.

For example, we worked with health professionals and other interested people in organizations. They are experts as well as users of the system with a stake in finding the answers. They continue this in many other areas of research, health, policy and program delivery.

Federal leadership in health is not about loud claims of moral power or of playing the constitutional trump cards. The legacy of leadership is not a hollow relic of the days when government coffers were bursting. It is a living tradition of looking out for the interests of all Canadians. It is a living tradition of seeing the gaps that affect the health of our citizens and in doing something to meet the need.

In a previous item of legislation, the old Bill C-91, there was some reaction to whether the Minister of Health would assume the responsibilities and would be held accountable for all of his responsibilities. Even though there was no question in our minds, we had a good representation by the hon. member for Fredericton-York-Sunbury who presented an amendment to eliminate all confusions. It was widely received by all members on both sides of the House and passed unanimously.

That is what we mean by looking at leadership. Leadership can mean action by this government alone but so often these days it means contributing to shared work. It is a form of leadership the government still believes to be absolutely important. It is one that Bill C-18 permits us to carry out.

I hope all members of the House will reflect on that carefully and give it resounding unanimous support.

Department Of Health Act
Government Orders

12:35 p.m.

Bloc

Antoine Dubé Lévis, QC

Mr. Speaker, I am pleased to rise in this debate on Bill C-18, given that I am a new member of the Standing Committee on Health. I have just come from the Standing Committee on Human Resources Development where, today, discussions were continuing on the bill establishing the Department of Human Resources Development. In my first speech on health, I have to recognize that the debate is of the same type.

Unfortunately, Quebecers' health care system is not entirely the product of political decisions and choices made in Quebec. The federal government has meddled in Quebec's affairs on a number of occasions. We must remember that the Constitution establishes health as a provincial matter.

To begin with, it should be remembered that the Quebec health care system existed long before the federal government intervened. The Government of Quebec set up the system and has always ensured its smooth operation. There are those who will claim that socialized health care was developed in Ottawa, but that is not the case.

The federal government simply passed the legislation justifying and providing the means for seizure of provincial jurisdictions. Every intrusion by the federal government through its legislation has brought a reaffirmation from the Quebec government of its control over and desire to exercise its jurisdiction over health care.

In 1987, Thomas Dupéré, of the Commission d'enquête sur les services de santé et les services sociaux du Québec, wrote that the implementation of federal programs had simply moved to the federal arena a debate which had begun at the provincial level and would have led to the same results in the same time span.

Intrusions started in 1943, when the Federal Department of Health established a national action plan on medicare. In 1945, it even proposed the implementation of a national program under full federal jurisdiction. And the federal government had the resources to realize its ambitions.

I have some difficulty concentrating on my speech because of the noise around me. Now, that is better.

So, from 1942 to 1947, Ottawa received more than $2 billion from Quebec which in return got only $100 million, in other words a pitance.

It is very clear that the federal government wanted to go even further in its determination to control and to give back to the provinces, not the tax powers they had before the war, but subsidies tied to the implementation of programs set up by the Government of Canada. That is what happened.

This was the beginning of a long centralization campaign by the federal government. In reaction, the provincial government of Quebec created its own income tax, Ottawa having refused to withdraw. Thus was born dual taxation from Quebec and Ottawa.

Successive Quebec premiers-among them Maurice Duplessis, with his famous slogan "Give us back our due", Jean Lesage and Daniel Johnson Senior-constantly tried to thwart this intrusion from the federal government and this seizure of some of the provincial financial powers.

This is how the federal government took upon itself the responsibility to finance, to some extent, the cost of health care and services. In so doing, it also grabbed the power to oversee the development and administration of the health care systems established by provincial governments.

Provinces wanted to improve their systems, but they had to organize and finance them at a time when they had just been stripped of some tax fields. As a result, they had to beg money from Ottawa. It is still the same today. The federal government may launch new ideas, but the provinces must find the money to fund them.

Let us turn to constitutional powers.

The federal government has violated the Constitution of Canada and still does so today. This is why the Prime Minister does not want to discuss the Constitution. He wants to proceed without discussing it.

However, the government itself admits that health and welfare are areas of provincial jurisdiction. Consequently, the ever growing federal structures and programs in these fields constitute a form of interference which periodically sours federal-provincial relations.

More precisely, the Constitution Act of 1867 gives the provinces complete authority in matters of health, and section 92.7 gives the provinces jurisdiction over the whole field of health and welfare. It is in the Constitution.

In order to bypass what was perfectly clear in the Constitution, the federal government invented a roundabout way to interfere and called it its spending power.

The federal government cannot interfere directly in areas of exclusive provincial jurisdiction. So, it uses an indirect mechanism. It gives provincial governments grants with strings attached; the provinces must abide by certain conditions for fear of losing these contributions.

Instead of using its lawmaking power, the federal government uses its spending power in areas of provincial jurisdiction. In our opinion, it amounts to financial blackmail using our own tax money.

In addition to this manufactured power, the federal government is using some legislative powers which should be limited in scope. A case in point is legislation derived from the criminal law such as

the Food and Drugs Act, and the Narcotic Control Act. The government provides services to or pays for the medical expenses of specific clients such as military personnel, RCMP officers, inmates, natives, immigrants and refugees. The federal government tries to increase its responsibilities and to look important by passing legislation in all these minor areas.

Moreover, the federal government sometimes justifies its interference in areas of exclusive provincial jurisdiction, invoking an ill-defined concept interpreted in a very broad sense, that of national interest.

Managing the Department of Health and all the small programs we described earlier which come under Ottawa's responsibility uses up only a small part of the budget, but constitutes the bulk of the administrative activities of the Department of Health. Without federal interference in areas of provincial jurisdiction, the department would be small and would only manage residual federal powers.

In fact, the largest part of federal expenditures is comprised of amounts paid to provinces through transfer programs. The federal government gives back with one hand part of what it took from provinces with the other. This is an example of very costly duplication which sustains the conflictual situation with the provinces and exists only because Ottawa is proud to be the one to sign the cheques. Meanwhile, there is less money for health.

Let us see how this money is distributed to the provinces. In theory, the Canada Health Act passed adopted in 1984 establishes the conditions for the allocation of federal grants in the health area. In fact though, these contributions are paid pursuant to the Federal-Provincial Fiscal Arrangements and Federal Post-Secondary Education and Health Contributions Act, what we now call established programs financing. Transfers to provinces do not come from the health department's budget, they are made by the Department of Finance.

This creates a bizarre situation where the Department of Health establishes national objectives and standards that provinces must abide by if they want to receive transfer payments, but the finance minister is the one distributing the money and determining the amounts. That mechanism makes a financial issue out of one which concerns only federal-provincial arrangements in the health area. In reality, the health minister is virtually a minister without portfolio as for the majority of the federal health budget.

This splitting of authority between the establishment of standards and financing results in a lack of cohesion between the development of the health policy and its implementation. On the one hand, the health minister wants to impose higher standards and closely monitor their application, which results in cost increases for the provinces, and on the other, the finance minister wants to reduce his deficit at the expense of the provinces and thus is cutting payments.

In the Spring of 1995, the National Council of Welfare, an organization whose mandate is to advise the health minister, cautioned her to beware of such a situation by saying, and I quote: "It would be extremely hypocritical to reduce contributions to the provinces -while increasing the requirements they would have to meet".

Despite fiscal arrangements, the transfer act is a federal statute establishing payments to the provinces unilaterally and without any consultation. Since 1977, these amounts have either been reduced, frozen or de-indexed. Their evolution no longer follows the real costs of provincial programs. In that regard we can say the federal government has broken its commitment to health care.

For over 10 years, the federal government has paid lip service to health care while at the same time continuously reducing its spending in this area.

Through established programs financing or EPF, the federal government transfers money to the provinces for health care and post-secondary education. The amount given to the provinces through EPF is paid partly in cash and partly by transferring tax points from the federal government to the provinces.

In reality, the federal government only spends the amount in cash that is accounted for in budgetary expenditures. Under the tax point transfer, a portion of federal taxes goes to the provinces. This is a way for the government to give back to the provinces some of the taxation powers it took away from them in the 1940s. How generous.

As a result of repeated cuts, Quebec will soon stop receiving cash payments and have to make do with the tax points it already has. Paradoxically, the federal government will soon stop spending anything out of its own pocket but will continue to impose its own standards on Quebec.

Since it was put in place in 1977-78, EPF has led to a unilateral withdrawal on the part of the federal government. When EPF came into effect, federal spending on health care was based partly on the national average and partly on the provinces' actual expenditures and accounted for some 50 per cent of total health spending.

Contributions to EPF were based on spending during the 1975-76 reference year and indexed to the GNP average per capita in the three previous years. This clearly showed a commitment to

ensure a relatively stable increase in the federal government's contribution based on the growth of the Canadian economy.

Since 1986, the federal government has made repeated cuts to EPF for health care, thus weakening, then severing the agreed upon link between the increase in federal contributions and economic growth. In fact, Liberals have continued to reduce financing, a practice they had vigorously condemned when the Tories were in power.

In 1986, the federal government announced a 2 per cent reduction in the EPF indexing factor, which meant that health transfers would follow the increase in the GNP, less 2 per cent.

In 1989, the indexing factor was once again reduced by 1 per cent, which meant that health transfers would follow the increase in the GNP, less 3 per cent.

In 1990, per capita allocations were frozen for two years supposedly. While health costs kept rising, the federal government stopped factoring in inflation. The freeze imposed by the federal government did not stop people from falling ill. This is one area where magical thinking does not work.

In 1991, this so-called temporary freeze was extended until 1995. In 1995, the current government announced a new program, the Canada social transfer, which entailed further cuts totalling $4.5 billion over two years. There is no guarantee whatsoever that more cuts will not be made in the future.

As regards the calculation of the federal contribution, the National Council of Welfare had this to say in its spring 1995 report: "No formula is provided in the budget to calculate the amount payable. Based on recent events, the federal government should impose a formula or an arbitrary amount".

So, actual health care costs are not taken into account at all when calculating federal funding. The government only pays what it is willing to pay, depending on its mood and on the amount of its deficit. The national council was right in asking for a formula that would take into account the actual needs of people, instead of the best interests of the federal treasury.

As for the Canada social transfer announced in the 1995 budget and now in effect since April 1, the National Council of Welfare, which is a federal organization whose role is to give advice to the Minister of Health, said: "The main aspect of this financial tool is that federal funding for all these programs will undergo major cuts".

Prevention programs in the health sector will be the first ones to be cut by the provinces, in an effort to solve their immediate financial problems. In the long term, this will endanger the health of Canadians.

All these cuts have already had harmful consequences. It is estimated that, between 1982 and 1994, Quebec suffered a shortfall of $8 billion because of underindexing, freezes or cuts affecting federal contributions. This is a large amount. This shortfall is partly responsible for the increase in Quebec's debt and income taxes, since the province refused to reduce its health care budget at the expense of Quebecers' health.

The proportion of Quebec's health care expenditures paid with federal transfers went down from 45.9 per cent in 1977-78 to only 33.7 per cent in 1994-95, a 12.2 per cent drop. Even though the federal withdrawal triggered a tax increase at the provincial level, the central government still maintained the same taxation level.

According to a study conducted by the C.D. Howe Institute, while transfer payment expenditures levelled off between 1988 and 1992, spending related to the other federal programs increased by 25.5 per cent. Transfers to the provinces for the health sector thus absorbed part of the federal deficit. While the federal government was spending too much, it was telling the provinces to tighten their belts.

The federal government could have found and still could find the money it needs for the social programs by eliminating or reducing its expenditures and closing some tax loopholes. This would make for a fairer tax system and would help bring in more money to maintain and improve the services and to reduce the debt. However, the federal government does not dare to cut the perks enjoyed by the good friends of the finance minister, the backers of Liberal party and the family of the Prime Minister.

Based on these figures and on the actions, and not the empty promises, of the federal government, we have to realize that the only real threat to the health of Quebecers and Canadians stems from the irresponsibility shown by the central government.

The 1984 Health Act was passed to ensure that the provinces affected by the economic recession of the 1980s would not tinker with the health system, even if, at the same time, the federal government was reducing transfer payments.

All of the provinces protested against this act, because the Canada Health Act contained new conditions above and beyond those already in effect. These new added responsibilities contrasted with the decrease in federal contributions resulting from the 1977 financial arrangements.

On the use of financial pressure tactics, allow me to make a few polite comments about the blackmail used by the federal government to force the provinces to totally support the federal vision. In 1983, Monique Bégin, the Liberal Minister of Health of the day, cautioned us: "The total amount of the contributions paid by the Government of Canada to the provinces for health services is very significant. Any province that constantly refuses to meet the conditions will lose the federal cash contribution and will probably be hard put to compensate for this loss. If the total contribution were to be withheld, health services in that province could have to

be suspended. This is the last thing the Government of Canada wants for Canadians. This option could create a situation worse than the problem it set out to solve".

What this means is that the confrontation strategy and the will of the federal government to control the provinces is, in fact, harmful to the health of the citizens themselves.

The dual initiative by the federal government, that is the creation of a national forum on health care without consulting the provinces and the stricter criteria and conditions contained in Bill C-18, has drawn a lot of criticism not only from the Government of Quebec-and this may be of interest to the new Minister of Intergovernmental Affairs-but from other provincial governments as well. He may want to watch this situation closely.

Let us see what the federalists have said about that. On September 19 of last year, the Conservative health minister of Ontario, Jim Wilson, criticized the federal government's lack of flexibility. I would like to apologize to the Speaker for my poor pronunciation in English, but I will go ahead anyway and do the best I can. I would add that I am taking courses to improve my English.

"I think it shows inflexibility on behalf of the federal government".

He also stated that we should not let the federal government dictate its interpretation of medicare to the provinces.

"The federal government be fought on principle for dictating its interpretation of medicare to the provinces".

The same day, Ralph Klein, Conservative premier of Alberta, also criticized the federal government's lack of flexibility.

"Marleau does not send a good signal to Quebec. It says there is no flexibility within the confederation".

The NDP health minister of British Columbia, Paul Ramsey, added that Mrs. Marleau-who held that federal portfolio at the time-had to change her approach. He stated that if medicare was threatened by the actions of the provinces, it was because of the $7 billion cuts over two years made by the federal government in the areas of health, welfare and post-secondary education. I will try another quotation in English.

"Last February's federal budget, which cut transfers to provinces for health, welfare and post-secondary education by $7 billion dollars over two years, has forced provinces to look at unpalatable cuts that threaten medicare".

In a joint communique issued at a health ministers meeting, the provinces stated that the federal government's will to make unilateral decisions with regard to the funding of health care, the interpretation of standards or the setting of arbitrary deadlines for consultation would not help in solving the problem.

"It is not helpful for the federal government to engage in unilateral decisions regarding funding or interpretations and arbitrary deadlines".

Concluding this section on the forum, it is obvious that reducing federal contributions causes a serious problem. Federal intervention was justified only by spending power, so any change to the federal health legislation without changes to the financial aspect runs the risk of having an absurd outcome.

Any increased provincial obligation without a corresponding increased federal contribution is tantamount, not to the exercise of federal spending power, but rather to the creation of a federal power to make the provinces spend money for it, and under its conditions.

In fact, the federal government's main objective is to lessen its financial burden related to the huge debt it has accumulated, at the cost of the provinces' fiscal health. In other words, the central government pushes a portion of its debt off on the provinces. By thus increasing the tax burden of the provinces, Ottawa lessens their manoeuvrability and forces them to make difficult, agonizing choices in its stead.

Because the federal government is not capable of respecting its commitments and because, all its fine words and the standards it claims to be setting unilaterally notwithstanding, it is the one threatening the health system with all these cuts. The federal government ought to decide to withdraw from the health field, one in which it ought never to have set foot to begin with. In this case, it ought to assume responsibility for its decisions and transfer tax resources to the provinces, in order to allow them to take over.

I have attempted in these past few minutes to establish this position, which in all aspects reflects the position of the various governments of Quebec over the years and the constitutional demands of the Government of Quebec. As I pointed out just now, since the new government has been in place, I have been a member of the standing committee on human resources, and in my daily work on that committee, particularly as the critic for training and post-secondary education, I have seen the same phenomenon at work there: an attempt to interfere-more than an attempt, constant interference, ongoing, and increasing.

Despite the promises of change the Prime Minister made in the last referendum campaign, when things were getting close and it looked like the referendum might go to the yes side, in the final days, he made promises. Before he became prime minister, we heard him speak for the no committee, stating time and time again during the referendum campaign that the federal government should and would agree to change its centralizing attitude so frequently criticized by Quebecers. We thought there would be a change. No chance.

Again yesterday, I spoke on Bill C-11, the old C-96, which dragged on at length and is now being re-introduced. Although these are old bills in new clothing, there has been no change to the federal government's centralizing attitude.

An attitude based solely on the government's grasping for increased powers.

Here is a parallel. We passed a resolution on the distinct society and what happened? In all of the government's actions, in matters of health and human resources development the government went from the notion of distinct society to the simplistic recognition of Quebec as the principal homeland of French language in North America.

This is a widely known historical fact, but it adds nothing. I am not the only one to say it. So does the leader of the Liberal Party, who is a full-fledged partner of the no side and of the present Minister of Intergovernmental Affairs. This full-fledged partner said that this gives nothing more to Quebec since it cannot lead to a transfer of powers, increased responsibilities, further clarification nor a greater clarity.

There are some grey areas with regard to the government's residual powers. We, Quebecers, we, the official opposition, had hoped to see the federal governement deal with this aspect in its new effort to decentralize. We had hoped it would clarify matters and put an end to the remaining grey areas. But on the contrary, it perpetuates them.

What is worse in the case of the bill making the department of Human Resources Development official as in this one, is that we can see that the government has adopted a soft pedal approach, a go slow approach, a slow combustion approach. You put a little bit of wood in the stove, you let it smoulder all night, and then you add a little bit more wood, hoping that Quebec's emotions will simmer down, that Quebecers and their national feelings will cool down and, with time, journalists and the media will pay less attention to the issue, which has been so long on the front page; if there is less coverage, people will not hear about is as much. This is the soft pedal approach .

Yesterday I said Bill C-11 was the law of silence. Today being Friday, I will be kinder. I notice a silence which is probably more understandable. Yesterday, when the government was passing a bill to officialize something that has been in existence for two and a half years, a bill creating the Department of Human Resources Development, I was explaining that if you exclude the servicing of the debt, the budget of that department was the largest item in the total federal budget, with more than 40 per cent of all expenditures.

At the Department of Health, they tried to reduce the figures by every possible means. When you look at the budget allocated to the Department of Health this year, you no longer find transfer payments for health, because they are listed somewhere else. Therefore, the budget of the department is only $1.8 billion. This is not much. But most of the spending is elsewhere, in other sections.

For example there is some in the Department of National Defence. There are many interventions. The federal government is there, but trying to hide the fact; it would have us believe it is giving way to the provinces, letting them manage their own business.

The very last amazing brainwave of the federal government is the famous Canada social transfer, which has been in existence since April 1st, although few people know it. What is it? Let us remind people. The Canada social transfer is a merging of all federal transfers for health, post-secondary education and welfare.

From now on, provinces will supposedly be able to set their own priorities. However, all this comes with a $7 billion cut. They are transferring to the provinces the cuts the federal government did not dare make. And so they should, in a way, but at the same time, the federal government is withdrawing from its financial commitment. And that is unacceptable.

The insult-the parliamentary secretary confirmed it this morning-is to attach to health transfers five principles, five inescapable conditions with thinly disguised threats. The government is saying to the provinces: "If you do not accept national standards, in the Canadian sense of the word, you may be penalized by cuts in funds allocated for health or post-secondary education, but especially health".

I heard excellent speeches in which it was said: "The health of Canadians is a concern to us". The former minister was particularly eloquent in the House; every time someone would ask her a question, she would start by saying: "Mr. Speaker, you know I am very concerned with the health of Canadians. That is why we will intervene here and there". She was asked why she had not consulted with the provinces, like she did with the health forum. She would then answer: "But you know, the health area is very important; there are stakeholders in it. We had to know their views".

Mr. Speaker, you are signalling me my time is up. I will conclude with that. I could go on and on. I will have the opportunity to come back on the matter since I will now sit on the health committee.

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1:15 p.m.

Reform

Ed Harper Simcoe Centre, ON

Mr. Speaker, I am pleased to participate in the debate on Bill C-18. Before I do that, I would like to respond to some of the comments made by the member for Eglinton-Lawrence earlier in the debate.

He started by talking about the leadership this government is providing in dealing with the crisis in health care. I suggest that the problems we are facing are being magnified. Indeed there is no leadership. No direction is being provided by the government to deal with the crisis in health care.

The member was looking back in his speech, talking about the Fathers of Confederation and the Constitution. Those are just words to justify the status quo. There were no forward looking solutions to deal with the problem. Instead there was a look back to justify the status quo.

The bottom line is that the federal government, while assuming the role of a minor payer, still wants to be the major player. It is not in the cards. It is going to change whether members realize it or not.

As an Ontario MP, as I am, he has to be very aware of the crisis in our province, the long waiting lists and the bed closures. It is projected that Ontario will spend $17 billion on health care and that the federal government will contribute $6 billion toward it. That is a far cry from the 50:50 cost sharing that allowed the federal government originally to intrude in what is a provincial responsibility.

The province of Ontario is looking for assistance. It needs help. It is not looking for rhetoric. It has a problem and it is looking for some help from the federal government in dealing with it.

One of the most interesting things that the member said in his earlier presentation was that the five principles of health care are debatable but not negotiable. Why in the world would anybody debate them if there is to be no negotiation? What the government is saying is: "My mind is made up. Do not in any way confuse me with the facts".

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1:15 p.m.

Reform

Dale Johnston Wetaskiwin, AB

Like the Liberal whip.

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1:15 p.m.

Reform

Ed Harper Simcoe Centre, ON

That is right. It is debatable but it is not negotiable. I seem to recognize that same line in many issues we are dealing with in the House. Health care is a great example of the problems we are in: It is debatable but in no way is it negotiable.

One cannot cover, in our health care system, 100 per cent of the cost 100 per cent of the time. That never was a reality and it has never been more true than it is today. The member alluded to our aging population. It is putting tremendous pressure on a system that is in dire need of an overhaul. It is not just Ontario that has a health care crisis. Every province is looking for negotiation, discussion and flexibility in the role of the federal government, a flexibility that sadly is not there.

This is a housekeeping bill. There are really no monetary expenditures involved so we have no grounds to oppose it. I should not say there is no cost. There is always a cost when we debate a bill in the time it takes to debate it. While there is no reason to debate the reorganization, there is a very strong reason to discuss health care. Reorganization is important. Rethinking health care is critical.

Everyone agrees that we must change, that we have a serious problem. I paraphrase the Prime Minister when he spoke in an interview with CBC radio. He said that the system was put in place to protect Canadian citizens from catastrophic crises in health and the family so they would not lose their homes. He said very clearly what we have been saying, that this was never intended to cover 100 per cent of the problems 100 per cent of the time.

He also alluded to the fact that the 10 per cent of GDP spent on health care is too high. It is the second highest in the world next to the United States and must be reduced. Those are the words, but where is the plan to accomplish that? There is nothing. What we got in the debate this morning were more words and more rhetoric with no plan to deal with health care.

Medicare is our most valued social program. Part of the rhetoric from the other side is that we are out to savage and destroy medicare when the reality is that we are the only party in this House that is dedicated to saving medicare for those in our country who need it. It needs support. It needs fresh thinking.

One of the major threats to medicare, indeed to all our social programs, is Canada's deficit and debt. The overspending that has taken place over the years has put us into a tremendous debt hole. That is the real threat to health care.

The finance minister continues day after day when he gets up in the House to pat himself on the back for reaching 3 per cent of GDP. He is not eliminating the overspending, he is reducing it. He

will have it reduced to 3 per cent of GDP. We are still living beyond our means.

In saying that, the finance minister is not telling the Canadian people what is the real danger to our social programs. While he is attempting to achieve this very low target, the debt is increasing from $400 billion to $500 billion to $600 billion in the term of this government, an increase of some $111 billion. Shame. That is what is killing health care and the social programs today.

The interest payments are going from $30 billion to $40 billion to $50 billion to service the debt. That $50 billion does not create one hospital bed. It does nothing for health care, yet the government is prepared to see that kind of overspending continue, to see that kind of debt accumulate and to see that $50 billion go up in smoke while not creating one job, not doing one thing to save our social programs. That is the real killer and that is the real threat to health care.

If we do not change we are in danger of losing medicare. If we do not start to open up our minds and be prepared to debate and to negotiate, we will be in danger of losing health care. Those who only talk are the real threat. Action is required. We do not know how much time we have to deal with this problem although we know it is not unlimited.

We want real debate, not cheap shots or rhetoric like "we are going to save medicare and there is the heartless group that will not". We want to have debate about a real plan, a plan to deal with the problem we are facing today.

There is a plan we should be talking about which has a three-pronged approach. The first is the stability of medicare funding. Funding for medicare needs to be stabilized so the provinces know where they are at. We have to focus our existing resources and we have define what the core of our health care is going to be. We have to offer choices beyond medicare. We have to face the realities of what is out there today.

In affirming medicare and supporting funding stability we must return to the best health care safety net in the world. We must remove the existing funding freeze and restore the per capita transfers to 1992-93 levels which Liberals continue to cut by stealth. The remaining cash transfers should be converted to tax points because as far behind as we are falling in the original 50:50 deal, it is going to be even less of a payer in the future.

A better job has to be done in focusing our resources. Canadians need to define what constitutes core or essential health care services. There needs to be a debate among the people about what those core services should be and medicare must be reserved for those core services.

We should look at the choices and the possibility of choices beyond medicare, remove the existing restrictions in law which prohibit choices in basic health care beyond publicly funded health care. Where medicare does not meet Canadians' needs they should have the option to exercise choices beyond medicare. Where Canadians exercise choice beyond medicare they will be responsible for arranging appropriate private funding on such choices, for example, with employers through benefit plans with third party insurance and through private resources.

Let the debate begin on some real solutions to dealing with the crisis in health care. All of the provinces, not just Ontario, are looking for that.

In closing, medicare is our most valued social program. I reinforce the fallacy in saying that only the federal government has a heart, only the federal government is concerned about saving health care. It belittles the premiers of the provinces to suggest that they would in any way be heartless or not be concerned about health care in their provinces. They will answer to the voters in their provinces for the job that they do in looking after their people and not going to the federal government and get into this "I'm not at fault, they're at fault" argument which has brought us to the point we are at today.

Talk will not do it. There needs to be a plan. Debate must begin on that plan. We must act now. I believe time is limited. Future Canadians, our children and our grandchildren, are counting on us to do that and Canadians deserve nothing less.

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1:25 p.m.

The Deputy Speaker

Shall I call it 1.30 p.m.?

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1:25 p.m.

Some hon. members

Agreed.

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1:25 p.m.

The Deputy Speaker

It being 1.30 p.m., the House will now proceed to the consideration of private members' business as listed on today's Order Paper.