Debates of Oct. 5th, 2000
House of Commons Hansard #127 of the 36th Parliament, 2nd Session. (The original version is on Parliament's site.) The word of the day was health.
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Canada Health Care, Early Childhood Development And Other Social Services Funding Act
Daniel Turp Beauharnois—Salaberry, QC
Canada Health Care, Early Childhood Development And Other Social Services Funding Act
Réal Ménard Hochelaga—Maisonneuve, QC
My colleague from Beauharnois—Salaberry has even taught this to his students. It is hard to imagine in a federal system worthy of being called one that a government can literally strangle the provinces with its policy, and this is what has happened.
It is in fact so true—and I want to make this point in my preliminary remarks, because I want to spend time on the essential issue of health—that in 1993, 1994, 1995 and 1996, governments, especially that of Quebec, witnessed a sort of transfer of clientele. In other words, all the cuts to health care or to employment insurance have had the effect of preventing people from qualifying for programs they had access to previously. They ended up turning to the program of income security in increasing numbers.
This is so true that some authors, such as economist Pierre Fortin, have estimated that the restrictions arising from the various federal government cuts have cost the Quebec public treasury additional millions. Clearly the agreement before us provides reparation. We must not ever forget that.
It is no small matter, when we consider the years 1994, 1995, 1996, 1997 and up to today. What was needed was a common stand by all the premiers, be they New Democrat, Conservative or Liberal. Brian Tobin has, in recent years, added a strong voice to this debate. He called upon the federal government to re-establish the transfer payments.
I repeat, we are going to subscribe to the agreement we have before us. We are going to make amendments, but we want the money to be made available to the provinces as promptly as possible. We are dealing with the outcome of a mess that was literally provoked by the federal government.
This is an example of why we on this side of the House are sovereignists. It makes no sense for there to be two orders of government, one of them with more financial means than the other because of its taxation powers and the division of powers.
Here is where the question lies. In modern life, as we are living it in this month of October in the year 2000, the major responsibilities our citizens expect us to meet fall under the jurisdiction of the provincial governments. Whether it be health or education, these are areas of responsibility that are at the core of our fellow citizens' lives, and ones on which the federal government has virtually no say, despite the fact that it is better off financially, with more financial resources than the provincial governments.
Nevertheless, without this common front, without the doggedness of the Bloc Quebecois which has made this a guideline, a baseline, a kind of leitmotif for all of its political action since the Minister of Finance's budget, without this concerted effort by the various actors putting pressure on the federal government, I do not believe that this would have been accomplished.
In my opinion, another explanatory factor for the agreement reached by the first ministers at the September 11 conference, in addition to all the ones that have come out of Winnipeg via Ottawa, is the imminence of a federal election.
The Prime Minister, cabinet and the whole government caucus knew full well that it would have been unthinkable to call an election after impoverishing the provinces, after exerting very real pressure on the health system, without doing something to restore the sharing of fiscal responsibilities.
To make things clear, let us take a look at what this agreement provides. The agreement is based on six major points. First, it seeks, as I said, to restore transfer payments. A total of $23.4 billion will be invested over the next 5 years. Next year it will be $18 billion, then $19 billion, $20 billion and $21 billion. Transfer payments will be increased to $21 billion and about $2 billion will be kept for policies directly aimed at young children.
In addition to that, a $1 billion trust will be set up for the acquisition of medical equipment. It is critical to realize how important this is for the health system, because medical technologies change very rapidly.
Last winter, I met the administrators of the various hospitals on the island of Montreal. I wanted to know how things were done, what their major management challenges were and what it meant, ultimately, for an administrator to provide health services to a community.
All the administrators told me about the importance of renewing the technological equipment in the medical sector. Acquisition costs for these technologies are extremely high and the life expectancy of this equipment is about five, six or seven years at best. So $1 billion will be earmarked for the acquisition of medical equipment.
The bill is too vague and an amendment will be necessary, because we want to correct that flaw. We want it to be clearly stipulated that the proposed funding, the $1 billion for the acquisition of medical technologies, will be entirely consistent and in no way discretionary with what was agreed at the meeting of first ministers in Ottawa.
I draw the attention of all parliamentarians to the fact that the final press release for the Ottawa conference gives the breakdown of this $1 billion for 2001-02. The totals are given for each province. For 2000-01, Quebec will be receiving $119.9 million; the amount for the following year will be $119.2 million. We must not find ourselves in a situation where we pass a bill that is not very clear about what the first ministers agreed to.
This is an extremely important part of the agreement. We attach very great importance to it and that is why we will be tabling an amendment here in the House if we go into committee of the whole for the subsequent stages.
In addition to the $1 billion fund for the acquisition of medical equipment, the purchase and installation of modern diagnostic tools and other medical equipment that is obviously urgently needed, there is a $500 million fund for the installation of health information technologies.
This is also an important feature of the agreement. We know that each of the provinces has a database and computer networks, information that may give a clearer picture not just of the progression of diseases, but of various trends in the medical community.
At the Ottawa conference this past September 11, the first ministers agreed to exchange this information. The purpose of the information exchange is to ensure compatibility among the various information systems so that data may be exchanged at high speed without any technological hitches.
This was made very clear in the communiqué. There was no reference to Canada-wide information standards, as there is in the bill. In order to make things very clear for those who are listening to us, and in order for them to clearly understand the reason for our amendment, I would like to read what the first ministers had agreed to in their final communiqué at the end of the September 11 conference.
Specifically in relation to health information and communication technology, both Premier Bouchard and Minister Marois agreed that it is important to have this exchange of information, and to have it work both ways, so that the provinces may also benefit. For example, the federal government has a health information network. It is important that this information circulate as freely as possible.
We know that every time the government of Mr. Bouchard, and of Mr. Parizeau before him, had the opportunity to serve the superior interests of Quebec, it made a contribution.
As an aside, I would remind hon. members that any time there was an opportunity to allow Quebecers to benefit from a change for the better in the status quo as far as their day-to-day services were concerned, the sovereignist governments, which are as everyone knows extremely vigilant in defending the interests of Quebec, whether in the time of René Lévesque, Jacques Parizeau or Lucien Bouchard, have taken advantage of that opportunity.
I want to remind members that the manpower agreement was negotiated by Louise Harel. It was not accomplished under the Bourassa government. It was vitally important to have a single window in Quebec in 1995 for those receiving income security and those receiving employment insurance. Quebec had had enough of making a distinction in connection with changes in the labour market that for too long had resulted in a duplication of programs that left the public confused. The result is that as we speak, someone who is unemployed in Quebec can access all of the Government of Quebec programs through a single window and does not need to go through a multitude of intermediaries.
The sovereignist governments, because their allegiance is to Quebec alone and to the people they represent, have, in very current matters that are at the heart of our fellow citizens' concerns, been able to come up with agreements where the federalist governments could not.
I have just given the example of manpower, but I could have given other examples. I would, however, like to get back to the matter of health. On the subject of health information and communication technology, it was agreed at article 7 of the agreement, which I quote, that:
All governments have made major investments in health information technologies in recent years to improve care and health system management.
First Ministers agree to work together to strengthen a Canada-wide health infostructure to improve quality, access and timeliness of health care for Canadians. First Ministers also commit to develop electronic health records and to enhance technologies like telehealth—
Telehealth is remote health care. I will give you as an example the case of a person who is x-rayed in Lotbinière riding but needs further treatment in the Saint-Luc hospital. It is then possible with telehealth to send the x-ray and the information by means of an electronic and computerized process.
Telehealth will become extremely important in the coming years, because we know that the treatment individuals are to receive may not be available in their community. I will continue reading from article 7:
—over the next few years.
Here I draw the attention of the members, because this is where we will introduce an amendment.
Governments will continue to work collaboratively to develop common data standards to ensure compatibility of health information networks. This will lead to more integrated delivery of health care services. They will also ensure the stringent protection of privacy, confidentiality and security of personal health information.
It goes without saying that this information must be secure.
There are several causes for concern in the bill. I repeat, Premier Bouchard and the health minister, Pauline Marois, have agreed that in order to follow developments and understand events in areas relating to health care it is important to have information circulate. That is understandable.
I will give you an example. The Quebec public drug plan covers certain drugs. We want to know if the equivalent of the drugs covered by this public program exists in other provinces. How much does AZT or a new medication for hypertension cost in Quebec, and what is its equivalent in other provinces? It would be helpful to provide this kind of information through a network, and that information should be accessible to all the stakeholders, but there is absolutely nothing on national health standards.
This morning, the leader of the Bloc Quebecois, the deputy leader of the government and yours truly were very surprised—let us not forget that we received the bill late yesterday afternoon—to see that the legal wording of clause 3 reads as follows:
- The Minister of Finance may make a direct payment of $500 million for the fiscal year beginning on April 1, 2000 to a corporation, to be named by order of the Governor in Council on the recommendation of the Minister of Health, for the purpose of developing and supporting the adoption of Canada-wide information standards and compatible communications technologies for health services in Canada.
As members can see, there is a difference between the text of the final release approved at the first ministers' conference on September 11 and the legal wording.
Perhaps the different wordings in the release and in the bill are an accident because the legal officers did not accurately reflect the will of the premiers and of the Prime Minister. That is possible, but the Bloc Quebecois will have to propose amendments, and I understand that the government will support such amendments. This will ensure an adequate process for everyone, and I gather that there will no obstruction from any side.
These are the main points of the agreement. I wanted to go over it again because I think it is vital to our understanding. Had it not been for the vigilance of the Bloc Quebecois, the common front presented by all the first ministers and, I think we would have to agree, the impending election, we would never have arrived at an agreement such as this.
I also wish to take this opportunity to remind the House that one year ago all the health ministers had asked their officials to try to determine the progression of health care costs. We cannot say this often enough. It would have been unbelievable, completely shameless of the federal government, and it would have shown a complete lack of civility and political good grace if the federal government had not made this gesture of atonement. This is the atonement of a hegemonic government that has repeatedly taken advantage of its financial position, that has acted unilaterally to make the provinces poorer, often creating additional costs for their respective treasuries.
All this was documented in a study, which I have summarized, because it is 200 pages long. This was a study commissioned by all health ministers. First, it looked at a well-known demand. At the time, all the provinces were calling on the federal government to restore transfer payments to 1994 levels immediately. This is pretty much what is being proposed. In this, the provinces have been successful.
It is worthwhile calling to mind that the study in question indicated that total provincial and territorial health expenditures were $11 billion in 1977. Why did they choose 1977? Because, hon. members will recall, that was the first year the existing programs were reformulated and the first year reference was made to established programs financing, the famous EPF.
Let us recall that in 1977 the provinces were spending $11 billion on health, whereas this year they will be spending $56 billion. This gives us an idea of the effort the provinces have had to expend in order to continue to provide health services to their respective populations. In parallel with the stepped up efforts of the province, the federal government has disengaged.
When I am asked to speak to people working in the health sector or at conferences, I always remind my listeners that for the year 2001-02, for example, if the government of Quebec wanted to provide exactly the same services as this year's to its population without adding any new services, its health budget would have to go up 5%. Thus, the health budget of the government of Quebec is rising more rapidly than the collective wealth being generated by the people of Quebec.
This is the dramatic situation that is going on. Once again, if the federal government had not re-established the transfer payments, it would have been extremely difficult for the government of Quebec to manage without jeopardizing other equally essential missions in the Quebec community. I think I have explained this sufficiently, so I will go on to the conclusion of the report.
I thank the hon. member for Québec for being here with me in the House. I do not think I have ever made a significant speech without her support. As far as politics is concerned, we are just about joined at the hip.
The main thrust of the conclusion of the report by all the ministers of health is extremely interesting. Let me read that conclusion. It says:
A review of the block funding for health shows that the gap between the current amount of the federal contribution, and the amount at which that contribution could be if it had increased significantly, has constantly grown bigger.
There is a big difference between the health care system of the eighties and that of the year 2000-01. For one thing, new diseases have surfaced. For example, AIDS was unknown before the eighties. Still, we won the battle against AIDS which, during the eighties and the early nineties, was a deadly disease. It is now a chronic disease, because we can control it with triple therapy.
The most important factor is, of course, the aging population. The Quebec population ages faster than the population in other countries. I have some figures here. Mr. Speaker, knowing your intellectual curiosity, I will be pleased to share these figures with you.
In 35 years, one quarter of Quebec's population will be over 55 years of age. In Germany or in France, it will take 65 years for that same phenomenon to occur, but in Quebec it will only take 35 years. Imagine the pressure that this puts on the public health system, but also the challenge that we will have to face when restructuring our health services.
Our generation is not the same as the generation of our parents or grandparents. People will not necessarily accept to live outside their homes when they get old. They will want to stay longer and longer, as long as possible, I would say, in their natural community.
This is one item of the budget that will be increasing, I am happy to tell the member for Argenteuil—Papineau—Mirabel, because he is our oldest member, although he is still very alert. He may even be the oldest member of the House. No, I think that distinction is reserved for the member for Terrebonne—Blainville. In any event, the member for Argenteuil—Papineau—Mirabel is the Bloc Quebecois critic for seniors' issues. We know that one of the budget items that will be growing in both absolute and relative terms is home care.
Governments are going to have to devote considerable effort to keeping people in their home setting. This means that the focus of service will have to shift from institutions to the community. This is called primary care. This is why the agreement provides for $800 million over five years to study how to keep people in their home setting as long as possible.
I was asked to speak for 30 minutes and I think I have done that. I will sum up with three points.
The Bloc Quebecois is delighted that the federal government has finally loosened the purse strings and is about to invest $23.4 billion over the next five years. We will of course make sure that Quebec gets its fair share.
On examining the bill, we noticed discrepancies between what the first ministers wanted and the wording of the bill. The Bloc Quebecois is going to move an amendment to clause 2 in order to ensure that the established population-based shares do indeed go to the provinces as agreed.
As for the compatibility of the various information networks and databases, which everyone agrees is important for a comprehensive overview, we will ensure that we do go the way of national standards, because this is not necessary and because it was not what the first ministers agreed to.
In conclusion, I assure the House of our desire to help see that the bill is passed quickly. I understand that in any event the government is going to agree to the amendments moved by the Bloc Quebecois.
Canada Health Care, Early Childhood Development And Other Social Services Funding Act
Judy Wasylycia-Leis Winnipeg North Centre, MB
Mr. Speaker, needless to say we welcome the opportunity to finally debate in a meaningful way the health care crisis in Canada today.
It is interesting to note that this is the first time in the last three years and four months since we were elected to this place in June 1997 that we have before us a bill from the government pertaining to the number one issue of Canadians. For three years and four months we have known full well that the country and its health care system is going deeper and deeper into crisis, but it has taken three years and four months for the government to finally bring the matter to the House and to allow for a thorough debate on this very critical issue.
The bill, whatever it is called, whatever number it has and whichever minister presents it, is clearly the government's supposed solution to its mismanagement of the health care situation in Canada today. Let us be under no illusions about what the bill is. It is the result of pressure, pushing, cajoling and prodding from Canadians everywhere in the country. It is a reluctant step in response to that outcry, that outpouring of concern.
Obviously we in the New Democratic Party welcome this opportunity. We have been raising the issue tirelessly in the House for the last number of years.
Members in the New Democratic Party caucus feel a tremendous responsibility to ensure that the work of our forefathers and foremothers in the CCF and the NDP in pioneering medicare is carried on. The House will appreciate that we feel the pioneering work, that innovative contribution to Canadian public policy, has in fact been jeopardized by the inaction, passivity and lack of leadership by the federal Liberal government.
There is clearly a need for the House to debate the health care issue. There is clearly a need for the House to ensure adequate and thorough review of the bill before us. I hope we have that opportunity. One gets the impression that the government is in fact attempting to push the bill through in short order. One can imagine our concern after reading news reports today quoting the Minister of Health's suggestion that the House would deal with the bill in one day.
Imagine our shock and concern when we read, as is mentioned in the Charlottetown Guardian , that the Minister of Health suggested at the federal-provincial health ministers meeting that the provinces bend the ear of opposition members of parliament if they want to ensure the bill passes before a possible fall election. I hope this is not accurate. I hope that members in the government are not trying to manipulate parliament or trying to use this place as a rubber stamp.
Before this parliament is one of the most important issues in the history of this country and the government wants to shove it through. It wants to cut off debate. It wants to deny the opportunity for thoughtful analysis, scrutiny and reflection. As some of my colleagues in the House have said, is this just another cynical election ploy to create the illusion, the false pretence to the Canadian public that the government is actually doing something on health care after neglecting this field and doing nothing for seven years? Surely not.
Surely this place is not about satisfying a particular party's agenda to advance its election timetable. Surely this place is not about satisfying the political agenda of one party.
We must ensure that we have some opportunity to debate this very important issue. We hope we will have that opportunity. We will certainly do our part to thoroughly review the bill and to offer our careful analysis.
Let us not forget, and let us be mindful of the fact that the bill was delivered to us yesterday at 3 p.m. Let us not forget or ignore the fact that this is a substantial piece of legislation. Let us not forget that we have a responsibility to ensure that this opportunity in the history of Canada is not forsaken for the whim of a political electoral agenda.
It is interesting that the House has never had a debate initiated by the government on the state of health care in the entire last three years and four months. We have also never had the opportunity to discuss this matter in the Standing Committee on Health, the parliamentary committee that is supposed to be the body, the avenue, for thorough review and study of the issues of the day.
Health care is the number one issue of the day. The health care system is in crisis. The government is clearly under pressure to listen to the voices of Canadians and we have not even had the opportunity to discuss this matter in the health committee. It has not been for lack of trying. In fact we have had motions before the health committee to convince the Liberal members on that committee that the committee should be reviewing the state of health care and should be providing important input and advice to the government. Of course the trained seals across the way rallied around the Minister of Health, who gives the directions. They cut off debate and denied the opportunity and assured us we would never have an opportunity as parliamentarians to thoroughly discuss this issue.
Here we are with our backs against the wall, I guess the Liberals would probably say. Here we are being told we have a limited opportunity to discuss the number one issue facing Canadians. I say shame on the Liberals. Shame on the government for not allowing this place, this democratic institution that speaks on behalf of all Canadians, to have a say in the future of health care in this country.
If we thought we were being manipulated by what we are hearing in the media and what the ministers are purported to have said at the health ministers meeting, it certainly has been confirmed by the full coverage of the government's advertising campaign. As we speak, $8 million of ads are happening to espouse the virtues of the deal and presumably of the legislation before us.
How is it that we are supposed to be offering a thorough analysis and ensuring proper parliamentary procedure around Bill C-45 when ads are already running saying it is a done deal? The ads are already saying it is over. Are we nothing but a rubber stamp? Is that all we are today? Let us hope not and let us hope we have a bit of time to discuss these issues.
While we are talking about the whole process and the clear sense we have that the government wants to push this bill through, let us look at the fact that the health committee has yet to reconvene. The health committee has yet to meet, elect a chair and plan an agenda. That says it all about how much the government cares about the democratic process and parliamentary procedures and respect for the institution. It has bypassed, ignored and violated every process available to parliamentarians. It has denied us the opportunity to speak on behalf of Canadians who care deeply about the issue.
What is the rush? Why is the government rushing the bill through if that is the case? Clearly the bill implements the September 11 deal of between the first ministers. That deal causes grave concern to all of us and does not even ensure that the increased transfer payments kick in until 2001. After reading this bill it will be clear that the Liberals want to rush through a bill that is not really meant to be operational until the spring of 2001.
Obviously we wonder what is the rush. The Liberals may argue that they need the bill to implement the special funds that first ministers agreed to pertaining to equipment, information technology and transition funds. If that is the case, then surely they would agree to split the bill. Give us an option to deal with what is urgent and pressing and allow for a much more thorough and comprehensive debate in terms of the whole issue of transfer payments and the future of medicare.
One also has to wonder, if it is so important to rush this bill through to make those special funds operational, why is it that only the funds pertaining to equipment and to information technology are mentioned in the bill? If, as the minister of revenue said earlier, the idea of transition funds to reform our primary health care system is so important, why is that not mentioned in the bill? Does the government have other ways to do that? If so, why is that other means not used to deploy the funds for the equipment and information technology parts of the agreement? It just does not make sense, unless this is simply a cynical ploy to present a facade, an illusion, to the people in an election soon to be called.
Let us not forget there have been seven years of neglect. Let us not forget that the government is now trying to compensate for incompetence, mismanagement, neglect and lack of leadership over the last seven years. Let us not forget that it was in 1995 that the bunch across the way took the biggest single bite out of health care funding in the history of the country.
Let us not forget that the government had an opportunity to act on a blueprint presented to parliament, the government and the Canadian people from the national forum on health. It suggested exactly what needed to be done for the future of medicare and the government sat on it and let it gather dust.
Let us not forget that in 1997 the government in its most cynical move ever, but maybe not as cynical as the one we are about to see, decided to campaign on the ideas of national pharmacare and home care. Three years and four months have passed since that time and not a step has been taken to move toward the implementation of those ideas. We have nothing but broken promises and empty rhetoric when it comes to the most fundamental issues of health care today.
Let us not forget that the government had an opportunity in the last budget to do what Canadians said it should do, to do what every provincial and territorial government said it should do, to do what every health care organization in the country said it should do. That was to increase financing and transfer payments for health care in a way that was significant, sufficient and predictable to meet the growing needs and demands on our system.
What did the government do? I am sure it knew it had a pretty significant surplus back then, given the projections we are hearing today of $33 billion for the present fiscal year. The government probably knew it had a pretty good surplus back in February 2000. What did it choose to do? It gave two cents for health care for every dollar in tax cuts. That was it, the two cents for health care budget.
We spent six months clamouring, pushing, prodding and cajoling the government to do something. We asked that it address the needs and the crisis in the health care system. We asked that it ensure that at this time of opportunity funds be put into health care at least to get us back in line with a 25% federal share of health care financing and ideally a 50:50 partnership.
Here we are today and finally it has chosen to act, to take a small step, a tiny step. With the September 11 deal, as outlined in this legislation, the government has put back most of the funds that it itself cut out of health care in 1995, but not quite. It is not even the full amount. We are still about $900 million short, if I am not mistaken. It still will not kick in until next year. There is still no long term predictability and sustainability in the system. Of course, we have to keep in mind that it has a limited timeframe. There is a five year period and nothing beyond that.
Even on the issue of money, which is only part of the picture and part of the work required, the government did a half job. It took a partial step. It could not even complete the task at hand when it came to the transfer payments it slashed back in its first term of office in 1995.
Let us not be under any illusions that this is a historic deal. Let us not try to paint this for something it is not. My goodness, the Canadian people are smarter than that. They know what this deal is all about. They are prepared, as we are, to acknowledge it is a small step, but it certainly is not a plan and a vision for the future.
My goodness, no wonder Canadians are asking if there really is any difference between the Liberals and the Alliance. Are the Liberals not just doing what the Alliance is saying? The Alliance leader has said that national standards are not needed. Obviously we totally disagree with that approach but the Liberals, who had an opportunity to move on national standards, let it drop off the agenda.
The Alliance has said that we do not need to have any enforcement of the Canada Health Act by way of financial penalties. The Liberals let it happen. They just do not enforce the Canada Health Act. They had an opportunity with bill 11 to do something, but they stood back and let that bill on private for profit hospitals make its way through the legislative route. Today we are facing this black moment in our history, this dark period in our time, where bill 11, the first bill in the country for private for profit hospitals, has become law.
The government had a golden opportunity not just to stabilize the system, but to move forward. I dare say it had the will and the support of many around the table at the first ministers' meeting on September 11, but it chose to go with the bare minimal approach. It chose to do the least possible. It chose risk management over dreaming big dreams and planning for the future.
What is missing in this deal is a plan for the future. Despite what the Prime Minister has tried to suggest in the House and despite what other members are saying today, there is nothing in this deal to advance the country toward a national pharmacare and home care plan. There is nothing.
Alliance members are clapping about that. Alliance members obviously do not support any kind of strengthening of the medicare system. The Alliance has actively advocated private, for profit health care. We do not expect much support from members on that side of the House for our position today, but we hold out a tiny bit of hope that maybe somehow we can get through to the government today to tell it clearly not to miss the opportunity to go back to the drawing board and come up with a plan that can be implemented now to renew and strengthen medicare.
We are at a crossroads. We said that last spring. We can go forward in terms of building a universal public health care system, or we can let it lapse into a two tier American style health care system. We are still at that crossroads today despite the bill. We are still here because of the lack of courage, the lack of dreaming, the lack of vision, the lack of decision making and the lack of leadership from the government.
I conclude my remarks by saying let us have a chance to debate this issue, to talk about the future and build a strong medicare system. Our fight, from our point of view, is far from over. It is clear to us that we cannot fix health care without a plan to control drug prices, without a national home care plan and without the courage to fight privatization.
We will keep speaking out in parliament and everywhere across the land so that we can continue to take steps toward restoring and renewing medicare. We will be even louder in our demands, in pushing for a national plan and a national vision, because the very future of medicare is at stake.
Jim Gouk West Kootenay—Okanagan, BC
Mr. Speaker, what takes place in the House from time to time is very unfortunate. Different parties, the opposition, and even, heaven forbid, sometimes people on the government side, actually come up with some good ideas. Unfortunately they couch them among much rhetoric and dogma. We lose the good part of what these members have to say when there is so much nonsense tied in with it.
I would like to question the member who just spoke about a specific aspect that was raised in my riding by an NDP cabinet minister who is running for the Liberal Party nomination. It is an interesting situation. He raised the matter of Alberta's bill 11, which is legislation that authorizes the provincial government to contract with the private sector to provide services that the government is not able to provide in a timely manner.
That is what the NDP is so adamantly opposed to, but in my province of British Columbia, which has an NDP government, exactly the same thing is done. The Workers' Compensation Board and the NDP provincial government contract with the private sector and hire doctors to queue jump, to bypass the system. Both the WCB and the NDP government frequently send patients to the United States health care system. The only difference is that it has not been legitimized through legislation. That government tries to pretend it is not doing that while in fact it has been doing that for far longer than Alberta has.
What is the hon. member opposed to in Alberta when her own provincial wing in British Columbia has been doing exactly the same thing?
Judy Wasylycia-Leis Winnipeg North Centre, MB
Mr. Speaker, I am glad to have this question because it is very important for the people of the country to know exactly where the political parties stand when it comes to something as fundamental as our universal public health care system.
I tell the member who expressed an opinion here today that he is wrong, that what Alberta is doing through bill 11 is endorsing and legitimizing private, for profit hospitals for the first time in the history of the country. We happen to believe that there is no room for profit in our health care system.
Obviously members of the Alliance Party have backing from private market forces and multinational corporations that want a piece of the pie. They see the health care system solely in terms of the potential for making money. They see it as an $82 billion golden egg.
We do not. We happen to think that the only way to run our health care system is to continue on the path of non-profit public administration, ensuring universal access to everyone in the country regardless of the money they make and regardless of where they live.
We are obviously having to deal with an incredible barrage from the forces of darkness in the country who believe that the only way to save our health care system is to allow for a private parallel health care system. That does not work. It is not more effective. It does not save money. It does not deal with waiting lists.
For a party that talks all the time about the most effective and efficient way to go, why does it not support us in our efforts to ensure that the medicare model, which as we know is fundamentally sound, is allowed to take us into the millennium to be the basis upon which we build a system that is truly responsive to the needs of Canadians?
Peter MacKay Pictou—Antigonish—Guysborough, NS
Mr. Speaker, I commend the hon. member for her passionate and informed remarks on this very timely and important matter.
We in this party very much embrace the same concept that much of what is wrong with health care now is more than just money. The money that has been proposed here is inadequate. The premier of her province, the premier of my province and others gathered with the Prime Minister with the genuine intent that they were looking for some indication the government was sincere in its approach and sincere in its intent to try to repair what is happening, to try to repair the undermining and the tearing of the fabric of health care.
What the Progressive Party of Canada and our leader have been proposing as one part of the remedy, not the be-all and end-all but one part, is to inject some stability and some long term commitment to the funding for health care.
We all know that the system is in need of nurses, doctors, equipment and beds, the fundamentals, but they also need to know there will be a plan that will allow them to plan for the future, that will allow them to address the ever increasing complexities and changing atmosphere in health care.
Does the hon. member also agree that this addition of a sixth principle to health care is what is needed as a starting point and that this is what should also have been included in this accord?
The hon. member referred to the current government as the forces of darkness. I would go one step further. The Prime Minister has become the Darth Vader of what has happened to health care. He is aided by the storm trooper Minister of Health and the faceless ewoks on the backbench who are ready to just let this happen. This is the quick fix: throwing a little money at it.
My colleague from New Brunswick Southwest has indicated that in the province of New Brunswick this influx of cash will result in nine days of funding. That is how quickly the money will be used up.
An hon. member
It is only six days.
Peter MacKay Pictou—Antigonish—Guysborough, NS
That new influx of cash will last between six and nine days. That is an indication of what is really happening. This is very much money that is promised at some point in the future.
With the deathbed reprieve that has been offered by this accord, is it stability of funding? Is it a commitment that the money is to be there not only in the short term but in the long term? Is there also an agreement, a willingness and an openness on the part of the government to work with provincial health ministers to look at the big scheme? Is it a mechanism which will allow for fundamental approaches that will keep doctors, nurses and hospitals open and working together on a non-partisan level to ensure that health care will be there for Canadians in the future?
Judy Wasylycia-Leis Winnipeg North Centre, MB
Mr. Speaker, I appreciate the question. What is at stake here is how we build a system that is sustainable for the future. That is where I believe the government missed the boat. It missed a golden opportunity.
I believe there was a will among many of the provincial premiers around that table to look at a broader vision of health care. I know that from Manitoba there was a real desire for and an interest in having leadership from the government around a national pharmacare plan.
Instead of any kind of commitment to pursue a mechanism for advancing and renewing medicare, instead of sending a clear signal about where medicare has to go in the future, we got nothing but more task forces, working groups and studies on all the key issues.
On the critical human resource question and the crisis we are soon to face in terms of a nursing shortfall we got a committee. On the matter of drug prices skyrocketing out of reach we got a committee. On the question of home care we got a committee. On the questions of basic accountability and national standards, so-called report cards, and I hate to even use those words, we got a task force.
I hardly think that this was taking advantage of the opportunity. At a time when there seemed to be the will and spirit to move forward together, the government dropped the ball, backed away, did the bare minimum and refused to show any kind of leadership in bringing different forces together and going forward. Canadians will pay the price for that.
In very short order people will realize that this so-called historic deal is hardly what it is cooked up to be. In short order Canadians will realize that the money is by and large already spent since there was such a need in the system and provincial governments were facing such a pinch because of rising health care costs and declining federal funds. Canadians will know very soon that the government let them down and that we missed a wonderful opportunity in our history.
Joe Clark Kings—Hants, NS
Mr. Speaker, the bill can most aptly be titled the postdated cheque bill because it promises a restoration of funds to provinces, to patients and to medical professions across the country which simply will not come on time.
The last dramatic action the government took with respect to Canada's health care system was that it made a deliberate choice to put the heaviest burden of its restraint measures upon Canada's health care and social systems. That was a deliberate choice. That was a clear demonstration of what it is now customary to call Liberal values. The Liberals picked first on the sick. They picked first on people who are in need in society. That is where the burden of the cuts came.
The last dramatic action was a series of unilateral cuts that were made without warning. They were devastating cuts that have done more to damage the health care system than any other single set of circumstances faced by the country in the last several years.
After five years of pain the government today suddenly calls for debate on Bill C-45, which would have cash transfers for health, post-secondary education and social services returned to 1994 levels, not by this year but by the year 2002-03.
Why did the government finally repent? This was not the government's will. It was pushed to this agreement by the provinces of Canada and by the virtual certainty that sooner or later it would have to stop hiding and face the people of Canada in a federal general election. Left to its own devices, the government would have continued to let the health care system drift into the disarray that has caused such hardship across the country.
Before these payments are made another 18 months will pass. Full restoration of the cuts will only occur eight years after the cuts were so brutally made. I repeat, those cuts were the single biggest factor in the erosion of the health care system in the country.
The change today is not driven by the erosion of the health care system. The change today is driven by a cynical political calculation of fear of an election in which the Liberals would be held to account for the damage they have done in hospital after hospital, home after home, family after family, right across Canada. They had every opportunity to change this policy earlier and they did not do that.
As I look at the legislative agenda of this parliament, I am struck by one thing. Whether the issue is employment insurance or whether the issue is health care funding, every initiative by the Liberal government is being driven by an attempt to repair the damage done by earlier Liberal Party initiatives. This is simply a damage control government. This is not a government that is seeking to serve the interests of the people of Canada.
The government claims this is full restoration of funding. It is not. The bill cheats the provinces, the patients and the health care professionals of Canada by at least $3 billion. Had it been passed and effective this week and had moneys been committed this year, nearly $3 billion more would be in the system than is in the system under the bill before us.
Canadians will not see any of the restored funds this winter. The first instalment only occurs next April 1. That is quite clear in Bill C-45. It is also clear with this cynical government that the Liberal Party ads are running but the money is not moving. That is the height of cynicism in a system like this.
The most important failure of this accord, apart from the fact that it is a postdated cheque that cheats the recipients, is that the government still has not assured the provinces of stable funding in the future. That means provinces, health care professionals and people who are ill or fear being ill are subject once again and still to the threat of massive unilateral cuts in health care funding by the federal government.
The funding for the next four years does not recognize actual health costs or other factors contributing to rising health costs.
The federal government has yet to guarantee the provinces stable funding in the future. The votes for the coming four years do not take into account the present costs of health care nor the other factors affecting these costs. Despite the reinstatement of the transfers, we have no assurance that the federal government will not unilaterally cut transfers once again in the event of an economic recession.
The arrogance of this government is beyond all. With an election on the horizon, it is now telling the provinces to push the opposition to pass the bill in a day. Why did the government not listen to the provinces and the opposition in recent years, when we were saying that unilateral cuts to health care had hurt Canadians considerably?
In January 1997, the provincial and territorial ministers of health informed the federal government that:
The cuts in federal transfer payments have resulted in a critical loss of revenues for the provinces and the territories, forcing them to make rapid changes to the system and seriously threatening their ability to maintain existing services. The reductions in federal funding accelerated the movement to reform a system that lacks the ability to absorb and sustain the adjustments that that requires.
Did we hear an announcement of funding for health care? No. How did the Prime Minister react? In response to the demand put to him by the premiers at the annual Saskatoon conference, the Prime Minister apparently expressed doubts about the unconditional payment of votes to the provinces. He wanted to impose conditions in order to prevent the provinces from funding income tax reductions with this money.
What is clear is that the Liberal Party's political agenda has held back health care in Canada. The federal government's interest is not in standards. That is the flag it flies behind. It is not interested in standards. It is interested in control. It does not matter what happens in hospitals across the country. It does not matter what happens to people who are sick or fear being sick. The government wants to control every single penny and if Canadians suffer that is just too bad. That is unacceptable in any civilized system.
At the same time the government removed its contribution and increased its demand for control. This is happening at the worst possible time in the evolution of the health care system because of the insistence on rigidity, the insistence on control and the absolute refusal to work with the other partners in the health care system to give us a better system.
We are living through a period now in which our health care system is assaulted by several fronts. There have been dramatic changes in technology. There are dramatic impacts upon the system by an aging population who will be able to stay alive and active much longer than before. There are profound changes brought by the possibilities of medication and by pharmaceutical and other developments.
This is a time of immense change. This is a time of great opportunities for leadership. This is the time when a Pierre Elliott Trudeau or a Lester Pearson would have risen to the occasion, but not this government. What the government has done is turn tail and run and let the health care system in Canada fall into tatters. That is absolutely unacceptable to any kind of Canadian.
Today we have a deal before us to restore the funding cuts which were made unilaterally. The agreement is overdue. It pays less than is owed but it is welcome because the system cannot stand to be starved any further. However, in all of this talk about putting some of the money back, in all of the focus on the postdated cheque, the clear reality is that we have not taken a single step closer to having a modern and contemporary health care plan based upon the principles of the Canada Health Act to ensure the health and security of Canadians into the next century.
There is money in the system now, or there will be in a couple of years, but there is no plan because this is a government which congenitally does not plan. It is a government of drift rather than a government of seizing the initiative and assuring the leadership of Canada.
The three day meeting of the health ministers this week came up with a nursing strategy that will establish committees to investigate the chronic shortage, to measure resources and to examine changing trends. Nurses have been saying for years that there were chronic shortages in the health care system. We hope we have nurses left in our system by the time the Liberal government finishes studying what is wrong. The ratio of practising registered nurses to the Canadian population in 1999 was one nurse for every 133 persons. In 1989 the ratio was 1:120. The average age of an RN employed in nursing in 1999 was 43, up from 41 in 1994.
The bill is silent on how it plans primary care reform. We know from the first ministers' conference that $800 million will be invested over four years to support innovation and reform in primary care. We do not know from the bill how that funding will be distributed.
Elizabeth Witmer, the minister of health for Ontario, is quoted as saying that with the primary care funding, 70% will go to provinces and territories and 30% will go into a fund that will have some Canada-wide applications, but that money is not going to be made available until next April.
Ontario will have to put more money in to meet expectations until the federal cash arrives. Ontario can do that. Unfortunately, not all the provinces in the country have that ability. This is an issue that is seriously missing in the government's health care deal.
The government claims that it is interested in the same quality of health care system across the country. However, it has forced this upon the provinces, giving them no alternative but to accept this or nothing, which leaves the poorer provinces with a lower standard of health care than the others. What kind of Liberal values does that represent? Where is the health plan for palliative care and hospital infrastructure? All of them are important aspects of primary health care reform.
Under Bill C-45 the provinces will know their funding for health care up to April 2005. That is five years. It takes 10 years to train a doctor. Doctors are integral to the reform of primary care. The Canadian Medical Association has just sent me, and I am sure other leaders, a copy of a letter in which says:
In the CMA's estimation the total cumulative funding commitments contained in the First Minister's agreement are more than $17 billion less than what we forecasted as needed to ensure the sustainability of the health care system.
That is $17 billion less. Not only is it less, it is late. There is far less here than meets the eye. The government is spending more money this month on health care ads than it is on health care. That is simply unacceptable in a nation like this.
Pharmaceutical management is an important part of our health care system. At the first ministers' meeting there was discussion about developing strategies for assessing the cost effectiveness of prescription drugs and means of drug purchasing costs. There is no concurrent commitment by the federal government to improve the timeliness of drug approval. Some pharmaceutical companies offer evidence that drug therapies reduce institutional care. The government has direct input in approving new drugs that help Canadians avoid lengthy institutional stays.
The Canadian Medical Association has stated that an unnecessarily long approval process delays access to new medications that may improve patients health status. However, the median time for regulatory approval of new drugs in Canada has been significantly longer than in countries such as the United Kingdom, Sweden. Our country has been criticized in several independent reviews on this issue.
The most important retreat that we evidenced today has not been the cut in funding, brutal and deadly though that has been in some cases. The most serious retreat has been the retreat from leadership by this federal government. The Liberals came to office at a time when the economy of Canada was growing sharply, largely because of initiatives which they opposed in opposition.
The OECD acknowledges that Canada's economic strength was won by the initiatives of a decade ago on trade, on the GST and on deregulation. The government did little to earn the surplus tabled last week and has done nothing at all to ensure those funds would be wisely invested in the future of Canada.
Despite the most favourable possible economic circumstances, the government has let the Canadian health care system fall into disarray. Was that inevitable? Did other governments of the world do that? Of course they did not. Other governments cared more about the health of their citizens than this Liberal government. That has shown up in the comparisons that have been made by independent agencies around the world.
This Canadian government sat back and let Canada's health system decline so sharply that even the World Health Organization ranked Canada behind most of the comparable world in the quality of our health care. Imagine that in the system of the Canada Health Act and in the system of medicare Canada is ranked by the World Health Organization behind most of the comparable world. Why is that? It is that we have a government in office that will not show the leadership that earlier Liberal governments showed. It lets things drift in the dust. It insists on jurisdiction but shows no leadership at all.
Canada has the resources and the tradition to be first in the world, but the government has brought us to 30th instead of first. If I may say so, it is not only the health care system that it has damaged.
I spent a good amount of time this summer talking to people in Kings county and Hants county in Nova Scotia who are very much involved in the health care system. Some are nurses, some are doctors, some are administrators and many more are people who are trying to get a doctor for a remote community or trying to ensure that it is possible for older people to travel easily to get their supply of drugs.
When I speak to people in the medical profession I hear over and over again that the problem is not just that the money is not there but there is a sense that there is no movement in the system, there is no plan and there is no hope. On a question like medical care where we have been in front of the world for so long, there is no hope.
Why is that? Is that the fault of Canada, the Canada that created the Canada Health Act, the Canada that created medicare? Of course not. That is the fault of the federal government in office today which has backed away time and time again from exercising the leadership that would have let Canada continue to be a leader in providing the highest quality health care to its citizens. The government has failed and Canadians are paying the price for that failure.
More is at stake here than the health care system, because what it has done on health care it is doing on other aspects of the Canadian community. It is not drawing together people who want to be together. It looks for polarization. That is its new theme. It looks for ways to divide Canadians instead of heeding the hopes of parliament. Instead of heeding, it is responding to the requests of provinces. It ignores them until it is time finally with an election looming to bring them together and to offer a deal they cannot resist, a postdated cheque. That is not leadership.
A system of co-operation in Canada, of co-operation among governments with professionals, with concerned citizens, is what we need to restore the country. As in so many issues there has been no leadership by the federal government. Even now its action has been forced by the combination of provincial pressure and the impending election. There is not even the slightest hint of federal leadership in developing a new health plan for Canada.
As I listened to the debate, as I watch what this minister and this government are doing, it seems to me they are moving closer and closer to where the leader of Her Majesty's official opposition says he wants his government to be. The federal government is drawing back from leadership in health care.
I know I am reaching the end of my time, so let me conclude on this note. There is one level of government in Canada able to speak for all of Canada. It is not just a question of money. It is not just a question of jurisdiction. It is a question of authority. If the national government will not lead, the system will not succeed.
The government does not lead. Our system is in trouble because there has not been the leadership that is needed. The bill is a long overdue step in the right direction, but it is a faltering step. It is a step under duress. It is a step that promises more than it delivers. Unless there is a plan to go with the money then the Canadian health care system will continue in that long decline that began with the election of this careless, drifting government.
Dennis Mills Broadview—Greenwood, ON
Mr. Speaker, I listened attentively to the right hon. member. I would like to remind him that in 1993 the government inherited a fiscal framework and a $42 billion deficit.
Further, in the 1995 budget there was a non-confidence motion on the floor of the House by the then opposition Reform Party. The then leader of the Conservative Party, the member for Saint John, voted that the cuts the government made to try and put the fiscal framework back together were not deep enough. That is where the Conservative Party stood in 1995.
Another point we have to make is that there is not a member of parliament in the House that does not want a good health care system for the country. The notion that the member and his party are the only ones that care about a proper health care system is not factually correct.
When a Prime Minister of Canada can pull 10 premiers together, including a separatist premier, and unanimously agree on a pact, I think that is something that Canadians respect.
Joe Clark Kings—Hants, NS
Mr. Speaker, I learned some time ago that when a member like the hon. member dwells so much in the past it is because he has a great fear of the future.
We are here talking about what needs to be done now because the system has suffered grievously over the last seven years, not only from the cuts but from the absolute absence of leadership.
He talks to me about bringing together different provinces and different groups. I know it can be done. I know it could have been done by any minister of health or any Prime Minister on that side who wanted to do it, but there was no will there to do it.
Finally on September 11, when the provinces forced the federal government to come to the table, it gave the provinces a take it or leave it deal, a postdated cheque that was better than nothing at all.
Do not talk to us about leadership. There has been no leadership on health care, no leadership by the government on making the federal and provincial government work together. This is a government that cuts and runs, a government adrift. It is the Canadian people who pay the price.
Jim Gouk West Kootenay—Okanagan, BC
Mr. Speaker, I will make this very brief. The only thing that is worse than the cuts and the policies of the federal government over there is the hypocrisy of the member who just spoke.
He talks about the cuts of the Liberal government. What about the fact that funding went down to 27% from 50% during his watch when he was a minister of the previous Conservative government? That is a cut of 46% of federal funding. Now he wants to point the finger at the people across the way who are no more to blame than the Conservatives are. They are all in it together: Liberal, Tory, same old story. Nothing has changed.
Joe Clark Kings—Hants, NS
Mr. Speaker, the hon. member is a better poet when he quotes someone else than he is a contributor to reasonable debate in the House. We know the position of his party on health care. The position of his party is that the federal government should continue to withdraw. The quite startling position of his leader is that the role of the federal government in a system like that of Canada should be as a mediator.
Does the hon. member think there would ever have been a Canada Health Act had the Prime Minister of Canada acted only as a mediator? Does anybody in the House believe that there would have been a Canada at all if the leaders of the federation had acted only as mediators?
There is a prominent role for the Government of Canada to be played in the health care system. The Canadian alliance reform party is running away from that role. Unhappily what it does by ideology the Liberal Party does by drift, running away from the leadership that the health care system needs.
John Solomon Regina—Lumsden—Lake Centre, SK
Mr. Speaker, I take this opportunity to congratulate the leader of the Conservative Party on his election.
I also make reference to the fact that the member for Kings—Hants talked about the Liberal legacy. I would like to ask a question of the leader of the Conservative Party about the Conservative legacy. In particular, under the Conservative government Bill C-91 was passed, the drug patent legislation, which provided 20 year monopoly pricing authority for pharmaceuticals with regard to prescription drugs.
The Liberals promised to repeal that if they got elected in 1993. In fact they did not repeal it. They enhanced it and we have therefore seen the cost of health care increase substantially due to the fact that prescription drugs costs have increased substantially.
Will the leader of the Conservative Party now stand in the House and refute the legacy of the Conservative government when it passed Bill C-91 and support the repealing of Bill C-91?