Debates of March 2nd, 2000

Questions Passed As Orders For Returns

[Derek Lee, Liberal, Parliamentary Secretary to Leader of the Government in the House of Commons]

Mr. Speaker, if Question No. 10 could be made an order for return, the return would be tabled immediately.

[The Speaker]

Is that agreed?

[Some hon. members]

Agreed. .[Text]

Question No. 10—

[Gilles Bernier, Progressive Conservative, Tobique—Mactaquac, NB]

With respect to the Québec ministerial tour taken by the Minister of Public Works and Government Services, the Minister of National Revenue, the President of the Treasury Board, the Secretary of State (Science, Research and Development) and the Secretary of State (Amateur Sport) from September 22 to 24, 1999, could the government advise the House of the costs of this trip including: transportation to, from and during the ministerial tour, accomodations, communications, meals, entertainment and alcoholic beverages for each of the ministers, their support staff and departmental staff?

Return tabled.

[Derek Lee, Liberal, Scarborough—Rouge River, ON]

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

[The Speaker]

Is that agreed?

[Some hon. members]

Agreed.

Supply

[Alexa McDonough, NDP, Halifax, NS]

moved:

That this House calls upon the government to stand up for the Canadian value of universal public health care by announcing within one week of the passage of this motion a substantial and sustained increase in cash transfers for health beyond the inadequate sum announced in the budget and by taking the steps necessary to prohibit private for-profit hospitals and to stop the growth of private for-profit health services in Canada.

[The Speaker]

I wish to inform the House that there is an error in the French text of the opposition motion, which may be found on page 19 of today's order paper. A corrigendum is available from the table.

I regret any inconvenience this may have caused hon. members.

[Alexa McDonough, NDP, Halifax, NS]

Mr. Speaker, thank you for reading aloud the very important motion on health care which the NDP opposition has placed before the House today. Every member of the House will have an opportunity to vote on it before the day is out.

I would like to indicate at the outset that I am very pleased to share my time with the member for Winnipeg North Centre, the hardworking health critic of the New Democratic Party.

The motion, on which every member of the House will have an opportunity to indicate where they stand before the day is out, deals with the undisputed number one priority of the Canadian people namely, health care, and more specifically the threat to health care that is currently a reality in this country.

This week we saw a budget introduced in which the government of the day indicated to Canadians that their priorities do not count. How else can we interpret a budget that makes available one dollar in tax cuts for every two cents allocated to health care? The government knows there is a serious health care crisis happening across the country.

In Saskatchewan in the 1940s Tommy Douglas took the first important step toward the introduction of a universal, publicly funded health care system for Canadians. He issued some very important advice. He said not to ever ever make the mistake of thinking that the enemies of a universal health care system will have gone away. They may have gone into the shadows, they may be hiding out, but there will always be those who take the view that they personally or their friends can benefit from a for profit health care system; a health care system that takes no account of whether people happen to live in a province where health care is available to them on the basis of need, or where people do not have money in their pockets to purchase the health care services they need. There will always be people who will want to benefit from a two tier health care system that looks a lot like that health care system to the south of us today in the United States of America.

That was very good advice, because we have today the political fight of our lives under way to ensure that we preserve and strengthen through change a universal public health care system, the single greatest achievement of Canadians. I think it is the very thing Canadians value most about being a Canadian.

Some may think that fight is taking place between the federal Liberal government and some Canadian premiers, notably the premiers of Ontario and Alberta. The Canadian people know better. Canadians know that the fight is taking place between those who value and will work to preserve and strengthen the universal health care system and those who place it in jeopardy. They know that those who have put it in jeopardy include on the same side of this battle the federal Liberal government of the day, the Conservative governments of Ontario and Alberta and others who would seize the opportunity that the federal Liberal government has created to tear down that universal health care system.

The first blow to that system was given in the 1995 federal Liberal budget but we do not have time to talk about how we got into this mess. As members of parliament elected to represent Canadians who value our universal health care system, today we need to stand and vote to preserve and strengthen that system. Every single member of the House will have the opportunity later today to indicate which side of this battle he or she is on.

Because we do not have a lot of time before that universal health care system slips away, in order to move quickly and dramatically we must take some very specific concrete steps. Our motion sets out three steps.

We must first take urgent fiscal action. That means restoring the cash transfers for health care to a minimum of 25% of health care spending over the next two years.

Second, the federal government must take the necessary steps to prohibit private for profit hospitals. We have to draw that line in the sand. The federal Liberal government knows perfectly well that Ralph Klein and his government have been busy moving in that direction. At this very moment they are preparing to take the next step that would allow for the operation of private for profit hospitals. It is the thin edge of the wedge. We have seen what has happened with eye clinics in Alberta. Canadians have had their eyes opened to what that means in terms of a two tier system. We cannot allow that to happen in Alberta. We cannot allow Mike Harris who is watching with glee to think he too can move in that direction.

Third, the federal government must stop other health services, such as home care from being privatized as well. In the province of Ontario the excellent home care services that were beginning to be put in place, beginning to be integrated into a comprehensive home care system have been torn down. Why have they been torn down? Because the federal Liberal government gave Mike Harris the permission he needed to do it. It cut so much money in unilateral cuts to health care starting in 1995 and still has not restored those lost funds. The Harris government said, “We are going to take this as permission to begin delivering home care at the lowest possible cost. We are going to shift it on to a private system”.

Excellent experience, respected health care and home care workers like the VON, the St. Elizabeth Society and the Red Cross have literally been thrown on the human scrap heap to make way for privatized home care. It is not a pretty picture.

Today every member of the House, including every member from the provinces of Ontario and Alberta who knows what an ugly picture that privatized home care is, has the opportunity to make it clear that he or she is prepared to stand and fight for what Canadians want, and that is a universal, publicly funded health care system.

We know that every member of the House understands that is what Canadians want and we know that the health minister will stand to say “Yes, but it takes money”. Then let us talk about the money. Yes, it takes changes. Let us talk about the changes. But let no member of the House use the excuse of cowardice or dithering or delaying to fail to stand in his or her place today to support the NDP opposition motion that is before us to strengthen and preserve through change the health care system for which Canadians have worked so hard.

[John Herron, Progressive Conservative, Fundy Royal, NB]

Madam Speaker, I applaud my colleagues in the NDP for bringing forward the debate in the House today on what clearly is Canada's number one priority.

Having said that, I would point out to the hon. leader of the NDP that they have really chosen to attack two provincial governments. I would point out in particular that the Progressive Conservative government of Mike Harris has put more money into health care than any other provincial government in Ontario's history, far more than that of the NDP.

Is the hon. member aware of that fact?

[Alexa McDonough, NDP, Halifax, NS]

Madam Speaker, the first thing I would do is welcome a member of the Progressive Conservative Party into the health care debate. Canadians have been waiting all week for that to happen.

Definitely I want to point out, to help remove any imaginary barriers to Progressive Conservative support for this resolution, that we were very careful not to mention Mike Harris and Ralph Klein in the resolution because we certainly did not want to give them an excuse not to come forward and make it clear that members of the Progressive Conservative caucus as well support a universal public health care system.

Anybody who imagines that Mike Harris is on the side of universal public health care simply has not been watching what has been going on in this country and in the province of Ontario for the last five years.

[Judy Wasylycia-Leis, NDP, Winnipeg North Centre, MB]

Madam Speaker, there is no question that this debate is more important than any other matter we are dealing with in terms of the future of the country. Universal public health care is the defining characteristic of Canada. It is a unifying force. It is the way we ensure that the Canadian values of compassion and caring, of co-operation and community are translated into action.

There is no question that over the last few years under this government we have lost much of what gives us a sense of Canadian identity. We have lost much of our nationhood. We have lost many of the tools to control our own destiny and many of the programs which Canadians cherish. This debate is really about taking back Canada, about getting control over our own destiny and knowing that if we lose medicare we lose the ties that bind and we throw overboard completely the moral and social values without which our society would become a ruthless jungle.

Today we are at the crossroads. We are at the fork in the road. We are standing at the precipice. The direction we go in the days and weeks ahead will determine what path we take.

It is important to look at why we have medicare and what it means to Canadians. My leader pointed to Tommy Douglas, the founder of medicare, and said that the concept of medicare is about our values and our sense of fairness. I can think of no better way to get across that point than to go back to the words of Tommy Douglas, who said:

Had I been a rich man's son the services of the finest surgeons would have been available. As an iron moulder's boy, I almost had my leg amputated before chance intervened and a specialist cured me without thought of a fee. All my adult life I have dreamed of the day when an experience like mine would be impossible and we would have in Canada a program of complete medical care without a price tag. And that is what we aim to achieve—the finest health service available to everyone regardless of ability to pay.

In this debate it is also very important to look to our neighbours to the south, to look to the American model of health care. That is very much at the heart of this debate, and where we are headed unless the government is prepared to act today. Do we want a society like the United States, where some 43 million people are without any kind of access to medical services? Do we want a situation where families in this wealthy country of Canada make difficult decisions about whether to fill a prescription, take a sick child to the doctor, or get a regular checkup?

A few years back I had the opportunity to be on a fact finding mission in the United States. I was struck by the horror stories of what people had to endure because they did not have a universal public health care system. I was struck by one story of a woman who needed a liver transplant. Her health insurance plan did not cover this particular intervention. The family had to come up with $150,000 in cash just to get on the donors list. The first organ transplant did not take. The family needed another $50,000 cash to get on the donors list again. The woman who went through that operation died. The family was left facing a bill of $400,000, of which only a portion was covered by their insurance plan.

Do we want that kind of situation in Canada? Is that not where we are headed unless we can somehow convince the government to act and act now?

It is also important to remember what happens when governments delay, when political paralysis sets in and when we do not act immediately when the first signs of danger appear.

I want to go back to a speech made by Stanley Knowles in 1958 in Gimli, Manitoba. He said: “The Liberals promised health insurance in 1919 but had no intention of starting it until 1959”. Stanley Knowles had a good sense of humour. He went on to say:

Apparently, it was Mr. Mackenzie King's reading of the Bible, about the children of Israel having to wander in the wilderness for 40 years that prompted him to require the people of Canada to wander in the wilderness of high medical costs for 40 years before making even a start in this field.

Today we actually have the spectacle of the present Liberals having Canadians wander again in the wilderness and of creating the horrific possibility of losing medicare because of inaction and political paralysis. We are here today with this motion because we want the government to act.

The focus of our motion is a federal budget that has been universally condemned by health organizations from one end of the country to the other, and by every provincial premier responsible for delivering health services to Canadians. The daunting challenge before us today is to somehow give expression to the desperation, the anger and the grief of those who are forced to cope with the inadequacies of our health system, especially as they listened to the finance minister's message on Monday.

Those who are stretched and stressed to the breaking point, trying to care for themselves or finding a way to pay for care for their loved ones, are the people we are speaking on behalf of today; those who know in their hearts that with an improved, fully funded, comprehensive health system, someone they knew, someone they loved, could have lived a longer and better life. The motion today is about just that.

The motion today is about stopping the slide to two tier health care. The motion today is about stopping Ralph Klein, who at 3.45 p.m. today, eastern time, will stand in the Alberta legislature and introduce a bill to allow profit care in Canada's hospital system. That is the measure of this federal budget.

The budget is the green light to Premier Klein, Premier Harris and other advocates of two tier American style health care. It is no coincidence that Premier Klein waited until the Liberal budget came down. He knows there is no money to back all the Liberal talk. He says “Let us roll up our sleeves and get on with two tier medicine”.

It is no coincidence either that the day after the budget the Reform Party told Canadian TV viewers—and I quote from the finance critic for the Reform Party—“Obviously we are going to have to look beyond the money and start to entertain some private sector solutions”.

Canadians do not want American style health care. They know that for profit medicine is not going to answer their needs. Premier Klein has offered no proof that private for profit health care is any more efficient than public health care. The Minister of Health has refused to stand and take him on, do the right thing and stop private for profit health care before it is too late.

We know, and all the studies show, that private health care typically costs more, provides lower quality services and fewer services, reduces accessibility and fairness and drives up the public cost in other jurisdictions.

The motion before us today is about the future of medicare. It is an opportunity for the government to change course and do the right thing. Ever since the budget was delivered Liberals have been saying that they know this is not enough. Did they not know that before Monday? Did they not know there was a crisis? Why did they not act in this budget? Why are they waiting?

We have before us an opportunity to show that medicare could be a model for all countries in the new global economy. After all, when we are talking about medical care we are talking about our sense of values. Do we think human life is important? Do we think the best health care which is available is something to which people are entitled by virtue of belonging to a civilized country? The answer from Canadians is a resounding yes. The question is: Why can the Liberals not see it?

I move:

That the motion be amended by adding before the word “Canadian” the following:

“cherished”.

[The Acting Speaker (Ms. Thibeault)]

The amendment is receivable.

[Myron Thompson, Reform, Wild Rose, AB]

Madam Speaker, having lived for the first 35 years of my life in the United States, I am fairly familiar with its medical system. With 90% of my relatives living there, I am quite familiar with what is happening in their lives in terms of the medical system.

I assure the member, after taking a careful look at the proposals from Ralph Klein—and I hope that the NDP will do the same—that his proposals are a far cry from being what they have in the United States. They are not that comparable. I wish the NDP would take a little closer look at it.

We all know that the Liberal government was responsible for causing this dilemma in the first place. There is no way that it will restore the money that it deliberately took out of health care since 1993. However, government spending is phenomenal in so many areas. If the health minister needs money, the government will have to stop some of the silly spending that is going on, some that I know the NDP approve of.

It is nice to do little things for culture and for art, but when we get down to the necessities of life, what would she request the government do in terms of not spending money? What areas would she like to see cut out in order to provide more money for health care?

[Judy Wasylycia-Leis, NDP, Winnipeg North Centre, MB]

Madam Speaker, I would make several comments in response to the question.

My first comment has to do with the American style of health care referenced by the member. If anyone has had any indepth involvement with people in the United States, they know just how precarious the system is and just how many people are left to suffer because they do not have access to health care and do not have insurance coverage. It is not uncommon to hear about people dying on the operating table because they did not have the money.

We were all shocked when Reformers stood in the House over the last couple of years and said things like “I can get better health care in Florida than I can get in socialized Canada”. We were shocked when the Leader of the Reform Party, just a month ago, stood up in the House and said “We should look at private sector investment in health care”. We were shocked this week when the finance critic stood up before Canadians and said “We have to look at opening up health care to private sector involvement and investment”. That is not the solution.

Let us also be clear that when it comes to this budget in terms of spending, what we really ended up with is a Reform style budget with all the focus on tax cuts and very little on the priorities of Canadians, the number one priority being health care. What we have in this budget is two cents for every dollar in cutbacks, in tax rollbacks from the government. Is that a response?

What the provinces want is a commitment from the government to restore transfer payments; the money it took out in 1995. The provinces are quite prepared, on the basis of that commitment and that determination, to get back to a 50:50 partnership, to in fact work to strengthen medicare, to restructure medicare and to improve medicare. We have to do it on the basis of a financial commitment from the federal government and the political will to truly preserve and strengthen medicare.

[Lynn Myers, Liberal, Waterloo—Wellington, ON]

Madam Speaker, I agree with some of the things the hon. member said. I certainly agree with the last point about the Reformers and how they want an American style two-tier medical system, which is an absolute disgrace.

However, where I do not agree with the hon. member is that we on the government side have made a commitment to Canadians that we will protect the health care system in Canada because it is an underlying value.

I wonder why the hon. member does not ask her leader, whom I see is in the House, the hon. member for Halifax, why in 1997 she said we should add an additional $1.5 billion. In 1998 she said we should add another $2.8 billion. Excuse me, that is not nearly enough and we on the government side have added a great deal more than that.

In their party platform in 1997, the NDP members argued that there should be $79 billion additional spent in Canada. How much of that was earmarked for health? It was 10%. Now we hear from the hon. member opposite all these nice words. My question to her is simple. Why does she not put aside this petty politic stuff, and do like the Canadian Medical Association and others have said, and get all the people together to work on long term solutions?

[Judy Wasylycia-Leis, NDP, Winnipeg North Centre, MB]

Madam Speaker, first, I will put a question back to the member. Is two cents on the dollar a true commitment for something as fundamental as medicare and universal health care?

The government cut $6 billion out of transfer payments in 1995. That has left a cumulative shortfall of $21 billion. This budget puts back two cents of every dollar in taxes which means that if all goes well the government might be up to a 15% share of funding for health care.

The member knows full well that the commitment of this party is for a 50:50 partnership. That is what we want to see.

[Allan Rock, Liberal, Minister of Health]

Mr. Speaker, I intend to share my speaking time.

I would like to begin by saying that I am delighted to have the opportunity to participate in the debate today on a matter of prime importance to Canadians.

What we are talking about today, Canada's health care system, represents a tangible expression of this nation's shared values. It is something that lies very close to the heart of our country's sense of self.

It seems to me that Canadians cherish medicare because to us it is about more than just doctors, hospitals and medical treatment. It is about the way we want to live. It is about being part of this country. Canadian medicare is about the promise that we make to each other as Canadians, that in times of need we will look after each other regardless of wealth or of privilege, and so it is a subject of fundamental importance to each of us.

The principles of the Canada Health Act, the principles on which Canadian medicare is built, are as sound today as they were decades ago when they were enshrined in federal law. Their soundness derives not just from the social equity, which is obvious, but also from the economic advantage that the single tier, universal coverage provides to Canadians and Canadian businesses.

Time and again the economic comparative advantage of Canadian medicare is demonstrated, and we must never lose sight of that fact. As sound as these principles are and as strong as the arguments are for preserving those principles, we have problems in practice of which every Canadian is aware. It is clear that the status quo is unacceptable. It cannot continue. There are people who are waiting too long, waiting hours in the emergency ward, waiting months for referral to a specialist, waiting a year for a long term bed, waiting what seems an eternity for someone to answer the call button in the understaffed hospital ward. The status quo is not on.

However, as we look for answers we must be careful to distinguish the real solutions from the false ones. We must resist the siren call of the private parallel system which is not the answer. Private for-profit medicine is not the intelligent or effective response. The private parallel provision of medical services is less effective, more expensive and, frankly, is inconsistent with the basic principles to which this nation is committed.

Surely the answer lies in renewing medicare, in finding new ways to provide services of quality to give Canadians and their families access to quality care in a timely fashion within the principles of medicare, within the principles of the Canada Health Act.

What is needed? I suggest two things are needed: first, the proper level of financing; and second, innovation and change, ideas and hard work to bring about the kind of structural changes that are necessary to adapt the principles to modern realities.

First, in terms of financing let us set the record straight on the contribution of the Government of Canada to our medicare system. Public spending on medicare every year approximates $60 billion. We transfer to provinces a total of about $40 billion, including equalization. If we subtract the equalization it is $30 billion in transfers this coming fiscal year through cash and tax points.

Looking historically at the utilization by provinces, just over half of that transfer is devoted to health care, about 54%, almost $17 billion. If we add the $3 billion that Canada spends directly for health care services for Canadian forces and aboriginal persons, it is over $20 billion. One-third of total public spending on health care in the country every year comes from the Government of Canada.

Let us be honest about the facts on financing. Let us tell the truth about role of the Government of Canada. One-third of all public funding on health care is contributed by the Government of Canada. The cash portion of that contribution, the cash portion of the transfers to the provinces has increased by fully 25% over the last two years as a result of the very budget measures that party is today attacking.

I said it would take two things to save and strengthen medicare. The first is the proper level of financing. The second is hard work with ideas and innovation to make the changes we must make so that services are provided and are accessible to Canadians in keeping with standards of quality.

Our objective must not be, as the NDP would seem to suggest, simply to make the health care system more expensive by spending more. Our objective must surely be to improve its quality and access to services by making the changes needed. That means long-term sustainability. It means learning from the provinces by looking at what they have done to innovate in recent years. It means sitting with the provinces, learning from their experiences and developing a shared agenda of common priorities, because one thing is certain, we will not succeed in this effort unless we work together.

I have sat with provincial ministers and I can say that year after year at the end of our meetings we produce a virtually identical list of common priorities of what has to happen to resolve the issues facing medicare. I have spoken and written about these issues at length in the past. Today is not the day to go into detail about them, but I will say, by way of summary, that the provincial priorities for innovation and change, priorities that I share, include new ways of delivering primary health care, that is to say the first line of family health services in communities.

Changing the way the primary health care is delivered is fundamental to restoring accessibility to medical services in the country. The second is broadening the availability of home and community care to reflect the reality of what happened with the downsizing of the hospital sector and the increased reliance on care outside hospitals. Provinces are moving in that direction as well. Many of them have made very significant investments in home and community care.

The time has now come to broaden that effort and to weave home and community care into medicare as an integral part of health services. In reality it is needed.

The third is a focus on quality care. The Canada Health Act does not speak of quality or standards of care. It talks about principles.

For the first time this spring we will produce a comprehensive report on outcuts in the health care system, measuring how it performs and with that measurement, which will allow us to manage better, we can work toward public discussions of quality in health care in Canada using information technology to monitor it, to track it and to integrate the various parts of our health care system so we can give better service to Canadians.

The Government of Canada has a crucial role to play in all this. It is a role of leadership. It is a role of co-ordination. It is a role of bringing constructive ideas to the table and of supporting the provinces in their own efforts to innovate and resolve these difficult issues.

I make no apology for the fact that some weeks ago I put some ideas on the table. I think it is my responsibility to lead a national discussion about where we go from here. The Government of Canada will be there throughout to do its part. I proposed meetings in the near future with my provincial counterparts so that we can work toward a plan of action, implementing the changes that we have all recognized for some time are necessary.

Let us now move from resolution to action. That is what I think we must do on behalf of the people of Canada. If that action requires a greater contribution from the government, if it requires a long term financial commitment from the government, as the Minister of Finance has said and the Prime Minister has always said, the Government of Canada will be there to do its part.

Let me conclude by saying that the status quo is not acceptable. We have to change in order to preserve medicare, to save and strengthen its principles. The choice is not between the status quo and a private for profit system of medicare. That is not the choice we face. The choice is between the status quo, which is unacceptable, and a renewed medicare operating within the principles of the Canada Health Act to do a better job. A country that had the wit to invent it can surely find the will and the ways to preserve it.

[Judy Wasylycia-Leis, NDP, Winnipeg North Centre, MB]

Madam Speaker, I would like to address the question of the financial contribution of the federal government. The minister and his colleagues have said time and time again over the last two days that the cash does not matter. They have actually tried to deflect attention by throwing in everything but the kitchen sink in the federal contribution toward health care.

Before 1993, when the government was in opposition, the Liberals criticized the Conservative government for changing the formula and said very clearly that it was the cash that matters. In the 1997 budget on page 65 the government said that it was the cash that counts in terms of program spending.

My first question is for the minister. Why does the cash not count today? Does he not realize that it is the glue that holds our health system together? It is the only way to stop the privatization forces under Klein, Harris and the Reform Party.

I have a second question. The minister and his colleagues are concerned and committed to stopping two tier Americanized private health care. Do they not recognize that by being passive, by aiding and abetting Alberta's privatization agenda, as they did when they allowed the 12 point agreement on private health services to take place, they are part of the problem? In order to truly support and enhance medicare they have to dissociate themselves from that position, rescind that agreement and go forward, fully supporting the principles of the Canada Health Act.

[Allan Rock, Liberal, Etobicoke Centre, ON]

Madam Speaker, the cash does matter. That is why in each of the last four budgets we have increased the cash very significantly, as I mentioned, by 25% over the last two years. The cash does matter and it has increased.

Just the other day the Minister of Finance announced $2.5 billion which will result in a permanent increase of $500 million a year in the cash floor. That will be $15.5 billion a year in the cash transfer to provinces.

Let me address another point the member raised. She talked about the passive role of the Government of Canada. We do not take a passive role. I reacted immediately to the proposals of Mr. Klein by saying that we would look at them very critically. I expressed concerns when I wrote to the minister of health of Alberta. We are awaiting the tabling of the legislation later today. We will examine it carefully to determine whether it is consistent with the Canada Health Act both in letter and in spirit.

We have aggressively proposed that ministers meet quickly to act, not just speak, on points of common priority in order to improve medicare. I do not think that is passive. That is the Government of Canada fulfilling the role it is intended to serve of leadership, co-ordination and working constructively with partners.

The last thing I will say is that I know we cannot succeed if we rely on personal attacks. I am not speaking now about members opposite. I am speaking of other participants in the debate. We will not advance this issue on the basis of personal attacks.

It is not too long ago that I was in the real world working and watching politics as a citizen. I can recall how disappointed my neighbours and I were when we saw politicians engage in personal attacks. It is very dismaying because it signals that they are not focusing on the public interest. They are not at work on what will make a difference.

I suggest to all my colleagues in this debate that we set aside personal attacks, that we focus on what Canadians are interested in, which is long term solutions to their medicare system, and that we work together in a constructive fashion to get those changes in place.

[Alexa McDonough, NDP, Halifax, NS]

Madam Speaker, the health minister invites us to look at what is happening in the real world. In the real world there are growing waiting lists. There are crowded emergency rooms. There are ambulances that cannot get into hospitals and are being turned away. There are people who cannot afford the soaring cost of pharmaceuticals.

In the real world the federal Liberals reduced their previous contribution of $18.5 billion down to $12.5 billion. How could the health minister not acknowledge that the government has not even restored the level of cash contributions to health care spending to what it was when the Liberals took office? How can they, in the real world, pretend that is not so?

[Allan Rock, Liberal, Etobicoke Centre, ON]

Madam Speaker, it has increased and we are contributing one-third of all public spending; but let me go beyond money to the second part of the equation which is the changes that are required.

The leader of the New Democratic Party talks about problems in emergency rooms. If she will go there as I have done and speak to the people who run hospitals, who run emergency rooms, and ask them why, they will give two reasons. The first reason is that family physicians, as hard as they work, cannot be on duty 24 hours a day. If we call them when their offices are closed there will be a tape machine saying go to emergency. That way we get too many people at the emergency department who ought to be served in a different way in another place.

The second reason is that there are people on stretchers in emergency departments waiting for admission to hospital who should be upstairs in beds and cannot go there. The beds upstairs are taken by people who should be moved out of hospital into home and community care, which does not exist. If we want to resolve the problems with emergency rooms and stop ambulances being turned away, we will buy into the agenda of the provincial ministers of health, which I support, to change primary care and to add home and community care where it is needed across the country.

[Roy Cullen, Liberal, Etobicoke North, ON]

Madam Speaker, I welcome the opportunity that today's motion offers to join my colleagues to reinforce for all Canadians our government's absolute commitment to health care and to present the facts about the federal government's contribution to health care in Canada.

Our priority is clear and concrete. It is to work through partnership with all orders of government and all stakeholders to provide Canadians in every region with the health care system they need and the health care system they rely upon.

Budget 2000 is based on previous budgets. It provides for the injection of an additional $2.5 billion dollars into the Canada transfer for health and social programs in order to help the provinces and territories fund health care and post-secondary education.

When we add this new $2.5 billion to the $11.5 billion CHST investment in last year's budget specifically for health care, we find that the cash portion of the CHST will reach $15.5 billion in the coming year, almost 25% higher than last year. This is the fourth time that the federal government has been able to turn better finances into a better quality of life through greater support for the CHST.

The budget provides an additional $1 billion in 2000-01 and $500 million in each of the following three years. The provinces and territories will have the flexibility to draw from the $2.5 billion that is being added to the CHST as they see fit. They can draw upon it to meet the most pressing needs in hospitals or universities or at any time over the course of four years as they see fit.

Some have said that this additional $2.5 billion for the CHST transfer is small potatoes. I cannot agree because $2.5 billion is not an insignificant amount of money. It is even more significant when added to the funding increases we made in previous years. As I just said, because of our CHST investments in the 1999 and 2000 budgets, in the coming year CHST cash will be almost 25% higher than last year. This is just the CHST cash portion.

Too many Canadians forget, because our critics often try to push it aside, the fact that federal support for the CHST also includes tax points. Tax points are converted into cash and paid to the provinces. They are the same as cash. Members opposite need to understand that. When the value of tax points is taken into account, total CHST transfers in the coming fiscal year will reach $31 billion, a new all time high.

The Canada health and social transfer has been fully restored to 1993-94 levels. At the same time the federal government's own direct program spending is down $4 billion from the levels when we first came into office. This clearly demonstrates our commitment to health and the priority we attach to health care.

It is not an abstract issue. What is a tax point transfer? As hon. opposition members should be aware, it simply means that the provinces can collect a portion of the taxes that would otherwise go to the federal government. Put differently, it allows the provinces to collect a higher share of taxes while federal revenues decrease by the same amount. Ultimately the individual taxpayer still pays the same amount.

There is an excellent reason why the provinces accepted these tax points and why they hang on to them today. I have not heard the provinces saying that they do not want the tax points. Why is that? It is because as the economy grows so does the value of these points. While there have been economic ups and downs, each of those tax points is worth much more today than when the programs they fund were introduced. In other words, it is a form of federal assistance that keeps on giving and keeps on growing.

When we hear calls for the federal government to hand over billions more for health and social programs, we should remember that this ignores the fact that provinces enjoy significant additional revenues from tax points already in their pockets each and every year.

The excellent performance of Canada's economy has significantly improved the value of the two other main transfers to the provinces and the territories.

Equalization payments to less prosperous provinces, for example, are up $500 million for this year over last year's budget projection, taking entitlements to $9.8 billion from the $9.3 billion previously projected. Territorial formula financing is nearly $100 million higher this year than was projected, taking entitlements to about $1.4 billion from about $1.3 billion previously projected.

When we combine these major transfer programs, the CHST, equalization and territorial formula financing, we see that total transfers to the provinces and territories will reach an estimated $39.4 billion this year. This will allow the provinces and territories to strengthen health care, post-secondary education and other social programs important to Canadians. The provinces can use the equalization payments for health care, education or social programs.

It is also interesting to look at federal transfers in terms of the contribution to estimated provincial and territorial revenues. I will give just a brief rundown. In 2000-01 federal transfers will account for about 45% of Newfoundland's estimated revenues. The corresponding figures for the other provinces and territories are approximately as follows: 40% for P.E.I., 42% for Nova Scotia, 37% for New Brunswick, 25% for Quebec, 20% for Ontario, 35% of the provincial revenues for Manitoba, 22% for Saskatchewan, 17% for Alberta, 20% for British Columbia, 81% for the Northwest Territories, 94% for Nunavut, and 71% for Yukon. These are significant contributions to the economies and the provincial revenues across Canada.

It is important to note that federal assistance for health care does not begin and end with transfers. For example, almost half of the grants from the federally sponsored Canada Foundation for Innovation have gone to health research. It is now a $1.9 billion foundation.

Good health and effective health care are much more than an issue of hospitals and clinics. My colleague the Minister of Health has spoken very eloquently today and many times before on this subject. This is why the 1999 budget announced an additional investment of $1.4 billion in health information systems, research, first nations and Inuit health services and health problem prevention. The 1999 budget also provided significant funding for a number of other important health initiatives like the national health surveillance network, the Canada health network and a variety of other initiatives.

The government's commitment to a strong health care system is a key priority and the reason that increasing funding for health was a central theme in the 1999 budget.

Governments both federal and provincial recognize the necessity of ensuring that Canada's health care system continues to meet the needs of its citizens into the future. The federal government has invested significant amounts of money in the CHST. However, money alone will not solve the long term health care problem.

In the report of the National Forum on Health to the Prime Minister not too long ago, it was noted that by international standards Canada's health care expenditures appear high among industrialized countries. Only the U.S. spends a higher share of its GDP than Canada and we know the reason. A full 30% of health care expenditure in the United States has been on administration, filling out forms.

Ottawa cannot do it alone. This is particularly important as Canada's baby boomers approach their senior years. This is why the federal and provincial health ministers have agreed to meet in the spring of this year.

I think I can speak for all my government colleagues when I say that our priority is to help sustain a health care system that meets the needs of all Canadians. This is why we will continue to apply the values of partnership and co-operation, values based on the recognition that health care is the responsibility of all of us. This is a responsibility I am confident will never be abandoned by the government and my party.

[Grant Hill, Reform, Macleod, AB]

Madam Speaker, the member opposite quoted a figure that is absolutely false. He talked about the international rankings of Canada in terms of health care expenditure. He quoted figures from 1993 when the Liberal government took office.

I wonder if the member would like to talk about Canada's international ranking in terms of expenditures on medicare today in the year 2000. I will mention them in my speech because I do not think the member knows what Canada's ranking is today. Internationally, where do we stand today in regard to expenditures on health care as a per cent of GDP?