Debates of Oct. 28th, 2002

Health Care System

[Greg Thompson, Progressive Conservative, New Brunswick Southwest, NB]

Mr. Speaker, there is no question that we need change in our health care system. It was interesting to listen to some of the members this morning. There is some commonality in our approach and differences as well, but there is one thing we agree on. We do not want to go to an American system of health care.

The leader of the Canadian Alliance talked a little bit about the American system this morning. I want to point out a couple of things. In comparison to the American system, our system is working pretty good. We do know there are problems with it. I am experiencing some in my home town in terms of doctor and nursing shortages, people who cannot get doctors and doctors retiring.

There is a headline story today in the Ottawa Citizen about the doctor retirement problem in Ontario. It is a big problem. One of the doctors pointed out how we got into this mess in Ontario in terms of doctor retirement. Twenty-five years ago Ontario decided it had too many doctors and launched action to stem the flow of doctors into the system. We are all victims of mistakes that were made many years ago. We have these changing demographics in Canada that makes it even more urgent that we address the problem soon.

In the American system 14.5% of GDP goes to health care. The Americans usually say it is 40% of people, but clearly well over 40% of people are completely left out of the American system with no health care. In Canada, where everyone is in the publicly funded system, it is costing us 9% of GDP, so we are getting a deal. However there are some problems that have been examined very carefully by Mr. Kirby.

I do not want to get into debate back and forth with members from various parties, but the member did mention something just a moment ago. I want to talk about that as well, because the Canadian Alliance leader is a trained economist, which I am not, and I do not know whether or not that gives him an advantage over me.

In the American system the tax brackets or the level of taxation in their society compared to ours, whether it is for corporations or individuals does not say it all. We know full well that in the American system one of the huge costs for American businesses is health care because they are required to pay that. It is just like a tax.

I want to use the specific case of a young family I spoke to in the United States a couple of weeks ago. This is typical, not an unusual case at all. It gives the example of how much it costs companies or corporations, either private or public, in the United States to do business and provide their workers with health care. The young couple in their mid-thirties have two children. He is working for a company where his health insurance premium for the year was $15,000. We might call that the Cadillac system because there is a zero deductible. In other words if he went to the hospital the first dollar would be paid by his insurance plan. The premium was $15,000 a year. His company paid $10,000 of that.

That is an expense that most companies in this country do not have. A lot of companies could not afford it, as is the case in the United States. In addition to that, the young man and his wife had to pay $5,000, but that was for Cadillac coverage in that system. The young man lost his job and now he is working for a smaller company that cannot afford that kind of coverage so it is up to him and his wife to provide coverage for their family. That coverage is costing him $600 a month. In my province that is the monthly rent or the mortgage payment for a lot of people or at least a car payment.

[Loyola Hearn, Progressive Conservative, St. John's West, NL]

Or the income for seniors.

[Greg Thompson, Progressive Conservative, New Brunswick Southwest, NB]

The member for St. John's West just said the income for seniors when we look at some of the restricted incomes that our seniors are on.

However, under the new plan, which is not a Cadillac plan, there is a $5,000 deductible. In other words, the only time the insurance company will pay anything is when it is over $5,000. It is a huge expense for them. I do not think we want to go there. We understand that the American system has big problems. I do not think we want to consider going into that system.

As one of the member's mentioned this morning, there is no question that the American health care system is driven by two groups of people, lawyers and insurance companies. I might mention actuaries as well who determine the rates of these individuals whether they are young people or older people. In fact some people cannot get any coverage at all. It is just like car insurance, if people are poor drivers it is really tough to get insurance. Some companies simply will not insure them no matter how much money they want to pay.

The interesting thing about the Kirby report is that it hit some of this head on and is pretty daring in some of the things that it proposed. One of the things that he suggested was that any new money, and he was talking about $5 billion a year going into the system, must buy change. He stated that throwing money into the system would not do the trick. It would not produce the kind of results that we want to see.

One of the reasons that would lead to that conclusion from those of us who watch the Auditor General's reports with a great deal of interest is the simple fact that under our system today, the system where we are transferring money to the provinces to deliver health care, the Liberal government has no idea how much money goes to the provinces. It does not know how much money is being spent on health care. The Auditor General pointed that out.

The reason being is that under the social transfer that money can be either spent on health, welfare or secondary education. How much of it goes to health? We do not know. What are the outcomes? There is no way under the Canada Health Act to measure whether it is being used in an efficient manner or if some of it is being wasted.

I would like to give an example. A couple of years ago the federal government put $250 million into new technology. Would a lawnmower be new technology? Would woodworking equipment in a hospital be new technology? Without being sophisticated health care administrators or doctors at any level, our answer would be no. However it shows the lack of safeguards and insurances built into the system to ensure that money is being spent wisely and in a fashion the program was designed for in the first place.

The money must buy change according to Senator Kirby and his committee. He said the health care system cannot go on the way that it has been going because we cannot sustain it. If we want to save the system, he suggested that we must be willing to pay for it. This is where we will part company with a lot of people on this one. He said that if we want this system we must ante up to the cash register.

He suggested that we could do it in a couple of different ways, but the final report came down to premiums for all Canadians on a progressive scale. People in the higher tax brackets would be paying more for that premium and people at the lower end would be paying less. It would boil down to people in our income bracket paying about $4 a day to preserve the system under the Kirby plan. People in the lower income brackets would be pay about 50¢ for that or the price of half a cup of coffee. Those are the decisions or observations he has thrown out there. Are we willing to pay for it? Before we jump up and start screaming that we are not willing to do that, we must examine a number of things.

First, is the statement made by members of other parties regarding the waste in government. There is no question there is waste in government and that those people over there have gone on a spending spree over the last number of years. I give them credit for some of the things they have done, such as deficit reduction, but there is no question that the spending side of it is something they do not brag about. That spending now is 25% higher than when they came to office. We must sort some of that out as well.

How much of it went to health care? We do know that the government put money into health care a couple of years ago. That money, as Kirby said, just disappeared. Nobody knows what happened to that money. It is, in a sense, unaccounted for.

We have spent a little bit of money on the military and not enough, of course. Some in the House are saying that we need more money for infrastructure in our cities. How much would that cost? It would be in the billions. Some are saying that the military needs a massive infusion of money. How much would that be? It could be $4 billion or $8 billion over a period of years. Some of us are suggesting that it must be billions immediately. What that precise number would be, I do not know, and I do not think anybody does, but we do know that money must come from some place.

We must be careful how we categorically reject that idea of a premium. When we are saying that we will find that money, that $5 billion a year that Kirby says must go into the system immediately on a sustained basis, can that money be found in government waste? I do not think we can find $5 billion in government waste today. Even if we take the two jets the Prime Minister bought that the Government of Canada did not need, that totals only $100 million. It is like C.D. Howe said, but we have gone from “What's a million?” to “What's a billion?” Well, a billion is a thousand million. That is a lot of money.

The Kirby committee suggested and rejected the idea of a dedicated tax. However, this might come with the Romanow report. The committee said that half of the GST, that is 3.5% of the 7%, should go directly into health care. It would be very transparent. We would know exactly how much was coming in from the federal government. However, the option other than a premium would be a dedicated tax. How would that work? Would Canadians categorically reject that?

The Prime Minister does not get out of bed in the morning, and he seldom puts his slippers on, unless he does a poll. The government has done a lot of polling on this, as have the think-tanks. What that polling has told the government is that 80% of Canadians support either a premium or a dedicated tax provided there are guarantees that health care will be there for you, Mr. Speaker, your children, my children and generations of Canadians who are coming behind us. This progressive decline in our health care system has all of us worried.

We only have to look to the south of us, which is how I opened the debate in the first place, to see how a system can come off the rails. We do not want that to happen in Canada, so I think that as Canadians we have to be prepared to make tough decisions. It reminds me of the 1980 election. There is a gentleman sitting behind me, the right hon. member for Calgary Centre, who as the prime minister at the time, going into that very tough election, proposed some tough dues for Canadians. What he suggested at that time was an 18¢ per gallon gas tax, which would have delivered the country from debt within five years, if I am correct. We as Canadians categorically rejected that. We said we would not do it. I can remember a friend of mine saying, and this is as true as I am standing here, “That's a case of beer a week for me. I'm not going to go for that”. But look where we have gone from there. The country would have been debt free. Now we are still burdened with a $550 billion combined debt in the country from over the years.

[An hon. member]

But what did the Liberals do?

[Greg Thompson, Progressive Conservative, New Brunswick Southwest, NB]

Of course we saw the other side of the story, which my political friend from Newfoundland would not want me to leave out. I think we can conclude that gas taxes in the next 12 months after that election went up by something in the order of anywhere from 36¢ to 72¢ a gallon. That is what I have heard.

My point is that it is reminiscent of that debate of over 20 years ago now. Canadians did not want to suffer any short term pain for long term gain. I would have to say that it is a tough thing to take to the electorate. I am not sure how accurate this is but an historian told me that at that time in our history there had never been a Government of Canada elected to office by promising less and not more. We would have to check our history. Can we believe that? As I look at the sloppy habits of behaviour that successive governments have gotten into over the years, I would say that the statement is probably true.

I think we have grown up a lot as a nation. I think we need to have an intelligent debate on this issue of premiums and taxes. If we look at the more advanced countries in the world in terms of delivery of health care, the European nations, particularly Sweden, Denmark, Britain, France and Norway, they all have good systems. Just about every one of those countries, without exception, has some sort of premium or tax involved in the payment of that system of delivery.

Senator Kirby has gone a long way in bringing that forward in terms of getting some intelligent debate out on that particular aspect of his plan. Now we are looking for the Romanow report, but I think we have to look very carefully at what the option would be if it is not going to be that one. I think most of us feel that there has to be a buy-in by the Canadian people, even in terms of smart cards, which is something that they are talking about as well, so that as individuals we know how much is being spent on health care for us and how much a particular service is costing.

I will conclude with this and I hope I get some questions from my colleagues. In regard to the American system there is an old expression that I think really sums it up: Americans are only one sickness away from bankruptcy. That is the system we do not want, but I think we have to approach this in a very mature, reasoned way. We have to look at all the options that are on the table before we conclude that one system is bad or that any system that might suggest a premium is bad and one that does not is good. I think we have room for some intelligent debate here. We look forward as this debate unfolds on the reports from Senator Kirby and Mr. Romanow. Certainly the government will have some tough choices to make and I hope we can contribute to some of the intelligent debate as the government makes those tough choices.

[John Bryden, Liberal, Ancaster—Dundas—Flamborough—Aldershot, ON]

Mr. Speaker, the member who just spoke acknowledged that $5 billion is needed but that $5 billion could not possibly come simply from trimming government waste. I must say to the member that I take that as a compliment to the efficiency of the government, that cutting waste in government would not provide $5 billion.

I would like to advance a very serious question to him. The reality is that health care spending, we understood from an earlier speech, amounts to about $75 billion a year, chiefly spent by non-profit organizations that are not directly accountable for their actions through the Corporations Act and not otherwise transparent. Would he feel that perhaps increased efficiencies would come of bringing these institutions, including the great hospitals, under the Access to Information Act and under the Canada Corporations Act, where there would be standards of corporate governance that they must obey, and would he not feel that this move alone would probably create sufficient efficiencies to not only find the $5 billion but to find far more than $5 billion?

[Greg Thompson, Progressive Conservative, New Brunswick Southwest, NB]

Mr. Speaker, I believe that there has to be transparency at every level of government. There is no question about that, but I want to try to stick just to the health care system. That is one of the points that the Auditor General made. We need to have transparency, accountability, predictability and a measurement of outcomes, because there is no question that in the health care system money is being spent in ways that are not really providing us with any new efficiencies in the system or that have anything to do with the delivery of services to clients or patients. There is no doubt at all about that.

I want to brag a little bit now and I do not want to be too boastful, but one of the bills I introduced last week, Bill C-238, is a patients' bill of rights. It is something that I think we have to consider in our country. I had a chance to introduce it last week. That was one of the things that Bill Clinton tried to do when he was trying to overhaul the American health care system. Actually I wrote to Washington and did a little bit of research on it. I said to myself that maybe it is time we had a patients' bill of rights so that we know what services we are entitled to and that we in turn know what our responsibilities are as users of the system. The Auditor General has identified that difficulty in our system in regard to that sense of accountability, that transparency, where the money is being spent, and who follows the money.

The other thing I want to point out is that it is not just a federal government problem. I have to be careful how I talk about this, because when we talk about closing hospitals in any part of the country we always get into trouble. There is a great article written by David Lutz, a family, criminal and personal injury lawyer from Hampton, New Brunswick, in the constituency of Fundy—Royal.

This is just to show how protective of the status quo we are in our own neighbourhoods, because we are talking about changing the status quo. That is what Kirby talks about, about not just throwing money at it. Money has to buy change. In New Brunswick we have a population of 757,000 people. We have 51 hospitals. Metro Toronto, and I think we have some Toronto members here today, has a population of 4.6 million and has 36 hospitals. Quoting from his article, he says “do the math”. Could anyone say it any better than Mr. Lutz?

He goes through it. We know that there is a difference between the country mouse and the city mouse, and we do know that there is a difference between a country hospital and a city hospital, but he goes on to say that if Toronto can get by with 9,600 beds, less than 10,000 beds for six times our population, and he is talking about the population of New Brunswick, of course, 750,000 or so, why do we need 12,800 beds? These are just questions he is throwing out. He is not suggesting that we close down any hospital. These are questions that I think are worth debating. We do have the doctor from Edmundston here. I am glad to see the parliamentary secretary to the minister here.

[John Bryden, Liberal, Ancaster—Dundas—Flamborough—Aldershot, ON]

Mr. Speaker, I rise on a point of order. With the greatest respect to the colleague who is speaking, a question was asked. I wonder if, in the interests of debate, the member could give us an opportunity on this side to ask other questions.

[The Deputy Speaker]

The member was able to make his request but it is certainly not a point of order.

[Greg Thompson, Progressive Conservative, New Brunswick Southwest, NB]

Mr. Speaker, I hope we can. I love these types of debates, but I wanted to get this point across.

What he is talking about is the area between Edmundston, the parliamentary secretary's hometown, and the part of the province that I represent. There is one constituency between us. I am going to quote directly from the article because I think it says it better than any of us can. It states:

Typical of the problem is the fact that between Fredericton and Edmundston there are eight hospitals, with Dr. Chalmers having 350 beds--

That is the name of the hospital in Fredericton.

--and Edmundston with 169. In between are facilities in Perth-Andover (42 beds), Bath (23), Woodstock (62), Tobique Valley (15), Grand Falls (35), and Saint-Quentin (12). I suggest that if all patients were polled as to whether they wanted to be treated in a hospital with more specialists and the latest technology, they would say “take me there”.

I think that point is worth considering. What I am trying to lay out here is that tough decisions are going to have to be made by all Canadians if we are going to change the system and make it better.

It is no good for me to point my finger over there, because when I do I have three fingers pointing back at me. We are in this collectively. We have to work together to fix it and that includes the provinces.

[Roy H. Bailey, Canadian Alliance, Souris—Moose Mountain, SK]

Mr. Speaker, both the hon. gentleman opposite and the member in his response talked about accountability. I would like to ask my colleague from New Brunswick to imagine for one moment that he is CEO of a large hospital operation and finds that he could buy an MRI from a private clinic for $750, but you know by looking at your books and through accountability it is costing $1,000. What would you do about that, sir?

[The Deputy Speaker]

I will just remind the hon. member for New Brunswick Southwest that the question really came through the Speaker.

[Greg Thompson, Progressive Conservative, New Brunswick Southwest, NB]

Mr. Speaker, they are legitimate questions. I guess it depends on whether the administrator of that hospital is a chartered accountant, a sociologist or a practitioner himself. I guess it depends on the mindset. The point I think the member is making is that there are certain efficiencies in the private sector that there may not be in the public sector. That is one of the points that Senator Kirby is making. Basically he believes in a public, single payer system, that is, the government, but some of these services can be performed in the private sector and probably better. For example, let us look at doctors. Doctors are businessmen. Most doctors are not practising within the walls of the hospital. They are paid by the government.

I think there are a lot of different ways under the system that we have, the public, single payer system, where that can actually work, but again this is about driving some of those efficiencies and working toward them. I think that given time and a deliberate choice that is what Canadians will want.

[Judy Sgro, Liberal, York West, ON]

Mr. Speaker, I am very pleased to be sharing my time with the member for Western Arctic today and to talk in the important debate on the future of health care in Canada. Clearly this is something that all of us value as Canadians, probably more than any other program that is delivered.

I am happy to speak a little in relation to seniors today. Seniors constitute the fastest growing population group in Canada. We have one of the highest life expectancy levels in the world, 81.5 years for women and 76 years for men. We must be living right in order to continue living the extra years that we clearly are living.

In 2001 it was estimated that 3.92 million Canadians were 65 years of age or older. By 2026 one Canadian in five, which equals 6.7 million people, will have reached the age of 65. The fastest growth in the seniors population is occurring among the oldest Canadians, that is, those 85 years of age and older. I am happy to state that Canadians generally are living longer and are living their later years in relatively good health. In 1997 more than three-quarters of seniors living at home viewed their health as good, very good or excellent while only 6% reported their health as poor.

It is important to note that healthy aging is not just for those who are free from disease and disability. It includes the successful management of chronic conditions such as diabetes, arthritis or incontinence so that seniors can continue to function well and remain actively engaged in life.

Multiple factors influence healthy aging. They include adequate income, education, appropriate housing, satisfying relationships, and of course safe environments. Older Canadians have the potential to improve their health and their well-being because many aging related diseases are preventable.

The federal government is constantly working to develop strategies and initiatives to expand disability free years of life to reduce the complications of chronic diseases and to improve the health of seniors. Investment in health promotion and disease prevention strategies to maintain the health of those who are aging well and to improve the health of those with chronic conditions who are at risk for serious problems is very important. Solid evidence shows that these interventions can improve the health of seniors even very late in life.

Let me give an example of two major initiatives. Through the Canadian diabetes strategy, Health Canada is working with a wide range of stakeholders to address the serious impacts of diabetes on an ever increasing number of Canadians, especially seniors. This is because the prevalence of type II diabetes is approaching 50% among Canadians over 65. The good news is that type II diabetes is preventable, controllable and manageable.

Veterans Affairs Canada and Health Canada have partnered on a community based program called the falls prevention initiative to help identify effective falls prevention strategies for veterans and seniors. Approximately one in three seniors will suffer a fall this year. Falls within this age group are a significant burden on the health care system, accounting for $2.4 billion in direct health care costs. Care for seniors injured from falls represents 41% of these costs, or almost $1 billion.

We are also addressing the issue of palliative care and end of life care. Senator Carstairs is the special minister responsible for palliative care and has established a secretariat on palliative and end of life care to coordinate and facilitate the development of a strategy to improve the end of life care for Canadians.

The Canadian Institutes of Health Research were established in 2000 to create and disseminate new knowledge to improve the health of Canadians, provide more effective health services and strengthen the health care system. The Institute of Aging is focusing on advancing knowledge with respect to understanding the aging process; promoting healthy aging; preventing and treating age related diseases and disabilities; improving health policies and systems; and understanding the social, cultural and environmental factors affecting the life of older Canadians. This work will yield valuable knowledge in specific areas of concern such as population, public health, cancer, circulatory and respiratory diseases, arthritis, diabetes, health services, and gender and health.

We are taking further action to close the gap in health status between aboriginal and non-aboriginal Canadians by putting in place a first nations health promotion and disease prevention strategy, with a targeted immunization program and by working with our partners to improve health care delivery on reserves.

Good health cannot be achieved alone. Health Canada's work with the provinces, territories and non-governmental stakeholders provides an opportunity to influence and support health initiatives in our communities. It is necessary to work together to respond to aging related issues.

At their June meeting, the federal, provincial and territorial ministers responsible for seniors discussed a wide range of issues posed by an aging population. They identified healthy aging, seniors wellness and elder abuse as priorities needing further attention. Ministers directed their officials to identify actions to help their governments as well as the Canadian society as a whole to prepare for these challenges and opportunities of our aging population. They reaffirmed also that enabling Canadians to maintain health and wellness in later life is a shared priority by all.

Increasing public awareness as well as encouraging and supporting initiatives such as active living, healthy eating, injury prevention and smoking cessation are key contributors to the health, independence and quality of life for today's and future seniors.

In April 2002 Canada along with 156 countries endorsed the Madrid international plan of action on aging which was presented at the United Nations Second World Assembly on Aging. The Madrid plan sets out three key policy themes: one, older persons and development; two, advancing health and well-being into old age; and three, ensuring and enabling supportive environments.

Canada was instrumental in significantly influencing the contents of the international plan of action on aging. We are looked upon as being a leader in aging policy and program development. The federal government is now examining its existing programs related to aging and seniors in order to determine its own domestic priorities.

Seniors play an important role in Canadian families and in our communities. It is a role that is best assumed and enjoyed when seniors experience good health. That is why we are all working together continuously to help the people of Canada maintain and improve their health.

[Peter Stoffer, NDP, Sackville—Musquodoboit Valley—Eastern Shore, NS]

Mr. Speaker, my hon. colleague's office happens to be across the hallway from mine. I have great respect for her and her efforts in trying to promote Canadian values among all Canadians, but there a couple of things I wish to raise.

The first is the disability tax credit. The government talks up a great storm but at the same time takes money away from those vulnerable in our society. I would hope that she would be one of those many backbench MPs in the Liberal Party who are opposed to the changes to that tax credit.

Most important, she did mention Sharon Carstairs and her work regarding the concerns of palliative care. As my colleague would know, I have had a bill in the House of Commons now for over three years which was just reintroduced and which was chosen in the lottery. We will get a chance to debate what she so eloquently talked about.

The bill basically says that anyone who has to be institutionalized as per a licensed physician could stay in the confines of their own home if there is a caregiver. If that caregiver needs to take leave from work in order to provide that care, that person should be able to collect employment insurance similar to the maternity leave benefits.

There is something for at the beginning of a person's life called maternity or paternity leave, which is a great program. It could be improved but it is still a good program. However there is nothing for at the end of a person's life, such as eternity leave. This is something that we hope to address. I could not help but notice that part of this issue appeared in the throne speech. Senator Carstairs is promoting it across the country as well.

Does the member for York West support those initiatives? Would she strive in all ways possible to make my bill a votable item so that we could have a proper debate for all Canadians to listen to?

[Judy Sgro, Liberal, York West, ON]

Mr. Speaker, the comments by my colleague across the floor and across the hall in our building are indicative of the fact that many of us come to Ottawa on issues we are concerned about, in particular the health care system, the issues in and around disability, and how we can help people in our communities.

I look forward to seeing his private member's bill come before the House. In fact I would like to see us work as quickly as we can to try to resolve those issues, whether we are doing them through my colleague's bill or through the recommendations and actions from Senator Carstair's committee.

[Deepak Obhrai, Canadian Alliance, Calgary East, AB]

Mr. Speaker, I was one of those guys who definitely benefited from our health care system this year when I had my medical problem. Through personal experience I can vouch that we have one of the best medical systems in the world. The doctors and nurses are critically important. It is very important for us to ensure that the system survives and is there for future generations. Today's take note debate is based on that.

My point is that while we debate this issue, the underlying fact remains that it is important for us to maintain the system, as the member alluded to, for all Canadians, seniors and everyone. I would like to know her thoughts on that.

[Judy Sgro, Liberal, York West, ON]

Mr. Speaker, I am pleased to see our colleague looking so well and so fit and applauding our system.

All of us as Canadians are immensely proud of the system we have. The question is how we are going to make it sustainable in the long term. Demographics clearly show that we have an aging population. We have been working with our partners in government to find more efficiencies in the system. Clearly we have enormous pressures ahead of us.

This debate is the beginning, along with Senator Kirby's report and Mr. Romanow's report. I would expect that we would have a variety of opportunities to look at some viable solutions so that a year from now we are not standing here continuing the debate on what we are going to do. We will have some answers that we will put into place to ensure that the Canadian health system is protected.

[Ethel Blondin-Andrew, Liberal, Secretary of State (Children and Youth)]

Mr. Speaker, I am pleased to have the opportunity to speak to this important debate today. I am very excited by the government's renewed commitment in the Speech from the Throne to close the gap in life chances between aboriginal and non-aboriginal Canadians.

In consideration of the debate I want to focus on aboriginal health issues. This is an approach that I have been advocating over my many years as a member of Parliament. I am thrilled to have the opportunity to work with the Minister of Health and her department in their commitment to close the health gap for our first nations and Inuit people. We know there is still a long way to go in closing this gap and, although progress is slow, it is being made.

Mortality and morbidity rates have fallen and the gap in life expectancy between aboriginal and non-aboriginal Canadians has decreased in the past 25 years. The life expectancy of status first nations women on and off reserve, for example, rose from about 66 years of age to 77 years of age. However that is still five years less than the Canadian average of 82 years of age for women nationally.

The health status of aboriginal people, particularly those living on reserve, still remains much poorer than that of other Canadians. Aboriginal people are still at greater risk of chronic disease. The rate of diabetes is four times higher, arthritis is three times higher and suicide is six times higher, especially among young people. Those are astonishing rates.

On some reserves conditions are such that the challenge of improving health outcomes is very complex. We are mindful that any long term solution requires an integrated and complementary approach. Factors, such as education and income, environmental factors like housing and water supply, and lifestyle factors like diet, exercise, smoking and alcohol intake, all influence the health status of first nations people and Inuit.

Work in improving the health of aboriginal people at Health Canada and with its partners is not just part of the government's broader commitment to improve life chances for aboriginal people. It is dependent upon the work of other federal departments and agencies, provincial and territorial governments and aboriginal communities to act on the broader determinants of health.

In my riding of the Western Arctic the health and social services department of the government of the Northwest Territories has put in place an action plan of commitments under the leadership of Minister Michael Miltenberger. This plan includes five areas and all residents of the Northwest Territories.

The first area improves the services to people. The second area improves the services to staff. This includes human resource development and planning. The third is improvements to system of wide management which will see a joint leadership council to provide leadership to the health and social services system and a system wide planning and reporting model. The fourth improves support to trustees of the leadership model for health and social services. The fifth improves system wide accountability by establishing clear accountability and action reporting.

We all have work to do and I am encouraged that the Speech from the Throne makes a number of specific commitments to take further action to close the gap in health status between aboriginal and non-aboriginal Canadians. These commitments are forward looking and positive and will work to support first nations people in laying the foundation for good health.

By putting in place the first nations health promotion and disease prevention strategy, the government will work to reduce the incidence of disease and mitigate the life threatening and disabling consequences of disease. A targeted immunization program that will ensure first nations' children on reserve have access to early childhood vaccinations will be an important part of disease prevention.

The first nations and Inuit health system delivered through Health Canada is the foundation for the federal government's delivery of health services to first nations and Inuit. Health Canada operates this large and dynamic health system providing a wide range of health care services. In the Speech from the Throne the government also specifically committed itself to working with its partners to improve health care delivery on reserve.

The first nations and Inuit health system provides services including nursing services, prenatal and children's programs, public health disease prevention, addiction services and environmental health services in over 600 first nations and Inuit communities.

In addition, Health Canada provides supplemental health benefits to over 700,000 first nations and Inuit individuals both on and off reserve in order cover the costs of prescription drugs, dental services, vision care and other benefits, including medical transportation to access medical services away from their home communities.

The federal government currently spends $1.3 billion per year to address the health care needs of first nations and Inuit. As well, provinces and territories cover the costs of physicians and hospital care. Greater coordination of the provincial and territorial governments to ensure efficient and seamless service delivery is the priority.

The government's goal is to work with first nations and Inuit communities and with the provinces and territories to renew, improve and close gaps in health services on reserve.

As for the broader health system, Health Canada recognizes that change and renewal are needed to provide high quality services to first nations and Inuit in the most efficient and effective way possible. This task has many challenges.

In its health delivery system role for first nations-Inuit, Health Canada faces many of the same pressures that are currently being felt by the provinces and territories. This includes nursing shortages in my riding and doctor shortages, rapidly increasing costs of prescription drugs and expensive new technologies. We also face challenges posed by such factors as remoteness, lower health status and a first nations and Inuit population growth rate more than twice the national average. Many of the communities in my riding are accessible only by air travel and people only have access to a doctor once a week, perhaps less than that, and a nursing station with one nurse the remainder of the time.

Amid considerable cost pressures, Health Canada has made progress in controlling expenditure growth. For example, the non-insured health benefits program has been successful in reducing its rate from 20% in 1991 to 5% and 8% in recent years. This does not go without challenges. There are many things to consider under the first nations non-insured health benefits system for aboriginal people. I must say that there are challenges and those are the things that we struggle with.

In collaboration with the Assembly of First Nations and the Inuit Tapiriit Kanatami, the national first nations-Inuit organizations, Health Canada has been working to develop and implement an overarching accountability framework. This framework is intended to ensure the most effective and efficient use of resources and better health programs and outcomes for first nations and Inuit people.

However our focus has not only been delivering our fundamental programs effectively and sustainably. We have also looked to improving and building upon that foundation.

Recently the government developed a home and community care program to provide core home care services on first nation reserves and in Inuit communities. Seventy-seven per cent of eligible communities have completed initial program planning activities and 37% of communities are already accessing home and community care services with over 180,000 clients.

Canada's aboriginal population is young. Thirty-five per cent of aboriginal people are under the age of 15. This means that aboriginal health care must have a strong focus on children. Childhood development from birth to age six lays the foundation for lifelong health and well-being. The focus on children and youth becomes more and more important as we see an increasing incidence of childhood diabetes and as we also work to combat tuberculosis in our communities.

Speaking of children, I welcome the commitment in the throne speech to put in place early childhood development programs for first nations, including an expansion of aboriginal head start. Aboriginal head start has proven to be a very successful program in first nations communities. It teaches our children simple life skills at an early age that will carry them through their school years.

In addition, the government has committed to improving parental supports and providing aboriginal communities with the tools they need to address fetal alcohol syndrome and its effects. FAS and FAE are disabilities caused by drinking during pregnancy. It is a completely preventable cause of birth defects and developmental delays that leave these children and their families with a legacy of profound and lasting challenges.

Consistent with the government's commitment in the Speech from the Throne, Health Canada is actively building partnerships with first nations and Inuit organizations and communities. We are moving toward the development of strategies to improve the effectiveness and sustainability of first nations and Inuit health.

Together we are working at finding solutions to these challenges and we are continuing our efforts to close the gap in the health status between aboriginal people and non-aboriginal Canadians.

There is no higher priority than the health of our citizens across Canada. As members can see from the statistics, we have a major challenge in dealing with the health of aboriginal people across the country.

I submit to the House that this debate is important in dealing with the health care of aboriginal people.

[Peter Stoffer, NDP, Sackville—Musquodoboit Valley—Eastern Shore, NS]

Mr. Speaker, I could not help but notice that again it is the government that brought in the child tax benefit but allowed the provinces to claw it back. So there was really no benefit at all to the people when the provinces were allowed to do that.

I thank the hon. member for focusing on aboriginal people. One of the biggest concerns we have in Canada is finding qualified doctors and nurses of aboriginal heritage who are in the medical field so they can return to their communities as medical professionals. This is not due to a lack of desire on the part of aboriginal people. It is due to the lack of finances and resources. The cost for many Canadians who are now 18 years old and getting out of high school and wanting to enter medical school is prohibitive. If the cost is prohibitive for the vast majority of Canadians, imagine what it is like for aboriginal people who wish to enter into the medical field?

I lived in Yukon for nine years. I think a large part of our problem when dealing with northern communities is that a lot of aboriginal communities are suffering from permanence in their medical staff or having a regular doctor that they can see frequently. One of the concerns the aboriginal people have is that they simply do not have the finances to take the courses at university to get a medical education.

What will the hon. member's government do to prepare young aboriginal people throughout Canada to get a medical degree so they can move back to their communities, if they so desire, to help the men and women on their reserves in their area?

[Ethel Blondin-Andrew, Liberal, Western Arctic, NT]

Mr. Speaker, my hon. colleague should know that we have a problem globally with recruitment and retention of professional health workers, be they doctors, nurses or in other categories. This is a global phenomena.

We are challenged and I suppose in days to come we will receive more reports that will help us to better focus on where we should go. It is not necessarily the issue of resources, it is the issue of priorities and this is definitely a priority.

Canadians should know that other organizations can speak to this better than us here in the House, one being the aboriginal physicians association. I have met with that organization since I became a member of Parliament 14 years ago.

It is true that many professional aboriginals have entered the field but more are needed. We need more health professionals in the mainstream, not just aboriginal professionals.

There was definitely a focus in previous budgets as well in the throne speech. I am presuming that the reports that have been put out and the ones that will come later will put greater emphasis on the need for health professionals.

The member is correct in saying that we share that concern. I know there will be a focus on that. I know we are doing a good job but we will continue to work harder for all Canadians.

[Loyola Hearn, Progressive Conservative, St. John's West, NL]

Mr. Speaker, the hon. Secretary of State for Children and Youth knows that it costs a tremendous amount to operate the health care system in our country. It would cost less if we had fewer people using the health care system. Fewer people would use the health care system if they were healthier and better educated.

We do not hear anyone talking about prevention. Does the secretary of state not think that if the government invested more in our youth so that every young Canadian had the opportunity to receive a solid education that we would significantly reduce the cost of health care in Canada?

[Ethel Blondin-Andrew, Liberal, Western Arctic, NT]

Mr. Speaker, I have been in cabinet for nine years and over those nine years most of the programs we undertake with young people are preventive and early intervention. These programs are geared to give children a healthier start. The national child benefit is one of those, prenatal nutrition, aboriginal head start, Inuit and first nations child care. All of those programs are designed to provide an earlier and a healthier start for children.

We know we have to be at the front end delivering the kinds of services to ensure a healthy start by building a foundation. Most if not all of the government programs are geared to that end. I think we are heading in the right direction and we will continue to do that.

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

Mr. Speaker, it is a pleasure and a privilege for me take part in this take note debate. However I have to question why we are even debating this. It is startling to me that we have a government that has been in power for a decade, with three majorities and three mandates, and it has put nothing more on the table on how to deliver health care. Here we are in the House at the government's call to debate health care.

I have no problem debating health care. In fact I really enjoy it and it is long overdue that we have a debate not only on health care but on health care reform and how to sustain it. That is needed and it is long overdue.

I listened very intently when my hon. colleagues from the Liberal Party put forward what they thought was rational debate on health care. I have failed to hear any new, innovative ideas about which we could have a true debate. It is very frustrating to me. We have been asked to come here to debate new ideas about reforming health care so we can sustain it into the 21st century and the government really has nothing on the table to debate.

I would like to talk a bit about what is going on with health care and what needs to be done to sustain it. In the throne speech we thought we would get a glimpse of the vision of the government and its plans for the future of health care. We saw absolutely nothing. There was very little vision and virtually nothing when it came to health care reform.

What do we see from the government? We see more studies. The Kirby report was delivered on Friday of last week. We have the Romanow report coming up next month. It is interesting that, since 1993, the government has commissioned enough studies that amount to $243 million and absolutely no reform. It is something that has to stop. We absolutely have to do more than just study health care. We have to implement it.

Some of the reforms and studies that have been going on in the provincial jurisdictions amaze me. I can point to the Clair Commission out of Quebec and the Fyke report out of Saskatchewan. Ontario, New Brunswick and B.C. are doing their own. Then there is the Mazankowski report of Alberta. It is frustrating to see the opposition coming from the federal side when we talk about some of these reports, especially the one in Alberta because it is the only one where we have seen a government actually implement the report.

We saw the report of the national forum on health in 1999, but it has sat on a shelf and nothing has been done. It was not that good things could not have happened in 1997, but they did not. Whether we will get somewhere with the Kirby Commission and the Romanow Commission has yet to be seen. It depends on whether the government will actually implement them. We hope that happens. What is actually happening in the meantime?

I just received a note, Mr. Speaker, I will be slitting my time with the hon. member for Peace River.

The Environics Research Group released a study two weeks ago. It said that eight out of ten Canadians want significant reforms to Canadian health care. That is absolutely amazing.

The Canadian Alliance Party felt that something had to be done in health care as well so we commissioned our own study after the last election because we did not think any government or any party really hit the nail on the head when it came to health care. We did that over the last couple of years. We came up with what we feel is a very clear policy that coincides with what we think Canadians are feeling.

Canadians are saying they want a timely health care system, one they can access in a timely way; one that is of high quality when we get to access it; one that is sustainable for their kids and their grandkids; and one which they can access regardless of their financial means. That system should take its eyes off itself and put them on the patient it is there to serve. It has to be a patient driven system. We need a government that realizes that the patient comes first because the patient is the one who is paying the bill. This needs to be looked at as we sustain health care in the future.

I talked a little about the Liberal legacy. The Liberals pulled money out of health care and watched the system drift into a crisis. We have seen the cracks get so wide in health care that it is shameful. The most unhealthy place to work in the country is within our facilities where moral is poor and the stress of the workplace is unbelievable. At the same time, waiting lists for people trying to get into the system are unacceptably high. We have over a million people on waiting lists right now who are trying to get into the system.

We have nurse shortages that have grown to unbelievable proportions. We know that we will need 113,000 new nurses between now and 2011. We need 2,500 doctors a year just to keep up with the present demand and that demand is growing more and more.

Just by watching the news media every evening, we see week in and week out the problems in health care, whether it is the lack of doctors in emergency rooms or ambulances that are held and are unable to deliver services according to their mandate, as one article stated last week. Every week one hears something new and astounding.

On top of that there are the cracks in the system where the employees of that system are frustrated. The nurses unions and health sciences people are striking. Doctors are striking in different provinces. We are seeing major problems.

Canada ranks 18th of the OECD nations in the number of MRIs, 17th in CT scanners and 8th in radiology equipment. If we cannot be first, I would like to know why. We should be first. That should be the goal. We should be striving for that. Canadians deserve to have the best health care system in the world, and they can have it. There is absolutely no reason why we are not.

In a 1988 poll, 43% of Canadians thought the health care system was fundamentally flawed. Last year that same poll was taken and that 43% had risen to 77% of Canadians who thought it was fatally flawed, and it is. Our health care system is ailing.

The Kirby report came out on Friday. I would like to make mention of a couple of things on which that committee worked hard. It tackled some complex problems that were politically charged. It was very thoughtful about its deliberations and we should applaud that 300 page report and some of its aspects.

Romanow was commissioned to do another report. The Kirby committee started two years ago. Romanow happened after that. In fact, we scratched our heads and wondered why the government would do that? Why would it spend another $15 million on a commission when it already had a Senate committee doing a very comprehensive study? Nonetheless, another $15 million has been spent.

The big question is whether it will actually be implemented? Will it go anywhere? Those are the questions we have to ask as we go forward.

Some things that have come out in the Kirby report are health care related. He has tried to sustain the health care system in the long run and has tried to expand it. I will mention a little more about that in a few minutes.

The thing that really puzzles me about the report is the new money that he has asked be put into it. Romanow likely will ask for the same thing. We said that back in 1997 when we said that it needed an injection of $4 billion a year. That is not new. What is amazing to me is we had a Liberal Senate committee struck to look into health care, yet it came forward and suggested we needed to raise taxes. When it comes to the kinds of changes that are needed for health care, that is fair ball. However I guess a leopard does not change its spots. When a committee dictates that we should raise taxes for this new money, then all of a sudden that puts on a political hat, and we dare not play politics with health care anymore.

It very frustrating to see the Kirby committee recommend a 1.5% increase in GST or national health care premiums. Where it gets the money is up to the government in power, not to Mr. Kirby. How that money is raised or where it comes from should be decided by the government in power. Throwing money into a broken system gives us a larger broken system, so that is not a solution we should be embracing.

It is absolutely amazing to see this kind of a report come forward when no study was undertaken even within the Kirby committee's deliberations to study from where the money should come from, yet this is one of the recommendations in the report.

If we do not add accountability into our system, if we do not reform it to a place where we hold the users and the providers more responsible and actually implement some of the reforms needed in our system, we will lose it. A health care system needs that efficiency. Any new money that goes into health care needs to have that as its ultimate goal. If not, we will lose it within a very short number of years.

It is very important that we keep that in mind when we look at implementing some of the changes that have been brought forward by the Kirby commission. We dare not allow another thing in health care, and that is what happened in the mid-1990s when we had unilateral cuts by this government in health care. It destabilized health care and put an unbelievable burden on the provincial governments to provide health care, which is their mandate.

My time is going very quickly and I would like to just make mention of what needs to take place when it comes to fixing the system.

When we fix the system, we do not expand a broken system to fix it. One thing Kirby also mentioned was that we should go into a pharmacare, home care and palliative care. Although those are limited within his report, we need to get the fundamentals right and we need to fix the system before we expand it and make it weaker. We really have to be careful of that.

When it comes drugs and what is happening with the Canadian drug problem, first, we do not debate that in this House. We do not debate the kinds of massive problems we have with addiction to prescription drugs, which is a reality that we need to talk about much more in this House. If the government had come with that as something to debate today, we would have had a really solid debate on some of the changes that need to take place.

However we agree with some of the things that are in the report, which are more placements for medical school and health care technologists. We absolutely need that. We also agree that there should be some sort of guarantee to the patients. He is focusing more on patients and the importance of putting patients first in his report. We have been saying that is long overdue.

There is absolutely no question that we have to get on with reforming the system, but we have to do it in a way that is sustainable to the system. One of the flies in the ointment of the Kirby commission is that most of what he talks about is provincial jurisdiction and that instead of taking the big stick approach with the provinces, we have to take the collaborative approach. What will be interesting, when we come to implement this, is to discern the difference between the provincial jurisdiction and the federal jurisdiction.

Looking forward, the government owes it to Canadians by acting quickly on these reports. We are calling for the action to take place within 90 days of Mr. Romanow's commission. That absolutely must take place. We dare not put these reports on a shelf and debate health care without recognizing the need to implement these reports.

[Peter Adams, Liberal, Peterborough, ON]

Mr. Speaker, I noticed that the member said the patient was the one paying the bill. I suspect he did not mean that exactly as I have said it. At least I hope he did not. I hope he meant that the patient, being one of the taxpayers, was one of the people paying the bill. It is my sincere hope that I am never sufficiently sick for all the taxes that I have paid into the health care system to be used for my bills. I am delighted that any addition to my taxes goes to pay for other people, and I strongly support a public system.

The member mentioned things like MRIs, radiology, drug plans and expensive things like that. He is obviously very concerned about the costs because he went on to discuss increased taxation and things of that type.

When I made a presentation to the Romanow commission on behalf of our rural caucus, I made the point that in rural areas not only was the standard of health lower than the rest of the country, the standard of health service was lower than the rest of the country, so the gulf between the two was particularly great. We emphasized prevention. We emphasized maintaining health so that we would not need the MRIs and that kind of thing, or at least that we would need them less; immunization programs; checkups for children in the schools, for example, physical checkups and dental checkups; and exercise programs, particularly for young children, being building into school programs. I know the member will say it is a provincial jurisdiction, but it is the sort of thing which if we start it earlier in a person's life, we can save billions of dollars and with the result of people living much happier and healthier lives.

What does the member think about prevention in health care?