House of Commons Hansard #16 of the 37th Parliament, 2nd Session. (The original version is on Parliament's site.) The word of the day was health.

Topics

Business of the House

11:05 a.m.

The Speaker

It is my duty pursuant to Standing Order 81(14) to inform the House that the motion to be considered tomorrow during consideration of the business of supply is as follows:

That, in the opinion of this House, government appointments of ambassadors, consuls general and heads of regulatory bodies and crown corporations should automatically be referred to the appropriate committee of the House of Commons for consideration, and that the relevant standing orders of the House of Commons should be amended accordingly.

This motion, standing in the name of the hon. member for Charlesbourg—Jacques-Cartier, is votable. Copies of the motion are available at the Table.

Health Care System
Government Orders

October 28th, 2002 / 11:05 a.m.

Westmount—Ville-Marie
Québec

Liberal

Lucienne Robillard for the Minister of Health

moved:

That this House take note of the ongoing public discussion of the future of the Canadian health care system.

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11:05 a.m.

Madawaska—Restigouche
New Brunswick

Liberal

Jeannot Castonguay Parliamentary Secretary to the Minister of Health

Mr. Speaker, I rise today to participate in the debate on the future of the health system in Canada.

This is the second take note debate on this issue and that in and of itself sends the signal that this government is committed to dealing with the renewal of the health care system so that Canadians can continue to have timely access to high quality health care now and in the future.

Before I make my brief formal comments, I would like to thank Senator Kirby and the Senate committee for their contribution to the debate on the future of health care. Their report, “The Health of Canadians--The Federal Role”, will be thoroughly analyzed and carefully considered as we move forward to renew our health care system.

The Speech from the Throne made it clear that the renewal of our health care system is a priority without compare. No issue, it said, touches Canadians more deeply than health care.

Our health system is a practical expression of the values that define us as a country. Our commitment , therefore, is to ensure a comprehensive system of care that remains publicly administered and universally acceptable. One that continues to be envied by the world.

In late November, just a few weeks away, the Romanow Commission will table its report on the future of Canada's health care system.

I want to assure all Canadians that, like them, the Government of Canada is anxious to get to the task of setting health care right for the future. The recommendations of the Romanow report, as well as those of the Kirby report, will undoubtedly assist us in our efforts.

With reports such as these and others, we can proceed with an agenda of positive change, ensuring that the views and values of all Canadians are reflected in our actions.

The Speech from the Throne makes it clear that health care renewal with our provincial and territorial partners is certainly one of our key priorities, but it is by no means the single area of focus.

Another issue that we will be focussing on is healthier living. I do not have to tell members of this House that increased physical activity, healthier eating and other preventive measures would translate to a better quality of life for all Canadians.

That is why, together with the provinces and territories, we will hold a healthy living summit next March. We will bring together all governments as well as experts and other interested parties to develop practical strategies for use in our urban, rural, and remote communities so that Canadians are given the information they need to lead healthier lives.

And the minister will be working with provincial and territorial colleagues to develop short, medium and long term pan-Canadian healthy living strategies that emphasize nutrition, physical activity, tobacco reduction and healthy weights, among other issues.

Our goal is to promote good health and reduce the risk factors associated with diabetes, cancer, and cardiovascular and respiratory diseases, and the burden they place on health care.

This government is dedicated to collaborative solutions to ensure that Canadians enjoy a healthier quality of life and a higher standing of health care.

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11:05 a.m.

Calgary Southwest
Alberta

Canadian Alliance

Stephen Harper Leader of the Opposition

Mr. Speaker, I wish to begin my remarks today by asking why we are suddenly debating health care. Is it because the federal government is doing something about health care? The answer is no. Is it because the federal government has any new policy for health care? No. Is it because the federal government is announcing any new funding for health care? No.

In fact a representative of the government today barely spoke at all on health care. I am appalled. I wish no insult to the parliamentary secretary but the government called this debate on health care and it would have been appropriate for the Minister of Health to come here and begin this debate today.

Instead, all we got was a very brief lecture which seemed to concentrate mainly on the necessity that we all live more healthy lifestyles. This unfortunately is standard practice. This is the second take note debate we have had in the House, a standard practice of the government which, at critical times, wants to change the subject, indulge in rhetoric rather than action and engage once again on a critical matter in careful positioning: watch where all of the various opposition parties stand before taking a communications position itself.

We have seen this before. We saw it even last week. Since I became a member again in May we have had scandal after scandal and so last week suddenly an ethics package appears. It turns out the ethics package has nothing to do with changing any of the practical rules for the ethical standards of the Prime Minister and members of cabinet whatsoever.

We have the same thing with Kyoto. We have the Kyoto accord which is sinking fast. Today it was mired in provincial opposition at the conference in Halifax. We had this developing last week. There was lack of industry consensus and lack of a plan. Suddenly late last week we had a Kyoto package, although the Kyoto package of course provides no key answers to questions on targets or costs.

I would suggest that this particular manner of acting by the government is most dangerous in the area of health care where people are genuinely being affected by it. We have had nine years now of excessive rhetoric from the Liberals on health care and lack of action, which is genuinely contributing to the continual deterioration of our health care system.

Of course this reached a crescendo in the last federal election, and I will speak about this later, when the government attacked provinces that were trying to reform the health care system while offering no alternatives of its own. Much of this situation comes today because of the cutbacks that the government introduced in health.

I remind the House that the former minister of finance loves to take credit for the elimination of an over $40 billion federal deficit. We have never begrudged him that credit but he also must be frank about how he did that. Between 1995 and 1998 tax revenues rose $30 billion. In other words, three-quarters of the deficit was eliminated by taxes. Ten billion dollars was eliminated by a reduction in expenditures in which $6 billion came from a reduction in health care transfers to the provinces.

The record of the government in health care and in federal spending was that it cut in its own back yard on its own administration by 2%. It cut military spending and security by 20% and cut health care by one-third. These ratios are exactly the opposite of what every province did to balance their budgets, although every province ultimately managed to balance their budget.

As a consequence of this, according to data from the Organisation for Economic Co-operation and Development, today we have a health care system that ranks 18th in terms of access to MRIs, 17th in terms of access to CT scanners and 8th in terms of access to radiation machines. In terms of risk of death by breast cancer, for example, Canada ranks sixth among OECD countries. According to the Fraser Institute, across Canada total waiting time is high both historically and internationally compared to 1993. “Compared to 1993, the waiting time in 2001-02 is 77 per cent higher”. Waiting time under this government has increased in all but one of the past eight years. Canadians deserve a much better health care system than that.

When the government came to power it was very common to hear Canadians refer to our health care system as the best health care system in the world. It is extraordinary now how seldom we hear that phrase spoken.

Before I move on to what we think is critical in health care, let me talk once again about the values that should guide us in the health care system. Whatever flaws our health care system has today, it is the only one we have and the only one ordinary Canadians have come to depend on it. In fact we were promised we could depend on it and persuaded to do away with most other alternatives.

Canadians are increasingly worried about the future of the health care system, which is one of the reasons I re-entered politics. Now that my wife Laureen and I have children we have had discussions over the past several years about our future, about planning our future and about planning our children's' future. We have had repeated discussions about some of the challenges we face and health care has come up a lot. My wife and I know we are at the end of what is called the baby boom and that by the time our critical health care needs develop health care will be well into a massive crisis unless something is done about where the system is going.

Where will ordinary Canadians go when we enter this crisis? The government has a monopoly on key health services. My wife and I and many other Canadian families have saved a lot of money for our retirement and other things, but not necessarily for health care. We thought we were paying tens of thousands of dollars a year in taxes toward a long term health care system. For most of us, unlike the Liberal elite in this country, running to the United States to get health care services is not an option simply because those services are expensive. They are expensive not just in absolute terms but expensive because of the policies of this government. With our dollar falling every year, anything purchased in the United States becomes more and more expensive.

What is important? Anyone who thinks about this should be very worried about this in the next 10 or 20 years. Anybody who thinks about this will need to ask some important questions. What is important about the health care system? What is it we are trying to preserve? What is it that we have to let go?

We will hear the Liberals tell us a number of things about the health care system and how important they are, but these often miss the point. They will talk about this as being a Canadian value, a nationalistic thing. They will talk about the public non-profit nature, about equality and about the fact that services are free. Let me address some of those issues because it is important that we have an honest debate.

First, is it really critical for us as individuals seeking health care that this system is Canadian, that somehow it defines the country and our nationalism? We are told this repeatedly by the Liberals and I know it is a popular view, but is it really true? My ancestors engaged in two world wars to fight for the values and freedoms of this country. They fought in those wars without a public health care system. I am not suggesting they did not want one. In fact, having public health care has been one of the benefits of winning those wars, preserving our freedom and moving our society forward. However, we did not fight wars to preserve the health care system. I would suggest that not many Canadians are willing to die for a health care ideology in a health care line-up. They may be willing to die for their country but they are not willing to die for the Liberal definition of the health care system.

When I talk about the health care system as a national value, I will speak specifically about the federal role in health care which has been particularly problematic.

Second, is the important thing about health care that it be public and non-profit? Contrary to a lot of Liberal rhetoric, the fact that our system is public is not what actually makes it terribly unique. For instance, even in the United States a majority of health care is provided publicly, not privately. The most recent figures I have suggest that roughly 69% of our health care is public versus 53% in the United States.

Most Canadians are shocked to learn, particularly with the deterioration in federal funding for health care, that the United States now actually spends more per capita on public health care than we do in Canada. All this spending should point out that while health care is non-profit in most cases in Canada, it is certainly not charity. It is an expensive business.

Do people care about how the health care system is delivered? I would suggest not. They care about whether they are getting treated or not. When we have a public system that increasingly justifies its monopoly through rationing, I must point out that this is having real impacts on ordinary Canadians with diagnoses, treatments and ultimately on mortality itself.

The third point is equality. Equality is an important value in our system and I must say that health care is more equally accessed in Canada than in the United States. That is an important value and one that we should continue to preserve.

However, health care is not equal in this country in any absolute sense of the word. I have already mentioned the fact that some Canadians, including the Liberal elite, can go regularly to the United States whenever the health care system fails them here, but not all Canadians have equal access to health care. Depending on where they live, their province, and whether they are rural or urban, some have superior access, as is the case in any publicly run monopoly. Those who are connected with its running have superior access.

Most important, public health care in Canada has never come close to covering all health services. Most Canadians have supplementary health care coverage. Some pay for it individually and others have it paid by their employers. The House of Commons has one of the best supplementary health care packages in the country. It is simply not available to average Canadian workers. We are fooling people if we think that somehow every Canadian gets equal access under our system.

Is it important that the system be free? First, let me be clear that no reasonable person believes that our health care system is free. We do not generally pay at the point of service, but our health care system is very expensive. It is very expensive and increasingly slow to deliver and hard to access.

The cost of our public health care system in 2001 was about $75 billion. Over $100 billion was spent on combined private and public services. It is not free. It is reflected largely in our tax burden. Our tax burden is too high. It is close to half of the disposable income of the average Canadian. In the U.S. the equivalent tax burden is only about one-third.

All those things may to some degree define our system, but if all of them are not what really matters or what should matter to people in our health care system, then what should matter? I would suggest two things.

First, that we actually get health care, that it be available. That is the single-most important thing and it tells us how ideological this debate has become when we have to remind people that health care be available, especially when we are sick. That means that health care must be patient-centred. It is the health of people that we must be concerned about and not as the Liberal government says, not as many of the invested interests of the health care system say, or so-called health advocacy groups say. It is the health of people that matters, and not the health of the system and those who work in it. That is our primary concern here.

Second, health care needs to be affordable. It is important that we can get it and that we can afford it. I would point out that affordability of health care is almost invariably delivered, whether it is publicly or privately, through insurance. Because of the nature of health care and health care expenditures which are unexpected and often large, it is almost always the case, with the exception perhaps of the extraordinarily rich, that health care must be delivered through an insurance program, whether public or private, and almost everyone requires health care insurance in this combination.

That does distinguish Canada, to some degree, from the United States. We have, as do most advanced industrial countries, a universally available public health insurance system. The United States, notwithstanding its large public expenditures on health care, has no such program. This is a system that this party supports. This is a principle which we will always defend and on which we should build.

However, what is important is that all Canadians get necessary, timely service regardless of financial means, that we do not saddle ordinary people with enormous bills for catastrophic health problems or, on the other extreme, provide them with a system that is so monopolized and rigid that they cannot get health care at all, regardless of these principles. The tax burden of doing this and providing this should crush neither our individual pocketbooks or our economy.

In this regard, what are the key challenges that our health care system faces today? First, what must we do about the availability question? This party has been clear. We must support efforts of the provinces and others to ensure that we have greater choice in health care delivery mechanisms.

Several provinces are involved in pushing for alternative private delivery, even on a profit basis. This is a natural development. In a properly functioning system, profit is the reward that businesses obtain for making substantial, long-term capital investments. One of the problems, given the nature of a government or a non-profit model of anything, particularly as we have seen it in our health care system, is the tendency to under invest in the long term.

This is a serious problem in this system. We have continually, progressively under invested in the development of health care professionals and we have under invested in capital equipment and purchasing, particularly as this system is becoming more capital intensive. That is a key reason why it is deteriorating.

Before the Liberals jump to their normal rhetoric, let me be clear that when the provinces today, which are talking about private delivery, talk about it, they are talking about private delivery options covered through public insurance mechanisms. The federal government, the Liberal Party, has been playing games opposing this, sometimes opposing it strongly, sometimes opposing it not so strongly. It is playing games with the health of Canadians, playing games with the efforts of the provinces and others to ensure that this health care system is properly funded and properly invested in for the long term.

During the last election, for example, this was particularly bad. The government attacked the provinces, especially Alberta, and has since attacked Quebec and has made not so subtle attacks on Ontario for all the same reasons, for trying to broaden private delivery of publicly insured health services. The government has repeated and has a rich record of rhetorical excess when it comes to this area. There is no better example of this approach than what happened in Alberta prior to and during the last federal election.

The Alberta government introduced the health care protection act. This act was introduced in the Alberta Legislature March 2, 2000. I want to make it clear what this act did because we would not know it if we listened to representatives of the government. This act banned the operation of full service, private hospitals. It banned queue jumping for medically necessary services, as well as charges for those services. It set out strict patient protection rules for the sale of enhanced services, services outside the medically necessary definition provided in the Canada Health Act.

The one change in this act by the Government of Alberta was to allow alternative delivery of health services. It provided for surgical facilities, whether public, private or non-profit, to receive public funds to deliver such services to Albertans. It did not change how Albertans received health care. They still require only their provincial health care card. It simply changed the way health care was delivered. I would point out that even the World Health Organizations has stated that the ownership of a health facility should not matter, what does matter is control, sanction and regulation by public bodies.

The Alberta reforms were modest. They allowed for surgical services to be delivered outside the public monopoly system. Yet despite their modesty and the sensibility of the reforms, a mere eight days after the bill was introduced, the federal government cranked up its rhetoric about this development.

On March 10 the federal government, in the form of the former health minister, did the equivalent of a drive-by shooting by delivering a speech in Calgary. He did this without first talking to the Alberta government and without letting it know he had concerns about the bill or acknowledging what Alberta's health care protection act actually had. What he did is he gave a speech. It was not a private talk. He gave a public speech in which he implicitly suggested without any evidence that the delivery of health care outside of existing public facilities threatened the system.

He made sure that this overblown rhetoric was nationally televised. He gave the media advance notice of this address more than he gave the Alberta government. He hand picked the audience. He ensured it was filled with the fearmongers about the health care system in Alberta, the Alberta Liberal Party and also the union backed friends of medicare. Then he sped away from the drive-by shooting without so much as a phone call to his Alberta counterpart to lay out his case. He even refused to provide a copy of his remarks to the Alberta government for three days.

The rhetorical excess of this speech, the refusal to work with the provinces, the imposition of a centralized view of health care from above has not been an isolated event. I could go through example after example of this with regard to various provinces on various issues over the last three years.

Let me point out that only as recently as this September, at a federal-provincial health minister's meeting, and later when the Alberta government made some additional announcements on new facilities, the present health minister was attacking and raising fears about the development of private health facilities within the public system. The position of the government is clear. Both the current and former health ministers have opposed the idea of allowing private firms to deliver health services even when that delivery means no additional charges to Canadians.

I have spent much of my time talking about alternative service delivery within the single pair system. I do so because this is the direction most provinces are moving in. It is a direction the government opposes. It is a direction that we support.

A government monopoly is not the only way to deliver health care to Canadians. Monopolies in the public sector are just as objectionable as monopolies in the private sector. It should not matter who delivers health care, whether it is private, profit, non for profit or public, as long as Canadians have access to those services through the public insurance system regardless of their financial needs.

We are going to have to become a lot more innovative and flexible in how we deliver health care while holding fast to the principle of universal access regardless of ability to pay.

On the affordability of the current system we have the Senate Kirby committee and we expect to have the Romanow commission soon urging that we spend more money on our health care system. We believe that is necessary. We have allocated, in our own draft budget documents, money for additional health care expenditure. We believe that is important, and I will not get into all the considerations today, provided there are careful considerations and we work with the provinces to ensure that these funds are used efficiently.

The Kirby committee and we expect the Romanow commission will go much farther. They are suggesting not just that we need more money but that we need more taxes as well to pay for health care. Let me make it clear on behalf of every member of this party that this is absolutely unacceptable.

The tax burden in this country is too high. It must fall for this country to be competitive, and for Canadians, whether through private or public facilities, to be able to access health care. The government must adjust its priorities to make health care a higher one.

For example, I just cannot help mentioning the money spent on Groupaction and Groupe Everest and all these friends. Is the sponsorship program as important to this country as spending additional money on health care?

I will say again that this is a government that is out of control in its general spending. In the past three years, under the former minister of finance, the government has raised program spending by over $25 billion. Only a portion of that, contrary to mythology, has gone to health care.

I was just looking at the public accounts report for 2001-02. Last year of the over $7 billion in additional spending, less than $3 billion went to fund additional health care expenditure. The question I need to add here is this. Given the way the federal government does it, are those additional infusions of money really even very effective?

This is the final point to which I want to get. Independent of the difficulties I have with the Liberals and some of their individual decisions in the health area, we have serious reservations of whether this is a party opposite that can ever really deal effectively with the health care problem because of the nature of the party's philosophy, in particular the nature of its attitude toward the federal structure of the country and toward the provinces.

It is significant that once again we are engaged in a grandstanding debate here. Literally the government says “Let's talk about health care” but it has no position whatsoever to deliver. We have had three national studies, two that are now completed and one that is ongoing, yet no meaningful proposals from the government. In fact, after 30-some years of federal intervention in the health care area, there remain no real national standards of what constitutes even core or medical services. Instead what we have and have always had is a constant painting of the provinces, which deliver the system and must improve the system, as somehow the enemy of the health care of Canadians. Of course today what we ultimately have over this period is the federal government using the basic fiscal imbalance that we have in the structure of our federation to score political points against the provinces.

The problem is the Liberal government's philosophy. The Liberals have always wanted to centralize all powers and decision making in Ottawa. In their view, while the provinces may be an administrative necessity in such a large country, they are also a nuisance. In our book, the Liberals have never been real federalists. They are centralists.

For example, we will remember that recently, and in the last federal election, this government attacked those provinces which had undertaken a comprehensive reform of health care, Alberta and Quebec in particular, provinces which were trying to attract private investment to the health system. The Liberals contended that there was nothing fundamentally wrong with Canada's health care system. That is their philosophy.

Following the election, recognizing public concerns about rising health costs and the deterioration of health care, the Liberals established the Romanow commission, which toured the country for two years at a cost of millions of dollars for a study in an area of provincial jurisdiction. Just weeks before submitting his report, what is Mr. Romanow telling us? He is telling us that there is no problem with the health system, except perhaps for some lack of funding and confidence.

Our party, the Canadian Alliance, must tell the truth to Canadians and Quebeckers. Our health care system is experiencing serious long-term problems. We can inject more money into it. We advocate this, but money alone will not solve the problem. The federal government must recognize that the health care system is first and foremost a provincial responsibility, that it was the provinces that established the system, that run it, and that, in the end, must solve the problems that are plaguing it. It is the Liberal government, it is the Liberals, who messed things up all along, who never kept their promises for funding, who reduced health care funding to balance the budget. They are the ones who are preventing innovation and blaming the provinces for their own failures.

We saw it again recently, when the former Minister of Finance, he who made drastic cuts to provincial transfers, attacked the Action Démocratique du Québec simply because it was suggesting new policies.

Mr. Dumont's ideas are somewhat different from ours. However, his ideas must be discussed by Quebeckers in the debate that is taking place in their province. It is not up to a leadership candidate for the federal Liberal party to decide, a candidate who, more importantly, is the one who created these problems.

A number of provinces are currently trying to cope with the problem by attracting more private investment into publically insured services. The federal government must support this initiative. Ever-growing waiting lists are unacceptable. Regardless of who is providing the health care services, what matters is that Canadians and Quebeckers have access to these services, regardless of their ability to pay.

The hon. member for Yellowhead, our health care critic, and others will speak at greater length today about some of our concerns in the health care area, our reaction to some of the proposals that are on the table and where we think the country should go.

I just want to end here by summarizing what I have talked about today. What I have tried to outline is the contrast between how the Canadian Alliance approaches the health care system and how the Liberals have approached it. First and foremost, just as a general phenomenon, the Liberals engage repeatedly in grandiose rhetoric aimed at generating headlines or diverting headlines from other subjects, headlines that hide the deeper reality that they have done nothing to address the health concerns of ordinary Canadians. This contrasts with our approach in addressing health care in a way that deals with the health concerns of average Canadians, the kind of average Canadians who fund and support the Canadian Alliance.

Second, when it comes to availability, the Liberals have and continue to oppose alternative service delivery for health care by making grandiose claims that this will somehow destroy the public medicare system. This contrasts with our support for provinces that are wishing to find alternative methods of delivering health care, to shorten waiting lists, to improve service and to reduce costs, while ensuring that Canadians have access to insurance services using only their provincial health care card.

Finally, when it comes to affordability, the Liberals engage repeatedly in grandiose rhetoric about the dollars they have spent or the dollars they will spend on health care. Of course the reality is that what they really want is new taxes to deal with health care because they simply cannot control their spending in any area whatsoever.

The reality of course is that after all this spending the Liberals do across the board, health care spending at the federal level is still actually below what it was when the government took office. Instead what we have is the Liberals pursuing this in a way that hampers efforts at reform in a key area of provincial jurisdiction. This contrasts with our approach of accepting the diverse nature of the country and accepting the positive leadership that the provinces have provided historically and are trying to provide now ensuring that Canadians have strong accessible health care services provided in a timely manner.

This party wants to work cooperatively with the provinces in this manner. There is no more important concern that ordinary Canadians have than receiving health care in a timely and accessible way. That is what we will continue to do. We will continue to challenge the government to stop this shameful charade of raising health care, attacking the provinces and, as it has done today, providing no solutions whatsoever.

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11:40 a.m.

The Acting Speaker (Mr. Bélair)

Beginning with the next speaker, speeches will last for 20 minutes and will be followed by a 10 minute period for questions and comments.

I would ask your cooperation also in indicating to the Chair if you will be sharing your time. It would greatly help us better manage this very important debate on a very important issue.

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11:40 a.m.

Bloc

Réal Ménard Hochelaga—Maisonneuve, QC

Mr. Speaker, it goes without saying that I will use my 20 minutes, and more if the House gives its consent. This take note debate initiated by the government is an important event, because there is no greater priority than health care and its availability.

I would like to mention a number of historical facts to help clarify the situation in which we find ourselves. In 1984, the Liberal government was about to lose power. This was a washed up government, overtaken by events, plagued by patronage and bad budget decisions. The result was that Canada found itself faced with an anticipated budget deficit of several millions of dollars.

What is often overlooked is the fact that, during the last year of its mandate, the Liberal government—under then Minister of Health Monique Bégin—introduced a bill which became a very important piece of legislation, namely the Canada Health Act.

Of course, this bill could not have been introduced if the federal government had stayed within the strict confines of the respective jurisdictions of the two levels of government. We all know that the federal government cannot get directly involved in the delivery of health services, except in the case of aboriginals, penitentiaries, epidemics, quarantines, drug certification and its logical corollary, drug licensing.

In 1984, the federal government, on the advice of the Privy Council, which is often said to be Canada's largest department of political science given the scope of its resources, used its spending power has an excuse to introduce a national health act. This sparked a more or less general outcry.

Even in Ontario, doctors went on strike for days because they feared that, under this national health legislation, they might be restricted in their ability to organize their work.

The Canada Health Act established a number of guiding principles to direct the way the provincial governments would organize the health system. This is why the majority, if not all of them, were opposed to the legislation. In this House, however, in 1984, all parties supported the Canada Health Act, including the opposition—Brian Mulroney had just come into power. I do not, of course, include the NDP here, as we are all aware that its approach has always been centralist. In short, all opposition parties, including the one now in government, were in favour of the National Health Act.

To recap briefly, this act encompassed five principles. There was to be public administration. There was to be comprehensiveness, in other words the provincial or territorial health insurance plan had a duty to cover all insurable health services. There was to be a specific minimum of coverage, or comprehensiveness. Then, of course, there was universality, which continues to be discussed to this day. There was the principle of portability, which implied that we were part of a common market as far as health was concerned. By virtue of his mobility, a person in Alberta, Saskatchewan or Quebec was supposed to have the same coverage. This, of course, was the principle of accessibility.

At that time, with the debates in the House of Commons, there was confirmation and reaffirmation of the commitment made in 1957 and again in 1961, when the federal government passed the legislation on health insurance and on hospital insurance.

It is important to recall that at that time the federal government made a commitment to be a partner and pay 50% of health care costs. That is the irony of the situation in which we now find ourselves.

There have been a number of commissions of inquiry by the federal government, by the Senate, the other House; there have been several studies, such as the report of the Romanow commission that is expected at the end of November. We have been asked to reflect on how the health care system should be reorganized. I do not mean to suggest that this should not be done, and I will come back to this later before my time runs out, but we are sidestepping the most fundamental fact.

That fact is that the government with the most resources, the federal government, the government which made promises in the past to cover 50% of health care costs, has completely, or almost completely, backed out of this promise. In what can only be described as a betrayal, it has broken its past promises and it has gotten away with it.

When the debate took place in 1983-84, the federal government was a significant partner in health care funding. Today, the situation is so troubling that all of the premiers, from Bernard Lord—I do not mean to bring up bad memories for the Tories—in New Brunswick, to the New Democrats in Saskatchewan, including the government of British Columbia, and the sovereignist Government of Quebec, have formed a coalition. They have mounted a campaign, with ads running on television almost every day, to remind people of the extent to which the federal government has backed out of its commitments.

Do members know how much the federal government is investing? For each dollar spent on health care, the federal government's contribution amounts to 14¢. For every dollar spent, the federal government's contribution is only 14¢. It is incredible. The federal government has a surplus of $6, $8, $12, $15, or $18 billion, yet it is unable to honour commitments it made in the mid 1980s.

I do not mind commissions of inquiry, to reflect on the issue of health care and how to solve the problems and how to reorganize it, but I think we must remember the following three facts.

First, as we speak, seven of the ten provinces have already set up commissions of their own; they have done a diagnosis of their environment and are well aware of the main challenges facing them in coming years.

In the years since 1996, Nova Scotia, Prince Edward Island, New Brunswick, Ontario, Saskatchewan, Alberta and Quebec have conducted their own commissions of inquiry. They have themselves done a diagnosis of their environment and are fully aware of what major changes lie ahead in health.

Before discussing the substance, let us look briefly at these major changes affecting health. Regardless of who is in power in the various provinces, some things are certain. For one, people grow old; our population is aging and people are living longer. Today, we are no longer talking about the old, but the very old.

In our ridings, it is not unusual to meet people who are 80, 85 or 90 years old and who are in relatively good health. But this puts considerable pressure on the health care system.

My friend, the hon. Parliamentary Secretary to the Minister of Health, is himself an internist, if I am not mistaken. This brings me to what the main pressures on the health care system are. People are living longer and want to stay in the community as long as possible.

This is the whole challenge of primary care, natural caregivers and home care. So much so that, at present, with the great pressures put on the health care system, it is matter of figuring out how to reorganize care to allow people who, again, are living to be not only old but very old, to remain in their natural communities. The information required to manage these situations is available.

We will recall that, in its 1998 budget, the federal government established three funds, one of which was for the acquisition of new medical technologies and another for monitoring the evolution of the health care system. It is within this fund that, on the basis of the expertise they had and the work of the task forces they had set up, most of the provinces identified the major changes that lie ahead. Home support is a very important issue.

The second—and not the least—challenge we face is the advancement of medical technology. Equipment and facilities are evolving so quickly that there is a new generation of equipment every three years on the average. Of course, these are what help provide care and extend life expectancy, so that a number of sicknesses that were fatal fifty years ago have been conquered and are now chronic conditions instead. Medical technology has, therefore, a major role to play.

The acquisition of new medical technology has, however, meant that now forecast investments are not in the thousands or millions, but billions. Where cardiovascular disease alone is concerned, we have the possibility of prolonging people's life expectancy, but often at a cost of $800,000 to $1 million per person. That is what we have to deal with. We are confronted with the cost of medical acts that have to be performed by specialists.

After the challenges of extended life expectancy and medical technology, we have a third challenge: a whole new generation of drugs. There is no longer any question of reopening the debate on generic versus the patented drugs.

Let us not forget that, last year, the House passed a bill that was the result of the ratification of a treaty. Since Canada is a member of the Council for TRIP, or Trade-Related Aspects of Intellectual Property Rights, this means that some things are now illegal. Canada would be in violation of the treaty if it did not provide a 20 year protection for all patents. This is true for patents that relate to copyrights and to the pharmaceutical industry. So, this is now a moot point. Canada cannot amend its legislation.

I was a member of the Standing Committee on Health when it reviewed the Patent Act, in 1997. I was also there when the legislation was reviewed in 2000. We can no longer think that Canada can reduce its protection for patents. Three factors must be considered, namely the increased life expectancy of people, the new medical technologies and the new drugs.

For example, let us look at hospital budgets. When I meet with hospital administrators, the first thing they mention is that the issue of drugs impacts on the pressure that contributes to the operating deficits of hospitals.

The debate that will have to take place in the House will have to deal with pharmaceutical companies that do research. Of course, I am not denying that it is a major investment. I am convinced that the Secretary of State for Amateur Sport is aware of that, because he runs and he is in good health. In fact, I would like to challenge him. I would be pleased to go for a run with him whenever it suits him. Mr. Speaker, I run half an hour every day and I am in relatively good shape. But let us not forget that some our fellow citizens need drugs.

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11:50 a.m.

An hon. member

Let us go for a walk on the Hill.

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11:50 a.m.

Bloc

Réal Ménard Hochelaga—Maisonneuve, QC

Let us go for a walk on the Hill. I am taking the Secretary of State up on his offer and I also invite all members of Parliament to practice some sport, because exercise is important. It oxygenates our system and it improves blood circulation, not to mention of course that it also helps eliminate some of the fatty tissues that, all too often, is present on the abdomens of some hon. members.

Back to the heart of the matter, the real issue that needs to be looked at. New drugs are very costly when they hit the market, and it is no simple matter. The Patented Medicine Prices Review Board, whose report I read every year, lists new drugs that have been registered and that are available. It is really quite easy for pharmaceutical companies, through their advertising people, to promote these drugs, yet there are very few new drugs with new therapeutic value. That is where we have a problem, as a society. Consumers want these new expensive drugs, but their therapeutic value is in reality far below that of drugs that already exist.

The debate should not be over how long patents should last. There must be a mechanism that gives us some guarantees, as parliamentarians, that when drugs are registered, they have new therapeutic value. This is how to put pressure to bear to obtain new drugs. Drugs, as a budget item in the hospital operating budgets, make up an extremely large share of expenses.

We know what to expect when it comes to health care systems. The Romanow commission will not contain anything new on the subject. This is not to say that we should not give some thought, as a society, as to how to reorganize the health care system. Of course, we should.

I recently had the pleasure of meeting with the minister of health, Mr. Legault. The Parti Quebecois really does provide excellent government for Quebeckers. The government has concerns, which need to be given some thought. For example, in a society like Quebec, there are 5,000 general practitioners, but only 1,000 of them work in emergency rooms.

Obviously, it is up to the government to ensure that emergency rooms are open 24 hours a day. That is the role of the government. However, if the Government of Quebec is to be able to carry out its responsibilities, the federal government will have to come up with some cash.

Let us be clear. All premiers are demanding—there is no ideological split here, and no partisanship—that transfer payments be restored to their 1993-94 levels. For health, this would mean at least $5 billion more.

With respect to the accumulated deficit, in Quebec alone, the cuts made by this government in health in 1993-94 have deprived the various health and finance ministers in the Quebec government of at least $3 billion. This is for health alone, to say nothing of income security or education. For health alone, there is a $3 billion shortfall when the provinces and the Quebec government have to plan the services they will be providing to the public.

What do we know? The finance ministers gave a mandate to a task force, whose report was released two years ago. If it wanted to provide citizens with exactly the same services in 2003 as in 2002, the Government of Quebec would have to increase its health budget by 5%. This trend will continue beyond 2003. It will continue in 2004, 2005, 2006. You can imagine the challenge it will pose for the provinces.

I cannot have only one minute left; I have not said half of what I wanted to say. I am confident I will have consent to continue.

Five percent, that is where the pressure comes from and by how much the budget will have to be increased. Quebec is investing $17 billion in health.

If this take note debate we are having today is to be meaningful, it would seem to me that it should result in a consensus to urge the federal government to agree with the analysis of all premiers, who are putting ads in newspapers and on television asking for the purse strings to be loosened. We do not need a new tax. There are constant surpluses.

Is there unanimous consent to allow me to continue for 10 minutes? Could you please check, Mr. Speaker?

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The Acting Speaker (Mr. Bélair)

Indeed, we can ask. Is there unanimous consent for the hon. member for Hochelaga—Maisonneuve to continue to speak for another 10 minutes?

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Noon

Some hon. members

Agreed.

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Noon

Some hon. members

No.

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NDP

Yvon Godin Acadie—Bathurst, NB

Mr. Speaker, today we are discussing health and the problems in each province. Last week, I myself asked a question on this subject here in the House. That question triggered a general reaction in the Bloc. My reference to Minister Legault was what triggered the reaction.

I was making reference to Minister Legault's reaction as reported on Radio-Canada, that there had been no complaints about private clinics renting out operating rooms for $350. He said that he would take action only if there were complaints.

What I would like to know is if the member agrees with acting only if there are complaints or reasonable doubt that the law is not being complied with, particularly in the private system. I believe the Bloc Quebecois does not support the existence of a private health system, or at least that is my impression. The hon. member could perhaps enlighten me on this.

There is also the matter of responsibility for making sure this does not happen in the provinces, and not only in Quebec. It makes no difference whether it is New Brunswick, Alberta or Ontario, the provincial government is responsible for being the guardian of our health system. It is not just a matter of waiting until there are complaints and of letting the rich take advantage, as they are doing at present.

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12:05 p.m.

Bloc

Réal Ménard Hochelaga—Maisonneuve, QC

Mr. Speaker, I would respectfully ask the hon. member to mind his own business, in three ways.

The Quebec government will decide how it delivers services in its own jurisdictions. It is not something for this House to decide. As an individual, I can say that I do not support the privatization of the health system. Having said that, 30% of the services in Quebec are already delivered by private stakeholders, under a relatively loose partnership. This is partly because the federal government has pulled out; in some cases, it is for reasons of convenience.

We can discuss this. I hope that the services will be public services when it comes to diagnosis, treatment and everything that is related to palliative care and primary care.

We can have a societal debate on this. For example, must laundry services absolutely be fully paid by the state, under a cumbersome organizational framework like the one we know? I think we should be open to other options.

The hon. member's question is surprising, because we know what this government and all its predecessors have done in their own jurisdictions. The hon. member should ask questions on what the federal government has done regarding health and the aboriginals. He should ask questions on health in penitentiaries, or on the national drug strategy, which was a dismal failure. The federal government should properly shoulder its responsibilities and the provinces will look after their health system, as is their prerogative under the Constitution.

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12:05 p.m.

NDP

Alexa McDonough Halifax, NS

Mr. Speaker, I want to say how pleased I am to have the opportunity to speak today on this take note debate on health care, although I think the traditional manner in which we express the resolution supporting a take note debate is rather feeble and is inadequate to the challenge that is before us. I just briefly remind all members that the resolution coming from the Minister of Health reads:

That this House take note of the ongoing public discussion of the future of the Canadian health care system.

Feeble and inadequate, to say the least, and I would be a lot happier if we were here today debating a resolution which very clearly expressed the urgency of every member of the House and every party represented in this House to nurse back to a state of health our health care system, the health care system that is the promise and the true benefits of a public, not for profit, comprehensive, universal health care system that Canadians need.

The member for Acadie—Bathurst will be sharing my time and I am very happy to do that. I listened to the question the member for Acadie—Bathurst put to the Bloc member who just spoke. I found it absolutely astounding, and I have to say deeply distressing, that the response of this Bloc member whom I generally admire for his progressiveness was to say to the member for Acadie—Bathurst to mind his own business, not to criticize what the Péquiste government in Quebec is doing on health care, and to only put the challenges to the federal Liberal government.

I have two responses to that. One is that it is precisely a question that is pointing out the weaknesses and inadequacies of what the federal Liberal government is doing on health care, because it is not taking seriously its responsibilities to enforce the standards of the Canada Health Act as it relates to privatization. Second, and I guess the reason I found that response so astounding from the Bloc member, was that in his retort to the member for Acadie—Bathurst he revealed how similar the view of his party is to that of the Canadian Alliance, by basically saying that what happens to health care for people all over this country is not the shared concern and responsibility of every member of the House.

I could not believe my ears when I heard the leader of the Alliance Party, the official opposition, stand up and say basically that people do not care where their health care comes from, they do not care how it is funded, they only care that an individual Canadian, when he or she is sick, is going to get the health care, period, which again shows that it completely lacks an understanding. Yes, individual Canadians, when they are sick, need and deserve health care and of course they are very upset when they are not getting it, but there is a fundamental Canadian value, one that was rejected by the Bloc member in his question, one absolutely rejected by the Canadian Alliance leader in the House today, which is that Canadians care about health care for themselves, but they also care deeply about Canadian health care for their neighbour.

That gets to the real question about the crisis that our medicare system is in. It is not an exaggeration to say that medicare in the country today is at a crossroads. We have a fundamental decision to make about the kind of health care system that we want in the 21st century.

I think that all Canadians are very concerned about the report that is to come from the Romanow commission, not from the backrooms or the inside of the Liberal Party or from a Liberal Senator but from a royal commission that has been given the mandate to go out across this country and invite Canadians' input. I think that Canadians are very concerned about ensuring that this report is given the weight and the careful attention that it desperately needs. Canadians deserve to make this decision about the future of our health care, both on the basis of shared values, which the opposition leader has rejected, and on the basis of solid information.

We have seen too many scare tactics and this has had the effect of stampeding Canadians toward extreme solutions and solutions that have no place in this debate, as we heard this morning.

It is remodelling, not demolition, that should be our watchword. The evidence is clear and convincing. Canadians strongly believe in the fundamental tenets of medicare. A single payer, public not for profit health care system does not solve all the problems because we decide to create that. However it does create the conditions, the possibility, the potential for Canadians to receive the health care they need when they need it, regardless of wealth or privilege and regardless of where they happen to live.

Health care in recent years has fallen short of the goal for far too many Canadians. Starved through cutbacks, Canadian health care has been ill-equipped to grapple with the challenges of increased costs, partially as a result of excessive drug patent protection, but also as a result of medical and technological advances. The result is an intolerable and growing burden, both on patients and on those who care for them.

I could not believe what I heard from the Canadian Alliance member when he said that the health of the system was not a problem and that we were not talking about the health of those who provide the care. Those are critical elements of a universal not for profit system. What does the leader of the official opposition think the health care system is other than those who work in it to prevent ill health and to provide treatment when people are sick and to bring them back to a state of health? Something has to change.

The interim report of the Romanow commission outlined four possible paths for medicare. Let me reiterate that the New Democratic Party of Canada believes that the first two of those paths would lead backward, not forward. They would lead back toward the very for profit health care system that made medicare so necessary in the first place.

Behind the friendly rhetoric of private sector choice lies the simple reality that for profit health care offers less care at a higher cost than public health care. Public sector health care dollars should go to health care, not to marketing campaigns, not to investor relations, not to mergers and acquisitions of health corporations and not to profit. Real world experience backs that up.

In Alberta waiting lists and costs for cataract surgery are greatest wherever private clinics dominate. In the United States for profit dialysis centres, patient death rates are 20% higher than in not for profit centres. U.S. health administration costs are more than double those in Canada. The failure of for profit health care is echoed in efforts to shift costs onto patients and their families. We believe that those efforts are blatantly unfair. They amount to regressive taxation and they hit hardest at those who can least afford them.

Evidence has shown that as well as being unfair these initiatives just do not work. Singapore's experience with medical savings accounts has been a disaster. User fees are no more successful in controlling costs. They discourage lower income patients from seeking the treatment they need for a minor ailment until it becomes a major expensive one.

It is critically important that we not give up the dream for universal, comprehensive, not for profit health care, a system of public health care that calls up among all members the requirement for courage, leadership and vision. It is important that we get on with ensuring that we have a comprehensive system that not only deals with people's illnesses, but also deals with the kind of preventive measures that can only be assured if we recognize the fact that it is the responsibility of government to create a system of health care that will address the need for prevention as well as for treatment for people when they need it, wherever they happen to live, whether they live in a province that is mean-spirited and tight-fisted or a province that understands that priority should be given to health care. We need national standards that will ensure that each Canadian gets the health care they need regardless of where they live. It is everybody's business to be concerned about that issue.

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12:15 p.m.

Bloc

Réal Ménard Hochelaga—Maisonneuve, QC

Mr. Speaker, I was a little saddened as I listened in the lobby to the comments by the leader of the New Democratic Party, which suggested a parallel between the position of the Bloc Quebecois and of the Canadian Alliance. I must point out to her that this is a rather ill-advised comparison.

I want to ask her if she agrees that the whole organization of health care should be the exclusive and undisputed prerogative of the provinces. Does the hon. member agree that the centralizing vision of her party is completely outdated and that it definitely has something to do with the small number of people who vote for her party?

I attended the NDP convention, where I was welcomed because I have many friends in that party, and I must say that it is time NDP members realized that their views are even more centralizing than those of Mr. Trudeau. These views are totally outdated.