House of Commons Hansard #39 of the 37th Parliament, 2nd Session. (The original version is on Parliament's site.) The word of the day was provinces.

Topics

Supplementary Estimates (A)Oral Question Period

3:15 p.m.

Some hon. members

Agreed.

Supplementary Estimates (A)Oral Question Period

3:15 p.m.

Progressive Conservative

Peter MacKay Progressive Conservative Pictou—Antigonish—Guysborough, NS

seconded by the member for Yorkton--Melville, moved:

That the Supplementary Estimates (A) be amended by reducing vote 1a under Justice by the amount of $62,872,916 and vote 5a under Justice by $9,109,670 and that the supply motions and the bill to be based thereon altered accordingly.

Supplementary Estimates (A)Oral Question Period

3:15 p.m.

The Speaker

The House has heard the terms of the motion. Is it the pleasure of the House adopt the motion?

Supplementary Estimates (A)Oral Question Period

3:15 p.m.

Some hon. members

Agreed.

(Motion agreed to)

Business of the HouseOral Question Period

December 5th, 2002 / 3:15 p.m.

The Speaker

I have received notice from the hon. member for Burnaby—Douglas that he is unable to move his motion during private members' hour on Friday, December 6. It has not been possible to arrange an exchange of positions in the order of precedence. Accordingly I am directing the Table Officers to drop that item of business to the bottom of the order of precedence.

The hour provided for the consideration of private members' business will consequently be suspended and the House will continue with the business before it at the time.

The House resumed consideration of the motion, and of the amendment.

SupplyGovernment Orders

3:20 p.m.

NDP

Wendy Lill NDP Dartmouth, NS

Mr. Speaker, in the House last week, after the Romanow commission report was tabled, I asked the Minister of Finance a question about health care funding but I am not sure if he completely understood because, in my estimation, I did not get a sufficient reply.

Under the present per capita method of health care funding, which was put in place by the previous finance minister, nearly 90% of the increase in federal transfers in the last three years has gone to the have provinces, namely, Ontario, B.C. and Alberta. The poorer provinces, such as Saskatchewan, New Brunswick, P.E.I. and Nova Scotia, have received almost no increase in cash transfers.

Romanow has called for changes in the funding formula to help the poorer provinces meet the health care needs of their citizens. Does the member for Pictou--Antigonish--Guysborough agree with the need to change the funding formula that discriminates against citizens of have not provinces such as Nova Scotia?

SupplyGovernment Orders

3:20 p.m.

Progressive Conservative

Peter MacKay Progressive Conservative Pictou—Antigonish—Guysborough, NS

Mr. Speaker, as usual the member for Dartmouth has raised a very salient point on this issue. She is certainly correct in suggesting that the have not provinces, including the province that we share, our home province of Nova Scotia, have been disproportionately affected by the former finance minister and his government's very cruel cuts to the CHST transfers.

We know now that, as with health care, as with democratic deficit and as with other positions, the Janus faced former finance minister is now in favour of putting money back into health care and trying to distance himself from the record with which he was associated for over nine years.

In short, my hon. colleague is correct. The Progressive Conservative Party would look at essentially following Romanow's recommendations to reassess the funding formula to see that the poorer provinces are not disproportionately affected by the cuts that have been handed down arbitrarily by the government. There is a necessity to revisit the needs and, if I could go so far as to say, the priorities.

Those priorities are different from time to time. Some provinces are in need of equipment and some are in need of personnel. Some are in need of more palliative care programs and some want to put more money into prevention.

I would suggest, in keeping with the motion that is before the House, that those provinces be given the latitude within the parameters of the Canada Health Act to decide those priorities without the specific interventions and strings tied to the financing as proposed in essence by the Romanow commission.

There is a need to look at some of the recommendations in the Romanow report but we do not want to be in a vacuum when we make our final determinations. The key is to put the money back. The money that was taken out is nowhere near the equivalent that is being suggested will be returned.

SupplyGovernment Orders

3:20 p.m.

Bloc

Réal Ménard Bloc Hochelaga—Maisonneuve, QC

Mr. Speaker, I would like to ask our colleague a few short questions.

I understand that he supports the Bloc Quebecois' philosophy and that he will thus be able to support our motion to the effect that, essentially, if we must rethink the health system, it must be done under the impetus of the provinces. I understand that he shares our concern about the fact that if the Romanow report should become a government policy, this would be the principal avenue toward centralization.

Could we rely on our colleague's support during the vote on the motion?

He supports our basic principle that the provinces must be in charge of organizing the health system and that the federal government's role must be to unconditionally restore transfer payments.

SupplyGovernment Orders

3:25 p.m.

Progressive Conservative

Peter MacKay Progressive Conservative Pictou—Antigonish—Guysborough, NS

Mr. Speaker, it is obvious that the Progressive Conservative Party supports this motion, with one exception. We must support this proposal, but the provinces must be involved according to the principles in the Canada Health Act.

We support the notion that the provinces are the final decision makers of the priorities, as the final arbitrators and final deliverers of health care, but those principles and those particular priorities must be in line and must be clearly within the parameters of the Canada Health Act.

Therefore, yes, the way in which the motion is worded, we would certainly support my hon. colleague. We believe the province of Quebec, as all provinces, my own included, benefit from living up to the obligations under the Canada Health Act. They can do so and still have the ability to choose their own priorities as to how they spend the money that they receive from the federal government.

SupplyGovernment Orders

3:25 p.m.

Bloc

Madeleine Dalphond-Guiral Bloc Laval Centre, QC

Mr. Speaker, before beginning my speech I wish to inform you that I will split my time with the hon. member for Terrebonne—Blainville.

Today, we decided to debate an issue that concerns each and every citizen, without exception. Indeed, in the wake of the Romanow report, the Bloc Quebecois proposed the following motion, as amended:

That the federal government give the provinces the additional money for health unconditionally, with the promise of the provinces to use all of it for health care according to the priorities they have established and to provide an accounting to their residents.

As we know, this is an issue that people feel strongly about. There are two reasons why this debate is so emotional. First, if we all agree that the quality of health care affects all of us, it is because sooner or later, directly or indirectly, we will all be confronted with the reality of illness and, of course, with how we should ensure quality care.

Secondly, in this case, the federal government's interference in provincial jurisdictions is another contributing factor to the tension that exists in our debates.

However, the last thing we are going to do is get carried away by our emotions, because we want to be able to objectively lay out all aspects of the issue. It is in this spirit that, together, we will briefly examine the findings and the impact of the Romanow report on the future of health care.

If we take a pragmatic look at the society in which we live, we can see that the current problems with our health system are really just the tip of the iceberg. Two factors are exacerbating the current situation. The demographic decline of recent years, combined with the aging of the population, forces us to the following conclusion: while there will be a larger number of sick people, there will be fewer taxpayers to fund health care. Therefore, it is essential that governments reinvest in health.

Also, the budget cuts made in recent years to put our fiscal house in order have seriously affected the quality of health care in the various Canadian provinces. These are the findings. Now, what should we do?

As mentioned earlier, the debate deals with an area of exclusive provincial jurisdiction. If we were to oversimplify things, but we all know that we will not do that, we could tell the provinces that it is up to them to provide citizens with the best health care services their tax dollars can buy and to eventually reinvest in health care. Unfortunately, our everyday reality is a sad one, because of the fiscal imbalance between the provinces and the federal government.

In fact, all of the stakeholders, except for the federal government of course, recognize the fiscal imbalance and Ottawa's underfunding of health. For every dollar spent on health care, the federal used to contribute 50¢, but now its contribution is down to 14¢. The public is right to request additional money for health. In fact, the 1993-94 data on the Canada Health and Social Transfer indicate that the federal contribution accounted for 22.4% of health expenditures in Quebec. However, the trends and the forecasts indicate that it will have dropped below 13% by 2005-06.

These statistics leave no doubt in our minds. Health care is seriously underfunded, which is why we totally agree with a significant increase in health funding.

After 18 long months, Mr. Romanow seems to have arrived at a conclusion that everyone has known for many years. However, what does he propose to solve the problem?

First, the former Premier of Saskatchewan says that to fix the health care system, the federal government should inject an additional $15 billion over the next three years. In fact, these billions of dollars should be given back to the provinces in the form of federal transfers, since it is money that belongs to them. The provinces should be able to use this money to develop appropriate action plans that are tailored to the problems that each province is experiencing. Even though the problem of population decline due to aging is a pan-Canadian phenomenon, the fact remains that the provinces are dealing with specific situations that require distinct solutions to be developed.

I would not wish this on anyone listening, but if you were suffering from pneumonia, for example, and I were to give you money for you to purchase medicine, but I forced you to buy ointment and bandages with this money, it would not be of much use to you. That is what the Romanow report wants the federal government to do.

My experience from nearly four decades in nursing, first as a nurse and then as an instructor, has taught me that no one is better placed than people who work in health care to find the appropriate solutions to specific problems. It is certainly not up to the federal government to tell us how to use the money that belongs to us in Quebec. It is up to the Government of Quebec, together with health care stakeholders, to decide on the best way to use money allocated to health care.

Even though the Romanow report came to the conclusion that the health care system is underfunded, we must question the real usefulness of the report. In Quebec, we have known for a long time that it is critical that health care budgets benefit from more money, particularly through increased federal transfers, as was confirmed by the Quebec commission on health care and social services led by Michel Clair. The Senate also conducted a similar study, the Kirby report. Was it really necessary for the federal government to spend some $15 million to tell us, 18 months later, what we already knew, and, adding insult to injury, to recommend that the federal government have a role in administering that which is none of its concern?

This is where the fundamental flaw is in the Romanow report. Having recognized that the federal government needs to invest more in health care, Mr. Romanow suggests that Ottawa should tie future federal transfers to certain conditions on their use. No way.

How can a former provincial minister have the nerve to recommend that the federal government meddle in an area that is exclusively under provincial jurisdiction? The Bloc Quebecois is not alone in its indignation. The Quebec National Assembly gave unanimous support to a motion along these lines. The Quebec Federation of General Practitioners and the college of physicians have expressed regret at the federal government's attitude in wanting to impose conditions. The father of the Quebec health insurance system, Claude Castonguay, finds it unacceptable that the federal government is trying to interfere in provincial affairs. Finally, the public is wondering whether once again they will be the ones to lose the most in these virtually endless quarrels over jurisdictional boundaries.

To see the federal government toying with whether to impose or not to impose a Canada-wide action plan is not only disturbing but also insulting to the public and their elected representatives. The matter needs to be decided upon clearly and without hesitation: it is up to the provinces, and only the provinces, to decide what is the best way to administer health care budgets.

Instead, we have been treated this past week to some disconcerting position-taking by the federal Liberals. While the Prime Minister still maintains that he will look after reaching an agreement with the provinces, the Minister of Industry comes charging in and announces that the federal government ought to proceed without worrying about what the provinces think. With statements such as this, this blundering minister has once again missed the opportunity to close the gap up a bit between him and his colleague from LaSalle—Émard in the leadership race. In fact, his words are evidence of his total disdain for Quebec and of his lack of respect for jurisdictional boundaries.

We agree that the funds transferred to the provinces as a reinvestment in health must be allocated in their entirety to health care.

This is why the Bloc Quebecois motion specifies that the provinces must undertake to use all of the additional money for health care.

This assurance is, in my opinion, and that of the entire population, the only thing the federal government has the right to demand.

SupplyGovernment Orders

3:35 p.m.

Bloc

Diane Bourgeois Bloc Terrebonne—Blainville, QC

Mr. Speaker, I am very pleased to take part in this debate, particularly so because, historically, women and women's groups have always attached a great deal of importance to women's health and to public health. Indeed, it is in the health and education sectors that we find the largest number of women, whether they are workers, volunteers or members of community groups.

In the few minutes that I have, I will try to present my vision, the vision of Quebec women on this motion, which is a votable item and which reads as follows:

That the federal government give the provinces the additional money for health unconditionally, with the promise of the provinces to use all of it for health care.

I know that, in front of me, there is a member from New Brunswick who is a doctor. At the outset, he agreed with the fact that we were asking, as a province, that our specific needs be recognized. He agreed with this view. The hon. member will understand that I am presenting the feminist view, which is the same as that of several provinces in Canada.

The Romanow report talks about standardizing health care, but all feminist movements, both in Quebec and in Canada, are opposed to a standard vision, for the simple reason that women have a global approach that is based on their individual specificity.

Women recognize that the needs of the provinces may be specific. Therefore, they say that a single Canada-wide health system, based strictly on broad national principles, cannot serve them. The specificity of women is not recognized.

Moreover, in light of all the federal cuts to the Canada health and social transfer in recent years, women have really been burned. They were deeply affected, particularly in Quebec.

Women have developed a very special approach, whereby community groups fill in to meet the needs of close ones. Women become natural caregivers; they take care of their relatives who are ill, and they also do a lot of volunteer work. According to the figures provided by the Canadian government's Council on the Status of Women, the percentage of women who look after relatives is significantly higher than that of any other group.

Despite an increase in revenue and a major hike in the cost of health care, the federal government has decreased its transfer payments, which has caused a fiscal imbalance in the health care sector. Women, among others, have been asked to ensure continuity. There was the whole de-institutionalization phenomenon that had a negative impact on women.

Like our women's groups in Quebec such as the AFEAS, I recommend that you read a study that was done by women from Portneuf, Quebec City and Charlevoix, entitled “Sentez-vous notre présence?” This study shows beyond a doubt that currently, a centralist approach to health care would be wrong anywhere in Canada. Funding for health that the provinces are entitled to must be restored as soon as possible.

I would also like to talk about the information highway. The Romanow commission recommends creating a vast Canadian primary care system. In Quebec, this type of care is already provided through the CLSCs, or community groups that work together with the CLSCs, and this is unique to Quebec. There is some cooperation, but nowhere is it as widespread as in Quebec.

A few years ago in Quebec, we started opening regional medical units along the lines of what the Romanow commission recommends. These already exist in Quebec, not in the other provinces. This is further evidence that health care cannot be standardized. There are things that already exist in Quebec that do not exist elsewhere.

I talked earlier about the health information highway. In Quebec, we already have these information highways. We are already ahead in delivering health care through CLSCs. We already have a head start over other regions in Canada. As Quebec women, we do not want to lose what we have. We do not want to undermine what the other provinces are doing, but we also want to keep moving forward. This is why we say that, since we are not at the same stage, we cannot have a standard health system. Give us the money and we will know how to use it.

Some people have already told us what they think about the Romanow report and women agree with this. Michel Clair says: “It seems to me that health care must be suited to the realities of the people in each province”.

A few months ago, I received a second visit—and I already mentioned this to the House—from the Fédération des femmes francophones hors Québec. Several women from New Brunswick became my very good friends. This is also the case for Ontario women. They came to tell us: “You have a strong asset in Quebec. Your comprehensive approach on women's health care is very well defined. In our provinces, not only do we have difficulty in getting health care in French, but we also have difficulty in having a comprehensive approach”.

For example, a woman may be sick because her home is not good enough for her or is inadequate. She can be sick and really be in need of mental health care. She can be sick for all kinds of reasons. This is a comprehensive approach. She can be the victim of violence, intimidation or harassment or find herself in difficulty because she does not have a job. This kind of comprehensive approach is not used elsewhere, but it is used in Quebec.

The Romanow commission must meet the needs of individual regions and their population. We need our money to be able to continue. The issue here is the inability of the public system to sustain increases in excess of 5% a year in health care spending. That is why it is important to have our money.

When the Prime Minister says that investments will have to focus on changes and on results, like ensuring access to health care 24 hours a day, 7 days a week, I would remind the House that, in Quebec, we already have what we call the 24/7 service, which is used quite extensively by women.

Since you are signalling to me that my time is up—10 minutes is not very long—I will say in conclusion that women in Quebec and elsewhere are not very pleased with this approach of creating a uniform health care system. Women in different regions of Canada have specific needs. Therefore, they are asking that the money be given to the provinces. They will know what to do with it.

SupplyGovernment Orders

3:45 p.m.

Liberal

Jacques Saada Liberal Brossard—La Prairie, QC

Mr. Speaker, I will be sharing my speaking time with the hon. Minister of Health.

I am pleased to speak today on the motion put forward by the Bloc Quebecois, which reads as follows:

That the federal government give the provinces the additional money for health unconditionally, with the promise of the provinces to use all of it for health, according to the priorities they have established and to provide an accounting to their residents.

It will not come as a surprise to anybody to hear me say that I will be voting against this motion, because of both its wording and content.

First, regarding the wording, it states “That the federal government give the provinces the additional money—”. “The” is a definite article. What money is this? Is it the funding to be provided under the Romanow report? Is it the funding that was debated in the National Assembly of Quebec? Is it money the government intends to hand out left and right? What money are we talking about?

It states further “--unconditionally, with the promise of the provinces to use all of it for health”.

To ask for such a promise is already to impose a condition. This statement is therefore intrinsically contradictory. Will the money be given unconditionally or not?

Let us take this a little further. I would personally be totally opposed to any additional transfer that would make the administrative burden heavier, instead of making the money directly available to patients. I would be totally opposed to any additional transfer that would be used, as happened in the past, to buy labour peace in the short term in order to get votes.

Finally, this motion makes no reference to the conditions set out in the Canada Health Act, which we in Quebec hold dear, like everyone else in Canada. For these reasons, which seem perfectly reasonable to me, I will not be able to vote in favour of a motion that does away with all conditions.

Regarding the amounts and the federal government's funding of health, I heard my hon. colleague opposite mention this earlier. I would like to dispute the validity of propaganda allegations to the effect that the federal government is contributing only 14% to health. This is absolutely not true.

This figure does not take into account tax point transfers, that is the power to levy taxes, which the federal government had and gave to the provinces. It does not take into account equalization payments, which can be used to invest in health, among other things. As we know, equalization is a system whereby federal taxes are redistributed among the have-not provinces.

This 14% figure does not take into account federal investments in health research. I am talking about research centres, centres of excellence, university research, and so on. I am talking about drug approvals. This 14% does not take into account any of these areas of investment.

This figure of 14% is totally wrong. In reality, if we take into account all federal health care investments, the federal government's contribution in this respect is already 40% and not 14%. Furthermore, our Prime Minister has already committed to increasing this share in our next budget.

The motion asks for an unconditional transfer payment. They are saying to us, “Give us the money. The rest is none of your business”. As if the federal government did not have to justify how it is spending taxpayers' money. As if the federal government were not also accountable. This motion does not ask us to work together for the good of the patient while mutually respecting our jurisdictions.

I wonder if the Bloc Québécois had time to read this sentence from the brief presented to the Romanow commission by the Conseil du patronat du Québec, and I quote:

In our opinion, a health care system based on the principle of collegiality needs to be developed, in order to allow both governments to take the necessary steps to reform the system.

I wonder, too, if the Bloc Québécois had time to read this sentence from the brief presented to the Romanow commission by the Association of Canadian Academic Healthcare Organizations, and I quote:

Governments must find a way to work together; otherwise, they risk costing Canadians the thing they hold most dear.

I will refrain from making a political analysis on the electoral motives of the Bloc Quebecois or the Parti Quebecois. The people of Quebec will, at the appropriate time, be the judge of the performance of its provincial government in the health area. This leads me to say something that I believe is absolutely fundamental.

When we talk about accountability, provincial governments must be accountable not to the federal government or a federal authority, but rather to their respective people. I understand that the Bloc has introduced an amendment this morning that specifies this and I agree with that amendment.

Many reports have been produced on health in Canada. The Kirby and Romanow reports are only the last ones in a long series. None of these reports is set in stone or is the Canadian government's policy, but all of them have the merit of putting us on track. They force us to reflect. We have an obligation to take action, of course, but to take action wisely. So let us reflect a little.

The Romanow report proposes the creation of a health council of Canada, whose role would concern me at the outset. If it were to be a funnel for the coordination of professional health training and study programs, for the accountability about provincial health management performance and so on, this would be, I think, totally unacceptable.

The spirit of our federation must not allow a federal authority to take over a provincial jurisdiction by giving as an excuse that it is badly managed or that it can do better. On the contrary, the spirit of our federation must allow for the original features and differences that we see in each province and each region.

We will have the opportunity to debate further, in this House and in our ridings, the issue of health, and in particular the Romanow report.

We will talk again about what I consider the strong points in the Romanow report, for example, the maintaining of the five conditions in the Canada Health Act. In this regard, I remind the House that the Bloc Quebecois' motion makes no reference whatsoever to these conditions, which are so important and fundamental to Canadians, including Quebeckers; the Canadian transfer with a built-in escalator established for five years in advance, in other words, stable funding; investments in primary care and home care; support to natural caregivers; creation of a national drug agency; study on patent protection, and so on. I agree with this, this seems interesting to me. I would like the issue to be discussed further.

We will also talk about the serious reservations that I have on my first reading of this report, that is, the health council of Canada, the adding of structures, a potential centralization, the reopening of the Canada Health Act, the rejection of any role for the private sector, and so on.

I must point out that the report contains 387 pages and 47 recommendations. I must respect the work of its authors by taking the time to look at it more closely before taking a particular position. The motion calls for the transfer of unknown amounts of money unconditionally.

If I say that the health system will have to better integrate hospital care in any agreement for federal transfers to the provinces, is this a condition? If the answer is yes, then I would remind members that it is a condition that was agreed to by the premier of the day, Mr. Bouchard, when he signed the health agreement on September 11, 2000.

If I talk about funds that are targeted for primary health care or for home care, is this a condition? If the answer is yes, then again it is a condition that was agreed to by Mr. Bouchard on September 11, 2000. All these conditions and many others are in the interest of the patient, and Mr. Bouchard had the good sense to recognize that fact in signing the agreement.

Therefore, a motion calling for unconditional transfers is unacceptable. It goes against the spirit of the agreement signed on September 11, 2000. I even think that, for the sake of integrity, Mr. Bouchard would have to vote against this motion because it goes against the spirit of the agreement that he signed.

I will vote against this motion because I think that it closes the door to any kind of cooperation between the Government of Canada and provincial governments. I will vote against this motion because only cooperation between our governments can lead to the renewal that our health care system so badly needs; a cooperation that is based on absolute respect for our respective jurisdictions and on the premise that initiatives that have already been undertaken by provincial governments will be taken into account, a cooperation that exists exclusively for the benefit of patients.

I think that this is what Canadians expect from us.

SupplyGovernment Orders

3:55 p.m.

Bloc

Réal Ménard Bloc Hochelaga—Maisonneuve, QC

Mr. Speaker, I thank our colleague for his speech. He addressed some crucial elements, which I am obviously glad that he raised.

We should try to keep things straight however. No member from the Bloc Quebecois believes that the Government of Quebec should not be accountable to the people.

The member began by saying that our motion was a vote-getting ploy. Need I remind him that we have been fighting on this issue every since the former financer minister tabled his first budget. As he knows, ill-advised and deep cuts were made in health care. So, our motion has nothing to do with any political agenda, but everything to do with our ideology. We believe that the provinces should be better equipped to provide the best services possible to the public.

If the hon. member thinks we are looking for electoral gain, then he must also think that Jean Charest is looking for electoral gain, that Mario Dumont is looking for electoral gain and that the ten premiers who joined forces in Halifax and asked the Prime Minister to raise the federal contribution to 18% must also be looking for electoral gain.

I am sure that is not what he meant to say. I urge him to take a critical look at this issue, to respect provincial jurisdictions and to voice his concerns at caucus so that the federal government gives the provinces the money they need unconditionally, while of course remaining totally accountable to the people of Quebec.

SupplyGovernment Orders

3:55 p.m.

Liberal

Jacques Saada Liberal Brossard—La Prairie, QC

Mr. Speaker, first, I am glad that my hon. colleague reminded the House of the federal government's role in funding health care. I am just surprised that he did not think to mention the recent investment of tens of billions of dollars in connection with this agreement on health that was signed at the time.

In terms of electioneering, I will read two relatively short sentences:

I also invite the Premier to watch what he says and does. I listened to what was being said earlier; we must be careful. Now is not the time for insults, or to stir up old quarrels. That is not what the public expects of us. The public expects us to treat the sick and take care of patients.

I was quoting Monique Gagnon-Tremblay, a Liberal member of the National Assembly of Quebec. She realized that the tone used by the Premier of Quebec was not appropriate under the circumstances and that it was aimed at getting votes.

SupplyGovernment Orders

4 p.m.

Edmonton West Alberta

Liberal

Anne McLellan LiberalMinister of Health

Mr. Speaker, the hon. members are all aware that tomorrow I am meeting with my provincial and territorial counterparts to talk about the renewal of our health care system.

I know from speaking with most of my provincial and territorial counterparts that they agree with the importance of being transparent, with sharing information with Canadians and with the positive impact this can have on the renewal of our health care system.

The federal government's position is clear and it mirrors the position of Canadians. We need to know, in fact we deserve to know, how much we spend on health care and what we spend it on. This sharing of information will result in a stronger health care system because, in part, it will reduce the finger pointing and eliminate the blame game. This is important and it should not be dismissed.

Canadians have made it clear they do not want to see their governments bickering. Rather, they expect governments to work together to strengthen our health care system, to provide them with timely access to high quality care now and in the future. And the federal government is determined to do its part.

I have said repeatedly, and I mean it sincerely, that we need to work cooperatively, both within the federal government and across all levels of government, to respond to the health concerns and priorities of Canadians.

The first issue, on which I have already touched, is that of Canadians' expectations. As everyone in the House well knows, we now have the benefit of the final report of the Commission on the Future of Health Care in Canada, the Romanow report.

He found that Canadians want the following things: better accountability from providers and governments as well as users; greater transparency about where the money goes and its impact; proof of value for money; and finally, greater efficiency and cooperation within and among governments.

My hon. colleague's call for the unconditional transfer of Canadians' tax dollars to the provinces certainly would not meet this test. The Government of Canada unequivocally shares Canadians' demand for commitment to the principle of accountability. There has also been consensus across the country that the Government of Canada has an important role to play in Canada's health care system.

Canadians expect the federal government to take a strong stand in upholding the values of equity, fairness and solidarity that underpin medicare and in ensuring that their tax dollars deliver back to them timely access to high quality care. Canadians are also saying, loud and clear, that now is the time to make sure that this system is going to be there for them and for their children when they need it. This is an obligation I take very seriously.

I want to assure all Canadians that, like them, the Government of Canada is anxious to get on to the task of setting health care on a sustainable course for the future. We have the political will to do what is necessary and what is right. Earlier this week the Prime Minister made it clear that the Government of Canada is committed to moving forward to provide Canadians with the health care system they want. The Prime Minister told Canadians:

A concrete action plan to modify medicare will require money. If we have an action plan to effect important, long term changes, and if all governments agree on that plan, I can assure you that the federal money required will be available.

What is needed now is collaboration: federal, provincial and territorial discussion and agreement on what shape this concrete plan should take. Fortunately we have the advantage of a solid track record in federal, provincial and territorial cooperation in this regard. I remind the House that just a little over two years ago, in fact in September 2000, we celebrated our shared success in reaching a landmark agreement with the provinces and territories to support the health care system.

On September 11, 2000, as I have mentioned, the Prime Minister announced $23.4 billion of new federal investments over five years to support agreements by first ministers on health renewal and early childhood development. The first ministers identified key priorities for collaboration on health care renewal.

I would remind my hon. colleague from Hochelaga--Maisonneuve that as a result of this agreement the Province of Quebec received $239 million from the medical equipment fund and a further $133 million from the primary health care transition fund, in addition to funding under the CHST.

I am confident we will achieve success once again when the first ministers meet early in the new year to determine where we go together from here.

We have proven that we can sit down together and set aside our political differences for the national good. We have demonstrated, through the dispute avoidance and resolution agreement, that regardless of our political affiliation we are all motivated by the shared desire to do what is right for Canadians.

Our objective tomorrow when health ministers meet is to discuss and, I hope, begin to plan the renewal of our health care system. We will provide our best advice to finance ministers and first ministers to establish that concrete plan and the necessary long term federal investments, which will be included in the next budget.

Given these developments, I believe that my hon. colleague's motion is not only ill-conceived but ill-timed. It would be, as I say, putting the cart before the horse for the federal government to unilaterally determine right now how, or how much, money should be transferred to the provinces and the territories before we have the plan for renewal to which I have referred.

I am fully aware of and respect the fact that the provinces and territories are primarily responsible for the organization and delivery of health care in the country. They are on the front lines. However, there is no question the federal government has an important leadership role to play, both in terms of the financing of health care and in relation to issues that are national in scope, such as the enforcement of the Canada Health Act. But this is not about the federal government imposing on the provinces. It is about collaborative partnership for the common good, because that is what Canadians expect.

Canadians want action now. That is why we need an action plan for renewal: a plan that federal, provincial and territorial governments all help to develop and in which they have ownership; a plan that will be responsive to Canadians' desire for timely access to high quality care; a plan that will renew our publicly funded health care system to ensure its immediate and long term sustainability; and a plan that will serve us all well and long into the future.

While it would be inappropriate to predict the outcome of the upcoming meetings, both among the health ministers this week and with the first ministers in a month or so, let me say that I have every confidence we will move forward quickly, so I encourage the hon. member of the opposition to set aside his motion and instead work with us to advance this goal. His constituents in Quebec, like mine in Alberta, want the assurance of a timely, reliable, high quality health care system that will be there for them when they need it, on the basis of their needs and not their ability to pay.

I am convinced that if we keep our focus on this simple but important objective, we will not only meet Canadians' expectations but become a stronger nation in the process, and all Canadians will thank us for that.

I look forward to my colleagues' comments and questions.

SupplyGovernment Orders

4:10 p.m.

Canadian Alliance

Jason Kenney Canadian Alliance Calgary Southeast, AB

Mr. Speaker, I would like to thank the minister for her remarks, although I am somewhat confused when she says that the Romanow report does not suggest nor does the government intend to impose requirements on the provinces, which of course occupy the exclusive constitutional jurisdiction for health care. However, my reading of the Romanow report is such that it effectively rules out any role for internal markets within the provision of public health care, and it effectively dismisses the range of blended systems in terms of delivery which exists in all the social democracies of Europe, including Sweden, France and Germany.

Out of an honest curiosity, I am just wondering if the minister could comment on why it is that the government seems so hostile to adopting the kinds of internal market systems that exist and the choices outside the state delivery that exist in western European countries, which all guarantee universal access regardless of financial means.

SupplyGovernment Orders

4:10 p.m.

Liberal

Anne McLellan Liberal Edmonton West, AB

Mr. Speaker, let me say first of all that it is not for me to interpret Mr. Romanow's report. Mr. Romanow does that eloquently. He has been doing that and I am sure he will continue to do that.

Let me say on behalf of the Government of Canada that we have always acknowledged the fact that, as it relates to the delivery of health care within a publicly financed system, we have enjoyed a blend of delivery modes. I see no reason why we will not continue to see innovation and experimentation on the part of the provinces and the territories around how we deliver health care to Canadians within a publicly financed system.

I have made it plain that my concern as the Minister of Health for the Government of Canada is in relation to the observance of, respect for and enforcement of the five principles of the Canada Health Act, but in terms of a choice, or blend, to use the hon. member's words, of delivery mechanisms, that is up to the provinces.

SupplyGovernment Orders

4:10 p.m.

Bloc

Réal Ménard Bloc Hochelaga—Maisonneuve, QC

Mr. Speaker, with all due respect, it takes some nerve to say what the minister just said because the premiers had to take out ads on television and in the papers, and meet in Halifax to call attention to the underfunding by the federal government, which has completely destroyed the health care system.

This is the first time we have seen this happen. The people of New Brunswick, Quebec, Ontario, no matter what their political stripe, had to pay for ads to convince the federal government to come up with funding.

Can the Minister of Health tell me what the National Assembly's consensus signifies to her? If Mario Dumont, Jean Charest, Bernard Landry and 125 members, representing all of Quebec, reject this report, what does it signify to her, in a parliamentary democracy?

SupplyGovernment Orders

4:10 p.m.

Liberal

Anne McLellan Liberal Edmonton West, AB

Mr. Speaker, let me first of all thank the hon. member for my promotion. I have always thought he was a man of exemplary good judgment.

The hon. member does raise a very serious question. I have enormous respect for all the provinces and territories. I have enormous respect for my provincial and territorial colleagues, including Monsieur Legault, whom I had the opportunity to meet with in September when health ministers met. I look forward to seeing him again tomorrow in Toronto.

In fact, I want to underscore again for all hon. members of the House that as far as we are concerned on this side of the House we will work in a spirit of collaboration and partnership. The provinces are the primary deliverers of health care. The provinces are 13 incubators in which innovation is taking place, dare I say on an almost daily basis, but the Government of Canada also has an important role to play in the area of health care. We must show leadership in relation to the principles of the Canada Health Act. We must show leadership in terms of working with the provinces on issues of national concern. We must do our part to fund this, Canadians' most cherished social program, and I can reassure everyone we will continue to do those things. We will continue to show that leadership in a spirit of partnership and collaboration.

SupplyGovernment Orders

4:15 p.m.

NDP

Wendy Lill NDP Dartmouth, NS

Mr. Speaker, as a member of Parliament for Nova Scotia, let me say that we have grave concerns about funding for the health care system. The present per capita funding formula sends 90% of the increase in health care spending to Ontario, B.C. and Alberta.

Roy Romanow did call for changes to the funding formula to help the poorer provinces meet the health care needs of their citizens. My question is, when the minister meets with the first ministers tomorrow in Toronto, will the federal government put forward a recommendation that the former finance minister's funding formula, which discriminates against poorer provinces, be changed to meet the needs of these provinces?

SupplyGovernment Orders

4:15 p.m.

Liberal

Anne McLellan Liberal Edmonton West, AB

Mr. Speaker, first I want to clarify for everybody that tomorrow's meeting is a meeting of health ministers, not first ministers. Obviously that is a key distinction, because first ministers will be left with final decisions around the renewal of our health care system.

Let me speak to the hon. member's specific question. Obviously the CHST is the main funding mechanism by which we transfer dollars for health care to the provinces, and that is a per capita mechanism, but of course the hon. member forgets about the importance of equalization. In fact, in a province like hers, Nova Scotia, equalization is a very important transfer of federal dollars to the province.

I know that sometimes the provinces forget to compute equalization or some percentage of those equalization payments into our total contribution for health care. That is most unfortunate, because in fact unless one includes some percentage of those equalization payments, which I believe now eight provinces in the country receive, one does not have the full picture in terms of the federal government's contribution to funding health care, not only in the hon. member's province of Nova Scotia but in all provinces.

SupplyGovernment Orders

4:15 p.m.

Bloc

Antoine Dubé Bloc Lévis-Et-Chutes-De-La-Chaudière, QC

Mr. Speaker, first, I wish to inform the Chair that I will split my time with the hon. member for Argenteuil—Papineau—Mirabel.

I think it is appropriate to read the motion before us today. This motion has been put forward by the hon. member for Hochelaga—Maisonneuve, who is our critic on health issues. Incidentally, he is doing an excellent job and I am taking this opportunity to congratulate him. The motion reads as follows:

That the federal government give the provinces the additional money for health unconditionally, with the promise of the provinces to use all of it for health care.

The hon. member for Drummond, who sits on the Standing Committee on Finance, proposed an amendment which reads as follows:

according to the priorities they have established and to provide an accounting to their residents.

This goes without saying. The main argument is included in the amendment. There is no question that Quebec agrees with the principle of being accountable to its own citizens. Quebec has an auditor general too.

I want to say a few words on the Romanow report. The recommendations included in this report call for a standardization of health care in Canada, and they deal with issues that fall under the exclusive jurisdiction of the provinces.

The Romanow report proposes structures, standards and more bureaucrats in Ottawa, which goes against the very spirit of the Constitution. Federal officials would start meddling in provincial matters.

The Romanow report proposes a single Canada-wide health system, which of course is unacceptable to Quebec. As the hon. member for Hochelaga—Maisonneuve pointed out, it is unacceptable not only to the Premier of Quebec, but also to the leaders of the other two parties in the National Assembly, and to all the members of that assembly, which passed a resolution to this effect.

I want to take a few moments to mention the comments made by Jean Charest, who said “Health is a jurisdiction of the Quebec National Assembly. It is not up to the federal government to set priorities, or to impose conditions on the transfer of funds”. He added that “Federal funding for health must be unconditional”. Mr. Charest emphasized that point.

With respect to the Romanow report, the leader of Action démocratique du Québec, Mario Dumont, said that “It essentially means more centralization, more bureaucracy, more exclusions regarding the diversification of services. In that sense, it goes against the ADQ's platform. It is contrary to the experiences of all the provinces that have tried to improve the operation of the health system”.

I think it is useful to mention these comments.

In short, the Romanow report would turn the current system upside down and lead to squabbling and endless discussions. In the meantime, patients are suffering and health care providers are exhausted.

I was listening when the health minister stated that the Romanow report would put an end to all the squabbling. On the contrary. Without going over all the recommendations in the Romanow report, we can see that it proposes a new structure, a Canada-wide council. That means more public servants. It would add a new principle to the Canada Health Act, the so-called accountability principle. It would extend the legislation to include diagnostic and home-care services. It wants to go further.

Since health care is an area of provincial jurisdiction, would it not be appropriate for the federal government to transfer money to Quebec?

Every since the Canada Health Act was passed and the system was established, the federal government has been collecting taxes in Quebec and, pursuant to its spending power, funding health care.

The Government of Quebec has the option of not agreeing to the conditions attached to the additional health funding. Maybe the Prime Minister will agree to hand over the money after meeting with the premiers, but we do not know the amount involved. What we know is that Quebec needs at least $50 million more a week.

If everyone were minding their own business in Canada, provinces would collect the taxes they needed to deliver health care.

Right now, the federal government is providing funding anyway; it wants to provide funding and many provinces, in fact all of them except Quebec, want to keep receiving funding from Ottawa.

This is what Mr. Bouchard did in 2000, when he was forced to accept the offer made at the time to increase funding for health care, but with a knife to his throat. Not accepting it would have meant refusing a considerable amount of money and being forced to tax Quebeckers more, which put us in a completely untenable situation. This is called fiscal strangulation; there is no other word for it. This is a very sensitive area; very important, given that it is health.

The Minister of Health is saying to us, “Do not squabble over this. Do not squabble over the Romanow report. Do not squabble over the possibility of the federal government going back to the funding levels that existed before this party took office”. That is what is being called for, returning to the funding levels that existed in 1993. The cuts were made unilaterally, need I add?

Mr. Romanow's study lasted 18 months and cost $15 million, if we are to believe the figures. Currently, there is a $50 million shortfall in health care funding per week. Imagine all of the things that could not be done. If we had received this money, there might be more doctors, more nurses, more equipment, more could have been done to help the health care system.

The Liberal Party is not able to be consistent on a motion moved in the House on distinct society; it cannot recognize that Quebec does things differently. We have the best health care system in Canada because, for example, when it comes to home care, we have the CLSCs. No other province has done as much as Quebec in terms of prevention and home care.

Incidentally, Mr. Romanow commented on this; his recommendations reflected these accomplishments. No other province, as far as I know—

SupplyGovernment Orders

4:20 p.m.

An hon. member

Oh, oh.

SupplyGovernment Orders

4:20 p.m.

Bloc

Antoine Dubé Bloc Lévis-Et-Chutes-De-La-Chaudière, QC

Mr. Speaker, the member for Hull—Aylmer is distracting me. Given that I live in his city during the week, and that we contribute to the economy of his riding, he should have the decency to listen to us. I live there during the week.

I will give the Romanow report one thing. He recognized that there is a shortfall, that health is underfunded and that there is a lack of transfers. He proposes at the very least returning to funding 25% of health care costs. He proposes that the federal government's contribution be set at least five years in advance.

Personally, I hope that the Prime Minister and the federal Minister of Health will recognize that fact and follow up on the recommendation about reinvesting in health care. As long as we stay in this system, where taxes are collected and where the federal government, using its spending power, invests in areas under provincial jurisdiction, we will have to keep this in mind.

In closing, I read the article by Paule Des Rivières, editorial writer for Le Devoir . I will read only one paragraph. While the government wants to interfere in areas under provincial jurisdiction, she writes, and I quote:

In 1994, the Auditor General found a huge amount, $8 billion, in unrecovered taxes at Revenue Canada; in 1995, he revealed that $720 million had been wasted on the construction of the bridge to Prince Edward Island; in 1996, he reported that harmonization of the GST in the Atlantic provinces had cost $1 billion; in 1997, he demonstrated that Ottawa could have obtained $1 billion more for the sale of its air navigation system; in 1998, he exposed negligence in the management of social insurance numbers; in 1999, he denounced the ridiculously high surplus in the employment insurance fund; in 2000, he confirmed that hundreds of millions of dollars had disappeared in uncontrolled grants at HRDC; in 2001, we learned that Ottawa had saved $400 million at the expense of senior citizens.

And now we are told that $1 billion will be spent for gun control, which is a lot more than expected. With these kinds of administrative blunders, it is unacceptable for the government to want to interfere in areas under provincial jurisdiction.