House of Commons Hansard #52 of the 37th Parliament, 3rd Session. (The original version is on Parliament's site.) The word of the day was health.

Topics

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12:35 p.m.

Liberal

Murray Calder Dufferin—Peel—Wellington—Grey, ON

Mr. Speaker, I am grateful for the opportunity to speak to the motion by the hon. member for Churchill respecting health care delivery.

Canadians enjoy one of the world's most successful health care systems. Canadians are among the healthiest people in the world. Our universal, publicly administered health care system has worked well for our country. The principles, as enshrined in the Canada Health Act have conferred significant benefits, both in terms of health status and our economy.

Nothing optimizes this philosophy better than Canada's universal, single payer health system that provides everyone, regardless of income, age, gender or place of residence, with equal access to quality medical health care. In the view of many, our health system is central to our national identity. It defines us and unites us as a nation.

On standard measures of both life expectancy and infant mortality, Canada outperforms the United States. In 1990 the life expectancy for Canadian men was two years longer than American men. By 1995 it was 2.8 years longer. In the same timeframe, Canadian women's life expectancy increased from 1.6 to 1.9 years beyond that of American women. Medicare has contributed to the improved health outcomes for our children. In fact, our infant mortality rates are among the lowest in the world. This is largely because Canadians have access to necessary medical care.

A report just released by the Commonwealth Fund on the quality of health care in industrialized countries comparing Canada, the U.S., the U.K., Australia and New Zealand found no single country to be superior overall. However, it did note that the U.S. spends 13.9% of GDP on health care versus just 9.7% of GDP in Canada, with no appreciable difference in health results. The results of that study clearly demonstrate that Canada has a quality health system and that Canada spends 57% less per capita than is spent by the U.S.

Similarly, according to a 1991 KPMG study, the administrative costs of maintaining health care accounted for 31% of health expenditures in the United States and just 16.7% in Canada. In Canada, more of our health care dollars go to providing the health care services our residents need, not paying to administer the program.

In the United States, where health care is privatized, there are over 43 million people who do not have any health insurance because they cannot afford it. American media reports have indicated that just over one-half of bankruptcies in that country are the direct result of an inability to pay medical bills. This alone is a strong argument for single tier medicine in Canada. We do not want to see Canadians suffering serious financial loss because of health related difficulties.

Health care in the United States is based on income and an individual's ability to pay rather than the need for care. Health costs continue to be a major burden for employers. The difference between our public system and the American private system is that a two tiered system simply costs more to deliver and administer.

Our health care system is critical to our country's productivity and ability to compete in an aggressive global marketplace. In Canada, we recognize that our success as a nation comes from our ability to commit to our core values: sharing risks and benefits; looking out for the most vulnerable; and equality of all citizens, all of which contribute to a strong economy.

The Canadian single payer health care system has made Canadian businesses more competitive in the world markets by helping to keep their costs of doing business down. This is because the cost of health care is shared between individuals, businesses and government. Medicare is an economic asset, not a liability.

Medicare is one of the factors that has allowed Canada to have one of the lowest payroll taxes among the G-8 countries.

The very nature of our health care system puts Canada in an excellent position to control the aggregate expenses of the health sector in our economy, since each provincial and territorial government is a predominant buyer of health care in this jurisdiction. This provides enormous leverage to negotiate fee structures and service costs, and to manage spending to achieve cost effective health outcomes.

Resources can be directed to factors that improve health status, not only those related to health care but also other determinants of health. Obviously, a lower cost system leaves workers with more disposable income to stimulate the economy, but that is only part of the story.

We also know that when there are fewer work days lost to illness, productivity increases. There are greater opportunities to obtain better paying jobs and a higher standard of living for all.

Finally, healthier people, as we know, make fewer demands on the health care system, live longer and contribute significantly to the overall wealth of a nation. What is good for society is good for our economy and vice versa.

The government is committed to doing its part in sustaining medicare. In addition to the commitment of $34.8 billion under 2003 accord, the government also created a new health transfer. This transfer enhances transparency and accountability and provides Canadians with a more accurate picture of federal contributions to health care and other key social sectors.

Provinces and territories retain their flexibility to decide where and how they will invest federal resources in each sector, but Canadians know what the federal government's significant contribution to health is all about.

We acknowledge that our health care system is in need of revitalization. We must find news ways of responding to Canadians' health care needs in a timely manner. We must not be afraid to accept the challenge of adopting new approaches consistent with the principles of the Canada Health Act.

Let me remind the members what those principles are. Public administration: In order to satisfy the criteria of public administration, the health care insurance plan of a province must be administered and operated on a non-profit basis by a public authority appointed or designated by the government of the province. The public authority must be responsible to the provincial government for that administration and operation.

Universality: Under the universality criteria all residents of a province must be insured persons under the provincial health plan.

Portability: Portability means that the insured persons are covered for medically necessary services when they move from one province to another within Canada.

Comprehensiveness: Under this criteria, the health care insurance plan of a province must insure all medically necessary health services provided by hospitals, medical practitioners or dentists in a hospital setting.

Accessibility: Accessibility ensures that insured persons have a reasonable access to medically necessary hospital and-or physician services without any financial or other barriers.

However, as we move toward finding solutions and implementing lasting changes to renew the health system, we must not lose what we value most; the social equity and the economic advantages of a publicly funded, single tier health care system.

Renewing medicare will take perseverance, commitment, hard work and time. As a government, we are prepared to face the challenge and we are dedicated to working with the provinces and the territories and Canadians as partners.

The true test of commitment is where we stand in times of challenge and of change. We, as a nation, had the sense to invent medicare, now we need to find the will and the way to strengthen it for the long term.

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12:45 p.m.

NDP

Pat Martin Winnipeg Centre, MB

Mr. Speaker, I thank the member for Dufferin—Peel—Wellington—Grey for his thoughtful remarks regarding the need and the value of our publicly funded health care system.

What struck me about my hon. colleague's speech is that, like the Minister of Health, he never once used the term publicly delivered health care system. He focused on the importance of a publicly funded health care system.

If he had read the motion properly, the one we put forward today, he would have seen that we were calling into question the growth of the delivery of health care services by private for profit initiatives. That is where my colleague's comments fall short of the mark.

He made lots of lofty comments, with which I wholeheartedly agree, about the importance, the value and even the economic advantages of our publicly funded health care system in this country. It is a national treasure. However we are drawing attention to the fact that our national treasure is being eroded by the growth of the privately delivered health care system.

I would ask the member if he is aware of the following facts. Most of our evidence regarding for profit health care comes from the United States where there is a mix of publicly funded, private for profit and private not for profit. The evidence or the examination of figures that we have comes from the American model. Is he aware that the for profit hospitals in the United States bill about $8,500 for every discharged patient, while the non-profit hospitals bill about $7,300 for each discharged patient?

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12:45 p.m.

Liberal

Murray Calder Dufferin—Peel—Wellington—Grey, ON

Mr. Speaker, I thought maybe the preamble would let me off answering the question but I will answer it.

I just want to give the member a bit of my background. I sat as a hospital board member for 12 years at the Louise Marshall Hospital in Mount Forest. I was the corporation treasurer for four years for that hospital. I see the exercise that is in front of us right now, that we have to enter into negotiations with the provinces and the territories, as the federal government, on a proactive basis to take health care into the next century, which is where we are at.

I am 54 and a baby boomer. People are turning 50 at the rate of over 52,000 a year. A lot of pressure will be put on the health care system so it has to be up and ready to run.

One of the things that irritated me more than anything else when I was a corporation treasurer is that if the administrator of the hospital and myself found a savings in our budget, for instance, $40,000, we were not allowed to put that money in a capital trust account to take a look at expenditures that the hospital would be faced with, such as needing a new MRI, an x-ray machine or anything else. In fact, it was even worse because the $40,000 that I had found, if I did not spend it at the end of the year, in the next budget year my budget would be reduced by $40,000.

That is something that actually exists within the province of Ontario which encourages wasteful spending. What I am saying is that we as a federal government have to get past the fact that we walk into the room with a blank cheque. We have to be part of the administrative process with health care to take it into the next millennium. That is what I am behind and what I want to see done.

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12:50 p.m.

NDP

Bev Desjarlais Churchill, MB

Mr. Speaker, I do not think there is any question that there may be cost savings within the health care system and that there needs to be some reform. I think Canadians have said loud and clear that they want the federal government to take a lead role in ensuring that the services are provided nationwide. The government will have to work out that partnership arrangement with the provinces.

In trying to clear the air on exactly where the government and members of the government stand, do they think it is all right to provide for profit delivery of health care services?

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12:50 p.m.

Liberal

Murray Calder Dufferin—Peel—Wellington—Grey, ON

Mr. Speaker, to clear the air, very simply we as a government have always said that we take a look at the five principles of the Canadian Health Act and we stand behind them.

To go further than that, this becomes a negotiating situation with the provinces and territories. Where do we want to take the health care system, knowing that the issues that are facing it right now and the increased usage that is coming in the future as the aging baby boomers hit it? Those are the questions that will have to be negotiated this summer with the provinces and the territories.

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12:50 p.m.

Canadian Alliance

Rob Merrifield Yellowhead, AB

Mr. Speaker, as the health critic for the new Conservative Party of Canada, it is a pleasure to take part in a debate that is very important to most Canadians. Health care is the number one issue for Canadians from one side of the country to the other.

Before we actually get into a debate on health care, we must understand the principles of health care and the values Canadians hold near and dear.

Our medicare system was founded on the principle that no one should go without health care because of an inability to pay for it. No one should lose their life savings because of a serious illness. That is a very compassionate and principled value. It is different from what our neighbours to the south have.

The Americans have a different value system. I am not here to judge them but that it is not a system we would want to applaud. It is a system that has a different value system. They say that they will not let anyone die on the streets and that they will look after people's medical needs but they have no problem draining people's bank accounts in the process. They have their value system and we have ours.

I do not hear any province or any party advocating an American system. I hear everyone applauding the Canadian value system with regard to that aspect.

How we sustain our system becomes the issue. We have to understand that is the value that we want to hold near and dear.

First, there is a lot of misinformation or uncertainty around the whole idea of where our present government is at with regard to our health care system. Of late, we have heard all sorts of conflicting messages coming from our federal government. It is really interesting to have a debate on it today where we can perhaps clear up some of this confusion.

I cannot determine how another party lays out its platform or communicates that platform, but I can communicate our platform. I will try to do that in the most aggressive and clearest way I possibly can and hope I can achieve that in the next few minutes.

As we move into the 21st century, we have to realize who is paying for our health care system and why it is so important to put the patient first. For far too long our emphasis has been strictly around this sacred cow, the health care system. We have to realize that the system is there and is paid for by the patient. The patient, therefore, has to be our primary focus and the primary focus of decisions made with regard to health care.

Let us take a look at what our health care system looks like today after a decade of Liberal government. Wait times have extended to a period beyond what we ever thought imaginable. Since 1993 the wait times have doubled. General practitioners are having serious problems managing their offices and coping with the stress of their jobs.

Among the OECD nation, Canada's medical wait lists are among the longest in the world. We actually are only second with regard to per capita spending.

It is not just a matter of throwing more money at a system and solving the problems in health care. We have to look far beyond that. We have to understand that it would consume all the money we could possibly throw at it and we have to be very discerning as to how we do that.

We have medical workplace shortages, shortages of doctors and nurses. The ideology in the 1990s, when this federal government came into power, was that the doctors drove health care costs, so if we get rid of the doctors we get rid of costs. That ideology was faulty at that time and it is faulty today.

The Canadian Medical Association said that in a decade from now we would have serious problems, and that is what we have. We have a workforce that is overworked, overstressed and burnt-out.

The SARS crisis of last year demonstrated just how vulnerable we are in the health care system. We saw how the threat of a SARS epidemic hit the Toronto area and how stressed the workforce was during that period of time. We even had nurses saying that they would not go into work because they were too stressed or burnt-out.

We have a serious situation when it comes to that side of health care because of the massive cuts and the direction in which the government went in the mid-1990s. Since 1995, $25 billion has been taken out of the purchasing power of the provincial governments to deliver on their health care, which is their mandate.

It is very important to understand that we are where we are because of a lack of leadership on health care. The Prime Minister when he was finance minister decided to unilaterally cut the legs out of health care. Unfortunately that did two things. Not only did the government cut the money out and leave the provinces high and dry with regard to the funding of health care, but it ruined a trust relationship which was an agreement on health care as to how both jurisdictions would jointly deal with health care. That relationship was broken and it is no wonder the provinces are a little shy when it comes to dealing with future plans, like a 10 year agreement on health care. I will talk about that later on.

Not only did we lose the money and health care was left to drift but also we lost the relationship with the provincial governments. Therefore, it should be no surprise to anyone what the state of health care is at the present time.

What are we looking at? What are some of the stresses and strains that are going to come on to the system as we look further into the 21st century? It is very important that we understand these stresses because if we do not, we will not get a clear picture of what we are headed into.

My hon. colleagues have been mentioning the demographic curve, which is important. The baby boomer generation is about to hit the health care system and that will have great significance. The last figures I saw are two years old, but it costs around $4,300 to $4,400 to look after an individual between the ages of 44 years and 65 years. For an individual between the ages of 65 and 75 years, the cost almost doubles. It doubles again for an individual between the ages of 75 and 85 years. The figure is over $14,000 by the time a person is 75 to 85 years of age. That is the average annual cost to look after those individuals.

When we look at the demographic curve, we see that the fastest growth in our population is those 65 years and over. When that hits our system and increases, it will be 2041 before we start to see any relief. The pressure on our health care system will continue to increase until that period of time.

We have to couple that with the obesity problems in our youth. I spoke to people from the Heart and Stroke Foundation and other associations. They were in my office a while back. They say the problem is that our young people today are going to be looking at heart and stroke problems at the ages of 45 to 55 instead of 65 to 75. They will hit the health care system at the same time.

We have to understand the dynamics of what we are looking at. Diabetes, cancer, heart and stroke and lung problems are all going to hit our system much more aggressively than we have seen in the past.

Until we understand what is coming at us, we cannot logically sit around the table and have a good discussion on how we are going to sustain our health care system into the future. It is very important that we do so. Right now 32% of the provincial and territorial budgets go into health care and by 2020 it is expected to be 44%. Almost half the money the provincial governments spend will go into health care. That is very significant.

Many of the challenges to health care are actually rooted in some of the good news stories. Our health care professionals are trained very well. Medical equipment is becoming much more sophisticated and new technologies are doing amazing things. Pharmaceutical products are more advanced and more specialized than ever before. Because of that, time spent in hospitals and acute care centres is being reduced.

I had to lay out that part of the scenario before getting to some of the solutions. As we move forward, I see three ways in which we could actually make a significant difference in health care.

The first one is to understand exactly what happened with the health accord on February 15 last year. For the first time in a decade both orders of governments, provincial and federal, sat down and decided on a plan on how to sustain the health care system for the next five years. It was a significant time because it was an attempt at mending a relationship, but it was also an attempt to look at health care funding more significantly and respecting both jurisdictions, the federal and provincial governments. This accord was very significant.

Our party agreed with the accord. We said the accord was a valuable road map ahead and that we should make sure that we comply with it. The second thing we wanted was to look at improving delivery and regulations of prescription drugs because of their significant role. The third thing was to renew our commitment to health promotion and disease prevention.

The Conservative Party of Canada agrees with the funding in the health accord. We do not agree with the numbers the health minister and the Prime Minister are using. They are saying there is $37 billion in new money, but people have to understand that $20 billion of that was from the 2000 accord and it is reannounced money. Nonetheless I do not want to confuse people with the numbers. Let us just say there is going to be some new money put into the accord.

The accord recognized the flexibility of provincial jurisdiction in delivering health care. It also looked at reforms to primary care, providing greater home care delivery systems and catastrophic drug coverage. It is very important that the flexibility be maintained in the hands of the provincial governments.

The accord created a dedicated health transfer so that we could stop the noise about who is paying for what. When the Auditor General takes a look at the books in Canada and how much money the federal government is putting in compared to the provinces, she says that she does not know because of the way it is struck. We are saying let us clear up this silly game of the numbers of dollars going into health care. It is all the same payers for the system. It is all taxpayer money, so let us just get that cleared up right off the bat.

The accord provided significant funds for diagnostic equipment as well as health information systems and research for hospitals. It promoted and established a national council which hopefully will give us some better performance measures for our health care system. Some of the provinces said that what the council's mandate was coming out of the accord was different from what was agreed to with the provinces, and that is why Alberta and Quebec decided to bail on the accord. The Health Council of Canada was supposed to be struck on May 6 and it did not get up and running until after December last year.

The timelines and many of the things that were supposed to be done in the accord have not been complied with by the federal government. One of those is the implementation of home care. The minimum basket of services was supposed to be decided by September last year. The common health system performance indicators were also supposed to be done by September. This was not complied with.

We also wanted to see progress, and there should have been progress already, on the catastrophic drug coverage. We realize that the health minister said in December last year that work on that has not even been thought about and has not even started yet. We are really nervous about that.

The aboriginal health reporting framework was also supposed to be initiated and worked on. Nothing is being done on that either.

We have had a year to comply with the health accord, with specific timelines of what should be done, when and why. The first time the Prime Minister met with the premiers, one would think they would have discussed what was not done and why that was not complied with, but none of that took place.

The Friday before the Monday of the throne speech, when the Prime Minister met with the premiers, all that was talked about was $2 billion more going into health care. It had nothing to do with how both orders of government had failed to come up with the actual agreement on the accord. We are really quite nervous in our party when we see a lack of commitment from the federal government with regard to the health accord.

Michael Decter, the chair of the national council, recently said that all of what we need to do with regard to laying out this five year plan in the accord is that we should get on with it, that we do not need another 10 year health accord. That is what is being proposed by the government, that we sit around and talk with the premiers again to come up with a 10 year plan on health care. We have a five year plan that is not being complied with. Why would we think that the government would agree with a 10 year plan that is somebody's dream at this stage of the game?

We are very nervous going into an election at the lack of commitment to what was already on the table, and the talk of something in the future that likely will not happen. It is just a political game. We cannot afford to play politics with health care anymore. We have seen that happen many times before. We cannot let that happen to us at this stage of the game. Health care should be a non-partisan issue. It should be something that is not fought on a political basis. It should be fought on the best interests of the patients and the best interests of the Canadian population.

Our party is saying that we want adequate, predictable and growing levels of funding for health care. We agree with more dollars going into health care but we must balance that off with greater accountability so that those dollars are spent in ways that are accountable and are actually going to achieve some of the goals that are asked for in the accord. We cannot make annual multibillion dollar infusions into health care without that kind of accountability happening.

Performance measures must be in place. Citizens and taxpayers must be able to see where those moneys are going to improve the health care system in Canada. If that is not the case, then we will be continually going in circles and spinning our wheels and not achieving what really needs to be done with regard to the sustainability of health care. We do not have the time to make these mistakes again.

I would also like to talk about prescription medication, because it is such an important area of our health care system. Our spending on prescription and non-prescription drugs is the fastest growing category of health expenditures in the country and is only second to hospitals. Very close to the same amount of money goes into hospitals and pharmaceuticals. Prescription medication is the fastest growing at 14.5% last year.

Prescription drugs play an important role in enhancing the health of Canadians. We all understand that. We know about some of the treatments and some of the technologies. They are doing amazing things. They are allowing Canadians to live healthier, more comfortable and longer lives. Over the past few decades pharmaceuticals have had an enormous impact on the health care system. New drug therapies have replaced many of the surgeries and have enabled patients to leave their hospital rooms much sooner.

Our aging population will ensure that drug consumption and spending will only increase when it comes to pharmaceuticals. Because of that, we have to go back to what I started with, which is the Canadian value on health care. No one should lose his or her life savings because of a serious illness. Many prescription medications and what is done with therapies and treatments are much different today from 20 years ago and the costs of those are going up much higher.

The health accord includes the pledge to provide Canadians with reasonable access to catastrophic drug coverage, with which we agree, to make sure that value is preserved. Canadians no longer would have to risk losing their life savings because of a serious illness.

Yesterday our leader announced that a Conservative government would propose that the federal government assume direct responsibility for this program. The drug costs are one of the fastest growing expenditures. We have to be sure that Canadians are comfortable in knowing that we will comply with the health accord with regard to catastrophic drug coverage.

It is important to understand that it is within federal jurisdiction to allow new drugs to come into this country and not only that but also the regulation of those drugs. That is all federal jurisdiction.

The health committee travelled this country from one end to the other dealing with the whole area of addiction to prescription medication and the misuse of medication. The reports are about to come in on some of the studies, but we know there is a minimum of 10,000 deaths per year because of misuse of prescription medications in Canada. From a federal perspective we could control that side of it. We have to do a much better job than what has been done in the past. We also must make sure that new drugs and better drugs are available for our citizens so that we can have the best health care system in the world.

It is very important that we put the patients first. One way to put the patients first is by helping them not to be patients in the first place.

The Conservative Party will do that by recognizing that wellness promotion and disease prevention are keys to improving the health of Canadians and ensuring the sustainability of our health care system. That is why we support the renewal of the Canadian strategy on HIV-AIDS. That is why we as a party support the tobacco prevention program, particularly aimed at our youth. That is why we will support the patient safety institute. That is why we will devote 1% of health care spending to the promotion of physical fitness and amateur sport.

We support also the new chief medical officer of health and the creation of the public health agency. It is unfortunate the government has dilly-dallied on this. We have been sitting vulnerable for a year now, waiting for the government to put in place a chief medical officer and an agency. Instead we have seen very little leadership in this area. Mark my words, we will likely see something within the next week with regard to a statement on a chief medical officer or the agency and where it will be placed. It is strictly about politics. It is unfortunate that we have to play politics with health care again. That is what I mean by putting the patients first, by making the kinds of decisions that are in the best interests of Canadians and not politics.

It is really interesting to see the position of Liberal Party on health care. I am not exactly sure what Liberals are thinking because we see so many conflicting areas and statements coming from them. A few weeks ago the Minister of Health talked about the Canada Health Act and what it allowed and did not allow. Then we hear that the Prime Minister goes to a private clinic for his services.

The Conservative Party is clear on its position on health care. We support Canada's system of universal public insurance. No one should be denied medical services because of inability to pay and no one who receives such services should find themselves and their families faced with health bills they cannot afford.

We need leadership on health care like never before.

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1:10 p.m.

Liberal

Paul Szabo Mississauga South, ON

Mr. Speaker, the member has touched on a number of aspects of health care. I am not sure if he heard my earlier question for the member from Churchill, but I would pose a similar one to him on how he defines health care. As he knows, under the Canada Health Act we talk about medically necessary, and that is hospitals and doctors.

An example, a doctor provides cosmetic surgery for anyone who wants to pay for it, but also provides services to the health care system where someone, for instance, has been injured in an automobile accident, has facial damage which requires that same surgery. One is as the result of an accident and the other is not. We are talking about a physician who is private for profit totally or a physician who has certain other aspects in his or her activity, depending on why the service is being provided and who is paying for it.

Would he clarify that in the context of this motion? I have some concern that the motion would basically state that doctor should not be in business because he or she would be characterized as being business for profit.

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1:15 p.m.

Canadian Alliance

Rob Merrifield Yellowhead, AB

Mr. Speaker, there is a very simple answer to that. When we look at the Canada Health Act, it is for medically necessary services. Medically necessary services are determined by the provinces. We have to respect their jurisdiction on that and we have to understand that is the way it works. If we want to change the Canada Health Act, that debate would have to happen nationally. That is what the NDP is suggesting. I disagree with that. Provinces need to have the flexibility on delivery.

The problem is not about who delivers the service. The problem is that we have no accessibility to the service. Canadians are really concerned about that. They want to have the services, which they pay for through their taxes, when they are in need of them. Right now a million people are on wait lists, many dying and many dying in emergency rooms because of inability to access the services for which they pay.

We put $121 billion a year into health care. All Canadians ask for is when they are sick and when they need it, it be there for them. That is being jeopardized right now. We have not seen anything yet.

The pressure on our health care system has not started. Just give it 10 or 20 years. What will our health care system look like in 2040? We have to change the paradigm. We have to make the patient first and we have to make decisions based on their best interests. We do that by allowing and respecting the jurisdictions of the provinces to deliver on health care. They will be rewarded or they will be victimized on how well they do in this.

Under a publicly funded system, we need competition within that system and there are many ways of doing that such as funding hospitals differently, funding doctors differently, how it is structured, who they contract out and so on. That all has to be part of a system that is strong and healthy. As we move forward, that flexibility has to be there. The health accord allowed for that and that was one reason we had no problem with the accord. We have a bigger problem with a government that has not committed to the health accord.

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1:15 p.m.

NDP

Bev Desjarlais Churchill, MB

Mr. Speaker, I will to allude to the fact that obviously my colleague from Mississauga South has a hard time understanding some the processes within the motion.

Without getting into that, I agree that patients want to be able to access the health service. Does the Conservative member believe that we should have a for profit system of health care delivery? My colleague from Mississauga suggests that when a doctor provides his services, that it is for profit. He is being paid to provide the service.

The for profit comes into play when a clinic operates so that there is a profit overhead apart from the cost of the physician's services or a nurse's services, or whatever. There is profit built into the equation, and the facts show that profit is usually around 15%.

Does my colleague believe that Canadian taxpayers should be paying for a for profit health care delivery?

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1:15 p.m.

Canadian Alliance

Rob Merrifield Yellowhead, AB

Mr. Speaker, all sorts of studies have been done on this issue over the last decade. In fact $243 million has been spent by this Liberal government on studying health care. Mr. Romanow said that 31% of our health care system was private right now, but he did not recommend getting rid of that element of our health care system.

Under the Canada Health Act, those delivery options are available. I hope my colleague is not suggesting that we shut down every medical clinic or doctor's office, because 90% or more of them are privately funded.

If we were to privatize the whole system would that be right or wrong? Certainly nobody is advocating privatizing the whole system. If we were to eliminate those flexibility options, will that save our system? It will not.

We have to stop the rhetoric about the nonsense of who delivers it and instead look at accessibility. Canadians are really concerned about whether the health care system will be there for them in their time of need. That is what we have to concern ourselves with as we move forward into the 21st century. It will take every Canadian, working together, to ensure that there is enough accountability in the system and that their dollars are spent in a way that will achieve those goals. It will tax everyone in the House to drop the politics and start to work in the best interests of Canadians.

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1:20 p.m.

NDP

Bev Desjarlais Churchill, MB

Mr. Speaker, I challenge my colleague's figure of 90% of clinics operating on a for profit basis in Canada. I would love to see those figures because I find them hard to believe.

Can proof be presented that the delivery of health services through private clinics already in place will deliver 14% to 15% less cost to the taxpayer? Let us say the provinces make a decision to provide this through public delivery because it will be cheaper. Will my colleague acknowledge that this is what we should do with taxpayer dollars? Will he agree that we should use that other 14% or 15% to enhance services elsewhere, whether it be to provide more home care, or respite care or other types of health care services? Is that not a better utilization of taxpayer dollars than giving that 14% to 15% to for profit providers?

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1:20 p.m.

Canadian Alliance

Rob Merrifield Yellowhead, AB

Mr. Speaker, the argument there is that it is the provinces that deliver on health care. They will either be rewarded or they will be disciplined by the electorate as to how successful they are in that delivery.

My colleague has asked why 14% or 15% of the profit should come out of taxpayer dollars, but she has not recognized the fact that private operators deliver a lot more efficiency in some ways. Under a single tier system, there has to be enough efficiency and competition so we know we are getting the best bang for the dollar.

That is where this is at. It is provincial jurisdiction. Medically necessary services are provided for Canadians from one end of the country to the other, regardless of their ability to pay. That is what we believe in. How those services are delivered is something with which the provinces will have to wrestle. It is their mandate. We should encourage them to be as aggressive as possible in the best interests of Canadians so services will be there for them.

This is not about delivery options. Can we stretch taxpayer dollars to the point where health services are available to Canadians when they have a serious illness and when they need the service?

Right now we have some serious problems with waiting times for services. Over one million people are on waiting lists. Many of them are beyond the medically acceptable level of wait time. We have a serious problem today, and the stress on the system has not even started yet.

This is not a productive debate with regard to whether we need public or private health services. What we really need to look at is accessibility. How can we ensure that Canadians will have a health care system in place in their time of need?

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1:20 p.m.

Liberal

Paul Szabo Mississauga South, ON

Mr. Speaker, today we are debating health care. I will talk about the motion in a moment, but I want to start by expressing my own view about the measure of success of a country.

Some would argue that it has something to do with economics. I would say the measure of success of a country is the measure of the health and well-being of its people. That is the true measure of success of a country.

The particular motion before us refers to private for profit delivery of health care. As I indicated earlier in my questions, I thought it lacked the clarity that was necessary for the House to really address it. However, the motion has brought us the opportunity to discuss some of the elements of our health care system, some of which is under the purview of the federal government, some of which is under the purview of the provincial government and some of which is the choice of Canadians who may choose to seek uninsured services from a health care provider.

The Canada Health Act has just celebrated its 20th anniversary for medically necessary insured services, and it passed unanimously in the House of Commons. I believe the existence of our publicly funded universal health care system is one of the most unifying elements that Canada has. It is that which we cherish so much, and most will agree that it is the most important asset we have in Canada, in terms of what is identified outside of Canada, is as one of our strongest points.

The health care system is very broad: obviously hospitals, doctors and nurses. However, these days health care for the public at large has been talked about in a much broader context than was ever envisaged or included in the Canada Health Act responsibilities. We now talk about pharmacare, the drug system. We now talk about home care, providing assistance to those who have had medical services and require care in the home for at least a point of time.

We also have dental care. That is a part of health care. Vision care is a part of health care. Psychiatric care is a part of health care. Not all these are included under the umbrella covered in the Canada Health Act. The Canada Health Act is for medically necessary insurance services.

The federal government has no responsibility to provide pharmacare. It has no responsibility to provide dental care. It has no responsibility to provide vision care, except if the need for that service is as a result of another occurrence, for instance, when someone needed dental care because the individual was in an accident. That would be covered. Normal, preventative and routine maintenance of dental care is not covered.

All of a sudden, in listening to the debate today, it is very clear to me that we are talking about health care in a much broader context than simply the responsibilities of the federal government. Having said that, there is no question in my mind that the public at large does not care to hear anything more about which jurisdiction is responsible.

Quite frankly, year after year, regardless of the issue, whether there are dual responsibilities or maybe even spread right down to a third level of government, Canadians do not care who is responsible. All they care about is that it is one taxpayer dollar. With regard to our health care system, all we really care about is that when medically necessary services are needed, they will be there on a reasonable basis and in accordance with the five principles of the Canada Health Act.

Those principles are: universality, which means it is available to all in Canada; accessibility, which means I can get it where I am, taking into account the geographic circumstances and the alternatives that would be necessary to qualify as providing accessible services; comprehensiveness, which means covering the full range of medically necessary services, not just providing a certain part of it in some areas but saying that it has to be comprehensive; portability, which means that regardless of where we live in Canada we would be able to get that service anywhere else in Canada; and finally, public administration, which is what most of this debate has been about in the context of private, for profit health care.

Private, for profit care has been talked about during this debate in two contexts. One has to do with a situation whereby an individual would go to a health care provider and pay for those services. Most Canadians would understand that to be private, for profit health care. It means that I go to a doctor and I want this and I want it now, and I am prepared to pay for it, so I can jump the queue. It might be, for instance, an MRI, magnetic resonance imaging.

There is another context in which private, for profit care has been discussed and I think it is the subtlety of this difference that is the important element of this discussion. This is private, for profit care in the context that the publicly funded system would acquire the services from a private, for profit institution, like a stand-alone clinic. Let us say, for instance, that someone went to the hospital after an auto accident and needed services. Let us say that the person had facial damage and had to have cosmetic surgery. That particular hospital may not have that particular service, so the public system would engage a private cosmetic surgeon. Cosmetic surgery is not an insured service unless it is as a result of, for instance, an accident. That means the health care system pays for it, not the individual.

There are two contexts here. I think it is important to understand that we are really trying to focus on the aspect of where the publicly funded or public administered system of our health care system would rely on services to be provided by those who are outside, who are not full time employees. They are in fact satellites out there that can provide those services for a fee, and there is a profit component. This is what this discussion and this debate have been swirling around. We have to make sure we are clear about the elements of which part we are talking about in terms of private, for profit health care.

Having said that, let me say that I spent almost 10 years on the board of the hospital in my own community. I learned a fair bit about the health care system. I have the ultimate respect for the primary care givers: the doctors and the nurses. These professions are extraordinary, and there are extraordinary credentials and extraordinary criteria, codes of ethics and guidelines for them.

In my own hospital in the 10 years I was on the board, the average length of stay of a patient in the hospital went down from about 7.2 days to about 4.7 days. That is a dramatic drop in the average length of stay. The reason it happened was that the health system is in its evolution, with the new technology, the new medicines, and the shift to an ambulatory system. One does not go to the hospital and prepare for a couple of days for surgery, have that surgery and recuperate for a couple of days. Now one can walk in and get same-day surgery and go home and recuperate there. It has totally changed the model of how health care is delivered.

I have a fundamental problem, though, with an ambulatory system. It is less invasive because of the technology, but what it does mean for people who are in the hospital and stay there for two or three or four days is that during that period of time when they have drugs required as a consequence of their surgery or their treatment, the cost of those drugs is covered by the publicly administered health care system. However, if one goes for ambulatory care treatment and it is day surgery, the cost of drugs required as a consequence of that surgery would be one's own cost. They would not be covered by the publicly administered health care system.

So now we have two situations. The hospital saves money and in fact closes beds, and indeed, in this particular hospital it went down from 650 to 400 beds, but it still could claim that it serviced more people with less beds because it was having a lot of day surgery. So suddenly not only were we downloading the cost of drugs to people, we were also downloading the recuperative care to families and to home care. That home care is not covered under medically necessary and insured services. That is provincial. The existence of home care and the extent to which it is provided is a provincial decision. It is not covered under medically necessary insured services under the Canada Health Act. Thus, over time, things have changed on what our view of health care is. It is much different today from what it was 20 years ago when the Canada Health Act came in.

In this morning's National Post there is what I think is a very good article written by Ms. Jane Brody on women and reproduction. It is an excellent piece. One of the things commented on is the fact that societally women are waiting a little longer before they have their families. It states, “Biologically speaking, the ideal age at which to have a baby is between 18 and 20”.

We know that is not happening very often now. In fact, people are waiting until their thirties before they have children. But the article also goes on to say that older women are more likely to suffer pregnancy complications: genetic abnormalities are more common in their fetuses and the miscarriage rate rises as the fertility rate falls.

Here is an example of how even societally how we live our lives is in fact changing the demands on our health care system. We have decided that we are going to wait longer to get married and longer to have children. As a consequence, however, it means that the costs to the health care system are also increasing, so there are other dynamics.

The point is that for the health care system as it was discussed and debated 20 years ago this past April 17--and in Parliament the Canada Health Act was passed unanimously--it was talking about hospitals and doctors and about what was medically necessary.

Today, “medically necessary” is not a defined term in the Canada Health Act, and it should be. We should define it. I would even refer it to the Standing Committee on Health. Let us talk and let us have some experts come and talk about what is medically necessary. As many of the people who have participated in this debate have already said, health care to them is what the people think health care is. Health care is not just the doctors, nurses and hospitals. Health care is community clinics. Health care is pharmacare and home care. It is the health and well-being of the person, the whole thing.

When we consider that we now get pharmacare, dental care and vision care, we suddenly are talking about a much different health care system and health care need that Canadians have focused on than what Parliament was talking about some 20 years ago.

When I was elected for the first time, in 1993, one of the first major tasks the government initiated was the National Forum on Health. It engaged some of the top medical professionals and administrators from right across the country. It spent two years studying our health care system. It provided interim reports and had consultations with Canadians. I can remember the booklets we had. I can remember the interim reports and the final report.

If members will hearken back to that period, the National Forum on Health concluded that there was enough money in the health care system. The problem was that we were not spending it wisely. That was the principal conclusion of the National Forum on Health, an independent public consultation with all of the expertise that was available. It concluded that there was enough money in the system.

We have now had another round with the Romanow commission. It consulted again all across Canada. Suddenly Mr. Romanow did a favour for us, I think, by telling us that we have to start thinking about our health care system in much broader terms than we contemplated back 20 years ago. We have to start talking about the health and well-being of Canadians in terms of what they need so that their health and well-being can be rated “high”. Because the higher the rating of the health and well-being of people, it is the measure of success of a country.

We have not yet finished the debate. I think that members would agree that pharmacare is a very important element, but drug costs now, in terms of the cost of medical services or medical expenses, are equal to what we spend on doctors. This is the result of change in the cost of medications.

This is not to say that on a blanket basis the pharmaceutical industry is somehow taking advantage of the health care system. The technology has changed. The drugs have changed. People are living longer. We only have to look at the average life expectancy of people these days. There is a significant increase in the length of our lives.

Members should also know this, which is one of the first things I remember from when the officials from the health department came before us back in 1993, at the first committee meeting I ever went to. The officials said that we spend 75% of our health care dollars fixing problems and only 25% preventing them. They said that this model we had back in 1993 was unsustainable. They also said that a dollar spent on prevention was far more productive than a dollar spent on curative or remedial health care spending.

So things have changed, Mr. Speaker. Things have changed dramatically in the health care system. Parliamentarians, with a motivation that I hope is beyond the political, are now seized with an opportunity to talk about what the people need. I think there is agreement that our health care system should be there for us when we need it, not because we can afford to pay.

One of the facts we in the health committee also found out early in my career was that about 75% of the health care costs in a person's lifetime will be incurred in the last two years of a person's life. Let us imagine that: 75% of the health care costs in our lifetime are spent in the last two years of our lives.

Why would that be? The reason is that we are talking about more life-threatening types of situations as we age. This means that the types of interventions, the specialists, the more expensive drugs and the equipment are all some of the most sophisticated equipment possible. It means that the resource intensity that is being used for life threatening situations goes up. That is why the health care cost is so high at the end.

We can all imagine that we have a system where we are now faced not only with defining what health care is and what is medically necessary, but we are also looking at an aging society and what demands that will make. The urgency is now.

I will conclude with what I believe is a fair assessment of my position on for profit health care delivery. To the extent that private for profit health care exists, the public health care system must be disadvantaged. The reason is not because of costs. It is because we are taking resources out of the public health care system and feeding the human resources into a private system. That means that the public system must be diminished. In my view, private for profit health care should not be an option in Canada.

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1:40 p.m.

NDP

Bev Desjarlais Churchill, MB

Mr. Speaker, it would be great if the government as a whole would make that statement and put some effort into ensuring that private for profit does not become the battle cry of the next election between the two parties.

My colleague mentioned a number of things. I just want to clarify some of those things with him.

He mentioned that the Canada Health Act did not envision all the things we are dealing with today within the health care system. That is absolutely true. I do not think people envisioned the rate of increase in new technologies and the increased costs being incurred by patients and the health care system. That is why we in the New Democratic Party have no problem looking into the Canada Health Act again and ensuring that it now addresses what Canadians see as their wish for a health care system.

The Liberals have in the past acknowledge that and promised in their last red book to implement pharmacare but here it is, seven years later, and we still do not have pharmacare. The Conservatives say that they will stand behind providing a pharmacare program. I am sure the Liberals will come out saying that as well but the reality is that it is not here.

My colleague also mentioned that some services would not be covered unless one was in an accident. I think this is the same in all provinces, but certainly within the province of Manitoba if there is an accident, whether it is a car accident or a work related accident, which is workman's compensation, it is a third party billing process through the health care system. These should not be dollars coming out of the health care system but as a third party liability.

However those costs often do get incurred by the health care system when, by rights, they should be handled by different service providers. That is already in place. I firmly believe that if it is a workplace injury it should be covered under workman's compensation.

I also want to comment on the fact that there is a schedule of payment for services, certainly within the province of Manitoba, and I would think the same in other provinces, where there is a maximum amount that can be paid for a particular service that a doctor performs.

If it is necessary to change the Canada Health Act to reflect the changing needs within the health care system so there is no longer the need for long hospital stays, as he said, and to provide medications when a person leaves, should we not be addressing those changes and including them within the health care system?

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1:45 p.m.

Liberal

Paul Szabo Mississauga South, ON

Mr. Speaker, to amend the Canada Health Act in order to put in the wishes of Canadians, as the member pointed out, theoretically we would have to take all the health care delivery services provided by the provinces and put them under federal jurisdiction. I would think that will probably not happen.

When the member commented on private for profit delivery versus a publicly administered system, she indicated that the public health system was more cost efficient. I want to repeat why I believe we should not have private health care. It is not so much that there are cost efficiencies. The issue is that to the extent that there is private for profit health care delivery out there, almost two tiered or semi-tiered, that means that real resources, like doctors, nurses and the best specialists, will be taken out of the public system. Therefore, if the resources available, the doctors, nurses and other resources, stay the same that means that the public system is losing real resources and probably some of the best resources available to the public system. That is the reason I oppose private for profit health care delivery.

By the same token though, there is a debate going on that if our only alternative, for instance in terms of having a hospital, is to enter into a P3 arrangement, a public-private partnership, do we want a hospital or no hospital? If there is no money, would it not be better to lever or co-finance the hospital for the community than to have no hospital at all? The services still have to be delivered at the best available price. In some cases, I think there is probably a good case where hospitals, even in a P3 partnership, would probably be more cost efficient than a publicly administered system that has to go out and borrow the money.