Madam Speaker, I am pleased to rise today to speak to the Reform Party motion concerning our health system. This motion provides for the compilation of a list of health care services considered as essential, to be fully funded by the federal and provincial governments, and a list of so-called non-core services, funded by private insurance and some form of user fee.
Naturally, we are against this motion for reasons that I will explain in my remarks. For one thing, the first part of the motion reads:
That this House recognize that since the inception of our National Health Care System the federal share of funding for health care in Canada has fallen from 50 per cent to 23 per cent-
While recognizing readily the federal government has reneged on its commitment, we feel that what should be denounced is the fact that the provinces were never compensated for this, and therefore saw their tax burden increase.
In fact, the federal government's unilateral approach to maintaining its status as a partner in the Canadian medicare scheme is far from making all the provinces happy. The provincial health ministers do not agree either on how to prevent the Canadian medicare scheme from being affected by reductions in services and in federal transfer payments.
As reported by Jean-Robert Sansfaçon in Le Devoir on April 13, the Minister of Health candidly explained, by paying a simple lump sum, the Canada social transfer, instead of making several different and progressively smaller payments for health, education and social assistance, Ottawa will be able to maintain a level of control that could otherwise elude it because of its reduced contribution. As clever as it may be, the reporter added, the Prime Minister's strategy is nonetheless grossly unfair.
Ottawa plans to reduce transfer payments to the provinces by $7 billion over three years starting in 1996-97. In Quebec, these cuts will jeopardize the health care system. During the health ministers' conference held in Vancouver, the Minister of Health, Mr. Rochon, released a study from his department indicating that Quebec, which is already experiencing an $8 billion shortfall, the equivalent of the annual budget for the Quebec health services network, following the changes made to health transfers since 1982-83, will be deprived of a further $2.4 billion in federal moneys, between now and 1997-98.
As pointed out by the hon. member for Drummond, who is celebrating her birthday today and to whom we wish all the best, the federal contribution is decreasing, having dropped from roughly 45.9 per cent of Quebec's health expenditures in 1977-78 to 33.7 per cent in 1994-95. It can therefore be estimated that, for Quebec, the most recent cuts in established programs financing will result in a reduction of some 10.6 per cent of the federal contribution to health expenditures.
This is typical of the federal government. It unilaterally decides to withdraw from a sector which, in any case, does not fall under its jurisdiction, without giving the provinces the appropriate financial compensation for this withdrawal. The Prime Minister said that this was an excellent system and that the government wants to maintain it. Why then withdraw from it if the system is so good?
The fact is that, once again, the provinces will have to maintain this excellent health care program, but without federal support. So, after imposing, back in 1984, the five great principles of the Canada Health Act, the federal government is now unilaterally and implacably withdrawing its financial support, while keeping the power to impose national standards.
Let me remind you of those principles. There is first of all the matter of comprehensiveness; this means that all health services provided by hospitals, medical practitioners and dentists must be insured. Two, universality means that all the people covered by the provincial plan should have access to all insured health services. Three, portability means that coverage of provincial plans is transferable from one province to another, and that health care services are also provided to insured persons who are temporarily out of their home province. Four, accessibility means that provincial plans must provide services on uniform terms and conditions, which means that billing is prohibited. As for public administration, it means that the health insurance plan must be administered on a non-profit basis by a public authority designated by the provincial government.
In Quebec we have no trouble with the five criteria. As far as we are concerned, they represent a minimum consensus. But what does the federal government have in mind, especially when we hear the Minister of Health spouting her earnest rhetoric as the great defender of the integrity of the Canadian medicare system? The cuts introduced unilaterally in the federal budget are draconian.
Perhaps I may quote from a presentation by the Minister of Health before the Senate Committee on euthanasia and assisted suicide, in which she referred to palliative care.
The minister said: "I want to touch on 10 areas requiring attention if the individual who is the focus of my concern is to be provided with high quality care at the end of life. First, we need better diagnosis and prognosis. We need provider training. It is essential. We need fully developed teams of providers, ranking from physicians and volunteer support networks to dealing with problems of the end of life. We may even need to develop new specialties in this area".
She went on to say: "Research into pain control and management should be a priority. We need to know more about comfort and the supports that focus on time of administration of drugs and dosages. We must introduce support networks for patients and their caregivers". Finally, and this is perhaps the best part of the speech:
"We need institutional development. There are not enough palliative care centres, especially outside of major urban areas. We need centres to coordinate community and home care, staffed with professionals with a sense of outreach and mobile forms of delivery".
Not only does the federal government take it upon itself to establish criteria, it also assumes the right to set priorities in areas that come under provincial jurisdiction, and now the Minister of Health, in response to the serious concerns she formulated, is going to cut transfer payments to the provinces. Is she doing the actual cutting? No. She is just taking orders from the Minister of Finance.
In other words, Canada's health care system is adrift, and although in Quebec there is still a very broad consensus in favour of the main criteria of the Canada Health Act, we understand why the Reform Party is suggesting ways to make the system more efficient because, in the end, the debate is about these main criteria. Will we keep doing what we are doing now, which means making cuts in all services, something the Quebec Minister of Health is forced to do because of federal cutbacks, or should we de-insure certain services? I think our Reform Party friends did well to raise this matter in the House.
The government has initiated major changes in health care funding, and we have to look beyond the rhetoric of the Minister of Health. In a speech to the Hospital Association on March 17, 1995, the Minister of Health once again recalled certain aspects of the system: "There is nothing in the budget that changes our technical capability to enforce the criteria of the Canada Health Act. The mechanism itself remains unchanged. If deductions must be made from transfer payments, deductions will be made either from the monetary portion of the new Canada Social Transfer or, if necessary, from other monetary transfers".
This is the so-called big stick. However, later on in her speech, the minister herself opened the door to a two-tier system. She said: "On the other hand, we must be reasonable. The government and I are not going to ask the provinces to cover services like plastic surgery. In practice, we must allow the provinces some flexibility in identifying the range of insured services. However", she admitted, "we must realize that, by excluding certain medical services from medicare, we open the door to the privatization of coverage of health care services and to a lessening of our ability to control costs".
Later, she alluded to her guilt, saying that as a politician-and I agree with her, that is essentially what she is in this case-she has to respect the wishes of Canadians, and Canadians are sending the government a clear message that they want the principles in the Canada Health Act to be upheld.
They are strangling the provinces, but are doing it under the pretence of self-professed good intentions. However, as Saskatchewan's Minister of Health, Lorne Calvert, said:
"We are asking, if the federal government unilaterally withdraws more and more from funding to regions, how do they plan to maintain the integrity of the system?"
Despite the many opportunities she has had this morning, the minister still has not answered this question. The federal government's share of health care funding is currently sitting at around 23 per cent and we are willing to bet that it will shrink even more. The net figure for health care, social assistance and education transfers from the federal government is $29.7 billion for 1995-96. This will drop to $26.9 billion in 1996-97, then to $25.1 million in 1997-98. And the minister admitted in her recent speech to the Canadian Hospital Association that a portion of this is for health, but she did not break it down.
In perhaps an attempt to justify the scope of the cuts, the Prime Minister pointed out that the United States spends 15 per cent of its GDP on health; Europe, 8 per cent, and Canada, 10 per cent. So, he asked in an interview on CBC's "Morningside" why Canada would not be able to do it, for example, with only nine per cent of GDP?
Does the Prime Minister not know that the Americans have private health care and that close to 40 million of them have no health care coverage whatsoever? Does he also not know that the
American government's attempt to implement a public health care system is meeting with strong opposition from the private sector?
I do not know if the government even realizes that, by implementing such cuts, it is imperilling its own system. The Prime Minister himself, by his statements on essential services, is actually helping along the demise of the current system and is paving the way for a two-tiered system.
Basically, this seeming desire to rationalize health care costs is expressed in freezes and reductions in transfer payments-and I would remind the minister that reference was made in the same speech to an annual increase in health care costs of approximately two per cent. These freezes and reductions in transfer payments conceal the governments real intention, which is to reduce the deficit on the backs of the provinces.
So, how can the government still claim it is legitimately justified in imposing standards and dictating policy on the management and operation of the provincial health care schemes? The government is passing itself off to the provinces as upholding the law and wants to consult them to find out how they should tighten their belts to cut costs and health services while meeting federal standards.
I would point out that, in this context, the consultation was between the federal Minister of Finance and the provincial finance ministers. Then, once everything was all wrapped up, the federal Minister of Health and her provincial counterparts were casually told that they would have streamline their systems.
The forum on health is surely another example of lack of respect for the provinces. Minister Rochon has already reiterated Quebec's opposition to the forum, another indication of the government's intransigence with the provinces.
I would also recall a statement made by the former Quebec Minister of Health, who is now the Minister of Labour in the federal government and who is curiously absent from the debate today. When she was Quebec's Minister of Health, she described the government's behaviour in connection with the forum on health as absurd. She went on to ask how the government could imagine reviewing the health care system without the participation of the provinces, which are responsible for delivery of services. She felt it was simply out of the question.
In the case of the Minister of Labour, we could say that customs change with time and speeches change with the level of government.
Under the 1867 Constitution Act, the provinces have full and exclusive jurisdiction over health care. The federal government's costly interference in this area, notably through program duplication, was based on its constitutional power to spend.
The federal government maintains that its involvement in health care is justified by the fact that the implementation and maintenance of medicare is a paramount issue of national interest and part of the rights and benefits associated with Canadian citizenship. Because of its debt, the federal government is withdrawing financially while still upholding the national interest and keeping the powers it gave itself.
According to Minister Rochon, the real solution would be for the federal government to withdraw completely from health care and transfer the tax points belonging to Quebec and, I would add, to each of the provinces.
The second part of the motion reads as follows:
-therefore the House urges the government to consult with the provinces and other stakeholders to determine core services to be completely funded by the federal and provincial governments. . .
Several members of this House, both on the government side and on the side of our friends from the Reform Party, have mentioned exceptions, examples of programs or treatments covered by special agreements.
I would also like to remind the House of the importance given in Quebec to the five fundamental principles of health care, which were the subject of major debate during the election campaign. As you will recall, the former Liberal provincial government, of which the new federal Minister of Labour was a member, wanted to eliminate the newsletter Malade sur pied , which lists the drugs that are covered or available. It also wanted to charge $20 in user fees for chemotherapy treatments for cancer patients. This directive provoked an outcry in Quebec. As a result, the Liberals quickly suspended it and the new government wasted no time in cancelling it.
We cannot eliminate all user fees. I know that Quebec charges user fees for some services, but the cuts imposed by the federal government force us to make unconscionable decisions, and I think that the federal government must take the blame for the health care cuts in each of the provinces.
The Quebec government is also considering the feasibility of introducing a basic universal drug plan that would benefit not only welfare recipients and seniors but the entire population and cover all new drugs and treatments for diseases such as AIDS and cancer.
In this regard, Quebec is still striving to ensure universal access. By supporting these measures, we in the Bloc Quebecois are telling the federal government that, if it cannot enforce these principles we care about, it should give us our tax points and we will deal with the matter. However, the federal government should not tell the provinces what they should do-and not in health care matters, in my opinion. As far as the other provinces are concerned, if a western province wants to take a different approach, it should be allowed to do so, provided it continues to
negotiate with all the other provinces. The issue of portability can be settled with or without the federal government, so that Albertans can be treated in Quebec and vice versa.
I think that the federal government must bear the greatest blame in this area.
In closing, I would like to remind you that we will oppose this motion, although we wish to commend the Reform Party for raising this issue in the House.
