Mr. Speaker, in 1984 the members of this House unanimously adopted the Canada Health Act. It was a particularly noteworthy event for two specific reasons. This legislation guaranteed quality health services to all Canadians, regardless of their income or their place of residence.
Furthermore, this piece of legislation was adopted unanimously by the members of all the parties. Everyone felt a national health insurance scheme was invaluable.
This government's commitment to universal health care remains unshaken. The Canada Health Act and the system we have built under its framework is a defining feature for our society. The essence of medicare is not to be found in the mysteries of a funding formula. It is certainly not to be found simply in the amount of money we spend. Rather, it is to be found in providing quality health care equally to all Canadians.
The five main principles underlying the Canada Health Act are: universality, accessibility, comprehensiveness, portability and public administration. They are rooted in values of fairness, social justice, compassion and respect for human dignity. These values are shared by all Canadians. They are part of our social fabric.
Some claim that our health insurance system is too costly and that we can no longer afford the luxury of a government funded system. On the contrary, I believe that our health insurance system is no luxury but a necessity and that public financing of this system helps keep health care costs under control.
In investing in health in general and in health care services, our government is helping to keep Canadians healthy and fit. They will be able to meet the economic challenges of the 21st century. Studies indicate that many days of work are lost to illness or accident. They all reach the same conclusion: these days lost have a negative effect on workers, society and the economy.
A health care system that Canadians can access without fear of financial hardship encourages people to seek medically necessary treatment before an illness or injury becomes life threatening or debilitating. Early diagnosis and treatment are far less expensive than chronic care, both to the individual and to the system. Such a system does not encourage patients to seek inappropriate care.
For those who think in terms of the bottom line, the principles of the Canada Health Act support an economically efficient health care system. These are economies of scale obtained from governments being the only buyers of medically necessary hospital and physician health care services and of the entire population being the customer base. A system that is publicly administered saves this country billions of dollars annually in administrative overhead. In hospitals and in clinics this frees up the resources in time to practise medicine, not administration.
Finally, medicare produces a healthy population, which in turn means a healthy and productive labour force. This is a reciprocal relationship between business and the health sector. A healthy business sector means economic growth. Economic growth means jobs. Jobs reduce unemployment, and less unemployment means a healthier population and reduced health costs. In other words, a healthy Canada is a wealthy Canada.
The fact that the Canada Health Act is both to flexible and too rigid was also deplored. Yet, according to the Canadian constitution, it is up to the provinces and territories to provide and administer health care services. Consequently, the provinces and territories must identify their own priorities and manage their resources.
Under the act, the provinces and territories must provide the required medical and hospital services. However, nothing prevents them from providing other types of services. This means that a province may pay for the costs of prescription drugs or dental care for children, while another may finance air ambulance services.
As long as it abides by the five basic principles underlying the Canada Health Act, each provincial or territorial government is free to provide additional services at its own cost, or experiment with different structures. The basic criteria governing federal financing under the Canada Health Act are the five principles previously mentioned. The government is not prepared to compromise on these principles.
The basic criteria for federal funding under the Canada Health Act are the five principles mentioned earlier. It is these that the government is not willing to negotiate.
The first principle is universality, meaning that all residents of a province must be insured under the provincial health plan if it is to receive federal support. We as Canadians believe we must all have access to medically necessary services. People cannot be deinsured because they might be costly for the system to cover. They cannot be turned away at the hospital door because, for example, they have not paid their quarterly tax bill or even their provincial premium. Any one of us needing health care will be treated the same as everyone else. This is what is meant by equity.
Accessibility on uniform terms and conditions is the second principle. We should not face any financial barriers in receiving health care, no extra billing, no user charges, no facility fees, no upfront cash payments. If the service is medically necessary, we
will get it at the time defined by medical consideration and not by money.
The principle of comprehensiveness is a recognition that Canadians have a number of needs which must be met. It would be unfair to insure only certain medical services. We will continue to contend that the provinces and territories must insure all medically necessary services.
However, comprehensiveness does not mean uniformity. It does not mean that the provinces and territories must all meet health care needs in exactly the same fashion. These needs must be met, but there is some flexibility as to how this can be achieved.
Portability means that Canadians are always covered by medicare when they travel or move within Canada. This is what gives our health care system its national dimension.
Canadians enjoy the freedom to work and travel anywhere in the country, without fear of losing their health insurance coverage. Each separate health insurance plan may be provincial in origin but is recognized nationally in every province across the country.
The fifth and final principle is public administration. Our health insurance plans must be operated by provincial governments on a non-profit basis. It is at the core of our ability to contain costs in a system and thus to deliver quality care at an affordable price.
Public administration is the key to ensuring all the other principles. When health insurance is operated and funded by the government, we can guarantee that health care is universal, accessible, comprehensive and portable because we have direct control over it. Public administration not only ensures that more of our health care dollars go toward patient care but it also makes governments more successful than the private sector in keeping health care costs under control.
In 1993 we spent about $72 billion on health care. This represents 10 per cent of our gross domestic product. The public component of that 10 per cent has been growing at less than 2 per cent. Compare that to private health spending which has been growing at 6.4 per cent.
However, complying with the provisions of the Canada Health Act does not prevent the provinces and territories from adopting innovative strategies to meet the challenges in providing health care services.
For example, British Columbia has set up emergency response teams, New Brunswick has established an extramural hospital and Quebec has achieved excellent results with its local community health centres. All these initiatives have solved different problems and demonstrate how flexible the legislation is.
The Minister of Health even recognized that private clinics offering medically necessary services can be an effective way to give such services, provided that the medically necessary services are fully covered by provincial or territorial health plans. What is totally unacceptable is, first, physicians extra-billing for services already covered by provincial or territorial health plans and, second, charging user fees for medically necessary services covered by provincial or territorial health plans.
In this era of fiscal restraint, Canadians want value for money. We pay for our health system collectively through our taxes. We all pay so that everyone can benefit according to need. There are altruistic human reasons and hard economic arguments for doing so. Whichever we support, the system works to our benefit. This government is committed to preserving the Canada Health Act because in spite of what its critics may say, it works.
For many of us, health care insurance is an essential part of the Canadian identity. We belong to a nation where all citizens are equal. Anyone in Canada can rely on reasonable access to health care services, not on the basis of wealth but according to need. Every Canadian can rest assured, now and in the future, that he or she will not be ruined financially by a serious illness. The Canadian health care system has no equal in the world. Treatment priorities are set in light of medically necessary services and not according to the patient's wealth.
The Canadian government takes very seriously its role as a defender of universal health care. The Minister of Health has expressed her strong opposition to facility fees, extra-billing and any other sign of a two-tier health care system. Canadians have entrusted their government with protecting their health care system. As the Prime Minister has repeatedly said, this government intends to show that it is worthy of this trust.