Debates of Nov. 2nd, 1995

Points Of Order

[Some hon. members]

Hear, hear.

[The Speaker]

My colleagues, it is not for your Speaker to judge that which is or is not erroneous in the statements made in the course of debate or question and answer period.

With all respect to my hon. colleague, the Reform whip, I would say that what he has said could be a point of debate, surely. If he does not agree with this statement, we go through this every day in here.

My decision is that it is not a point of order. I will hear a point of order from the hon. member for Calgary Centre.

[Jim Silye, Reform, Calgary Centre, AB]

Mr. Speaker, in light of what you had to do today in naming two members, does it mean that because the numbers have changed that we are now the official opposition?

[Some hon. members]

Oh, oh.

[Randy White, Reform, Fraser Valley West, BC]

We want the money.

[The Speaker]

That might be a point of clarification, but it is not a point of order.

Privilege

[Ted White, Reform, North Vancouver, BC]

Mr. Speaker, tone of voice in this place can be as important as what is actually said. During question period the Deputy Prime Minister, in answer to a question from the member for Beaver River, said that 51 Reform MPs were too busy doing other things to attend the Montreal rally.

The tone of voice used by the Deputy Prime Minister imputed motive and inferred that-

[Some hon. members]

Oh, oh.

[The Speaker]

We will have the Thursday question in a moment. I want to give my response here.

Colleagues, it is true that not only words may be offensive in this House, indeed unparliamentary. It is true that the tone of an answer might also cause your Speaker to say that such and such a statement is unparliamentary.

I was listening very closely to the debate. Although many statements today were offensive to one side or the other, in my view as far as the decorum of this House and the conducting of the question period are concerned, they were within the area of acceptability.

With regard to that particular point of privilege, I would rule it was not a point of privilege.

Business Of The House

[Michel Gauthier, Bloc, Roberval, QC]

Mr. Speaker, I rise, not on a point of order, but to ask the Thursday question. I would like our colleague to tell us what is on the legislative agenda.

[The Speaker]

The hon. solicitor general.

[Herb Gray, Liberal, Leader of the Government in the House of Commons and Solicitor General of Canada]

Mr. Speaker, I am speaking today as government House leader.

[The Speaker]

You will forgive me, you look the same. The hon. government House leader.

[Herb Gray, Liberal, Windsor West, ON]

Mr. Speaker, I want the record of the House to show I am speaking in a calm, measured tone of voice with no intention of sarcasm or innuendo.

[Some hon. members]

Oh, oh.

[Herb Gray, Liberal, Windsor West, ON]

It is our intention to continue with the list of items already being considered by the House today. I am referring to second reading of Bill C-95, the reorganization of the Department of Health; third reading of Bill C-94 relating to fuel additives; second reading of Bill C-96, the human resources development department reorganization, and report stage and third reading of Bill C-52, the Department of Public Works and Government Services reorganization.

Tomorrow we would like to deal with Bill C-108, the National Housing Act amendments. We would then resume the list I have just read out.

Finally, we will be in ongoing consultations with the opposition parties about the scheduling of other business, including opposition days.

[Ray Speaker, Reform, Lethbridge]

Mr. Speaker, may I put a question to the government House leader? My colleagues and I are deeply concerned about the government's fall agenda.

The facts, as I look at them, in the last 46 or 47 days are as follows. Just four new bills have been introduced in this House, no aging paper has been presented, no UI legislation has been tabled. There has been a refusal to call bills which the separatists object to. Twelve of nineteen bills were such-

[The Speaker]

I would take it this has to do with House business. With all respect, I would ask the House leader of the Reform Party to please put his question.

[Ray Speaker, Reform, Lethbridge]

Mr. Speaker, I will do that.

I plead with the government House leader to commit this House to a serious legislative agenda before the end of this fall session and I would like to know what it is.

At this point in time we have had no indication of any kind of serious legislation; not even the voice of intent, never mind something in concrete form.

[Herb Gray, Liberal, Windsor West, ON]

Mr. Speaker, when we resumed the session I said we had some 30 measures waiting on the Order Paper from the end of the session in June for debate. I said that we would be proceeding in an orderly fashion with those measures as a priority.

I do not know why our colleagues think we should have scrapped all those measures. I thought they wanted a measure to tighten up the parole and correction system, Bill C-45. Now they are on record as opposing that. I thought they wanted a measure to have a better witness protection system, Bill C-58. Now they are on record as opposing that.

Now that we have dealt with a bill to create an environmental auditor general, they are in effect saying that was not worth while. Now that we are dealing with measures on dangerous fuel additives, they are saying they did not want those measures to be debated. Now that we have debated a measure to update our transportation regulations, the Reform Party is saying that was not worth while.

I will conclude my remarks without your saying anything,Mr. Speaker. I can see your face; a tone of voice is not necessary. On each and every one of the measures they participated in the debate. They put down amendments. They called for votes. By their actions they are saying the House leader for the Reform Party simply does not know what he is talking about.

The House resumed consideration of the motion.

Department Of Health Act

[Pauline Picard, Bloc, Drummond, QC]

Mr. Speaker, could you tell me how much time I have left?

[The Speaker]

You have 27 minutes.

[Pauline Picard, Bloc, Drummond, QC]

Mr. Speaker, it is difficult to begin to debate a bill and be interrupted by question period, but I will nevertheless summarize a bit what I said and then to on.

We are debating an act to establish the Department of Health and to amend and repeal certain Acts. I had said that, in fact, the bill was aimed at replacing the name of the Department of Health and Welfare by the shortened title of Department of Health.

Generally, not a lot of sections have changed, but in reading this bill, we realize that certain sections have been changed, repealed or added, only some. In some cases we see that the government, as a good government, is once again legitimizing its authority and is giving the Minister of Health authority to intervene yet again in areas that are under exclusive provincial jurisdiction.

I gave a brief history and I am going to summarize what I said to conclude with the clauses I mentioned earlier, which provide the powers of the minister, who may intervene in areas of provincial jurisdiction.

Under section 92(7.16) of the Constitution Act, 1867, and according to the courts, the sectors of health and social services are exclusively under the jurisdiction of Quebec and the other provinces. Since as far back as 1919, Ottawa has been getting increasingly involved in these sectors, forcing Quebec even here to comply with so called national standards and objectives.

As far as we are concerned, federal initiatives in the area of health and welfare, except for those dealing specifically with certain groups of people-members of the Canadian Forces, sailors, Indians, immigrants and prisoners-have no clear constitutional basis. They depend entirely on the federal government's spending power, which allows it to take many more major initiatives.

In 1919, the Department of Health was created and the first subsidies granted. In 1948, the national health subsidy program was introduced. In 1957, the Hospital Insurance and Diagnostic Services Act was passed by Parliament. The Medical Care Act was

passed in 1966, and the Canada Health Act, known as Bill C-6, in 1984. The Canada Health Act replacing the 1957 and 1966 laws set national standards and imposed requirements limiting the autonomy of Quebec and the provinces. Bill C-6 set out provincial obligations: universality, accessibility, interprovincial portability, public administration, and comprehensiveness. Failure to meet these criteria may lead the federal government to withhold transfer payments to the provinces for health care.

As early as 1926, Quebec denounced the federal government's interference in the area of health, and the reservations then expressed by the Taschereau government were reiterated by every succeeding administration. Health Canada has become so big that its 1995-96 estimates set aside $1.5 billion for operating expenditures-$347 million for personnel costs and $703 million for goods and services-and $6.9 billion for transfer payments. However, this contribution to the provinces, which is, as I was saying, subject to compliance with national standards, does not prevent the federal government from going ahead with its own health and welfare initiatives, as shown by the list I just gave you on the subject of duplication.

The 1991 national strategy for the integration of persons with disabilities, with a budget of $46 million over five years; the 1991 federal initiative against violence, with a budget of $136 million over four years; the new horizons program; the seniors secretariat; the national strategy to reduce tobacco use; the national drug strategy; the national AIDS strategy; the pregnancy and child development program; the children's bureau, the national forum on health. All these initiatives directly encroach on existing programs. Such cases of overlap and duplication cost a lot of money.

I would now like to make a few comments on the government's red book commitment with respect to the national forum on health. With respect to health, the federal government does not intend to cut any slack to the provinces, as promised in the fall 1993 election campaign, when its intention to hold a national forum on health, if it was elected, was made public.

The federal health minister made no secret of Ottawa's centralizing designs. During its election campaign, the Liberal Party of Canada released a document entitled "Creating Opportunity: The Liberal Plan for Canada", better known as the red book. Reference is made in this book to being committed to holding a national forum on health, and the way this commitment is worded hardly conceals the federal government's desire to take control over health care in Canada. Let me read you what it says. "The role of the federal government should include the mobilization of effort to bring together Canada's wealth of talent and knowledge in the health care field." If that is not the expression of a will to centralize, I do not know what is. "This is a societal issue in which every Canadian has an interest. The federal government must provide the means to ensure that Canadians are involved and informed, and can understand the issues and the options."

On june 29, 1994, despite the objections of the provinces, the federal health minister announced the creation of this forum. To date, four work sessions have been held, and not one province is represented at this forum. The forum's mandate is to develop a vision of what the Canadian health care system will be in the 21st century; foster dialogue with Canadians concerning their health care system to ensure that, while respecting the general principles of the system and preserving its benefits, the renewal process under way will make the system better and lead to greater public health; establish priorities for the future and bring about a wider consensus on the changes that are required.

Following the invitation sent by the federal health minister,Mr. Rochon, Quebec's minister of health and social services, gave the following reasons, in a letter dated October 14, 1994, to explain why the Quebec government would not participate.

The mandate of this forum is an encroachment by the federal government in a field which essentially falls under provincial jurisdiction, and that is unacceptable. The clearly stated objective of your government, which is to give the forum a mandate to define future priorities, in the context of health care reform, and to define the means to that end, is a direct intrusion in provincial governments' affairs. This is something that cannot be hidden behind the consultative nature you ascribe to the recommendations that would come out of this forum.

That was the Quebec health minister's response to his federal counterpart.

Quebec's health minister also pointed out that Quebec had not waited for the presumed leadership of the federal government to undertake a reform, adding that important concrete measures had been taken, that an extensive public hearing process had enabled Quebecers to state their views and their needs, thus fostering a joint effort to define priorities and means of action, and that, in recent years, the federal government had made major cuts in its transfers to the provinces.

What we have here is yet another measure which demonstrates the federal government's intention to get involved in the health sector. Indeed, Bill C-95 includes provisions which clearly give the health minister a legitimate power to interfere, yet again, in fields of provincial jurisdiction.

If we look at these clauses, far from acting in good faith by withdrawing from this area that does not come under its jurisdiction, the federal government has every opportunity to gradually take over areas of provincial jurisdiction when it is in its interest. I am not saying that this is a major bill; it has been portrayed as harmless and inconsequential, but the reality is far different.

Subclause 4(1) of Bill C-95 sets out the powers, duties and functions of the Minister of Health. It proposes that the minister's powers extend to "all matters over which Parliament has jurisdiction relating to the promotion and preservation of the health of the people of Canada".

The Department of National Health and Welfare Act contained a similar provision. Parliament's jurisdiction over public health could cause confusion. This provision should be more specific.

The following clauses are more subtle. Subclause 4(2) lists the health minister's powers, duties and functions, including "the promotion and preservation of the physical, mental and social well-being of the people of Canada".

This provision would give the federal government the authority and legitimacy to interfere in an area of exclusive provincial jurisdiction.

Subclause 4(2) then mentions "the protection of the people of Canada against risks to health and the spreading of diseases". This does not appear in the original act that Bill C-95 would replace.

This would allow the federal government to move to protect the health and safety of the people in the name of national interest and of the power to ensure peace, order and good government. Paragraph 4(1)(c) places investigation and research into public health, including the monitoring of diseases, under federal jurisdiction.

This provision creates a problem, since clause 12 provides that "nothing in this act or the regulations authorizes the minister or any officer or employee of the department to exercise any jurisdiction or control over any health authority operating under the laws of any province". There is obvious confusion here.

How does Health Canada plan to ensure this continuous disease control monitoring without having access to the necessary information? According to the Act respecting health services and social services, health care institutions are health agencies governed by provincial legislation.

Is that really a problem? Does clause 12 effectively limit federal intervention in health matters or is it a mere front put up to reassure the provinces, a line that the federal government will have no qualms crossing if and when it pleases, as it has done in recent years?

Clause 4 may therefore be interpreted rather freely and broadly. There certainly is cause for concern about the real scope of this clause, which can be interpreted many different ways and ascribed many intentions. This is how, as usual, the federal government tries to expand into provincial areas of jurisdiction through a seemingly simplistic and innocuous project.

But no one is fool enough not to guess what it is up to. Bill C-95 is another fine example of the federal way of doing things: silently, without making any waves, because it knows full well that no one agrees with its handling of health care.

Needless to say that, for all those reasons and many more-that my colleagues will have the opportunity to raise later on-, we cannot support in any way Bill C-95. Mr. Speaker, before closing, I would like to table the following amendment to Bill C-95.

I move, seconded by the hon. member for Joliette:

That the motion be amended by deleting all the words after the word "That" and substituting the following: "this House declines to give second reading to Bill C-95, An Act to establish the Department of Health and to amend and repeal certain Acts, because the principle of the Bill does not provide for including in the Minister's powers, duties and functions, the power to award full and entire financial compensation to any province wishing to exercise fully its jurisdiction over health".

[Grant Hill, Reform, Macleod, AB]

Mr. Speaker, Bill C-95 is really not much more than a bill to change the name of the Department of Health. On that basis it is surprising that we will spend so much time debating it. If I asked a high school class how long they thought it would take to change the name of a department, they would tell me it would probably take a minute.

I see this debate being used by my colleagues as an opportunity to talk about health care in a broader sense and I will seize that opportunity too. This bill is what my House leader said it was a few moments ago when he said it was a pretty thin soup on the legislative agenda we have seen lately.

Let me start my comments about health care in general by making a statement I would like to have emblazoned across the forehead of my colleagues across the way as coming from the health critic of the Reform Party. I will say it over and over again until they finally do recognize and plainly hear what I am saying: Medicare is our best social program. Medicare is the program I think we should protect with all our resources.

Let me follow that by saying U.S. style medicare, U.S. style medicine is absolutely unacceptable to Canadians and to Reformers. There is no desire anywhere in Canada to move toward a system like the U.S. has. How many times can I say that? How many times can I express it? How many times can I emblazon it on the foreheads of my colleagues?

Our public system which is tax supported, which is universal, which is comprehensive, which is accessible to all and which is publicly administered, is truly unparalleled. Medicare is our best social program. This social program however has some cracks in it. The cracks must be talked about and addressed. If we simply stand

idly by and let the best social program we have break down, we have not done what we should be doing as legislators.

I beg my colleagues across the way to stop the rhetoric. I beg them to stop this nonsense about a U.S. style two tier system. I beg them instead to listen carefully to the actual proposals I make. I beg them to actually debate with me those proposals line by line instead of with buzzwords, instead of with rhetoric, instead of with platitudes. Please debate the concerns.

Why does our medicare system have cracks? What are the cracks I see? I see an aging population in Canada. Each one of us knows that as we age, medical expenses go up. In the last three years of life, 70 per cent of our health care expenditures are spent.

I see new innovative technology coming along that was never envisaged when medicare came on the scene. I see organ transplants, joint replacements, things we never dreamed about when health care was set up. Some of those things are profoundly expensive. Some are very difficult to fit into the framework we have.

Finally what are probably driving the cracks, and I wish they were not, are the funding shortfalls. We are in a position now where the federal government is spending over $1,200 per person to service the debt, that is servicing the interest on our debt annually while we spend $268 per person on medicare.

If nothing else, those three things which are happening in medicare have produced profound cracks. Ignore them, pay no attention to them and our most valuable social program will not just have cracks, it will implode. It will not survive.

If anyone takes from that that I say medicare is finished or done, I will say it again: Medicare is our most valuable social program. It needs support. It needs protection. It does not need U.S. style two tier changes. How many times must I say it?

There are two routes to travel in health care changes. Surely we know that health care changes must come but there are two routes to travel as I see it.

One route is to ration the procedures we do. That is avenue number one which we are on today, the rationing of services. We can ration by waiting in line. We can wait so long that we scream, or sadly in some cases, we can wait so long that we die. Rationing by waiting.

We can cap budgets and say that this is all we can afford. Anything beyond that point will not be done. We can have 30 operating room days instead of 100 operating room days. We can close beds. We can actually remove them from the system. It is being done. We can fire nurses and say to them: "You cannot do your nursing any longer. Step outside the system. Maybe you would be just fine as an accountant". That is one route and the one I am afraid we are on today, the rationing of services. I decry that and say it will not suffice.

The other route we can travel is if our medicare system does not meet the needs of an individual, they should have the choice to step beyond the public system and access something else. That is where I think we should go. Please remember that does not mean tossing our good public system away. It means our tax supported system will maintain itself, but if medicare does not meet the needs of an individual patient, they should be able to step outside. I can only explain this best by giving some examples.

A little girl by the name of Stephanie, a tiny patient, has adenoid problems and fluid in her ears. She is in pain. This is not a life threatening problem but she cannot hear as well as she would like. She is constantly concerned. She goes in to get her antibiotic and the specialist tells her parents that Stephanie really needs to have her adenoids removed and the fluid drained from her ears. Her parents ask the doctor how soon this can be done. It is an eight-month wait in Nepean for that procedure today.

Stephanie is not in the worst difficulty, but what happens for the eight months she has to wait? She is on antibiotic every three weeks, and the antibiotic cost is about $40. There is actually some extra discomfort for her, so she misses play school. When she misses play school mom has to stay home from work or have a babysitter come in. Those things are economic, and I would set them aside and say that they are okay. But for Stephanie herself, the pain and disruption is there. Her parents ask what choice they have. The public medicare system is going to provide her service in eight months. Is there nothing that can be done? Yes, there is something a Nepean couple could do today. They could go to Rochester. They considered very carefully going to Rochester for their sweetheart to get her adenoids out.

There is another choice. I am sad to say that it does not exist in Ontario now. The choice is a little clinic in Alberta. This clinic is run by an ear, nose, and throat surgeon exactly of the same capability as hers. He got ticked off with the fact that the waiting list in Alberta was eight months. He said there had to be another way. There were not enough bed opening times for him to bring kids into the hospital. This is not a hard procedure. The facilities will cost him about $30,000, and he can get the operating room microscope, which is not that difficult to sterilize. He could do it in his office with an anaesthetist and the equipment for that. He wondered if there was a demand for this.

Today in Alberta he is doing that. The cost is $125 out of the patient's pocket. The waiting time is two weeks. Little Stephanie in pain is given the choice. This is what I want. I want Stephanie's parents to have the choice. If the public system and the eight-month wait is okay for Stephanie and okay for them, so be it. If they say that it is not acceptable to them, I want them desperately to be able to access that facility. And it should not be in Rochester; it should be in Ottawa.

If there is anyone in the Chamber who would deny that sweet little girl that choice, I want them to stand now. I cannot imagine a Canadian who would do that.

Thin edge of the wedge? Our public system cratering because of the potential of choice? Find me the country in this world that has a public system like Canada's and a complementary private clinic that has caused the public system to crater and I will sit down. There is no such country.

Let me take the other side of the coin now. My mother, who is living in Alberta, recently had a cataract operation. She had a choice. There is a clinic in Alberta that would do her cataract operation for $1,250 out of pocket, with a very short waiting time of two weeks. The waiting time in the public system for her was four months. "Twelve hundred and fifty bucks, boy, that's a lot of loot", says my mom. "How bad are my eyes? Not so bad at all. I can still watch TV. I can still read the newspaper. I think I will wait. I think I can easily wait for four months." And she did. Her surgery was performed trouble free. This was a public system providing for her needs in the way it should.

If there is no demand in Canada for options outside medicare, there will be no such clinics springing up. Interestingly enough, in a country I am familiar with, some of the private clinics, these choice clinics that have sprung up, have now gone bankrupt because the public system has become so efficient, provided all the services, and pushed them aside.

Why do Canadians not have more confidence in this most valuable social program to say that it will crater if some choice springs up? How is it that this most valuable social program would not survive if there were choice and if the only choice were to go to Europe? It makes no sense to me whatever.

I talked about how funding goes down because of debt. What happens if funding from the government drops so low that there is not enough in a community?

Tomorrow I am going to my twin riding of Saskatoon to speak to the law faculty. I have already had the opportunity of being there. I found out that in Saskatoon the provincial and federal funds have given them no capital expenditures for the last three years-none. They said they had some things the people in Saskatoon want, and they raised through foundations $2 million-from corporations, individuals, and people who are involved in the health care field doing projects. They put those funds into capital improvements: equipment and new technology.

The public will not stand for an inferior product in health. Health is more important to Canadians than any other thing we have or we can give them.

I say again that the individuals in this country who will not debate this issue straight up with Reformers who are willing to talk openly about the cracks-not the explosions, not the breakdown, not a crisis, but cracks in our most valuable social program-are ideologically driven and not driven by care, not driven by health needs, and not driven by common sense.

I am going to end my discourse today by saying that medicare is our most valuable social program. The biggest threat to medicare in Canada is politicians who wrap themselves in some kind of a flag and will not truly address the issues.