Debates of Nov. 6th, 1995

Questions On The Order Paper

[Nelson Riis, NDP, Kamloops, BC]

With respect to the government policy regarding the protection of workers from environmental tobacco smoke (ETS), ( a ) are there any estimates of the number of workers under the federal jurisdiction who are (i) exposed to ETS resulting from smoking where smoking is permitted, (ii) exposed to ETS resulting from smoking where smoking is not permitted, and if so, what are these estimates, ( b ) are workers who are exposed to ETS justified in quitting their jobs within the meaning of the Unemployment Insurance Act, and ( c ) since 1989, (i) have any inspections been made to ensure compliance with the Non-Smokers' Health Act, and if so, how many, (ii) have any tickets been issued pursuant to the Non-Smokers' Health Act and if so, how many?

[Lucienne Robillard, Liberal, Minister of Labour]

The Non-Smokers Health Act affects almost 650,000 workers in about 26,700 workplaces under federal jurisdiction and approximately 240,000 employees of the Public Service of Canada. a ) (i) There is no estimate of the number or percentage of federally regulated workers who are exposed to environmental

tobacco smoke resulting from smoking where smoking is permitted and ( a ) (ii) where smoking is not permitted. b ) Under the UI act, ``just cause'' for voluntarily leaving an employment exists where, having regard to all the circumstances, the claimant had no reasonable alternative to leaving employment.

Working conditions that constitute a danger to health or safety is one of the 13 specific circumstances identified by the legislation that may constitute just cause for voluntarily leaving employment.

Before leaving the employment, a reasonable alternative for the person working in such a place would be to report the situation to the employer and/or the union so that the situation can be remedied within a reasonable period of time. If the situation still does not improve and the working conditions likely affect his or her health, a person could reasonably prove his or her point by means of a medical certificate or other similar document. c ) (i) The national statistics at our disposal reveal that from April 1, 1990 to March 31, 1995, there were 144 inspections and 467 complaint investigations conducted under the Non-smokers Health Act. c ) (ii) Until the Contraventions Act (Bill C-46) is proclaimed, issuing warnings or initiating prosecutions are the only alternatives to ``ticketing'' an individual for non-compliance. To this end, labour branch officials ask the employer or employee to sign an assurance of voluntary compliance (AVCs), by which they make the commitment to cease the contravention within a specified period of time. Failure to do so can lead to prosecution. From April 1, 1990 to March 31, 1995, a total of 156 AVCs have been received by safety officers and no prosecutions have been initiated.

[Peter Milliken, Liberal, Kingston and the Islands, ON]

Mr. Speaker, I would ask that the remaining questions be allowed to stand.

[The Acting Speaker (Mr. Kilger)]

Is it agreed?

[Some hon. members]

Agreed.

The House resumed consideration of the motion that Bill C-95, an act to establish the Department of Health and to amend and repeal certain acts, be read the second time and referred to a committee; and of the amendment.

Department Of Health Act

[Dianne Brushett, Liberal, Cumberland—Colchester, NS]

Mr. Speaker, as we consider Bill C-95, hon. members will want to reflect on the business of the Department of Health as it embarks on its new life, its new beginnings.

The department is no longer responsible for social assistance. Does this reduce its importance in the national structure? Is it fading away? Is it weakened? Far from it. As I read the results, the Department of Health is now poised and primed to take on perhaps the greatest challenge it has ever known. It has gathered its strength in order to guard the health of Canadians through an era of stress, strain and dislocation that is testing us all.

It is finding alternatives to the financial resources once thought inexhaustible but now known to be limited alternatives described by words such as collaboration, knowledge and intelligence, waste reduction and value for money. These are the watch words of the new department, focused today more than ever on health because it is focused on health alone.

The basic facts of Bill C-95 are as follows. The department is renamed. Some inspectors are empowered. The social well-being dimension of health is acknowledged and there are to be charges to businesses for services that have business value.

A new name means a new focus. This is what the bill is about, what is in the bill and who can object. It is eminently reasonable. It has been well set out by the minister and by other hon. members and the significance of the new name, the Department of Health, is personified in that single word because of the very importance of health to Canadians.

I would go one step further. The Department of Health is a symbol of a new beginning. This nominal act speaks volumes about a determination to focus intensely on the health of Canadians, our most precious resource.

The renamed department will continue all the essential work that has helped Canadians reach the top of the world rankings in health. However, it will do far more than maintain hallowed traditions. It intends to be a dynamic player in a world filled with new challenges and opportunities for health care.

The department is in business to protect the health of Canadians but it is doing that business in a new way, streamlined by a new vision of the way things must work in the future.

What indicators are there of this new approach? None is more practical or more telling than the consolidation in the department of 11 separate activities distinguished as such even up to the recent main estimates into just four business lines. This move reflects what has been learned from the program review process and participation in the science and technology policy review. More than this, it reflects a willingness to consult, to listen, to learn and to change.

The first of the new business lines will position the department to support and renew the health system in Canada. It will try to achieve a better balance among health care, disease prevention and health protection and promotion.

Quality health care services contribute to the health of the population, but good health is not simply the result of health care. Rather, it is more true to say health care is the result of ill health. Good health arises from a host of social, economic and environmental lifestyles and genetic factors.

Hon. members are aware of the initiatives undertaken by the Prime Minister's national forum on health to determine the necessary and sufficient conditions for health and identify the root cause of illness. The recommendations of the national forum will guide the department in its efforts to make the system healthier for all Canadians.

It will work with the provinces and territories to contain costs, including the costs of prescription drugs, in order to ease spending pressure on governments and the private health care system. It will lead consultation aimed at interpreting the Canada Health Act but it will not cease to enforce the act so that universal access to appropriate health care is maintained throughout Canada.

Canadians look to the federal government, to hon. members here in the House, to create bridges among the provinces. They want us to ensure national standards for health care. They insist we intervene to remedy inequalities and protect infrastructure. For all of this the Department of Health is our means, our instrument.

Another line of business the department has recently adapted will focus on the health problems of disadvantaged groups. This involves marshalling a number of existing programs toward this single objective. It involves new programs to be delivered in partnership with the provinces. As well, it involves improving the flexibility to respond when a new health need arises.

The department will intervene to help protect those at most risk when it is clear that the federal government is placed to provide the best care at the lowest cost. Affordable health care of the highest quality is the aim, the objective, while eliminating overlap and duplication with the provinces and other partners.

I will not dwell on the delivery of health services to First Nations, Inuit and the people of Yukon. I pass over it not because it is less important. Indeed it accounts for the largest share of the department's entire budget. I pass over it because it has been thoroughly explored in the representation of the minister and other hon. members speaking on the bill.

This is the new business line that flows least change from the department's previous portfolio of responsibilities. Helping native people and northerners attain a level of health comparable to that of other Canadians who live in similar conditions has long been a goal of this department, a goal of this government. The goal has not yet been achieved, but great strides are being made in the right direction to serve the people of the north.

The fourth reconstituted business line of the Department of Health seeks to reduce the health risks to Canadians arising from food and drugs, from consumer products and medical devices, from disease and disaster. This is the regulatory and compliance thrust of the department. This is the heart of health protection, where the department stands on guard to preserve the health of Canadians. It is here that Bill C-95 adds some muscle and meat to the refocused mission of the Department of Health.

The transfer of responsibility for the safety of consumer products and workplace equipment is formalized in the bill. Officials of the department get powers in the bill to inspect possible disease-carrying agents entering this country by way of foreign products. The costs of services provided to businesses may be recovered under a provision of the bill. If risks to Canadians are going to be managed effectively in an era of restraint, new ways to meet those costs must be found. This is one such way.

The late Lewis Thomas was a physician who taught at Yale. He was a great essayist and was called the poet laureate of 20th century medical science. Dr. Thomas wrote that the term health industry provides the illusion that it is in a general way all one thing and that it turns out on demand a single unambiguous product which is health.

Thus, health care has become the new name for medicine. Health care delivery is what doctors and nurses do along with hospitals and other professionals working with them. They are now known collectively as the health providers or the health team. Patients have become health consumers. Once we start on this line, there is no stopping.

We tend to forget sometimes that health is not simply a product distributed in neat little packages from a constantly replenished inventory on a shelf somewhere. We also forget sometimes in our rhapsodies over a multibillion dollar health system that it ultimately comes down to one patient, often hurt and scared, and one medical professional who may or may not be sure either about the cause of the complaint or what to do about it. It is a face to face, one to one confrontation as to what to do. This reality is part of the new understanding of the department which will be renamed with the passage of the bill.

I take the minister at her word, given to doctors at the CMA leadership conference in March, that decisions will be based on solid Canadian values such as fairness, compassion and respect for the fundamental dignity of all people, of all Canadians.

In the October edition of the Fraser Forum , which is published by the Fraser Institute, there was an article entitled: ``Two-tier health care system''. I quote from the article:

I would say that of all the government health plans in Europe the German system is the king among the blind. However, it's still one-eyed, it is still inferior compared to a purely private system, I believe. Now, the German system does not guarantee universal coverage-

The Canadian system is the best system, the single tier system. Only last week we heard that great American, Ralph Nader, telling us here in Canada to be vigilant, to be watchful and not to lose that single tier system where all Canadians have access to excellent health care.

I am pleased to speak on Bill C-95 today. I am pleased to enunciate for the second time the new name, Department of Health, and the significance we in this government place on the health of our people and the well-being of all Canadians. It is because of this naming, the single word health, that we give no extended situations to other things but singly the health of Canadians and the prominence it will play within our government.

I urge hon. members in this House to support the government with this very important bill. It is the fibre that helps this country maintain the strength of its unity.

[Osvaldo Nunez, Bloc, Bourassa, QC]

Mr. Speaker, I rise today to speak on Bill C-95, an act to establish the Department of Health and to amend and repeal certain acts.

The main change brought about by Bill C-95 is the change in designation from Department of National Health and Welfare to Department of Health. I welcome this opportunity today, because this bill speaks volumes about this government's intention to further centralize and strengthen its powers despite its pre-referendum rhetoric about decentralizing.

On the face of it, this bill looks completely innocuous, technical, minor and inconsequential. Yet, some provisions of this bill could have a major impact on the exclusive provincial jurisdiction over health care.

I will go over them rapidly because my colleagues from the Bloc Quebecois have already reviewed significant health issues since the beginning of the Canadian confederation. Just the same, it is imperative, in my opinion, to bear in mind what, obviously, this government tends to forget, and that is that, under the constitution, health is an exclusive provincial jurisdiction.

Everyone agree on this. How can certain provisions of this bill be justified in that context, I wonder? I am referring in particular to clause 4, which states that:

4.(1) The powers, duties and functions of the Minister extend to and include all matters-relating to the promotion and preservation of the health of people-

(2)-the Minister's powers, duties and functions-include the following matters: a ) the promotion and preservation of the physical, mental and social well-being of the people of Canada; b ) the protection of the people of Canada against risks to health and the spreading of diseases; c ) investigation and research into public health- d ) the establishment and control of safety standards-for consumer products- e ) the protection of public health on railways, ships, aircraft- f ) the promotion and preservation of the health of the public servants and other employees of the Government of Canada; h )-the collection, analysis, interpretation, publication and distribution of information relating to public health; and i ) cooperation with provincial authorities with a view to the coordination of efforts made or proposed for preserving and improving public health.

These are provisions which are far-reaching and whose legal implications are difficult to foresee. This is especially worrisome since part of these are new provisions which were not found in the former act, that is to say the act respecting the Department of National Health and Welfare.

This bill reveals the federal government's will to centralize, as do other facts. I refer you in particular to the red book published by the Liberal Party of Canada, which called for widespread consultations on health care in the form of a public forum. I quote from page 80 of the red book: "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. 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". These sentences speak for themselves and clearly show the Liberal Party's intentions even before they came to power.

In June of 1994, the Minister of Health announced the creation of this forum. Though its own Minister of Health, Quebec vigorously denounced this initiative and refused to take part in this exercise. And Quebec was not the only province that registered a protest. To this day, no province is a participant in this forum.

A few days before the referendum, some federal spokespersons changed their tune in order to win. They were focusing on change, decentralization, and powers to be negotiated with the provinces. What is happening now? Exactly a week after a significant vote that clearly revealed Quebecers' desire for change, we in this House are debating a bill that brings us back to the sad reality. No change can be expected from the current government.

The government has no intention of relinquishing any of its powers, despite what it said before the referendum. I hope that the minister will fully comply with clause 12 of the bill, which reads as follows:

1. 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.

Mr. Speaker, allow me to give a historical overview of the legislation and of the federal government's interference in the area of health care. First, let us not forget that section 92.16 of the Constitution Act gives the provinces overall jurisdiction over health issues on their territory, by providing the following, and I quote: "-generally all matters of a merely local or private nature in the province".

Moreover, subsections 7, 13 and 16 of section 92 recognize the provinces' jurisdiction over hospitals, the medical profession and practice, as well as health care, on their territory.

Health is clearly a provincial, not a federal responsibility. However, the federal government has always managed to interfere in that sector, either through legislative measures such as the Food and Drug Act, or indirectly through its spending power.

Such interference has often generated tension and conflicts between the central and provincial governments. Quebec has certainly been the one denouncing most often and most directly Ottawa's interference in its field of jurisdiction. In 1919, the federal government established the health department and gave it the authority to provide grants.

In 1945, during a federal-provincial conference, the federal government proposed the establishment of a national health care program for which it would assume total responsibility. It should be pointed out that, in those days, after the war, the federal government exercised almost total control over the primary fields of taxation.

In 1948, a national health grant program was set up. In 1957, the federal Hospital Insurance and Diagnostic Services Act was passed, followed in 1966 by the Medical Care Act. The Canada Health Act was then passed in 1984, after a long debate and a lot of criticism. The central government had decided to legislate to ensure that health care and services that were medically necessary would remain accessible, available to all and free.

That federal act had the effect of imposing on the provinces the obligation to comply with these principles, in spite of budget cuts that the central government would make in transfer payments to the provinces for the health sector. The federal government also gave itself the power to impose monetary penalties on non-complying provinces. That act establishes national standards, namely, as I said, the universality of services, accessibility, transferability from province to province, public management and comprehensiveness. If these standards are not met, Ottawa can withhold its transfer payments for health care.

Based on the 1995-96 budget, Health Canada will spend some $1.5 billion to operate the program and some $7.4 billion in transfer payments. This department funds, among other things, the integration of people with disabilities, the fight against domestic violence, the new horizons program, the Seniors Secretariat, the fight against smoking, the national anti drug campaign, the national AIDS strategy, programs on pregnancy and child development, the Children's Bureau and the national health forum.

I have always supported a health insurance scheme that is universal, free, provincially administered, funded by our taxes and available to all. I do not support a system with two tiers: one for the rich and the other for the poor. I am, for example, concerned about what is happening in the United States, which does not have a public health scheme, preventing millions of people from having access to proper health care. Health, in my opinion, is people's most precious possession. This is why we must protect this system, and make preventing disease and promoting health our priority.

Naturally, with Canada's and Quebec's aging population, health care costs more and more. But services must not be rationed, nor cuts made unjustifiably. Unfortunately, Canada's entire health care system is in an acute state of crisis. Since the program's inception in 1977, the rate of growth of its funding has not kept up. This has meant a shortfall for the provinces. For example, in 1986, the federal government cut the rate of growth of transfers by 2 per cent. In 1989, the indexing factor was reduced by 1 per cent. In 1990, Bill C-69 froze transfers at the 1989-90 level for a two-year period. In 1991, the federal government extended the freeze another three years. All this time, the Liberals were vigorously criticizing these cuts.

Now that they are in power, they have totally changed their position and continue to nibble away at the Canadian health system. Scandalous.

It must be pointed out that, between 1977 and 1994, Ottawa's contribution to the health system dropped from 45.9 per cent to

33.7 per cent, and Quebec and the provinces have had to absorb this 10.6 per cent shortfall, with great difficulty.

The forecasts for 1997-98 indicate that the federal share of funding will be 28.5 per cent. Total cuts for Quebec alone are $8 billion dollars. To this must be added the $308 million reduction for 1995-96 and the $587 for 1997-98 in the Canada social transfer.

Is this what the flexible federalism of the Liberal government means? The only thing it is decentralizing is the deficit.

My fear is that these cuts will lead to the end of the health system as we know it. I am against social program cuts, as I have stated in this House on numerous occasions, particularly cuts in health programs through the drastic reductions in transfers to the provinces.

I support the campaign by the Canadian Labour Congress, the CLC, to save the Canadian health system. This coming December 5, the leaders of that organization will be here to meet some of the ministers and members as part of their campaign. The same battle is being waged in Quebec by the FTQ.

As a sovereignist, I voted Yes on October 30 because of my conviction that we in Quebec can build a more just society, a more egalitarian, more humane society. I am concerned about the Liberal Government's lean to the right, its blind cuts in unemployment insurance, social assistance, old age pensions, postsecondary education and so on. I am concerned about the antisocial orientations, with their lack of concern for what becomes of the least advantaged members of society, developed by the governments of Ralph Klein in Alberta and Mike Harris in Ontario, both Conservative governments.

In addition, I am greatly concerned about the right-wing, sometimes ultraright philosophy of the Reform, particularly when it comes to immigration, firearms control, cuts and the battle against the deficit.

The British Columbia NDP government's decision to refuse social assistance to anyone who has not been in the province for three months concerns me.

So, nearly all of English Canada is aligning along the most conservative of lines. In my opinion, the federal government ought to show some compassion, understanding and generosity towards our poor and needy fellow citizens. Canada has the means to protect the unemployed, the welfare recipients, the sick and so on.

My wish in closing is for the federal government to do everything necessary to preserve the health system in Canada.

[Jesse Flis, Liberal, Parliamentary Secretary to Minister of Foreign Affairs]

Mr. Speaker, I listened very carefully to the words of the member for Bourassa. I wonder if he could clarify a few things.

He again reminds us that he is a sovereignist. I do not know what that has to do with this bill. I would remind him to reflect on the words the former Premier of Quebec and his own leader used about the kinds of people they want to live in that part of Canada. So when he says he is a sovereignist, I assume he means that he is a Canadian sovereignist.

I get this feeling in statements in the foreign affairs committee and in the House that to that party everything seems to be a provincial jurisdiction. There seems to be nothing left for the federal government and provinces to co-operate on. Here is a bill that calls for co-operation to maintain health standards across Canada and keep costs down, and the hon. member cannot even support that.

He quoted from clause 2. I refer him to paragraph (i), where the minister's powers, duties, and functions relating to health include "co-operation with provincial authorities with a view to the co-ordination of efforts made or proposed for preserving and improving public health". Is the hon. member honestly against this kind of a bill?

He also went on to say that he is against the two-tier system. Great, I agree with him. So am I, and so is everyone on this side of the House, the government side. How does he expect to prevent the two-tier system if he allows health care to be the total responsibility of the province?

My wife happens to live in Ontario and her brothers live in Quebec. Their mother used to switch from Quebec to Ontario. She would live at her son's at one time and at her daughter's another time. If each province is responsible for its own health system, their mother could not have done that. Under the present system she was able to move from province to province and have her prescriptions, doctor bills, and everything covered. Thank God, she lived to 89. She had gone through Siberia and had the kind of life that no one would want to hear about in this House. Yet she lived in this country happily until she was 89 because of the health system in this country and because of the standards that were kept from province to province.

I would like the hon. member to clarify what he means. He is against the two-tier system, yet he wants no federal involvement at all. How does he expect to maintain Canadian standards if he wants health to be the sole jurisdiction of the provinces?

[Osvaldo Nunez, Bloc, Bourassa, QC]

Mr. Speaker, I would remind the hon. member, as I did in my address, that health is a provincial matter, not because I say so, but because the constitution says so. Very clearly. I quoted section 92 earlier.

I am sure, as I have already said, that we in Quebec are capable of providing care to the entire population, care funded from our taxes, quality care. We in Quebec have no need of the federal government to provide our entire population with such care.

Furthermore, the health system in Canada is at risk today, not because of the provinces, but because of federal cuts in transfers to the provinces. That is where the true danger lies.

I think that the hon. member ought to get up to criticize his own government's cuts in the system of transfers to the provinces. I trust that he will react to the next federal budget because it will seriously aggravate the situation. The government will be making cuts everywhere, including health care, in the next budget.

[Hedy Fry, Liberal, Parliamentary Secretary to Minister of Health]

Mr. Speaker, I want to comment on the hon. member's statement.

Much has been said about paragraph 4.(2)(a) and that it in fact has begun to encroach on provincial jurisdiction. I would like to refer the hon. member to clause 12, which states:

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.

That clearly specifies that the bill does not move into provincial jurisdiction.

I will quickly touch on the issue of transfer payments. In 1991-92 federal health transfers as a percentage of provincial expenditures were 31.2 per cent. In 1993-94 to Quebec it was 31.9 per cent. In 1994-95 it was 31.7 per cent. In 1995-96 it is 32.2 per cent. I may not be an accountant but I surely know that is an increase in terms of percentage of expenditure.

The major transfer to Quebec will approach $11.7 billion in 1995-96. It will account for over 30 per cent of Quebec's estimated revenues in 1995-96. It means that roughly $1,590 per person is spent in Quebec by the federal government.

[Osvaldo Nunez, Bloc, Bourassa, QC]

Mr. Speaker, briefly, I appreciate the hon. member's comments but I find that there are certain contradictions in clause 12 of this bill, which have been pointed out by the critic for our party. Furthermore, practice and experience have shown us that, even where there are clauses to forbid federal interference in provincial matters, the federal level retains the spending power, which it sometimes uses to interfere unduly in provincial matters.

[Paul Szabo, Liberal, Mississauga South, ON]

Mr. Speaker, during the last number of years a significant trend has occurred in health care in Canada in relation to the average length of stay that Canadians have in hospitals. In Ontario alone the average length of stay has reduced from some seven days to about 4.2 days.

There has also been a major shift toward ambulatory care. Rather than having people go to the hospital and wait for a day for surgery and so on, they come in on the same day of surgery and are out a lot quicker; similarly with regard to maternity.

The member should also appreciate that there have been substantial changes in medical technology as well as in medications and that in fact Canadians are living longer today than they have historically. They continue to live longer. In addition there has been a tremendous elimination of duplication of services between hospitals and community agencies.

All this results in a substantial reduction in health care costs. Yet the member will clearly find out, if he checks the figures, that our health care institutions province by province have been able to service as many or more Canadians with less facilities. Those are the savings.

Because the savings have been achieved by the provinces the federal government has not achieved any benefit from the savings. The member should realize that health care is much cheaper to provide now and that the cuts simply reflect the lower cost of providing health care to all Canadians.

[Osvaldo Nunez, Bloc, Bourassa, QC]

Mr. Speaker, as I said in my speech, I am in favour of a universal health system that is free of charge and funded from tax revenues. I think that this is a major benefit for the population, and one I would not like to see endangered. That is why I would invite the hon. member across the way to pressure the Minister of Finance to stop making cuts in transfer payments to the provinces in order to finance the health program.

Contrary to what the hon. member states, I feel that costs are on the upswing at present, particularly because of longer life expectancies. The population wants care, increased care. In my riding of Bourassa there are very many seniors who complain of not having proper health care. We can work together to improve the system, but not to destroy it, as you will by making cuts in the health field.

[Mary Clancy, Liberal, Parliamentary Secretary to Minister of Citizenship and Immigration]

Mr. Speaker, may I say that it gives me a great deal of pride today to speak in support of Bill C-95 to establish the Department of Health.

My pride lies not just in the federal government's record of accomplishment and achievement in the broad health domain, although I have a great deal of pride in that, but also in a health system that is the envy of the world. On top of that I have pride in the knowledge that the genius of Canada's Constitution is found in the fact that the world's finest health system did not come about at the expense of a fundamental respect for the letter and spirit of our Constitution.

While we are batting around our good and much maligned Constitution I should like to make a slight comment. Members of either the official opposition or the third party who are fond of making comments about the Constitution could perhaps learn a bit if they would read the Constitution. Many of the misapprehensions we have heard from both those opposition sides might be cleared up if they would merely read it. Maybe they need some help in reading it. However they should read it.

We could speculate on how the Fathers of Confederation would have dealt with health care had they any idea of the enormous technological changes that would take place in the first century of our country's history and in the even more profound technological advances that continue to arise each and every day. Perhaps we could speculate on how the Constitution would have been written if anyone in 1867 could have imagined the day when health expenditures would account for about one-tenth of Canada's economy.

Last Thursday the hon. member for Drummond enumerated the various heads of power over health the Constitution assigns to provincial legislatures. She drew particular attention to subsections 92(7), 92(13) and 92(16) which deal with health institutions, property and civil rights, and local matters. The hon. member could have added that subsection 92(2) deals with local taxation and spending and has health implications.

Those listening to the hon. member's stirring defence of Canada's Constitution could have been forgiven for thinking that everything the Constitution has to say about health is encapsulated in subsection 92. The fact of the matter is that other subsections also have considerable relevance. In the interest of peace, order and good government and in the interest of ensuring the people of Canada understand what is actually happening I should like to name some of them.

Subsection 91(27) gives the Parliament of Canada exclusive jurisdiction over criminal law. "Ah", I hear some people cry, "what does that have to do with health?" I will tell them. It is the basis of a number of statutes protecting public health and safety. That is federal jurisdiction.

Subsection 91(2) assigns to the federal Parliament responsibilities for international and interprovincial trade. It again supports the basis for federal regulations, as a small example, in the area of drugs and medical devices. That is federal jurisdiction once again.

Subsection 91(11) gives the federal Parliament explicit power over quarantine and marine hospitals. That is an interesting sidelight. It reveals a good deal of the thinking in 1867 about where matters cease to be local and take on national significance: quarantine and marine hospitals. It is not too big a stretch to see that should be and indeed is constitutionally within the federal domain.

Subsection 91(7) concerns the military and veterans. It is federal. Subsection 91(8) has to do with the federal public service and subsection 91(4) concerns aboriginals and lands reserved for aboriginals.

All these powers account for a great deal of the federal role in health. They account for the considerable array of the duties and responsibilities set out in clause 4 of Bill C-95 and by extension they account for the vast majority of Health Canada's operating expenses.

When viewed from the perspective of federal constitutional responsibilities, health is clearly a great deal broader than my hon. friend's narrow view of health care delivery, important though that is. No one in the Department of Health and no one on the government side is trying to minimize the responsibility of the provinces in health care. It is clearly not my intention to reopen the Constitution on this occasion but to separate myths from reality, particularly as they regard the application of federal spending powers in the health field.

I will again reiterate my earlier comment. The Constitution is a wonderful compilation of documents that has been much maligned both by the official opposition for obvious reasons and by the third party for reasons I can only claim are obscure. Most of their reasons are pretty obscure to me.

The biggest myth is that the spending power broadens the sphere of federal regulation. The reality is that nothing in the Constitution gives the federal Parliament the means to regulate provincial matters in the guise of spending power. Perhaps I could say it again very slowly. It can attach conditions to the funds it makes available to the provinces. However, just as it cannot compel the provinces to accept the funds it offers, neither does it buy jurisdiction when its offer of funds is accepted.

Clause 12 of Bill C-95 makes the limitation clear just as the existing Department of National Health and Welfare Act also makes it clear. It states:

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.

That is why the Canada Health Act does not forbid user fees. It does not require that provincial legislatures forbid them. It simply makes it clear that any province which decides to finance medically necessary health services through such means cannot count on receiving the full amount of financial assistance the federal government is prepared to offer.

This brings me to the matter that the federal government is intruding into provincial prerogatives. There is an immense distinction to be drawn between intrusion and involvement. The motivation for the federal government's involvement in health financing does not derive from any desire to centralize powers or to colonize a field of provincial jurisdiction.

The federal role in health care has been the exercise of leadership. There are those who would hold that leadership is a dirty word or a symptom of megalomania. I hold differently, as do members on this side of the House. I hold that leadership is a characteristic all Canadians value. All Canadians from all regions of the country expect and demand their federal Parliament to display leadership. It is not a dirty word. It is a great word which we over here absolutely applaud.

It is here that doctors and hospitals cease to have just local significance. The value that all Canadians share transcends being merely local. The importance that all Canadians attach to the principles of universal health care is a defining characteristic of the Canadian psyche. This is who we are. This is what we stand for. This is what we are proud of and this is what we fight for.

How is it possible to overlook this aspect of health care? I do not understand it. It is beyond me. At a time when all Canadians welcome the positive forces of reconciliation and partnership, I cannot understand how we in the House would allow ourselves to ignore the positive contribution that the federal government has made and continues to make to the health and well-being of all Canadians and to the articulation of the spirit of community that hold us in high regard the world over.

Before I close I should like to tell a little story about something that took place in my first session of Parliament in the House when we were in opposition. There had been a debate, again I believe it was an opposition day debate on the question of health care. After the debate was over, I joined two of my colleagues, one from my own region of Atlantic Canada and another from Ontario. We talked about how important medicare and the Canadian health care system was to each one of us.

It turned out that each one of us had had fathers who had suffered and families that suffered because of injury and illness prior to the development of medicare in this country, prior to the Canadian health care system. We came from three different backgrounds, from three different areas of the country, but all three of us remembered what it was like in childhood and how our families had suffered because the Canadian health care system had not yet been put into place, put into place I might add by the federal government, a federal Liberal government.

This is why I am pleased to have had an opportunity to speak in support of Bill C-95. This is why I and my colleagues on this side of the House in the Government of Canada will fight and maintain the Canadian health care system in the face of all odds.

[Christiane Gagnon, Bloc, Québec, QC]

Mr. Speaker, I welcome this opportunity to speak today in the debate on Bill C-95, an act to establish the Department of Health and to amend and repeal certain acts.

I feel particularly concerned by this bill since in my riding, 50 per cent of the population lives below the poverty line and the quality of health care is extremely important. Although the government claims it is only a technical bill, its purpose merely to change the name of the Department of Health, that is not the case.

Since 1919, we have seen the same situation time and time again. Once more, the federal government has shown its desire to invade provincial jurisdictions, as we will show later on.

I must firmly condemn the latest in a series of hijackings by the federal government. It hijacked the jurisdiction of the provinces over health care. It started many years ago in 1945, and it is about to finish the job.

Particularly revealing in this respect is the well known national forum on health. This forum, announced during the election campaign in the fall of 1993, was established a year later. Its mandate was very clear: to develop a vision of the future of Canada's health care system, foster discussion with Canadians on their health care system, identify priorities for the future and achieve a broader consensus on the changes that are required.

We know that the provinces, which according to the constitution have jurisdiction over health care, are not involved in the forum.

What this means? The answer is simple. Instead of showing some willingness to respect the jurisdictions of the provinces, the government has simply gone over their heads without consulting

them. The membership of the forum is a case in point, and I quote the Minister of Health: "The forum now has 22 members with a vast experience in health care, either as professionals, volunteers or consumers, and it will be a pleasure to join them in the months to come to work on a wide range of issues".

As you can see, the federal government did not bother to appoint representatives for the provincial governments. Consumers, professionals and volunteers come under the exclusive jurisdiction of the provinces. If any doubts remain as to the determination of this government to get the provinces out of this area, let me eliminate them immediately by quoting what was said by the parliamentary secretary to the Minister of Health at the twelfth international convention of the International Society for Quality in Health Care last May. She said, speaking on behalf of the government: "Canada has already taken many steps to achieve its goal: renewal of the health care system. We are reinforcing the community aspect of health care, improving the role of consumers in this respect and looking for a more integrated approach to health which goes beyond care as such". She went on to say: "We want to improve the effectiveness and quality of health care, and one of our common priorities is to promote the use of guidelines for clinical practice. We want health care to focus on the practices that are most effective for various high-risk groups".

These are fighting words for the provinces. Since when has the community aspect of health care or the role of consumers and health care been a federal responsibility? Are these not the exclusive responsibility of the provincial governments?

Why did the federal government, as it paid lip service to eliminating duplication and overlap, set up the national forum on health? I wonder. The answer is clear: this government is caught up in its desire for centralization and its obsession with encroachment. It never intended to withdraw from the areas of provincial jurisdiction it has invaded with impunity since 1919.

It is too bad that public opinion and the opinion of governments, including that of Quebec, are not important at all to this government. If only this duplication could be an asset, but unfortunately, that is not the case, as we shall see.

Let us look at the repercussions of this obnoxious policy on provincial governments. In Quebec, the provincial government has for a number of years considered the changes that will be necessary to deal with budgetary constraints and at the same time improve health care services to the public.

Through broad public consultations, Quebecers had a chance to express their needs and expectations and help identify priorities and implementation mechanisms. The Quebec government's action plan is ready and is now being implemented. Is there any justification for the expense of the new consultations carried out by the forum? Would it not have been better to respect the autonomy and jurisdiction of the Government of Quebec and transfer all moneys concerned directly to it for the benefit of Quebecers?

I am sure this option never crossed the mind of the federal Liberals. Now it cannot be done, because the federal Minister of Health announced in March her firm intention to direct all health policy matters.

As they were thus assuming their so-called leadership, they cut transfers to the provinces, thus depriving those who provide the services of the funds they need to set up their own policies. In fact, provincial governments, not only Quebec, will have to slash health spending. In addition to their own budget constraints, they will have to deal with cuts in federal funding.

Once again it will be women who feel the effect. A report on women's health prepared by the International Federation of Gynaecology and Obstetrics revealed a year ago that women were sick or incapacitated longer than men. Moreover, as their life expectancy is longer than men's, it is primarily they who will be deprived of necessary health care because of the expenses arising from duplication in health matters and cuts in federal spending.

For Quebec, these cuts represent more than $8 billion over 10 years. The provinces were not consulted, although they have to incorporate them and suffer the wrath of their citizens. We have to bear the unbearable.

Allow me to conclude with a quote from an article that appeared in La Presse on March 4, 1995, which aptly summarizes the situation. It said that, together with the provinces, Ottawa would have to establish a list of essential services that would continue to be covered by the health insurance plan. It felt that this was the way Ottawa intended to allow the provinces to deal with increased health costs in a context of reduced federal transfers. In the end, according to the article, the bill for services not considered essential would have to be paid by taxpayers.

The aim of Bill C-95 is to enshrine government control over health. We have no intention of supporting this greed, which will mean Quebecers and Canadians alike will suffer.

[Pierre De Savoye, Bloc, Portneuf, QC]

Mr. Speaker, I listened with interest to the comments made by my colleague from Quebec. She raised what I think is an extremely important point, which I would like her to develop further.

She talked about centralization and decentralization. We now see that the federal government, in particular the Department of Health, is trying to centralize a number of health matters, especially the general direction of health care in Canada.

At the same time, we see that the provinces, including Quebec, want to make innovative, creative decisions to better manage health care within their territories. In Quebec, there is a wide consensus to decentralize health care decisions to administrative regions. I am not talking about Canada's administrative regions but about administrative regions in Quebec. We see that the people want to be able to define in their own communities the kind of health care services they need and to have access to them.

This is in complete opposition to the tendency evident in the federal government's measures. Our concerns are justified. The federal government's centralizing vision is totally out of touch with the expectations of people in every province, including Quebec.

I would like the hon. member for Quebec to expand on this, to give the people listening to us and the members of this House an overview of Quebec's favoured approach, which seems to strike a chord in some other provinces.

[Christiane Gagnon, Bloc, Québec, QC]

Mr. Speaker, of course, this debate we are having today, members and ministers of previous governments have already had it. Legislation has been passed since 1919 that basically encroaches on provincial areas of jurisdiction.

That is not what the constitution of 1866 intended. What it intended was for the provinces to have full and complete jurisdiction over health, education and manpower training. I think that what is happening-When I look at the federal government's expenditures, I think that the problem comes from the federal spending power.

Federal spending for 1995-96 is $1.5 billion for operations, $347 million for personnel and $703 million for goods and services. If this money had been transferred to the provinces, Quebec and the other provinces would have had more money for health care, and would not have had to impose budgetary restraints and to cut back personnel and services at the taxpayers' expense.

What do you do at a forum? You discuss. You try to find a way to sing the same tune as the other provinces. But in the end, as minister Rochon pointed out in the Quebec national assembly, all that the provinces do at meetings and federal-provincial conferences is complain about not having enough money. There are costs involved with holding forums and conferences. When you do not have enough money, you stop discussing and start acting.

And in acting, you need money to follow these actions through. I think that agonizing choices lie ahead. Quebec's goal has always been to provide a safety net in several areas such as social services, health and education.

The federal government is driving us back against the wall by providing less funding. Federal transfers to the provinces have been reduced by $8 billion. Who does the public turn to? To the one making the cuts, the one that says: "We will not be improving services this year because we do not have enough money. Instead, we will be downsizing". As a result, employees too are concerned.

I think that I am not the first person to make this point. Since 1919, other parliamentarians, from Taschereau to Jean Lesage, have made it before me. I think that there must be some truth in what we say. I cannot understand the federal government. We have to keep hitting it with the same arguments over and over again. What a waste of time. Time has come to act. And to act, we need money.

[Paul Szabo, Liberal, Mississauga South, ON]

Mr. Speaker, I listened with interest to the speech made by the hon. member. I would like to try to put this in a simpler context. I think what the hon. member was saying and what many Bloc members are saying is that they would like the province to be totally responsible for health care with no federal involvement whatsoever.

I would like to give the member a simple example and ask the member's comment on one particular aspect of health care that we take care of, and that is the research, study, and recommendations to deal with specific problems Canadians have. One of them I am quite interested in is fetal alcohol syndrome or fetal alcohol effects. That disease affects about one in 500 births. It also accounts for five per cent of all fetal defects in Canada. That particular disease results in central nervous system disorders, brain damage, cognitive problems, attention problems, and so on. It is a very serious problem.

The federal government, using part of its money, one of many studies and programs it does, looked into this in 1992 and apparently is coming out again with a joint statement with the provinces with regard to a strategy to deal with fetal alcohol syndrome and fetal alcohol effects. That is just one example.

Does the member not agree that there are problems of health in Canada that are much better dealt with as a national Canada-wide effort-AIDS, aboriginal health, alcoholism, drugs, and so on-and are better handled by the federal government rather than handled individually in each and every province?

[Christiane Gagnon, Bloc, Québec, QC]

Mr. Speaker, I do not deny that there are health problems, but the provinces are certainly able to meet the needs of the public. The federal government is not there to set standards, organize forums and make studies. Rather, its role is to transfer money to the provinces, so that they can act directly where it is

needed. I do not deny that there are problems with alcoholism. However, I believe that Quebec is certainly capable of setting up its own programs and making realistic decisions, based on the existing demand and need.

You talk about national standards. These may be appropriate for a province, but less so for another. When you set national standards, you must also provide financial support. We are discussing eligibility for all. I agree with that principle. However, do you not think that the federal government jeopardizes access, for the population as a whole, to quality health services, by spending and generating costs without even seeking our approval?

The issue is not health care, but transfer payments and the provinces' responsibility.

As I said before, ministers and members of provincial legislatures, not only in Quebec, have been wondering about decentralization since 1919. The word "decentralization" was not invented in Quebec. Other provinces are also concerned. Just look at what is happening in Ontario and in British Columbia, which will pass a law that may not please everyone. The federal government interferes in fields of provincial jurisdiction. Given that $603 million is spent on goods and services, and another $347 million on personnel, the federal should let the provinces spend the money where it is really needed and avoid duplication of services and personnel.

[Rose-Marie Ur, Liberal, Lambton—Middlesex, ON]

Mr. Speaker, I rise to address the House in support of Bill C-95, an act respecting the Department of Health.

I would like to take this opportunity to congratulate the minister who proposes this bill for the efforts she has made over the past year to defend and strengthen the principles enshrined in the Canada Health Act that underpin Canada's magnificent medicare system. I might add, it is a system of which I was proud to be a part in my previous position as a health care professional.

The department this bill deals with is an essential part of the fabric of this nation. The minister has said that it touches the life of every Canadian every day. Medicare in Canada transcends medicine. It is both a service for Canadians and a critical bond with Canadian federalism. Without it we would suffer as individuals and as a country.

It is essential that medicare be sustained and strengthened and that it remain as a bond within the country. This is the challenge and the responsibility of this department. This is the reason for Health Canada, and the reason I will support Bill C-95 without reservation.

It is true that the provinces have primary responsibility for the design and delivery of health care services. This is as it should be. Health care is a local responsibility. Doctors and hospitals work in communities. Provincial control of health care is not a weakness of the system, it is a considerable strength. The values, beliefs, wants and aspirations that define Canada and the Canadian identity are not unique to any sector of the Canadian population or to any region of this great country of ours. But the circumstances in which health care is delivered differ across regions, and the health care needs and priorities of these regions will differ. What we have is an opportunity system, where 12 variations on a common set of principles all going at medical problems in slightly different ways provide administrators and practitioners in different parts of the country with the opportunity to learn from each other.

The provinces plan, manage, and operate the health care system, but through the exercise of the federal role and through its transfers to the province, a national health system is the reality in Canada.

There are clearly many important health matters that require national leadership and co-ordination. There would be little to be gained, for example, if the work of the federal laboratory for disease control were duplicated in each province.

Many federal initiatives in the areas of health promotion and disease prevention have stimulated provinces, public health authorities, and non-governmental organizations to work to improve the health of all Canadians. Health Canada also has a special role to play with respect to the delivery of certain health services to First Nations, which will continue until the process of devolving responsibility for self-government has been completed.

After World War II ended, our forefathers and our predecessors, federal and provincial, looked down the road and asked what kind of nation we wanted to have. What kind of health care system do we want to have? What kinds of values do we have? As a country, as a people, and as the Liberal Party, we concluded that top-flight medical care was of paramount importance. We also recognized certain principles of fairness, equity, and efficiency that reflect the ideal of Canadians. Out of all this, our system of medicare was assembled just over a decade ago. It was anchored by the Canada Health Act.

If I may remind hon. members, the Canada Health Act came into being in order to defend the principles that were the foundation of medicare, principles of equal and universal access, principles that were even then under attack by various schemes that allowed extra billing and user fees.

In 1983, extra billing in various provinces amounted to $100 million, a total that had doubled over the previous five years. An erosion of medicare was taking place. The erosion was stopped by the minister in 1984. When there were signs of it restarting in 1994 under the guise of private clinics, it was stopped again by this minister, who has insisted that the federal government will ensure that the fundamental principles of the health care act are maintained.

The minister has said that it is not her intention to preclude the use of private clinics, which are often a cost-effective way to deliver services. She has said though that they have the potential to create a two-tiered system of health care: one level of service for the wealthy and another for the rest of Canadians. This is unacceptable today, just as it has been unacceptable through all the years we have been building and defending Canada's medicare system.

There is no mistaking where Canadians stand on this issue. Canadians want effective federal leadership in the health field. This is evident from the favourable reaction to the minister's announcement regarding user fees at private clinics.

Hon. members who have concerned themselves with the evolution of the health care system will be familiar with the work ofDr. Michael Rachlis. He was co-author of Second Opinion , an influential book that examined the Canadian system. Dr. Rachlis recently criticized the combining of public and private medicare, saying ``it entails a wrong prescription for what is wrong with our health care system and then issues a wrong diagnosis''.

Frank Maynard, former Deputy Minister of Health for Manitoba, warned:

We already have the beginnings of a two-tier system; we should not enlarge it. Health care is not a commodity, so it is not a valid choice to offer the rich faster access to required medical service.

Wendy Armstrong, president of the Alberta chapter of the Consumers' Association of Canada, wrote:

What happens is private clinics choose to treat things with the least risk of complication, least overhead cost and with potentially high volume. It's skimming the cream.

I could multiply these quotations by the hundreds, but I will conclude with only one. This segment is from a letter to the editor published by the Calgary Herald on October 16, 1995:

It is time for Albertans to stand behind the federal government and demand universality of health care. This issue has nothing to do with political affiliation. It has everything to do with preserving a cornerstone of what makes Canada the best country in the world.

That just about sums it up. We are all in it together. For the most part we are all delighted to be in it, because there is no better system to be in, anywhere in the world.

The role of the Department of Health is to sustain and improve Canada's health system, to keep it intact. That is why I support the department, and that is why I support this bill.

[Pierre De Savoye, Bloc, Portneuf, QC]

Mr. Speaker, we know that transfer payments for health and postsecondary education have been reduced over the last several years.

I personally asked the Minister of Health to give me the figures in constant dollars on a per capita basis. There has been indeed a 7 per cent reduction over the last four or five years. Obviously, this has had an impact on the provinces' ability to assume their responsibilities with regard to health.

In Quebec, for example, we know that the Minister of Finance has announced a $1.5 billion reduction in transfer payments for health and postsecondary education for next year. At the same time, we learn that the federal government is going to spend $2 billion to buy armoured vehicles.

There is some type of dichotomy here. I want to believe that we do need armoured vehicles, but health is also essential. Armoured vehicles will not be much help to us when we get sick. There are societal choices to be made.

I know that Quebec would not have made that choice. I know that if Quebec had collected its tax money directly from the taxpayers, it would not have chosen to invest that money in armoured vehicles rather than in health care.

I would like my colleague opposite, if she can listen to me, to talk about the societal choices that are made here, in this House, and that have an impact not only in Quebec but in every province. These are the choices that have Canadians increasingly worried about their province's ability to provide them with the health care services they need, considering the fact that they have paid for these services but, for some reason or other, that money seems to have come to Ottawa on a one way ticket.

How is it that this money finds its way here but is not being returned where it should to fund something as essential and fundamental as health?

Lip service is a nice thing, but here we should do something more. We heard from the MP opposite. I am waiting for your answer.

[Rose-Marie Ur, Liberal, Lambton—Middlesex, ON]

Mr. Speaker, I thank the hon. member for his questions. To reassure the member, I indeed was listening. I had my earphone in and I did understand his question.

I can certainly vouch for the efficiencies within Health Canada as a health care professional. Dollars are being cut and a lot of Canadians are going to suffer.

The member can rest assured that with efficiencies within Health Canada, new technologies and research and development, they enable us to work more efficiently with less dollars and to look at eliminating duplication and look at where services can be done differently. This is the direction we are headed. It does not mean that Canadians will be getting less health care, but that they will get health care that all Canadians can afford, rich or poor. I can attest to that avenue in the health care system or any other department.

[Margaret Bridgman, Reform, Surrey North, BC]

Mr. Speaker, I would like the hon. member to expand in other areas the act covers besides the medicare or health insurance component.

One concern I have is in relation to section 4(2)(a) where it actually says that the department will be responsible for the promotion and preservation of the physical, mental and social well-being of the people of Canada. What I am thinking about here is the social well-being component of the statement. With the removal of welfare from the health and welfare department making it strictly health, does the hon. member not think that addressing the social well-being aspect is being inhibited now by having to deal and collaborate with other departments? Following on that, the Department of Consumer and Corporate Affairs was deleted and a lot of that mandate when to industry.

I feel that the department is being diluted in its ability to address the actual social component.

[Rose-Marie Ur, Liberal, Lambton—Middlesex, ON]

Mr. Speaker, I thank my hon. colleague for her question. We have worked hard at health committee meetings and I understand her sincere question.

There has been sufficient research and involvement within Health Canada to make this diversity within the ministry as to who best can allocate for all Canadians. I believe the right choice has been made by looking at the ministry and the Department of Consumer and Corporate Affairs working in conjunction with Health Canada. It is going to be more productive because of the avenues taken and it will be beneficial to all Canadians.