Debates of Nov. 7th, 1995

Privilege

[Michel Gauthier, Bloc, Roberval, QC]

Mr. Speaker, during question period, when we asked the Minister of National Defence about his complicity with and tolerance for those who celebrated Marc Lépine, the École polytechnique killer, the minister accused the whole Bloc Quebecois political formation and all Quebec sovereignists of being racist.

I would respectfully point out to you that this term is totally unparliamentary, unjustified and unacceptable, and I demand an apology.

[Some hon. members]

Hear, hear.

[The Speaker]

My dear colleagues, if you want, I will check what was said in Hansard , but at this time I do not see this as a question of privilege. I will review what was said and reported in Hansard , and I will get back to the House if necessary.

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 other acts, be read the second time and referred to a committee.

Department Of Health Act

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

Madam Speaker, I am glad to have a few more minutes. Before being cut off I was responding to Bloc Quebecois members yesterday when they stated that the federal government had no right dabbling in health care. They failed to realize that a country must have certain standards. Hopefully the act will provide the standards.

I had experience with the health services of the province many years ago when it brought in a universal health care system. Line ups were so long that patients started paying doctors under the table to jump the queue. We do not want that. It demonstrates that people who have money get the care prior to the ones who do not have money. That is not the Liberal way of doing things and it is not the Canadian way of doing things.

We have heard the Prime Minister and the Minister of Health repeat over and over in the House that whether we are rich or poor we get the same health care, the same health services.

The bill hopes to save taxpayers money by doing things more efficiently, by co-operating with the provinces, the municipalities and the federal government. How can we best deliver health services taking into account today's technologies? People are sent home almost the same day they are operated on or the next day. By using these technologies hopefully we will be able to do things more efficiently.

This morning the Reform Party was jumping up, shouting and saying that there was nothing new in the bill. Its members offered their proposal. Their proposal is the American proposal where over 69 million Americans do not have proper health care. The polls show very clearly that Canadians do not want that.

My daughter just graduated from university and is now working. In the time of budget cuts when we had to reduce our deficit and our public debt I asked her as a young Canadian going out into the workforce who could pay for her health care, et cetera, what she would like the federal government to protect. Her answer was very interesting. Of all things the federal government is involved in she chose health care. She asked us not to touch health care. This is a Canadian starting out in the workforce, having graduated from university.

We are not building Canada for ourselves. We are building Canada for future generations, for our children and for their children. This is why the federal government has to take leadership. We cannot turn it over to jurisdictions where there will be no national standards. We cannot turn it over to a system where in one province we have to pay a lot more for an operation than in another province. Then people start flocking to the province where services are more available.

A personal friend of mine flew in from Florida for an operation in a Toronto hospital. He was a Canadian on vacation in Florida. Unfortunately there was not a bed for him. He had to fly to a Saskatoon hospital but did not make it. Is that the kind of health care we want, or do we want the kind of health care that when I need a triple bypass I get it right away because otherwise it may be too late?

Let us build a country wherein it will not be too late to have an operation. Let us build a country where everyone has equal access when they need it.

[Maud Debien, Bloc, Laval East, QC]

Madam Speaker, I will start with some general comments on Bill C-95 before the House today. I quite agree with the Reform Party's concern about the meagreness of our legislative menu, but our positions converge so far and no further.

This government has made a habit of using ostensibly harmless bills to introduce provisions in which it assumes more and more powers. That is the case with Bill C-95. This bill establishes the Department of Health and amends and repeals certain acts. The purpose of this legislation is first of all to change the name of the department. What could be more ordinary?

After a closer look, however, we see that this bill contains provisions that are quite the opposite of the changes we were promised during the referendum campaign. It is this aspect of the bill, these new measures that are supposed to clarify the mandate of the federal Department of Health and will in fact increase its importance, which are revealing. Clause 4(2)( a ) and( b ) is particularly disturbing.

This clause provides, and I quote:

-the minister's powers, duties and functions relating to health 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;

On the pretext of intervening on behalf of the well-being of the people of Canada, Ottawa could outflank the provinces in an area that is a provincial responsibility. These two clauses in Bill C-95

give an indication of the very broad application this bill might have. It may have serious repercussions.

Need we recall that the Canadian Constitution of 1867 specifically recognizes health as an exclusive responsibility of the provinces? I know this government would rather not hear about the Constitution. That is just too bad. As long as this government keeps violating the Constitution, it will hear about it from Quebec, at any rate.

The federal government's intrusion in this provincial jurisdiction flies in the face of the very principles of Canadian federalism. And then they wonder why it does not work. They are trying to use the power of disallowance, based on considerations such as national interest, peace and good government, and of course the government's spending powers, to again restrict the prerogatives of the provinces.

However, as the federal government tries to encroach on jurisdictions that are exclusive to the provinces, its financial contribution decreases steadily.

In less than 20 years, the federal government's contribution to health care funding dropped from 45.9 per cent in 1977 to an expected 28 per cent in 1997. Finally, to divert attention from its financial withdrawal, the federal government proposed in its last budget a more flexible transfer payment formula under which all the money goes into a single envelope called the Canada social transfer. The federal government announced in the same breath that it would withdraw unilaterally and cut payments to Quebec by $308 million in 1995-96 and by more than $587 million in 1997-98.

The provinces were given the choice of cutting in either education, health or welfare. What a great example of decentralization and co-operation. Talk about flexible federalism. When a government can no longer afford to pay, it must have the basic decency not to try to impose its national standards and objectives more vigorously at the same time.

Since coming to power, the Liberal government has chosen to keep its deficit from growing by attacking social programs and going after the most vulnerable in our society. Yet, it is still trying to pursue Trudeau's old dream of controlling the provincial health care systems through national standards.

The federal government is now getting ready to invade the provinces' jurisdiction through the back door. For example, subclause 4(2)(c) of the bill gives the federal Department of Health the power to conduct investigations and research into public health. You may think that this is a noble objective. But how will the federal government conduct these investigations and this research?

Even though it is not mentioned in the bill, should the federal government have access to all the information needed to carry out its mission? Most of this information is often held by health organizations subject to provincial legislation.

This whole debate may appear pretty technical, but it may lead to many futile squabbles and discussions simply because the federal government does not respect its own fundamental law.

Of course, Bill C-95 shows our federal big brother's commitment to look after the health of all Canadians. It does not, however, tell us what steps the federal Department of Health will take to fulfil these noble ambitions. This is no accident. It is not in the federal government's interests to remind us once again that it is continuing its attempt to encroach on our jurisdiction over health matters.

In fact, on November 2, in the debate on second reading of bill C-95, the hon. parliamentary secretary to the Minister of Health plainly admitted that "its renewed commitment to a long and glorious tradition has inspired Liberal governments, politicians of every party and Canadian people over many years, indeed over many decades". Later, her Liberal colleague, the hon. member for Pierrefonds-Dollard, added that the Minister of Health had, and I quote: "strongly and successfully defended the principles championed for half a century by the Liberal Party, while developing Canada's health care system".

It is obvious that, through Bill C-95 in particular, the Minister of Health is carrying on the work that Marc Lalonde and Monique Bégin started. And after that, we wonder what is wrong with the federal system. Upholding a long and glorious tradition of duplication, overlap and encroachment, now I have seen it all. Just days ago, the Prime Minister promised major changes to accommodate the provinces, and Quebec in particular.

But today, we have before us yet another bill put forward by the federal government, which is doing everything it can to centralize and once again intrude on provincial areas of jurisdiction.

To paraphrase no committee chairman Michel Bélanger, this is the beauty of it. If the government is really committed to reducing the deficit, it should start by eliminating duplication and overlap with respect to health matters. But, on the contrary, Trudeau's followers are carrying on his work. I could mention, among others things, the fact that the department allocates important budgets for programs and projects that already exist in Quebec. Here are some examples: the strategy for the integration of handicapped people, the fight against family violence, the new horizons program, the seniors secretariat, the fight against tobacco, the anti-drug strategy,

the strategy against AIDS, the program on pregnancy and child development, the forum on health, and so on.

What happened to the commitment made barely fifteen days ago by the Prime Minister, who promised that changes would be made?

You will understand that, as an elected member representing Quebec, I simply cannot support Bill C-95.

[Raymond Bonin, Liberal, Nickel Belt, ON]

Madam Speaker, I would like to express my support for Bill C-95.

In this connection, I would like to discuss what Health Canada has accomplished and recall that our country is very proud, and rightly so, of its health care system.

In fact, there is no other system like it in the world. We also have the Canada Health Act, which contains the five basic principles of our system: universality, accessibility, comprehensiveness, portability, and public administration.

Our health system has contributed enormously to our excellent quality of life. Furthermore, co-operation at the international level helps us stay abreast of new advances in health care in many other countries. Thanks to this co-operation, users and providers are informed of what is being done in the rest of the world. All industrialized countries exchange information and, as a result, are able to act efficiently and effectively.

Canada has already introduced a number of measures to help achieve its goal of renewing the health care system. We are reinforcing the community aspect of health care, improving the role of consumers with respect to health care and seeking a more integrated approach to health which goes beyond health care. A large proportion of our present and future interventions is focused on the principal factors that determine our health. A fundamental truth has transpired, and it is that health is more than just care. This is an incentive to understand the complex set of factors that create a society whose members are all in the best possible health.

Governments and communities are examining social, economic, physical and psychological aspects as well as other factors. The work being done in these areas supports and complements the services provided by the regular health care system.

We are beginning to understand the close and complex connections between factors that determine our health, and our decision-making is aimed at improving the quality of health care services. The national forum on health plays an important role in this respect.

In fact, the forum's role is to project a model of health care for the twenty-first century. The forum's team consists of 24 Canadian men and women: health professionals, volunteers and consumers who have come from across the country.

While our appreciation of the complexity of the interrelated factors that contribute to overall health has grown, so too have the challenges in making effective choices about how to allocate increasingly limited resources.

The federal government has taken a leadership role in communicating with all stakeholders, including the public, in terms of the kind of future systems we want and can afford. The national forum on health will play an important role in this regard.

If we are to preserve and improve our health care system we must first decide what is essential. In this regard the national forum on health and other bodies will provide important advice to the government.

One of the jobs of the members of the forum is to engage in honest and open discussions with Canadians about influences on our health and on our health care system in the coming years.

Four working groups have already been set up and are responsible for various aspects: decisions based on convincing evidence, health determiners, values and achieving a balance.

The forum was set up in response to Canadians' concerns, and Canadians are justifiably proud of their health system.

The forum is trying to find ways to improve both the health of Canadians and the effectiveness and efficiency of health care services, and public participation is vital to the fulfilment of its mandate.

Through a range of activities, the members of the forum are informing the public about the problems and the options for improvement of health and health care services in Canada.

The forum's broad public consultation will enable all Canadians to help develop recommendations.

Every Canadian will have an opportunity to express his or her values and convictions.

The federal government is also working in concert with its provincial and territorial counterparts through the conference of ministers of health. One of our common priorities in order to enhance the appropriateness and quality of health care has been to promote and strengthen the use of clinical practise guidelines. We want to orient health care on which practices work best for different groups at risk.

I would also like to point out that Canada is renowned worldwide as a centre for research, treatment and pharmaceutical developments.

Specifically, our country is a leader in the area of chemotherapy. Throughout the world, researchers and practitioners are investing in work of great significance to the millions of Canadians suffering from cancer or an infectious disease, and to those who are at their side in their struggle. The work done so far has had tangible results.

In 1990 approximately 413,000 Canadians who had been diagnosed with cancer within the previous decade were still alive. More than one-third of these people had lived more than five years since their initial diagnosis. Many of them had chemotherapy to thank for their success in fighting cancer. This year alone a further 125,000 Canadians will be diagnosed with cancer. They will look to advances in treatment such as chemotherapy for answers and hope.

In addition to chemotherapy, vaccines play another important role in our public health efforts. For example, while the hepatitis B vaccine is used successfully in the prevention of infection it also prevents the development of cancer of the liver. Another example is the BCG vaccine which is accepted as a therapeutic agent for treating cancer of the bladder and is also known to be used in the prevention of tuberculosis especially in countries where the incidence of tuberculosis is high.

We also know that the appearance of resistant strains in the case of tuberculosis, for instance, is a cause of grave concern among public health authorities.

In a world in which international travel has become commonplace, experience has shown that the progress we have made in fighting infectious diseases within our borders is no longer enough.

These factors are so many reasons why Canada puts such emphasis on health issues. Many of our health care priorities centre on the use of chemotherapy.

Health Canada is both a partner and a facilitator in medical research and efforts deployed in the public health sector in Canada.

This is an indication of the importance of progress achieved thanks to research and the government's resolve to continue this work.

The federal role in research has been generally well accepted in this country. Provincial research programs have frequently developed their own provincial research councils around the federal council to avoid overlap while ensuring their own research goals are met.

One of the best examples of the provincial research model is that of Quebec. Some hon. members may not be aware that one of the chief architects of the conseil de recherches, now the fonds de recherches, is the present Quebec minister of health, Jean Rochon. Mr. Rochon is a former dean of medicine at the University of Laval as well as the chair of the external advisory committee for Health Canada's national health research development program. He is also the author of the Rochon report and has worked for the World Health Organization. I suppose it is not surprising that research in Mr. Rochon's province is so well organized.

Contacts at the international level play a key role in the process. These contacts are long established, and we now have many mechanisms to help us overcome the barriers of time and space and work as a team to conquer disease.

Madam Speaker, just think what Pasteur would have accomplished with the help of Internet! Whether we are talking about cancer or infectious diseases, the entire population of this planet benefits from the co-operation of Health Canada with all concerned. I believe that together we will be able to make the requisite changes in our cherished health care system and bring it into the next century. I think we are on the right track.

I would now like to quote an old Arab saying: "He who has health has hope; he who has hope lacks nothing". With the help of all concerned, Canadians will keep both health and hope.

[Jim Abbott, Reform, Kootenay East, BC]

Madam Speaker, I was particularly touched by the comments of the member for Parkdale-High Park about his friend who on coming back from Florida was not able to find suitable medical treatment in Toronto. He had to go to Saskatoon and unfortunately it was too late.

Few issues treat all of us the same but the issue of health is one of them. All of us are concerned about health not only for ourselves but also for our families, friends and neighbours.

The hon. member for Nickel Belt, who just spoke, said that our country is very proud of its health system. I agree with that. He also said our health service has greatly contributed to our wonderful quality of life. I also agree with that.

The problem, I suggest, is the fact that the Liberals seem to think that they have a corner on wisdom when it comes to health care, that only they have the answers. This is really unfortunate.

I have also listened to the postering of the Bloc Quebecois during this debate. This is the official opposition that the Liberals choose to have in this House of Commons, contrary to anything else they may say. All the Bloc can do is posture about the whole situation with respect to Quebec in this country. It seems to me a shame

when we are actually dealing with an issue that has something to do with all of us.

The member for Parkdale-High Park said we must build a health care system before it is too late. Unfortunately, with the greatest respect to that member and to the Liberals, I say that the status quo as it pertains to medicare as it is presently constructed is not an option and that is the whole problem. The status quo is not an option.

Someone earlier in the debate today said that the Liberals were committed to medicare and to seeing that there are no barriers to access. I suggest that one of the greatest barriers to access is the $7 billion that the Liberals are pulling out of this part of the program.

Let us take a look at health care. The health minister threatens the provincial governments if they choose to try and come up with some new solutions or some different ways of looking at things in the same envelope from which they are taking $7 billion over two years.

The province of British Columbia has decided that it has to take some action because it is being cut back so drastically by the federal government that it again is responded to by the HRD minister with threats.

All of us in the House have times when we have to sit in front of students who are saying, what about the funding for education? We have to say we are sorry but that is part of the $7 billion package that is being cut back.

I suggest that this is not an honest policy. The Liberals are saying they are committed to medicare and yet at the same time they are taking $7 billion out of health, CAP and education. It is just not honest.

The member for Nickel Belt brought up the issue of the forum. He speaks about having a frank and open dialogue with Canadians. What I am speaking to here specifically is that words can become walls because they can create a caricature.

It is the desire of the majority of the Liberal members to create a caricature. They are saying the Reform Party is opposed to medicare, is opposed to saving what the member for Nickel Belt has already said, that our health service has greatly contributed our wonderful quality of life. The status quo cannot be maintained and we are the only party in this House prepared to say that. Let us take a look at what the options are, as opposed to simply rolling back and pulling in the amount of money that is presently available.

The member for Nickel Belt asked the question, let us determine what is essential. What is essential? Are all medical services essential? In what situation is cosmetic surgery essential? In what situation is liposuction essential? In what situation is sex change surgery essential? There has to be a list saying what medical procedures are essential. What is going to be covered by the contributions of people paying taxes in Canada?

I would suggest with the greatest respect and honestly in honour of what the member for Parkdale-High Park had to say about his friend, we must bill before it is too late. I ask him and I ask all Liberals in the House to realize that they do not have a corner on wisdom. They do not have a corner on a desire to see health care maintained and enhanced. In fact, the Reform Party has a plan called medicare plus which opens up a whole new way of being able to get to the root problem. The status quo cannot be maintained. We must make changes and we are prepared to make suggestions for changes.

In summary, I respectfully request that the Liberals within the hearing of my voice today reconsider and realize that they do not have a corner on wisdom. Perhaps we, in the Reform Party, have a couple of ideas that are at least worthwhile considering.

Why will they not co-operate with us in getting into an open dialogue so that Canadians can have an opportunity to have input into this process so that truly we can build a sustainable health care system in Canada.

[Andy Scott, Liberal, Fredericton—York—Sunbury, NB]

Madam Speaker, I am pleased to have the opportunity to speak in support of Bill C-95.

In creating the Department of Health, this bill not only makes good administrative sense, it also makes good economic sense. The concepts of health and economics are intertwined. The health of the Canadian people is vital to the health of the Canadian economy and the health of the Canadian economy is vital to the health of Canadian people.

Our medicare system is based on sound economic principles, the same kind investors look for in evaluating a private sector enterprise. There are four main reasons for the success of this system.

First, our publicly funded system has enormous economies of scale. We have only one insurer in each province that provides standard health insurance coverage to all residents. No risk rating is needed. Payments to providers are simple. Financing the system is streamlined.

Second, our system results in lower overhead costs. Researchers at Harvard have found that Canada spends only 1.1 per cent of gross domestic product on health care administration. The United States with its private health insurance scheme spends about two and a half times that much. If we spent as much as the Americans do on administration, health care expenditures in Canada would increase by $18.5 billion a year. That is more than the entire health care budget for the province of Ontario.

Third, a publicly financed system can ensure universal coverage. That is an important element to a healthy workforce which contributes to a more competitive economy and economic growth. When there are fewer work days lost to illness productivity increases. Healthier people make fewer demands on the system. They live longer and they contribute more to the overall wealth of the nation.

The fourth factor that makes public health insurance more efficient is government's tremendous bargaining power in negotiating the cost of service by setting and enforcing global budgets for hospitals and physicians' fees. This gives government powerful levers to keep health care costs under control. In fact real per capita public health expenditures in this country have been declining since 1993. Estimates for 1994 suggest public spending on health declined in real terms by about 3.4 per cent.

Economic analysis makes it clear that Canada's health system provides major economic benefits. These benefits stem from efficiencies and cost savings associated with public funding.

Our health system attracts investment to Canada and it helps business to compete from Canada. Enormous economies of scale, lower overhead costs, improved worker productivity, tremendous bargaining power and proven results; if you heard, Madam Speaker, of a private company that could point to those attributes you would be rushing off to call your broker.

Our public health insurance system is a major asset to business. It is not a subsidy. It is an efficiency. We have entered an era when the public sector's role is quite appropriately being re-examined. Valid questions are being asked about government's place and the values of public funding versus private funding.

Health care is one area where government is not just as efficient, it is more efficient. It is not by accident that the United Nations rates Canada number one in the human development index. It has taken effort, and the development of the medicare system has been an important part of that.

It is also not surprising that an Environics survey in late 1993 concluded that 79 per cent of Canadians believe it is very important for the federal government to sustain the health system. Medicare, as we know, is an insurance program. In effect we have used our ingenuity, our foresight and tax dollars to create a giant insurance pool covering all Canadians. Health care needs and the related costs that medicare covers would generally exist no matter what system we have in place to pay and as we know health services are never free. Public or private, somebody must pay.

All we have to do is look at the auto industry. For every car that rolls off the assembly lines of Detroit the cost includes an average of more than $700 U.S. for privately funded health insurance. Is it any wonder that the big three automakers have consistently been among the strongest voices for a comprehensive public health insurance plan in the United States? Universal coverage is much more difficult, if not impossible, in a system based on private insurance schemes. We have evidence of that in the United States where fully 15 per cent of Americans are without any health insurance at all.

One fact will put this in perspective. We spend only 1.1 per cent of our GDP on health care administration. That is about $272 per person. The U.S. spends about two and a half times that much, about $615 U.S. per person and not one of those billions of additional dollars goes to patient services.

There is no direct relationship between increased health care spending and health outcomes. Health is determined by a number of factors of which health care is only one. The environment within which we are raised and live in is another. We do not necessarily gain better health from extra health care spending.

With those two facts it is clear that controlling health costs makes sense for both the public and the private sector. The need is to spend money wisely. Our medicare system, through federal-provincial funding, covers 72 per cent of total health spending in Canada, but some costs add nothing to positive outcomes.

The first economic benefit of our medicare system is that we have administrative overhead costs under control. We have one organization in each province that provides insurance coverage, not dozens or hundreds, as in an American state. We do not have the elaborate and costly processes that private insurers need to rate the risk of people or groups.

Think for a moment about private car insurance and the different premium structures for young, old, men, women, experienced and accident-prone drivers. We do not require the intensive control systems private insurers use to monitor premiums and set payment schedules. Simply put, we do not spend as much on overhead.

The relative difference in spending between us and our neighbour to the south saves our economy $30 billion a year. That is why we have large employers, seniors, working people, and health activists warning against the erosion of medicare. They know that costs will increase significantly with a two-tier system. They know another thing: we will all foot the bill.

Hon. members might be interested in another related economic benefit of Canada's medicare system; that is, a better record of controlling costs. Each provincial and territorial government is the predominant buyer of health care in their jurisdiction. This gives them enormous leverage to give the most service at the best price to taxpayers. They can negotiate fee structures and service costs in a

way no private insurer could ever hope to. They can shift spending to achieve more cost-effective outcomes.

In comparison with the public sector record, the private health sector has had little success in cost control. It accounts for more than a quarter of all health spending, and its costs have been growing at more than six per cent per year since 1990. Individuals and insurers in the private sector have found little leverage to bring these costs under control.

Canadians understand this difference. We have agreed as a country to pool our risk across society. We have agreed to let governments work out fair prices as the buyer on our behalf. The economic benefits of our medicare system are something all Canadians can share. We win in the quality of our health care system, which is second to none in the world. We also win in economic terms.

I am proud to support the passage of Bill C-95, which gives a new name to a department that has been working hard and well for all Canadians.

[Ethel Blondin-Andrew, Liberal, Secretary of State (Training and Youth)]

Madam Speaker, today I rise to speak in support of Bill C-95. It is with great pleasure that I do so.

To me the bill symbolizes a fundamental feature of our federation: the ability to achieve an appropriate level of the decentralization of powers between the federal government and the provinces. This is illustrated by our system of federal-provincial transfer payments for health. The system embodies a balance between the powers of the federal government and the powers of provincial governments, which is serving our country well. It provides for the national character of our health system while at the same time recognizing the constitutional jurisdiction of the provinces and territories over health care.

Our system of transfer payments for health has gone through an evolution over the last 30 years, an evolution that parallels the evolution of our health system as overseen by the Department of Health and the evolution of our federation.

In the 1950s, in an effort to foster the development of a national hospital insurance plan, the government passed legislation enabling it to cost-share health programs. The passage of the Hospital Insurance and Diagnostic Act in 1957 encouraged the development of hospital insurance programs in all provinces and territories. Through the offer to cost-share hospital and diagnostic services on roughly a 50-50 basis, the HID legislation allowed the government to share in the cost of provincial hospital insurance plans that met a minimum eligibility and coverage standard.

By 1961 all ten provinces and two territories had public insurance plans that provided comprehensive coverage for in-hospital care for all residents. Then in the 1960s came legislation enabling the federal government to cost-share medical care insurance programs. In 1966 a federal offer to pay about one half of the cost of physician services insurance programs operated by the provinces became law in the medical care act. The act was actually implemented in 1968.

At this point I would like to digress and perhaps bring a more human and local tone to the piece of legislation we are dealing with today. I would like to inject just how important this piece of legislation is to the territory I come from. I could probably exemplify that by using the particular issue of tuberculosis.

In the Northwest Territories tuberculosis is still a major problem, as it is among the aboriginal population throughout Canada. In fact, I am an individual of the aboriginal population who spent 14 months in a sanatorium for tuberculosis, which was the treatment in the early 1960s. There were many other people who also did. It became almost routine that families had members who were afflicted or died from tuberculosis or were treated for an extended period of time.

The rate of tuberculosis among Canadian natives is 43 times higher than among non-natives. According to Statistics Canada, the rate of TB among status natives was 47 per 100,000 in 1993. By contrast, Bangladesh has a TB rate of 43.6 per 100,000. The rate for non-native Canadians across the country was 6.9 per 100,000.

One big problem that has an effect on these numbers is the accessibility to the health system and proper testing facilities. The availability in the north is difficult, often as the result of a lack of proper equipment. Many of the communities where people are afflicted are very remote and very hard to reach.

Lack of accessibility is also a problem for other communicable diseases, such as sexually transmitted diseases. In the north the STD rates are estimated by the Government of the Northwest Territories Department of Health and Social Services at 10 to 12 times higher than the national average.

Life expectancy numbers are another indicator of the general health levels of a population. Earlier this year the National Advisory Council on Aging, NACA, released its report, which contained more distressing numbers for the aboriginal population. A highlight of the report is that life expectancy for native women and men is 47 and 46 years, respectively, compared to 75 and 68 for the non-native population. The median age of the native population is 10 years younger than that of the Canadian population. The native elderly often experience premature aging, leading to death

due to high rates of degenerative diseases. Native people use much more informal care, family and friends, for certain dimensions of life-meals, shopping, et cetera-than non-native people.

The needs of older native persons for core services, for example adult care services, exceed the needs of the comparable non-native population. Aboriginal seniors residing off reserves are frequently excluded from the communities in which they live and the native communities from which they come.

It is also important to note that the Northwest Territories has the second highest alcohol consumption rate in Canada; five to six times the national average in reported violent assaults; and a suicide rate that is two to three times the national average. These are all symptoms, perhaps not directly related to health, but they have a huge impact on the wellness of a community and as a result have a huge impact on the health care system, either directly or indirectly.

The approach in relating this to the whole health care system is to look at preventative health measures. That is the innovation all levels of government are looking at. Organizations, aboriginal, non-aboriginal, those who live in the north are looking at ways of cutting costs, looking at ways of taking preventative measures and innovative measures that are going to help provide a more efficient and effective system that will serve their people.

One difficulty in the north that is taken for granted in southern Canada is interpreters. In many cases, without them a proper diagnosis cannot be made. Follow-up for major surgery is often difficult because patients have long distances to travel, often to the south. Often the follow-up does not take place for three to six months.

Accessibility is often difficult. As mentioned earlier, people often have to travel long distances away from their families, their primary support system, to receive care. Also, accessibility to medicine and prescription drugs is a problem.

We also have another important issue that aboriginal people and non-aboriginal people in the remote regions really take seriously, and that is nutrition. Nutrition and sustenance for those people are very important. The principal objective, for instance, of the food mail subsidy program is to improve nutrition and health in northern communities, which do not have year-round surface transportation. They are mostly isolated. There is usually air service and prices are from 30 per cent to 60 per cent higher.

Thank God for the country food chain that the aboriginal people have sustained for themselves. This is very important. Last year the government extended the program for one year with a budget of $17.1 million pending a review of the program. The north experiences the highest levels of unemployment, poverty, and child malnutrition. This subsidy only applies to nutritious foods that require refrigeration or have a short shelf life, as well as infant formula, infant foods, and non-carbonated water. The cost of living in the north is currently 30 per cent to 40 per cent higher than anywhere else in Canada, and in some areas it is even higher.

We have a great health system in Canada, and we would like to support it and continue it and make it even better, especially for me in my riding in the Northwest Territories as part of Canada.

[Keith Martin, Reform, Esquimalt—Juan de Fuca, BC]

Madam Speaker, I would like to commend the hon. member from across the way for so eloquently describing the plight of the people in her land. Truly, one of the profound tragedies in this country is to see the plight of the aboriginal people, a society that has been wracked in many cases by terrible levels of substance abuse, sexual abuse, interpersonal violence. Health care parameters, whichever way you wish to measure them, are some of the worst in our country.

If we look at the reasons behind this, one of the things one cannot help but look at is employment and being gainfully employed and being able to provide for yourself and your family. The ability to have gainful employment is integral to an individual's self-respect and self-pride. In turn, that imparts a pride and self-respect on the community at large.

A community and an individual cannot have self-pride and self-respect if it is given from somewhere else. They have to take it themselves. It cannot be given by a plethora of social programs from the federal government. These programs, while necessary, are not the answer.

The reason I say that is if you look at the terrible statistics the hon. member from the Northwest Territories has mentioned, you will find that these are mere symptoms of programs and an approach to the aboriginal people in this country that have indeed failed and failed dismally.

We have to work with aboriginal people to enable them to take care of themselves, to provide them with skills training and skills programs that will enable them to be gainfully employed. If we are able to do that, aboriginal people can stand on their own two feet and provide for themselves and their communities. Then, as we just mentioned, the incidence of sexual abuse, violence, STDs and infant mortality would come down.

We have to change our approach, change the direction in which we are looking. This would not be a replacement of essential social programs. Usually we do not have gainful employment in areas that are far removed and very desolate. Sometimes it is possible through the forestry and fishing industries but usually it is not the case.

It is important that aboriginal people be allowed to develop infrastructures and industries that can be self-sustaining in areas appropriate for them. Many northern and remote areas cannot develop sustainable industries that will provide for the needs and demands of people whether they are aboriginal or non-aboriginal.

We are pouring in money to provide for people to live in areas far removed from where they can take care of themselves and their families. This approach must stop because it simply cannot work. Again the duty of the federal government will be to provide aboriginal people with the skills training necessary for them to stand on their own two feet. It is absolutely integral to anybody's ability to have pride and self-respect and to society's ability to have pride and self-respect.

I hope the government does not pursue the same course it and previous governments have been taking for decades. The politically correct thing to say is that we will merely pour more money into social programs and social schemes for aboriginal people, but this will simply not work because it does not address the root causes of why the individuals were there in the first place.

I hope the government takes a very careful look at its programs in the future to try to bring down the terrible parameters among aboriginal people and provide them with the ability to stand on their own two feet in the future.

[Roseanne Skoke, Liberal, Central Nova, NS]

Madam Speaker, I welcome the opportunity to speak in support of Bill C-95, an act to create the Department of Health, because it is through the Department of Health that Canadians express the values that underlie the Canadian health system. I speak of the values embodied in the Canada Health Act, an act which is the responsibility of the Minister of Health and through her the Department of Health.

The Department of Health is instrumental in protecting and preserving the Canada Health Act and with it the values that underlie Canadian society. The principles of the Canada Health Act, universality, accessibility, comprehensiveness, portability and public administration, are rooted in our common values. These Canadian values are equity, fairness, compassion and respect for the fundamental dignity of all. Canadian society has cherished these values for many years and the concern shown recently by those who feel the health system is threatened clearly indicates those values remain strong.

The Canadian concern for the preservation of our health system is heightened when we hear the Reform Party's position on medicare throughout this debate. The Reform Party's position is simplistic and in reality is an attempt to undermine and destroy the five fundamental principles of the Canada Health Act.

The Reform Party's promotion of user fees will not be tolerated by Canadians. The user fee system advanced by the Reform Party will lead to a United States health care system. This is unacceptable for Canadians. User fees will affect accessibility and universality. Universality is not based on insurability criteria or the number of pre-existing medical conditions that exist in a person. All Canadians are entitled to medically required health services.

The first and fundamental principle in our Canada Health Act is universality. All Canadians should benefit on uniform terms and conditions from medicare. Universality really means that we as Canadians believe we are all the same when it comes to health care needs. It does not matter what our health status is or how big our wallet is or where we happen to live in the country. Everyone who needs health care will be treated the same. This is equity. It recognizes our dignity as human beings and shows we are fair and compassionate people.

Accessibility is the second principle. What does it mean? It means that we should not face any barriers in receiving health care, no point of service charges such as extra billing or user charges. Underneath it means that we practise in Canada what we preach. We say that all Canadians are to be treated equitably and we ensure that they will be. The accessibility principle makes sure that no discriminatory measures can be put in place that would result in Canadians being treated differently. All are to have reasonable access to necessary health care services based solely on need.

I call upon the Minister of Health to enforce vigorously the provisions of the Canada Health Act, to ensure that user fees or service charges are not implemented in any riding in any province in Canada. I wish to go on record today as supporting the Minister of Health in her initiatives to protect and defend the principles set forth in the Canada Health Act.

The principle of comprehensiveness recognizes that Canadians have a range of health care needs and those needs should be met. Delve deeper, however, and we see that comprehensiveness means we practise fairness. It would not be fair to ensure only some medically necessary services and not others. For example, it would not be fair to cover only services that cost catastrophic amounts, while leaving other just as necessary services uninsured. Immunization of a child against measles is just as necessary as a coronary bypass operation. Indeed immunization has society-wide benefits.

Throughout the debate the Bloc Quebecois continuously refers to the intrusiveness of the bill into provincial jurisdiction and reminds us of the exclusive jurisdiction of the provinces regarding administration and management of the health care system. The Bloc Quebecois has failed to advise the House of the flexibility that the Canada Health Act provides. Eighty-nine per cent of Canadians

including the Quebecois support the Canada Health Act and the medicare system.

The delivery of health care is a provincial responsibility. Canadians respect this and the diversity that it brings. In the end we will all benefit from diversity because a successful innovation developed in one province can be borrowed and adapted by others. For example, let us look at the CLSCs developed in Quebec, the extra-mural hospital in New Brunswick and the quick response teams in British Columbia.

Innovation has never been as important as it is today. During these difficult fiscal times the health system must adapt and change. It must do this at a faster rate than ever before. Innovation is needed to make sure that the health system continues to adapt to changing circumstances. Pressures on the health system are always changing: changing demographics, changing technologies, changing fiscal situations. The comprehensiveness principle recognizes that health systems must be adaptable and allows for innovation.

The Reformers' approach to medicare simply implies that there is not enough money in the system to afford health care in Canada. They address the issue by compromising fundamental and basic values and principles set forth in the Canada Health Act. This is unacceptable. The user fee approach will lead to a United States health care system that is not to be supported in Canada.

Money cannot be the determining factor of success in a health care system. If money were the major criteria the United States would have the best health care system in the world as it spends 14 per cent of its GDP on health.

Based on OECD statistics United States ranks 14th in the world among developing countries. Japan spends the least amount of money in the world on its health care system and Canada spends 9.4 per cent of its gross domestic product on health care. Managing the system, protecting our values and fundamental principles will allow us to save money and to administer health care more efficiently and effectively.

The fifth and final principle is that of public administration. Our health insurance plans must be operated by provincial governments on a non-profit basis. Public administration is the means by which we ensure all other principles. When health insurance is operated and funded through governments we can easily make sure that health care is universal, accessible, comprehensive and portable because we have direct control over it.

After having heard the debate and comments of the member for Calgary Centre I urge him to read carefully Bill C-95. I draw to the hon. member's attention the words health and welfare. For the information of the House, welfare is now to be correctly directed to the jurisdiction of the Department of Human Resources. Human resources is responsible for employment, training and creating opportunity for unemployed Canadians.

On the other hand, health is to remain within the Department of Health. Through Bill C-95, the creation of the Department of Health, the department responsible for the Canada Health Act, we are affirming the principles and values that we hold dear as Canadians. I urge all members of the House to do the same.

[The Acting Speaker (Mrs. Maheu)]

Is the House ready for the question?

[Some hon. members]

Question.

[The Acting Speaker (Mrs. Maheu)]

The question is on the motion. Is it the pleasure of the House to adopt the motion?

[Some hon. members]

Agreed.

[Some hon. members]

No.

[The Acting Speaker (Mrs. Maheu)]

All those in favour of the motion will please say yea.

[Some hon. members]

Yea.

[The Acting Speaker (Mrs. Maheu)]

All those opposed will please say nay.

[Some hon. members]

Nay.

[The Acting Speaker (Mrs. Maheu)]

In my opinion the yeas have it.

And more than five members having risen:

[The Acting Speaker (Mrs. Maheu)]

Call in the members.

And the bells having rung:

[The Acting Speaker (Mrs. Maheu)]

Pursuant to Standing Order 45(5), the recorded division on the question stands deferred until tomorrow at 5 p.m., at which time the bells to call in the members will sound for not more than 15 minutes.

It is my duty, pursuant to Standing Order 38, to inform the House that the questions to be raised tonight at the time of adjournment are as follows: the hon. member for Québec-child poverty; the hon. member for Kamouraska-Rivière-du-Loup-manpower training.

The House resumed from November 6 consideration of the motion that Bill C-94, an act to regulate interprovincial trade in and the importation for commercial purposes of certain manganese based substances, be read the third time and passed.