There was a promise to provide a new blueprint for social reform. It was broken without apology or explanation when the Minister of Human Resources Development failed to deliver his green paper.
There was a promise not to increase the tax load on the long suffering, overtaxed Canadian taxpayer. It was broken to the tune of $500 million a year with the imposition of a 1.5 cent a litre tax on gasoline.
There was a promise of a more open Parliament where MPs would be free from party discipline. It was dictatorially broken when Liberal MPs who voted against the government's gun control bill were stripped of their committee positions.
The first part of the motion we are considering draws attention to yet another broken Liberal promise, one of the most serious of all. For the benefit of members, this is the connection between broken promises and the motion.
When national medicare was introduced at the federal level by a minority Liberal government 30 years ago, Prime Minister Pearson solemnly promised Canadians, the provinces and the House that the federal government would pay 50 per cent of the costs. This was the fiscal promise on which medicare rested. This was the condition insisted on by the provinces and promised by the federal government, a promise without which the provinces would not have agreed to national medicare.
The Liberals even wrote that promise into the old 1966 medical care act, section 5, which stated that "the amount of the contribution payable by Canada to a province in respect to a medical care insurance plan is an amount equal to 50 per cent of". It then went on to list the various cost components of the plan.
What is the state of that sacred promise today? Today the federal government's contribution to health care funding is not 50 per cent as promised. It is now less than 23 per cent and falling.
The Prime Minister and the health minister can profess their undying commitment to the principles of medicare until they retire from public life clutching their two-tier MP pension. The truth of the matter is that every day, every hour in every province, in every community, in every part of the country, whenever and wherever Canadians draw on national medicare, the government is breaking its fundamental promise to pay 50 per cent of the bill.
Because it is breaking that fundamental financial promise it is slowly undermining the other principles of medicare. It undermines accessibility as waiting lists get longer and longer. It undermines comprehensiveness as more and more health services are delisted from provincial insurance plans. It undermines universality as the system evolves into a multi-tier system with access to the various tiers being tied increasingly to ability to pay.
The second part of the motion before the House proposes a solution to this dilemma, which I will get to in a moment. Before I do so I would like to clear away one of the myths of medicare, a myth to which the Prime Minister and the health minister cling, a myth which prevents a clear diagnosis of the problem and the solution. That myth is that Canada has a one-tier medical system to which all Canadians have universal access regardless of ability to pay and opening up the Canada Health Act will lead to a U.S. style two-tiered system where ability to pay is the key to access.
The indisputable fact is that Canada already has a multi-tiered health care system, access to which has been made more restricted by rising health care costs and declining federal support. The challenge is to reform medicare so that one of those tiers contains all the essential health services required by Canadians, financed by sufficient federal and provincial funding so that no Canadian is denied access to those services because of inability to pay.
How to do that I will discuss in a moment. Lest there be some simple minded folk among us who still cling to the notion that Canada still has a single-tiered medical care system, let me submit evidence to the contrary.
I could quote from the exhaustive 1994 health care study by Dr. Ralph Sutherland and Dr. Jane Fulton entitled "Spending Smarter and Spending Less". On pages 98 and 99 of that study, they discussed the myth of the one-tier system and dismiss it as nonsense. They end by saying that the two-tier system is and always has been a reality in Canada.
They then go on to discuss how to make a multi-tier system work for the benefit of all Canadians which is the real challenge and real problem. Rather than quote extensively from the academic or technical literature, I prefer to share with the House a note I received just yesterday from a Canadian physician to whom I put the question, does Canada presently have a one-tier or two-tier system?
He says flatly that a two-tier system already exists. Should a person be admitted to a hospital, he or she can obtain a private room should he or she have the funds to pay for it or an insurance program that covers it. Otherwise this is not available.
People can hire a private duty nurse for 24-hour care if they can afford to pay for it. Many nursing and home care services are also available should the patient be able to afford to pay for them.
Recently midwifery has been introduced. Again this is only available to those who can afford to pay for these services. People can have access to procedures such as abortions in private facilities if they are able to pay the private facility fee.
People who can afford to may have an insurance plan to cover the cost of pharmaceuticals. Those who cannot afford to pay this fee must pay for it out of their own pocket.
The Workers' Compensation Board in this province has contracted many private facilities to provide services for its clients in order for them to obtain these services more quickly than possible in the public system and thus get them back to work in a more timely fashion.
Members of the military have been flown to the base hospital in Ottawa to have surgical procedures performed rather than being on a waiting list. I have also recently learned that the military purchases surgical procedures such as arthroscopies at private clinics as it is cheaper than purchasing the same procedures through the public sector.
As well, we all know the ultimate two-tier system is available to those who can afford to pay for it by leaving the country and having services provided in the United States.
Many leading edge technologies and therapies are not available in this country. In order to obtain them one must leave the country and purchase them in the U.S. A country of our stature should be ashamed of the fact that it is not able to provide those services.
He concludes by saying: "As I hope is demonstrated by the above examples, almost all aspects of health care in Canada are two-tiered and available to people on a private basis except for the physician's services. This and certain procedures which are only available in public hospitals are the only services that are not presently available in two tiers in this country".
Why on earth the Prime Minister and the health minister would continue to deny the existence of a multi-tiered health care system or to pretend that the five criteria of the Canada Health Act preclude such a system is beyond me. Childlike belief in the myths of medicare at the highest levels of the federal government must end if the problems of Canadian health care are to be resolved.
The second portion of the motion before us indicates the way in which Reform believes the government could guarantee universal access for all Canadians to a set of essential health services regardless of ability to pay in a multi-tiered system.
In order to provide secure funding for health care into the 21st century, substantive discussions and negotiations are required among all the key players: representatives of health care users, taxpayers, health care practitioners, health care administrators, health care insurers, the provinces and the federal government.
Reform proposes that these discussions and negotiations should focus on completing a health care funding matrix such as that shown on page 48 of the Reform taxpayers budget.
This is the type of framework for refinancing health care, saving medicare, which the Prime Minister and the federal government should have provided through that national health care forum which they have not. This is the framework required to produce meaningful amendments to the Canada Health Act, amendments which the health minister continues to fail to provide. This framework suggests that the first item on the agenda should be a discussion of how best to divide essential health services into core services and non-core services.
The core services would be those health care services most essential to Canadians, the financing of which would be guaranteed by the federal and provincial governments up to some minimal national standard. They would be those services which make the most demonstrable contribution to improving the health of Canadians and which must be provided in the most cost effective way possible.
These core services would constitute the heart of medicare. All Canadians would be guaranteed access to these services across the country up to some national standard regardless of their ability to pay.
Provinces and individuals would be allowed to provide and secure services that went beyond the core services if they so desired. The federal government would not be involved in the financing of such services.
Services designated as non-core services, for example, cosmetic surgery as distinguished from more necessary surgery or
fibreglass casts for broken limbs as distinct from plaster casts, would be funded through a more flexible combination of funding sources, including private insurance and user pay.
To those members opposite who will challenge us to elaborate on what should be considered core and non-core services, I would invite them to listen carefully to my medical colleagues, the member for Macleod and the member for Esquimalt-Juan de Fuca, and ask questions at the end of those remarks.
I would encourage all MPs to refrain from getting too deeply into that discussion. It is not our role in the federal Parliament, either constitutionally or practically. It is not the role of a distant federal government that is paying less than one-quarter of the bills to define those services. That is the old way. It is the top down way. It is the Meech Lake approach to medicare. It is the centralizing way and it is not the way of the future.
The definition of those services must primarily come from health care users, the people who use them, from the practitioners who actually practice them and from the administrators at the local and provincial levels. We should do everything we can through parliamentary committees, personal speeches and dialogue, through the national health care forum to facilitate those discussions and to listen. But we should not try to dictate the final division of services.
After those discussions occur, our role will be to commit federal funding to whatever Canadians define as core services, up to some minimal national standard in co-operation with the provinces.
There is no question in my mind that there is an urgent need for health care reform in Canada, particularly in light of the failure of the federal budget to eliminate the deficit. These reforms are required to preserve the best features of the present system; to prevent the funding system from being completely destroyed by interest on the debt; to provide flexibility to allow the provinces' health care administrators and physicians to better adapt to the health care needs of Canadians.
Canadians are asking and will continue to ask: From whom is the leadership for health care reform going to come? I would suggest it is not coming from the federal government under the current Prime Minister or health minister. They resist every proposal for change. They resist the diagnosis that would lead to real proposals for change. They charge anyone who advocates change with being an enemy of medicare, which is a reactionary position, or a proponent of U.S. style health care, charges which are completely untrue. They are only dragged into the discussion of health care reform at all by their officials telling them that if they do not do something, the system is going to collapse and they are going to carry the blame.
Therefore I suggest that the leadership for health care reform, and it is occurring in many spheres, where the public is now ahead of the politicians and the government, must come from the patient user community, from taxpayers, from the medical community, from administrators and local governments, from provincial authorities, from the bottom up, not the top down.
If in 1960 Ottawa had had the monopoly it has today on setting terms and conditions of health care services and financing, the present medicare system would not have come into being. Canadian medicare did not start in Ottawa. It did not start anywhere near Ottawa. It started in Saskatchewan and it really started there in an operational sense with the Swift Current Hospital District in that province.
The concept was incorporated by the old CCF into its political platform and then stolen by the federal Liberals. I can assure concerned citizens and real health care reformers across the country they will find allies and advocates of sensible change to the health care system in the Reform caucus.
I urge all hon. members who wish to save and advance the best features of Canadian medicare to support this motion.