Madam Speaker, I rise to speak with a mixture of emotions. There is some confusion, some humour, and some sadness.
I am confused that members of the third party would bring forth this kind of motion when it so clearly contraindicates everything they have ever said in the past during their campaign and even during their proposed budget earlier this year.
There is some pleasure because I am proud to be able to speak for the system of health care we are espousing in this country and in which we so firmly believe. And there is a little sadness because one of the movers of this motion is a physician and has shown such a lack of understanding of the system, the words, the terminology and the principles that medicare is all about. It saddens me that he should rise to speak to this motion when he so obviously does not understand the system. I would like to know why he does not understand it.
What we have heard is simplistic rhetoric. It is the kind of thing we have come to expect from the third party: there is always a simple answer; let us not confuse the complexity of the question, let us just throw a simple answer at it.
What is so simplistic about it and what is so rhetorical about it is in terms of the statement of the problem, which is not factual. The statement of the problem is not based on fact at all. As the Minister of Health said when she spoke earlier, the figures quoted, which indicate a decrease in the percentage of payments to the provinces from the federal government, are absolutely untrue. The statement talks about total health care cost. It does not show any understanding of what the cost the federal government contributes to, as written in the established programs financing, is all about. That cost is purely for hospital and physician services. It is not for the whole bailiwick of health care services, which each province has expanded or constricted as it feels it wants. That is not what the federal government sends the transfer payments for; it is purely for physician and hospital service. That is the first bit of disinformation that came about in this.
The second thing that is simplistic and rhetorical about the whole thing is the solution, the constructive alternatives we were given. They have absolutely nothing to do with ensuring efficient, universal, affordable, quality health care in this country. Universal quality health care is far more complicated than giving a cute, uninformed speech. It is a complex issue.
Let us look at the preamble of the speech made by the hon. member for Calgary Southwest. He talked about the fact that we already have a multi-tier system. That alone shows a lack of understanding of what is meant by the term comprehensive, which is one of the five principles of medicare. It shows a lack of understanding of what medically required services means. It shows a lack of understanding of what the terms universality and accessibility actually mean under the Canada Health Act. The hon. member did not even read the Canada Health Act. He does not even understand the definition of the terms.
The whole idea of having a multi-tier system is one of the usual red herrings that are thrown at us. Of course we have systems where there are always and have always been non-medically required services that patients pay for. They have always paid for them. If anyone wishes to have a face lift, they can always pay for one. There are many instances where people think they want something that is not medically required and they go out and buy it. That does not constitute a multi-tier system; that constitutes a system that operates outside of what the Canada Health Act defines as the five principles of medicare. The hon. member should go back and read the Canada Health Act.
The other thing the hon. member said in his preamble was that users should define full services. Users define full services? I do not know that many patients would want to define what an essential service is and what a medically required service is, because they are not physicians. They may want to participate in the decision making of what is appropriate in the treatment, but they would not want to define what is clinically necessary and clinically required for them. That is why they go to a physician or a health care provider. That alone seems to me to be a rather simplistic and very impractical solution.
What else do we have if we have started off with the first part of the motion being based on a false premise? The whole scaffold on which the argument is based is nothing more than
smoke and mirrors. It is a weak scaffold because it is based on lack of fact, lack of information, and lack of knowledge.
The hon. member said that we talked earlier on about the 50 per cent the federal government is supposed to transfer to the provinces.
As the minister and I said earlier, we were never supposed to transfer 50 per cent. In 1975-76 we transferred 39 per cent of total health care. That 39 per cent constituted a greater percentage toward hospital and physician services only which is where it was supposed to go. Therefore, the rest of it is nonsense.
That has not gone down a great deal when we look at the fact that in 1992-93 the total percentage of transfer has gone down to 32 per cent and the provinces have expanded their total pot. That again is a false presumption of what the percentages should mean.
There again I think the mathematics and the understandings were not done. If the figures were wrong and the assumptions were wrong, is the whole concept we are debating today wrong? It must be because it is based on a false assumption and a false concept.
Everyone is saying that we need more money for health care. The concept of more money does not seem to sit well with the third party. The leader of the third party said in his budget speech and in fact said in Saskatchewan that he would transfer more tax points to the provinces. He would give them more money.
Simple mathematics, and I am not a mathematician, tells me that in taking away from one side of an equation there is surely a corresponding addition to the other side. Therefore, if we take money away from our big pot to give more tax points to the provinces, what the hon. member did not factor in in his budget speech is that he is going to be $10 billion deeper in the hole in the deficit. How does that make sense with fiscal responsibility and cutting the deficit to zero in one year that we were talking about? It does not make sense. None of it makes sense.
It is widely recognized as a fact that anyone who understands health care economics knows that throwing more money at health care is not the answer. In fact the quality, the outcome, the efficiency and the effectiveness of a health care system does not depend on money. If it did, the United States which spends the most amount of money not only per capita but as a percentage of GDP on health care would have the best health care system in the world. However, it does not.
At the moment the country that ranks the highest for having the best health care system in the world is Japan. It spends a lot less money than Canada spends as a percentage of GDP. Money and a good system do not equate. Money in a health care system does not equal outcome.
We know that many other things determine whether people are healthy or not. They have to do with socioeconomic factors, environmental factors, lifestyle factors and quality of life factors. None of those things are part of giving people more medical care. We can give people more medical care and we will not decrease those outcomes one whit. Throwing money at the health care system is not the answer.
The challenge is how wisely we spend the money we put into the health care system so we can use the money for the socioeconomic and other issues that determine health. It is one of the big challenges we have to look at when we talk about health care.
Let us look again at the third party using money as a criteria for effective and efficient health care services. If we talk about that then we are talking clearly about the fact that if one cannot afford the health care system and more money has to be thrown at it then people must pay for the health care system. Therefore, we are back to this hidden or not so hidden agenda the third party is talking about which is in fact finding a way to get the user, the person who is sick, to pay for their health care.
It is a not so clever plot to say the system needs more money, the system needs more money, the system needs more money. Then we are going to have to say that if we are going to balance our budgets, and we cannot find the money from government, let us charge the people, the ill. Let us tax them. That is what is so underhanded and so disturbing about this motion, the whole concept that is underlying what we are talking about here today.
It is a typical mentality that comes from people who espouse a south of the border policy on health care. We look at the United States and the kind of health care it gives. Yes, there is a two tier system there and yes of course people are allowed to buy health care but it is based on one criteria, the pocketbook. Those who can afford it can have unlimited access to health care. Those who cannot afford it, we see what the outcome is.
At the moment the United States is sixth among the developing countries in its health care outcomes. It does not have the health care outcomes of a developed country because those who cannot afford it, with poverty being the major determinant of health, those people are sicker.
That is the way the Reform Party would have us go and it concerns me. In fact, if we give the rich unlimited access to health care what we see is that the number of interventions and the amount of laboratory tests are greater as a percentage of users in the United States than it is in Canada. The people who are using them more are based purely on the people who are in a
high socioeconomic bracket. In other words there are people who are having care and interventions.
Open heart surgery is one example. The rich are getting more open heart surgery. It does not fulfil the criteria of whether they need it or not. The fact is they want it, they want to buy it and they are getting it. I do not consider that to be good medicine and I do not consider it to be good health care. I do not think we want that situation in this country.
Let us look then at the solutions the third party recommended. The solutions it talks about are core services. We all know on reading the Canada Health Act and if we understand the principles of medicare, that the definition of medically required services is a provincial jurisdiction. The provinces have to define medically required services. This is a good thing. The provinces are where the regional disparities lie. Different provinces have different health care problems. Different provinces have different needs.
We talk about bottom up care. It is appropriate to have the provinces deciding. That is what we have tried to do when we have discussed how we give the provinces more decision making in health care. It is to allow them to provide appropriate services for people where they need it, when they need it and how they need it. They know that better than the central government.
We believe our role to play as the central government is to bring about and co-ordinate what it is we see within the principle that those medically required services are based on clear clinical guidelines. This is why the health forum was set up. The health forum is dealing right now with how we define, how we look at outcomes. It is dealing with how we look at what is the care and the criteria necessary to provide those outcomes so that we are not guessing as the hon. member for Macleod would have us do and set all sorts of criteria for who should get it and what a core service is.
The hon. member for Macleod has decided that a core service should be something that is on a list of items. A core service is not an item. If we take for example the item of ultrasound for pregnant women and say that only one ultrasound will be done on a pregnant woman, that does not make any sense. Some pregnant women clinically require more than one while others only require one.
We need to look at clinical guidelines when we talk about core services, not whether the item is a good idea or not, not to generically define items. That will not give us good care.
Nor should it be like the hon. member for Macleod said to the Calgary Herald when he defined who should get health care and who should not and that if a woman in her past history had been promiscuous and had her tubes blocked she should not have a tubal ligation paid for by the government. What sort of subjective, moral, paternalistic health care system are we talking about here when we want to define core services that way? That concerns me a great deal.
We also hear terms like private insurance. We all know from the United States and Robert Evans of UBC has shown us very clearly that multiple insurance systems and multiple payer systems are more expensive. They are more inefficient and in fact do not create the right kind of outcomes.
The United States has multiple payer systems. The administrative costs are 25 per cent of the health care costs. Recent studies have shown in the United States that if that 25 per cent on administration could be rolled into a single payer system, there would be enough money to give health care services to the 37 million Americans who do not have it right now. If the money spent on Massachusetts Blue Cross alone could be decreased in administration there would be universal health care in the United States.
When we talk about health care and about multiple systems, we are talking about greater costs. We are talking about defining who can no longer be insured because they are now chronically ill.
In the United States someone who is chronically ill becomes uninsurable. Even if that person has millions of dollars to buy insurance, he cannot buy it. That person has to pay out of his pocket. That is okay if he has millions of dollars but someone who is a middle income worker cannot.
The other term "benefactors to pay" as I see it is a nice term for user fees. We are hearing all these little words that have been put in so that it sounds wonderful. We are talking about a two-tier system that in this country does not define what we see as health care.
When we talk about health care we are talking about looking at how we can save money on health care costs. Recent studies at the University of Ottawa and Judith Maxwell have told us that we can save $7 billion a year in health care costs if we do some real things. For example we could shift from hospital based care to community based care. We could look at how we set clinical guidelines for care. We could look at how we help the determinants of health so that the socioeconomic factors that create illness in people are decreased.
There are many things we can do to decrease health care costs without changing the five principles of medicare, without having to make people who are sick pay. The only way the third party can see for solving the problems is to define core services with the kind of hidden agenda it is defining. Reformers are talking about user fees and multiple insurance systems.
What is wrong with that solution is that every system of health care in the world is based on some sort of rationale. The rationale in this country has to do with clinical need and that is the way we want to keep it. I do not ever want us to see where the rationale for our health care system is the pocketbook. There-
fore I strongly speak against first and foremost the problem which is not factual and also the solutions put forward this morning by members of the third party.