Madam Speaker, I am grateful for this opportunity to talk about medicare and the Canada Health Act. I want to explain how and why the government supports medicare and why we on this side of the House will continue to support it.
The Reform Party asks whether we have the will to uphold the principles of the Canada Health Act. There are no grounds for dire predictions that the federal government will not be able to uphold the Canada Health Act or that Canada's health care system will disintegrate as a result of the budget.
Let me remind the House how clear the budget speech was on this matter. The Minister of Finance said no change would be made to the Canada Health Act. The Minister of Health was equally clear when she spoke to the Canadian Hospital Association last March: "There is no change in the government's commitment or in my commitment to uphold and enforce the principles of the Canada Health Act". As the Prime Minister said in Saskatoon, for Canadians these principles are not negotiable.
The new transfers will be a block funding arrangement. That may worry some members but let us not forget that block funding for health and post-secondary education is 18 years old. The established programs financing funding mechanisms put in place in 1977 were a block funding arrangement. There is no requirement for the provinces to spend the money on health. What there is and what was nailed down in 1984 when the Liberal government passed the Canada Health Act is the requirement that provinces deliver health care services in compliance with the five conditions of the act or face a deduction from the money transferred to them.
Nothing in the budget will change the government's technical ability to enforce the Canada Health Act principles. The enforcement mechanism remains the same. If deductions from transfer payments are necessary they will be made.
Canadians can rest assured that Canada's social and health transfer will not reduce federal ability to enforce the principles. We will enforce them because these principles of universality, accessibility, comprehensiveness, portability and public administration are ultimately rooted in our common values. They are Canadian values such as equity, fairness, compassion and respect for the fundamental dignity of all. We will also enforce the principles of the Canada Health Act because they support an economically efficient health care system.
It is worth reminding opposition members the principles of the Canada Health Act are not just words. They have meaning. I want to touch briefly on each of these principles.
The first principle is universality, although residents in a province must be insured by the provincial health plan to receive federal support. What this really means is that we all must have access to services. People cannot be deinsured because they might be costly for the system to cover. We cannot be turned away at the hospital door because we have not paid our quarterly tax bill or provincial premium. If we need health care we will be treated the same as anyone else.
Accessibility on uniform terms and conditions is the second principle. It means we should not face any financial barriers in receiving health care: no extra billing, no user charges, no facility fees, no up front cash payment. If the service is medically necessary we will get it at a time defined by medical considerations, not by the size of our wallet.
Next is comprehensiveness. This principle recognizes Canadians have a range of health care needs and that those needs should be met. Scratch the surface a little more and we see that comprehensiveness again means we practise fairness. It would not be fair to ensure only some medically necessary services and not others. I do not believe we can, nor should we try to, choose at the federal level which service is medically necessary. We should continue to interpret the Canada Health Act as required coverage of all medically necessary services.
The government will continue to take the position that if a province ensures any part of the cost of a service, it is an indication it believes it to be medically necessary and all of the costs must be covered.
Justice Emmett Hall in his original royal commission on medicare recommended a very comprehensive package. Liberal governments of the 1960s, 1970s and 1980s accepted the concept of comprehensiveness, although not quite as broad a concept as Justice Hall's. Liberal governments in the 1990s will not turn their backs on this principle.
The fourth principle is portability. It means Canadians maintain their health plan coverage when they travel or move. The portability principle is rooted in one of the fundamental elements underpinning our federation. It recognizes our right of mobility. Canadians are free to work and travel anywhere in the country without fear of losing their health insurance coverage.
Portability is what makes our national health insurance truly national. Each separate health insurance plan may be provincial in origin but is recognized nationally in every province across the country.
The fifth principle is public administration. Our health insurance plan must be operated by provincial governments on a not for profit basis. In my view this principle never seems to get the same attention as the others but it should. It is at the core of our ability to contain costs in the system and thus to deliver quality care at an affordable price.
One would think that of all five principles, the Reform Party would be able to relate to this one. Public administration is the means by which we ensure all the other principles. When health insurance is operated and funded through government, we can guarantee that health care is universal, accessible, comprehensive and portable because we have direct control over it.
It is through public administration that we also demonstrate our collective responsibility for our health care system. Canadians are responsible for paying for their health care system. We do it collectively through our taxes. We pay so that everyone can benefit according to need. We have agreed to provide this most essential of human services together. We must not lose that.
Public administration also demonstrates something else about Canadians, our pragmatism. We want value for money and administering health insurance publicly is the best way to get it in health care. We need only look to the experience of our American neighbours to compare the efficiency of public administration with private administration.
Not only does public administration make sure more of our health care dollars go toward patient care, government can be more successful than the private sector in keeping health care costs under control.
In 1993 we spent about $72 billion on health care. This represents 10 per cent of our gross domestic product. The public component of that 10 per cent has been growing at less than 2 per cent. Compare that to private health spending, which has been growing at 6.4 per cent.
Over the last three years per capita spending on the publicly administered part of our system has been declining. Since our GDP has been growing, it is safe to predict that in 1994 and 1995 we will come in with less than 10 per cent of GDP devoted to health care.
Saying the federal government wants to maintain the principles of the Canada Health Act is not enough. We have to know the public is behind us. We all know that as politicians we cannot escape the will of our constituents. They put us in office and they can take us out. The same is true for the government. Canadians are all saying one thing to us very clearly: they want us to enforce the principles of the Canada Health Act.
In Canada's health care system there are no first or second class citizens. We enjoy rights and privileges as Canadians that are the envy of the world. We can live wherever we want in Canada and have access to health care when we need it.
The many values that make up Canada's social fabric are reflected in the five principles of the Canada Health Act. They reflect the Canadian concern for justice and equity in our health care system and they are not going to disappear. Canadians, including I am sure everyone in this House, will not allow that to happen.
As I said a moment ago, we only need to compare ourselves with the United States. They have been trying for years to get a health care system. They have a private health care system that people purchase from private companies. They spend between 13 per cent and 14 per cent of their GDP on health care. What does this extra money get them? There are 38 million people who are not covered at all, and millions more are minimally covered. That does not sound like a great exchange: more for less. Therefore, I do not see what good privatizing our health care system will do.
I also want to point out there are countries that have allowed extra billing. I know of one, Italy, that has allowed and allows to this date extra billing and private clinics. However, it may happen that a person is in a public hospital. The doctor will say: "I need to do a surgery, which is very expensive; I can only do it if you come to such and such a clinic, but it will cost you so much money". That is setting up two classes of services: if you pay more, you get served faster, and maybe that specialist will treat you there.
In this country it does not matter if one is poor or rich or even homeless. If you require assistance or surgery you choose the specialist or the doctor who will treat you. That is what a comprehensive and accessible medicare should be about. We need that kind of security, that kind of stability. Our health is the most precious thing we have, allowing us to do all of the other things we want to do. We talk about unemployment. If people are insecure about their health they cannot study, they cannot train, they cannot work.
This gives Canadians a sense of stability. They do not have to worry or lose their homes and become paupers because they are ill or their children or parents are ill.
Yes, we have a new world. We have a much larger population of seniors. We need to look at different treatments. That is true. That does not mean in any way retrenching one bit on the principles of health care, not one bit. I would never support any such direction. We must look at new treatments and new ways of assisting people.
Preventative medicine in this country must become the norm, and not, as it is now, a reaction. We are still treating symptoms in many cases, and not dealing with preventative medicine. If we were to deal aggressively with that over and above the costs we now have, we would lower health costs in this country considerably. We should be looking at how we can improve our medicare system and our health system and its delivery through preventative and other measures, and not diminish the principles of health care. That is totally unacceptable. This government would never support that.
We need to redouble our efforts to make sure even programs like psychiatric services are considered to be fundamental services. We have far too many children who are on waiting lists. Yes, a province has decided that is not a necessary service.
Maybe we need to look at that. It is a preventative service. This is what I mean by looking at innovative ways of dealing with the cost of medicare, not denying Canadians the right to access medicare.