This kind of approach by the Reform Party of cost cutting simply will not work.
I call the attention of the member opposite to a recently published book entitled Public Finance in Canada . It states that increased cost sharing in government medicare plans, where the policyholders can afford them, have great potential for reducing health care spending. However, it adds for such plans to be effective governments will have to ban the development of supplementary health insurance that will turn the patient's share of cost into a third party payment.
Simply put, increased cost sharing will have to be made mandatory and applied to all insurance plans, public and private, which would require increased government regulation of the health insurance industry.
I am perplexed that the Reform Party with its penchant for less government involvement is now calling for the very opposite. Is this a deliberate change of policy or a lack of understanding of the dynamics of health care financing in Canada?
The Reform Party is proposing a return to user fees. One very noted Canadian health care economist said that this is like a zombie, not to be resurrected again. User fees deter necessary care just as much as frivolous care. Reformers are showing signs that they have not even read the literature.
I am proud to be a member of the Liberal Party of Canada, which in 1919 conceived the idea for a national medicare plan. It is a party that in government gave birth to its reality. It is a party that when in government again nurtured and restrengthened the national health policy with the passage of the Canada Health Act of 1984. It is the legal centrepiece of our medical system as we know it today and a system that bans user fees and insists on equal access for all citizens regardless of their financial means.
The proposal by the Reform Party might not pose a problem for those with six or seven figure incomes but for me, for my Winnipeg North constituents and for the vast majority of Canadians it is utterly unacceptable. Inevitably we would be left with a system in which only the financially fit would survive. That sort of social Darwinism is anathema to the government.
The government is not looking to make Reform Party style compromises where the health of Canadians is at stake. Yes, this government has acknowledged the need to contain health care costs, which in 1991 were roughly equal to 10 per cent of the gross domestic product.
The difference between the government approach and the policies embraced by the party opposite is that the government is not prepared to surrender the principles of medicare to fiscal constraints but instead is working to balance fiscal responsibility and the preservation of medicare.
The solution is not easy. The government believes in a more imaginative approach than simply wielding a broad scalpel and cutting away indiscriminately at medicare as the Reform Party proposal would do.
Utilizing alternative modalities to achieve desired health outcomes and substituting equally effective lower cost treatment approaches for the traditional are parts of a strategic approach to meaningful reform of the health care system.
For example, more patients could be managed at home on an outpatient basis rather than in hospital. Patients could be encouraged to see their family physicians before consulting specialists. Medications could be used instead of surgery where possible. Other health care professionals could substitute for medical doctors in defined areas of treatment. Some of these approaches may require legislation to ensure that health care professional substitution does not compromise standards.
Another means of controlling expenditures without compromising quality of care involves eliminating costly waste in our system. Just as certain established medical routines, such as annual physicals and routine chest radiographs of tuberculosis patients on follow up have been discredited as effective and efficient health policies, other diagnostic and therapeutic routines should be scrutinized. There could be a greater reliance on physiotherapy and less on orthopaedic surgery.
Physicians should not hesitate to debate the issue of human resources supply in relation to the per capita needs of the community nor the issue of arranging funding so that moneys will be allocated according to patient needs and not the provider's level of activity.
All of these elements and many more constitute an effective health care reform strategy which would ultimately yield greater dividends for all Canadians in contrast to the quick fix, multi-tiered system the Reform Party proposes.
The government has positioned itself as a staunch defender of medicare as we know it but that does not mean it is committed to the status quo. It means that the government will continue to explore creative and cost effective options for maintaining health care for all Canadians in accordance with the five principles of medicare.
That is why the government has launched the National Forum on Health chaired by the Prime Minister. That is why the Canada health and social transfer program is now being negotiated between the provinces and the federal government, giving provinces the flexibility to deliver the health care system but, at the same time, maintaining the five principles of medicare. Then and only then can we ensure the crown jewel of our social programs survives and is strengthened. We can also ensure the quality of health care for all Canadians, rich or poor.
In conclusion, I appeal to the Reform Party to withdraw its motion rather than face the certain defeat it merits from the majority of the House, who have been sent here by the vast majority of Canadians to be their voice and their guardians and to defend, preserve and strengthen medicare.