That, in the opinion of this House, the government should consider allowing the provinces greater flexibility in the provision of health insurance and services.
Mr. Speaker, the request in my motion is simple. The Reform Party, like all Canadians, Canadian political parties, Canadians working in health care and a multitude of other Canadians, including the provincial premiers, recognizes the provinces have been delegated legal and constitutional responsibility to provide health insurance and services in Canada.
As the provision of health services and insurance has been delegated to the provinces, I am asking they be given the authority to achieve it or to carry it out.
The actual delegating of this task is not the hard part. The giving up of the authority over the actual control of how the task is carried out is the hard part. Unless the delegator, the federal government, is willing and able to devise the plan, update it as necessary and authorize each aspect of it prior to its implementation, in which case this is not feasible, the delegator must be prepared to delegate out some authority and in order to achieve what they want they identify what is to be achieved by the provinces, what components or principles are to be included and what standards of performance are expected. Then they give the authority necessary for the provinces to achieve this.
As a national government we can legislate these guidelines, standards or principles, or both, or whatever else we should call them. We have done this via the Canada Health Act. We have established five fundamental principles to be incorporated by each province in its approach to providing health insurance and services. The principles are accessibility, comprehensiveness, portability, public administration and universality.
The Reform Party believes these are sound national principles. The problem is not the principles themselves but the accompanying description or definition applied to each of them. For example, in the act the definition or interpretation of accessibility includes only one aspect of what access to care can actually mean, based on a person's ability to pay. That is commendable, as it opens the door for all Canadians regardless of their personal financial position to receive or have access to health care.
However, another aspect of access is when does one have the access to the actual treatment necessary for the condition one is presenting. I am thinking now in relation to the when part from a clinical or medical point of view. If a person requires a hip replacement, for example, or finds a lump on their body in some area it should not be, to get access to treatment can take sometimes weeks or months. Access to treatment from a medical and clinical aspect is extremely important, sort of the stitch in time premise.
Early intervention in many situations saves future grief and discomfort for the individual as well as saving health care dollars in the long run, as one is addressing or presenting a condition much earlier than one would be by leaving it for months or weeks and so on.
There are other problems with the Canada Health Act. There are restrictive clauses that create these problems. Portability comes to mind as another one.
These problems must be addressed and resolved. The act needs revising and updating, allowing for more flexibility for the provinces not only in the administration and management of the service but also in the actual meaning or interpretation of the five principles. The meaning of decentralization of authority must play a much larger role in our health care system to preserve it.
In the Financial Post on April 22 of this year an article was written by Alan Toulin entitled ``Decentralization Appeals to Canadians' Desire for Control''. Alan Toulin is saying Canadians want more control over the things that directly affect their lives, and governments at all levels are feeling the pressure of this growing public sentiment.
He also quotes a leading business figure from Quebec, André Bérard, the National Bank chairman and chief executive officer.
Mr. Bérard apparently delivered a speech in Ottawa on how the process of decentralization is an inescapable force for both businesses and governments at all levels.
Mr. Toulin makes reference that Mr. Bérard argues that those levels of government responsible for the spending of the money are the ones who should decide how health care, education and income security should be organized:
Citizens are more vigilant and can have more direct control over the actions of provincial and local governments when it comes to the spending decisions on behalf of the public interest, Mr. Bérard believes. In a country as large and diverse as Canada it is clear that many citizens feel Ottawa is a remote, lumbering government that cannot be controlled by them.
"The nearer the level of government is to the citizens, the more merciless these citizens are when they see public waste. They know that they are the ones who will ultimately pay. They are merciless because they know that they will have real power; that their voice will be heard; that their vote will not be diluted by millions of others", Bérard said.
He goes on further to sing the praises of decentralization.
That is basically what we are saying in this motion. There needs to be more flexibility. That kind of authority can go to the provinces and they can get on with providing health care according to the five major principles. Then they will be evaluated by the people in the province.
Another component in the health care system that needs some serious revamping is funding. The initial agreement between the federal government and the provincial governments was a 50:50 split. Over the years that has eroded. We have a system of tax points and cash payments known as established program financing. Because the tax points grow over time as the economy grows, the cash portion of EPF is shrinking. It is down to 23 per cent now from 50 per cent.
Established program funding was introduced in 1977, replacing the cost sharing of post-secondary education and health care with a fixed per capita block funding transfer. That was the first time federal funding growth was unrelated to provincial program costs. It was designed to increase the rate of growth in population and in the national economy.
Over the years further amendments were brought into the EPF system. In 1986, Bill C-96 reduced the growth of the EPF transfer. The payments were still tied to economic and demographic growth but their annual per capita growth rate was 2 per cent lower than what it would have been under the old formula.
In 1991, Bill C-69 froze the EPF transfers at their 1989 levels. That was to be applicable for two years. In 1991 Bill C-20 extended the freeze on the per capita transfers to provinces for another three years. Therefore the provincial entitlements will continue to increase at the same rate as the population.
Beginning in 1995-96 the rate of increase of the EPF entitlements will be limited to per capita rates of increase in the GNP minus 3 per cent. We continue to play little games in the funding component of our health system.
Instead of just health and post-secondary education in the block transfers, government has added welfare into the block. From an article on April 13 in the Globe and Mail entitled ``Ottawa is trying to heal health-care strife'', by Edward Greenspon, he says:
Part of the logic of lumping the three programs into a single fund was to allow Ottawa to blur their minds of where cuts fell and to pass to the provinces the hot potato of how to distribute the pain.
Further along in the same article, he goes on to say:
Figures in the budget show that Ottawa will, in fact, reduce its cash transfers over the next three years to $10.3 billion from $17 billion, a rollback of almost 40 per cent. And the government has given no assurances of when it will end.
Federal funding in support of health insurance and services should be unconditional and should recognize different levels of economic development in the provinces.
The federal government has established five fundamental principles via the Health Care Act. It needs to be looked at from the point of view of interpretation. It is a little ambiguous in that the government can interpret it one way and the provinces can see a different interpretation. We also need to look at whether we actually need the cash component of the EPF as a whip to keep the provinces in line. Is that really necessary?
In the article to which I made reference, I beg the question whether it is actually necessary to have that kind of control over the provinces. If one decentralizes it into the provincial area, the people will rise up and say what they want. If they are not happy with what they are getting, especially if they have the five guiding principles from the national government to make some sort of evaluation judgment, they will rise up and tell their government to spend their health care dollars with less waste or they can vote the government out and get one which will provide the services.
Put the control there. Let the provinces establish the methods of providing health care according to the five basic principles, and define them a little better so they are not ambiguous interpretations, and let the people judge whether they are satisfied.
In the Ottawa Citizen on May 1 an article entitled,
Time for a tonic'' stated:The provinces-are demanding more leeway in controlling their costs. And increasingly, provincial cost-cut-
ting measures are running afoul of the federal government's reading of the Canada Health Act".
To my mind the word "leeway" in that article is very suggestive of flexibility. The provinces are asking for flexibility. The article also makes reference to the government's reading of the act. That could be interpreted as suggesting different methods of interpreting how one can read the act; the federal government reads it one way and the provinces may read it another way. That again points to the need for revision of the act, allowing for broader and more flexible definitions. At the same time the need for using the cash payment as the whip should be addressed.
The government must do something concrete and substantial. It must take some positive action to preserve the health care system for Canadians. It has been stated it is a priority of the government by both the Prime Minister and the health minister. However, when we consider the financial threats which our health care system is facing and the lack of action by the government to diminish those threats we wonder what kind of a priority it is.
The most apparent action to date has been on a reactive or defensive basis. With respect to the user fee situation in British Columbia and the private clinic situation in Alberta, the government's action was based on its interpretation of the ambiguous accessibility clause of the health care act That has to be addressed. So far that is the most assertive or aggressive type of behaviour we have seen from the government in relation to health and it has been in a defensive mode.
Other actions taken by the government tend to leave us confused and without a sense of direction. It campaigned in 1993 on no cuts to health care. During its first year in office it continued to say that it would protect the health care funding to Canadians. However, earlier this year we started hearing things like "cuts to social programs, including medicare. We have to address all social programs. If they are all going to be cut, then health care will be rolled in there with them".
We also heard the system needs to be reformed, that there are problems with the health act and those problems must be addressed. We also heard from various ministers the provinces should be given more flexibility to manage their affairs.
Block funding was set up, including the three components: health, post-secondary education and welfare. This is being sold, to my mind, as an opportunity for provinces to have more flexibility but in a sort of backhanded way. They are given less money and then told they have three components where they can be flexible applying that money.
That is not what we are saying in our flexibility plan. It is what the government is trying to sell when it says that flexibility must be given to the provinces. I think it was Ted Byfield who said we have inflexible flexibility, which is basically what we are looking at here.
Reformers believe that the provinces are fully capable of providing quality health care to their residents as long as they are allowed the stable funding to do so. They need the resources. A workman is only as good as the tools he has.
The leader of the Reform Party said it best in Toronto last November to the Ontario Hospital Association. I would like to quote him. "It is the provinces, not the federal government, that have the constitutional jurisdiction to operate on our health care system. It is the provinces, not the federal government, that provide the bulk of health care funding. And it is the provinces, not the federal government, that have the greatest experience in health care delivery".
I suggest a prescription. If the decision is to devolve health care to the provinces what does this mean in a detailed type of prescription? I would like to make three suggestions: first, transfer tax room to the provinces; second, define core health services; and third, amend the Canada Health Act with those things in place on a national basis. The provinces would have the guidelines and authority to get on and provide a health care program that we can not only afford but want as well.
The Reform Party taxpayer budget outlined how we could decentralize health care by ceding addition tax room to the provinces. This would ensure more stable funding for provincial health care over time. The provinces would not have to worry about what new legislation, steps or cuts the federal government would be making from year to year or the interpretation that each different government would make to the various components of the health act.
At the end of the process of the transferring tax room, provinces would present the revenue levels and flexibility necessary to fund health care according to the demands of the electorate and within fiscal restraints.
Decentralization of health care would ensure that services were delivered and funded by the level of government closest to the people. I made reference to that earlier.
From the point of view of defining-