Mr. Speaker, I am pleased to rise in this debate on Bill C-18, given that I am a new member of the Standing Committee on Health. I have just come from the Standing Committee on Human Resources Development where, today, discussions were continuing on the bill establishing the Department of Human Resources Development. In my first speech on health, I have to recognize that the debate is of the same type.
Unfortunately, Quebecers' health care system is not entirely the product of political decisions and choices made in Quebec. The federal government has meddled in Quebec's affairs on a number of occasions. We must remember that the Constitution establishes health as a provincial matter.
To begin with, it should be remembered that the Quebec health care system existed long before the federal government intervened. The Government of Quebec set up the system and has always ensured its smooth operation. There are those who will claim that socialized health care was developed in Ottawa, but that is not the case.
The federal government simply passed the legislation justifying and providing the means for seizure of provincial jurisdictions. Every intrusion by the federal government through its legislation has brought a reaffirmation from the Quebec government of its control over and desire to exercise its jurisdiction over health care.
In 1987, Thomas Dupéré, of the Commission d'enquête sur les services de santé et les services sociaux du Québec, wrote that the implementation of federal programs had simply moved to the federal arena a debate which had begun at the provincial level and would have led to the same results in the same time span.
Intrusions started in 1943, when the Federal Department of Health established a national action plan on medicare. In 1945, it even proposed the implementation of a national program under full federal jurisdiction. And the federal government had the resources to realize its ambitions.
I have some difficulty concentrating on my speech because of the noise around me. Now, that is better.
So, from 1942 to 1947, Ottawa received more than $2 billion from Quebec which in return got only $100 million, in other words a pitance.
It is very clear that the federal government wanted to go even further in its determination to control and to give back to the provinces, not the tax powers they had before the war, but subsidies tied to the implementation of programs set up by the Government of Canada. That is what happened.
This was the beginning of a long centralization campaign by the federal government. In reaction, the provincial government of Quebec created its own income tax, Ottawa having refused to withdraw. Thus was born dual taxation from Quebec and Ottawa.
Successive Quebec premiers-among them Maurice Duplessis, with his famous slogan "Give us back our due", Jean Lesage and Daniel Johnson Senior-constantly tried to thwart this intrusion from the federal government and this seizure of some of the provincial financial powers.
This is how the federal government took upon itself the responsibility to finance, to some extent, the cost of health care and services. In so doing, it also grabbed the power to oversee the development and administration of the health care systems established by provincial governments.
Provinces wanted to improve their systems, but they had to organize and finance them at a time when they had just been stripped of some tax fields. As a result, they had to beg money from Ottawa. It is still the same today. The federal government may launch new ideas, but the provinces must find the money to fund them.
Let us turn to constitutional powers.
The federal government has violated the Constitution of Canada and still does so today. This is why the Prime Minister does not want to discuss the Constitution. He wants to proceed without discussing it.
However, the government itself admits that health and welfare are areas of provincial jurisdiction. Consequently, the ever growing federal structures and programs in these fields constitute a form of interference which periodically sours federal-provincial relations.
More precisely, the Constitution Act of 1867 gives the provinces complete authority in matters of health, and section 92.7 gives the provinces jurisdiction over the whole field of health and welfare. It is in the Constitution.
In order to bypass what was perfectly clear in the Constitution, the federal government invented a roundabout way to interfere and called it its spending power.
The federal government cannot interfere directly in areas of exclusive provincial jurisdiction. So, it uses an indirect mechanism. It gives provincial governments grants with strings attached; the provinces must abide by certain conditions for fear of losing these contributions.
Instead of using its lawmaking power, the federal government uses its spending power in areas of provincial jurisdiction. In our opinion, it amounts to financial blackmail using our own tax money.
In addition to this manufactured power, the federal government is using some legislative powers which should be limited in scope. A case in point is legislation derived from the criminal law such as
the Food and Drugs Act, and the Narcotic Control Act. The government provides services to or pays for the medical expenses of specific clients such as military personnel, RCMP officers, inmates, natives, immigrants and refugees. The federal government tries to increase its responsibilities and to look important by passing legislation in all these minor areas.
Moreover, the federal government sometimes justifies its interference in areas of exclusive provincial jurisdiction, invoking an ill-defined concept interpreted in a very broad sense, that of national interest.
Managing the Department of Health and all the small programs we described earlier which come under Ottawa's responsibility uses up only a small part of the budget, but constitutes the bulk of the administrative activities of the Department of Health. Without federal interference in areas of provincial jurisdiction, the department would be small and would only manage residual federal powers.
In fact, the largest part of federal expenditures is comprised of amounts paid to provinces through transfer programs. The federal government gives back with one hand part of what it took from provinces with the other. This is an example of very costly duplication which sustains the conflictual situation with the provinces and exists only because Ottawa is proud to be the one to sign the cheques. Meanwhile, there is less money for health.
Let us see how this money is distributed to the provinces. In theory, the Canada Health Act passed adopted in 1984 establishes the conditions for the allocation of federal grants in the health area. In fact though, these contributions are paid pursuant to the Federal-Provincial Fiscal Arrangements and Federal Post-Secondary Education and Health Contributions Act, what we now call established programs financing. Transfers to provinces do not come from the health department's budget, they are made by the Department of Finance.
This creates a bizarre situation where the Department of Health establishes national objectives and standards that provinces must abide by if they want to receive transfer payments, but the finance minister is the one distributing the money and determining the amounts. That mechanism makes a financial issue out of one which concerns only federal-provincial arrangements in the health area. In reality, the health minister is virtually a minister without portfolio as for the majority of the federal health budget.
This splitting of authority between the establishment of standards and financing results in a lack of cohesion between the development of the health policy and its implementation. On the one hand, the health minister wants to impose higher standards and closely monitor their application, which results in cost increases for the provinces, and on the other, the finance minister wants to reduce his deficit at the expense of the provinces and thus is cutting payments.
In the Spring of 1995, the National Council of Welfare, an organization whose mandate is to advise the health minister, cautioned her to beware of such a situation by saying, and I quote: "It would be extremely hypocritical to reduce contributions to the provinces -while increasing the requirements they would have to meet".
Despite fiscal arrangements, the transfer act is a federal statute establishing payments to the provinces unilaterally and without any consultation. Since 1977, these amounts have either been reduced, frozen or de-indexed. Their evolution no longer follows the real costs of provincial programs. In that regard we can say the federal government has broken its commitment to health care.
For over 10 years, the federal government has paid lip service to health care while at the same time continuously reducing its spending in this area.
Through established programs financing or EPF, the federal government transfers money to the provinces for health care and post-secondary education. The amount given to the provinces through EPF is paid partly in cash and partly by transferring tax points from the federal government to the provinces.
In reality, the federal government only spends the amount in cash that is accounted for in budgetary expenditures. Under the tax point transfer, a portion of federal taxes goes to the provinces. This is a way for the government to give back to the provinces some of the taxation powers it took away from them in the 1940s. How generous.
As a result of repeated cuts, Quebec will soon stop receiving cash payments and have to make do with the tax points it already has. Paradoxically, the federal government will soon stop spending anything out of its own pocket but will continue to impose its own standards on Quebec.
Since it was put in place in 1977-78, EPF has led to a unilateral withdrawal on the part of the federal government. When EPF came into effect, federal spending on health care was based partly on the national average and partly on the provinces' actual expenditures and accounted for some 50 per cent of total health spending.
Contributions to EPF were based on spending during the 1975-76 reference year and indexed to the GNP average per capita in the three previous years. This clearly showed a commitment to
ensure a relatively stable increase in the federal government's contribution based on the growth of the Canadian economy.
Since 1986, the federal government has made repeated cuts to EPF for health care, thus weakening, then severing the agreed upon link between the increase in federal contributions and economic growth. In fact, Liberals have continued to reduce financing, a practice they had vigorously condemned when the Tories were in power.
In 1986, the federal government announced a 2 per cent reduction in the EPF indexing factor, which meant that health transfers would follow the increase in the GNP, less 2 per cent.
In 1989, the indexing factor was once again reduced by 1 per cent, which meant that health transfers would follow the increase in the GNP, less 3 per cent.
In 1990, per capita allocations were frozen for two years supposedly. While health costs kept rising, the federal government stopped factoring in inflation. The freeze imposed by the federal government did not stop people from falling ill. This is one area where magical thinking does not work.
In 1991, this so-called temporary freeze was extended until 1995. In 1995, the current government announced a new program, the Canada social transfer, which entailed further cuts totalling $4.5 billion over two years. There is no guarantee whatsoever that more cuts will not be made in the future.
As regards the calculation of the federal contribution, the National Council of Welfare had this to say in its spring 1995 report: "No formula is provided in the budget to calculate the amount payable. Based on recent events, the federal government should impose a formula or an arbitrary amount".
So, actual health care costs are not taken into account at all when calculating federal funding. The government only pays what it is willing to pay, depending on its mood and on the amount of its deficit. The national council was right in asking for a formula that would take into account the actual needs of people, instead of the best interests of the federal treasury.
As for the Canada social transfer announced in the 1995 budget and now in effect since April 1, the National Council of Welfare, which is a federal organization whose role is to give advice to the Minister of Health, said: "The main aspect of this financial tool is that federal funding for all these programs will undergo major cuts".
Prevention programs in the health sector will be the first ones to be cut by the provinces, in an effort to solve their immediate financial problems. In the long term, this will endanger the health of Canadians.
All these cuts have already had harmful consequences. It is estimated that, between 1982 and 1994, Quebec suffered a shortfall of $8 billion because of underindexing, freezes or cuts affecting federal contributions. This is a large amount. This shortfall is partly responsible for the increase in Quebec's debt and income taxes, since the province refused to reduce its health care budget at the expense of Quebecers' health.
The proportion of Quebec's health care expenditures paid with federal transfers went down from 45.9 per cent in 1977-78 to only 33.7 per cent in 1994-95, a 12.2 per cent drop. Even though the federal withdrawal triggered a tax increase at the provincial level, the central government still maintained the same taxation level.
According to a study conducted by the C.D. Howe Institute, while transfer payment expenditures levelled off between 1988 and 1992, spending related to the other federal programs increased by 25.5 per cent. Transfers to the provinces for the health sector thus absorbed part of the federal deficit. While the federal government was spending too much, it was telling the provinces to tighten their belts.
The federal government could have found and still could find the money it needs for the social programs by eliminating or reducing its expenditures and closing some tax loopholes. This would make for a fairer tax system and would help bring in more money to maintain and improve the services and to reduce the debt. However, the federal government does not dare to cut the perks enjoyed by the good friends of the finance minister, the backers of Liberal party and the family of the Prime Minister.
Based on these figures and on the actions, and not the empty promises, of the federal government, we have to realize that the only real threat to the health of Quebecers and Canadians stems from the irresponsibility shown by the central government.
The 1984 Health Act was passed to ensure that the provinces affected by the economic recession of the 1980s would not tinker with the health system, even if, at the same time, the federal government was reducing transfer payments.
All of the provinces protested against this act, because the Canada Health Act contained new conditions above and beyond those already in effect. These new added responsibilities contrasted with the decrease in federal contributions resulting from the 1977 financial arrangements.
On the use of financial pressure tactics, allow me to make a few polite comments about the blackmail used by the federal government to force the provinces to totally support the federal vision. In 1983, Monique Bégin, the Liberal Minister of Health of the day, cautioned us: "The total amount of the contributions paid by the Government of Canada to the provinces for health services is very significant. Any province that constantly refuses to meet the conditions will lose the federal cash contribution and will probably be hard put to compensate for this loss. If the total contribution were to be withheld, health services in that province could have to
be suspended. This is the last thing the Government of Canada wants for Canadians. This option could create a situation worse than the problem it set out to solve".
What this means is that the confrontation strategy and the will of the federal government to control the provinces is, in fact, harmful to the health of the citizens themselves.
The dual initiative by the federal government, that is the creation of a national forum on health care without consulting the provinces and the stricter criteria and conditions contained in Bill C-18, has drawn a lot of criticism not only from the Government of Quebec-and this may be of interest to the new Minister of Intergovernmental Affairs-but from other provincial governments as well. He may want to watch this situation closely.
Let us see what the federalists have said about that. On September 19 of last year, the Conservative health minister of Ontario, Jim Wilson, criticized the federal government's lack of flexibility. I would like to apologize to the Speaker for my poor pronunciation in English, but I will go ahead anyway and do the best I can. I would add that I am taking courses to improve my English.
"I think it shows inflexibility on behalf of the federal government".
He also stated that we should not let the federal government dictate its interpretation of medicare to the provinces.
"The federal government be fought on principle for dictating its interpretation of medicare to the provinces".
The same day, Ralph Klein, Conservative premier of Alberta, also criticized the federal government's lack of flexibility.
"Marleau does not send a good signal to Quebec. It says there is no flexibility within the confederation".
The NDP health minister of British Columbia, Paul Ramsey, added that Mrs. Marleau-who held that federal portfolio at the time-had to change her approach. He stated that if medicare was threatened by the actions of the provinces, it was because of the $7 billion cuts over two years made by the federal government in the areas of health, welfare and post-secondary education. I will try another quotation in English.
"Last February's federal budget, which cut transfers to provinces for health, welfare and post-secondary education by $7 billion dollars over two years, has forced provinces to look at unpalatable cuts that threaten medicare".
In a joint communique issued at a health ministers meeting, the provinces stated that the federal government's will to make unilateral decisions with regard to the funding of health care, the interpretation of standards or the setting of arbitrary deadlines for consultation would not help in solving the problem.
"It is not helpful for the federal government to engage in unilateral decisions regarding funding or interpretations and arbitrary deadlines".
Concluding this section on the forum, it is obvious that reducing federal contributions causes a serious problem. Federal intervention was justified only by spending power, so any change to the federal health legislation without changes to the financial aspect runs the risk of having an absurd outcome.
Any increased provincial obligation without a corresponding increased federal contribution is tantamount, not to the exercise of federal spending power, but rather to the creation of a federal power to make the provinces spend money for it, and under its conditions.
In fact, the federal government's main objective is to lessen its financial burden related to the huge debt it has accumulated, at the cost of the provinces' fiscal health. In other words, the central government pushes a portion of its debt off on the provinces. By thus increasing the tax burden of the provinces, Ottawa lessens their manoeuvrability and forces them to make difficult, agonizing choices in its stead.
Because the federal government is not capable of respecting its commitments and because, all its fine words and the standards it claims to be setting unilaterally notwithstanding, it is the one threatening the health system with all these cuts. The federal government ought to decide to withdraw from the health field, one in which it ought never to have set foot to begin with. In this case, it ought to assume responsibility for its decisions and transfer tax resources to the provinces, in order to allow them to take over.
I have attempted in these past few minutes to establish this position, which in all aspects reflects the position of the various governments of Quebec over the years and the constitutional demands of the Government of Quebec. As I pointed out just now, since the new government has been in place, I have been a member of the standing committee on human resources, and in my daily work on that committee, particularly as the critic for training and post-secondary education, I have seen the same phenomenon at work there: an attempt to interfere-more than an attempt, constant interference, ongoing, and increasing.
Despite the promises of change the Prime Minister made in the last referendum campaign, when things were getting close and it looked like the referendum might go to the yes side, in the final days, he made promises. Before he became prime minister, we heard him speak for the no committee, stating time and time again during the referendum campaign that the federal government should and would agree to change its centralizing attitude so frequently criticized by Quebecers. We thought there would be a change. No chance.
Again yesterday, I spoke on Bill C-11, the old C-96, which dragged on at length and is now being re-introduced. Although these are old bills in new clothing, there has been no change to the federal government's centralizing attitude.
An attitude based solely on the government's grasping for increased powers.
Here is a parallel. We passed a resolution on the distinct society and what happened? In all of the government's actions, in matters of health and human resources development the government went from the notion of distinct society to the simplistic recognition of Quebec as the principal homeland of French language in North America.
This is a widely known historical fact, but it adds nothing. I am not the only one to say it. So does the leader of the Liberal Party, who is a full-fledged partner of the no side and of the present Minister of Intergovernmental Affairs. This full-fledged partner said that this gives nothing more to Quebec since it cannot lead to a transfer of powers, increased responsibilities, further clarification nor a greater clarity.
There are some grey areas with regard to the government's residual powers. We, Quebecers, we, the official opposition, had hoped to see the federal governement deal with this aspect in its new effort to decentralize. We had hoped it would clarify matters and put an end to the remaining grey areas. But on the contrary, it perpetuates them.
What is worse in the case of the bill making the department of Human Resources Development official as in this one, is that we can see that the government has adopted a soft pedal approach, a go slow approach, a slow combustion approach. You put a little bit of wood in the stove, you let it smoulder all night, and then you add a little bit more wood, hoping that Quebec's emotions will simmer down, that Quebecers and their national feelings will cool down and, with time, journalists and the media will pay less attention to the issue, which has been so long on the front page; if there is less coverage, people will not hear about is as much. This is the soft pedal approach .
Yesterday I said Bill C-11 was the law of silence. Today being Friday, I will be kinder. I notice a silence which is probably more understandable. Yesterday, when the government was passing a bill to officialize something that has been in existence for two and a half years, a bill creating the Department of Human Resources Development, I was explaining that if you exclude the servicing of the debt, the budget of that department was the largest item in the total federal budget, with more than 40 per cent of all expenditures.
At the Department of Health, they tried to reduce the figures by every possible means. When you look at the budget allocated to the Department of Health this year, you no longer find transfer payments for health, because they are listed somewhere else. Therefore, the budget of the department is only $1.8 billion. This is not much. But most of the spending is elsewhere, in other sections.
For example there is some in the Department of National Defence. There are many interventions. The federal government is there, but trying to hide the fact; it would have us believe it is giving way to the provinces, letting them manage their own business.
The very last amazing brainwave of the federal government is the famous Canada social transfer, which has been in existence since April 1st, although few people know it. What is it? Let us remind people. The Canada social transfer is a merging of all federal transfers for health, post-secondary education and welfare.
From now on, provinces will supposedly be able to set their own priorities. However, all this comes with a $7 billion cut. They are transferring to the provinces the cuts the federal government did not dare make. And so they should, in a way, but at the same time, the federal government is withdrawing from its financial commitment. And that is unacceptable.
The insult-the parliamentary secretary confirmed it this morning-is to attach to health transfers five principles, five inescapable conditions with thinly disguised threats. The government is saying to the provinces: "If you do not accept national standards, in the Canadian sense of the word, you may be penalized by cuts in funds allocated for health or post-secondary education, but especially health".
I heard excellent speeches in which it was said: "The health of Canadians is a concern to us". The former minister was particularly eloquent in the House; every time someone would ask her a question, she would start by saying: "Mr. Speaker, you know I am very concerned with the health of Canadians. That is why we will intervene here and there". She was asked why she had not consulted with the provinces, like she did with the health forum. She would then answer: "But you know, the health area is very important; there are stakeholders in it. We had to know their views".
Mr. Speaker, you are signalling me my time is up. I will conclude with that. I could go on and on. I will have the opportunity to come back on the matter since I will now sit on the health committee.
