Mr. Speaker, I do not know why you would want to limit me. We are talking about something that is fundamental to the Canadian health system. We are talking about responsibility, jurisdiction and accountability.
To reframe everything for everyone's edification, when the debate was interrupted by question period I was talking about jurisdiction in the Constitution of Canada. I was looking at why and how it was flexible and why and how the role of the federal government has evolved and continues to evolve under those jurisdictions.
When interrupted I was making reference to section 92. Canada's Constitution does not begin and end with section 92. That is most particularly true in the field of health. Very briefly, let me describe what that means.
I see my esteemed colleague has joined the ranks of the House. He is listening very attentively so that I make all of the appropriate references under the Constitution. I refer to the Minister of Intergovernmental Affairs who is a constitutional expert. I look forward to his applauding my references.
Section 91(27) gives the Parliament of Canada exclusive jurisdiction over criminal law, the basis for a number of laws protecting public health and safety. Section 91(2) assigns responsibilities to the federal government for international and interprovincial trade. This forms the basis for federal regulations on drugs and medical devices, as an example.
Section 91(11) gives the federal Parliament explicit power over quarantine and marine hospitals, which I would add, reveals a good deal of the thinking back in 1867 about where matters cease to be local and begin to take on national significance.
Section 91(7) concerns military and veterans. Section 91(8) has to do with the federal public service and section 91(4) concerns aboriginals and lands reserved to aboriginals.
Every one of these powers establishes or implies a clear federal role in health issues. They account for the considerable array of the duties and responsibilities set out in clause 4 of Bill C-18.
Moreover, they account for the vast majority of Health Canada's operating expenses. Health, when viewed from a perspective of federal constitutional responsibilities, is clearly a good deal broader than the health care delivered. It is a comprehensive view and has been for many years.
This is where other federal powers have come into play. Much has been made in the course of debate of the federal spending power. That is specified in section 91(1A) of the Constitution. Much has been made of the power to raise money by any mode of taxation for which there is provision in section 91(3).
However, do these powers broaden the sphere of federal regulation? Do they offer the opportunity for jurisdiction by stealth, as it were? The reality is that nothing in the Constitution gives the federal Parliament the means to regulate provincial matters in the guise of spending powers. I think my hon. colleague would agree. It can attach conditions to the funds it makes available to the provinces. However, just as it cannot compel the provinces to accept the funds it offers, neither does it buy jurisdiction when provinces accept those funds.
Clause 12 of Bill C-18 makes this limitation clear. It continues a point that was made in the existing Department of National Health and Welfare Act:
- Nothing in this Act or the regulations authorizes the Minister or any officer or employee of the Department to exercise any jurisdiction or control over any health authority operating under the laws of any province.
This is why the Canada Health Act does not forbid user fees, if I can conjure up the term, nor does it require provincial legislatures to forbid them. I ask members to take careful note of the language being used. It simply makes it clear that any province that decides to finance medically necessary health services with user fees can expect a corresponding reduction in federal funding. They cannot have it both ways. The government is not obliged as a federal entity to spend money where it has a fundamental objection. This brings me to another myth, that is, the federal government is intruding in provincial jurisdiction.
It has been a constant theme in opposition commentary at almost every stage of the debate so far. Both opposition parties have made common cause in their belief that the best government in Ottawa is no government in Ottawa.
That is difficult to understand from members who get themselves elected to come to Parliament to represent the national interest. The motivation for the federal government's involvement in health financing does not derive from any desire to centralize powers. No one here has a wish to invade a field of purely provincial jurisdiction.
The federal role in health has been an exercise of leadership. There are those who would hold that leadership is not a word that is acceptable. Some of my colleagues opposite might think it is even a dirty word today. Some believe it to be a power grab. We should never apologize for saying that federal leadership in health is a commitment that Canadians expect and want exercised. I dare say that examples of that leadership abound.
We based our commitments on health to Canadians during the 1993 election campaign in a belief that when there are national needs, we need national action. It was part of our platform as a party and part of our platform as a government. It was the basis of programs outlined in the red book commitments. It continues to be the basis of action since. I would like to cite an example.
The Minister of Health has announced a leadership initiative in the blood system. A question came up today in question period. The government understands that the blood system needs to be restructured. Rebuilding the system is appropriate and right for the government to pursue in partnership with other systems.
When we recognize that, we give ample evidence of the kind of leadership role that the government has been exercising. A restructured system can only enhance the government's current efforts as a regulator to ensure safety and quality of the blood supply.
It is essential, I might add, as the minister underscored in question period, to act now and to begin the process before Justice Krever and his inquiry makes the final recommendations. There is no need to wait. The final report will not be ignored. It will be looked at as a building block of the new system.
Let me offer another example, if I may, of the kind of leadership Canadians want and support. In July 1994, some 18 months ago, the then Minister of Health, announced the Canada prenatal nutrition program. The program is helping to support other programs for pregnant women who have a high risk of delivering low birth weight babies. Members probably want to know why that is important. These programs provide food supplementation, nutrition, lifestyle counselling and information to such women.
The government designed this program to dovetail with existing provincial initiatives to encourage them where they do not now exist. Much of the program in the red book was based on building partnerships, not stimulating competition, at least in the area of government services. It was not designed to duplicate good programs that were already in place or to override them.
It should be noted that it could cost up to $60,000 to meet the health needs of just one low birth weight baby. That is just the immediate financial cost. The price in developmental delays that can echo through the lifetime of such an individual, family and society are incalculable. These children start life well behind others. Many, unfortunately never catch up.
When you realize that 21,000 such babies are born each year, you begin to get an appreciation of the sheer magnitude of the problems being addressed by that program.
To hear some during the course of this debate, the federal government should just stick to its knitting and stay out of issues such as this. They seem to suggest that if there is no need for leadership, perhaps some provincial government may take action. If less affluent provinces cannot afford to take action, it is just one of those things, c'est la vie, as they say en français. That is their stand. It is not ours.
We have looked at the facts and the needs and we have taken action. Canadians will not buy limp excuses for inaction from my colleagues opposite, not for one second. They know that leadership does not involve the use of the word perhaps or the word may. They recognize that leadership is about seeing what needs to be done and finding the best way to do it.
Of course, the defining example of federal leadership in health has been our staunch defence of the principles of the Canada Health Act. The Minister of Health has been clear in his stand. He has said that he will debate the principles of the Canada Health Act with anyone, anywhere, at any time. One thing should be clear to all colleagues. Although the five principles may be debatable, they are not negotiable.
The government has never claimed that it wants to tell the provinces how to run their health systems. However, it does claim a nation building role of setting values that Canadians share no matter where they live.
It is equally clear that Canadians trust the government to defend those values. Canadians will not support the whittling away of the principles of medicare which some provinces have attempted. Canadians are clearly supportive of the federal government in its resolve to stand by those principles. Clearly, they do not accept such thin rationale, including the ones trotted out here by the opposition parties which pretend to support the principles of medicare while permitting their decline and erosion.
Leadership means taking a stand on fundamental issues. Medicare is one of those issues. I dare say that Canadians are happy of it.
Let us put the leadership issue into context. There is a real world of relations between the federal government and the provinces. It is not one of differences but one of co-operation. The leadership the government exercises in the field of health does not come from the
barricades. It comes from a long tradition of commitment to the health of Canadians. That commitment is shared by the provinces and the territories.
It is something that cannot be reflected in a written Constitution. It does not appear in the media obsession of conflict and tough talking sound bites, in five-second clips; yet it is a reality, day in and day out.
For us to achieve our health goals for Canadians, the federal government needs to work with provincial and territorial governments, and so we do. All governments need to work with health professionals and administrators, interested organizations and others with a contribution toward better health for Canadians. Once again, we do.
That co-operation takes place in so many ways. For example, we have 12 distinct but interlocking systems of health care in Canada. At a time when some are questioning the merits of federalism, it says a lot that governments have worked together so well that Canadians look at twelve systems and see only one.
They see medicare as a national program even if it consists of 12 different provincial and territorial health insurance plans. One reason for that almost seamless approach to health in Canada is the constant process of consultation and co-ordination that goes on.
One of the important vehicles we have is the conference of federal, provincial and territorial ministers of health. This forum allows governments to work together on research, policy development and practical issues.
This process of co-ordination allows governments to compare notes on the big issues that affect all of them. Consider health system renewal. We have clearly moved passed the time when the nips and tucks to the status quo will do. The issues are moving too fast for us to tinker with old approaches and the old paradigms in many cases.
Consider the broad issues. We have an aging population, which is already creating important implications for how we structure and how we deliver care. We have health inequalities that face the poor, rural dwellers, aboriginal people and women. We have a group of issues which speaks to how the health system works; cost control, the supply and distribution of physicians and the respective roles of all health professionals and need analysis.
The balance between institutional and community based care and the appropriateness and intensity of care are significant concerns. They all need good answers.
Leadership means thinking through these issues and their implications for the health of Canadians in a comprehensive and intelligent manner. The federal government has taken a leading role in these efforts through initiatives such as the national forum on health.
The federal government has never claimed sole ownership of this issue. We have recognized the impressive work of the provinces and the territories because they too exercise leadership. Within health care every province and territory has taken innovative reform and renewal actions. We have made clear our belief that we can learn from each other.
We can all contribute to addressing common priorities. Some are as basic, as the research into clinical practice guidelines. It is hard to believe but we have no firm idea how effective some common medical practices are in terms of either costs or results. This is an affliction for all western societies. Governments are working together to address issues such as this, but it is something governments alone can do.
For example, we worked with health professionals and other interested people in organizations. They are experts as well as users of the system with a stake in finding the answers. They continue this in many other areas of research, health, policy and program delivery.
Federal leadership in health is not about loud claims of moral power or of playing the constitutional trump cards. The legacy of leadership is not a hollow relic of the days when government coffers were bursting. It is a living tradition of looking out for the interests of all Canadians. It is a living tradition of seeing the gaps that affect the health of our citizens and in doing something to meet the need.
In a previous item of legislation, the old Bill C-91, there was some reaction to whether the Minister of Health would assume the responsibilities and would be held accountable for all of his responsibilities. Even though there was no question in our minds, we had a good representation by the hon. member for Fredericton-York-Sunbury who presented an amendment to eliminate all confusions. It was widely received by all members on both sides of the House and passed unanimously.
That is what we mean by looking at leadership. Leadership can mean action by this government alone but so often these days it means contributing to shared work. It is a form of leadership the government still believes to be absolutely important. It is one that Bill C-18 permits us to carry out.
I hope all members of the House will reflect on that carefully and give it resounding unanimous support.