Mr. Speaker, on first looking at the bill to establish the Department of Health, one might think that it was a housekeeping bill, that it was quite ordinary, since there was at one time a department that looked after social affairs, welfare and such things. One might also tell oneself that the federal government had already played a role in this field and that this was probably just an update.
But it is also an opportunity to look at what the federal government has to do and what its responsibility is in the health sector. For this, we must look back at the origins of our health system. In the past, because of its spending power, the federal government contributed to the development of programs that, while they must be recognized, often parallelled those run by the provincial governments.
Today, these prosperous times are pretty much over and we are facing a completely different situation. The federal government is reducing its spending on health by billions of dollars, but insists on maintaining national standards. It is determined that the rules should be the same throughout Canada.
The way the government has found to ensure this is by creating a department, by means of the Canada Health Act, which sets these standards. But it is like anything else: to keep the thing going, you need the corresponding funds and an effective way to put them to use.
I think that the best example of very inappropriate interference by the federal government in this sector is the creation of the National Forum on Health. What is the National Forum on Health? It is a group of specialists appointed by the federal government with a mandate to improve the health of Canadians, increase the efficiency and effectiveness of health services, and formulate related recommendations for the government. It is a forum with a multi-million dollar budget.
The problem is that this forum is looking at a provincial field of jurisdiction, because in Canada the everyday management of health is a provincial responsibility. When there is a problem in a hospital or community health centre or any other kind of health problem, it is the provincial government that is responsible. It is to the province that people must address their questions and inquiries as to why things are not working or their praise when things are working as they should.
The federal government, meanwhile, gives itself the right to meddle in this area by assigning to the forum the very general mandate of improving the health of Canadians and increasing the efficiency and effectiveness of health care. Unfortunately, the provinces were not invited to participate in this forum as full-fledged members. How can the federal government assess the quality of Canadians' health without allowing the main players to participate and have their say in this? This forum has a budget of several millions of dollars and, when we see how difficult it is to fund health care across Canada, we cannot help but think that these millions of dollars could have been better spent elsewhere.
I know that if the people in my region had received any of this money, they would have known exactly what to do with it. Given the need to restructure the system, to reduce the number of beds for seniors, to convert hospitals, if money had been available, if the federal government had withdrawn from health care and allowed the provinces, including Quebec, to act in this area without increasing taxes, interesting solutions could surely have been put forward.
Why is the federal government stubbornly meddling in this area even though it does not have the money to do so? One cannot help but wonder if this has anything to do with the significant impact of health care on voters. Of course, a government with the power to spend as it sees fit, a power only limited by its capacity to borrow, may be tempted to meddle in areas likely to improve its chances of re-election, in areas that may improve the government's image but are none of its business.
For instance, the federal government has a strategy for the integration of people with disabilities, while Quebec has the Office des personnes handicapées du Québec. This is an obvious case of duplication since it is impossible to act in an area like this without part of the budget going to administration. Had the money allocated to the strategy for the integration of people with disabilities been transferred to the provinces, all the money could have gone straight to the handicapped, since most of the administrative costs would already have been borne by the existing bureaucracy.
At the same time there is a federal strategy on violence, an anti-drug policy, an AIDS strategy, the children's bureau, an anti-smoking strategy, all areas in which provincial government take similar action and that require dialogue between the two levels
of government, if duplication is to be prevented. Interface committees have to be established, which involves operating expenditures, but these committees do not provide services directly to the public.
This is important, especially since individual citizens are wondering these days why the system costs so much to operate. Are doctors, the nursing staff or those providing services on the front lines in the hospitals overpaid? Or are there not clearly savings to be made at the administrative level?
When the federal government acts in exactly the same areas as the provinces, we must ask ourselves who is responsible for these areas under the Constitution. It is clearly stated that health matters come under the jurisdiction of the provinces. So, under the cover of an innocuous bill, the federal government is once again meddling in the provinces' affairs. In that sense, it is not playing the role it was intended to play, it keeps interfering in an area over which it does not necessarily have jurisdiction and it could even take conflicting action in certain areas.
There is also an element that is more tendentious, in a sense: federal interference in the form of national standards. This leaves the provinces, who are facing budget cuts, with the unpleasant task of making choices, taking into account population dynamics and ageing. They deal directly with clients and have to make choices in terms of direct service, but at present they do not have all the leeway they could have on behalf of those clients, because spending power in this specific area is in the hands of another level of government, which interferes indirectly.
We are also faced with a somewhat absurd situation. In past decades, the federal government invested a lot of money in that sector and a number of programs were created. Now, we no longer have the means to fund these programs. However, the federal government would never say that it is because less money is being given to the provinces.
It invokes the need for national standards to justify telling the provinces that they must somehow find a way to meet these standards. This puts the provinces in situations which can sometimes be absurd, given that they have no money for certain programs, while spending could be reduced in other sectors, but is not.
Imagine a federal government that would only get involved in those areas for which it is responsible. Imagine the latitude that provinces would have from a taxation point of view, to look after their own areas of jurisdiction. The federal government would then simply have to assume its own responsibilities.
In such a situation, federal cuts affecting national defence could be used by the central government to fulfil its responsibilities. However, withdrawing from an area such as the health sector could also be a way to reduce the size of the federal government, which spends about $1 billion in that sector, even though it does not come under its jurisdiction.
Let me stress my point by mentioning again the areas in which the federal government is involved. There is the issue of family violence. As you know, family violence is the result of a whole set of situations. The Government of Quebec, among others, has implemented policies to deal with this issue. However, federal initiatives do not necessarily complement these policies and there is room for improvement in that regard.
The Bloc Quebecois' position on these issues is not necessarily held only by Quebec sovereignists, or like minded proponents of independence.
As an example, I give you Lucienne Robillard, now a federal minister. At the time, she was Quebec's health minister. On September 27, 1994, she told La Presse , and I quote: ``The behaviour of the federal government makes no sense. How can the health system be overhauled without involving the provinces, which are responsible for the delivery of services? It is quite simply unacceptable''.
I think that says it all. These are the words of the minister, who was a minister in a provincial Liberal government, a federalist provincial government, in reference to the national forum on health on September 27, 1994.
In the same vein, Thérèse Lavoie-Roux, a senator, told the Senate on May 31, 1994 that the government was wrong to neglect the role of the provinces. She asked the following questions, and I quote: "Are the provinces not considered major partners? Why were they not invited to participate in the forum? Does the government leader find it appropriate for the government to be acting unilaterally on a matter of provincial responsibility?"
We must remember how it was that the national forum on health came about. The Prime Minister invited the provinces to take part in the creation of this forum. Talk about hard to believe. Here we have a provincial field of responsibility, and the provinces are relegated to a position of listening to what is going on but not allowed to voice their views, to make suggestions for improvement. Perhaps it was feared that the provinces might indeed make some suggestions. Perhaps the provinces ought to have joined forces to state that the best thing would be for the federal government to pull out of this area and to turn the available funds over to the provinces for their own use.
Despite provincial opposition, despite opposition from such people as the senator, despite submissions from everywhere in Canada, the federal government has decided to continue, to go ahead with its project, to create the national forum on health, solely
for the purpose of meeting the campaign promise that had been made.
How effective was the forum? Are there many people who have seen concrete solutions offered by the forum? Are the millions of dollars spent in this sector being used to improve Canadians' health, as the mandate given it by the federal government would have it?
What more needs to be said to make it clear that the federal government is involved in an area it does not necessarily have any business being involved in? In the bill it is indicated that it could not intervene in areas that are already governed by the health authorities, yet these are described elsewhere in the bill as authorities with which it may have dealings.
In the last budget, the government decided to create a research centre in this area, once again an action that appears totally praiseworthy at first. We are told that health research is really very important, will lead to the develop of new drugs, will help people be healthier.
But if we look a bit further, we see that the provinces have the same mandate. There will be overlap in spending at a time when we cannot afford to do that.
When asked where to cut, we answer: "Eliminate overlap". Health is a case in point, a clear case where the federal government should be made to withdraw from this area. Before passing a bill establishing the health department, in its present form, before granting the minister, as in clause 4, extremely wide powers to take action, we must question the real scope of the clause.
Clause 4 deals with the powers, duties and functions of the minister with regard to health, including:
(a) the promotion and preservation of the physical, mental and social well-being of the people of Canada;
I think that some provincial health ministers must have wondered who was responsible for what when they read this clause.
Paragraph 4(2)(b) says:
(b) the protection of the people of Canada against risks to health and the spreading of diseases;
In this case, the federal government can always invoke the national interest and the federal power related to law and order, and good government to step in to protect the health and safety of the people of Canada.
The concept of good government is an interesting one, but one which is open to abuse. Perhaps this bill should have been better framed, better defined, to state clearly in which fields the federal government is allowed to take action and to limit it to those.
For instance, when we talk about health care for natives, we realize that the Constitution provides the legal basis for action. But when we talk about getting involved in people's health in general, we realize that under the Constitution, this is under provincial jurisdiction, and we question whether it is legitimate to keep on interfering in this area.
As a matter of fact, had it not been for the possibility, in the beginning, in the sixties and seventies, to use the spending power, that is to tax citizens to provide them with services in order to make the federal government more visible, it is unlikely that such interference would have occurred.
After the second world war, the federal government realized that with the power to levy taxes it had increased through income tax, it weilded great political power. So it tried to implement a universal, Canada-wide health system to provide the same services all over the country. However, there are different regions in Canada and, since there are two levels of government, different provinces can make different choices according to what their citizens want.
The power the federal government wields, through national standards, allows it to try to impose the same behaviour to all provincial governments, but this is not necessarily good. If Quebecers and Canadians had wanted that, they would have said so and the Constitution would provide for this area to come under federal jurisdiction, but it is not the case. This is not what is in the Constitution.
For many who are involved with federal programs the reality is always the same. Take, for example, the new horizons program. The orientation of that program has changed from year to year, at the whim of successive governments. There were years where seniors' clubs in various municipalities were able to buy very useful equipment. Suddenly, last year, the program changed direction, but the connection between that change and the needs of the people was not at all clear.
Today, the new horizons program is aimed at specific clients who would be in a difficult situation. I do not know it members see the direct link there is with the local implementation of CLSC policies. Local community service centres have mandates to help seniors, but they do not have the financial resources of such programs as the new horizons program; they see this as federal involvement that, often, goes against their own action. There are fields of activity where the action of the federal government may go directly against the action of the provinces, and it is very difficult to understand exactly what the federal government's objective is, in that regard.
There are other fields of activity. For instance the fight against AIDS and drug enforcement. In the past, there were different approaches according to different governments. The federal government might prefer a more punitive approach. The provincial government might prefer an approach that will correct behaviour patterns. In the case of young offenders, for example, we have seen
provincial governments-the Quebec government, among others-put in place systems such as the Direction de la protection de la jeunesse, and different sectors where crime has been greatly reduced in Quebec. This has a direct link with to the health issue.
If the federal government chooses a totally differing line of action, then it is a disservice to the people, and services are not as efficient as possible.
In conclusion, I think that, in this era of dwindling financial resources that calls for very wise choices, the federal government-instead of creating a department like the Department of Health and meddling in areas of provincial jurisdiction-should consider withdrawing from health care and transferring the money to the provinces so that each of them can provide services that meet the needs of the people.
A province with a widely scattered or a sizeable rural population and one with large urban centres can make very different health choices. It might be unwise to try to impose the same standards on both.
This is also directly linked to the provinces' respective policies regarding development and other matters. Health is not simply a matter of spending money on drugs. It is the result of the actions taken by the various stakeholders in society.
I think that, in the past, the federal government's actions in the area of health, because of the amount of money available, led to the development of some worthwhile programs. Today, however, its attempt to impose very high standards while at the same time reducing the amount transferred to the provinces so they can provide these services puts people before a difficult choice, as the federal government will be assessed on the basis of its programs.
People put pressure on the governments to develop programs against family violence, for instance. Yet, the provinces, which are responsible in this area, cannot afford to take action, because the federal government does not give them the means to do so. Taxpayers are stretched to the limit. In the end, people are in no position to assess the quality of health care. They tend to blame the government providing the services, when the cuts are made by the government that continues to collect the taxes without providing the expected services.