Mr. Speaker, it is a pleasure to speak in three ways this evening, first as the member of parliament for St. Paul's, second as a member of the finance committee and third as someone who has fought hard for the protection of the Canadian health care system and who feels deeply that the confidence that Canadians have in that system is the most serious protection we have against the slippery slope to a two tiered system.
In St. Paul's we had a prebudget consultation of some of the opinion leaders and it was clear that they too felt there were three main things that we should be focusing on. They felt that debt reduction was imperative. It was clearly the priority of those people who were in attendance. The talk of debt reduction focused on how much should be spent on that and many mentioned how debt reduction would have a positive impact in a number of ways.
Almost everyone in attendance at the meeting spoke about social spending. While most discussed their priorities for the 1999 budget in terms of health care, medical research or employment spending, many cautioned that the instability of our economy in a volatile global environment necessitated prudence in any spending measures. They also felt that we should be cautious about raising spending expectations.
With respect to health spending, many of those in attendance expressed concerns about the growing gap between the rich and the poor, which we have heard a lot about. They expressed a desire to see the 1999 budget address the connection between poverty and health and preventive care. National standards were also mentioned as being health priorities. Health spending topped the social spending agenda for the people in attendance.
The other area was in research spending. While discussing social spending many mentioned the need to increase spending on scientific research and that this would be a very concrete investment that would have high returns. In fact some of them were specific in that 1% of public health dollars should be the target perhaps over a three or five year period.
Tax reduction was also a priority for some of the people in St. Paul's and some felt that it should be a major priority. Like debt reduction, many saw that the benefit of tax reduction would translate into improvements in other areas. The number one priority was to decrease personal taxes, especially for those who live in poverty. Some felt quite strongly that paying slightly higher taxes than some other nations, notably the one to the south, was part of living in a just and civil society. They placed tax relief after the spending initiatives.
In the finance committee we found that there were many, many thoughtful presentations. People talked about the brain drain, about the need for health care and research. There was a rather interesting presentation on the progress indicators as they change from the GDP. In fact in St. Paul's we had a town hall meeting on that subject in the past month, looking at some of the work of Marilyn Waring. We are very proud that as Canadians it is the first time StatsCan has been able to actually put the unpaid work of women into our census.
There were many external factors which those of us on the finance committee felt. Obviously there was the change in terms of the OECD warning us about debt reduction, as well as its admonition with respect to the necessary tax cuts.
Members felt that the rising tax burden of Canadians and the lack of disposable income was a problem, as we have seen disposable income, personal after tax income, fall steadily since 1990.
People were concerned about the UN, although we still are number one in human development. We felt the fact that we are 10th in human poverty was something we should look at. Obviously, we considered the conference board's concern regarding our standard of living and, again, the fact that our best and brightest are leaving to go to other countries.
We felt clearly that an increase in the personal tax exemption would be a good thing for almost all Canadians. This would take a certain percentage of Canadians right off the tax rolls. It would be of specific help for the working poor in terms of their disposable income.
There was one night in St. Paul's when we had a town hall meeting on bank mergers where there was one very vocal person who said “Don't give the provinces any more money for health care”. This was unlike the hon. member for Markham, in that they felt that they could not be trusted in terms of what they would do with it.
That has been the major debate in this country regarding what we actually do about the CHST. I would like to remind the hon. member for Markham that in the Progressive Conservative election platform they were actually going to reduce the cash transfer to zero. I do not think that then they would feel that the federal government was giving zero to health care. We have to continue to remember that there is only one taxpayer. We have to figure out what it is that Canadians need in order to feel confident about the quality of health care in their country.
There are four things that are most important when dealing with health care and how important it is to Canadians. We must remind ourselves that unfortunately when the Canada Health Act was written the word quality was nowhere to be seen.
Although the five tenets of the Canada Health Act presumed high quality care, I do not think it could have presumed the sort of bargain basement care that has come about since people have not actually been accountable for how the money is spent.
The trends from hospitals to community care, doctor to multidisciplinary and a kind of evidence-based, best practices kind of care have not been dealt with appropriately in the follow-up to the Canada Health Act.
First, we have to recommit to the Canada Health Act. Second, we must begin to measure what the outcomes actually are in terms of the waiting lists and in terms of a real commitment to the information technology that is required to do that.
Michael Decter, who is head of Canadian Health Information, said in Maclean's in June that Canada had badly underinvested in health information and that we spend only 2% of our total health care budget on health information. He said that we would get much better value for our total health dollar if we increased this vital investment to 4%.
We have to know what we are doing. One of my concerns has been that when the Canadian Medical Association or anybody else continues their chant about underfunding we do not actually know where that money is going. People are continually concerned about unnecessary surgery, antibiotics for virile infections and many other things.
In 1995 there was a paper called “Sustainable Health Care for Canada” done by Angus, Auer, Cloutier and Albert. It was very clear about what we have to be doing. We have to be dealing with the fiscal pressures on government, the lack of knowledge about the links between health care and help, the ethical dilemmas involved in rationing health care services and contradictory incentives built into the rules and regulations governing health care. They felt that those tensions were not new, but that we could not keep throwing money at the problem.
They felt that if we actually moved to best practices there would be $7 billion worth of savings every year. In those days 15% of the public health care costs could be saved.
We should actually move to a more accountable system. Money will not be the problem. We need to have some sort of accountability, as we said, in terms of the Ontario Hospital Association saying this was really about mismanagement and not necessarily just about money.
We have informal standards in this country. When the B.C. cancer outcome rates are much better than the rest of the country we sort of see that as an informal standard. When Quebec's home care system is better than the rest of the country, viewed by experts, we see that as an informal standard that all Canadians expect.
We now have to find a way to have all three levels of government report to Canadians on a regular basis. It is not big brother checking up on the provinces. It must be, as the Minister of Health has said, a way for all levels of government to be accountable to Canadians about how their health care dollars are being spent, their tax dollars.
The fourth area has to be in research. As some of the people in St. Paul's have said, the idea of moving to a target of 1% of public health dollars for health care is a target that we should be shooting for.
The proposal for the Canadian institutes of health research is a good one and I am thrilled that we are starting to see things like population health, clinical and evaluative sciences, and primary prevention, as well as our amazing track record in the medical model of research.
I am hugely optimistic as we move into this next budget. It is a thrilling problem to have a surplus. I think that all Canadians thank the government for what it has done in a prudent fashion and I look forward to the budget.