Debates of April 14th, 1999

Questions On The Order Paper

[The Deputy Speaker]

Is that agreed?

[Some hon. members]

Agreed.

Motions For Papers

[Peter Adams, Liberal, Parliamentary Secretary to Leader of the Government in the House of Commons]

Mr. Speaker, Notices of Motions for the Production of Papers No. 55, in the name of the hon. member for Cariboo—Chilcotin, and No. 56, in the name of the hon. member for Charlesbourg, are acceptable to the government, except for those documents which cannot be released pursuant to the Access to Information Act. These papers will be tabled immediately.

Motion No. P-55

That a Humble Address be presented to His Excellency praying that he will cause to be laid before this House a copy of all correspondence between the Government of Canada and the United States Environmental Protection Agency and United States Customs relating to intelligence and surveillance capacity concerning ozone-depleting substances.

Motion No. P-56

That an Order of the House do issue for copies of all documents, reports, notes, memorandums, letters, correspondence and minutes of meetings regarding the use of inmates of federal institutions as guinea pigs in experiments on the effects of LSD and, in particular, the report commissioned by the Solicitor General of Canada from the McGill Centre for Medicine, Ethics and Law.

[The Deputy Speaker]

Subject to the reservations expressed by the parliamentary secretary, is it the pleasure of the House that Motions Nos. P-55 and P-56 be deemed to have been adopted?

[Some hon. members]

Agreed.

(Motion agreed to)

[Peter Adams, Liberal, Peterborough, ON]

Mr. Speaker, I would ask that all other Notices of Motions for the Production of Papers be allowed to stand.

[The Deputy Speaker]

Is it agreed that the remaining Notices of Motions for the Production of Papers shall stand?

[Some hon. members]

Agreed.

The House resumed from April 12 consideration of the motion that Bill C-71, an act to implement certain provisions of the budget tabled in parliament on February 16, 1999, be read the second time and referred to a committee.

Budget Implementation Act, 1999

[Carolyn Bennett, Liberal, St. Paul's, ON]

Mr. Speaker, it is a pleasure for me to rise today to speak to Bill C-71, the budget implementation act of 1999. The premise today is that it is a great budget that will be easy to implement because it was a great process.

It is on the ground that problems are felt, it is on the ground that real solutions are formulated and it is on the ground that budgets are implemented. I hope we will never return to the day when ministers of finance and a few close advisors cloister themselves and then come out of their perceived telephone booths to announce to Canadians what they think is good for Canadians. We know that does not work. People do not want to be told what is good for them when they have not been included in the process.

I have been pretty fortunate to have come from an institution like Women's College Hospital. Women's College Hospital had the motto “Non quo sed quo modo”, meaning that it is not only what we do but how we do it. It is very interesting that when we have a motto such as that we actually look at the way we do things.

In the federal budget there are two hows: how we decide what we want and how we do what we want. It was indeed the process in terms of how we decide what we want, the thorough consultation and rigorous analysis of this budget, that has ensured its relevance to Canadians and thereby its success in implementation.

It is a feminist theory, if we are allowed to use that term, which I am proud to use, that is actually part of inclusive decision making. One of my great heroes, Ursula Franklin, once told a story of being invited to a PD day at a school. She insisted that all of the staff be included. The teachers thought that maybe just the faculty should be included. However, because the topic of the day was identifying children at risk, Ursula felt that she would like to have all of the staff there.

It was quite interesting that as they began the day, within the first half hour the janitor put up his hand and said “I know kids from violent homes because they are on the doorstep when I open up the school in the morning”. It was in the next half hour that the Jamaican cook put up her hand and said “I know who the kids are who are hungry because they help me clear the plates. I know they are eating the scraps on the way to the kitchen”.

It is only through inclusive decision making that we end up with a result that is relevant and one which we can implement.

As a new member of the finance committee I was truly impressed with the inclusive nature of the process, with the thoughtful and impressive deputations and with the ability to analyse problems, present solutions that had been tried in other jurisdictions, present the risk of doing nothing and the rationale for government to invest in these solutions.

We heard from the grassroots across the country. We heard from the researchers, the policy analysts and the business community. We heard concerns of health care, brain drain, decreasing disposable income and our debt. We also heard their solutions. They felt that reinvestment in health care was imperative. They felt that we should reinvest in research, target tax relief and get our debt to GDP in line. We heard from all of the partners whom we will need to implement these policies.

On February 16 the Minister of Finance presented what I think was a brilliantly crafted balance of the solutions presented. The availability of resources were allocated according to the priorities stated by Canadians. Health care was without a doubt number one. Our most valued social program received the major investment.

It was clear that just money would not ensure the restoration of Canadians' confidence in the system. Experts, including the National Forum on Health, have been very clear. There has to be real accountability for the dollars spent. There have to be dollars for a health information system that will begin that process. The Canadian Institute of Health Research will begin the exemplary process of co-ordinating research in the broadest definition of health from the molecule to the community. We will be able to look at health promotion, disease prevention and treatment and research into best practices in health care delivery. We know that best practices could save an additional $7 billion a year.

The 1999 budget was exciting because of the other how also, the second how of how we do things. That is the landmark agreement of the social union. It will begin a process by which the federal and provincial governments will commit to a new transparent method of delivering programs. They will have to report their outcomes to Canadians.

Our Prime Minister's commitment to getting the health accord and the social union signed has rendered the dollars assigned in this budget even more important. Canadians can now be assured that every dollar will go as far as it possibly can. Evaluation and accountability are now imperative. The new social union framework values Canadians' equality, respect for diversity, fairness, individual dignity and responsibility, mutual aid and our responsibility for one another. These things have been agreed upon.

It is no longer the survival of the fittest in this big cold country. A long time ago we decided that we would look after one another. We are not going to be asking levels of government to report to one another; we are asking all levels of government to report to Canadians.

That all Canadians are created equal and should be treated equal and equal per Canadian funding was a principle of the social union.

We have to meet the needs of Canadians with sustaining social programs and services. We have reaffirmed the Canada Health Act in active participation in a social and economic life.

The second principle was mobility. This will allow Canadians to pursue opportunities. It ensures what is so important, that a Canadian is a Canadian.

The third premise which is extremely important is the public accountability and transparency in terms of getting the health information systems, achieving and measuring results, involvement of Canadians and ensuring fair and transparent practices. It is this point that will make every dollar spent in the budget go that much further.

Working in partnership for Canadians, joint planning and collaboration, reciprocal notice and consultation was the fourth aspect.

The fifth aspect was a proper clarification of the federal spending power. This means that dollars assigned in a federal budget have been predetermined and will be easily implemented. Dispute avoidance and resolution was obviously important, as was the three year review.

In my riding there was great debate before the budget about giving dollars to the provinces in the CHST. One very adamant constituent was very clear at our prebudget consultation that we were not to just give money to Mr. Harris.

The signing of the social union health accord has been a tremendous step forward for our federalism. Canadians need to feel confident that dollars dedicated for health care would be spent on health care. The commitment to transparency is imperative to rebuild the confidence of Canadians. It makes me very optimistic in terms of the truly positive role for government.

Social union will ensure that Canadians will continue to be consulted to set their social priorities. The federal and provincial governments have to make sure that it happens. It is only in that way that we get to deal properly with the tough issues like the preschool development of our children, homelessness, and persons with disabilities which cross all ministries and all levels of government.

Last week in St. Paul's we had a town hall meeting with the Minister of Intergovernmental Affairs. We also had a panel consisting of Lorne Sossin, a constitutional lawyer; Barbara Cameron, a professor of political science from York University; Martha Friendly, a child care researcher; and Andrew Coyne. It was an interesting debate in St. Paul's, a riding that is known for caring desperately about the big picture and putting Canada first.

It came from that meeting how complex our federalism is and how important it is that we deal with a matrix of responsibilities, accountabilities, but together set some real objectives as to what it means to be a Canadian and what we care about. It is imperative that we move forward with our partners, the private sector, the third sector and our provincial colleagues.

We have our choices, our policy levers and our incentives and our programs. We actually continue to ask Canadians at election time what they care about. We tell them how we interpreted that in our speech from the throne, but it is at budget time where we get to set the priorities that came forward with the dollars that have been allocated.

This budget was a balanced one. It reflected the true priorities of Canadians as they said to us. Therefore it will be an extraordinarily easy budget to implement because the people implementing it were the people involved in deciding what was there.

[Ken Epp, Reform, Elk Island, AB]

Mr. Speaker, I have the pleasure of working on the finance committee with the hon. member. It is always fun to get into the debates and ask questions of witnesses when they come to our committee. I have a couple of questions for the hon. member.

She talked a little bit about this new federalism. The Prime Minister and the health minister with the collusion of the finance minister have altered our Constitution. By using the federal spending power, they have basically held a club over the heads of the premiers of the provinces and have thereby intruded into what is constitutionally a provincial jurisdiction.

Even though I say this somewhat reluctantly, I think it was probably only the premier of Quebec who had—what do you call it in French—the chutzpah to stand up against what the government is saying. Of course, Quebec got the money anyway so it did not really matter. The other premiers did not do this.

I have quite a concern about the federal government taxing the dickens out of us. We are overtaxed and we are talking here today about the budget. We are taxed like anything. Most families have noticed the tax pressure. The provinces have reduced tax room because of this. The federal government by taking all this money from us, really backs the provinces into a corner in terms of economic freedom of what they can do to manage the health care system. Then this government turns around and says “Okay, we are going to give you some of your money back but the condition is that it must be used only for health”. That is a straight violation of the Constitution of Canada. Most constitutional experts say that.

While I certainly share the concern of the member with respect to health and the funding of health, we know that this government by its reduction of the transfers to the provinces over the last number of years has made a substantial negative impact on the reduction of health care services for Canadians. The Liberals are now gingerly giving a little bit of it back and they say that is helping while at the same time they are breaking the Constitution.

I would sure like to hear the comments of the member on that particular subject.

[Carolyn Bennett, Liberal, St. Paul's, ON]

Mr. Speaker, I think the issue is the provinces all have agreed that this is necessary. There was no club to their heads. Even Quebec signed a health accord saying it was extremely important that people understand what it is for.

Constitutionally, actually it was only hospitals that were the provincial responsibility. There has always been an agreement that health care is a joint responsibility in terms of what we do federally, research and prevention and all of those things.

What is imperative is that throwing money at problems without any accountability would not be acceptable to any taxpayer or any business person. We are saying there has to be a set of objectives and we will then figure out what the performance indicators are, what are the kinds of things that the various sectors can agree on as to what is acceptable.

I agree that you cannot start measuring things unless you have an ability to remedy the things that are not working properly. A 1995 document from the University of Ottawa and Queen's University made it clear that if we moved to what is in the social union, best practices, we would be saving $7 billion a year in health care.

We are doing too many unnecessary surgeries. We are giving antibiotics for colds. We are doing way too many things that are totally ineffective. We are ordering tons of laboratory tests that have been outdated for 20 years.

We need a way to help the provinces share best practices and help them save money to be able to provide exemplary and optimal patient care. This is not going to be if we keep allowing money to go places without the kind of scrutiny and accountability Canadians expect.

I am thrilled that these two things have come together. It is amazing that the hon. member would say that there was a club to the heads of the provincial premiers. They all willingly signed it.

The social union talks about transparency. It talks about best practices. It talks about accountability. It talks about involving Canadians in setting their social priorities. Hopefully at the end of the turf war of we are going to set some objectives and promise Canadians that they are going to happen together. It is the beginning of trying to get some sense out of this very complex federalism.

There were experts present at our town hall meeting last week. The Minister of Intergovernmental Affairs was fabulous in explaining that fact and compared this to other countries. For example in the United States, unless the states sign on to lowering the driver's age they do not get any money for highways. We could not pull that off in Canada if we tried. Canadians would not want that kind of power for the central government.

There is also huge power for the provincial premiers. We have an interesting complex tug in terms of tension. This has been a brilliant piece of work that a lot of us were very worried about before. It is thrilling to actually see this work and now be able to implement things, to put the meat on the bones of the social union, get these sectoral agreements going, start setting objectives and actually give Canadians a bang for their buck.

[Gilles-A. Perron, Bloc, Saint-Eustache—Sainte-Thérèse, QC]

Mr. Speaker, I would like to put a question to the member for St. Paul's.

We will recall that, on February 4, 1999, under the social agreement signed by the premiers, except the Premier of Quebec naturally, and the Prime Minister of Canada, the Government of Canada promised to consult the provincial and territorial governments at least a year before renewing or significantly changing the funding of the existing social transfers to the provinces.

My question is as follows: How do you explain the government's going back on its word and its signature, since two weeks later, the federal government radically changed the formula for allocating social transfers among the provinces? Please explain this change and this going back on its commitment.

[The Deputy Speaker]

The hon. member knows that he must address the Chair and not the member directly. The hon. member for St. Paul's.

[Carolyn Bennett, Liberal, St. Paul's, ON]

Mr. Speaker, I would draw the hon. member's attention to the principle of the social union which was to treat all Canadians with fairness and equity. It was extraordinarily important to the finance minister and to the government that all Canadians receive on a per capita basis their rightful percentage of the CHST.

It was an anomaly that had been capped by the previous government and it needed to be right. It needed to be fair. It is part of the social union principle that all Canadians be treated equally. Therefore that was reflected in the budget.

[Jack Ramsay, Reform, Crowfoot, AB]

Mr. Speaker, I have a brief question.

It is very clear where authority lies for health care. It is under section 92. It falls within the realm of the provincial governments. I would like the hon. member to tell the House where she sees within the BNA act, the Constitution of this country, authority of the federal government over health care. If she could tell the House that I would be pleased.

[Carolyn Bennett, Liberal, St. Paul's, ON]

The issue is health care delivery and there has been a consensus that health care delivery must be dealt with by the province. Some of the standards that have been set in terms of the Medical Research Council of Canada and all of the things we have had before have always had joint agreement in terms of—

[An hon. member]

Where is the authority?

[Carolyn Bennett, Liberal, St. Paul's, ON]

I will be more than happy to find it but I do trust—

[An hon. member]

The spending power, the federal spending power.

[Carolyn Bennett, Liberal, St. Paul's, ON]

It is in the federal spending power to set priorities which we think are in the best interest of all Canadians. That is separate from health care delivery.

[Grant Hill, Reform, Macleod, AB]

Mr. Speaker, budget implementation is of great interest to me because the budget was characterized as a “health budget”. We have heard a lot about the health budget. The previous speaker being a physician and rather glowing about the budget obviously believes it was a health budget.

One issue has been fascinating to me. I have had an opportunity to go about the country and express this sentiment. The Liberal government has promised to put $11.5 billion back into health care over the next five years. There was a significant amount of advertising to that effect. One would not think that it would have to advertise such good news. One would not think it would have to spend $2.5 million to tell everyone. That message should go across the country, it is so exciting.

Why did the government have to advertise it? In truth it had to advertise it because in the previous five years it took out $21.4 billion cumulatively since the day the finance minister took over.

I asked kids in grade eight what they thought of that as a balance and they said “Doc, we don't think that is a very good balance. Doc, we think that is a crazy balance”. I have a little graphic that I used. I cannot use props in the House but I can describe a prop in the House. Here is the prop I used to show what the Liberal government did with medical funding for the provinces.

I held up an intravenous bag with 1,000 cc's of IV fluid in it. I coloured the fluid red so it would like blood. Some of my colleagues have seen this. The 1,000 cc's represents the $1,453 per taxpayer that was being transferred from the federal government to the provinces for health care when it took over.

Then I held up another bag with 596 cc's of IV fluid in it. There is a significant difference. Anyone looking at it would say that it just about half, which is true. That is what the federal government was transferring per taxpayer for medicare just before the budget.

Then I took a big syringe and put about 100 cc's into the IV bag, which pumped it all the way up to 692 cc's. I showed the two bags, the full one and the one with 692 cc's in it. We must remember that it was at 1,000 cc's when I started and now it is down to 692 cc's. The response to that is dramatic. People just say it is not keeping up.

What has been the result, the practical down to earth result? The public does not really give a hoot about jurisdiction. If there were no effect on health it would say that was not a big deal, but the evidence of problems in our health care system are legion.

I have chosen to look at the newspaper reports over the last little while. There are too many for me to go through. It would take my whole speaking time. However I will touch on just a few of the recent news reporting relating to health.

In Newfoundland 600 people need heart surgery every year. The province can only afford 400 so 200 have a choice. They can get in a waiting line or they can go across the border to the States.

On January 19 this year every surgery was cancelled at the Kelowna General Hospital in B.C. Why? Because there were not enough beds and personnel to look after them. That comes from the CANOE news of January 19. On and on they go. There are dozens of examples.

Women in Summerside, P.E.I., have to wait one year for a mammogram because one machine broke down and the government there cannot afford the $75,000 to fix it. How will it get fixed? The foundation will go out and raise private funds to look after that.

In Montreal the waiting list for a hip operation can be as long as 15 months. For gallstone surgery, which is a painful condition, it takes 2.5 months. That information comes from the Gazette .

Here is another very interesting one. Patients in Manitoba waiting for an MRI are being offered from a private U.S. medical clinic in Fargo, North Dakota, a charter air service and free night in a hotel so that they can get a timely MRI. How many Manitobans have taken advantage of that? There have been 120 Manitobans who have said they will not wait. That was in the Winnipeg Free Press on January 27.

At the Grace Hospital in Winnipeg there were corridors jammed with patients. There was no room for them in the wards. In one case there was no room to put a baby that had sadly passed on so nurses hid the little baby behind a curtain while doctors worked on other patients beside it.

An elderly man was incontinent after days of near neglect in a hospital. His friend asked a nurse to put diapers on him. The response was “We don't have diapers. You must go and buy those yourself”. On it goes.

It is interesting. We have a nursing strike right now in Saskatchewan demonstrating stress. We have an exodus of trained health care workers. In the last two years 1,400 of our best trained specialists have left and will never return.

The federal government can say all those things are provincial and we do not have anything to do with that. There is, however, a hospital at Sioux Lookout. It is interesting that the health minister mentioned it in question period today. I will go through the story of the Sioux Lookout Hospital which is a federal responsibility. This is a hospital for natives alone. The federal government has complete responsibility for that hospital.

This is a story of incompetent bungling. In the spring of 1997 Health Canada was first warned that a crisis at the Sioux Lookout Hospital was coming. I have three letters directed to the Minister of Health and his officials which said there would be a shortage of physicians at the hospital.

The story is quite interesting. The University of Toronto had been looking after physician recruitment for that area for 30 years and a deficit had occurred. They said they could not continue to look after the deficit. They warned that by June 1998 they would be pulling out unless that deficit could be taken care of. It was simple.

Mae Katt, Ontario regional director for Health Canada, said there was no problem, that they would have 15 physicians from McMaster on that date.

The conditions deteriorated. The warnings were raised. Health Canada refused to respond to the University of Toronto. McMaster, negotiating with the Sioux Lookout individuals and this Mae Katt, just simply said it could not do it in time.

What happened on June 30? This could not happen in a third world country. With five hours notice the Sioux Lookout emergency was closed. A closed sign was put up in an emergency department for natives and 16,000 natives were without emergency care.

A contract finally appeared. It was a like a contract for an F-18. It had nothing to do with medical issues. Things were crossed out and whited out. The physicians who were there just simply said they could not sign it. They were threatened with losing their seniority if they did not sign it. They lost their seniority. They left the north. Instead of 15 physicians looking after Sioux Lookout, today there are 4.

I have been privileged to look over this story and finally, in the last month, advertising has gone out for recruiting. Anyone who knows anything about recruiting physicians for the north will know how long that will take. We will not have physicians in the north until this summer at the very earliest.

What did the hon. member for Kenora—Rainy River have to say about this? These are his words relating specifically to Sioux Lookout:

The medical services branch has totally bungled everything here. This issue has been totally mismanaged.

The Liberal member for Kenora—Rainy River did everything he could do to get our Minister of Health to listen. He begged him.

Do we know what his response was? The minister sent up one of his underlings who said there was a nursing crisis that was just as big. That was the response of Joanne Meyer, an executive assistant. They went over the nursing crisis. We would think that there would be an immediate response.

There was an immediate response. Here is the letter sent by the native communities to the World Health Organization in Geneva, Switzerland, begging for some help. We go to Switzerland to look after our native brothers in the north. They went to Doctors Without Borders.

They were cared for by Doctors Without Borders. It is absolutely abominable.

Sioux Lookout is an example of how the federal government looks after its specific responsibility. The diary of this story is not through. The natives today in Sioux Lookout are on a hunger strike. They are sitting there with their arms folded, saying this should not happen in a country like Canada, but it did.

Now the Minister of Health, belatedly, will trot up north, sit down with them and say “Come and get involved in my task force”. I would like him to say why he did not respond to these problems when he got the initial warnings two years ago. I am willing to provide the letters specifically directed toward the Minister of Health to anyone who wants to see them. Sioux Lookout is an example of a tragic situation in Canada.

Time is so short. After talking about the bungling at Sioux Lookout, let me talk about the bungling on the hepatitis C issue in Canada. As a physician I gave my patients blood. As a surgeon I gave them blood. I trusted that our blood system was as good as it could be. I found out through Judge Krever that was not true, that we gave patients in Canada dirty blood, blood infected with hepatitis C.

Judge Krever, who became our expert in tainted blood, said we should look after everyone who is sick from receiving tainted blood; not just give them money because they are positive with hepatitis C but give them something if they are in trouble.

I understood what he said. I understood why he said that the federal regulators had made a mess. He said the provincial regulators had made mistakes and he said that the Red Cross had been involved as well. I have watched with wonder how the government could try to weasel out of that responsibility.

I have also watched with wonder a compassionate Ontario premier say that he will not just give narrow compensation to the group from 1986 to 1990 but will give compensation to everyone, and he did that. I have watched Quebec now change its proposals. It is looking at compensating everyone. I have watched as lawyers argue, fight and bicker over the funds that should be going to the individuals who are ill. I had occasion to sit down with a few of them here in Ottawa just the other night. I listened to them talk about their needs and their worries. The local regional government is taking better care of these individuals than the ones who are really responsible.

I have also watched Swiss authorities being charged and huge sanctions put upon them for exactly the same actions in Switzerland. I have watched the French authorities bring to trial the prime minister, the health minister, the social affairs minister of the day for the same actions. I wonder where are we in Canada for these poor people with hepatitis C. I think this will go down as one of the blackest chapters as it relates to health. Of course, I point across the way for that responsibility.

Let me talk briefly about the future of medicare as I see it. I really and truly believe that this social program is so valuable even though the Liberal motto seems to be “we will just hide our heads in the sand and have the status quo”. I say that two tier medicine is alive and well in Canada thanks to the Liberal policies. There is one tier for the dead and there is another tier for the waiting. That is said with tongue in cheek, but it is truly sad.

What do we need to do to improve and protect this health care system of ours? The first step needs to be funding that is not hidden under the Canada health and social transfer. That was the way the Liberals got away with this tremendous reduction in funding. Health care funding from the federal government should be so specific, so clear, so straight, so plain that no one could ever get away with reducing it as they did. It should also be indexed to inflation.

I would cast this Canada health and social transfer into the dustbin of history and have health care funding so plain and clear, as I said. We could have the other funding just the same. That is something the Canadian Medical Association has called for and it is certainly something I personally agree with.

We also need to stop thinking of this as a system, but think of it as care. The patient must come first again. We have had a health care system that has been driven by politicians, by bureaucrats and frankly by the medical profession. I do not think that is the way to drive this system. The solutions will come from the individuals who are most affected. I would put the patient first. We need specific mechanisms to reduce the waiting lists in Canada.

Where will we go with our medicare system? It is fascinating. Last Friday was the 15 year anniversary of the Canada Health Act. Monique Bégin, a Liberal, a good Liberal, was responsible for the Canada Health Act. I listened to comments made by her. She said very plainly that the Canada Health Act needs to be revisited. She said that there are breakdowns in the Canada Health Act. What a brave woman. She is talking about looking after health rather than the politicization of our health care system. That is really, truly where I believe we should go.

I am quite optimistic about the future of our health care system. If we can get away from the name calling, if we can get away from speaking about basic changes to our health care system as being an Americanization or two tier, if we can get down to the level of actually looking at and trying to fix this system, I think we have a real good chance.

I am optimistic because of New Zealand's experience. It came so close to losing its health care system when it hit the debt wall, and it did. New Zealanders lost virtually all their social programs. Their senior citizens programs were battered. They lost transportation subsidies. They lost all the subsidies for their agricultural projects.

They did not lose their medicare. They did everything they had to do to save their medicare system. They went so far as to put advertising on their ambulances to pay for the fuel so they would not lose their medicare system. They chose a route I do not agree with. They chose the route of user fees to improve and increase the cash flow for their medicare. But losing virtually every other social program, New Zealanders clung to their medicare system.

As I consult with Canadians across the land, I hear them say “Don't let go of this medicare system”. In my view, medicare will survive not because of the actions of this Liberal administration, but in spite them.

[Carolyn Bennett, Liberal, St. Paul's, ON]

Mr. Speaker, I have two questions for the hon. member.

In the litany of individual provincial problems with health care delivery the member made it sound like this is only about money.

I would ask the member to comment on the Ontario Hospital Association's presentation to the finance committee. The association said that this is not about money. This is about mismanagement. It is about not having income-outcome measures and setting best practices and those kinds of things.

How can the member prove that this is just about money? How can he blame the federal government for what some people feel is a mismanagement problem in terms of the delivery system?

I am astounded that as a physician, a profession which is criticized for over-medicalizing our health care, the member could actually think that we could fund a sort of fix it part of the system instead of a holistic model that the patients know works. A health transfer does not deal with the social determinants of health, poverty, violence, the environment and all those things.

The only way to a sustainable health care system is to keep people well and not let them get sick. It is only the doctors that seem to have trouble getting the picture.

[Grant Hill, Reform, Macleod, AB]

Mr. Speaker, I am sure the member missed the initial comments I made. Those comments were fairly specific.

There will have been $11.5 billion put back into health over the coming five years, with $21.4 billion taken out in the previous five years. Does the member see that balance? My colleague will shake her head and say this did not happen. I ask her to look at the amount transferred to the provinces in 1993 and look at the amount transferred at the end of the next five years. The member will find that this is an incredible reduction.

My time is relatively short here but we could go beyond my comments on the issue of mismanagement in the system and we certainly should go beyond my comments. I am not trying to talk about the whole health care system. I am talking about the federal responsibility when it relates to the funding component. If that is beyond the ken of the Liberals, I can understand why they would go ahead and make those reductions and think they are not a big deal.

Does the Ontario Hospital Association have the capability of finding some mismanagement in the system? You bet and it certainly should do that.

It is also interesting to note that the province of Ontario spends more on medicare in one year than the federal government transfers to the whole country. Where is the rubber hitting the road? The rubber is hitting the road for the provinces and this administration made it difficult for them. In spite of those reductions the provinces found more money for health care.

It is a dreadful debate when we look at just a narrow component. This government has done more to harm medicare than any other government in Canadian history.

[René Canuel, Bloc, Matapédia—Matane, QC]

Mr. Speaker, I listened to my colleague's very accurate description of the truly painful situation in most hospitals. He is a doctor himself and can describe up close what we see from the outside.

In my riding, a rural riding, there is the hospital in Ste-Anne-des-Monts, the one in Maria, the one in Amqui and the one in Matane.

Having spoken with many doctors, nurses and especially patients, I know things are difficult. When the Rochon reform began, certain adjustments had to be made. Doctors and nurses, particularly those on the front line, had to work twice as hard to provide more or less the same level of care.

Last week, one of my friends died in the hospital in Rimouski. Her husband and children told me she had received exceptional care, despite all the federal cuts.

I take this opportunity to thank the doctors and nurses who deal with this situation, who often work overtime with a limited staff to preserve the quality of patient care.

I congratulate these people because they really care. When staff cuts are made, it is not easy to continue to provide the same quality of care, because we are dealing with human lives, not objects.

I have a question for the hon. member, who is a doctor. Earlier, he mentioned that many doctors are moving abroad, particularly to the United States. Nurses are also leaving. Of course, salaries are a factor. The fact that these people are not paid the same as doctors in the United States might a reason for their leaving the country.

Would it not be possible for a government to remove some of the quotas in universities? As we know, there are quotas in medical schools. It is hard to get accepted in medical school. We are told there is shortage of doctors. I agree that doctors work really hard, but there are not enough of them.

Does the hon. member think there is a way to train more doctors, particularly in the regions? Each year, we have to go to the universities, almost beg young doctors and give them special benefits to convince them to come to our regions. Every year, we have to go through this exercise, which should not be necessary, in my opinion. The regions should be served as adequately as the large urban centres. I would like to hear the hon. member on this.