My colleague from Beauharnois—Salaberry has even taught this to his students. It is hard to imagine in a federal system worthy of being called one that a government can literally strangle the provinces with its policy, and this is what has happened.
It is in fact so true—and I want to make this point in my preliminary remarks, because I want to spend time on the essential issue of health—that in 1993, 1994, 1995 and 1996, governments, especially that of Quebec, witnessed a sort of transfer of clientele. In other words, all the cuts to health care or to employment insurance have had the effect of preventing people from qualifying for programs they had access to previously. They ended up turning to the program of income security in increasing numbers.
This is so true that some authors, such as economist Pierre Fortin, have estimated that the restrictions arising from the various federal government cuts have cost the Quebec public treasury additional millions. Clearly the agreement before us provides reparation. We must not ever forget that.
It is no small matter, when we consider the years 1994, 1995, 1996, 1997 and up to today. What was needed was a common stand by all the premiers, be they New Democrat, Conservative or Liberal. Brian Tobin has, in recent years, added a strong voice to this debate. He called upon the federal government to re-establish the transfer payments.
I repeat, we are going to subscribe to the agreement we have before us. We are going to make amendments, but we want the money to be made available to the provinces as promptly as possible. We are dealing with the outcome of a mess that was literally provoked by the federal government.
This is an example of why we on this side of the House are sovereignists. It makes no sense for there to be two orders of government, one of them with more financial means than the other because of its taxation powers and the division of powers.
Here is where the question lies. In modern life, as we are living it in this month of October in the year 2000, the major responsibilities our citizens expect us to meet fall under the jurisdiction of the provincial governments. Whether it be health or education, these are areas of responsibility that are at the core of our fellow citizens' lives, and ones on which the federal government has virtually no say, despite the fact that it is better off financially, with more financial resources than the provincial governments.
Nevertheless, without this common front, without the doggedness of the Bloc Quebecois which has made this a guideline, a baseline, a kind of leitmotif for all of its political action since the Minister of Finance's budget, without this concerted effort by the various actors putting pressure on the federal government, I do not believe that this would have been accomplished.
In my opinion, another explanatory factor for the agreement reached by the first ministers at the September 11 conference, in addition to all the ones that have come out of Winnipeg via Ottawa, is the imminence of a federal election.
The Prime Minister, cabinet and the whole government caucus knew full well that it would have been unthinkable to call an election after impoverishing the provinces, after exerting very real pressure on the health system, without doing something to restore the sharing of fiscal responsibilities.
To make things clear, let us take a look at what this agreement provides. The agreement is based on six major points. First, it seeks, as I said, to restore transfer payments. A total of $23.4 billion will be invested over the next 5 years. Next year it will be $18 billion, then $19 billion, $20 billion and $21 billion. Transfer payments will be increased to $21 billion and about $2 billion will be kept for policies directly aimed at young children.
In addition to that, a $1 billion trust will be set up for the acquisition of medical equipment. It is critical to realize how important this is for the health system, because medical technologies change very rapidly.
Last winter, I met the administrators of the various hospitals on the island of Montreal. I wanted to know how things were done, what their major management challenges were and what it meant, ultimately, for an administrator to provide health services to a community.
All the administrators told me about the importance of renewing the technological equipment in the medical sector. Acquisition costs for these technologies are extremely high and the life expectancy of this equipment is about five, six or seven years at best. So $1 billion will be earmarked for the acquisition of medical equipment.
The bill is too vague and an amendment will be necessary, because we want to correct that flaw. We want it to be clearly stipulated that the proposed funding, the $1 billion for the acquisition of medical technologies, will be entirely consistent and in no way discretionary with what was agreed at the meeting of first ministers in Ottawa.
I draw the attention of all parliamentarians to the fact that the final press release for the Ottawa conference gives the breakdown of this $1 billion for 2001-02. The totals are given for each province. For 2000-01, Quebec will be receiving $119.9 million; the amount for the following year will be $119.2 million. We must not find ourselves in a situation where we pass a bill that is not very clear about what the first ministers agreed to.
This is an extremely important part of the agreement. We attach very great importance to it and that is why we will be tabling an amendment here in the House if we go into committee of the whole for the subsequent stages.
In addition to the $1 billion fund for the acquisition of medical equipment, the purchase and installation of modern diagnostic tools and other medical equipment that is obviously urgently needed, there is a $500 million fund for the installation of health information technologies.
This is also an important feature of the agreement. We know that each of the provinces has a database and computer networks, information that may give a clearer picture not just of the progression of diseases, but of various trends in the medical community.
At the Ottawa conference this past September 11, the first ministers agreed to exchange this information. The purpose of the information exchange is to ensure compatibility among the various information systems so that data may be exchanged at high speed without any technological hitches.
This was made very clear in the communiqué. There was no reference to Canada-wide information standards, as there is in the bill. In order to make things very clear for those who are listening to us, and in order for them to clearly understand the reason for our amendment, I would like to read what the first ministers had agreed to in their final communiqué at the end of the September 11 conference.
Specifically in relation to health information and communication technology, both Premier Bouchard and Minister Marois agreed that it is important to have this exchange of information, and to have it work both ways, so that the provinces may also benefit. For example, the federal government has a health information network. It is important that this information circulate as freely as possible.
We know that every time the government of Mr. Bouchard, and of Mr. Parizeau before him, had the opportunity to serve the superior interests of Quebec, it made a contribution.
As an aside, I would remind hon. members that any time there was an opportunity to allow Quebecers to benefit from a change for the better in the status quo as far as their day-to-day services were concerned, the sovereignist governments, which are as everyone knows extremely vigilant in defending the interests of Quebec, whether in the time of René Lévesque, Jacques Parizeau or Lucien Bouchard, have taken advantage of that opportunity.
I want to remind members that the manpower agreement was negotiated by Louise Harel. It was not accomplished under the Bourassa government. It was vitally important to have a single window in Quebec in 1995 for those receiving income security and those receiving employment insurance. Quebec had had enough of making a distinction in connection with changes in the labour market that for too long had resulted in a duplication of programs that left the public confused. The result is that as we speak, someone who is unemployed in Quebec can access all of the Government of Quebec programs through a single window and does not need to go through a multitude of intermediaries.
The sovereignist governments, because their allegiance is to Quebec alone and to the people they represent, have, in very current matters that are at the heart of our fellow citizens' concerns, been able to come up with agreements where the federalist governments could not.
I have just given the example of manpower, but I could have given other examples. I would, however, like to get back to the matter of health. On the subject of health information and communication technology, it was agreed at article 7 of the agreement, which I quote, that:
All governments have made major investments in health information technologies in recent years to improve care and health system management.
First Ministers agree to work together to strengthen a Canada-wide health infostructure to improve quality, access and timeliness of health care for Canadians. First Ministers also commit to develop electronic health records and to enhance technologies like telehealth—
Telehealth is remote health care. I will give you as an example the case of a person who is x-rayed in Lotbinière riding but needs further treatment in the Saint-Luc hospital. It is then possible with telehealth to send the x-ray and the information by means of an electronic and computerized process.
Telehealth will become extremely important in the coming years, because we know that the treatment individuals are to receive may not be available in their community. I will continue reading from article 7:
—over the next few years.
Here I draw the attention of the members, because this is where we will introduce an amendment.
Governments will continue to work collaboratively to develop common data standards to ensure compatibility of health information networks. This will lead to more integrated delivery of health care services. They will also ensure the stringent protection of privacy, confidentiality and security of personal health information.
It goes without saying that this information must be secure.
There are several causes for concern in the bill. I repeat, Premier Bouchard and the health minister, Pauline Marois, have agreed that in order to follow developments and understand events in areas relating to health care it is important to have information circulate. That is understandable.
I will give you an example. The Quebec public drug plan covers certain drugs. We want to know if the equivalent of the drugs covered by this public program exists in other provinces. How much does AZT or a new medication for hypertension cost in Quebec, and what is its equivalent in other provinces? It would be helpful to provide this kind of information through a network, and that information should be accessible to all the stakeholders, but there is absolutely nothing on national health standards.
This morning, the leader of the Bloc Quebecois, the deputy leader of the government and yours truly were very surprised—let us not forget that we received the bill late yesterday afternoon—to see that the legal wording of clause 3 reads as follows:
- The Minister of Finance may make a direct payment of $500 million for the fiscal year beginning on April 1, 2000 to a corporation, to be named by order of the Governor in Council on the recommendation of the Minister of Health, for the purpose of developing and supporting the adoption of Canada-wide information standards and compatible communications technologies for health services in Canada.
As members can see, there is a difference between the text of the final release approved at the first ministers' conference on September 11 and the legal wording.
Perhaps the different wordings in the release and in the bill are an accident because the legal officers did not accurately reflect the will of the premiers and of the Prime Minister. That is possible, but the Bloc Quebecois will have to propose amendments, and I understand that the government will support such amendments. This will ensure an adequate process for everyone, and I gather that there will no obstruction from any side.
These are the main points of the agreement. I wanted to go over it again because I think it is vital to our understanding. Had it not been for the vigilance of the Bloc Quebecois, the common front presented by all the first ministers and, I think we would have to agree, the impending election, we would never have arrived at an agreement such as this.
I also wish to take this opportunity to remind the House that one year ago all the health ministers had asked their officials to try to determine the progression of health care costs. We cannot say this often enough. It would have been unbelievable, completely shameless of the federal government, and it would have shown a complete lack of civility and political good grace if the federal government had not made this gesture of atonement. This is the atonement of a hegemonic government that has repeatedly taken advantage of its financial position, that has acted unilaterally to make the provinces poorer, often creating additional costs for their respective treasuries.
All this was documented in a study, which I have summarized, because it is 200 pages long. This was a study commissioned by all health ministers. First, it looked at a well-known demand. At the time, all the provinces were calling on the federal government to restore transfer payments to 1994 levels immediately. This is pretty much what is being proposed. In this, the provinces have been successful.
It is worthwhile calling to mind that the study in question indicated that total provincial and territorial health expenditures were $11 billion in 1977. Why did they choose 1977? Because, hon. members will recall, that was the first year the existing programs were reformulated and the first year reference was made to established programs financing, the famous EPF.
Let us recall that in 1977 the provinces were spending $11 billion on health, whereas this year they will be spending $56 billion. This gives us an idea of the effort the provinces have had to expend in order to continue to provide health services to their respective populations. In parallel with the stepped up efforts of the province, the federal government has disengaged.
When I am asked to speak to people working in the health sector or at conferences, I always remind my listeners that for the year 2001-02, for example, if the government of Quebec wanted to provide exactly the same services as this year's to its population without adding any new services, its health budget would have to go up 5%. Thus, the health budget of the government of Quebec is rising more rapidly than the collective wealth being generated by the people of Quebec.
This is the dramatic situation that is going on. Once again, if the federal government had not re-established the transfer payments, it would have been extremely difficult for the government of Quebec to manage without jeopardizing other equally essential missions in the Quebec community. I think I have explained this sufficiently, so I will go on to the conclusion of the report.
I thank the hon. member for Québec for being here with me in the House. I do not think I have ever made a significant speech without her support. As far as politics is concerned, we are just about joined at the hip.
The main thrust of the conclusion of the report by all the ministers of health is extremely interesting. Let me read that conclusion. It says:
A review of the block funding for health shows that the gap between the current amount of the federal contribution, and the amount at which that contribution could be if it had increased significantly, has constantly grown bigger.
There is a big difference between the health care system of the eighties and that of the year 2000-01. For one thing, new diseases have surfaced. For example, AIDS was unknown before the eighties. Still, we won the battle against AIDS which, during the eighties and the early nineties, was a deadly disease. It is now a chronic disease, because we can control it with triple therapy.
The most important factor is, of course, the aging population. The Quebec population ages faster than the population in other countries. I have some figures here. Mr. Speaker, knowing your intellectual curiosity, I will be pleased to share these figures with you.
In 35 years, one quarter of Quebec's population will be over 55 years of age. In Germany or in France, it will take 65 years for that same phenomenon to occur, but in Quebec it will only take 35 years. Imagine the pressure that this puts on the public health system, but also the challenge that we will have to face when restructuring our health services.
Our generation is not the same as the generation of our parents or grandparents. People will not necessarily accept to live outside their homes when they get old. They will want to stay longer and longer, as long as possible, I would say, in their natural community.
This is one item of the budget that will be increasing, I am happy to tell the member for Argenteuil—Papineau—Mirabel, because he is our oldest member, although he is still very alert. He may even be the oldest member of the House. No, I think that distinction is reserved for the member for Terrebonne—Blainville. In any event, the member for Argenteuil—Papineau—Mirabel is the Bloc Quebecois critic for seniors' issues. We know that one of the budget items that will be growing in both absolute and relative terms is home care.
Governments are going to have to devote considerable effort to keeping people in their home setting. This means that the focus of service will have to shift from institutions to the community. This is called primary care. This is why the agreement provides for $800 million over five years to study how to keep people in their home setting as long as possible.
I was asked to speak for 30 minutes and I think I have done that. I will sum up with three points.
The Bloc Quebecois is delighted that the federal government has finally loosened the purse strings and is about to invest $23.4 billion over the next five years. We will of course make sure that Quebec gets its fair share.
On examining the bill, we noticed discrepancies between what the first ministers wanted and the wording of the bill. The Bloc Quebecois is going to move an amendment to clause 2 in order to ensure that the established population-based shares do indeed go to the provinces as agreed.
As for the compatibility of the various information networks and databases, which everyone agrees is important for a comprehensive overview, we will ensure that we do go the way of national standards, because this is not necessary and because it was not what the first ministers agreed to.
In conclusion, I assure the House of our desire to help see that the bill is passed quickly. I understand that in any event the government is going to agree to the amendments moved by the Bloc Quebecois.