Mr. Speaker, the bill can most aptly be titled the postdated cheque bill because it promises a restoration of funds to provinces, to patients and to medical professions across the country which simply will not come on time.
The last dramatic action the government took with respect to Canada's health care system was that it made a deliberate choice to put the heaviest burden of its restraint measures upon Canada's health care and social systems. That was a deliberate choice. That was a clear demonstration of what it is now customary to call Liberal values. The Liberals picked first on the sick. They picked first on people who are in need in society. That is where the burden of the cuts came.
The last dramatic action was a series of unilateral cuts that were made without warning. They were devastating cuts that have done more to damage the health care system than any other single set of circumstances faced by the country in the last several years.
After five years of pain the government today suddenly calls for debate on Bill C-45, which would have cash transfers for health, post-secondary education and social services returned to 1994 levels, not by this year but by the year 2002-03.
Why did the government finally repent? This was not the government's will. It was pushed to this agreement by the provinces of Canada and by the virtual certainty that sooner or later it would have to stop hiding and face the people of Canada in a federal general election. Left to its own devices, the government would have continued to let the health care system drift into the disarray that has caused such hardship across the country.
Before these payments are made another 18 months will pass. Full restoration of the cuts will only occur eight years after the cuts were so brutally made. I repeat, those cuts were the single biggest factor in the erosion of the health care system in the country.
The change today is not driven by the erosion of the health care system. The change today is driven by a cynical political calculation of fear of an election in which the Liberals would be held to account for the damage they have done in hospital after hospital, home after home, family after family, right across Canada. They had every opportunity to change this policy earlier and they did not do that.
As I look at the legislative agenda of this parliament, I am struck by one thing. Whether the issue is employment insurance or whether the issue is health care funding, every initiative by the Liberal government is being driven by an attempt to repair the damage done by earlier Liberal Party initiatives. This is simply a damage control government. This is not a government that is seeking to serve the interests of the people of Canada.
The government claims this is full restoration of funding. It is not. The bill cheats the provinces, the patients and the health care professionals of Canada by at least $3 billion. Had it been passed and effective this week and had moneys been committed this year, nearly $3 billion more would be in the system than is in the system under the bill before us.
Canadians will not see any of the restored funds this winter. The first instalment only occurs next April 1. That is quite clear in Bill C-45. It is also clear with this cynical government that the Liberal Party ads are running but the money is not moving. That is the height of cynicism in a system like this.
The most important failure of this accord, apart from the fact that it is a postdated cheque that cheats the recipients, is that the government still has not assured the provinces of stable funding in the future. That means provinces, health care professionals and people who are ill or fear being ill are subject once again and still to the threat of massive unilateral cuts in health care funding by the federal government.
The funding for the next four years does not recognize actual health costs or other factors contributing to rising health costs.
The federal government has yet to guarantee the provinces stable funding in the future. The votes for the coming four years do not take into account the present costs of health care nor the other factors affecting these costs. Despite the reinstatement of the transfers, we have no assurance that the federal government will not unilaterally cut transfers once again in the event of an economic recession.
The arrogance of this government is beyond all. With an election on the horizon, it is now telling the provinces to push the opposition to pass the bill in a day. Why did the government not listen to the provinces and the opposition in recent years, when we were saying that unilateral cuts to health care had hurt Canadians considerably?
In January 1997, the provincial and territorial ministers of health informed the federal government that:
The cuts in federal transfer payments have resulted in a critical loss of revenues for the provinces and the territories, forcing them to make rapid changes to the system and seriously threatening their ability to maintain existing services. The reductions in federal funding accelerated the movement to reform a system that lacks the ability to absorb and sustain the adjustments that that requires.
Did we hear an announcement of funding for health care? No. How did the Prime Minister react? In response to the demand put to him by the premiers at the annual Saskatoon conference, the Prime Minister apparently expressed doubts about the unconditional payment of votes to the provinces. He wanted to impose conditions in order to prevent the provinces from funding income tax reductions with this money.
What is clear is that the Liberal Party's political agenda has held back health care in Canada. The federal government's interest is not in standards. That is the flag it flies behind. It is not interested in standards. It is interested in control. It does not matter what happens in hospitals across the country. It does not matter what happens to people who are sick or fear being sick. The government wants to control every single penny and if Canadians suffer that is just too bad. That is unacceptable in any civilized system.
At the same time the government removed its contribution and increased its demand for control. This is happening at the worst possible time in the evolution of the health care system because of the insistence on rigidity, the insistence on control and the absolute refusal to work with the other partners in the health care system to give us a better system.
We are living through a period now in which our health care system is assaulted by several fronts. There have been dramatic changes in technology. There are dramatic impacts upon the system by an aging population who will be able to stay alive and active much longer than before. There are profound changes brought by the possibilities of medication and by pharmaceutical and other developments.
This is a time of immense change. This is a time of great opportunities for leadership. This is the time when a Pierre Elliott Trudeau or a Lester Pearson would have risen to the occasion, but not this government. What the government has done is turn tail and run and let the health care system in Canada fall into tatters. That is absolutely unacceptable to any kind of Canadian.
Today we have a deal before us to restore the funding cuts which were made unilaterally. The agreement is overdue. It pays less than is owed but it is welcome because the system cannot stand to be starved any further. However, in all of this talk about putting some of the money back, in all of the focus on the postdated cheque, the clear reality is that we have not taken a single step closer to having a modern and contemporary health care plan based upon the principles of the Canada Health Act to ensure the health and security of Canadians into the next century.
There is money in the system now, or there will be in a couple of years, but there is no plan because this is a government which congenitally does not plan. It is a government of drift rather than a government of seizing the initiative and assuring the leadership of Canada.
The three day meeting of the health ministers this week came up with a nursing strategy that will establish committees to investigate the chronic shortage, to measure resources and to examine changing trends. Nurses have been saying for years that there were chronic shortages in the health care system. We hope we have nurses left in our system by the time the Liberal government finishes studying what is wrong. The ratio of practising registered nurses to the Canadian population in 1999 was one nurse for every 133 persons. In 1989 the ratio was 1:120. The average age of an RN employed in nursing in 1999 was 43, up from 41 in 1994.
The bill is silent on how it plans primary care reform. We know from the first ministers' conference that $800 million will be invested over four years to support innovation and reform in primary care. We do not know from the bill how that funding will be distributed.
Elizabeth Witmer, the minister of health for Ontario, is quoted as saying that with the primary care funding, 70% will go to provinces and territories and 30% will go into a fund that will have some Canada-wide applications, but that money is not going to be made available until next April.
Ontario will have to put more money in to meet expectations until the federal cash arrives. Ontario can do that. Unfortunately, not all the provinces in the country have that ability. This is an issue that is seriously missing in the government's health care deal.
The government claims that it is interested in the same quality of health care system across the country. However, it has forced this upon the provinces, giving them no alternative but to accept this or nothing, which leaves the poorer provinces with a lower standard of health care than the others. What kind of Liberal values does that represent? Where is the health plan for palliative care and hospital infrastructure? All of them are important aspects of primary health care reform.
Under Bill C-45 the provinces will know their funding for health care up to April 2005. That is five years. It takes 10 years to train a doctor. Doctors are integral to the reform of primary care. The Canadian Medical Association has just sent me, and I am sure other leaders, a copy of a letter in which says:
In the CMA's estimation the total cumulative funding commitments contained in the First Minister's agreement are more than $17 billion less than what we forecasted as needed to ensure the sustainability of the health care system.
That is $17 billion less. Not only is it less, it is late. There is far less here than meets the eye. The government is spending more money this month on health care ads than it is on health care. That is simply unacceptable in a nation like this.
Pharmaceutical management is an important part of our health care system. At the first ministers' meeting there was discussion about developing strategies for assessing the cost effectiveness of prescription drugs and means of drug purchasing costs. There is no concurrent commitment by the federal government to improve the timeliness of drug approval. Some pharmaceutical companies offer evidence that drug therapies reduce institutional care. The government has direct input in approving new drugs that help Canadians avoid lengthy institutional stays.
The Canadian Medical Association has stated that an unnecessarily long approval process delays access to new medications that may improve patients health status. However, the median time for regulatory approval of new drugs in Canada has been significantly longer than in countries such as the United Kingdom, Sweden. Our country has been criticized in several independent reviews on this issue.
The most important retreat that we evidenced today has not been the cut in funding, brutal and deadly though that has been in some cases. The most serious retreat has been the retreat from leadership by this federal government. The Liberals came to office at a time when the economy of Canada was growing sharply, largely because of initiatives which they opposed in opposition.
The OECD acknowledges that Canada's economic strength was won by the initiatives of a decade ago on trade, on the GST and on deregulation. The government did little to earn the surplus tabled last week and has done nothing at all to ensure those funds would be wisely invested in the future of Canada.
Despite the most favourable possible economic circumstances, the government has let the Canadian health care system fall into disarray. Was that inevitable? Did other governments of the world do that? Of course they did not. Other governments cared more about the health of their citizens than this Liberal government. That has shown up in the comparisons that have been made by independent agencies around the world.
This Canadian government sat back and let Canada's health system decline so sharply that even the World Health Organization ranked Canada behind most of the comparable world in the quality of our health care. Imagine that in the system of the Canada Health Act and in the system of medicare Canada is ranked by the World Health Organization behind most of the comparable world. Why is that? It is that we have a government in office that will not show the leadership that earlier Liberal governments showed. It lets things drift in the dust. It insists on jurisdiction but shows no leadership at all.
Canada has the resources and the tradition to be first in the world, but the government has brought us to 30th instead of first. If I may say so, it is not only the health care system that it has damaged.
I spent a good amount of time this summer talking to people in Kings county and Hants county in Nova Scotia who are very much involved in the health care system. Some are nurses, some are doctors, some are administrators and many more are people who are trying to get a doctor for a remote community or trying to ensure that it is possible for older people to travel easily to get their supply of drugs.
When I speak to people in the medical profession I hear over and over again that the problem is not just that the money is not there but there is a sense that there is no movement in the system, there is no plan and there is no hope. On a question like medical care where we have been in front of the world for so long, there is no hope.
Why is that? Is that the fault of Canada, the Canada that created the Canada Health Act, the Canada that created medicare? Of course not. That is the fault of the federal government in office today which has backed away time and time again from exercising the leadership that would have let Canada continue to be a leader in providing the highest quality health care to its citizens. The government has failed and Canadians are paying the price for that failure.
More is at stake here than the health care system, because what it has done on health care it is doing on other aspects of the Canadian community. It is not drawing together people who want to be together. It looks for polarization. That is its new theme. It looks for ways to divide Canadians instead of heeding the hopes of parliament. Instead of heeding, it is responding to the requests of provinces. It ignores them until it is time finally with an election looming to bring them together and to offer a deal they cannot resist, a postdated cheque. That is not leadership.
A system of co-operation in Canada, of co-operation among governments with professionals, with concerned citizens, is what we need to restore the country. As in so many issues there has been no leadership by the federal government. Even now its action has been forced by the combination of provincial pressure and the impending election. There is not even the slightest hint of federal leadership in developing a new health plan for Canada.
As I listened to the debate, as I watch what this minister and this government are doing, it seems to me they are moving closer and closer to where the leader of Her Majesty's official opposition says he wants his government to be. The federal government is drawing back from leadership in health care.
I know I am reaching the end of my time, so let me conclude on this note. There is one level of government in Canada able to speak for all of Canada. It is not just a question of money. It is not just a question of jurisdiction. It is a question of authority. If the national government will not lead, the system will not succeed.
The government does not lead. Our system is in trouble because there has not been the leadership that is needed. The bill is a long overdue step in the right direction, but it is a faltering step. It is a step under duress. It is a step that promises more than it delivers. Unless there is a plan to go with the money then the Canadian health care system will continue in that long decline that began with the election of this careless, drifting government.