Debates of March 2nd, 2000

Minister For International Trade

[Pierre Pettigrew, Liberal, Papineau—Saint-Denis, QC]

I wish to tell the House that I did have a good conversation with my deputy minister, and I have every confidence that Department of International Trade programs are in good shape right now.

I also have every confidence that the Export Development Corporation is doing a good job.

Health Care

[Bev Desjarlais, NDP, Churchill, MB]

Mr. Speaker, the failing health of our aboriginal peoples is a direct result of the life they were forced into by Canadian government policy.

Last night CBC told Canadians from coast to coast about the crisis on Island Lake. Those same conditions exist in numerous first nation communities.

The budget ignored the aboriginal health crisis. There was not one new dollar for first nations' health care. How long do aboriginal people have to wait before the government does something? How many must die?

[Allan Rock, Liberal, Minister of Health]

Mr. Speaker, last year's budget dedicated over $200 million to aboriginal health and added the capacity of Health Canada to develop home and community care on reserves in first nations communities and to increase the number of medical personnel, including nurses.

It is very difficult, as the member will know, to engage the services of doctors and nurses to provide services in far-flung communities in the north. We are doing the best we can. We are improving our resources and we will work toward meeting those health care needs.

National Defence

[Elsie Wayne, Progressive Conservative, Saint John, NB]

Mr. Speaker, in the hours following the budget, the Minister of National Defence was on television pitching a grocery list of the new expenditures of his department. The minister is on the record as saying that the Sea King replacement is his top priority but he has also recently said that CF-18 refits is his top priority.

Will the minister please get up in the House and tell Canadians when he is going to replace those Sea King helicopters that are so dangerous and should not be in the air?

[Art Eggleton, Liberal, Minister of National Defence]

Mr. Speaker, let me make it clear. My top priority is to make sure that our troops who do a great job for us get the tools they need to do the job. Replacement of the Sea Kings is a matter we are proceeding on at this moment. It is our top procurement priority and one on which we are finalizing the strategy because we need to replace those Sea King helicopters and soon.

Business Of The House

[Chuck Strahl, Reform, Fraser Valley, BC]

Mr. Speaker, I think Canadians would be interested to know what the government is going to bring forth in legislation or motions or whatever for tomorrow and the week after our break.

Canadians are probably particularly interested to know whether debate will be allowed or whether it is going to be shut down. We are interested in whether the minister has reconsidered his motion on the order paper which will restrict the democratic rights of members of the opposition or whether he plans to bring it in forthwith.

[Don Boudria, Liberal, Leader of the Government in the House of Commons]

Mr. Speaker, I think the hon. member is referring to the restoration of the rights of members and nothing else.

This afternoon we shall complete the allotted day of the New Democratic Party which I understand will result in a vote later this day.

Tomorrow we shall consider the motion to improve the rules of the House of Commons albeit temporarily, a motion which is in my name. Should we complete these improvements early tomorrow, we would then follow it with Bill C-10 and Bill C-13.

When we return on March 13, we shall attempt to complete the study of the motion should it not be completed tomorrow and then commence report stage of the clarity bill, Bill C-20, under the very distinguished leadership of the Minister of Intergovernmental Affairs.

The House resumed consideration of the motion and of the amendment.

Supply

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

Mr. Speaker, it is a pleasure to speak to the motion. It calls on the government to stand up for our most cherished value but unfortunately it picks a method which will not work. We need to look at the whole health care crisis as one of planning.

The 1999 budget in terms of the initial possibility provided a $3.5 billion infusion as well as the other $8 billion. There was an opportunity for the provincial and territorial governments to begin some planning. Also the 1999 budget provided real money for investing in health information systems that would begin to look at what was committed in the social union framework agreement in terms of dealing with information that could help Canadians understand how their health care dollars are being spent, by whom and with what results.

What is happening with the provinces is similar to when I had to try to explain to my father why I was asking for a raise in my allowance.

I do not quite understand this crisis. We heard time after time in the finance committee that this was a crisis of mismanagement not a crisis of dollars. Patching it with more infusions in a piecemeal way will not remotely help our health care system. It reminds me of Michael Ignatieff's statement that the most important barrier to progressive movements in this country is some sort of nostalgic vision of a paradise in the past.

Money is not going to fix it without an absolute commitment to real reform. Time after time the finance committee heard, even from the employer committee of health care of Ontario, that putting more money into the health care system even if it were available is not the answer. International comparisons indicate that the total level of financial support for Canadian health care as a percentage of gross national product is among the highest in the world.

We emphasized the need to start focusing on an integrated system of delivering health care rather than continuing to support the current system of inefficient, cost ineffective suppliers and stakeholders. Our focus is for the best quality health care at the lowest cost, a goal which we believe is shared by all levels of government.

The Canadian Health Care Association said it was aware that money alone would not solve all of the challenges facing the health care system. We have to commit to do things differently. The federal government must set an example. The pointing of fingers in all levels of government should stop. We have to regain our position as the moral authority but that is not done by continuing to patch a system that needs real reform.

Monique Bégin in her speech to the health care economists at the Emmett Hall lecture last August said that we have to remember that between 1985 and 1995 Canada had increased its total health expenditures dramatically without offering better services, or more services, or different services to the public. Canada had become and still is the second most expensive country in the world in terms of total health care expenditures.

We have to figure out what does and does not work and stop doing what does not work. It is a concern of mine that continuing to patch a system that is inherently not a system, a patchwork quilt of non-systems, is a huge barrier to progress. It is a huge barrier to the ultimate sustainability of the the system. It is too important to get on with real accountability.

It is important that we listen to Doug Angus of the University of Ottawa and Queen's University who said that significant cost savings are valuable. His 1995 paper said that there would be a $7 billion in savings in the system if people were in the right level of care. We need to benchmark better practices and share those across Canada.

We need to invest. Hopefully the CIHR will do that. The Council for Health Research said that we can no longer just do disease based health research. We have to do real research on the health care system itself to ensure we effectively use our health care dollars in health care delivery.

This nation needs a plan. The plan must be based on accountability. It cannot be some romantic vision of doing things the same old way. We have to do things differently. The British Medical Journal reported that if the airline system were run the same way the health care system is run in North America in terms of accountability, a 747 would be coming down once a week and we would be doing something about it.

If 20% to 30% of admissions for seniors are because of drug interactions that are totally preventable, we should be moving on those policies. The minute the smoking rate comes down in youth, we see a decrease in dollars for prenatal care, for premature babies and for post-operative pneumonia. Removing scatter rugs from the homes of seniors would dramatically prevent broken hips. There are serious issues we have to get on with in terms of prevention.

I am totally frustrated when childhood asthma goes up that people just ask for more respirators. We cannot do this. Air quality goes down, childhood asthma goes up. We have to deal with the air quality.

It is extraordinarily important to note when looking at this big underfunding crisis, which unfortunately is supported by our NDP colleagues across the way, that the underfunding is going to get us into big trouble. The evil dark forces from the Fraser Institute to some of the medical associations are crying. In terms of Alberta and Ontario, I believe they are desperately trying to break medicare. They are trying to show us that there will never be enough money, that the government pockets will never be deep enough and that the only possible solution is privatized medicine and user fees. We know user fees do not work. They are only a deterrent to the most fragile in our society, the pregnant teens and the fragile diabetics.

Private hospitals cost more money to society. I was in Alberta last month when the Calgary hospital was blown up. It is extraordinary that we ended up with this worry about waiting lists. At least seven operating rooms were blown up and now private operating rooms are needed to help with the waiting lists. This is not okay and I must say I am not sure that it was by accident.

There is absolute mismanagement or misplanning. Even Duncan Sinclair said that the hospital restructuring process in Ontario was done backward. If we build up the community support, we will eventually need fewer hospitals and fewer beds. Doing it in the opposite order creates a crisis.

A crisis has been created similar to what Michael Decter talked about in that there would be a huge crisis if bank branches were closed and people were not taught how to use ATMs. It is exactly the same in closing hospitals without having the supports and services in the community.

We must be smarter. We have to talk about real outcomes in health care. How much money we spend is no longer good enough. Mr. Harris spent $400 million in the severance package to lay off nurses, $400 million to hire them back and $200 million to pay the consultants to tell them how to fire them and hire them back. This is not good spending of health care dollars. I do not want $1 billion spent that way and I do not think we should give him another $1 billion so he can do the same thing again.

It is extraordinary that we are in a position of being blackmailed to give people more money when there is no evidence as to how it is being spent. Canadians want it to be spent properly. They do not want us throwing money at things if it is not.

The social union framework agreement says that we will share best practices with transparency and accountability. When I chaired the World Health Organization's breakfast on TB, Canada did not submit its TB numbers for last year. We have a zero at the World Health Organization because the provinces would not hand in their TB numbers. This is not co-operation. It is no way to plan a health care system and we have to get on with it.

Harvard medical school professors have shown us that in the for profit hospitals the costs were 25% higher than in the not for profit hospitals. That is not in keeping with the social union framework agreement. In the social union framework agreement we promised that there would be an equitable way of looking at things. I am hugely enthusiastic and optimistic. We can have a perfect health care system with 9.3% of the GDP.

We need the provinces to come to the table with their best practices. Let New Brunswick speak about its level of care. Let us see the fabulous software program from McGill dealing with drug interactions which could prevent unnecessary admissions. Let Edmonton bring its knowledge on the flu epidemic. Let B.C. bring its prevention knowledge.

If at the meeting with the minister in May every province shows what it is doing perfectly well, we would have a fabulous health care system. It will take them to drawing down the dollars that have not been used in Quebec, Newfoundland and Ontario. We have to get information technologies in there and make it an accountable system which protects all Canadians, one that we can be totally confident in.

[Keith Martin, Reform, Esquimalt—Juan de Fuca, BC]

Mr. Speaker, I believe all members of the House have the same objective of ensuring that the health care system is available to all Canadians and has no financial barriers to it. We have a serious problem. As the member knows we have an aging population. The population of people over the age of 65 will double in the next 30 years.

Ralph Klein is proposing in Alberta that if the public system cannot take care of patients he will pay those in the private sector to provide health care services. Then people on waiting lists will get medical care when they need it at a cost lower than the cost in the public system. How will this damage the public system?

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

Mr. Speaker, the hon. member knows perfectly well that there is no evidence to show that a private health care system is cheaper. The evidence we have seen from around the world shows the administrative costs in a public system are at 9%. In a private system the costs are at 25%.

My major concern is that human beings, the physicians and the caregivers, are seduced to the private system, which makes the public system waiting lists longer.

I have another concern about the private system. My experience is with the tiny ones that exist in Toronto. What happens after hours in private hospitals? Who looks after the complications? The patients go straight back into the public system with even less accountability.

I think we want a system that is properly organized, not one that will actually allow doctors to be seduced into a private system with no accountability. In a for profit system the administration costs go up for some reason.

[Peter Mancini, NDP, Sydney—Victoria, NS]

Mr. Speaker, I listened to my colleague carefully. In her answer just now she clearly indicates that she is opposed to private for profit hospitals in health care. I take it she has no problem with that part of the motion which we in the NDP put forward today. I know she agrees that public health care is cherished by Canadians, so she does not have a problem with the first part of the motion.

Is there a problem with the motion where it calls for substantial and sustained increases in cash transfers to the provinces? She talks about a partnership and sitting down with the provinces and getting the best ideas. If the federal government as a partner is only putting in 15 cents on the dollar, does it not lose the moral authority to direct how the health care system operates?

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

Mr. Speaker, I agree with the member's comments on the private sector. I do not agree that cash transfers without accountability is the answer at all. Canadians do not want us to be pointing fingers and dividing up loonies in fifteens and thirties. Nobody really cares. It is the same taxpayer. Whether it is a tax point or a cash transfer or anything, people want the system to work. We as the federal government should be able to share in the best practices across the country.

I am hugely worried. We planned a system last year which was a five year plan in terms of health care dollars. Because they mismanaged they get to come back asking for more cash, more cash, more cash, when they did not put in the information technology and there are not accountable.

When I ran for office Mr. Harris was complaining that it was our fault that Women's College Hospital on Wellesley was being closed when the reduction in the transfer in that year was $1.3 billion. His 30% tax cut was $4.9 billion. He had more than the ability to absorb that. I think Canadians are starting to get it, that this is not about more and more and more. It is about doing it better.

[Charlie Penson, Reform, Peace River, AB]

Mr. Speaker, I listened to the member talking about the potential for losing doctors to the private system. I think she called it being seduced into the private system and away from the public sector.

I ask for her opinion on what is happening right now with Canadian doctors being seduced into the private sector. It is even worse than that. They are being seduced into the private sector in the United States. We are losing all kinds of doctors to the United States.

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

Mr. Speaker, a lot of those doctors are coming home. The reason for that is that in Canada we understand that the social determinants of health are extraordinarily important. Good doctors have to work on poverty, violence and the environment. There is a huge disincentive in terms of family for doctors to want to stay there very long, and the best and the brightest are coming home.

[Keith Martin, Reform, Esquimalt—Juan de Fuca, BC]

Mr. Speaker, I thank the NDP for bringing the motion to the floor of the House. It is the most important issue affecting Canadians today. While we have a different way of getting to our end point, our end point is the same. We want to make sure that all Canadians have access to health care when they need it and not when the bottom line allows it, which is contrary to the situation of today.

We must recognize that we have a problem. What are we asking for? The problem is that the demand on our health care is exceeding and stripping our ability to supply the resources. That is why provinces like Alberta and Ontario are looking at ways to ensure that their people, their citizens, will get health care when they need it.

Speaking personally as a physician I can tell the House that too often Canadians are not getting the health care they need. For example, people in the province of Quebec are waiting 14 weeks for essential cancer treatment. It is the same situation as in the province of British Columbia. Some are being forced to the United States at a cost that is far greater than what it would cost in their own provinces. Why? It is not because the provinces do not want to provide the system but because they simply do not have the money to do it.

Right now every tenet of the Canada Health Act is being violated. I will just go through them for the House. On the issue of accessibility, is waiting 14 weeks accessible health care for essential cancer treatment? Is waiting six months for open heart surgery accessible health care?

The first day I walked into my hospital at Christmas when I worked for a week, I did not think it was fair that 12 out of 14 beds in my emergency department were filled with patients waiting to get into the hospital. They were not geriatric patients but people waiting to get into the ICU because they had unstable angina. There were patients with compound fractures, sick children who needed admission to the hospital for investigation, and many other people.

Why? It is because we do not have any beds. Why? It is because the hospital does not have any money to open hospital rooms. It does not have money to pay for nurses. That is why people are not getting accessible health care.

The next day we had a disaster. A bus full of children was hit by a logging truck. Only two of them were critically injured. Let us imagine if more were injured. We would have been in a situation that I do not even want to comprehend.

I would like to speak to the myth of universality. Quebec has not signed on. Although 90% of the people of the province of British Columbia have done, so some 10% of people have no health care.

On the issue of portability, can people take the same health care from one province to another? In theory, yes, but in practice they cannot because different things are covered in different provinces.

On the issue of public administration, one-third of all health care dollars spent in the country today comes from the private sector, from people's pockets.

People do not have access to home care. They do not have access to dental services. They do not have access to certain drugs or only have access if they have dollars in their pockets. The nonsense portrayed by members on the other side who say that we have a single tier system is absolute bunk. We have had a multi-tier system for years and it is getting worse.

As I mentioned in my earlier question, the population is aging. The cold hard reality is that the number of people aged 65 will double in the next 30 years. People use 70% of health care dollars after the age of 65. As they get older, the number of people who are working declines. This means the tax base declines substantially. As our demand goes up, our tax base goes down. We have more expensive technologies today than we had in the past and that will be the case in the future.

The discrepancy between supply and demand will widen. Who will be hurt but the poor and the middle class? The rich will always have an opportunity to purchase their health care when they need it. They will go south or will have connections so that they can jump the queue.

Let us talk about facts and not rhetoric. We have to put politics aside. For too long the health care issue has been used as a political football by members on various sides. Hide behind the Canada Health Act and we are looked upon as the great white knight that will defend the health of Canadians. Try to propose alternative solutions and we are labelled and branded as enemies of the state. Nothing could be further from the truth.

Not a person in the House wants an American style health care system. Everyone in the House is committed to a health care system that enables all Canadians to have access to services when they need them. The question is how do we do it. If we recognize the facts I just mentioned then we must recognize that we need more money in our system. As other members have mentioned, we need to do other things, but the cold, hard reality is that we need more funding. That funding will not come from tax dollars that we will be able to raise now or in the future. Therefore, how do we get the money?

I will speak personally. If we amend the Canada Health Act to allow private services to strengthen the public system, not detract from it or weaken it, we will be able to access some of those resources. Canada is among a small family of countries including Cuba and North Korea that do not allow private services to occur by legislation? What a great group to be in.

If private services are used intelligently and have proper restrictions placed on them to address the issue of manpower so that medical personnel are obligated to work, say, a minimum of 40 hours a week in the public sector, Canadians will have access to the medical personnel they require.

If we allow a private system to work in parallel and separate so that there is no co-funding, we will ensure that people have a choice. If people want, they can access the private system or the public system. Ultimately the people on the private system will take pressure off the public system and there will be more money available within the public system on a per capita basis. The most impoverished people in the country who do not have a choice could then access the public system quicker than they could today.

Is it unequal? Yes, it is. I would argue it is better to have an unequal system that provides better access to health care for all Canadians than we have today, particularly the poor and middle classes. Then we would be on the right track. At the end of the day the only reason to change anything would be to ensure that the poor and middle classes have health care when they need it. There would be a better health care and better access than we have today. The government is certainly not doing that.

The government likes to trot out and say that it is defending the status quo. If a person in the province of British Columbia is injured while working he or she jumps to the top of the line in the public system. That is not fair. Public money should not be available so that a certain group, say the rich, have quicker access than the poor. If they are to legislate this area, and I personally advocate that they do, they have to ensure a complete separation. Not a nickel of public money, not a nickel of taxpayer money, would be used in the private system. A private system must be completely separate from the public. If we could do that we would get away from what has happened in England and in the United States where people can queue jump within a public system. I and every member of the House would completely and utterly oppose that to the end of our days.

We must also look at the issue of manpower. Within the nursing profession there will be a lack of 112,000 nurses in the next 10 years. In my profession, the physician population, we have an enormous lack of specialists, which will only get worse.

If one takes the case of nephrology, we will have an enormous lack of nephrologists, that is, kidney specialists, and as our population ages and as the case of end stage renal failure expands, we will have a greater demand for those specialists. Where will they come from? They will not materialize overnight. With the cutbacks at the universities we are not able to keep up with the physician or nursing populations that will be required in the future.

A colleague from my party made the very cogent observation that people are going south. Why are both nurses and doctors going south? It is not necessarily because they want more money, although certainly some of them do. It is because most of them are sick and tired of having to tell patients “I'm sorry, your surgery is cancelled today, it will be done in six months”.

No one wants to look into the eyes of a patient at 8 o'clock in the morning and have to say that the operation cannot be done that day because the OR has been shut down due to the hospital's lack of money. It is crushing for the patient. It should never ever happen in this country but it does.

We must talk about specific solutions to deal with this problem. We cannot hide behind the rhetoric any longer.

One sidebar and one potential economic opportunity for the solution I mentioned is that patients from the United States and international patients will be able to come to Canada and receive private sector health care. This would be an incredible boon in terms of job creation and it would generate billions of dollars to Canada's medical system. Yes, it would be a private system, but billions of dollars in our country generates thousands of jobs.

Why do we not allow that to happen? We do not allow it to happen because of a philosophical myth that the government continues to portray. If we do that we will be able to reverse the brain drain that has been occurring for so long, keep our medical professionals in the country, the doctors, nurses, techs and others, and we will have an infusion of capital into our medical system. If we do not do this, the situation we have today in the country, which is far less than desirable, will only get worse.

I ask members from all sides to please put aside the rhetoric. It is no use trying to scare the public by saying that the private sector is the demon that will destroy the public system. It could if it was not dealt with properly but we can channel a private system to ensure that it will strengthen the public system not weaken it. It is not difficult to do and it can be done.

If Tommy Douglas, a man I greatly respect, saw what we have done to our health care system today he would be rolling in his grave. He would be appalled because it was never designed to do what we are asking it to do today. It is not and never was designed to be all things to all people. It was designed to ensure that Canadians got their essential health care when they needed it.

Today, when we are asking for many other things, such as alternative medicine, home care, dental services and pharmacare, things that will cost billions of dollars, where will we get the money? The cold, hard reality is that we do not have it.

When the health minister starts trotting out solutions, such as 24-hour call lines and saying that geriatric patients are the reason hospital beds are full, is, to put it kindly, naive. It is true that there are some patients who occupy acute care beds. It is true that the geriatric population puts a great strain on the system. However, the people waiting in the emergency departments for a hospital bed are people who need ICU, people who need their fractures treated, people who have medical problems that are complex and simply cannot be treated at home.

The health minister likes to say that with technologies getting better, laparoscopic surgery patients will be able to go home earlier. That is true if it is done properly. What is happening now is patients are being discharged earlier and are sicker and the responsibility for their care is placed on the shoulders of families who do not have the wherewithal to treat them.

It is very disheartening to look into the eyes of an 80 year old woman who is taking care of her 85 year old spouse who is sick, sicker than she is I might add. Both are ill but she is forced to deal with this. We need to look at other ways not only from the funding perspective, which I focused this speech on, but also into some other intelligent ways of dealing with various problems.

One issue is to take a cold, hard look at administration. In some hospitals administration has expanded dramatically. That needs to be cut down. On the issue of the geriatric population, I can only implore the health minister to look at the experience of Saskatchewan. It has incorporated a very intelligent program, an outreach program that has brought geriatric people with medical problems into centres where they have had basically one stop shopping. Many of their health care problems have been treated and dealt with there so that they can go home. The bottom line is a higher quality of health care for them, a higher quality of life, which is the most important, and also the saving of millions of dollars to the health care system. We need to look at that.

It is disingenuous to claim that by defending the status quo and by just saying that we need to make changes without expressing what those are only enables this issue to go around in a big circle once again. The only way we will solve this is for the health minister to bring together his provincial counterparts and say “We can't allow this to occur any longer. We've got to stop the political nonsense and start putting patients first”.

As I said at the beginning of my speech, too often patients have been put last on the list of priorities but politics have been put as the prime priority because it has been far too attractive to stand and defend the status quo and say limply that we want to have changes without addressing it.

We need to look at experiences in other countries. If we look at the European experience, they have allowed private services to occur but also support the public system.

We also need to look at prevention. I proposed a national headstart program in the House in 1997 which passed. It was on models in Moncton; Ypsilanti, Michigan and in Hawaii. An integrated approach to that would save billions of dollars and save thousands of children's lives. It is a practical and pragmatic approach. I know the Minister of Labour has been leader in this in her town of Moncton. I commend her for the outstanding work that she and her husband have done for many years. However, this motion, although passed, has been moribund because the government has failed to act.

I have said to the Minister of Health, the Minister of HRD and the Minister of Justice that they should get together with their provincial counterparts and look at all the programs they have that deal with early childhood intervention. They should rationalize these program, throw out what does not work, keep what does and have a seamless integrated approach for our children that starts at the prenatal stage and deals with the medical community at time zero, deals with the mentorship program that has worked in Hawaii and also the school system up to the age of eight. If children grow up in a loving and secure environment where their basic needs are met, they will have the greatest chance of growing up to be productive and integrated members of society.

This morning I filmed for my television program an outstanding young woman who has a program called the Sage project here in Ottawa. For roughly $7,000 she educated 550 immigrant children who did not know how to speak English. Those children have all gone on to post-secondary education and all of them have done well. Some of these children were on the lowest socioeconomic rung in our society. Many of them come from impoverished backgrounds and abusive situations, but the beauty of it is that she has focused on the basic needs of children. By using volunteers, she has managed to save the lives of 2,000 children in Ottawa by giving them a head start. She has done this with no government money and only a few thousand dollars. It is a model that can be used all across this country.

I implore people to contact my office or the young lady in charge of the Sage project so they too can us that model. It is an outstanding project that helps people learn English. It could also be expanded to all children.

The best way to deal with prevention is to start even before a woman becomes pregnant because then we could address issues such as fetal alcohol syndrome, which, incidentally, is the leading cause of preventable brain damage in our country today.

I have worked in jails, both as a guard and as a physician. I can tell the House that the number of people in prison suffering from FAS or FAE is epidemic. This is irreversible brain damage. The average IQ of these people is 67. Their cognitive functions are impaired and their learning functions are impaired. They have emotional difficulties and cannot function properly in school. They are ostracised. Many, unfortunately, turn to crime. They are often in home situations that are less than desirable. They have a one way ticket to a life that none of us would wish upon anyone.

This is a preventable problem and I do not hear a peep from the other side. I implore, plead and beg the ministers on the other side to use the head start program, listen to their cabinet members, look at the three models I have described, Moncton, Ypsilanti and Hawaii, and work with members from across party lines to do what they said they would do for kids. They should use existing resources to employ the head start program. The House has adopted it, supported it and passed it. They should do it for our children and do it now.

[Rey D. Pagtakhan, Liberal, Winnipeg North—St. Paul, MB]

Mr. Speaker, I enjoy the debates of my colleagues, both in the House and in the medical profession.

I would first like to say that patients come first as far as our health care system is concerned, but profit, never. When the member made the comment that not a penny was coming from the public purse for private health care, I must remind him that when a profit institution exists through our tax system, some money does come from the public purse.

Second, he said that doctors have gone to the United States. I must say that it has been my privilege to have trained in the United States and decided to be a Canadian. Just because we have an excellent medicare system it does mean that we have to settle for the status quo? Of course not.

The Minister of Health has made it clear that we have to go forward and institute meaningful reform. What he said earlier this afternoon was that money alone, important as it is, was not the only means for a solution. He said that we must have leadership and that leadership means we must have ideas, vision, planning and good management.

I was surprised that the member debating did not consider the option in his debate that we can reform the health care system and make it even better without creating a parallel private system. For example, we can have a national health information system. We can re-orient our practice guidelines.

I ask the member opposite if his party is opposed to the CHST transfer. Is he committed to a full privatization if he believes that this is so good?

[Keith Martin, Reform, Esquimalt—Juan de Fuca, BC]

Mr. Speaker, first of all we support access of patients to health care.

The member mentioned that the minister talked about meaningful change. He said we want to talk about reform, ideas, vision, planning. What reform? What vision? What ideas? What planning? I have not heard a single reasonable specific suggestion from the minister ever on how we can ensure that people will have access to health care when they need it.

Money is not all of the answer but it is part of it. When every single hospital in Quebec is running a deficit, no one can tell me that all of those hospitals are mismanaged. Those hospitals and the nurses and doctors in them are trying to cobble together a system for the people of Quebec but they do not have the resources to do the job. No one can tell me that when I cannot find a pillow for a patient with congestive heart failure in the emergency department that it is good health care, or that money does not make a difference. We need both. We need ideas for reconstructing our health care system and we need the money to do the job.

I will put it in a nutshell. The member knows full well what I am talking about. There is the aging population, the more expensive technology, the fact that we are asking for more, that we have more demand, the fact that our tax base will shrink because more people will be retired than working. Those are the facts and that is where the squeeze exists.

We have to put patients first. Is an institute that puts patients first and makes a profit a bad thing? Will we begrudge that? That is not the issue. The issue is to make sure that no Canadians will be deprived of health care because they do not have enough money in their pockets. All of us would support that to the end of our days.

What we do not support is the system right now where governments prevent Canadians from getting access to health care because they are withdrawing and withholding support because they do not have the money. And because governments do not have the money, patients are not getting access to health care.

In the 1960s people did not have access to health care because they did not have money in their pockets. Now it is governments that are depriving people of health care because they do not have the money in their pockets. Surely there is a middle ground. I have articulated it. We want to make sure that patients get health care. I have shown them the way.

[Greg Thompson, Progressive Conservative, Charlotte, NB]

Mr. Speaker, I appreciate the hon. member's remarks; it was a very good speech. I want the member to comment on the ad hoc approach, the undisciplined approach, the year by year, day by day approach the government has taken in regard to health care for seven years.

The minister this morning when he was in the House talked about this new idea of co-operation and getting together with the health ministers. The government has had seven years to do it. I wonder why the government has waited so long to come up with this so-called meaningful dialogue with the provinces. Obviously the provinces are the primary care givers and an important part of the equation.

I want to couple the lack of funding with the biggest issue before the House in the last month or so, the difficulties within HRDC. If we look at the estimates the Minister of Human Resources Development has received an additional $1.3 billion this year alone. Health care, supposedly the number one issue in Canada, is receiving $2.5 billion over four years. The other point is the minister of HRDC is receiving $200 million in discretionary funding.

Why is there this disjointed approach within the present government in terms of addressing the number one issue, yet giving back money to a department that has clearly mismanaged what it does have?

[Keith Martin, Reform, Esquimalt—Juan de Fuca, BC]

Mr. Speaker, my hon. colleague has been a very strong spokesperson for better health care for Canadians for a very long time.

I cannot answer some of the questions and only the government can answer some of them itself. We would all be very interested in knowing the answers.

That the government has waited seven years is absolutely outrageous. For reasons I do not understand, on the issue of health care the government has been in intellectual purgatory for a very long time. That is a crying shame.

My hon. colleague has worked with me on the issue of organ donation. We gave the government a plan supported by our respective parties that would save 175 lives a year. The plan is there. What has the government done? Nothing. It has done nothing on this issue. It is a motherhood issue and it has done nothing on it which is absolutely bizarre.

On the issue of why the government has a piecemeal approach, I want to reiterate that it has been far too attractive for the government to hide behind the Canada Health Act and say, “We are the defenders of health care. We are the defenders who make sure that people have access to health care when they need it”. It has been far too attractive for the government to do that because that is what Canadians want. But it has been done at the expense of invigorating and changing our health care system so that Canadians do get access to health care, so that they are not financially deprived.

The people who get hurt the most by the government's inaction and posturing are the poor and middle class. That is a shame because none of us in the House want to see that happen. Again health care is a political football and it has been used to political advantage instead of to the patient's advantage.

[Ken Epp, Reform, Elk Island, AB]

Mr. Speaker, I have enjoyed the debate on health care today. It is healthy for us to get down to the nitty-gritty of what makes the health care system work.

These days we are remembering the first anniversary of the death of my aunt who was in a publicly funded hospital in Saskatchewan. I wanted to say that because otherwise people would think that this has to be Ralph Klein's fault. But she was in Saskatchewan, the home of medicare. Basically she got terrible care. I hate to say this but it is true. She fell out of bed after having a stroke, not once, not twice, not three times but four times because there was no staff available. When she rang for help no one came. Finally she tried to get out of bed herself in order to go to the washroom and she fell and injured herself terribly.

Finally her family said enough of this. They moved her from that publicly funded hospital to a care centre that is operated by a religious organization. She got excellent care there until she passed away about a year ago.

No matter how we cut it, there is deep trouble in the public health care system when for whatever reason, and whether it is the federal or the provincial government that is involved, there is not enough money to hire enough staff so that people who are in hospital can be looked after in a reasonable fashion. It is atrocious that the Liberal government with all its cuts to health care has hampered the ability of provinces like Saskatchewan to provide health care for its citizens.

Provinces simply do not have the money. They are still forced to send taxpayers' dollars to Ottawa and they do not get them back in proportion. I would like the hon. member to comment on the actual funding part of it.

[Keith Martin, Reform, Esquimalt—Juan de Fuca, BC]

Mr. Speaker, the bottom line is the government has ripped out $21 billion from transfers to the provinces over the last seven years while it has been hammering the provinces and continues to hammer the provinces to ensure that people get the health care when they need it. That is the cold-hearted reality.

As I said before, we cannot say to the taxpayers that more money will be forthcoming in the future to cover all that we ask for. Certainly the government should put back what it has taken away. That is the minimum obligation. We will continue to fight the fight to ensure that happens.

[Bernard Patry, Liberal, Pierrefonds—Dollard, QC]

Mr. Speaker, for your information I will be sharing my time with the hon. member from Abitibi—Baie-James—Nunavik.

I am pleased to speak on the opposition motion, which I consider very important. I too have concerns about access to necessary health care, including emergency room services.

Crowded emergency rooms create numerous problems involving various factors. As we know, there is a shortage of doctors after hours, there are not enough beds available, and a good number of the available beds are occupied by patients requiring long term care because home care and community services do not meet the needs of these people.

Those are but a few of the reasons why emergency rooms may have to turn back ambulances for example.

As the health minister already said, this long-standing situation is unacceptable. That being said, we cannot logically deal with the issue of short term hospital services without studying the whole care program. We need an integrated health care system.

To increase accessibility, we have to change our practices and our way of delivering health care services. However, we must make appropriate changes that will ensure the future of our medicare system.

As was mentioned by my colleague, the Minister of Health, two elements are essential. First, a change is needed in the way primary health care services are delivered in our communities. Second, home and community care must be provided so as to ensure that long term, rehabilitative and chronic care beds are available as required, and to free beds for short term care in hospitals.

Those are also the main priorities that health ministers have indicated at their last annual meeting. We all agree on the need to resolve those urgent concerns. Now we must take action. We need a plan to implement these changes.

If primary health care were provided in a different way in communities across the country, the problem of crowded emergency rooms would be resolved. Different models were proposed. However, if we do not change the way primary health care services are provided, we will not meet the needs of the communities. We will not succeed in alleviating the pressure on the emergency rooms.

If we do not put the emphasis on prevention and health promotion, we will not be able to take maximum advantage of the skills of all the health care providers.

Therefore, we must agree first on the kind of reform needed to provide integrated and full primary health care services. Then we must develop outside hospitals ways of dealing with those who need home and community care. I think there is a direct link between the availability of home and community care and the pressure on the hospitals.

If emergency wards are crowded, it is due in part to the shortage of space caused by patients who cannot go home, but do not have access to chronic, rehabilitative or long term care beds. They are stuck there and they occupy the beds that those on stretchers in the emergency wards could use. In this respect, home care is one solution among others.

Through facilitation, co-ordination and co-operation, the government will help the provinces and territories to implement a clear and coherent vision of a renewed, integrated and comprehensive health care system.

Let us talk about funding. As we know, the premiers expressed the need for additional funding for the health care system and will continue to do so. Last year the federal government invested $11.5 billion in health care through the Canada health and social transfer, or CHST. It was the most important one-time investment ever made by this government.

Increased federal funding for health care was provided to the provinces and territories to them alleviate immediate public concerns, such as overcrowded emergency rooms, long waiting lists and diagnostic services.

As we all know, budget 2000 increased by $2.5 billion over four years CHST funding for health care and post-secondary education. This increase raised the level of transfers to $15.5 billion for 2000-01 and subsequent years. Through the increase in cash transfers, coupled with increasing tax transfers, the CHST will reach an all time high of $30.8 billion in 2000-01.

By 2003-04, total transfers to the CHST should reach $32.7 billion.

Increased federal transfers will provide for a stable growth of transfers and will ensure that high quality health care will be available to anyone who needs it.

We have fully restored what was commonly known as the health component of the CHST to the levels existing before the spending reduction period of the mid 1990s.

However, this is not only about money, it is about the way this money is used. It is crucial to understand that the Canadian medicare system will not be able to give Canadians an appropriate access to quality health care in the years to come if it is not renewed considerably through co-operation and innovations. Status quo is not an option.

With respect to the management and delivery of health care services, innovative approaches to renewing Canada's public system of health care will be necessary.

Clearly, the challenge will be to find a way to accomplish this while maintaining the fundamentals of medicare. Through the health transition fund, the Government of Canada provides funds for innovative pilot projects, based on four priorities, including primary health care, home care and community care.

Many projects funded by the HTF look at ways to improve the use of emergency rooms and access to alternative services.

HTF projects allow us to collect and analyse data on what works and what does not. We must cope with change, learn from the past and use the knowledge we gain from the pilot projects carried out across our country.

Consequently, in order to settle the crisis in the emergency rooms, we must start by dealing with primary health care, home care and community health care.

To this end, the Minister of Health wrote to his provincial counterparts, proposing a meeting in May to develop a plan that would make these items a reality. The minister will certainly keep you informed of any new development arising from this meeting.

I repeat that the answer is not simply to increase funding. The federal government, the provinces and the territories must work together. If we keep on doing what we have always done, we will continue to achieve the same results, with emergency rooms turning away ambulances and problems regarding accessibility to services.

We have the necessary resources, incentives and environment to implement changes that will allow us to improve our health care system and to provide Canadians with a comprehensive, integrated health care system.

Canadians are proud of their health care system, which was built over the years. We will protect it and make the changes necessary to ensure that it remains a part of our Canadian heritage.

[Gordon Earle, NDP, Halifax West, NS]

Mr. Speaker, I listened with interest to my hon. colleague's comments regarding our motion and the health care system.

He talked about the importance of pharmacare, home care and community care. I would be the first to agree that those are very important aspects of our health care system. I am wondering if the hon. member has any comments as to why the government would not have given something very concrete in providing assistance or resources for those areas of concern.

I realize the budget has indicated that further down the road there will be discussions with the provinces around some of these issues. Knowing that the budget was coming up and knowing that health care was the number one priority of Canadians right across the country, I am wondering why we are looking further down the road. Why could there not have been some leadership taken prior to the budget to establish a very clear indication of the resources that would be available to assist provinces with these very important areas of concern?

It sounds as if this is an afterthought, something left hanging out there, something that is up to the provinces to initiate. I would suggest that the federal government has the responsibility to show leadership and make sure there is a good national standard of health care right across the country. Leadership should be taken by the federal government to ensure that those kinds of programs are put in place and are properly resourced.

[Bernard Patry, Liberal, Pierrefonds—Dollard, QC]

Mr. Speaker, I want to thank the NDP member for his question.

This is a very good question, but the member knows that this is a funding issue and not a leadership issue. We know that there is a provincial jurisdiction in that matter and that we cannot move forward without a consensus of all provincial and federal health ministers.

In Quebec, my home province, we are ahead of all other Canadian provinces in that we have local community service centres or CLSCs as well as home care.

We have thus taken a shift to ambulatory care, which is very important and quite appreciated by the people. But, before applying this to all provinces, there must be consensus and true dialogue between the provincial ministers and the federal minister.