Debates of March 2nd, 2000

Supply

[Yvon Godin, NDP, Acadie—Bathurst, NB]

Mr. Speaker, I would like to ask my colleague a question and make a comment.

In 1969, if hon. members will recall, the federal government's share of the health care system costs in Canada was 50%. Today, in the year 2000, its share has dropped to 15.3%, and that includes the new investment of $2.5 billion. This is quite a difference.

If we look at the American system, people have to pay to get real health care. This is what Canadians want to avoid. Since the the budget was brought down in the House on Monday, Canadians from all across the country have expressed their opinion and the premiers of all the provinces indicated their disagreement with the way the federal government supports health care.

For instance, if the federal government contributes only 15%, the provinces have to kick in 85%. Can we imagine what that will cost the provinces? If the federal government really wants to preserve health care and avoid privatization, is my colleague across the way ready to admit we are facing an urgent situation, especially when we consider the reactions of the Premier of Alberta, of Premier Mike Harris and of the Premier of Newfoundland, Brian Tobin? He said “We will have to come to Ottawa to get the money, because this makes no sense whatsoever”.

Those were the words of an important member of the Liberal Party, a man who is respected by the Prime Minister of Canada. He supported the other premiers, who claim that there is not enough money for health care. There is nothing more important than health. Health is what matters. We need the federal government and its 50:50 partnership.

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

Mr. Speaker, I thank the member for Acadie—Bathurst for his question. I totally agree that we should not fall for what the Reform Party and the Progressive Conservative Party propose on this issue. We have to maintain a public system open to all Canadians.

As for the funding issue, I think we should question quite a number of things, but the main issue is that we must put the patient first. This is what is missing now. In Canada, there are too many technocrats, who deal with all sorts of things, and the patient is not the major concern.

When provinces get the opportunity to do whatever they can to make the patient the top priority and when the medical and nursing stakeholders return to the decision making circles within provincial governments, then I am sure we will have the necessary funds to provide adequate medical services to people.

[Guy St-Julien, Liberal, Abitibi, QC]

Mr. Speaker, let me set the record straight as to the level of priority our government places on health care, particularly with regard to federal transfers to the provinces and territories.

On February 18, for the fourth consecutive year, our government chose to increase transfers to the provinces and territories through the Canada health and social transfer.

In the 2000 budget, we announced the transfer of a further $2.5 billion to the provinces and territories to be used over four years for post-secondary education and health care.

The $2.5 billion is in addition to the greatest investment in the history of our government that was announced in the 1999 budget, an investment of $11.5 billion for health care alone.

The 2000 federal budget proves once again that the health of Canadians and the future of their health care system are among the federal government's top priorities.

The Canada health and social transfer is the most important federal transfer to the provinces. It provides cash transfers and tax points to the provinces and territories to support health care, post-secondary education, social services and welfare programs.

The Canada health and social transfer is a block funding mechanism. It allows provinces and territories to grant funds to social programs according to priorities.

Why am I taking part in this debate on the issue of transfers? Because these last few weeks in my region, Abitibi-Témiscamingue, the members of the Parti Quebecois have often talked about the issue of federal transfers, and I wish to present a summary of what was said.

In 2000-01, the Canada health and social transfer to provinces and territories will reach a new height, $31 billion. Of this, there will be $15.3 billion in tax points and $15.5 in cash transfers.

A transfer of tax points is an important part of the ongoing support provided by the federal government to provincial and territorial social programs. A tax point transfer occurs when the federal government reduces its tax rate and allows the provinces to raise their tax rate by an equivalent amount. With such a measure, the provinces can get more revenues without increasing the total tax burden of Canadians.

By next year, CHST transfers to provinces and territories will be $960 per person and, by 2003-04, $985.

My friends of the Parti Quebecois in Abitibi-Témiscamingue should know that, under the CHST, the Government of Quebec will obtain $992 per person in 1999-00, $1,026 in 2000-01, $1,011 in 2001-02, $1,024 in 2002-03 and $1,038 in 2003-04.

However, as the government has said many times, we cannot stop there. The challenge facing the health care sector does not involve only money, it primarily involves changes to the health system.

In its last throne speech, the government reaffirmed its commitment to move forward with its provincial and territorial partners and with the health care sector on common priorities.

Those priorities include testing of innovations in integrated delivery of services in areas such as home care and drug insurance, making sure that citizens from every region of Canada, and rural areas in particular, have improved access through a modern health information system to up-to-date information on health issues and treatment options, to enable them to make better informed choices, and protecting the health of Canadians by strengthening the Canadian food safety program.

The challenge for the government is to identify what changes are required and how the various governments can co-operate to meet the health needs of Canadians now and in the future.

The federal government took the commitment to protect the five tenets of health care as stated in the Canada Health Act. These are: public administration, comprehensiveness, universality, portability and accessibility.

They reflect the will to give all Canadians reasonable access to insured hospital and medical services in accordance with the prepayment formula and under the same conditions everywhere.

This past year, the health ministers of Quebec and the other provinces made substantial progress in identifying what must be done to meet the short and long term health needs of Canadians.

They acknowledged unanimously that co-operation was the best way of ensuring Canadians of access to quality care and to the information required to make informed decisions for enhanced health and well-being.

We realize that dollars and cents are not enough. There must be investment in health care in order to have an accurate idea of the quality of care provided and the extent to which the system yields good results as far as health is concerned.

Quality of care is not merely a matter of funding. Consideration must also be given to the efficiency and appropriateness of care, treatment and services delivered to the Canadian people, and the integration of those services.

The federal, provincial and territorial governments cannot afford to use our limited resources for health care in an inefficient manner.

That is why the federal government is vigorously in favour of striking a partnership for reforming and renewing the health system.

The provincial and territorial ministers of health have been invited to meet together in May of 2000 to discuss three key issues that must be settled in order to fully resolve the recurring problems in the system and to restore public confidence in health insurance.

The first issue is this: to change the way primary care is delivered, in order to improve access and to adapt human resource-related policies in order to facilitate change.

The second: to enhance home and community care and to examine national objectives in order to integrate these types of care into the health system.

The third one: to strengthen co-operation between the federal government, the provinces and the territories in accounting for the system's performance for the Canadian public, in releasing information on the results obtained and in establishing the bases for public debate on the standards for health care.

As the 1999 and 2000 budgets have shown, the federal government recognizes that stable and predictable federal funding in the health sector is important to ensure the provinces and territories can meet the immediate needs of their residents and plan for the future.

The Canada health and social transfer provides this stability and predictability by guaranteeing an annual financial transfer of $15.5 billion starting in 2000-01 and an overall transfer that will increase to nearly $33 billion in 2003-04.

It is time the governments stopped debating about levels of funding of six or seven years ago and began facing challenges of the Canadian health care system before them today.

The federal government, like the provincial and territorial governments, recognizes that in the future decisions on investments in health care will have to be based on a plan reflecting this desire of Canadians, that the approach to health care will have to be better integrated, new resources will have to be used to meet this need of Canadians, which is to have a quality system.

We have to work together to achieve this shared objective of revitalizing our health care system so it will provide accessible, viable and high quality health care to all Canadians.

In closing, to the nurses, hospital staffs in Canada and to all the doctors who, today, are caring for Canadians, I say thank you for your support.

[Yvon Godin, NDP, Acadie—Bathurst, NB]

Mr. Speaker, I listened to the member for Abitibi—Baie-James—Nunavik talk about the health care system, about the billions and billions of dollars that the federal Liberal government has put into health.

I have some more percentages. I do not know whether my colleague remembers that, in 1969, when the Liberal government was in power—the governments that followed did the same thing—it began to make cuts, with the result that transfers to the provinces are now 15% of what they were.

Would the member agree with me that today in Canada our children or our parents have to wait for treatment in hospital corridors, that people have to wait six months for cancer treatment or for a heart operation?

One of my sisters-in-law was operated on for cancer in Quebec City in January. She had to go to Augusta in the United States for her treatments. She had to stay five weeks and the treatments cost Canada or Quebec $18,5000. Here in Canada we are not even capable of treating our own citizens. I would like to know where the member stands on this.

Would he agree that the federal government should change its approach to provincial transfer payments so that our parents and our children do not find themselves stuck in hospital corridors waiting for care?

[Guy St-Julien, Liberal, Abitibi, QC]

Mr. Speaker, the NDP member told us about 1969 and made reference to the province of Quebec. He told us about how his sister-in-law had to go to the United States for an operation.

In 1994 Quebecers paid $28 billion in taxes to the federal government, which then gave back between $34 billion and $35 billion to the province. Quebec always stood to gain.

It is deplorable to see patients in hospital corridors and people being transferred to the United States. But we learned one thing yesterday: it is not strictly a matter of money. The fact is that Quebec left money dormant in the Toronto-Dominion Bank, in Toronto. Meanwhile, the Quebec minister of health, Pauline Marois, was making every attempt to get money in February of last year. There was none for the hon. member's sister-in-law. The money was dormant in Toronto and people were not receiving the treatments they need. This was dereliction of duty on the part of the separatist government in Quebec.

[Christiane Gagnon, Bloc, Québec, QC]

Mr. Speaker, it is easy to assess the situation in Quebec when we are not there to look at the finances, but the problem is the same for Quebec and the other provinces. Quebec is not the only one in that situation.

There is money in trusts and there are funds for ad hoc needs, but this does not allow the provinces to set up a longer term management structure.

In Quebec, some money is in trust and some is in the Quebec government's overall budget. The Minister of Finance decided to use the surplus money, not the money in trust, because that money will be needed next year to meet the 4% annual budget increase for health.

Before making such comments, the member should look at what the federal government has done to the provinces. The Liberals may boast about the $2.5 billion over four years, but this is not what the provinces need to meet the requirements relating to the restructuring of our health system.

[Guy St-Julien, Liberal, Abitibi, QC]

Mr. Speaker, one day people will talk about the Quebec minister of finance and his statement that “the health problem is not a matter of money”. That is what Mr. Landry said yesterday.

The hon. member has referred to trust funds. The amount was put in trust by the federal government, but Quebec could have immediate transferred that amount of $842 million for the care of all those people lined up in hospital corridors or on waiting lists, instead of sending them to the States. That is quite a substantial amount, $842 million, not to mention the interest. One has to remember the interest. We learned this last evening, 12 months after the federal government gave the money in question to the province of Quebec. And they talk of shortages.

Let us not just talk about trusts. Let us talk about the region of Abitibi—Témiscamingue. I have an excerpt here from a daily newspaper in the Vallée-de-l'Or region, the Parlemenu . The article by Denis LaBrecque addresses the shortage of physicians in remote areas.

The region is far from Quebec City and far from Ottawa, and there is a shortage of doctors. In part, the article reads as follows:

Representatives of the health, education and business sectors met together in Val-d'Or Tuesday evening to address the situation. At the same time, they reviewed all of the initiatives taken to date in an attempt to remedy the situation, none of them as yet successfully.

Solutions must be sought together. With all the political parties and all the provincial governments, new approaches must be found. Let us move on this, and perhaps we will manage to improve things for those who are sick.

[Christiane Gagnon, Bloc, Québec, QC]

Mr. Speaker, I am very pleased to take part in this debate, because I feel particularly concerned as a Bloc Quebecois member.

Today, we are debating a motion from the NDP asking that adequate moneys be put back into health to meet the various expectations in that sector.

A number of members addressed this issue, including some who are doctors by training.

Depending on which party we represent, we have a different reading of the situation. The Liberal Party—a fellow member who is a doctor addressed the issue—tends to put the blame on public servants, on those who manage health services.

Personally, I would rather agree with the opposition's reading of the health care situation. Obviously, this view does not agree with that of the Liberal Party. Members from opposition parties who have some experience in the health sector told us that there is also a serious funding problem.

This does not mean there is no need to review our ways of doing things, to adjust. We know that several factors are disrupting the traditional ways of doing things in the health sector.

I will talk about this issue, before dealing with our minor disagreement with a Liberal member about the $841 million in trust that were given by the Liberal government and that were supposed to be spent within three years. We could ask why the Liberal government is not putting back into the Canada social transfer moneys that come back year after year, to meet regular expenditures.

These are non recurrent amounts and the provinces probably have a hard time anticipating the necessary margins to deal with very urgent problems.

The dynamic in the health care sector in Canada and particularly in Quebec is such that a greater adjustment will be required for the ageing population. Fortunately for Quebec, although unfortunately in other ways, we have the lowest infant mortality rate of all Canadian provinces. That having been said, funding is needed so that we can meet the need for more health services.

For example, in Quebec the mortality rate is 4.6% for every 1,000 births while in Canada it is 5.6% or 5.7%. Earlier, I was a bit insulted to hear the Liberal member say that in Canada, and in Quebec in particular, they are doing a poor job of managing their budgets, that they are not spending them on the right services and that our health care system is not effective enough.

I would qualify this. If, for instance, our infant mortality rate is lower than the rest of Canada's, this means that our health care services—we must not be too partisan—generally meet the population's needs.

For five years now, there have been cuts to the system that have gone a long way towards eliminating the deficit. We know that public finances are in very, very good shape in Canada. The surplus was originally estimated at $95 billion, and is now estimated at $137 billion. Some put it at around $167 billion.

With such a large surplus, this government could have committed a much larger amount. But it announced $2.5 billion, again in a trust, that the provinces will be able to spend over a four-year period. It may well have thought this was enough but I think that the needs of the health care system are much more pressing than the government wants to admit.

The result is increasing pressure on demand. We know that there have been demographic changes, technological developments and the emergence of new needs. I will go into this a bit later on.

Major changes have been made to the organization of social and health care services in a very short period. Quebec had no choice. It was already behind other countries and some provinces.

Significant gains were made in the move to ambulatory care and in the increased efficiency of the health care network. However, there are weak spots and sectors to be consolidated, waiting lists for surgery, emergencies to be recognized, human resources to be shouldered and equipment to be replaced. All of this brings with it the challenges of rectifying the situation in the health care sector.

The network's financial situation must also be rectified and its functioning improved. We agree on that. However, the federal government has to help with financial support for the provinces.

Looking at the course of the health care system, we see that, between 1975 and 1994, public spending often grew faster than did the public purse. Since 1994, the Government of Quebec has taken major steps to balance the budget.

Health care spending increases by 4% annually. In the coming years, we will have to come to terms with this urgency to meet needs.

On the subject of the trust fund in Toronto, a certain perspective is required on the demands that will be made in the coming years, and this involves a variety of reasons, which I can give later. The population is ageing and this will lead to increased demand in various areas of health care.

The shift to ambulatory care means moving some medical procedures out of hospitals. We know we have to learn how to better deal with the new demands on the health care system. We have to increase the proportion of actual day surgery as compared to potential day surgery from 72% to 88%, bring down the hospitalization rate for surgery from 32.8 to 23.9 per 1,000, and lower the total number of hospitalizations by 11.5%. This is the approach we have to follow with regard to the shift to ambulatory care.

The average hospital stay needs to be shortened. In medicine, it should be 7.5 days instead of 8.8, and in surgery, 8.2 instead of 8.7.

There is still room for improvement to better deal with these new demands and meet the challenges of the shift to ambulatory care.

From a financial point of view, since 1994-1995, the Quebec government has been trying to put a lid on its expenses while still doing a good job, and it has worked. I will not get into the details of the cases reported on a daily basis by the papers over the last couple of years. I believe the Quebec government is trying hard to bring some measure of efficiency to the health care system while giving it the tools necessary to respond quickly and appropriately to health care needs.

Even in the institutions experiencing financial difficulties, there has been a significant effort to streamline operations. However, it has not been enough to offset the impact of the upward pressure on costs.

We are faced with dealing with new technology. We are faced with dealing with a more expensive approach to care than 20 years ago. The shift to ambulatory care has allowed the streamlining of the system, but other factors are putting upward pressures on expenses, namely demographic changes, the development of new technologies, and new needs.

It is said that the number of people over the age of 65 will be 60% higher in 2011 than it was in 1991, and the increase will be even greater for the 85-plus age group. In 2011, there will be 84% more people aged 85. In 2030, 25% of Quebecers will be over the age of 65.

This means that the changes that have just been made in the health system are intended precisely to respond to the fact that the population of Quebec is ageing more rapidly than elsewhere in Canada and other countries as well.

I have a table here which illustrates the fact that it will take 35 years for the percentage of the Quebec population aged 65 or over to rise from 12% to 24%. It shows 35 years for Quebec to reach that level; Canada, 45; Germany, 65; France, 70 and England, 75. There were many children born at a certain time in our history. A number of my colleagues are baby-boomers, and they will reach the honourable age of 60 or 65 in about another ten years and be users of the health system.

The population of Quebec is ageing at an amazing rate. This must be addressed. A strategy is needed for the approach to health care, but money is needed as well, in order to support all the new technologies and all the new methodologies. It is said that the ageing of the population of Quebec will be twice that of the European countries.

The health system is experiencing the pressures of demographic change. I will explain the implications of this.

In the emergency departments, for example, there were 50,000 more people lying on stretchers in 1998 and 1999 than there were in 1994 and 1995. Of these, 56% were age 75 and older. The reason for overcrowding in emergency rooms is that more people have been going there since 1994.

In radiation oncology, needs are increasing rapidly, particularly for people over 50. The first baby boomers have already reached that age. New cases of cancer are increasing at the rate of 3% a year. We must be able to respond to this increase.

The same is true in cardiology. Needs are increasing, particularly from age 50 on. More coronary bypasses are being performed on seniors. The number of heart surgeries is increasing by 3.6% a year and there has been a 260% increase in angioplasties in the last ten years.

In other specialties, the fact that people are living longer and that there is an increase in the number of very elderly people is adding to needs. The number of cataract surgeries has increased by 8% in the last three years, and 30% in the last two.

There is an increasing need in various specialties to cope with all those who need treatment and who require new technologies, more doctors, and more people who are able to respond adequately to all these emergencies.

There was a boom in the 1980s, particularly with respect to medical technologies, drugs and information. For example, medical imaging technologies now allow speedier and more effective intervention but cost more. The Liberal member who says that we are not capable of spending money effectively has a short term view of what is going on in the health care sector.

She really does not know what is going on. She really must not be familiar with the new dynamics, the new pressures resulting from demographic change or the system's difficulties in meeting these needs.

Spending on medication can be said to have increased, and Quebec is a leader in this area with a drug plan. There are also new requirements in the field of health, new problems have arisen, such as AIDS, Alzheimer's disease and related illnesses. In 1999, there were 66,183 such cases, and today there are 103,783. Some people require more services in their community.

In looking at the annual 4% increase in spending in the health sector, we must also look at all the new dynamics. We cannot say it is the fault of the provinces for having badly managed health services. We must take a new tack in dealing with this.

I do not think anyone is acting in bad faith. There are new dynamics, perhaps they were unforeseen, but they must be dealt with in the coming years. With the money we get from the federal government, more has to be done with less.

The Canada social transfer was higher in 1993 than it is today. When we are told the figure will be $2.4 billion compared with what we were given prior to 1993, when there were fewer requirements, I can understand why everything is going awry. I can understand as well that the problem does not lie in Quebec alone. It is present in other provinces.

We heard members of the NDP, the Reform Party and the Progressive Conservative Party from all regions of Canada describe the same problem. Therefore, I am a little disappointed to hear overblown speeches that are disconnected from the reality of everyday life, this for the sole purpose of boasting about giving $2.4 billion, again in a trust.

A trust is not what will enable us to implement long term strategies to determine how much hospitals can spend on supplies and on staff.

We are certainly prepared to look at the situation, but we still need money to support those who work in the health sector. We hear that some people feel exhausted and belittled. I think that even nowadays the pay, the work and the achievements of these people should make them feel appreciated. A decent salary allows a person to take a vacation and to feed his or her children.

We should look at the health sector as a whole and not use a piecemeal approach to avoid doing our duty. If we ask a lot from the federal government, it is because we give it billions of dollars in taxes, $31 billion to be precise.

I would have a lot more to add, but I will conclude by saying that the way the government intends to fund the Canada social transfer, that is in an ad hoc fashion, through trusts, will not allow the provinces to plan in the long term and to meet long term needs in the years to come.

I spoke about our ageing population. We need to pay attention to this phenomenon, as we may be the next ones to ask for adequate care, because of health problems.

[Claude Bachand, Bloc, Saint-Jean, QC]

Mr. Speaker, I want to congratulate my colleague from Quebec for her eloquence. I thought her speech was just brilliant. However, I also heard brilliant but demagogic speeches from certain Liberal members, in particular with regard to the $842 million being mismanaged.

I heard my colleague say, at the beginning of her speech, that she would get back to that issue, but I suppose she got carried away and did not have time to do so. I want to give her the opportunity to give us and particularly to give our colleagues opposite an explanation about the headlines which we saw in the newspapers today and which have been used extensively by our political opponents to try to show us once again that we are incapable of good management.

I ask my colleague to make a brief comment on that.

[Christiane Gagnon, Bloc, Québec, QC]

Mr. Speaker, I thank my colleague for giving me extra time to explain what a malicious deed the setting up of the trust by the government really was.

We know that the federal government invested $3.5 billion in the last budget and gave the provinces the right to spend this over the following three years.

The governments also planned to inject some funds into the financial area, and Quebec had decided on a figure of $2 billion in investments. Initially, its plan was for $1.7 billion, plus an additional $300 million for health during fiscal 1999-2000 and 2000-2001.

The Government of Quebec made that investment. Instead of taking the $841 million from the fund—knowing that it will need this money for the next budget, investment in health being far from over, for all the reasons I have given—the Government of Quebec is going to have a surplus because the government made that investment. The Government of Quebec is going to draw upon the surplus instead of the trust fund, because what is in that fund will be needed for a long term health investment strategy.

I am not worried about how the Government of Quebec is going to spend that trust money. We know it will go for health, but a strategy is needed, and that is what the Government of Quebec is going to address. By taking the $841 million from the budget surplus, the Government of Quebec has made health a priority, rather than setting having a budget surplus as its priority, as this government has.

[Jocelyne Girard-Bujold, Bloc, Jonquière, QC]

Mr. Speaker, it was with great interest and attention that I listened to my colleague, the member for Québec.

I wish all government members had been present to hear what is going on in the health care sector, not just in Quebec, but throughout Canada. I think we have just been given an accurate picture of what is going on throughout Canada, and the member for Québec has just outlined for us the long-term needs of the provinces and of Quebec.

I would like to ask my colleague whether she thinks that this government needs to interfere so blatantly in health care with the Canada social transfer. That was what it wanted to do with the CHST, but the Government of Quebec refused to go along. I would like her to tell us about Quebec's real concerns in the health care sector.

[Christiane Gagnon, Bloc, Québec, QC]

Mr. Speaker, I will begin by saying that the Canada social transfer represents an annual shortfall of $1.7 billion. When the government announces that the provinces will be getting back $2.5 billion over four years, that leaves Quebec terribly short.

The Canada social transfer is $1.7 billion, but $875 million go to health, $375 million to education and $450 million to social assistance. Do people realize what the loss of $875 million means in practical terms?

It means 3,000 doctors and 5,000 nurses. The $375 million would hire 5,800 university professors and there would be another $325 million for income security for those on social assistance.

The provinces are being given a difficult choice. This is terrible and has got to stop. I hope that the meeting of the health ministers will lead to something, that this government will be made to understand that it is up to the provinces to meet the public's pressing demands. It is not up to the federal government to take over from the provinces.

If there had been enough money, if the government had done its homework, if $18.8 billion had been made available—the amount the provinces are entitled to expect in order to meet health care needs—I could perhaps say the provinces had not done their homework and had mismanaged their budget. Instead of increasing this $18.8 billion, what has the government been doing? It has been cutting it back. To date, $31 billion has been taken away from the education, health care and social assistance network.

It is high time the public understood and the government stopped blaming the provinces.

I can speak for Quebec, while you may be able to speak for your region, Mr. Speaker. Honestly, I think that the Government of Quebec is trying to find practical and valid solutions. It can meet the needs of its people. We do not need the federal government, and certainly not the members on the government side, to give us any lessons.

[Alex Shepherd, Liberal, Durham, ON]

Mr. Speaker, I will be sharing my time with the member for Broadview—Greenwood.

I am very happy to engage in this debate dealing with health care spending by the federal government and the provinces. It seems to me that the problem is the whole issue of accountability. To the people who are in their living rooms watching this debate and who are concerned about the health care issue, it is appropriate for us to ask not about whether it is new money we need, but how the money was spent in the past. We can judge the sincerity of secondary levels of governments by how they are spending the actual moneys we transfer to them.

A number of people have mentioned the report on what the province of Quebec did with some of its money. It has taken it out of the account we provided last year and invested $841 million in Quebec savings bonds and Hydro Quebec. It has earned something like $16 million in interest. The point is the money was not spent on health care.

We have had a lot of complaints from the province of Ontario, and Mr. Harris in particular, that it needs more money because the money provided in the last federal budget was not adequate. Ontario is pounding on the table and is really upset because it did not get enough money. It is very appropriate that we sit down and ask what the province of Ontario did with the money it already had.

I am drawing my information not from my notes but from the Ontario government's budget book, pages 38 and 55 and from its third quarter fiscal results dated February 4, 2000. Looking through those pages I see that of the $3.5 billion allocation that was made in fiscal year 1999-2000, the province of Ontario's share was $1.323 billion. I also see in the same books that the province of Ontario drew down $755 million on that account. For those people who are watching the debate, it is very hard to relate billions and millions when most of us have a hard time finding $25 to put some gas in our tank. It does not buy very much today.

Getting back to the equation, $1.323 billion was transferred to Ontario and it drew down $755 million, which left a balance of $568 million. Of the money we gave it last year, $568 million has remained unspent.

I do not know if, like the province of Quebec, Ontario has invested it in securities and is earning interest on it. The fact is that money is still sitting there. It has not spent it at all. The important part is $755 million went into the Ontario government coffers.

In addition to the $755 million of new money, we had increased our normal allotment under the CHST by $190 million to the province of Ontario. To get all my figures together, $190 million plus the $755 million comes to $945 million. That is $945 million of new money that went to the province of Ontario in fiscal year 1999-2000.

The question is what did the province of Ontario do with this new money? The opposition party is saying it wants more money but what did Ontario do with the money it received?

I have looked through the pages of the Ontario government expenditures. What have I discovered? I have discovered that the new spending on health care for the province of Ontario for the 1999-2000 fiscal year was $320 million.

Think about that. The federal government put the money in a trust account. Ontario took $755 million out of the trust account. We gave Ontario another $190 million of new money. It had $945 million of new money. How much new money did it spend on health care? Only $320 million. The difference is $625 million that the federal government transferred to the province of Ontario that it did not spend on health care.

When thinking of a trust account, what is the concept of trust? We put money in trust and say, “We put it in trust for you and we trust you as a provincial government to spend it on your people and spend it for its original intention which is health care”. What did the province of Ontario do? Ontario withdrew this money in trust, $755 million, added it to another $190 million in new money that we gave, and only spent $320 million in new dollars.

There is $625 million missing, $625 million of Canadian taxpayers' money that was transferred to the province of Ontario to undertake new spending in health care that never happened.

We talk about accountability in government. This is the problem with this whole debate. People blame us for the health care system but we do not control how the money is being spent. This is a clear example. Mr. Harris has the audacity to shout all over the land today, “We need more money. We did not get enough money from you guys”, when in fact the province of Ontario got $625 million new dollars which it stuck in its back pocket and never spent on the people of Ontario.

If that were not enough, in its fiscal estimates the province of Ontario now anticipates an additional $1 billion surplus this fiscal year. Is that not an amazing thing. There is $625 million seemingly missing and the province of Ontario now has a $1 billion surplus, a surplus $1 billion larger than it was going to have in the first place. What did the province of Ontario do with this money? I do not know.

We do know the province of Ontario spent $4.7 billion in tax cuts. Perhaps that is what the Ontario government did with it. We know that it has done all kinds of other spending. Worse than that we know it also raised its deficit by $20 billion. Those people in Ontario are spending money like drunken sailors, but it is not going into the health care system.

Members of the opposition have been saying that only 3 cents went to health care.

[An hon. member]

Two cents.

[Alex Shepherd, Liberal, Durham, ON]

Two cents. Should we give the province of Ontario or the province of Quebec another 2 cents when that has been the track record? Ontario took $625 million of our money, said it was going to spend it on health care and did not spend it at all.

It took money out of a trust account, which was being held in trust for the people of Ontario, and then did not spend it on them. For all the people who are lined up in the wards, and for all the people who are having trouble with health care in Ontario, and in Quebec, ask where the $625 million went.

Maybe that is a better answer than blaming the federal government, because we gave it to them. We spent it on the province of Ontario, but the province of Ontario did not spend it on the people. It did not spend it on the sick. It did not spend it on those people who are being threatened on a daily basis by disease. It did not spend it on the frail. It did not spend it on the aging. I do not know what the province spent it on. It spent it on its rich friends, I guess, or the $4.7 billion in tax cuts, but it did not spend it on the province of Ontario.

We are not going to give the province any more money. We should not have given it that money, if that is the way it spends. We need an accountability system in the country which will tell us where the money has been spent and will ensure that it goes to the people. Do not tell me it is about more money.

[Bev Desjarlais, NDP, Churchill, MB]

Mr. Speaker, it is somewhat hypocritical to have members of the governing side talk about the accountability of taxpayer dollars after what we have been listening to for the last number of weeks concerning the human resources department.

I do not think there is any question that if taxpayer dollars for health care are not going to health care, the government should be doing something about it. There is no question.

If the government knows that is happening and it is not doing anything about it, then it is at fault because that money should be going to health care. There is absolutely no question.

It is along the same lines as the EI dollars, the EI premiums that come in to give employment insurance benefits to the workers in Canada, for jobs and training throughout Canada, and to assist employers. What did the government do with that money? It used it to create a surplus. It sounds an awful lot like the member's version of Mike Harris.

What does he have to say about that?

[Alex Shepherd, Liberal, Durham, ON]

Mr. Speaker, looking at the motion which is before us today, members of the NDP are co-conspirators with the Harris government because they have come to this place and said “Give us more money. Mr. Harris wants more money. Give us more money”.

They are the co-conspirators with the likes of Mr. Harris and Mr. Klein, who have no intention of spending it on the people.

[Jocelyne Girard-Bujold, Bloc, Jonquière, QC]

Mr. Speaker, now I have seen it all in this House.

The Liberals have the gall to pass judgment on the way the provinces are managed. If the member wants to pass judgment on a province's administration, he should run for election in that particular province. I have always respected other levels of government. If I were him, I would be ashamed of what he just did.

Is he not ashamed of what his government has been doing since 1993-94, when it cut health, social and education transfer payments to the provinces by $38.7 billion? This has meant a shortfall of $30.5 billion for all the provinces since 1993. It is $11.1 billion in Quebec and $10.5 billion in Ontario.

I think the member would be well advised to clean up his own backyard before he tries to clean others.

[Alex Shepherd, Liberal, Durham, ON]

Mr. Speaker, I think the essence of that question was that I should be ashamed because I am standing here trying to prevent taxpayers' money from being misspent. I am not ashamed at all. I will defend the taxpayers of the province of Quebec if I have to. The finance minister for Quebec is saying “It is not about money. It is not about spending money. We cannot find the doctors, so we are not going to spend the money anyway”.

Am I ashamed of defending the taxpayers of Quebec? Not on your life.

[Dennis Mills, Liberal, Broadview—Greenwood, ON]

Mr. Speaker, I appreciate having the opportunity to participate in this debate. I have always held a very high level of respect for the New Democratic Party and its commitment to this issue, but the notion that it would, without any discussion or exchange of ideas, want an immediate, substantial and sustained increase in cash transfers to the provinces absolutely boggles my mind.

[An hon. member]

Do you have another idea over there?

[Dennis Mills, Liberal, Broadview—Greenwood, ON]

The member for Saint John is another member for whom I have immense respect, but I say to the members opposite that this is not just about sending money to the provinces.

In my community, in downtown Toronto, a young man died in an ambulance because he could not get admittance to a hospital.

When my constituents listen to us talk, I think most of them would be lost in all of these numbers: billions here, hundreds of millions there.

In no way, shape or form am I trying to put down my constituents or members, but I think we are going at this issue the wrong way. The member for Durham talked about this the other day. We should be talking about re-engineering the health care system. We should be going back to Emmett Hall's report to give our whole system a health check. I have not heard one speech in the House today which mentioned health prevention. How much emphasis do we put on health prevention in the debate today?

I will give a couple of specific examples. A year and a half ago, in our sport committee where we were looking at the importance of having a physically active nation, we were told that men and women should spend at least half an hour a day doing some physical exercise. The best doctors in our country appeared before us. Those surgeons had studies that were ratified not only by our best, but by the best in the world, which stated that if we could increase Canadians' commitment to physical activity an additional 10% we could put downward pressure on health care costs within 18 months to the tune of $5 billion annually.

As a government we have a responsibility to mobilize the people of the nation to become more responsible toward themselves and to become more physically active. Again I will go back to my colleague from Durham. This is not just about giving Premier Harris or Premier Tobin blank cheques. It is not about that.

I would not give anybody a blank cheque in this area because it would delay the process of re-engineering the system. We need to go back to Emmett Hall's report, take some of those principles and reapply them.

What about the whole realm of alternative medicine? What about mental health? What about the environment?

When will we talk not only about sending cheques here or sending billions there? When will we have a debate on the creative things we can do as members of parliament, as the House of Commons of Canada, which we can bring to the ministers of health and the premiers of the provinces? We all have a part to play. I do not think we are talking about it enough in the House. All we want to talk about is sending cheques here and there. Is that what the House of Commons has become, a cheque writing machine?

We have many intelligent men and women in the House and we should be using our brains to put forward creative ideas. Where are the creative ideas on fixing the health care system? To quote my colleague from Durham, we should be re-engineering the system. Is there anyone who disagrees that we have to re-engineer the system?

We have heard the notion of Premier Klein wanting to privatize the system. Let me tell my colleague from Cape Breton that with all of the eye surgery that was done in the province of Alberta, all the analyses show that private clinics cost more. One of the things that makes this country great is the fact that everybody has access to the health care system. That is one of our trademarks as a nation.

The notion that we would create an environment where premiers would be allowed to experiment with private health care boggles my mind. NDP members would give blank cheques to Premier Harris and let—

[An hon. member]

No, 50:50.

[Dennis Mills, Liberal, Broadview—Greenwood, ON]

That is what the motion says. The motion says, announcing within one week of the passage of the motion a substantial and sustained increase in cash transfers. The NDP did not even put an amount on it. It did not put an amount on what it would give. I would not give my dear friend Brian Tobin a blank cheque.

Let us stop talking about money and start talking about creative ideas. What about mobilizing people to become more physically active? What is wrong with that?

I say sincerely that I do not believe there is a single member of parliament who wants to be sitting here with a fragile health care system, and we all admit it is fragile.

[An hon. member]

It is your fault.