Debates of May 18th, 2000

Supply

[Judy Wasylycia-Leis, NDP, Winnipeg North Centre, MB]

Mr. Speaker, I am very pleased on behalf of my colleagues in the New Democratic Party to be able to address a situation that is obviously at a very critical juncture in the history of the country.

We come to this debate with a serious, constructive motion to demand that the government stand and take action. We come to this debate with the understanding of so many Canadians that we are at a defining moment in our history when it comes to the number one priority facing Canadians: health care, access to quality health care across the country, and the preservation of a system that has held the country in good stead.

I am very pleased to be able to follow my leader, the leader of the New Democratic Party, who has been leading the fight in speaking out on behalf of Canadians and their number one concern. She is the only leader in the House, the only leader of a national political party who has decided to hold the government to account and to reflect the concerns of the Canadian public.

All my colleagues in the New Democratic Party have been fighting this issue day in and day out, week after week, month after month. It is an important issue. It is imperative for us to hold the government to account and to move it from its words and rhetoric to the point where it is prepared to have political courage and to take action.

We have a very constructive proposition for the government today. We hope the Minister of Health is listening carefully, as I see he is, and will convince his colleagues to support us in this request.

As my leader has done in her opening remarks, let me just briefly put the motion in some historical context. It will come as no surprise to the Minister of Health when I say again today that we have been pressuring the minister month after month to do something about bill 11.

I do not need to mention the fact that for seven months the Minister of Health has said he will act later. He said he will act when he gets the mail. He will act when the bill is unveiled. He will act when the bill is introduced. He will act after amendments, after regulations, and now he is saying after implementation.

What has been the action so far? Nothing, nil. I do not like to get carried away with the rhetoric in the House, but I have a difficult time not pointing out that this is a very shameful performance on the part of the Minister of Health, and I think he knows it.

Let us look at the response of the Minister of Health and his colleagues over the last number of months. We tried in the House to do something as simple as getting the government to acknowledge the existence of a number of legal opinions about how bill 11 violates the Canada Health Act and how it opens up NAFTA.

We could not even get the government to allow us to present those legal opinions. It did not even want to have a look at them. It did not even want to acknowledge their existence because it would put the government in the terrible position of having to recognize the facts forcing it to act now and act today.

We asked about the NAFTA implications, something that has been acknowledged as a very serious concern by credible organizations from one end of the country to the other. What did the Liberals do? They reversed themselves without a single legal opinion to back them up. All the while we have the reform alliance and the Tories cheering Ralph Klein on, supporting, aiding and abetting an agenda which opens up our health care system to a two tier American style approach.

By the inaction of the Minister of Health the government is letting the right wing forces send a message, make a difference, influence the public agenda. The passivity and inaction of the minister are destructive and dangerous in more ways than one when it comes to the future of the country and the future of national health care that held Canada in good stead.

What the Canadian Alliance and the Tories are suggesting is something that Canadians abhor, something that has been rejected time and time again. It is absolutely critical for the government to stand today to put an end to that kind of agenda, to counter it immediately and to do so by way of concerted and decisive action.

What does the minister continue to do? He continues to dodge and weave, wait and see, hide and seek. He is now saying after all the time he has had to study bill 11 that it complies with the Canada Health Act. He has given us no legal opinion. He has given no evidence for the sudden decision to claim there is no violation of the Canada Health Act.

I know I should not comment on how many Liberal members are in the House, but I hope the Minister of Health will get to all of them over the course of the day. I would like them to think about what they are doing and what is happening. The health minister has said private for profit hospitals do not violate the Canada Health Act. The legacy of the government will not be brave decisive action but explicit consent to a two tier American style health care system.

We used the words of the minister in the motion because we thought they were a significant indication of the wishes of Canadians. He says that he has grave reservations about investing public funds in private for profit facilities. Grave concerns do not stop health care from becoming a commodity to be bought and sold on the open market. Grave concerns do nothing to stop bill 11 from being proclaimed.

We know the minister has had a heck of a time trying to get his head around it and do something decisive over the past seven months, but we are here today saying that he now has a window of opportunity to act before bill 11 is actually proclaimed.

I have lots more to say and I think the best way to actually say what the motion is all about is to read a letter to the editor of the Globe and Mail of today by Don Schmidt. He wrote:

Canadians expect more from the federal government and Allan Rock—

[The Deputy Speaker]

Order, please.

[Judy Wasylycia-Leis, NDP, Winnipeg North Centre, MB]

I am quoting, Mr. Speaker.

[The Deputy Speaker]

The member may quote but I know she will want to comply with the rules by referring to the Minister of Health by title and not by name.

[Judy Wasylycia-Leis, NDP, Winnipeg North Centre, MB]

I apologize, Mr. Speaker. The letter continued:

—than being “vigilant in ensuring that the principles of the Canada Health Act are respected throughout the country”.

Most Canadians expect (the Minister of Health) to legislate—that's right: pass laws—so that a two tier health system is unable to develop further. Do your job, (Mr. Minister).

There is much more to be said. I hope the Minister of Health has the message and sees it as a constructive suggestion. Before concluding, I move:

That the motion be amended by inserting the word “decisively” between the words “act” and “on”.

[The Deputy Speaker]

The question is on the amendment.

[Grant Hill, Reform, Macleod, AB]

Mr. Speaker, my colleague asked a question of the leader of the NDP a few moments ago. He tried to do it twice and did not get an answer, so I would like to try again.

The NDP government in B.C. wants to protect medicare, as I believe every individual in the House wants to do. It has recently experimented with private practice procedures relating to cataract surgery and minor surgical procedures. They have reduced the waiting lines for those two procedures in a relatively short time. This is an innovation and it involves doing exactly what bill 11 attempts to do, reduce waiting lines in Alberta. The NDP government is making innovations in exactly the same way.

Would the member comment about B.C.'s attempt to reduce waiting lines by doing exactly what bill 11 is trying to do?

[Judy Wasylycia-Leis, NDP, Winnipeg North Centre, MB]

Mr. Speaker, the alliance members want to have it both ways in this debate. On the one hand they say that they are in support of medicare, while on the other hand they do not acknowledge that these principles are being violated today. The principle of accessibility is being violated under bill 11. Members cannot stand in the House and say they support medicare and then say we should go further than bill 11.

The member also seems to feel that the only way we can deal with waiting lists and the need for more efficiencies in our system is through privatization. Since when did privatization become the only solution for innovation? Alliance members joined with New Democrats in the House many months ago and said that the solution to the problem was in convincing the government to restore the cash transfer payments so that there would be adequate cash on the table to meet the needs of Canadians so we could shape our system to deal with growing and emerging needs in the health care system today.

Why have these members suddenly decided to support the likes of Ralph Klein, Stockwell Day and Mike Harris to pursue an American agenda, and not a Canadian approach to something as vital as universal access to health care?

[Werner Schmidt, Reform, Kelowna, BC]

Mr. Speaker, I want to thank the hon. member for becoming so dramatic and so excited in her answer to my colleague from Macleod.

There is a very simple question being asked. Does the member support or not support the NDP government's approach to an innovation that is being tried in Vancouver? Why is it that the member cannot say yes or no?

The hon. member has suggested that there are many different ways of innovating, and I quite agree with her. This is a sister organization, an NDP government in British Columbia, which is using a particular innovation. All we want to know is whether those members would support that innovation.

[Judy Wasylycia-Leis, NDP, Winnipeg North Centre, MB]

Mr. Speaker, we have a motion before the House today to try to get some support to stop bill 11. That party is confused about its own position and is afraid to clearly indicate to Canadian people that it is in favour of a parallel, private two tier health care system. That party comes to the House with specific issues pertaining to provincial governments.

I would be happy to look into examples of health care delivery that are innovative. I would also inquire into each of the examples to see if there is any breach of the Canada Health Act. What is fundamental to us today—and I would hope alliance members would eventually come to this point—is the preservation of medicare; it is giving Canadians the wherewithal to preserve medicare and build for the future.

My goodness, I would hope that in this kind of questioning from alliance members they are not skirting their responsibilities. We are engaging in a debate about the future of medicare and whether the Canada Health Act is able to uphold the principles of medicare. Are those members prepared to say clearly through this debate, and on how they vote on this motion, that they believe in medicare and will do anything to uphold the principles of accessibility, comprehensiveness, universality, portability and non-profit administration? Are they or are they not prepared to join us in this most critical and fundamental question?

[Allan Rock, Liberal, Minister of Health]

Mr. Speaker, I will be dividing my time this morning with the hon. member for Bruce—Grey.

I welcome the opportunity to address the House, as Minister of Health, on an issue of such current and continuing priority. I acknowledge the importance of the motion which the hon. member for Halifax has put before the House of Commons today. The issue is of fundamental significance because the way a nation chooses to provide for health care services to those who are sick speaks directly to the values of that nation.

In our case, the values of Canadians are reflected and codified in the Canada Health Act. Although the Canada Health Act was written and adopted many years ago, its principles are as relevant now, as important now and as necessary now as they were when the statute was first written.

Public medicare in Canada has allowed us to provide health care services to our citizens in a way that is socially fair, while at the same time putting in place a health care system that is economically efficient and is a competitive advantage in the business world to our businesses when they compete with those of other nations.

Let me say at the outset that we, on this side of the House, share the concerns that have given rise to the motion which is presented today on behalf of the New Democratic Party. While we share those concerns, our strategy in dealing with them differs from that proposed by the leader of the NDP. Simply stated, there is no need to amend the Canada Health Act to deal with the concerns that have been raised. The Canada Health Act already contains both the rules and the penalties to enable the Government of Canada to ensure compliance with its principles. They are already in the Canada Health Act.

I would like to point out that, as Minister of Health for Canada, it is my responsibility to monitor the health systems of the provinces and territories in order to ensure that they meet the criteria and conditions of the Canada Health Act. If there is an infraction, I am required by the act to consult the provinces or territories in question.

Over the years, a number of potential problems of non-compliance have been resolved by negotiation, without having to invoke the penalties provided by the Canada Health Act. If negotiations failed, however, the Government of Canada has the power to withhold funds from the provinces.

I want to emphasize that this power is not simply theoretical. It is not just a rule written on paper. This authority has been exercised a number of times in recent years. For example, between 1984 and 1987 the Government of Canada withheld about $245 million from seven provinces that permitted user fees and/or extra billing.

In 1992 to 1993 the Government of Canada withheld funds from British Columbia in respect of extra billing arising out of the dispute between the provincial government and the B.C. medical association.

In 1995 our government deducted payments from four provinces that charged facility fees for medically necessary services at private clinics.

In each case the principles of the Canada Health Act, without being amended, had been contravened and in each case the Government of Canada acted.

In the context of bill 11 I have both spoken publicly and written directly to the Government of Alberta to express my concerns with that legislation. Indeed, I asked the Government of Alberta to amend bill 11, and I expressed the view that while on its face bill 11 does not contravene the Canada Health Act, by allowing private for profit facilities to both provide insured services and to charge fees for enhanced services bill 11 creates circumstances which could be used to contravene the principle of accessibility in the Canada Health Act. That is the real concern.

When we combine that with the fact that the policy of the Alberta government contemplates overnight stays in private for profit facilities, which takes private for profit further than it has so far gone in the country, we asked the Government of Alberta to amend its legislation. It did not. As a result, one week ago today, in a ministerial statement, speaking on behalf of the Prime Minister and this government, I said in the House that because Alberta has gone ahead with this legislation, which we thought was ill-advised, we would do the following things.

First, we will deem these private for profit facilities, as they are called in bill 11, hospitals within the meaning of that term in the Canada Health Act. The practical consequence of that is that charging anyone for any part of an insured service will be considered a violation of the Canada Health Act and will attract the penalties provided for in that statute.

Second, in response to the concern expressed by the auditor general last year that Health Canada does not have the resources to monitor and enforce the act, we are increasing considerably the capacity of Health Canada to do just that, and, as we have watched in the past, we will watch carefully to see if these private for profit hospitals imperil the principle of accessibility, contravening the Canada Health Act. If they do, as we have done in the past, we will act. We will exercise the power of the Government of Canada under the Canada Health Act and do what is necessary to protect medicare.

Clearly, we have the will and the means to ensure that the Canada Health Act is respected. We are going to ensure that the principles set out in the act are respected in Alberta and elsewhere in the country.

Let me be perfectly clear: this government would not like to merely to play the role of referee. We would much prefer to work in partnership with our provincial colleagues.

Let me say a few words in closing about medicare renewal. Like almost every other developed country in the world, Canada is going through the process of improving and adapting its health care system to meet the pressures of our current time: an aging population, the increased cost of drugs and technology, and changes in the way in which medical services are delivered on the ground.

We have an enormous advantage in this country because we have the best health care system in the world. Our challenge, indeed our duty, is to renew medicare in a way that is consistent with our principles and to overcome the problems of the shortages, the waiting lists, while staying true to our basic principles.

While the federal role of enforcer which we are discussing today is crucial, simply enforcing the rules is not by itself sufficient to achieve the medicare renewal that must be undertaken. It will require much more. It will require more federal money for health care transferred to the provinces. It will require hard work with the provinces to develop common goals and priorities to know that additional money is going to support a plan that will produce better health care for Canadians. It will require our listening to the health care workers, the doctors, the nurses and others, so that they are involved and a part of the process, and not excluded. It will involve hearing the public, its concerns and its priorities.

I have started a process with my provincial partners toward medicare renewal. I have invited them to come to the table with me and talk about a plan for this purpose. It is to that process and that purpose that I am unconditionally committed.

We will succeed. We must succeed. Canadians expect and deserve no less.

[Alexa McDonough, NDP, Halifax, NS]

Mr. Speaker, let me say first that I could not agree more with the Minister of Health when he says that Canadians want this government and this minister to be more than just an arbiter of disputes and more than just an enforcer when provincial governments violate the principles of the Canada Health Act.

He then goes on in his usual way to talk about the importance of partnership. There is no government in the history of this country, since the introduction of the first steps of universal, not for profit health care, that has done more damage to the health care partnership than this government.

What clearer indication could there be than provincial governments of all political stripes from coast to coast to coast having said that if this government is sincere about wanting to restore the partnership, then it has to recognize that it cannot even claim the mantle of partnership when the federal government has reduced its contribution to health care funding from 50% to below 14%, and in some provinces, as low as 11%?

Canadians have already spoken. The minister, in his pious list of things that this government must do, said that we must listen to Canadians. Canadians have said that they want universal, not for profit, single tier health care protected and they want it protected it now. They want the federal government to recommit to the partnership, to rescind, to get rid of the duplicitous 12 point deal that it entered into secretly with Alberta, which opened the way for bill 11, and to enforce the Canada Health Act.

This means that when a government brings in a bill, such as bill 11, which so clearly and deliberately threatens the universality and the most important access principles of the Canada Health Act, then this government must take action.

The former minister of health, Monique Bégin, when there was an explosion of extra billing of user fees, did not hesitate to bring in legislative measures, and we did not hesitate to support her in that.

How can the minister think that an American solution is what Canadians want, if has he listened to them, when it is a Canadian health crisis created by the actions of this federal Liberal government?

[Allan Rock, Liberal, Etobicoke Centre, ON]

Mr. Speaker, whatever sympathy the member might inspire by going generally in the right direction on values, she forfeits through her overstatement and misunderstanding.

I take the member to suggest that enforcement means amending the act. I take the member to insist that taking action means introducing a bill to change the Canada Health Act. She is wrong. Taking action, protecting medicare and standing up for the principles means doing exactly what we have undertaken to do, which is to watch what is happening on the ground.

If those private for profit hospitals use the power to charge for enhanced services at the same time as insured services in order to restrict access only to those with the cash or give preferred access to those willing to pay more, that will be a contravention of the act and we will act. We have the power, the political will and the mandate.

The leader of the New Democratic Party has just suggested that the only kind of action she thinks is appropriate is to amend the Canada Health Act. There is no need to amend the Canada Health Act. The principles, the purpose and the powers are already there.

This House, this member and Canadians have the solemn undertaking of this minister, the Prime Minister and this government that, if necessary, we will use that power to protect those principles not only in Alberta but throughout this land.

[Grant Hill, Reform, Macleod, AB]

Mr. Speaker, I will try the same question that I asked of the NDP.

In B.C. contracting out for private facilities is being attempted to reduce the waiting lines on some minor surgery and cataract surgery. Does this minister have a problem with the NDP government in B.C. doing that, yes or no?

[Allan Rock, Liberal, Etobicoke Centre, ON]

Mr. Speaker, I am familiar with that example. The member for Macleod will discover, if he looks a little more closely, that under those circumstances they are not permitted to charge for enhanced services at the same time that they are charging for insured services. They do not talk about overnight stays. The policy is not to create private for profit hospitals. There is room for innovation in Canadian medicare but there is a line that should not be crossed. Imperilling the principles of the Canada Health Act is something that ought not to be encouraged.

What is described in B.C. is not what bill 11 has provided for. Bill 11 expressly says that the private for profit facilities can charge for the enhanced services as well as the insured services. That is the crucial distinction between Alberta and the example that the Canadian Alliance is referring to in British Columbia.

[Ovid Jackson, Liberal, Bruce—Grey, ON]

Mr. Speaker, it is my pleasure to speak to the opposition motion regarding Alberta's bill 11. This is a very important topic and of concern to all Canadians.

At the outset, I must say that on May 5 the Alberta legislature passed bill 11. The bill will create the regulatory framework for contracting services to private for profit facilities. The federal health minister has relayed his concerns about this bill. Prior to the passage of the bill, and contrary to the remarks made by the opposition, time and time again the minister has voiced his concerns about the bill. He has said that the federal government was really concerned about some of the views expressed.

The government is committed to ensuring that our health care system will not be put in jeopardy. We wish to make sure that the opportunity exists to detail these concerns and commitments.

There are some disturbing trends happening with medicare. I share the views of my fellow Canadians about what is happening in Alberta. These trends do not speak to the values of Canadians. Indeed, we need to know how people are looking at medicare. On one hand, Alberta will have the medically necessary services. On the other hand, it will also provide enhanced medical services. I believe that is a contradiction. Time and time again when we have compared services provided by the private sector, double billings have occurred and it has not worked.

Our medicare system is one of the best in the world. Like many medicare systems, things are changing. MRIs and various other things are causing this change. Adopting new technology does not mean that Canada should end up with a two tier medical system.

In a policy statement in November 1999, the Alberta government announced its intention to have private delivery of some surgical services. At the same time, the federal health minister raised some important issues related to the sustainability and integrity of the public health care system, including the consistency of the proposed measures with the spirit and intent of the Canada Health Act. He conveyed these views publicly not just in one province but across the country.

In November we asked how private for profit delivery of health services would reduce waiting lines for services in a way that would contain costs and maintain quality, but these questions were not answered. On the contrary, based on the opinions of experts, and actual experience in Alberta, the waiting period for services had increased. In areas where private for profit clinics were used, these lists exceeded those of the public sector.

On the subject of costs, our minister asked if we could expect private for profit hospitals to save money. Would they be more cost effective? Again, the Alberta Consumers Association of Canada found that a shift in cataract surgery from the public sector to the private sector resulted in increased costs for consumers not only in the actual cost of the operation, but in administrative costs as well as transaction costs.

The health minister asked how pressure from private investors to de-insure more services, so services can be charged for privately and their profits will balloon, would be addressed. He also asked how pressure from private investors to purchase medical goods or services patients do not require would be addressed. He asked how the tendering process for contracting would be open and transparent.

The bill was passed. It contains a commitment to preserve the principles of the Canada Health Act as the foundation of the health system in Alberta. However, the sincerity of this commitment is suspect given that the question is still outstanding.

Earlier this year the Prime Minister and the Alberta premier asked all Canadian health ministers to compare the bill to similar provincial legislation. There are important differences in the way Alberta intends to proceed. In particular, the sale of enhanced or extra services in combination with medical goods and services insured in the public system, unlike in other provinces, represents a serious concern in relation to the principles of accessibility in the Canada Health Act.

How serious is this? The day the bill was passed, the Saskatchewan premier, Mr. Roy Romanow, answered. He said “When we released our legislation our press release was entitled a bill to prevent two tiered health care”. He continued “We are at odds with bill 11 in Alberta”.

Back in Alberta the legislation bans queue-jumping, where supposedly people who could afford to pay for these enhanced services get quicker access to insured services but concerns remain about how this ban will be monitored and reported on.

The health minister respectfully suggested that the bill be amended to prevent this, as does the legislation in Ontario and Saskatchewan, but it was not.

Another key concern, specifically and clearly expressed by our government, relates to private for profit facilities accommodating overnight stays for patients. This too represents another important difference between the approach of the Alberta government, going far beyond what is in place in other provinces. The health minister suggested that the bill be changed to prohibit services involving overnight stays until the full implications for Canada's health care system are understood.

On April 7 the health minister put the Alberta government on notice that these types of facilities that would be regulated under this legislation would be considered hospitals under the Canada Health Act. This means that all hospital services provided by these facilities must be fully insured and, like hospitals, these facilities are prohibited from selling any insured service to an insured person on a private basis. As the federal health minister said “This is in keeping with the fundamental principle of our single tiered health care system, care based on need not on the ability to pay”, or the size of their pocket book or credit card.

On the day after bill 11 was passed, the federal health minister reiterated these concerns noting how the Alberta government did not respond to any of his recommendations. He said “Bill 11 is not the direction in which we should be heading to strengthen our publicly funded health care system. We have grave reservations about investing public funds in private-for-profit facilities”. He also announced that the federal government would be strengthening its capacity to detect violations under the act, should they occur.

We will act. The strengthening means that the minister has now committed some $5.5 million to improve administration of the Canada Health Act. With additional staff distributed across the country our health care monitoring capabilities will be enhanced and will ensure compliance with the act.

I want to say categorically that the health care system reflects one of the basic values of Canadians. I am not animated too often in the House, but I will be right behind the minister to make sure that there is not a two tier system. Let us imagine for a minute that somebody thinks he or she could make money from somebody who is ill. I rest my case.

We will be monitoring the legislation. The government is committed to make sure that Canadians get the care they desire, that it is not two tiered, and that it is not based on someone's pocketbook.

[Gordon Earle, NDP, Halifax West, NS]

Mr. Speaker, I will ask the hon. member a question which I had hoped to ask the health minister. I am sure he can answer it. Does the government have in its possession a legal opinion concerning Alberta's bill 11 and the Canada Health Act? If so, will it table that document for the benefit of the House?

[Ovid Jackson, Liberal, Bruce—Grey, ON]

Mr. Speaker, I am not aware that the government has any such document. If the minister has that opinion, I am sure that based on the usual conditions of whatever privacy laws are involved he will share it with the House.

[Grant Hill, Reform, Macleod, AB]

Mr. Speaker, I appreciate the opportunity to speak to health care in broad terms and Alberta's bill 11 in more specific terms.

It is interesting that the NDP has actually called for amendments to the Canada Health Act. It does that with a view to strengthening the Canada Health Act, in its opinion. My idea of going down that road would be to make the Canada Health Act more rigid, and I would not do so. I would like to make the Canada Health Act more innovative and allow some changes.

Let me talk briefly about the Canada Health Act and how it is doing, a subject that is not often addressed in the House. I should like to talk first about portability, one of the big principles of the Canada Health Act. How are we doing with portability?

As far as the people of Quebec are concerned, each Quebec patient who goes to another province has difficulty with services, because the Province of Quebec does not pay full compensation for services provided in the other provinces.

Portability in this instance is being broken every day. The health minister sits here saying that he is the enforcer of the Canada Health Act. My comment is that it is complete nonsense because portability is being broken. He knows it, and he does nothing about portability.

How are we doing with accessibility in the Canada Health Act? It is pretty straightforward. We just have to look at the waiting lines in Canada. They are now being monitored by the government. A year ago it set up a monitoring system to see how we were doing with the waiting lists.

I wait with great interest to see what that monitoring shows. There are monitors that have been doing this for almost 10 years now. I monitored it as a physician in my own practice. When I set up my practice in 1970 and I closed it in 1993 I know my patients were waiting longer for services. On accessibility we are doing very poorly.

Comprehensiveness is another big principle of the Canada Health Act. How are we doing with comprehensiveness? I listened to members opposite say that delisting is going on. That is absolutely true. More and more procedures are being taken off the provincial lists of what is covered and what is not covered by health care. Comprehensiveness is also at risk.

One part of the Canada Health Act is doing wonderfully well, and that is public administration. There is a monopoly in health care in Canada which many of us believe is serving the Canadian public poorly.

Medicare is in stress. This is not unique to Canada, but there are specific things going on in Canada which put our medicare system even more at stress. I have mentioned the waiting lines. I have not mentioned the brain drain of some of our most experienced nurses, lab technicians and physicians who are leaving the country.

One of the big reasons for it is that we are falling behind in technology. A well trained nurse who works in a critical care unit and does not have the most modern facilities says “I am doing a bad job. I learned in school how to do a better job. Just across the line in Boston they have better equipment. I will go there and serve my patients better”. I hear people say that it is only about income. It is not. There is an income difference. There is a tax difference. There is also a technology difference.

I am reminded of a young woman who told me the other day that she was having trouble getting pregnant. She went to her physician in Ottawa who said that at one time there was no problem because there were a couple of world experts in obstetrics in Ottawa. He wanted to send her to them but they had both left. One of them is in Boston and the other is in Florida. He said she would have to wait a little while until we get another world renowned expert in obstetrics for those who are having trouble getting pregnant. That was in Ottawa, and that is taking place in every city in the country.

I mentioned technology. There are ways to measure it. We have dropped from the top three in technology in 1993 in the OECD countries to being number twenty-three. Something happened in 1993. Most people who watch politics will know that there was a new government elected at that point in time.

I will speak specifically to bill 11, what it means and what I think it offers to Canadians. I am not certain that bill 11 is the answer for waiting lists, but the Klein government has plainly said that it wants to try a specific mechanism to reduce the waiting lines in that province. Waiting lines are measurable. It is not that tough. It also said if there were complications in terms of minor procedures that it would allow people to stay overnight in private facilities which exist in Alberta and in every other province.

For those who stand back and say that we should not talk about private for profit facilities, every abortion clinic in the country, every Morgentaler clinic, is a private for profit clinic. I know that my colleagues in other parties recognize this but will not talk about it. They will not talk about the cosmetic surgery clinics that are totally private and are doing things that are outside medicare because they are not covered by the system. They will not talk about private facilities that are doing minor procedures like vasectomies outside hospitals.

Is there some advantage to those facilities? There are some potential problems recognized but there are some advantages. The cost per day to the taxpayers for a major hospital with an emergency, critical care and administration is about $1,500. A private freestanding facility with very little administrative cost, with all the cost being borne by the people who are investors in that clinic, some of whom might well be nurses or lab techs, has relatively low costs which average somewhere around $150 per day in terms of overall cost.

Could we take a minor procedure like a tonsillectomy from a major hospital costing $1,500 a day and do it in a facility costing $150 a day? Could we free up some spaces in that $1,500 a day facility for the bigger procedures that are required to happen there, the major surgery, the major problems? There is some advantage to moving such procedures out of the big facility and into a smaller one.

Bill 11, according to the health minister's own words, does not tread on the Canada Health Act. However he says that it might. Here we are talking about motivation. He said that there was a threat of selling uninsured services while offering insured services. He said to me today that was not done in any other facility or province. I want to say that is categorically and demonstrably false.

I hope the minister will listen to this example. In every emergency department in the country that provides insured services an individual with a broken arm can obtain a cast. The cast is covered by health care. However, if the individual wants to upgrade the cast to a fibreglass one he or she will pay. It is the individual's decision. It is a little lighter. It is waterproof. It allows significant mobility in some cases.

That upgraded service, that enhanced service that is not covered by medicare, is being provided in a facility which provides insured services. The minister says that it is not the same. I beg to differ. Is it not for profit? Out of the pocket comes the $10 for the fibreglass cast. That is an uninsured service being provided by an insured facility. The minister can say anything he wants. It is just flat out provided.

Let me go to bill 11. I have a copy of it. I believe in going to the source. As I said, this is Alberta's mechanism to try to reduce waiting lines for surgery. Will it be successful? I am not sure but I am willing to give them a chance to prove that it will be.

On the issue of enhanced services bill 11 says that enhanced medical goods and services are upgrades that are not medically necessary, like foldable lenses for cataract surgery. A person might choose those upgrades. A sensible patient could say that a foldable lens has some advantages. It is not covered under medicare, so he or she will have to pay for it. The information must be explained to the person in writing. It cannot be nudge, nudge, wink, wink, we cannot provide the lens wanted but only the enhanced lens. The information must be provided in writing with an outline of the costs and advantages. Patients then have an opportunity to review it and change their minds as long as they have not received the service.

There is are big fines of $10,000 for the offence of not providing the information and $20,000 for every offence thereafter. This is legalistic stuff. I think the health minister would like it. It is important to note that if the upgraded product or service is all that is available, in other words if the foldable lens is all that is available, it cannot be charged outside medicare.

This gets away from the legitimate concern that the facility might say that it has no lenses other than foldable lenses. If foldable lenses are all that is available, it cannot charge for them. Those are responses to legitimate concerns. I admit the concerns are legitimate because it would break the principles of the public health care system if those services were offered in an inappropriate way.

I strayed from my NDP colleagues and the health minister on bill 11. Will it work? This is Alberta's opportunity to prove whether or not it will work. Would I hire more health police to look after it? There are health police in Alberta. There are patients in every hospital in Alberta in waiting lines. They will decide whether to step out of a waiting line and go to an overnight facility to receive services. If it were my mom, I might take her in my car and try to get her out of the waiting line.

Should we let Albertans decide this? If it does not work, what will happen? Bye-bye bill 11, maybe bye-bye Klein. I think Albertans will turf Klein out if it is an inappropriate bill. We do not need health police.

[An hon. member]

That would never go down. Elect the Liberals.

[Grant Hill, Reform, Macleod, AB]

My colleague across the way said to elect Liberals. Maybe that would happen if bill 11 is inappropriate. But do we need an all-seeing omnipotent health minister from Ottawa to come along and say he does not think the motive behind the bill is good? Not in my books we do not.

I do not have forever, but I will talk about a couple of other innovations which I think are worth considering. These are for public consumption, to reject, think about, or not. This is not alliance policy. These are my thoughts on the issue.

What about thinking of a completely different way of delivering the money to individuals in Canada for health care services? What about a medisave account? I would equate this to an insurance policy on a car. We do not insure our cars for oil changes. We insure them for major catastrophes like an awful crash that would break us if it happened. We insure for the repair bills on a major issue.

What if we insured for catastrophic things in Canada? Instead of giving money to the governments to look after everything, what if we gave $100 to each patient in a medisave account? This would be for the regular run of the mill preventive things, regular checkups, a visit to the emergency room for suturing and whatnot. It would be the patient's responsibility. That first $100, which is a very arbitrary figure, would be the patient's responsibility. The person would not spend it if he or she did not need it. The government would allow the person to put those funds into retirement, but the person would be able to keep those funds in a medisave account for the future.

What would that do? That would make people think about what medical procedures cost in this country. Many do not know. Many do not know what an ultrasound for a newborn baby is worth today because they never ever get a bill for it. It is free, paid for by the taxpayer.

That would put a person in a position where, if they had had a cardiogram a year ago and had paid for it out of their medisave account, and they were told during their annual physical they needed a cardiogram again, they might ask whether they really did need it because it would eat up their medisave money. There would be a discussion as to whether or not that would be useful. I believe there is some degree of personal responsibility when it comes to the funding for our health care system.

That was the medisave account idea. It was a very brief overview and I admit not very thorough, but it is an idea.

I have a second idea. The threat of suit in Canada for nurses and doctors is a major cost driver. Somebody who comes into the office with a headache is often given procedures that are not really the best for looking after a headache. They are procedures that are designed to prevent a suit, prevent medical legal action if the individual ends up having more than a simple headache, for example a tumour. The medical legal system in this country is driving costs up. It is becoming more and more like the U.S. in terms of litigation.

In my first speech in the House many years ago I asked the health minister to address the issue of medical jurisprudence. I thought as a lawyer he would grab on to that. Of course, it would mean fewer lawyers, so maybe I understand now.

What principles do I think should guide the federal government on health care? First, I value our public system. I have practised in it and I know that it is a valuable system. But I think we have gone astray when we talk about American style two tier, because on this issue it is literally the wrong debate. Medicare is being used in most countries in the world. It is not being used in the U.S. Taxpayer funded medicare is not there.

When we compare ourselves, let us compare ourselves to similar medicare systems such as those in Europe, Asia or Scandinavia. Countries there have chosen some safety valves in addition to taxpayer funded medicare. Medicare is not falling apart. It is not going down the tubes. Ours would not either if we looked at some of those innovations.

The big principle is that we should remember the patient. Let us put the patient first. Let us stop putting the system first. If we did that in our deliberations here in Ottawa and across Canada, we would be much farther ahead.

The federal government has a role as a paymaster. It is so straightforward that the funding should be predictable. It should be obvious that it is going to medicare and it should be growing with our population growth. Our aging population is another issue. As a paymaster the federal government has a very specific role to play.

The health minister said he would play the role if the provinces played by his rules. I disagree with that. The current approach of threatening the provinces if they do not follow the health minister's rules to bring in health police to enhance the number of people wandering around the country trying to find breaks to the Canada Health Act, deeming private clinics as hospitals, have we ever heard a more legalistic view? Deeming. He is going to deem a private clinic as a hospital.

I say again that if we forget about imperilling the system and instead look at the perils to the patient, we will be better off.

[Brent St. Denis, Liberal, Algoma—Manitoulin, ON]

Mr. Speaker, I listened to the hon. member's speech. While he covered a lot of territory, he confused me a bit. The member is a physician and has worked in the system. He is probably aware more than most of us in the House of the daily difficulties faced not only by practitioners such as himself but by those who depend on the system for their health needs.

The member skated around some of the more important fundamental issues. In using that reference, I would like to comment that he is a pretty good hockey player. We on this side appreciated the chance to play against that side last night. He has shown marked improvement from the first time we had the experience a few years ago. I commend him in that regard. But skating around important issues such as health care is another matter.

Like others in the House, I read a fairly thorough report in one of the national papers which reported on the Australian experience with what in no other way could be described as a two tier health system.

The member and his fellow reform-alliance members are in the midst of a leadership race. I cannot claim to know exactly what position on two tier health care each of the candidates has. The member for Esquimalt—Juan de Fuca has made it clear that he supports a two tier system. I would suspect that another candidate, the treasurer of Alberta who is on leave from that position, obviously supports bill 11.

I am not an expert on the health system except for having to visit the doctor from time to time. I wonder if the member could tell us where he stands with regard to a two tier system where those with the resources can have speedier access to certain procedures compared to those who depend on a publicly funded system.

[Grant Hill, Reform, Macleod, AB]

Mr. Speaker, in reference to skating, I think he checked me into the boards and it was not very nice at all. I meant that as a joke, it is not true at all.

On the issue of a two tier system, personally I reject two tier medicine. My colleague from Esquimalt—Juan de Fuca who is also a physician has chosen that as his solution. That is a personal solution. That is not the alliance position.

I have already suggested the sort of thing I think would be useful to innovate in health care. We need to have more responsibility for knowing what the costs are and have a reason to husband the resources. Let me take this opportunity to put forward another suggestion.

Every patient for every service in Canada should get a bill that shows the date for the service, what the service was and what the cost was and they should have to sign it. They would not pay a nickel for that bill, but they would simply sign it to say that they received it. That would do two things. It would let them know what the procedure cost and it would also prevent extra billing or padded billing by physicians. Some physicians put in bills that are not really appropriate. My colleagues do not like me to say that, but it is accurate and true. This would be a mechanism for bringing some of the responsibility back to the individual patient. There is none today.

My colleague across the way said that I skated around. I hope that is as direct and forceful a way of saying what I believe should be some of the changes.

I am willing to listen to others. Would the Minister of Health say the same thing? I wish he would.

[Dick Proctor, NDP, Palliser, SK]

Mr. Speaker, I appreciate the opportunity to ask a question. I know there is probably not much time given the hockey references across the way.

The hon. member for Macleod is a physician. He is basically saying he is not sure about Bill 11, but let us try it and give it a chance. His arguments are that in one of these new surgical facilities it might be $500 a day versus the $1,500 that it would cost to run the health care system in a major hospital. Let me ask the doctor a hypothetical question. What happens at one of these facilities when there is a complication in the surgery?

The member for Macleod mentioned tonsillectomies. We have all heard horror stories about tonsillectomies. It is normally a minor procedure, but there can be serious problems from time to time. What happens at that point? Presumably the difference of $1,000 a day between the surgical facility and the major hospital is that the surgical facility does not have all the bells and whistles that the major hospital has. That sick person now needs intensive care and has to be rushed to the major hospital. What happens at that point? Do we have queue jumping? Is the person in the other system who has been slated for that bed available at the Edmonton hospital all of a sudden bypassed because somebody coming out of the private facility is in intensive care and needs help in a hurry?

That is the problem a lot of people have with this notion. I would appreciate the hon. member's response to that.

[Grant Hill, Reform, Macleod, AB]

Mr. Speaker, what a refreshing change to actually have a non-attack. That is a very legitimate question and one which I appreciate.

Since I did tonsillectomies on my own in a public facility, I know that the complication rate is somewhere around 1%. Of 100 tonsillectomies, one of them will bleed and require the trip to the major facility the member talks about.

Would I then do the 100 in the $1,000 or $1,500 a day facility? Not a chance. I would do the 100 in the $150 a day facility and for the complication would go to the big major public facility. Surely the math is not tough to figure out. They are both being covered by public funds. They are not being covered by private funds because a tonsillectomy is an insured service under medicare.

It would be a very legitimate concern if there were 99 coming from the one facility and plugging up the major facility. Surely the 99 that would be done outside the major hospital would open up beds that are not currently opened up.

I thank the hon. member for what I consider to be a constructive, eyeball to eyeball comment. It is refreshing and a treat to get.