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.